Board Certified Ophthalmologist Neuro-Ophthalmology Questions and Answers

Question 1

A 28-year-old woman presents with a three-day history of painful, progressively worsening vision in her left eye.
On examination, her visual acuity is 20/200 in the affected eye, and a prominent relative afferent pupillary defect is present.
Which of the following clinical features is most characteristic of typical optic neuritis associated with multiple sclerosis?

Accepted Answer

Pain that is exacerbated by eye movement

Answer

Severe optic disc edema (papilledema)

Answer

Absence of pain with eye movements

Answer

No improvement in vision after several weeks

Question 2

A 74-year-old female presents with an acute, profound, and painless loss of vision in her right eye. She also reports several weeks of new-onset headaches, scalp tenderness, and pain in her jaw when chewing. Examination reveals a pale, swollen optic disc in the right eye. What is the most critical immediate step in management?

Accepted Answer

Administer high-dose systemic corticosteroids immediately

Answer

Order an urgent temporal artery biopsy

Answer

Schedule an MRI of the brain and orbits

Answer

Obtain a stat erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

Question 3

A 66-year-old man with a history of type 2 diabetes and hypertension presents with the sudden onset of horizontal double vision. Examination reveals an esotropia in the primary position that worsens on left gaze, with a clear limitation of abduction in the left eye. Pupillary function, eyelid position, and all other extraocular movements are normal. What is the most likely diagnosis?

Accepted Answer

Microvascular sixth nerve palsy

Answer

Cavernous sinus thrombosis

Answer

Myasthenia Gravis

Answer

Third nerve palsy

Question 4

A patient's visual field testing demonstrates a loss of the outer half of the visual field in both eyes. This defect, known as a bitemporal hemianopia, is most classically caused by a lesion at which location?

Accepted Answer

Optic chiasm

Answer

Occipital lobe

Answer

Optic nerve

Answer

Optic tract

Question 5

Which of the following findings is a core component of the classic triad for Horner's syndrome?

Accepted Answer

Miosis

Answer

Mydriasis

Answer

Lid retraction

Answer

Exophthalmos

Question 6

A 26-year-old obese female presents with a 2-month history of daily headaches, pulsatile tinnitus, and transient visual obscurations. Fundus examination reveals bilateral optic disc edema. An MRI of the brain is normal. A lumbar puncture is performed, which shows an elevated opening pressure of 32 cm H2O with normal cerebrospinal fluid composition. What is the most likely diagnosis?

Accepted Answer

Idiopathic Intracranial Hypertension (IIH)

Answer

Optic neuritis

Answer

Meningioma

Answer

Hypertensive retinopathy