Neurology Quiz | Neuroq quiz | Practice MCQ #mcq.ImBooz

• (A) A 28-year-old man presents with right eye pain and blurry vision developing over 3 days. After examination and further history, a diagnosis of papillitis is made. How can papillitis be distinguished from the papilledema of increased intracranial pressure (ICP)?
• (B) Associated homonymous hemianopsia
• (C) Characteristic visual loss
• (D) Associated limitation of eye movement

Check AnswerSolution[C]:-Visual loss is usually substantial with papillitis, an inflammation of the optic nerve head, and inconsequential with papilledema. Patients with papillitis usually also have pain on moving the globe and sensitivity to light pressure on the globe. About 1 in 10 patients have both eyes involved simultaneously. Papillitis is often an early sign of multiple sclerosis.

• (A) A subfrontal meningioma
• (B) Slitlike ventricles
• (C) Transtentorial herniation
• (D) Metastatic breast carcinoma

Check AnswerSolution[B]:-Although papilledema must be considered evidence of a potentially life-threatening intracranial process, optic nerve bulging in this young woman is most likely from pseudotumor cerebri. This is a relatively benign condition that occasionally develops in obese or pregnant women. CSF pressure is markedly elevated in these patients, but they are not at risk of herniation. The condition is presumed to arise from hormonal problems. Without treatment, the increased intracranial pressure will produce optic nerve damage with loss of visual acuity.

• (A) Retinitis pigmentosa
• (B) Neurosyphilis
• (C) Sarcoidosis
• (D) Conversion disorder

Check AnswerSolution[D]:-Tunnel vision must be distinguished from concentric constriction. In the latter, the area perceived enlarges as the test screen is moved farther away from the patient, but the overall visual field is always smaller than the normal visual field. Concentric constriction associated with optic atrophy may develop with neurosyphilis. Tunnel vision, on the other hand, is characterized by the patient reporting the same size field even as the test screen is removed farther away. Tunnel vision is not a physiologic pattern of visual loss and should suggest either conversion disorder or malingering. Significant spiraling of the visual field, in which repeat testing of the same part of the visual field during the same examination leads to a successively smaller field each time, similarly may reflect conversion or malingering, although stress or panic may lead to mild effects of this sort.

• (A) Early cataract formation in the right eye
• (B) Optic atrophy
• (C) Hippus
• (D) Oscillopsia

Check AnswerSolution[B]:-The test performed is usually called the swinging flashlight test, and the pupillary finding is a Marcus Gunn, or afferent pupillary, defect. It commonly develops in persons with MS as a sequela of optic neuritis. Damage to the optic nerve reduces the light perceived with the affected eye. If the other eye has less or no optic atrophy, the consensual response of the pupil to light perceived by the better eye will constrict the pupil in the atrophic eye, even though direct light to the injured eye does not elicit a strong pupillary constriction.

• (A) Visual evoked response (VER) testing
• (B) Electroencephalography (EEG)
• (C) Computed tomography (CT)
• (D) Magnetic resonance imaging (MRI)

Check AnswerSolution[D]:-This young woman almost certainly has MS. Her visual loss can be explained by optic neuritis, and her bladder problems may be due to demyelination of corticospinal tract fibers. Many patients are reluctant to discuss minor problems with bladder, bowel, or sexual function with a physician of the opposite sex. The positive Babinski sign, focal dysmetria, and apparent dysarthria all support the diagnosis of a multifocal central nervous system (CNS) lesion. Multiple lesions disseminated in time and space are typical of MS. With MRI, the multifocal areas of demyelination should be apparent. Many more lesions may be evident on MRI than are suggested by the physical examination.

• (A) Bitemporal hemianopsia
• (B) Nyctalopia (night blindness)
• (C) Severe loss of visual acuity
• (D) Mild loss of visual acuity

Check AnswerSolution[A]:-The cones of the retina are packed into the macula, and the primary focus of the lens is at the macula. The macula is therefore responsible for visual acuity. Therefore, injury to the macula results in significant loss of acuity, often with preservation of peripheral vision. The macula is usually evident on ophthalmologic examination because it normally reflects a point of light that can be seen through the ophthalmoscope. It is located 3-to-4 mm temporally from the optic disc. Bitemporal hemianopsia is seen in injury to the optic chiasm, as from pituitary tumors. Nyctalopia (night blindness) is seen in retinal degeneration (eg, retinitis pigmentosa), vitamin A deficiency, and color blindness. Scintillating scotomas are the classic signature of the migraine aura.

• (A) Retinal tears
• (B) Optic atrophy
• (C) Segmental narrowing of arterioles
• (D) Drusen

Check AnswerSolution[C]:-The vessels apparent on funduscopic examination of the retina are arterioles and venules. In addition to segmental narrowing of arterioles, the retina may exhibit arteriolar straightening and arteriolar-venular compression. The thickened arteriolar wall compresses the venule at the point where they cross, a pattern often referred to as nicking.

• (A) Sarcoidosis
• (B) Chronic hypertension
• (C) Diabetes mellitus
• (D) Chorioretinitis

Check AnswerSolution[C]:-These aneurysms appear as small red dots on the surface of the retina. They may appear as one of the first manifestations of diabetes mellitus and are rarely larger than 90 ?m across. They may be more obvious in green light. A proliferative retinopathy may occur along with these microaneurysms in the patient with diabetes mellitus.

• (A) Oculomotor
• (B) Trochlear
• (C) Abducens
• (D) Ciliary

Check AnswerSolution[C]:-Injury to the sixth nerve produces a lateral rectus palsy. This type of ocular motor paresis is twice as common as a third-nerve palsy and six times as common as fourth-nerve problems. With lateral rectus weakness, the affected eye will remain inverted on attempts to look straight ahead.

• (A) Pontine glioma
• (B) Medullary glioma
• (C) Mesencephalic infarction
• (D) Pontine infarction

Check AnswerSolution[A]:-An abducens dysfunction with lateral rectus palsy in a child may develop due to increased intracranial pressure or direct damage to the brainstem. With a brainstem glioma, both brainstem damage and increased intracranial pressure may develop secondary to the tumor. Metastatic lesions from the nasopharynx or vascular disease are more likely causes of ocular motor dysfunction in adults, especially in the elderly.

• (A) Ischemia
• (B) Infection
• (C) Neoplasm
• (D) Trauma

Check AnswerSolution[B]:-Gradenigo syndrome arises with an osteomyelitis of the petrous pyramid. The abducens and trigeminal nerves are affected as they pass close to the tip of the petrous bone. Chronic ear infections may extend to the petrous pyramid and produce this syndrome if they are not properly managed.

• (A) Superior division of the third cranial nerve
• (B) Inferior division of the third cranial nerve
• (C) Fourth (trochlear) cranial nerve
• (D) Long ciliary nerve

Check AnswerSolution[C]:-The fourth cranial nerve innervates the superior oblique muscle. Because this muscle extends far anterior in the orbit, it is at high risk of injury with trauma to the orbit or the full face. The third nerve is especially vulnerable to pressure from aneurysms, but it is usually not disturbed with head trauma unless there are local fractures impinging on it. Injury to the fourth nerve with facial trauma will usually induce a slight head tilt to compensate for impaired intorsion of the affected eye.

• (A) Superior division of the third
• (B) Inferior division of the third
• (C) Fourth (trochlear)
• (D) Long ciliary

Check AnswerSolution[C]:-Varicella zoster, previously known as herpes zoster, spreads to the face along the trigeminal nerve. The fourth nerve is presumably involved because it shares its nerve sheath with the ophthalmic division of the trigeminal nerve. The third and sixth nerves may also be involved with varicella zoster, but this occurs much less frequently than involvement of the fourth nerve.

• (A) Impaired adduction
• (B) Impaired pupillary constriction
• (C) Impaired depression
• (D) Impaired elevation

Check AnswerSolution[B]:-The pupilloconstrictor fibers of the third nerve lie superficially on the nerve. Lesions compressing the nerve impinge on these fibers before they disturb the ocular motor fibers. The third nerve is not involved in abduction of the globe; this is accomplished by the abducens nerve, which controls the lateral rectus muscle.

• (A) Poor pupillodilation
• (B) Poor pupilloconstriction
• (C) Sparing of pupillary function
• (D) Inversion of the affected eye

Check AnswerSolution[C]:-The vessel usually obstructed with diabetic third-nerve injury is deep in the third nerve. The superficial fibers to the iris are supplied by a separate set of vessels, and these are usually spared with diabetes mellitus. With the damaged third nerve, the affected person may complain of pain in and about the eye.

• (A) Mesencephalic infarction
• (B) Aberrant third-nerve regeneration
• (C) Iridocyclitis
• (D) Pontine glioma

Check AnswerSolution[B]:-Oculomotor fibers that have been damaged reversibly may regenerate and connect to the wrong target. This aberrant regeneration is seen most often with lesions that chronically compress the third nerve. Aneurysms, cholesteatomas, and neoplasms should be suspected in the person exhibiting this type of disturbance.

• (A) A mesencephalic or pontine injury
• (B) Thalamic hemorrhage
• (C) Cerebellar dysfunction
• (D) Cortical injury in the frontal eye fields

Check AnswerSolution[A]:-In the medial longitudinal fasciculus (MLF) syndrome, the patient has incomplete adduction ipsilateral to the lesion in the MLF on conjugate lateral gaze. On attempted conjugate lateral gaze away from the side of the lesion, the patient has nystagmus in the abducting eye. The fast component of the nystagmus is directed temporally. This is also referred to as internuclear ophthalmoplegia

• (A) Progressive supranuclear palsy
• (B) MS
• (C) Subacute sclerosing panencephalitis (SSPE)
• (D) Progressive multifocal leukoencephalopathy (PML)

Check AnswerSolution[B]:-Vascular disease may produce bilateral injury to the MLF in the elderly, but it is an unlikely explanation in the young adult. Injury to the MLF in MS is demyelinating. Bilateral MLF syndromes associated with optic atrophy are virtually diagnostic of MS in persons under 40 years of age.

• (A) Hysteria
• (B) Drug intoxication
• (C) Eyestrain
• (D) Myopia

Check AnswerSolution[B]:-Alcohol and barbiturates are the drugs that most often cause nystagmus. A variety of hypnotic and anti-epileptic drugs are also often implicated because they are widely used by the general population. Although the severity of nystagmus in the two eyes may be unequal, it is invariably worse in the horizontal plane of gaze when the nystagmus is an adverse effect of drug use.

• (A) SSPE
• (B) MS
• (C) Pontine glioma
• (D) Cervicomedullary junction ischemia

Check AnswerSolution[C]:-The phenomenon described is commonly referred to as ocular bobbing. It is an involuntary movement that usually develops with pontine damage. Damage to the cerebellum occasionally produces a similar disturbance of eye movements.