Board Certified Ophthalmologist Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers 3

Question 1

A 62-year-old man with giant cell arteritis develops sudden bilateral vision loss. ESR is 95 mm/hr and CRP is elevated. What is the most critical immediate treatment?

Accepted Answer

High-dose intravenous methylprednisolone

Answer

Oral aspirin 325 mg daily

Answer

Plasma exchange therapy

Answer

Intravitreal anti-VEGF injection

Question 2

A patient presents with a right homonymous hemianopia that is denser superiorly (pie-in-the-sky defect). Where is the most likely location of the lesion?

Accepted Answer

Left temporal lobe (Meyer's loop)

Answer

Right temporal lobe (Meyer's loop)

Answer

Right parietal lobe

Answer

Left occipital cortex

Question 3

Which pupillary finding is characteristic of a dorsal midbrain (Parinaud) syndrome?

Accepted Answer

Light-near dissociation with large pupils

Answer

Horner syndrome

Answer

Marcus Gunn pupil

Answer

Argyll Robertson pupils

Question 4

A 28-year-old woman with known myasthenia gravis presents with fluctuating ptosis and diplopia that worsens throughout the day. Ice pack test improves the ptosis. What percentage of ocular myasthenia patients will develop generalized disease within two years?

Accepted Answer

50-60%

Answer

10-15%

Answer

25-30%

Answer

80-90%

Question 5

A patient with thyroid eye disease presents with compressive optic neuropathy. Visual acuity is 20/60, color vision is reduced, and CT orbit shows enlarged extraocular muscles at the orbital apex. What is the initial treatment of choice?

Accepted Answer

High-dose systemic corticosteroids

Answer

Orbital decompression surgery

Answer

Orbital radiation therapy

Answer

Selenium supplementation

Question 6

A 55-year-old patient presents with painless progressive binocular diplopia and inability to look upward or downward. MRI reveals a lesion in the rostral midbrain. Which eye movement abnormality is most specific to this localization?

Accepted Answer

Convergence-retraction nystagmus

Answer

Downbeat nystagmus

Answer

Periodic alternating nystagmus

Answer

See-saw nystagmus