TQ Quiz | Neuro Nuggets: Warning Signs in Neuro-Ophthalmology (Quebec 2024)

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1. Which of the following is true about using “PERRLA” in the pupil exam?*

A - Pupils equal, round, reactive to light and accommodation (PERRLA) is sufficient pupillary exam for neuro-ophthalmology

B - A Horner syndrome is an RAPD

C - PERRLA checks both the ocular sympathetic and parasympathetic pathways equally well

D - PERRLA doesn’t check for an RAPD

2. Which of the following is true about using “PERRLA” in the pupil exam?*

A - Pupils equal, round, reactive to light and accommodation (PERRLA) is a sufficient pupillary exam for neuro-ophthalmology

B - A Horner syndrome can have a PERRLA exam

C - PERRLA checks both the ocular sympathetic and parasympathetic pathways equally well

D - PERRLA checks for an RAPD

3. Which of the following imaging studies is sufficient for evaluating the entire oculosympathetic pathway in the Horner syndrome?*

A - MRI head plus CT chest and contrast MRA neck

B - CT neck plus CT chest with and without contrast

C - MRA head and neck with and without gadolinum

D - MRI head and orbit with gadolinium and fat sat

E - MRI head to thoracic T2 in chest with MRA

4. Which of the following imaging studies is sufficient for evaluating the entire parasympathetic pathway for the pupil?*

A - MRI head plus CT chest and contrast MRA neck

B - CT neck plus CT chest with and without contrast

C - MRA head and neck with and without gadolinum

D - MRI head and orbit with gadolinium and MRA

E - MRI head to thoracic T2 in chest with MRA

5. Which of the following findings is most consistent with a Horner syndrome?*

A - Relative afferent pupillary defect

B - Anisocoria greater in dark

C - Poor light reaction

D - Light near dissociation of pupils

6. Which of the following findings is most consistent with a Horner syndrome?*

A - Relative afferent pupillary defect

B - Dilation lag

C - Poor light reaction

D - Light near dissociation of pupils

7. Which of the following is most complete documentation of the eye motility exam?*

A - Prism cover/uncover test and ductions and versions

B - Documenting EOMI

C - Describing symptoms of diplopia

D - Recording misalignment tropia vs. phoria

8. Which of the following is most complete documentation of the ocular alignment?*

A - Prism cover/uncover test in diagnostic positions of gaze with ductions and versions

B - Documenting extraocular motility with EOMI

C - Describing symptoms of diplopia

D - Recording misalignment tropia vs. phoria

9. Which of the following is the most likely cause of an acute, painless, loss of vision, RAPD and a swollen optic disc in an elderly female?*

A - Arteritic anterior ischemic optic neuropathy

B - Non-arteritic anterior ischemic optic neuropathy

C - Posterior ischemic optic neuropathy

D - Optic neuritis

10. Which of the following is the most likely cause of visual loss in a 60 year old man with pallid disc 11. edema and a cilioretinal artery occlusion OD*

A - Pituitary apoplexy

B - Posterior communicating artery aneurysm

C - Giant cell arteritis

D - NAION

11. Which of the following is a diagnostic feature on OCT for optic disc drusen?*

A - Peripapillary hyperreflective ovoid mass like structure (PHOMS)

B - Hyporeflective core with hyperreflective rim

C - Peripapillary subretinal fluid

D - Bruch’s membrane opening (BMO) and RPE bending anteriorly

12. Which of the following is the eponym for the finding of optic disc edema in one eye and optic atrophy in the contralateral eye from a compressive intracranial lesion?*

A - Foster Kennedy syndrome

B - Argyll Robertson syndrome

C - Horner syndrome

D - Pseudo-Foster Kennedy syndrome

13. Which of the following phakomatoses is associated with giant disc drusen (astrocytoma)?*

A - Neurofibromatosis 1

B - Tuberous sclerosis

C - Von Hippel Lindau

D - Wyburn Mason

14. Which of the following is the next most appropriate step in a patient with severe and acute visual loss and papilledema from IIH?*

A - Oral acetazolamide

B - Surgical intervention (e.g., shunting procedure)

C - Intravenous steroids

D - Serial lumbar punctures

15. Which of the following optic disc abnormalities is associated with optic nerve sheath meningioma?*

A - Nettleship collaterals

B - Prepapillary arteriole loop

C - Optociliary shunt vessels

D - Neovascularization of disc

16. Which of the following optic disc lesions is associated with basal encephalocoele?*

A - Morning glory disc

B - Prepapillary loop

C - Optociliary shunt vessel

D - Optic disc drusen

17. Which of the following is the most likely phakomatosis in a patient with optic disc head hemangioma?*

A - Von Hippel Lindau

B - Neurofibromatosis 1

C - Tuberous sclerosis

D - Wyburn Mason

18. Which of the following is the most likely cause for optic disc edema with a macular star figure?*

A - B. henselae

B - Staph aureus

C - Strep pneumo

D - H. influenza

19. Which of the following is the most likely phakomatosis in a patient with a retinal AVM?*

A - Von Hippel Lindau

B - Wyburn Mason

C - Neurofibromatosis 1

D - Tuberous sclerosis

20. Which of the following is the neuroimaging is the study of choice for papilledema?*

A - CT head

B - CTA neck

C - MRI with MRV

D - MRA

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