front 1 Which muscle group moves the eyes within the orbits? A. Internal ocular muscles | back 1 C. Extraocular muscles |
front 2 Internal ocular muscles primarily control: A. Eyelid elevation and closure | back 2 B. Pupillary size and accommodation |
front 3 Nuclear/infranuclear ocular motor pathways include: A. Cortex, thalamus, cerebellum | back 3 D. Nuclei, nerves, and muscles |
front 4 Supranuclear ocular motor pathways include: A. Peripheral nerves and muscles | back 4 B. Brainstem and forebrain circuits |
front 5 Both nuclear/infranuclear and supranuclear ocular pathways ultimately involve brainstem nuclei of: A. II, III, and IV | back 5 B. III, IV, and VI |
front 6 The lateral, superior, medial, and inferior rectus muscles insert onto the: A. Cornea | back 6 D. Sclera |
front 7 Which of the following best describes the anatomical path (origin, pulley, and insertion) of the superior oblique muscle? A. Originates from the body of the sphenoid, passes through the trochlea, and inserts on the superior-lateral globe. B. Originates from the body of the sphenoid, passes through the annulus of Zinn, and inserts on the inferior globe. C. Originates from the medial orbital wall, passes through the trochlea, and inserts on the superior globe. D. Originates from the maxilla, passes through the annulus of Zinn, and inserts on the lateral globe. | back 7 A. Originates from the body of the sphenoid, passes through the trochlea, and inserts on the superior-lateral globe. |
front 8 Intorsion is: A. Downward movement of the eye | back 8 C. Upper pole moves inward |
front 9 Extorsion is: A. Medial rotation of lower pole | back 9 B. Upper pole moves outward |
front 10 Which of the following best describes the anatomical origin and insertion of the inferior oblique muscle? A. Originates from the anterior medial orbital floor (maxilla) and inserts on the inferolateral globe. B. Originates from the orbital apex (annulus of Zinn) and inserts on the inferior sclera. C. Originates from the sphenoid bone, passes through the trochlea, and inserts inferiorly. D. Originates from the common tendinous ring and inserts on the superior globe. | back 10 A. Originates from the anterior medial orbital floor (maxilla) and inserts on the inferolateral globe. |
front 11 Abduction (lateral) movement of eye | back 11 Lateral rectus |
front 12 Adduction (medial) movement of eye | back 12 Medial rectus |
front 13 Elevation and intorsion | back 13 Superior rectus |
front 14 Depression and extorsion | back 14 Inferior rectus |
front 15 Elevation and extorsion | back 15 Inferior oblique |
front 16 Depression and intorsion | back 16 Superior oblique |
front 17 Levator palpebrae superioris primarily: A. Elevates the eyelid | back 17 A. Elevates the eyelid |
front 18 The ciliary muscle primarily: A. Abducts the globe | back 18 C. Adjusts lens thickness |
front 19 CN III, IV, and VI pass through the _____ and enter the orbit via the _____. A. Optic canal; orbital apex | back 19 D. Cavernous sinus; superior orbital fissure |
front 20 The superior division of the oculomotor nerve innervates the: A. Medial rectus and inferior rectus | back 20 B. Levator and superior rectus |
front 21 The inferior division of the oculomotor nerve supplies the: A. Medial rectus, inferior rectus, inferior oblique | back 21 A. Medial rectus, inferior rectus, inferior oblique |
front 22 The inferior division of CN III carries which fibers to which targets? A. Motor fibers to lateral rectus | back 22 C. Preganglionic parasympathetics to pupil and ciliary muscle |
front 23 The Edinger-Westphal nucleus contains: A. Branchial motor neurons | back 23 B. Preganglionic parasympathetic neurons |
front 24 Parasympathetic fibers from the Edinger–Westphal nucleus are especially vulnerable to aneurysms of the: A. Posterior communicating artery | back 24 A. Posterior communicating artery |
front 25 A painful oculomotor palsy with pupillary involvement should raise greatest concern for: A. Cavernous sinus thrombosis | back 25 C. Posterior communicating aneurysm |
front 26 Can unilateral weakness of levator palpebrae superioris and pupillary dilator muscles be caused by a single unilateral lesion? A. Yes, usually | back 26 D. No |
front 27 The trochlear nuclei lie at the level of the: A. Superior colliculi and red nucleus | back 27 B. Inferior colliculi and SCP decussation |
front 28 Which cranial nerve exits the brainstem dorsally and has crossed fibers? A. Oculomotor nerve | back 28 C. Trochlear nerve |
front 29 Trochlear nerves are particularly susceptible to compression from: A. Cerebellar tumors | back 29 A. Cerebellar tumors |
front 30 The abducens nerve exits the dura and enters: A. Meckel’s cave | back 30 D. Dorello’s canal |
front 31 The abducens nerve is especially susceptible to injury from: A. Lateral brain shift and high ICP | back 31 B. Downward traction and high ICP |
front 32 From distal to proximal, causes of diplopia include fracture, then: A. NMJ, muscles, CN palsies | back 32 C. Muscles, NMJ, CN palsies |
front 33 Injury to an extraocular muscle most directly causes: A. Dysconjugate gaze | back 33 A. Dysconjugate gaze |
front 34 Abnormal lateral deviation of one eye is called: A. Esotropia | back 34 D. Exotropia |
front 35 Abnormal medial deviation of one eye is called: A. Exotropia | back 35 B. Esotropia |
front 36 Vertical deviation of one eye is called: A. Esotropia | back 36 C. Hypertropia |
front 37 A penlight shone at both eyes shows asymmetric corneal reflections. This suggests: A. Subtle dysconjugate gaze | back 37 A. Subtle dysconjugate gaze |
front 38 A mild latent weakness revealed only when one eye is covered is called: A. Exotropia | back 38 D. Phoria |
front 39 Amblyopia is: A. Vertical misalignment | back 39 B. Decreased vision in one eye |
front 40 With a complete CN III palsy, the eye can still perform: A. Abduction, depression, intorsion | back 40 A. Abduction, depression, intorsion |
front 41 Injury to the oculomotor nerve causes _____ of the pupil. A. Constriction | back 41 D. Dilation |
front 42 Diplopia that is worse when looking at near objects rather than far objects suggests: A. Trochlear palsy | back 42 B. Oculomotor palsy |
front 43 Diagonal diplopia that worsens when looking up and medially is most consistent with: A. Abducens palsy | back 43 C. Oculomotor palsy |
front 44 Herniation of the medial temporal lobe over the tentorium cerebelli can compress the: A. Oculomotor nerve | back 44 A. Oculomotor nerve |
front 45 In all suspected cases of oculomotor nerve palsy, which studies should be ordered? A. EEG and lumbar puncture | back 45 D. CTA and MRA |
front 46 Aneurysmal oculomotor palsy classically involves the: A. Corneal reflex | back 46 B. Pupil |
front 47 Pupil-sparing oculomotor palsy is most likely caused by: A. Uncal herniation | back 47 C. Diabetes or microvascular neuropathy |
front 48 A patient has ptosis, a “down and out” eye, and a dilated pupil. The most concerning cause is: A. Posterior communicating aneurysm | back 48 A. Posterior communicating aneurysm |
front 49 Horizontal diplopia after elevated intracranial pressure most likely reflects injury to: A. Trochlear nerve | back 49 D. Abducens nerve |
front 50 The oculomotor nuclei are located at the level of the: A. Superior colliculi and red nuclei | back 50 A. Superior colliculi and red nuclei |
front 51 Relative to the cerebral aqueduct, the oculomotor nuclei lie: A. Dorsal to tectum | back 51 C. Ventral to periaqueductal gray |
front 52 The abducens nuclei lie: A. In the rostral midbrain | back 52 D. On the floor of the fourth ventricle |
front 53 The abducens nuclei are located in the: A. Upper/mid pons | back 53 B. Mid/lower pons |
front 54 The dorsal subnuclei of the oculomotor nucleus innervate the: A. Ipsilateral Medial rectus | back 54 B. Ipsilateral Inferior rectus |
front 55 The intermediate subnuclei of the oculomotor nucleus innervate the ipsilateral: A. Ipsilateral Medial oblique | back 55 B. Ipsilateral Inferior oblique |
front 56 The ventral subnuclei of the oculomotor nucleus innervate the: A. Ipsilateral Medial rectus | back 56 A. Ipsilateral Medial rectus |
front 57 The Edinger-Westphal subnucleus innervates the pupillary constrictors and ciliary muscles on the: A. Ipsilateral side | back 57 B. Bilateral sides |
front 58 The central caudal subnucleus supplies the levator palpebrae superioris: A. Bilaterally | back 58 A. Bilaterally |
front 59 A nuclear lesion affecting the medial subnucleus would most directly weaken the: A. Ipsilateral superior rectus | back 59 D. Contralateral superior rectus |
front 60 Which is a supranuclear cause of diplopia? A. Orbital fracture | back 60 C. Internuclear ophthalmoplegia |
front 61 Which is also listed as a supranuclear cause of diplopia? A. Skew deviation | back 61 A. Skew deviation |
front 62 Which additional category is included among supranuclear causes of diplopia in this material? A. Neuromuscular junction disease | back 62 B. Ingestion of toxins |
front 63 In mild dysconjugate gaze, patients may have only: A. Complete ophthalmoplegia | back 63 D. Visual blurring |
front 64 Monocular diplopia or polyopia is not caused by: A. Ophthalmologic disease | back 64 C. Eye movement abnormalities |
front 65 In oculomotor nerve palsy, the eye typically rests in a: A. Down and out position | back 65 A. Down and out position |
front 66 Complete ptosis requiring manual lid elevation is most suggestive of: A. Trochlear palsy | back 66 C. Oculomotor palsy |
front 67 del | back 67 del |
front 68 Trochlear nerve palsy produces vertical diplopia because of loss of: A. Elevation and extorsion | back 68 D. Depression and intorsion |
front 69 A patient improves diplopia by looking up and tilting the head away from the affected eye. This pattern suggests: A. Oculomotor palsy | back 69 B. Trochlear palsy |
front 70 Vertical diplopia in trochlear nerve palsy is usually worst when the eye looks: A. Downward and nasally | back 70 A. Downward and nasally |
front 71 Which finding supports trochlear nerve palsy? A. Affected eye has esotropia | back 71 C. Affected eye has hypertropia |
front 72 A patient sees two pen lines, with the lower line tilted, and has had a subtle compensatory head tilt since childhood but diplopia in adulthood. The best diagnosis is: A. Acute abducens palsy | back 72 D. Congenital trochlear palsy |
front 73 Vertical disparity of the eyes due to a supranuclear lesion is called: A. Esotropia | back 73 B. Skew deviation |
front 74 Skew deviation can result from lesions in the: A. Cerebellum, brainstem, or inner ear | back 74 A. Cerebellum, brainstem, or inner ear |
front 75 Lesions of the abducens nerve classically produce: A. Vertical diplopia | back 75 C. Horizontal diplopia |
front 76 Diplopia that improves at near but worsens at distance most strongly suggests: A. Oculomotor palsy | back 76 C. Abducens palsy |
front 77 Diplopia that worsens when the affected eye abducts is most consistent with: A. Trochlear palsy | back 77 B. Abducens palsy |
front 78 The abducens nerve is especially vulnerable to: A. Downward traction from elevated ICP | back 78 A. Downward traction from elevated ICP |
front 79 A pontine infarct affecting abducens pathways most likely causes: A. Contralateral adduction weakness | back 79 C. Ipsilateral abduction weakness |
front 80 A lesion of the abducens nucleus may also produce facial weakness because of nearby involvement of: A. CN V nucleus | back 80 B. CN VII nucleus |
front 81 Light entering one eye activates retinal ganglion cells that project to: A. The ipsilateral optic tract | back 81 C. Both optic tracts |
front 82 The pupillary light reflex travels centrally in the _____ pathway through the _____ of the superior colliculus. A. Geniculocalcarine; tectum | back 82 B. Extrageniculate; brachium |
front 83 The pupillary light reflex reaches the: A. Pretectal area | back 83 A. Pretectal area |
front 84 Relative to the oculomotor nuclei, the Edinger-Westphal nuclei lie: A. Ventral and posterior | back 84 C. Dorsal and anterior |
front 85 Which list gives all three components of accommodation? A. Dilation, divergence, blinking | back 85 B. Constriction, lens accommodation, convergence |
front 86 The accommodation response is initiated by visual signals relayed to the: A. Pretectal area | back 86 C. Visual cortex |
front 87 The descending sympathetic pathway for pupillary dilation activates preganglionic neurons in the: A. Dorsal horn | back 87 C. Intermediolateral column |
front 88 Preganglionic sympathetic fibers reach the paravertebral chain through the: A. Gray rami communicantes | back 88 B. White rami communicantes |
front 89 Postganglionic sympathetic fibers to the pupillary dilator arise from the: A. Ciliary ganglion | back 89 D. Superior cervical ganglion |
front 90 Postganglionic sympathetic fibers ascend to the cavernous sinus and then innervate the: A. Pupillary constrictor muscle | back 90 C. Pupillary dilator muscle |
front 91 The sympathetic pathway also innervates Müller’s muscle, which: A. Constricts the pupil | back 91 B. Elevates the upper eyelid |
front 92 Asymmetry of pupil size is called: A. Anisocoria | back 92 A. Anisocoria |
front 93 Injury to the Edinger-Westphal nuclei can cause a: A. Bilaterally constricted pupil | back 93 B. Unilaterally dilated pupil |
front 94 Ptosis in Horner syndrome is due to denervation of: A. Levator palpebrae superioris | back 94 C. Müller’s muscle |
front 95 Miosis in Horner syndrome is caused by loss of sympathetic input to the: A. Pupillary constrictor | back 95 B. Pupillary dilator |
front 96 Anisocoria that is more obvious in the dark suggests: A. Oculomotor lesion | back 96 C. Horner syndrome |
front 97 Pupillary dilation after hydroxyamphetamine drops indicates a: A. Postganglionic lesion | back 97 B. Preganglionic lesion |
front 98 The absence of anhidrosis favors a _____ sympathetic lesion. A. Central | back 98 D. Postganglionic |
front 99 Bilateral small but light-reactive pupils are most consistent with lesions of the: A. Midbrain | back 99 B. Pons |
front 100 An absent direct response with a normal consensual response is characteristic of: A. Horner syndrome | back 100 C. Marcus Gunn pupils |
front 101 Marcus Gunn pupils result from injury to the: A. Optic nerve, retina, or eye | back 101 A. Optic nerve, retina, or eye |
front 102 A lesion at or behind the optic chiasm would produce Marcus Gunn pupils: A. Always | back 102 D. Never |
front 103 The best bedside test for Marcus Gunn pupils is the: A. Doll’s eye test | back 103 B. Swinging flashlight test |
front 104 During the swinging flashlight test, paradoxical dilation every few seconds suggests: A. Horner syndrome | back 104 C. Marcus Gunn pupils |
front 105 A patient with optic neuritis has a relative afferent pupillary defect. Can optic nerve or retinal disease itself explain anisocoria? A. Yes, commonly | back 105 D. No |
front 106 Benign anisocoria is usually defined by a pupil asymmetry of: A. Less than 0.6 mm | back 106 A. Less than 0.6 mm |
front 107 A patient found unresponsive has bilateral pinpoint pupils. Which intoxication is most likely? A. Anticholinergics | back 107 C. Opiates |
front 108 Barbiturate overdose classically causes: A. Bilateral fixed dilated pupils | back 108 B. Bilateral small pupils |
front 109 A dilated pupil constricts with 1% pilocarpine. This finding supports: A. Muscarinic blockade | back 109 D. Parasympathetic lesion |
front 110 The classic light-near dissociation pupil associated with neurosyphilis is the: A. Argyll Robertson pupil | back 110 A. Argyll Robertson pupil |
front 111 Degeneration of the ciliary ganglion or postganglionic parasympathetic neurons causes a mid-dilated pupil known as: A. Argyll Robertson pupil | back 111 B. Adie myotonic pupil |
front 112 A pupil that is irregular and off-center suggests the rare disorder: A. Adie myotonic pupil | back 112 C. Midbrain corectopia |
front 113 Opening of the eye is mediated primarily by: A. Levator and Müller muscles | back 113 A. Levator and Müller muscles |
front 114 Eye closure is produced by the _____ muscle innervated by _____. A. Levator palpebrae; CN III | back 114 D. Orbicularis oculi; CN VII |
front 115 Mild ptosis is most suggestive of: A. Myasthenia gravis | back 115 B. Horner syndrome |
front 116 Ptosis that worsens with sustained upgaze most strongly suggests: A. Horner syndrome | back 116 B. Oculomotor lesion |
front 117 Bilateral ptosis without loss of consciousness suggests a dorsal lesion affecting the: A. Central caudal nucleus | back 117 A. Central caudal nucleus |
front 118 The cavernous sinus lies between the _____ and _____ layers of dura. A. Arachnoid and meningeal | back 118 B. Periosteal and dural |
front 119 Within the cavernous sinus, the nerve closest to the carotid siphon is the: A. Oculomotor nerve | back 119 C. Abducens nerve |
front 120 The orbital apex is the region where orbital _____ converge. A. Nerves, arteries, and veins | back 120 A. Nerves, arteries, and veins |
front 121 Cavernous sinus syndrome classically disrupts: A. CN II, III, IV | back 121 D. CN III, IV, VI |
front 122 The first nerve typically affected by a cavernous carotid aneurysm is the: A. Oculomotor nerve | back 122 C. Abducens nerve |
front 123 Supranuclear output from CN III, IV, and VI systems generates which eye movements? A. Horizontal, vertical, vergence | back 123 A. Horizontal, vertical, vergence |
front 124 Stable viewing of a moving target is mediated by: A. Vergence | back 124 D. Smooth pursuit |
front 125 The oculomotor and trochlear nuclei are in the _____, whereas the abducens nucleus is in the _____. A. Pons; medulla | back 125 C. Midbrain; pons |
front 126 The tract interconnecting eye movement nuclei with vestibular nuclei is the: A. Medial longitudinal fasciculus | back 126 A. Medial longitudinal fasciculus |
front 127 A dilated pupil fails to constrict after 1% pilocarpine. This most strongly suggests: A. Preganglionic parasympathetic lesion | back 127 B. Muscarinic blockade |
front 128 _____ are rapid eye movements reaching velocities of up to 700° per second | back 128 Saccades |
front 129 _____ eye movements maintain fused fixation by both eyes as targets move toward or away from the viewer | back 129 Vergence |
front 130 _____ is a rhythmic form of reflex eye movements composed of slow eye movements in one direction interrupted repeatedly by fast, saccade-like eye movements in the opposite direction. | back 130 Nystagmus |