NBEO NBEO Neuro-Optometry & Visual Fields

Question 1

A patient has a right homonymous hemianopia with macular sparing. Where is the lesion most likely located?

Accepted Answer

Left occipital lobe

Answer

Macular-sparing homonymous hemianopia localizes to the occipital cortex because the macula has dual blood supply and a large cortical representation at the occipital pole.

Question 2

Which pupillary finding is associated with Horner syndrome?

Accepted Answer

Miosis, ptosis, and anhidrosis

Answer

Horner syndrome results from disruption of the sympathetic pathway and presents with miosis, ptosis (from superior and inferior tarsal muscles), and anhidrosis.

Question 3

A Marcus Gunn pupil (relative afferent pupillary defect) indicates a lesion in which structure?

Accepted Answer

Afferent visual pathway (optic nerve or retina) on the affected side

Answer

A RAPD indicates asymmetric afferent input, meaning the optic nerve or retina on the affected side transmits less light signal to the midbrain.

Question 4

Which visual field defect is produced by a lesion at the optic chiasm?

Accepted Answer

Bitemporal hemianopia

Answer

A chiasmal lesion (commonly a pituitary adenoma) damages crossing nasal fibers, resulting in loss of both temporal fields — bitemporal hemianopia.

Question 5

What is the most common intracranial cause of a third nerve (CN III) palsy with pupil involvement?

Accepted Answer

Posterior communicating artery aneurysm

Answer

A posterior communicating artery aneurysm compresses the pupillomotor fibers on the outside of CN III, causing a complete third nerve palsy with a fixed, dilated pupil.

NBEO - National Board of Examiners in Optometry Practice Test

NBEO - National Board of Examiners in Optometry Practice Test

NBEO NBEO Neuro-Optometry & Visual Fields