ABO Neuro-Ophthalmology 2

Question 1

A 52-year-old presents with acute headache, ptosis, and a dilated, poorly reactive left pupil with limited adduction and elevation. What is the most appropriate next step?

Accepted Answer

Urgent CT angiography or MR angiography

Answer

Pupil-involving third nerve palsy with headache suggests a posterior communicating artery aneurysm requiring urgent vascular imaging.

Question 2

In a patient with suspected Horner syndrome, topical apraclonidine 0.5% typically produces which result?

Accepted Answer

Dilation of the affected pupil and elevation of the ptotic lid

Answer

Denervation supersensitivity of alpha-1 receptors causes the Horner pupil to dilate and the lid to rise, reversing anisocoria.

Question 3

A young woman has a unilaterally dilated pupil with poor light reaction, slow tonic near response, and sectoral iris paralysis. Which test supports the diagnosis?

Accepted Answer

Constriction with dilute pilocarpine 0.125%

Answer

Adie tonic pupil shows cholinergic denervation supersensitivity and constricts to dilute pilocarpine.

Question 4

According to the Idiopathic Intracranial Hypertension Treatment Trial, which intervention combined with weight loss improved visual field outcomes in mild visual loss?

Accepted Answer

Acetazolamide

Answer

IIHTT showed acetazolamide plus diet improved perimetric mean deviation versus diet alone.

Question 5

A patient has a right hypertropia that worsens on left gaze and on right head tilt. Which muscle is paretic?

Accepted Answer

Right superior oblique

Answer

The Parks-Bielschowsky three-step test localizes this pattern to a right superior oblique (fourth nerve) palsy.

ABO - American Board of Ophthalmology Practice Test

ABO - American Board of Ophthalmology Practice Test

ABO Neuro-Ophthalmology 2