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PRETEST NEUROLOGY > eye disease > Flashcards

Flashcards in eye disease Deck (40):
1

361. A 36-year-old woman has tunnel vision in which she reports the same size area of perception regardless of how far from the testing screen the examination is performed. This history often indicates which of the following?

a. Retinitis pigmentosa

b. Neurosyphilis

c. Sarcoidosis

d. Chorioretinitis

e. Conversion disorder

e. Conversion disorder

2

362. The most common form of retinal degeneration is

a. Serous retinitis

b. Retinitis pigmentosa

c. Confluent drusen

d. Drug-induced retinopathy

e. Paraneoplastic retinal degeneration

b. Retinitis pigmentosa

3

363. A newborn child is being examined. During ophthalmologic evalua-tion, it is noticed that the red reflex is absent. Which of the following could this indicate?

a. Congenital cataracts

b. Chorioretinitis

c. Retinitis pigmentosa

d. Optic atrophy

e. Holoprosencephaly

a. Congenital cataracts

4

364. Glaucoma develops in nearly one-third of children with

a. Type 1 neurofibromatosis

b. Type 2 neurofibromatosis

c. Sturge-Weber syndrome (encephalotrigeminal angiomatosis)

d. Tuberous sclerosis

e. Arnold-Chiari malformation

c. Sturge-Weber syndrome (encephalotrigeminal angiomatosis)

5

365. A 23-year-old HIV-infected woman presents with visual loss. After testing, the diagnosis of retinitis caused by cytomegalovirus (CMV) is made. Which of the following should be used to treat this patient?

a. Cytarabine

b. Vidarabine

c. Ribavirin

d. Interferon

e. Ganciclovir

e. Ganciclovir

6

366. A 52-year-old woman is being evaluated for the acute appearance of a large central scotoma. Which of the following most likely preceded her presentation?

a. Pseudotumor cerebri

b. Chronic ethanolism

c. Chlorpromazine ingestion

d. Methyl alcohol intoxication

e. Isoniazid use

d. Methyl alcohol intoxication

7

367. 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 pap-illedema of increased intracranial pressure?

a. Degree of swelling of the optic disc

b. Associated homonymous hemianopsia

c. Characteristic visual loss

d. Associated limitation of eye movement

e. Loss of red reflex

c. Characteristic visual loss

8

Items 368–369 A 19-year-old woman with complaints of headaches and visual blur- ring has prominent bulging of both optic nerve heads with obscuration of all margins of both optic discs. Her physician is reluctant to pursue neuro- logic studies because the patient is 8 months pregnant and had similar complaints during the last month of another pregnancy. Her physical and neurologic examination are otherwise unrevealing. 368. If neuroimaging studies were to be performed on this woman, they probably would reveal

a. A subfrontal meningioma

b. Intraventricular blood

c. Slitlike ventricles

d. Transtentorial herniation

e. Metastatic breast carcinoma

c. Slitlike ventricles

9

369. The treatment of choice for this young woman is

a. Lumbar puncture

b. Cesarean section

c. Induction of labor

d. Vitamin A supplements

e. Acetazolamide

a. Lumbar puncture

10

370. A young man with multiple sclerosis (MS) exhibits paradoxical dilation of the right pupil when a flashlight is redirected from the left eye into the right eye. Swinging the flashlight back to the left eye produces constriction of the right pupil. This patient apparently has

a. Early cataract formation in the right eye

b. Occipital lobe damage on the left

c. Oscillopsia

d. Hippus

e. Optic atrophy

e. Optic atrophy

11

371. A 23-year-old woman complains of 2 days of visual loss associated with discomfort in the right eye. She appears otherwise healthy, but her family reports recurrent problems with bladder control over the prior 2 years, which the patient is reluctant to discuss. On neurologic examination, this young woman exhibits dysmetria in her right arm, a plantar extensor response of the left foot, and slurred speech. The most informative ancillary test would be

a. Visual evoked response (VER) testing

b. Sural nerve biopsy

c. Electroencephalography (EEG)

d. Magnetic resonance imaging (MRI)

e. Computed tomography (CT)

d. Magnetic resonance imaging (MRI)

12

372. Injuries to the macula or fovea centralis typically affect vision by producing

a. Bitemporal hemianopsia

b. Nyctalopia (night blindness)

c. Scintillating scotomas

d. Mild loss of visual acuity

e. Severe loss of visual acuity

e. Severe loss of visual acuity

13

373. A 64-year-old man who has had hypertension for over 30 years is being examined. The most obvious changes seen during retinal exam would include which of the following?

a. Retinal tears

b. Optic atrophy

c. Segmental narrowing of arterioles

d. Drusen

e. Telangiectasias

c. Segmental narrowing of arterioles

14

374. Routine funduscopic examination of a 52-year-old man reveals small, discrete red dots located in largest numbers in the paracentral region. Such retinal microaneurysms most often occur with which of the following?

a. Sarcoidosis

b. Chronic hypertension

c. Diabetes mellitus

d. Anterior communicating aneurysms

e. Chorioretinitis

c. Diabetes mellitus

15

375. A 72-year-old woman presents with the acute onset of double vision. The second image disappears if she covers either eye. The ocular motor nerve most likely to be impaired in this patient is the

a. Oculomotor

b. Trochlear

c. Abducens

d. Ciliary

e. Müller’s

c. Abducens

16

376. A 7-year-old girl acutely develops double vision that worsens over the course of a few days. Examination reveals a sixth-nerve (abducens) palsy. She is most likely to have which of the following?

a. Pontine glioma

b. Medullary glioma

c. Mesencephalic infarction

d. Pontine infarction

e. Medullary infarction

a. Pontine glioma

17

377. A 6-year-old girl has left facial pain and blurry vision. Careful examination reveals a deficit of the abducens nerve. Which of the following is the most likely etiology?

a. Ischemia

b. Infection

c. Neoplasm

d. Trauma

e. Hemorrhage

b. Infection

18

378. A 19-year-old man is hit in the face with a lead pipe. The ocular motor muscle most likely to be injured in this case is that innervated by the

a. Superior division of the third cranial nerve

b. Inferior division of the third cranial nerve

c. Fourth (trochlear) cranial nerve

d. Sixth (abducens) cranial nerve

e. Long ciliary nerve

c. Fourth (trochlear) cranial nerve

19

379. A 17-year-old girl develops a painful vesicular rash around her left eye. This is followed by blurry vision that occurs only when both eyes are open. She is diagnosed with varicella zoster ophthalmicus. Which ocular motor nerve is most likely to be affected?

a. Superior division of the third

b. Inferior division of the third

c. Fourth (trochlear)

d. Sixth (abducens)

e. Long ciliary

c. Fourth (trochlear)

20

380. A 32-year-old woman has an MRI done because of a first seizure. No etiology for the seizure is found, but there is the incidental finding of an aneurysm. The aneurysm is 5 mm and affects the posterior communicating artery. It is very close to the third cranial nerve. The initial sign of pressure on the third nerve is usually impaired

a. Adduction

b. Abduction

c. Depression

d. Elevation

e. Pupillary constriction

e. Pupillary constriction

21

381. A 58-year-old man with type 2 diabetes presents with the acute onset of double vision. Examination reveals a deficit of the third cranial nerve. A third-nerve palsy associated with diabetes mellitus is usually characterized by

a. Poor pupillodilation

b. Poor pupilloconstriction

c. Sparing of pupillary function

d. Inversion of the affected eye

e. Upward deviation of the affected eye

c. Sparing of pupillary function

22

382. A 65-year-old man is having a neurological exam because of tingling in his feet. During the course of the examination, it is noticed that pupillary constriction occurs with attempted adduction of the globe. This suggests which of the following?

a. Mesencephalic infarction

b. Pontine glioma

c. Acute glaucoma

d. Iridocyclitis

e. Aberrant third-nerve regeneration

e. Aberrant third-nerve regeneration

23

383. Evidence of internuclear ophthalmoplegia (INO) indicates

a. A mesencephalic or pontine injury

b. Thalamic hemorrhage

c. Cerebellar dysfunction

d. Cortical injury in the frontal eye fields

e. Medullary infarction

a. A mesencephalic or pontine injury

24

384. The most likely diagnosis in a 30-year-old woman with evidence of bilateral injury to the medial longitudinal fasciculus (MLF) is

a. Progressive supranuclear palsy

b. MS

c. Subacute sclerosing panencephalitis (SSPE)

d. Progressive multifocal leukoencephalopathy (PML)

e. Botulism

b. MS

25

385. A 42-year-old man has horizontal nystagmus in primary gaze and while looking to both the left and the right. The only other examination finding is a slight gait ataxia. The most likely cause of this patient’s induced nystagmus is which of the following?

a. Hysteria

b. Drug intoxication

c. Eyestrain

d. Myopia

e. Hypermetropia

b. Drug intoxication

26

386. The child with rapid downward deviation of both eyes followed by slow upward conjugate eye movements probably has

a. SSPE

b. MS

c. Pontine glioma

d. Cervicomedullary junction ischemia

e. Cerebral palsy (CP)

c. Pontine glioma

27

387. A 25-year-old male is being evaluated. Rhythmic jerk nystagmus is elicited by having the patient look at a rotating drum with stripes on it. This finding suggests which of the following?

a. Drug toxicity

b. Brainstem ischemia

c. Parinaud syndrome

d. Unilateral parietal lobe damage

e. No pathologic lesion in the brain

e. No pathologic lesion in the brain

28

388. A 36-year-old man abruptly loses vision in one eye. His retina appears cloudy and grayish yellow with narrowed arterioles. The fovea appears cherry red, and the vessels that are obvious appear to have segmented columns of blood. This man probably has

a. Chorioretinitis

b. Occlusion of the central retinal vein

c. Occlusion of the central retinal artery

d. Optic neuritis

e. Tay-Sachs disease

c. Occlusion of the central retinal artery

29

389. A 62-year-old man with hypertension has an episode in which he suddenly loses vision in his left eye. He is outside walking up the street, as he does every day, when suddenly the vision in his left eye goes black. When he closes his right eye, he can barely see at all. Within 2 h, his vision is back to normal. Amaurosis fugax usually arises because of disease in which of the following arteries?

a. Middle cerebral

b. Posterior cerebral

c. Anterior cerebral

d. Internal carotid

e. Anterior choroidal

d. Internal carotid

30

390. A 5-year-old girl sustains a cut on her face from broken glass. Ini- tially, the injury appears superficial except for a small area of deeper pene- tration just above the right eyebrow. Within 4 days, the child complains of periorbital pain and double vision. The tissues about the eye are erythema- tous, and the eye appears to bulge slightly. The optic disc is sharp, and no afferent pupillary defect is apparent. Visual acuity in the affected eye is pre- served. This child probably has

a. Orbital cellulitis

b. Cavernous sinus thrombosis

c. Transverse sinus thrombosis

d. Optic neuritis

e. Diphtheritic polyneuropathy

a. Orbital cellulitis

31

391. An otherwise healthy young woman has poorly responsive pupils that are dilated. Visual acuity is normal. A careful neurologic examination reveals bilaterally absent Achilles tendon jerks. This woman probably has

a. A cervical spinal cord tumor

b. A brainstem glioma

c. MS

d. A posterior communicating artery aneurysm

e. Benign tonic pupillary dilatation

e. Benign tonic pupillary dilatation

32

392. With neurosyphilis, the pupil

a. Is completely normal

b. Reacts poorly to light but accommodates well

c. Accommodates poorly but reacts well to light

d. Is pinpoint and regular in shape

e. Is fixed and dilated

b. Reacts poorly to light but accommodates well

33

Items 393–395 A 60-year-old right-handed man underwent heart transplantation 2 weeks ago for severe ischemic cardiomyopathy. He had an uneventful post- operative course and went home after 1 week. He is now readmitted from an outside hospital where he was admitted with headaches, increasing con- fusion, and a generalized seizure. He relates that he has had difficulty see- ing for several days. On exam, he has a blood pressure of 180/100. His pupils are equal and reactive, but he has difficulty reading and finding objects presented to him. Motor and sensory function are normal. An MRI shows several areas of T2 signal abnormality in the occipital and parietal lobe white matter bilaterally. A diffusion-weighted MRI sequence, sensitive to the changes of acute infarction, is negative. 393. This patient’s history, exam, and laboratory findings are most consis- tent with which of the following diagnoses?

a. Cyclosporine toxicity

b. Steroid psychosis

c. Occipital lobe infarction

d. Ischemic optic neuropathies

e. Retinal detachment

a. Cyclosporine toxicity

34

394. The patient recovers from this event, and a follow-up MRI 1 month later is completely normal. Six months later, he again presents with visual loss. About 2 weeks before, he began to notice difficulty seeing the television. Within 1 week, he noticed that the inferior field of vision in the right eye was much worse than the top of his vision. Within a few more days, he noticed the bottom of the vision in his left eye worsen as well. This has been painless. He has otherwise felt well, without headaches or cognitive changes. An oph- thalmologist saw bilateral papillitis with white exudates of the nasal part of the discs. There is no history of alcohol use, and the patient has stopped smoking since his heart transplant. On examination, he appears well. Blood pressure is 160/80; pulse is 100 and regular. There are no carotid bruits. Pupils are equal and reactive. Visual acuity is 20/400 OU, with central- inferior scotomas (left larger than right). Neurologic exam is otherwise nor- mal. An MRI scan with and without gadolinium contrast agent, including orbital cuts, is negative, as is CSF examination. This patient’s history, exam, and laboratory findings are now most consistent with which of the following diagnoses?

a. Cyclosporine toxicity

b. Occipital lobe lymphoma

c. Tobacco-alcohol amblyopia

d. Ischemic optic neuropathies

e. Retinal detachment

d. Ischemic optic neuropathies

35

395. Three months later, the patient’s vision is essentially unchanged. He is able to see in his superior fields, but cannot drive. Funduscopic exam at this time is likely to show which of the following?

a. Papilledema

b. Optic disc pallor

c. Retinal exudates

d. Retinal vein enlargement

e. Drusen

f. Absence of venous pulsations

g. Corkscrew vessels

h. Tilted discs

b. Optic disc pallor

36

DIRECTIONS: Each group of questions below consists of lettered options followed by a set of numbered items. For each numbered item, select the one lettered option with which it is mostclosely associated. Each lettered option may be used once, more than once, or not at all. Items 396–400 For each clinical scenario, select the probable visual field discovered on tangent screen testing as depicted. 396. A 30-year-old woman with diabetes mellitus and menstrual irregu- larities complains of chronic headaches with blurring of vision. On exami- nation, she has a lantern jaw, prominent nose, spade-shaped hands, and prominent supraorbital ridges. She is slightly taller than other members of her family. (SELECT 1 FIELD)

Q image thumb

396. C

A image thumb
37

DIRECTIONS: Each group of questions below consists of lettered options followed by a set of numbered items. For each numbered item, select the one lettered option with which it is mostclosely associated. Each lettered option may be used once, more than once, or not at all. Items 396–400 For each clinical scenario, select the probable visual field discovered on tangent screen testing as depicted.397. A 17-year-old woman with recurrent enuresis notes pain and visual problems in her left eye. Six months before the development of the visual difficulty, she had transient weakness in both legs for 2 days. Her parents noted slurring and slowing of her speech that appeared to persist long after the transient gait ataxia and leg weakness resolved. (SELECT 1 FIELD)

Q image thumb

397. A

A image thumb
38

DIRECTIONS: Each group of questions below consists of lettered options followed by a set of numbered items. For each numbered item, select the one lettered option with which it is mostclosely associated. Each lettered option may be used once, more than once, or not at all. Items 396–400 For each clinical scenario, select the probable visual field discovered on tangent screen testing as depicted. 398. A 40-year-old man suffers a gunshot wound to the back of the head. An MRI reveals extensive damage to the left occipital lobe with sparing of the right occipital lobe. (SELECT 1 FIELD)

Q image thumb

398. D

A image thumb
39

DIRECTIONS: Each group of questions below consists of lettered options followed by a set of numbered items. For each numbered item, select the one lettered option with which it is mostclosely associated. Each lettered option may be used once, more than once, or not at all. Items 396–400 For each clinical scenario, select the probable visual field discovered on tangent screen testing as depicted. 399. A 51-year-old woman complains of progressive loss of visual acuity in her left eye. Over the course of 5 years, her acuity has deteriorated from 20/20 to 20/400. An MRI of her brain reveals a large meningioma imping- ing on the left side of the optic chiasm. There is no associated hydro- cephalus. (SELECT 1 FIELD)

Q image thumb

399.B

A image thumb
40

DIRECTIONS: Each group of questions below consists of lettered options followed by a set of numbered items. For each numbered item, select the one lettered option with which it is mostclosely associated. Each lettered option may be used once, more than once, or not at all. Items 396–400 For each clinical scenario, select the probable visual field discovered on tangent screen testing as depicted.

400. A 65-year-old man develops language problems with no loss of con- sciousness. He is found to have a receptive aphasia, and an MRI scan con- firms an area of infarction in the left temporal lobe confined to structures above and lateral to the temporal horn of the lateral ventricle. (SELECT 1 FIELD)

Q image thumb

400. E

A image thumb