Test 14  (neuro-ophthalmology) 

1. The following signs and symptoms are useful for differentiating 
    between papilloedema and optic neuritis:

a. central scotoma.

b. decreased visual acuity

c. optic disc swelling

d. history of recurrent transient arm weakness

e. pain behind eye

Answera.T   b.T  c.F  d.T e.T
Optic disc swellings can occur in both papilloedema and optic nerve neuritis.
Decreased visual acuity, central scotoma, pain behind eye and history of recurrent transient arm weakness are suggestive of optic neuritis.

2. In a patient with optic neuritis, the following signs are suggestive of
    multiple sclerosis:

a. muscle weakness after taking a hot bath

b. difficulty in walking heel to toe

c. urine incontinence

d. wasting of small muscles of the head

e. nystagmus

Answera.T   b.T   c.T   d.F  e.T
Multiple sclerosis involves the central nervous system. Wasting of the muscle is a feature of  peripheral neuropathy.
Delayed nerve conduction occurs in multiple sclerosis 
with raised temperature and can give rise to muscle weakness and increased central scotoma.
Difficulty in walking heel to toe is a feature of cerebellar sign as is nystagmus.
Urine incontinence and problem with micturition are seen in multiple sclerosis.

3. Syringobulbia causes:

a. nystagmus

b. dysphagia

c. tongue wasting

d. bilateral Babinski's signs

e. impaired perception of pain and temperature with 
    preserved light touch and propioception in the upper 
    extremities

Answera.T   b.T  c.T  d.T  e.T
Syringobulbia and syringomyelia are slowly progressive 
enlargement of a fluid filled cyst "syrinx" within the cord or medulla oblongata.
This results in damages to anterior horn cells, crossing 
of spinothalamic tract fibres and lateral corticospinal tract at  the cervical and thoracic levels.

4. In a patient with optic atrophy, the following signs are useful in 
    differentiating subacute combined degeneration of the cord from 
    multiple sclerosis:

a. absent ankle jerk

b. bilateral Babinski signs

c. sensory loss in a stocking distribution

d. macrocytic anaemia

e. ataxia

Answera.T   b.F  c.T   d.T  e.F
Subacute combined degeneration of the cord (SCDC) is caused by vitamin B12 and / or folate deficiency. 
Therefore, macrocytic anaemia is common. SCDC also causes peripheral neuropathy resulting in sensory loss in a stocking distribution and absent knee jerks.
Ataxia and upgoing toes (Babinski's signs) are seen in both conditions.

5. In a patient with ptosis and diplopia, the following findings 
    are suggestive of myasthenia gravis :

a. symmetrical involvement

b. thymoma on CT chest scan

c. increased serum creatinine phosphokinase 

d. improved lid movement after applying ice cube 
    to the lid

e. absent tendon reflexes

Answera.F   b.T  c.F   d.T  e.F
Involvement of the lids and extraocular muscles are 
typically asymmetrical in myasthenia gravis. Symmetrical 
involvement suggests chronic progressive external ophthalmoplegia.
Tendon reflexes are preserved.
Creatinine phosphokinase is normal.

 
 

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