Oph_1st neuro
Ophthalmology Neuro Quiz
Test your knowledge on neuro-ophthalmology with our comprehensive quiz covering a wide range of topics related to optic nerve conditions, visual pathways, and more. Challenge yourself and enhance your understanding of this important field.
Key Features:
- 103 carefully curated questions.
- Multiple-choice format for thorough assessment.
- Perfect for students, educators, and professionals in ophthalmology.
Which one of the following concerning the intracranial portion of the optic nerve is false?
It is typically 10 to 17 mm in length.
Once it enters the intracranial cavity, the optic nerve no longer has a sheath
There is generally some redundancy within the intracranial optic nerve. d.
It enters the intracranial cavity medial to the internal carotid artery..
Which of the following concerning the optic chiasm is true?
As many fibers cross as do not cross.
The posterior portion of the chiasm has a high density of macular fibers.
The superior fibers are the first to cross
The chiasm typically lies 1 mm above the anterior pituitary gland.
Which of the following retrochiasmal locations can induce a monocular visual field defect with a single lesion alone?
Lateral geniculate body..
occipital lobe
parietal lobe.
temporal lobe
The cause of optic disc edema is
Swollen peripapillary myelinated nerve fiber layer.
Breakdown of the blood retinal barrier
extracellular fluid accumulation
interruption of axonal transport.
Which of the following concerning papilledema is true?
Loss of venous pulsations is a particularly specific finding.
Papilledema is more commonly unilateral.
Symptoms accompanying papilledema may include visual loss and transient obscurations of vision
The most typical visual field finding in chronic papilledema is an enlarged blind spot.
Which of the following are universal findings in patients with pseudotumor cerebri?
Papilledema
increased intracranial pressure
Abnormal cerebrospinal fluid composition
Normal neurologic examination
Indication for treatment of pseudotumor cerebri includes which of the following?
Papilledema
Obesity.
visual field loss
Optic disc drusen
Pseudotumor cerebri, also known as idiopathic intracranial hypertension (IIH), can be associated with the use of all of the exogenous substances except
Acetylsalicylic acid.
Nalidixic acid
tetracycline.
vitamin A.
The most common cause of permanent visual loss in patients with cavernous sinus–dural fistulae is
Corneal exposure.
open-angle glaucoma.
choroidal effusions
Neovascular glaucoma
All of following concerning giant cell arteritis are true except:
Ninety-five percent of untreated patients will have contralateral involvement of the other eye, within days to weeks.
Visual loss is typically mild with visual acuity being better than 20/100 in 60% of the patients
It is exceedingly rare in patients <50 years old and is more common in females
Forty percent of untreated patients will develop some form of permanent visual loss. c.
Which of the following concerning optic nerve glioma is true?
These tumors are more likely to be aggressively malignant in children than in adults.
Optic nerve glioma is more frequently seen in children than adults
The vast majority of patients will have associated neurofibromatosis
Optociliary shunt vessels of the disc occur more commonly with optic nerve gliomas than with meningiomas of the optic nerve ≈
Which of the following is true regarding morning glory disc anomaly?
Retinal vessels emanate from the center of the optic disc.
Occult transsphenoidal basal encephaloceles may be present
It is more common in males than females
Visual acuity is normal in these patients.
Which of the following is true regarding optic pits?
Visual field defects are not seen
Serous detachment of the macula can occur
Optic pits are typically located nasally.
Optic pits are typically bilateral.
Which of the following is true regarding the treatment for optic neuritis?
Intravenous methylprednisolone improves the longterm visual acuity compared to no treatment.
Corticosteroid therapy has no long-term beneficial effect for vision
Oral prednisone is preferred over intravenous methylprednisolone as initial therapy
Intravenous methylprednisolone is proven to reduce the long-term risk of multiple sclerosis.
The most common location for a cerebral aneurysm associated with acute third nerve palsy is
The junction of posterior communicating artery and the internal carotid artery.
The junction of posterior communicating and posterior cerebral arteries
The junction of the posterior cerebral artery and the internal carotid artery.
The junction of the vertebral and superior cerebellar arteries
A 42-year-old diabetic man presents with a painful partial third nerve palsy. On his first follow-up visit, you notice that, when looking down, his upper eyelid appears to retract or lag. This finding essentially rules out the possibility of a.. b. a
diabetic third nerve palsy
Aneurysm.
meningioma.
Trauma.
The most common cause of acquired fourth nerve palsy in adults is
Tumor.
Trauma.
Vascular
idiopathic
The most common cause of isolated sixth nerve palsy is
Ischemia.
Raised intracranial pressure.
aneurysm.
Tumor.
The finding that all three types of Duane’s syndrome share is
A deficit of adduction.
a deficit of abduction.
globe retraction with adduction
Esotropia.
Which of the following concerning Marcus Gun jawwinking syndrome is false?
It is a synkinetic movement of the eyelid associated with jaw movement.
It is an example of aberrant regeneration
The patient can present with ptosis.
The eyelid can elevate upon opening of the mouth.
A 26-year-old female presents to your office with blurred vision for 3 days in her left eye. Fundus examination reveals disc edema with a macular star. She has no medical problems including diabetes or hypertension. You astutely diagnose her has having neuroretinitis. What is the most likely cause?
underlying diabetes
Bartonella henselae
Multiple sclerosis
Underlying hypertension
Which one of the following concerning Adie’s tonic pupil is false?
The differential diagnosis of a tonic pupil includes herpes zoster, syphilis, and giant cell arteritis.
The majority of affected patients will have unilateral involvement
Patients may have accommodative symptoms or photophobia
Pupillary constriction in response to pilocarpine 1% is conclusive evidence of denervation hypersensitivity
Glaucoma is associated with which phakomatoses?
Tuberous sclerosis
von Hippel-Lindau disease
Sturge-Weber syndrome.
Ataxia–telangiectasia
Chronic sinopulmonary infections may be seen as part of
tuberous sclerosis
Neurofibromatosis
angiomatosis retinae.
Ataxia–telangiectasia.
All of the following can have chronic progressive external ophthalmoplegia (CPEO) except
Oculopharyngeal dystrophy
Thyroid eye disease
Kearns-Sayre syndrome
Myotonic dystrophy
Which of the following statements is false regarding monocular diplopia?
It can be caused by lenticonus
There are no genetic syndromes associated with monocular diplopia
It can be caused by retinal pathologies.
It can be caused by high astigmatism.
The most common sign of Graves’ ophthalmopathy is
Conjunctival injection over the horizontal rectus muscles
lid retraction
Esotropia
Proptosis.
The most frequently involved extraocular muscle in Graves’ ophthalmopathy is the
Inferior rectus.
Lateral rectus.
Superior rectus
Medial rectus
Posterior ischemic optic neuropathy (PION) typically occurs in what setting?
1 to 2 weeks after viral infection
Post radiation therapy
Post spinal surgery
Raised intracranial pressure.
In a patient complaining of headache and transient visual obscurations whose examination reveals bilateral disc edema, the first diagnostic intervention to be undertaken is
CT scanning
lumbar puncture.
measurement of blood pressure
Measurement of sedimentation rate
Which of the following disorders is clearly associated with optic nerve drusen?
pseudotumor cerebri
Migraines.
Giant cell arteritis
retinitis pigmentosa
The most common fundus finding in a patient with acute traumatic optic neuropathy is
Disc pallor.
. Disc edema
Choroidal ruptures
unremarkable fundus.
Which of the following concerning diabetic papillopathy is true?
Visual loss is generally severe
It is typically painful
Development of the disorder seems to be independent of the degree of blood sugar control
The papillopathy is generally followed by the development of florid neovascularization
Modalities useful in the treatment of optic neuropathy secondary to thyroid eye disease include all of the following except
orbital radiation.
Subtotal thyroidectomy
Corticosteroid therapy
Orbital decompression surgery.
Which one of the following nerves supplies the cornea?
frontal nerve.
Lacrimal nerve.
Nasociliary nerve.
Supraorbital nerve.
Potential complications of carotid-cavernous fistulae include all of the following except
retinal vasculitis.
Retinal neovascularization
Glaucomatous optic nerve damage
Corneal ulceration.
Which one of the following regarding pseudotumor cerebri is true?
Many cases are probably on the basis of decreased reabsorption of CSF
Headache is the sine qua non of the disease (i.e., it is a universal symptom among patients with the disorder)
Neurologic abnormalities, including abducens palsy, are common
Opening pressure and CSF protein levels are typically elevated
Which of the following medications is most clearly associated with drug-induced myasthenia?
Warfarin
D-penicillamine
Diltiazem
Ranitidine
Ocular pulsations may be seen in all of the following except:
neurofibromatosis
Carotid-cavernous sinus fistulas
Capillary hemangioma
Orbitoencephaloceles
A patient with multiple sclerosis could have all of the following except:
Skew deviation
Bitemporal visual field deficit
Retinal venous sheathing
Amaurosis
Uhthoff symptom describes:
The decrease in vision with an increase in body temperature
The inability to distinguish faces
An electric shock sensation with neck flexion
The ability to see moving objects but not stationary ones
Which one of the following signs would not be expected with a classic migraine?
Headache
Premonitory aura
Scintillating lights
Persistent leg tingling and weakness
Which one of the following is not a criterion for the diagnosis of pseudotumor cerebri (idiopathic intracranial hypertension)?
Bilateral papilledema
Normal cerebrospinal fluid composition
Elevated opening pressure on lumbar puncture
Normal neuroimaging studies
A 22-year-old man presents to the emergency department with a 1-day history of diplopia. Examination reveals limitation of abduction of the right eye and limitation of elevation of the left eye. The pupils measure 7 mm OD and 8 mm OS with poor reaction to light and accommodation. Bilateral ptosis is present. The least useful test needed to confirm the diagnosis is:
Clostridium botulinum toxin test
Tensilon test
GQ1b antibody test
Lumbar puncture
A 68-year-old man developed a sudden onset of vomiting, imbalance, and double vision. On examination, he had a concomitant 10 PD left hypertropia and ataxia. What test should be ordered?
Cerebral MRI and arteriography
Tensilon test
Carotid ultrasonography
Cerebral arteriography
A 41-year-old woman presents with a 3-month history of shimmering photopsias in the left eye in association with a “dark spot” temporal to fixation in that eye which has gradually increased in size. The least likely diagnosis is:
Acute zonal occult outer retinopathy (AZOOR)
Cancer-associated retinopathy
Gyrate atrophy
MS
Which muscles are affected most commonly in thyroid eye disease?
Inferior oblique, inferior rectus
Medial rectus, inferior rectus
Superior rectus, inferior oblique
Lateral rectus, superior oblique
Which treatment in the Optic Neuritis Treatment Trial (ONTT) had the highest rate of recurrence?
IV methylprednisolone and oral prednisone
Oral prednisone alone
IV methylprednisolone alone
Observation
The most common cause of binocular transient visual loss lasting 30 minutes in a 29-year- old woman is
Migraine
Thromboembolism
Pseudotumor cerebri
Giant cell arteritis
A 69-year-old woman reports awakening 2 days earlier with blurred vision in the inferior visual filed OS. This morning, she noted extension of visual loss to the superior visual field OS. Over the past month, she has felt weak and tired, and recently she developed a headache. Examination reveals visual acuity of hand motions in the affected eye, with an afferent pupillary defect and pale optic disc edema. The following statements are true except
The major ophthalmic goal of therapy in arteritis AION is to prevent visual loss in the fellow eye
Corticosteroids therapy should be initiated after return of a positive temporal artery result.
This clinical scenario most likely represents arteritis anterior ischemic optic neuropathy (AION).
Initial management include evaluation of sedimentation rate and C-reactive protein
A 65-year-old male presents with a 1-hour history of acute right homonymous hemianopia. Which imaging modality would best demonstrate an acute infarct of the left occipital lobe?
CT With contrast
TI-weighted MRI
Diffusion-weighted MRI
Cerebral angiogram
A Lesion of the lift occipital lobe
Results in an incongruous right homonymous hemianopic visual filed defect, which may demonstrate sparing of the fixation region
Is usually associated with impaired visual acuity
Is typically associated with impaired optokinetic nystagmus with targets moving to the left
May show a monocular right temporal visual field defect
A 27-year-old man was struck in the right forehead during a fight. He presented to the emergency department complaining of inability to see out of his right eye. The examination results revealed vision of light perception in the right eye, 20/20 in the left eye. Confrontation field testing was normal in the left eye. Eye movements were full, and there was evidence of orbital trauma. Pupils were equal in size and reacted well, with no evidence of an afferent pupillary defect. Which of the following is the most likely diagnosis?
Optic tract injury
Occipital lobe contusion
Indirect traumatic optic neuropathy
Functional visual loss
Which of the following is not a typical feature of the dorsal midbrain syndrome (also known as Parinaud syndrome or pretectal syndrome)?
Lid retraction
Saccadic paresis of upgaze
Convergence-retraction nystagmus
Small pupils that react poorly to light and briskly to near
The Optic Neuritis Treatment Trial (ONTT) and follow-up studies indicate all of the following except
Intravenous methylprednisolone administered within 8 days after visual loss significantly reduces the 10 year risk of developing MS.
Intravenous methylprednisolone may speed visual recovery during the first 2-3 weeks after onset but has no lasting visual benefit.
Oral prednisone alone at 1mg/kg/day may increasing recurrence rate.
The overall 10 year risk of developing multiple sclerosis after isolated optic neuritis is approximately 38%.
A 22 –year- old woman was referred due to anisocoria. The patient had not been aware of the problem. The right pupil was 3 mm and slightly oval in shape, and the left pupil was 5 mm and round. The right pupil reacted poorly to light but promptly to near, whereas the left pupil reacted normally to both light and near. Which of the following is the most likely diagnosis?
Argyll-Robertson pupils
Old Adie’s pupil, right eye
Physiologic anisocoria
Acute Adie’s pupil, left eye
All of the following are true about cerebrovascular disease causing transient monocular visual loss except
The transient visual loss may be a harbinger of stroke.
The incidence of permanent blindness is low
Depending on the degree of carotid stenosis, carotid endarterectomy may be warranted.
Visual loss generally lasts more than 15 minute.
All of the following would be expected to show restriction during forced duction testing except
Thyroid-associated orbitopathy
Congenital fibrosis of the extraocular muscles
Orbital fracture with inferior rectus entrapment
Internuclear ophthalmoplegia
Which of the following is not a feature of myotonic dystrophy?
Inability to relax one’s grasp
Hatchet face
Subluxed lenses
Ophthalmoplegia
Which of the following is not considered to be an illusion?
Pulfrich phenomenon
Metamorphopsia
Micropsia
Palinopsia
A previously healthy 25-year-old woman presents with acute visual loss OD (20/20) and a right relative afferent pupillary defect (RAPD). MRI show 2 ovoid periventricular T2 hyper-intensities. Which of the following statements is false?
She will have clinically definite multiple sclerosis if she experiences even one more unex-plained neurologic event lasting 48 hour.
She has 50%-60% chance of developing multiple sclerosis over the next 10 years
He vision will most likely not recover
Treatment with oral corticosteroids alone will increase her risk of future attacks of visual loss
Which of the following is most likely to prompt additional evaluation in a patient with facial palsy?
Upper and lower facial musculature equally affected
Facial palsy occurring in a patient older than 50 years of age.
Recovery of facial nerve function that occurs 3 weeks after the facial palsy
Simultneous bilateral facial palsy
An underlying condition is most likely to be determined in a patient with isolate eye pain and
Poor response to tricyclic antidepressants
Normal neuroimaging of the brain and orbits
Ipsilateral facial numbness
Pain for greater than 2 years 14
A 1- year-old child presents with monocular vertical nystagmus. What is the best course of action?
Undertake neuroimaging (preferable MRI)
Follow the case to see whether abnormal head position develops
Undertake drug toxicology screening
Follow the case to see whether head nodding develops
In automated perimetry
Static technique, indicating a nonmoving target of varying intensity, is commonly used
For displayed decibel values, a higher number indicates worse visual sensitivity
The visual threshold is the maximum visual stimulus seen at a point
The mean deviation is a measure of localized deviations from normal
Optic disc drusen typically demonstrate all of the following features except a. b.
Visual acuity loss
Arcuate visual field defects
High reflective signal on B-Scan ultrasonography
Optic disc elevation and blurred margins
After a motor vehicle accident, a young man presents with unilateral marked proptosis, displopia, and prominent episcleral vessels. He complains of a rushing sound in his head. Which of the following is the most likely possibility?
Retro-orbital hemorrhage
Orbital floor fracture
Carotid-cavernous fistula
Posteriorly draining dural shunt
A 45-year-old present with painful left Horner syndrome of 3 days duration. The most appropriate imaging would be
MR/MRA, brain and neck
Catheter floor fracture
CT, head
MRI, neck
All of the following are common causes of transient visual loss except
Migraine
Nonarteritic ischemic optic neuropathy
Giant cell arteritis
Pseudotumor cerebri
Which eye movement disorder is most commonly seen in patients with paraneoplastic syndrome?
Upbeat nystagmus
Downbeat nystagmus
Superior oblique myokymia
Opsoclonus
Lesions involving the optic chiasm
Often are associated with papilledema
Commonly include pituitary adenomas, meningiomas, craniopharyngiomas, and stroke
May show markedly asymmetric involvement of the temporal visual fields
Do not demonstrate afferent pupillary defects
Diplopia with associated bilateral abduction defects and pupillary constriction upon attempted lateral gaze is most likely due to
Myasthenia gravis
Graves disease
Spasm of the near reflex
Bilateral sixth nerve palsies
Interruption of visual information between the occipital lobe and the dominant angular gyrus cause
Alexia without agraphia
Simulatanagnosia
Balint syndrome
Gestmann syndrome
A patient presents with CN VI and CN VII palsies. The most likely lesion location is the
Midbrain
Pons
Cavernous sinus
Medulla
Optic atrophy
Is never segmental
Is an early sign of outer retinal layer damage
Usually requires 4-8 weeks to develop after optic nerve injury
Is always associated with a central scotoma
A 32-year-old woman develops visual loss in the right eye. She has a right RPAD and a moderately swollen optic nerve with flame-shaped hemorrhages. Previous history includes 16 Bell’s palsy on 2 occasions and several episodes of “Pink eye" over the last 5 years. The most hlpfl diagnostic testing would be
A chest x-ray and angiotensin-converting enzyme
Lumbar puncture
Bartonella henselae titers
An MRI
A 30-year-old woman reports a 2-month history of headaches and progressive visual loss OS. She takes no medications and is not obese. Examination reveals visual acuity of 20/20 OD and 20/70 OS, with a generally depressed visual field OS. There is an afferent pupillary defect OS, and the optic discs show bilateral edema, slightly paler on the left. The most important next diagnostic step is
CBC with sedimentation rate
Ultrasonography of the orbits
A lumbar puncture
MR scan of the brain
A 55- year-old patient with diabetes presents with double vision. Which of the following finding would lead you to order MRI of the brain as the initial diagnostic test?
Isolated pupil-sparing complete third cranial nerve palsy of 3 days’ duration
Right fourth cranial nerve palsy with bilateral ptosis that clearly gets worse as the day progresses, present for 1 week
Isolated pupil-sparing complete third cranial nerve palsy of 8 months duration
Lid retraction OU, restriction of upgaze OU, injection over the medial and lateral recti muscles OU, and elevation of intraocular pressure from 16 to 28 mm Hg in both eyes with upgazeLid retraction OU, restriction of upgaze OU, injection over the medial and lateral recti muscles OU, and elevation of intraocular pressure from 16 to 28 mm Hg in both eyes with upgaze
The clinical history and finding most typical of optic nerve sheath meningioma include all of the following except
Slowly progressive visual loss
Atrophy or swelling of the optic disc
Marked proptosis
Female
Which finding would most likely prompt additional evaluation in a patient with headaches? .
Headache that recurs in a different location
A family history of headaches
Persistent visual field defect after the headaches resolves
Transient positive visual phenomena that occur 20-30 minutes before the onset of the headaches
Which of the following is indicated if aberrant regeneration occurs in resolving oculomotor (CN III) nerve palsy that had been presumed to be due to diabetes mellitus?
No further workup is indicated
Lumbar puncture
Cranial MRI scanning
Westergren erythrocyte sedimentation rate and C-reactive protein
Which of the following is true regarding sympatc innervation of the iris sphincter muscle?
Sympathetic fibers synapse at the superior cervical ganglion and travel with the short posterior ciliary nerves.
Sympathetic fibers synapse at the ciliary ganglion and travel with the short posterior ciliary nerves
Sympathetic fibers synapse at the superior cervical ganglion and travel with the long posterior ciliary nerve
Sympathetic fibers synapse at the superior cervical ganglion and travel with the long posterior ciliary nerves
With a horizontal gaze palsy to right, all the following may be true except
Cerebral angiography should be performed urgently
The lesion may be in the right CN VI nucleus
The eye movement pattern could be functional in origin
Caloric testing may be useful in patient evaluation
Which of the following causes of facial nerve dysfunction is more commonly bilateral at onset?
Essential blepharospasm
Hemifacial spasm
Apraxia of the eyelid opening
Bell’s day
Congruity of homonymous visual field defects
Requires assessment of the optiokinetic responses
Indicates a lesion of the optic chiasm
Is seen with occipital lobe disease
Is of little help in topographic localization
A 24-year-old smoker presents with painless, semiacute, progressive visual loss in his right eye. Both eyes are normal on fundus evaluation, and MRI results are normal. There months later, the affected eye has not improved, and vision in the patient’s left eye has deteriorated. Repeated MRI and a lumbar puncture yield negative results. The complete blood count and assays for antinuclear antibody, fluorescent treponemal antibody absorption, angiotensin-converting enzyme, Lyme titer, vitamin B12, and folate are normal. What is the most likely diagnosis?
Leber hereditary optic neuropathy (LHON)
Posterior schiemic optic neuropathy (PION) 18
Multiple sclerosis (MS)
Tobacco-alcohol optic neuropathy
Optic nerve axon emerges from:
Rods and cones
Amacrine cells
Inner nuclear layer
Ganglion cells
Papilloedema has all the following characteristics except:
Hyperemia of disc
Field defect
Marked loss of vision
Blurring of disc margins
Homonymous hemianopia is the result of a lesion in:
Optic chiasma
Retina
Optic tract
Optic nerve
Mydriasis is present in all the following except:
Pontine haemorrhage
Third nerve lesion
Datura poisoning
Fourth stage of anesthesia
D-shaped pupil occurs in:
Iridocyclitis
Iridodenesis
Iridodialysis
Cyclodialsis
In complete third nerve paralysis the direction of the affected eye in the primary position is:
Inward
Outward and down
Outward
Outward and up
Primary optic atrophy results from:
Chronic glaucoma
Papilledema
Neurological disease
Retinal disease
Retro-bulbar optic neuritis is characterized by:
Impaired consensual light reflex in the affected eye
Marked swelling of the optic disc.
Impaired direct light reflex in the affected eye
Normal visual acuity
The type of optic atrophy that follows retro-bulbar neuritis is:
Glaucomatous optic atrophy
Secondary optic atrophy
Consecutive optic atrophy
Primary optic atrophy
A male patient 30 years old with visual acuity of 6/6 in both eyes. Twelve hours ago he presented with drop of vision of the left eye. On examination, visual acuity was 6/6 in the right eye and 6/60 in the left eye. Fundus examination showed blurred edges of the left optic disc. The most probable diagnosis is:
Raised ocular tension
Central retinal artery occlusion
Optic neuritis
Raised intra cranial pressure
All are seen in 3rd nerve palsy except: .
Ptosis
Diplopia
Miosis
Outwards eye deviation
Homonymous hemianopia is due to lesion at:
Optic tract
Optic nerve
Optic chiasma
Retina e. Occipital cortex
Which is not found in papilloedema?
Blurred vision
Blurred margins of disc
Cupping of disc
Retinal edema
Optic disc diameter is: 20
1 mm
3 mm
2 mm
1.5 mm
Optic nerve function is best studied by:
Direct Ophthalmoscope
Gonioscop
Retinoscope
Perimetry
Which of the following is most useful in distinguishing the case of anisocoria that is greater in dark than in light?
Cocain 10%
A. b. Pilocarpine 0.1%
Pilocarpine 1%
Pilocarpine 2.5%
Parasympathetic fibers destined for the pupil reside in the
Medulla
Medial portion of CN III
Posterior communicating artery
Pons
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