Test 12  (neuro-ophthalmology) 

1. The following are true about neuroretinitis caused by cat-scratch 
    fever:

a. the pathogen is Bartonella henselae

b. the disease is usually acquired from cat under one year 
    of age 

c. skin test is commonly used to diagnose the condition

d. lymphadenopathy is common

e. low-grade fever is usually present

Answera.T   b.T  c.F  d.T e.T
Cat-scratch fever is one of the recognized causes of 
neuroretinitis. It is a zoonotic infection with B henselae 
and the main reservoir is in kittens and cat under one year of age.
Lymphadenopathy and low-grade fever are common.
Skin test is now rarely used being superseded by PCR and serological tests.

2. Neuroretinitis from cat-scratch fever:

a. shows optic nerve swelling

b. macular star is typical

c. the vision usually returns to normal even without
    treatment

d. antibiotics shorten the course of the disease

e. is usually bilateral

Answera.T   b.T   c.T   d.T  e.F
Neuroretinitis is characterized by macular star, optic 
nerve swelling and mild vitritis.
Neuroretinitis from cat-scratch fever is usually unilateral.
The disease is self-limiting and the vision usually returns to normal even without treatment.
Although the organism is sensitive to several antibiotics 
such as rifampicin and ciprofloxacin, the benefit of 
antibiotics in immunocompetent patients have not been fully established. 
 

3. The following are true about cat-scratch fever:

a. it is caused by a Gram positive bacillus

b. caseating granulomas are seen in lymph node

c. in patients who develop neuroretinitis, visual loss
    is typically preceded by systemic illness

d. it is a cause of Parinaud's oculoglandular fever

e. an aching neck with cough or movement is common

Answera.F   b.T  c.F  d.T  e.T
B. henselae is a Gram negative bacillus.
Fever, cervical lymphadenopathy are common in cat-scratch fever. 
Patients who develop neuroretinitis usually have 
a history of systemic illness preceding the visual
loss. This illness include lymphadenopathy, follicular conjunctivitis and meningismus.

4. Cecocentral scotoma occurs in:

a. vitamin A deficiency

b. vitamin B12 deficiency

c. folate deficiency

d. thiamine deficiency

e. vitamin E deficiency

Answera.F  b.T  c.T  d.T  e.F
Cecocentral scotoma occurs in nutritional optic 
neuropathy and is seen in vitamin B12, thiamine 
and folate deficiency and also in tobacco-alcohol amblyopia.

5. The following are features of nutritional optic neuropathy:

a. temporal pallor of the optic discs

b. relative afferent pupillary defect

c. constricted visual fields

d. loss of the fibres in the papillomacular bundle.

e. colour vision loss

Answera.T   b.F  c.F   d.T  e.T
The optic neuropathy is symmetrical and therefore relative afferent pupillary defect is uncommon.
The typical visual field is Cecocentral scotoma.

 
 

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