1. A 27-year-old man with monthly migraine headache has a dilated left pupil and blurred vision.

He denies diplopia. His last headache was 2 weeks ago and resolved after 1 day. Visual acuity is
20/20 OU, ocular motility is normal, and there is no ptosis. The pupils measure 5 mm OD, 6.5 mm
OS, and they constrict to 3 mm OD, 5.5 mm OS with light stimulus. Direct and consensual
reactions are the same in each eye. That is the next step in managing this patient?
a. Urgent noninvasive angiography (magnetic resonance angiography or computed tomography
angiography)
b. Hospital admission to a neuro-intensive care unit
c. Reassurance and outpatient observation
d. Laboratory screening for organophosphate poisoning
e. Ultrasonograpy of the eye
(AAO Jilid 5 Edisi tahun 2014-2015, halaman 358)

2. A 75-year-old woman with long-standing hypertension reports 3 days of horizontal diplopia

worse when looking to the right. It is constant at distance and bothers her most when driving. It is
not present when reading. Examination shows a deficit of abduction of the right eye. What is the
next step in managing this patient?
a. Obtain a basic metabolic panel, complete blood count with differential, erythrocyie
sedimentation rate, and C-reactive protein determination.
b. Send her to the local emergency department for urgent cranial imaging.
c. Prescribe base-out prism to correct the diplopia.
d. Advise observation and re-examination in 3 months.
e. Conservative
(AAO Jilid 5 Edisi tahun 2014-2015, halaman 358)

3. A 37-year-old woman describes persistent and worsening headache for 2 days and diplopia since
yesterday. Visual acuity is normal, and the fundus is unremarkable. Extraocular movements appear
grossly normal; cover testing shows the following: exotropia 5 prism diopters (~), right hypertropia
4~ in primary gaze; exotropia 9~, right hypertropia 3~ on right gaze; exotropia 1~, right
hypertropia 7 ~ on left gaze; and exotropia 6~, left hypertropia 4~ on downgaze. Both pupils react
to light with a less brisk response on the left.
What systemic risk factors are most relevant to this clinical presentation?
a. Classic migraine headache since age 16 years
b. Smoking 1 pack cigarettes daily for 20 years
c. Numbness in both feet
d. Diabetes mellitus
e. Hypertension
(AAO Jilid 5 Edisi tahun 2014-2015, halaman 358)