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NeuroOphthalmologyOKAP
ReviewQuestions2012
RudraniBanik,M.D.
AssociateAdjunctSurgeon
TheNewYorkEye&EarInfirmary
1.A28yearoldobesewomancomplainsoftransientvisual
losslastingsecondsintherighteyewhenrisingfromabent
position.ExaminationrevealsnormalacuityOUwith
fundoscopy asshown.Whatisthebestcourseofaction?
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1.A28yearoldobesewomancomplainsoftransient
visuallosslastingsecondsintherighteyewhenrising
fromabentposition.Examinationrevealsnormal
acuityOUwith fundoscopy asshown.Whatisthebest
courseofaction?
A.Medicaltherapyforintracranialhypertension;noneedforneuroimaging
B.CTofthebrain,thenmedicaltherapyforintracranialhypertension
C.MRIandlumbarpuncture,thenmedicaltherapyforintracranial
hypertension
D.CTofthebrain,thenashuntingprocedureforintracranialhypertension
1.A28yearoldobesewomancomplainsoftransient
visuallosslastingsecondsintherighteyewhenrising
fromabentposition.Examinationrevealsnormal
acuityOUwith fundoscopy asshownbelow.Whatis
thebestcourseofaction?
A.Medicaltherapyforintracranialhypertension;noneedforneuroimaging
B.CTofthebrain,thenmedicaltherapyforintracranialhypertension
C.MRIandlumbarpuncture,thenmedicaltherapyforintracranial
hypertension
D.CTofthebrain,thenashuntingprocedureforintracranialhypertension
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Case#1a
2.A68yearoldobesewomancomplainsoftransientvisual
losslastingsecondsintherighteyewhenrisingfromabent
position.ExaminationrevealsnormalacuityOUwith
fundoscopy asshownbelow.Whatisthebestcourseofaction?
A.Medicaltherapyforintracranialhypertension;noneedfor
neuroimaging
B.CTofthebrain,thenmedicaltherapyforintracranialhypertension
C.MRIandlumbarpuncture,thenmedicaltherapyforintracranial
hypertension
D.Bloodpressuremeasurement
Case#1a
2.A68yearoldobesewomancomplainsoftransientvisual
losslastingsecondsintherighteyewhenrisingfromabent
position.ExaminationrevealsnormalacuityOUwith
fundoscopy asshownbelow.Whatisthebestcourseofaction?
A.Medicaltherapyforintracranialhypertension;noneedfor
neuroimaging
B.CTofthebrain,thenmedicaltherapyforintracranialhypertension
C.MRIandlumbarpuncture,thenmedicaltherapyforintracranial
hypertension
D.Bloodpressuremeasurement
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3.A35yearoldwomanpresents
withsuddenpainfullossofvisionof
herrighteye.Herexamination
revealsvisionof20/80ODand
20/20OS.Pupilsdemonstratean
afferentpupillary defectoftheright
eye.Adenseinferioraltitudinal
defectencroachesoncentral
fixationOD,andtheleftvisualfield
isnormal.Theremainderofthe
examinationisnormal.Fundus
examinationoftherighteyeis
shown.
3.Howwouldyoucounselthispatient?
A.Sheisunlikelytohaveopticneuritisbecausetheopticnerveon
examinationisnormal;however,sheneedsanMRIscanofthe
orbitstoruleoutatumor.
B.Shehasopticneuritisandshouldbeginoneoftheproven
treatmentsformultiplesclerosis(MS)topreventitsonset.
C.SheshouldhaveanMRIscantoruleoutatumor,aswellastake
oralcorticosteroidstoassessthebenefit.
D.ShehasopticneuritisandshouldhaveanMRIscanofthebrain
toassessherriskforMS.
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3.Howwouldyoucounselthispatient?
A.Sheisunlikelytohaveopticneuritisbecausetheopticnerveon
examinationisnormal;however,sheneedsanMRIscanofthe
orbitstoruleoutatumor.
B.Shehasopticneuritisandshouldbeginoneoftheproven
treatmentsformultiplesclerosis(MS)topreventitsonset.
C.SheshouldhaveanMRIscantoruleoutatumor,aswellastake
oralcorticosteroidstoassessthebenefit.
D.ShehasopticneuritisandshouldhaveanMRIscanofthebrain
toassessherriskforMS.
4.ThepatientsMRIresultsare
shown.Whatisherlongterm
riskfordevelopingMS?
A. 25%
B. 50%
C. 72%
D. Insufficientevidence
provided
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4.ThepatientsMRIresultsare
shown.Whatisherlongterm
riskfordevelopingMS?
A. 25%
B. 50%
C. 72%
D. Insufficientevidence
provided
5.BasedontheCHAMPSresults,
thispatientstreatmentoptions
include:
A.IVsteroidsonly
B.Treatmentwithplasmapheresis
C.Treatmentwithinterferonbeta
1a(Avonex)
D.Treatmentwithfingolimod
(Gilenya)
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5.BasedontheCHAMPSresults,
thispatientstreatmentoptions
include:
A.IVsteroidsonly
B.Treatmentwithplasmapheresis
C.Treatmentwithinterferonbeta
1a(Avonex)
D.Treatmentwithfingolimod
(Gilenya)
6.Whichofthefollowingconditionsinvolvingthe
facialmusclesismostlikelytobeunilateral?
A.Apraxia ofeyelidopening
B.Hemifacial spasm
C.MillerFishersyndrome
D.Benignessentialblepharospasm
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6.Whichofthefollowingconditionsinvolvingthe
facialmusclesismostlikelytobeunilateral?
A.Apraxia ofeyelidopening
B.Hemifacial spasm
C.MillerFishersyndrome
D.Benignessentialblepharospasm
7.Inthispatient,whatisthenextstepin
appropriatemanagement?
A.Obtainhistoryofpriorfacialpalsy;ifpositive,thenno
furthermanagementrequired
B.Obtainhistoryofpriorfacialpalsy;ifnegative,thenno
furthermanagementrequired
C.Treatwithbotulinum toxin
D.Treatwithtegretol
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7.Inthispatient,whatisthenextstepinappropriate
management?
A.Obtainhistoryofpriorfacialpalsy;ifpositive,thenno
furthermanagementrequired
B.Obtainhistoryofpriorfacialpalsy;ifnegative,thenno
furthermanagementrequired
C.Treatwithbotulinum toxin
D.Treatwithtegretol
8.A78yearoldmanwithischemicheartdiseaseand
hypertensionexperiencesasingle10 minuteepisode
ofpainlessvisuallossinhislefteye.Hedescribesthe
episodeasa"graywindowshade"beingpulleddown
andthenreleased.Whichisthemostlikelyetiologyof
hisvisualloss?
A.migraine
B.vertebrobasilar circulationinsufficiency
C.Uhthoff phenomenon
D.retinalarteryembolus
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8.A78yearoldmanwithischemicheartdiseaseand
hypertensionexperiencesasingle10 minuteepisode
ofpainlessvisuallossinhislefteye.Hedescribesthe
episodeasa"graywindowshade"beingpulleddown
andthenreleased.Whichisthemostlikelyetiologyof
hisvisualloss?
A.migraine
B.vertebrobasilar circulationinsufficiency
C.Uhthoff phenomenon
D.retinalarteryembolus
9.Whichofthefollowingtestswouldbeleast
appropriateforthepreviouspatient?
A.MRIBrainwithcontrast
B.Dopplercarotidultrasound
C.ESRandCRP
D.Transesophagealechocardiography
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9.Whichofthefollowingtestswouldbeleast
appropriateforthepreviouspatient?
A.MRIBrainwithcontrast
B.Dopplercarotidultrasound
C.ESRandCRP
D.Transesophagealechocardiography
10.A 50yearoldwomandevelopedvariable
doublevision1monthagoandappearstohave
fatigableptosis.Shehasnosystemicsymptoms.
Whichofthefollowingstatementsistrue?
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10.A 50yearoldwomandevelopedvariabledoublevision1monthago
andappearstohavefatigableptosis.Shehasnosystemicsymptoms.
Whichofthefollowingstatementsistrue?
A.Anormalantiacetylcholinereceptorantibodyleveleffectivelyrulesout
myastheniagravis
B.Herriskofdevelopinggeneralizedmyastheniaisabout85%over2years
C.The50%occurrenceofconcomitantthyroideyediseasemaycomplicate
thediagnosisofmyasthenia.
D.Animprovementof2mminptosis followinga10minuteice
applicationtotheeyelidconfirmsthediagnosisofmyasthenia.
10.A 50yearoldwomandevelopedvariabledoublevision1monthago
andappearstohavefatigableptosis.Shehasnosystemicsymptoms.
Whichofthefollowingstatementsistrue?
A.Anormalantiacetylcholinereceptorantibodyleveleffectivelyrulesout
myastheniagravis
B.Herriskofdevelopinggeneralizedmyastheniaisabout85%over2years
C.The50%occurrenceofconcomitantthyroideyediseasemaycomplicate
thediagnosisofmyasthenia.
D.Animprovementof2mminptosis followinga10minuteice
applicationtotheeyelidconfirmsthediagnosisofmyasthenia.
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11.Whichofthefollowingconditionsdoesnot
predisposeanindividualtospecificintracraniallesions?
A.ataxiatelangiectasia (LouisBar)
B.racemose angioma (WyburnMason)
C.retinalangiomatosis (vonHippelLindau)
D.tuberoussclerosis(Bourneville)
11.Whichofthefollowingconditionsdoesnot
predisposeanindividualtospecificintracraniallesions?
A.ataxiatelangiectasia (LouisBar)
B.racemose angioma (WyburnMason)
C.retinalangiomatosis (vonHippelLindau)
D.tuberoussclerosis(Bourneville)
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12.A77yearoldhypertensive
mancomplainsofsuddenlossof
visioninthelefteye.Heisfoundto
be20/25ODandlightperception
OS,withadenseleftafferent
pupillary defect.
Rightfundus examination
demonstratesanormalopticdisc
butanumberofcottonwool
spots.Examinationofthelefteye
isasshown.
12.A77yearoldhypertensivemancomplainsofsuddenlossofvisionintheleft
eye.Heisfoundtobe20/25ODandlightperceptionOS,withadenseleftafferent
pupillary defect.Rightfundus examinationdemonstratesanormalopticdiscbuta
numberofcottonwoolspots.Examinationofthelefteye isasshown.Whatisthe
appropriatesequenceofevaluationinthispatient?
A.immediateerythrocytesedimentationrate(ESR)andCreactiveprotein;the
officetocallpatientwithresults
B.immediateESRandC reactiveprotein,thentheinstitutionofcorticosteroids,
followedbyatemporalarterybiopsy
C.immediateESRandCreactiveprotein,thenatemporalarterybiopsy,followed
bytheinstitutionofcorticosteroids,dependingonbiopsyresults
D.immediateESRandCreactiveprotein,thentheinstitutionofcorticosteroids;no
biopsynecessaryifclinicalsuspicionishigh
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12.A77yearoldhypertensivemancomplainsofsuddenlossofvisionintheleft
eye.Heisfoundtobe20/25ODandlightperceptionOS,withadenseleftafferent
pupillary defect.Rightfundus examinationdemonstratesanormalopticdiscbuta
numberofcottonwoolspots.Examinationofthelefteye isasshown.Whatisthe
appropriatesequenceofevaluationinthispatient?
A.immediateerythrocytesedimentationrate(ESR)andCreactiveprotein;the
officetocallpatientwithresults
B.immediateESRandC reactiveprotein,thentheinstitutionofcorticosteroids,
followedbyatemporalarterybiopsy
C.immediateESRandCreactiveprotein,thenatemporalarterybiopsy,followed
bytheinstitutionofcorticosteroids,dependingonbiopsyresults
D.immediateESRandCreactiveprotein,thentheinstitutionofcorticosteroids;no
biopsynecessaryifclinicalsuspicionishigh
13.Themedialorbitalwalliscomposedofallofthe
followingbonesexcept:
A.ethmoid
B.Lacrimal
C.sphenoid
D.frontal
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13.Themedialorbitalwalliscomposedofallofthe
followingbonesexcept:
A.ethmoid
B.Lacrimal
C.sphenoid
D.frontal
14.Thetestleast likelytobehelpfulin
determiningnonorganicvisuallossis
A.Automatedperimetry
B.Goldmann perimetry
C.Tangentscreenperimetry
D.Verticalprismdissociationtest
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14.Thetestleast likelytobehelpfulin
determiningnonorganicvisuallossis
A.Automatedperimetry
B.Goldmann perimetry
C.Tangentscreenperimetry
D.Verticalprismdissociationtest
15.A54yearoldwomanreportsvisuallossintherighteye
occurringover3days.Visionisnolightperceptioninthe
righteye.Whatfindingwouldsuggestnonorganicvisual
loss?
A. AnRAPDOD
B. noeyemovementswhenamirrormovesovertherighteye
C. anamaurotic pupil
D. noeyemovementswhena6Dbaseoutprismisplacedover
therighteye
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15.A54yearoldwomanreportsvisuallossintherighteye
occurringover3days.Visionisnolightperceptioninthe
righteye.Whatfindingwouldsuggestnonorganicvisual
loss?
A. AnRAPDOD
B. eyemovementswhenamirrormovesovertherighteye
C. anamaurotic pupil
D. noeyemovementswhena6Dbaseoutprismisplacedover
therighteye
16.A20yearold,previouslyhealthy, female
complainsofheadacheandhasafixed,dilated
leftpupil. Herexaminationisotherwise
normal.
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16.A20yearold,previouslyhealthy, femalecomplainsof
headacheandhasafixed,dilatedleftpupil. Herexamination
isotherwisenormal.Whichofthefollowingisleast likelyto
behelpfulintheinitialevaluation?
A.observation
B.dilute(0.125%)pilocarpine
C.1%pilocarpine
D.Hydroxyamphetamine
16.A20yearold,previouslyhealthy, femalecomplainsof
headacheandhasafixed,dilatedleftpupil. Herexamination
isotherwisenormal.Whichofthefollowingisleast likelyto
behelpfulintheinitialevaluation?
A.observation
B.dilute(0.125%)pilocarpine
C.1%pilocarpine
D.Hydroxyamphetamine
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17.Ahorizontalgazepalsyisindicativeofwhich
ofthefollowing?
A.Middlecerebralarteryinfarction
B.alesionoftheipsilateral frontallobe
C.alesionofthecontralateral frontallobe
D.damagetothepontine gazecenters
17.Ahorizontalgazepalsyisindicativeofwhich
ofthefollowing?
A.Middlecerebralarteryinfarction
B.alesionoftheipsilateral frontallobe
C.alesionofthecontralateral frontallobe
D.damagetothepontine gazecenters
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HorizontalGazePathways
withinBrainstem
Abducensnucleus
Sendsaxonstoinnervate
ipsilaterallateralrectus
Sendaxonsthrough
contralateralMLFto
innervatecontralateral
medialrectus subnucleus
HorizontalGazePathways
withinBrainstem
StimulationofRight abducens nucleusresults
inconjugategazetoRight
StimulationofLeft abducens nucleusresultsin
conjugategazetoLeft
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18.Thebrainstemhorizontalsaccadicgeneratoristhe
A.nucleusreticularis tegmenti pontis
B.rostral interstitialnucleusofthemediallongitudinal
fasciculus
C.paramedian pontine reticularformation
D.interstitialnucleusofCajal
17.Thebrainstemhorizontalsaccadicgeneratoristhe
A.nucleusreticularis tegmenti pontis
B.rostral interstitialnucleusofthemediallongitudinal
fasciculus
C.paramedian pontine reticularformation
D.interstitialnucleusofCajal
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19.Whatistheclinicalpresentationofanuclearthirdcranialnerve
palsy?
A.Unilateralthirdcranialnervepalsywithipsilateral ptosis
B. Completeunilateralthirdnervepalsyinvolvingthepupilsonly
C.Completeunilateralthirdnervepalsywithcontralateral superior
rectusparesisandbilateralptosis
D.Completebilateralthirdnervepalsywithdilatedpupilonone
sideonly
19.Whatistheclinicalpresentationofanuclearthirdcranialnerve
palsy?
A.Unilateralthirdcranialnervepalsywithipsilateral ptosis
B. Completeunilateralthirdnervepalsyinvolvingthepupilsonly
C.Completeunilateralthirdnervepalsywithcontralateral superior
rectusparesisandbilateralptosis
D.Completebilateralthirdnervepalsywithdilatedpupilonone
sideonly
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CNIIINuclearParesis
Rare
Bilateralptosis
involvescentralcaudalnucleuswhichinnervatesBOTH
levators
Bilateralupgazeparesis
Eachsuperiorrectusinnervatedbycontralateral
subnucleus
Asfiberscross,theyalsogothroughtheotherSR
subnucleus
CNIIINuclearParesis
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20.Inanemergencyroomsetting,whichof
thefollowingimagingstudiesisthemost
appropriateforthirdcranialnervepalsyina
patientwiththeworstheadacheofhis life?
20.Inanemergencyroomsetting,whichofthefollowingimaging
studiesisthemostappropriateforthirdcranialnervepalsyina
patientwiththeworstheadacheofhislife?
A.ContrastMRIOrbitforinflammatoryorbitalpseudotumor
B.NoncontrastMRIbrainforaneurysm
C.NoncontrastCTheadforsubarachnoidhemorrhage
D.NoncontrastCtOrbitforhematoma
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20.Inanemergencyroomsetting,whichofthefollowingimaging
studiesisthemostappropriateforthirdcranialnervepalsyina
patientwiththeworstheadacheofhislife?
A.ContrastMRIOrbitforinflammatoryorbitalpseudotumor
B.NoncontrastMRIbrainforaneurysm
C.NoncontrastCTheadforsubarachnoidhemorrhage
D.NoncontrastCtOrbitforhematoma
21.Themostimportantfactorindeterminingthe
workupofapatientwithacutethirdnervepalsyis:
A.ageofpatient
B.pupilinvolvement
C.presenceorabsenceofpain
D.visualacuity
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21.Themostimportantfactorindeterminingthe
workupofapatientwithacutethirdnervepalsyis:
A.ageofpatient
B.pupilinvolvement
C.presenceorabsenceofpain
D.visualacuity
22.Anisolatedsixthnervepalsyinapatientolderthan
50yearsismostoftendueto:
A.demyelinating disease
B.traumaticbraininjury
C.microvascular ischemia
D.braintumor
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22.Anisolatedsixthnervepalsyinapatientolderthan
50yearsismostoftendueto:
A.demyelinating disease
B.traumaticbraininjury
C.microvascular ischemia
D.braintumor
23.Anisolatedsixthnervepalsyinanotherwisehealthy30
yearoldpatientunlikelytobedueto:
A.demyelinating disease
B.traumaticbraininjury
C.microvascular ischemia
D.braintumor
E.Postviral
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23.Anisolatedsixthnervepalsyinanotherwisehealthy30
yearoldpatientunlikelytobedueto:
A.demyelinating disease
B.traumaticbraininjury
C.microvascular ischemia
D.braintumor
E.Postviral
SixthNervePalsy:Evaluation
Age<40:
Trauma?
Bluntheadtrauma
Medialwallfracture
Postviralorpost
vaccination?
Duanes?
Thyroid?
Ifnopredisposingfactors,
needsneuroimaging!
Age>40
Vasculopath?
R/oDM,HTN,
hypercholesterolemia
R/oTemporalarteritis
Askabouthistoryof
malignancy,
Ifso,thenneeds
imaging!
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24.A79yearoldwomanpresentswithanacuteonsetofbinocular
horizontaldiplopia anddizziness.Examinationrevealsalefthead
turnwithanesotropia thatisworseonleftgaze.Thereisdecreased
cornealsensationanddecreasedblinkingontheleft.Whereisa
lesionsuspected
A.Occipitalcortex
B.Cavernoussinus
C.Cerebellopontine angle
D.Orbitalapex
24.A79yearoldwomanpresentswithanacuteonsetofbinocular
horizontaldiplopia anddizziness.Examinationrevealsalefthead
turnwithanesotropia thatisworseonleftgaze.Thereisdecreased
cornealsensationanddecreasedblinkingontheleft.Whereisa
lesionsuspected
A.Occipitalcortex
B.Cavernoussinus
C.Cerebellopontine angle
D.Orbitalapex
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25.A59yearoldmancomplainsofdecreased
visionimmediatelyuponemergingfrom
anesthesiafollowingcardiacbypasssurgery.
Onexamination,thepatientreportsbarelight
perceptionvisionOU.Externalexamination,
extraocular movements,pupillary reaction,
andexaminationareallnormal.
25.A59yearoldmancomplainsofdecreasedvisionimmediately
uponemergingfromanesthesiafollowingcardiacbypasssurgery.
Onexamination,thepatientreportsbarelightperceptionvision
OU.Externalexamination,extraocular movements,pupillary
reaction,andexaminationareallnormal.Whichofthefollowingis
themostlikelycauseofthevisualloss
A.bilateralanteriorischemicopticneuropathy
B.bilateraloccipitalinfarcts
C.functionalornonorganicvisualloss
D.pituitaryapoplexy
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25.A59yearoldmancomplainsofdecreasedvisionimmediately
uponemergingfromanesthesiafollowingcardiacbypasssurgery.
Onexamination,thepatientreportsbarelightperceptionvision
OU.Externalexamination,extraocular movements,pupillary
reaction,andexaminationareallnormal.Whichofthefollowingis
themostlikelycauseofthevisualloss
A.bilateralanteriorischemicopticneuropathy
B.bilateraloccipitalinfarcts
C.functionalornonorganicvisualloss
D.pituitaryapoplexy
26.Whatisthelocationofthelesionthatcausesa
righthomonymoushemianopic scotoma?
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26.Whatisthelocationofthelesionthatcausesaright
homonymoushemianopic scotoma?
A. Posteriorcentralchiasm
B. Leftgeniculate body
C. Leftposterioroccipitallobe
D. Junctionoftheopticnerveandleftchiasm
26.Whatisthelocationofthelesionthatcausesaright
homonymoushemianopic scotoma?
A. Posteriorcentralchiasm
B. Leftgeniculate body
C. Leftposterioroccipitallobe
D. Junctionoftheopticnerveandleftchiasm
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27.Followinganautomobileaccidentwithhead
trauma,ayoungmancomplainsofdiplopia.In
theprimarypositionhehas6prismdiopters (PD)
ofrighthypertropia.Inleftgazehehas12PDof
righthypertropia.Inrightgazehehas9PDofleft
hypertropia.Inprimarypositionthereare15 of
relativeexcyclotorsion andanesotropia develops
indowngaze.Whatisthemostlikelydiagnosis?
27.Followinganautomobileaccidentwithheadtrauma,ayoung
mancomplainsofdiplopia.Intheprimarypositionhehas6prism
diopters (PD)ofrighthypertropia.Inleftgazehehas12PDofright
hypertropia.Inrightgazehehas9PDoflefthypertropia.Inprimary
positionthereare15 ofrelativeexcyclotorsion andanesotropia
developsindowngaze.Whatisthemostlikelydiagnosis?
A.Bilateralfourthcranialnervepalsies
B.Rightthirdandfourthcranialnervepalsies
C.Rightorbitalfloorfracturewithentrapment
D.Bilateralpartialthirdcranialnervepalsies
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27.Followinganautomobileaccidentwithheadtrauma,ayoung
mancomplainsofdiplopia.Intheprimarypositionhehas6prism
diopters (PD)ofrighthypertropia.Inleftgazehehas12PDofright
hypertropia.Inrightgazehehas9PDoflefthypertropia.Inprimary
positionthereare15 ofrelativeexcyclotorsion andanesotropia
developsindowngaze.Whatisthemostlikelydiagnosis?
A.Bilateralfourthcranialnervepalsies
B.Rightthirdandfourthcranialnervepalsies
C.Rightorbitalfloorfracturewithentrapment
D.Bilateralpartialthirdcranialnervepalsies
28.Leber hereditaryopticneuropathyismost
commonlyassociatedwith
A.sexlinkedrecessivetransmission
B.amitochondrialDNAmutationatthe3460position
C.apathognomonic opticnerveappearance
D.amitochondrialDNAmutationatthe11778position
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28.Leber hereditaryopticneuropathyismost
commonlyassociatedwith
A.sexlinkedrecessivetransmission
B.amitochondrialDNAmutationatthe3460position
C.apathognomonic opticnerveappearance
D.amitochondrialDNAmutationatthe11778position
29.Whichofthefollowingisleastconsistentwithtoxic
nutritionalopticneuropathy?
A.AlowserumandB12andthiamine
B.A1.2logunitrelativeafferentpupillary defect(RAPD)
C.Temporalpalloroftheopticdiscs
D.Bilateralcecocentral scotomas
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29.Whichofthefollowingisleastconsistentwithtoxic
nutritionalopticneuropathy?
A.AlowserumandB12andthiamine
B.A1.2logunitrelativeafferentpupillary defect(RAPD)
C.Temporalpalloroftheopticdiscs
D.Bilateralcecocentral scotomas
30.A26yearoldnurseinanophthalmologycliniccomplainsof
rightsidedbrowache.Examinationofbotheyesisnormal,except
forthepresenceofa1.5mm,nonreactiverightpupiltolightor
nearstimuli.Thepupildoesnotdilateindarkness.Theleftpupilis4
mmandbrisklyreactive.Thepatienthasnoptosis andnormal
ocularmotility.Theanteriorchamberhasnocellandflare.The
mostlikelydiagnosisis:
A.Instillationofmiotic agent
B.Adie'spupil
C.ArgyllRobertsonpupil
D.Horner'ssyndrome
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30.A26yearoldnurseinanophthalmologycliniccomplainsofright
sidedbrowache.Examinationofbotheyesisnormal,exceptforthe
presenceofa1.5mm,nonreactiverightpupiltolightornearstimuli.The
pupildoesnotdilateindarkness.Theleftpupilis4mmandbriskly
reactive.Thepatienthasnoptosis andnormalocularmotility.The
anteriorchamberhasnocellandflare.Themostlikelydiagnosisis:
A.Instillationofmiotic agent
B.Adie'spupil
C.ArgyllRobertsonpupil
D.Horner'ssyndrome
31.A63yearoldrighthandedmanhasanisolatedinfarctofthe
entireleftparietallobe.Whichofthefollowingwouldyouleast
expecttofindonexamination?
A.Rightleftconfusion
B.Impairedoptokinetic nystagmus withthetapegoingtotheleft
C.Acalculia
D.Arighthomonymoushemianopsia,worseinthesuperior
hemifield thanintheinferiorhemifield
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31.A63yearoldrighthandedmanhasanisolatedinfarctofthe
entireleftparietallobe.Whichofthefollowingwouldyouleast
expecttofindonexamination?
A.Rightleftconfusion
B.Impairedoptokinetic nystagmus withthetapegoingtotheleft
C.Acalculia
D.Arighthomonymoushemianopsia,worseinthesuperior
hemifield thanintheinferiorhemifield
32. Apatientwithsuddenonsetofsevereheadache,
sixthnervepalsy,andabitemporal visualfielddefect
likelyhas
A.arupturedophthalmicarteryaneurysm
B.pituitaryapoplexy
C.meningeal carcinomatosis
D.multiplesclerosis
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32. Apatientwithsuddenonsetofsevereheadache,
sixthnervepalsy,andabitemporal visualfielddefect
likelyhas
A.arupturedophthalmicarteryaneurysm
B.pituitaryapoplexy
C.meningeal carcinomatosis
D.multiplesclerosis
33.Ahealthy50yearoldwomanacutely
developsapainful,postganglionicHorner
syndrome.Imagingshouldbedirectedtofind
whatpathology?
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33.Ahealthy50yearoldwomanacutelydevelopsa
painful,postganglionicHornersyndrome.Imaging
shouldbedirectedtofindwhatpathology?
A.brainstemstroke
B.apicallungtumor
C.carotiddissection
D.multiplesclerosis
33.Ahealthy50yearoldwomanacutelydevelopsa
painful,postganglionicHornersyndrome.Imaging
shouldbedirectedtofindwhatpathology?
A.brainstemstroke
B.apicallungtumor
C.carotiddissection
D.multiplesclerosis
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34.Allofthefollowingarefeaturesoftonicpupil
except:
A.Tonicnearresponse
B.poorlightreflex
C.cholinergicdenervation supersensitivity
D.Poornearreflex
34.Allofthefollowingarefeaturesoftonicpupil
except:
A.Tonicnearresponse
B.poorlightreflex
C.cholinergicdenervation supersensitivity
D.Poornearreflex
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35.Whichofthefollowingwouldbethebestimagingstudy
inapatientwitharightopticneuropathyandthirdnerve
palsy?
A.MRIofthebrainwithcontrast
B.MRIofthebrainandorbitswithcontrastandfat
suppression
C.MRAoftheheadandneck
D.CTBrainandOrbitswithcontrast
35.Whichofthefollowingwouldbethebestimagingstudy
inapatientwitharightopticneuropathyandthirdnerve
palsy?
A.MRIofthebrainwithcontrast
B.MRIofthebrainandorbitswithcontrastandfat
suppression
C.MRAoftheheadandneck
D.CTBrainandOrbitswithcontrast