Neuro-optho

Question 1

How can you distinguish causes of VA problems?

Answer 1

use pinhole test - if visual acuity improves, likely a refractive rather than neuro issue

Question 2

What is Adie’s pupil and how can it be demonstrated?

Answer 2

dilated tonic pupil, - give pilocarpine and affected pupil contracts more

Question 3

What are Argyll Robertson pupils?

Answer 3

small irregular pupils associated with syphillis

Question 4

What are the most common casues of unilateral optic disk swelling?

Answer 4

optic neuritis, acute ischemic optic neuropathy, orbital compressive lesions

Question 5

What is Foster Kennedy syndrome?

Answer 5

ipsilateral disk atrophy due to optic nerve compression and papilledema in contralateral optic disk due to increased ICP from frontal lobe tumor

Question 6

A patient presents with an asymptomatic enlarged blind spot and hyaline bodies on fundus exam. This is..

Answer 6

pseudopapilledma from small hyaline concretions - use CT to see bodies

Question 7

What is the difference between comitant and incomitant strabismus?

Answer 7

incomitant - degree of misalignment varies with direction of gaze

Question 8

A patient presents with oblique diplopia worse on down gaze. What is this? What will improve symptoms?

Answer 8

4th nerve palsy - tilting head away from lesion helps

Question 9

What is the difference between a “phoria” and a “tropia”

Answer 9

tropia - misalignment of eyes when both eyes are opened and binocular vision is possible
phoria - misalignment when binocular vision is not present; does not cause diplopia because eyes are aligned when both are open

Question 10

What is a one-and-a-half syndrome?

Answer 10

lesion involving PPRF, VIth nerve nucleus and adjacent ipsilateral MLF - patient can only abduct contralateral eye
(inability to adduct = INO)
(causes gaze palsy to ipsilateral side and INO in contralateral gaze)

Question 11

A patient has an upgaze disturbance. This is..

Answer 11

perinaud’s syndrome - likely caused by pineal tumor compressing dorsal midbrain

Question 12

What is oculomotor apraxia?

Answer 12

Inability to produce saccades

Question 13

What conditions are associated with periodic alternating nystagmus?

Answer 13

MS, bilateral blindness, craniocervical junction abnormalities, anticonvulsant toxicity

Question 14

What conditions are associated with upbeating nystagmus?

Answer 14

lesions of cerebellar vermis, Wernicke’s,

Question 15

What conditions are associated with a downbeating nystagmus?

Answer 15

spinocerebellar degeneration, MS, familial periodic ataxia, drug intoxication

Question 16

What are key differences between central and peripheral nystagmus?

Answer 16

peripheral - usually unilateral, unidirectional, never vertical, tinnitus often present, severe vertigo
central - bidirectional, bilateral; mild vertigo

Question 17

Where are horizontal saccades initiated?

Answer 17

contralateral frontal eye fields, superior colliculus

Question 18

Where are vertical saccades initiated?

Answer 18

bilateral frontal eye fields or superior colliculus

Question 19

A young woman with MS develops a severe headache and her BP drops after delivery. This is..

Answer 19

pituitary apoplexy

Question 20

A patient who has been on chronic corticosteroids for asthma presets with blurred vision and her fundus can’t be visualized. This is..

Answer 20

lens opacity from chronic steroids

Question 21

A patient has sudden double vision and when she looks to the left, the right eye does not fully adduct and there is nystagmus of the abducting left eye. This is..

Answer 21

right INO

Question 22

A patient presents pain on movement of her right eye and dimming vision. The fundus shows central scotoma. This isi..

Answer 22

optic neuritis

Question 23

A 13 year old patient presents with dizziness, slurred speech and double vision. It goes away in 15 minutes and then he has a severe headache and begins vomiting. This is a …

Answer 23

basilar migraine

Question 24

A 38 year old woman collapses and begins vomiting. Her neck is rigid, she has a dilated left pupil, her left lid droops and her left eye is abducted. This is..

Answer 24

PCOM aneurysm

Question 25

A patient presents with a re eye, cloudiness in the cornea and a large right pupil. This is ..

Answer 25

acute angle glaucoma

Question 26

A woman comes in with visual problems involving loss sparing central vision. The field remains the same no matter how far the testing screen is performed. This is..

Answer 26

tunnel vision

Question 27

A patient Presents with blindness in 1 eye after 4 hours of decreased vision. Fundoscopic exam shows edema, enlarged veins and several hemorrhages. This is…

Answer 27

Central retinal vein occlusion