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Neuro 13

front 1

Which muscle group moves the eyes within the orbits?

A. Internal ocular muscles
B. Ciliary body muscles
C. Extraocular muscles
D. Pupillary sphincter muscles

back 1

C. Extraocular muscles

front 2

Internal ocular muscles primarily control:

A. Eyelid elevation and closure
B. Pupillary size and accommodation
C. Globe movement within orbit
D. Lacrimal secretion and blinking

back 2

B. Pupillary size and accommodation

front 3

Nuclear/infranuclear ocular motor pathways include:

A. Cortex, thalamus, cerebellum
B. Retina, LGN, visual cortex
C. Forebrain circuits, LGN, visual cortex
D. Nuclei, nerves, and muscles

back 3

D. Nuclei, nerves, and muscles

front 4

Supranuclear ocular motor pathways include:

A. Peripheral nerves and muscles
B. Brainstem and forebrain circuits
C. Retina and thalamus only
D. Orbit and extraocular fascia

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
B. III, IV, and VI
C. III, V, and VII
D. IV, V, and VI

back 5

B. III, IV, and VI

front 6

The lateral, superior, medial, and inferior rectus muscles insert onto the:

A. Cornea
B. Lens capsule
C. Tarsal plate
D. Sclera

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
B. Nasal deviation of the globe
C. Upper pole moves inward
D. Upper pole moves outward

back 8

C. Upper pole moves inward

front 9

Extorsion is:

A. Medial rotation of lower pole
B. Upper pole moves outward
C. Lateral translation of globe
D. Downward movement in abduction

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
B. Constricts the pupil
C. Abducts the eye
D. Accommodates the lens

back 17

A. Elevates the eyelid

front 18

The ciliary muscle primarily:

A. Abducts the globe
B. Elevates the eyelid
C. Adjusts lens thickness
D. Constricts the palpebral fissure

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
B. Jugular foramen; optic canal
C. Foramen rotundum; fissure
D. Cavernous sinus; superior orbital fissure

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
B. Levator and superior rectus
C. Inferior oblique and levator
D. Superior rectus and medial 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
B. Superior rectus, inferior rectus, inferior oblique
C. Lateral rectus and inferior rectus
D. Superior oblique and medial rectus

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
B. Sensory fibers to cornea
C. Preganglionic parasympathetics to pupil and ciliary muscle
D. Postganglionic sympathetics to iris dilator

back 22

C. Preganglionic parasympathetics to pupil and ciliary muscle

front 23

The Edinger-Westphal nucleus contains:

A. Branchial motor neurons
B. Preganglionic parasympathetic neurons
C. General sensory neurons
D. Somatic sensory 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
B. Anterior cerebral artery
C. Superior cerebellar artery
D. Middle cerebral 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
B. Diabetic neuropathy
C. Posterior communicating aneurysm
D. Myasthenia gravis

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
B. Yes, always
C. Sometimes
D. No

back 26

D. No

front 27

The trochlear nuclei lie at the level of the:

A. Superior colliculi and red nucleus
B. Inferior colliculi and SCP decussation
C. Facial colliculi and MLF
D. Obex and pyramidal decussation

back 27

B. Inferior colliculi and SCP decussation

front 28

Which cranial nerve exits the brainstem dorsally and has crossed fibers?

A. Oculomotor nerve
B. Abducens nerve
C. Trochlear nerve
D. Trigeminal nerve

back 28

C. Trochlear nerve

front 29

Trochlear nerves are particularly susceptible to compression from:

A. Cerebellar tumors
B. Pituitary adenomas
C. ICA aneurysms
D. Vestibular schwannomas

back 29

A. Cerebellar tumors

front 30

The abducens nerve exits the dura and enters:

A. Meckel’s cave
B. Internal auditory meatus
C. Cavernous sinus
D. Dorello’s canal

back 30

D. Dorello’s canal

front 31

The abducens nerve is especially susceptible to injury from:

A. Lateral brain shift and high ICP
B. Downward traction and high ICP
C. Basilar thrombosis and low ICP
D. Optic nerve edema and low 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
B. CN palsies, muscles, NMJ
C. Muscles, NMJ, CN palsies
D. CN palsies, NMJ, muscles

back 32

C. Muscles, NMJ, CN palsies

front 33

Injury to an extraocular muscle most directly causes:

A. Dysconjugate gaze
B. Monocular blindness
C. Miosis
D. Visual field loss

back 33

A. Dysconjugate gaze

front 34

Abnormal lateral deviation of one eye is called:

A. Esotropia
B. Hypertropia
C. Phoria
D. Exotropia

back 34

D. Exotropia

front 35

Abnormal medial deviation of one eye is called:

A. Exotropia
B. Esotropia
C. Hypertropia
D. Amblyopia

back 35

B. Esotropia

front 36

Vertical deviation of one eye is called:

A. Esotropia
B. Exotropia
C. Hypertropia
D. Phoria

back 36

C. Hypertropia

front 37

A penlight shone at both eyes shows asymmetric corneal reflections. This suggests:

A. Subtle dysconjugate gaze
B. Papilledema
C. Afferent pupillary defect
D. Monocular blindness

back 37

A. Subtle dysconjugate gaze

front 38

A mild latent weakness revealed only when one eye is covered is called:

A. Exotropia
B. Hypertropia
C. Amblyopia
D. Phoria

back 38

D. Phoria

front 39

Amblyopia is:

A. Vertical misalignment
B. Decreased vision in one eye
C. Latent ocular drift
D. Diplopia on lateral gaze

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
B. Adduction, elevation, extorsion
C. Abduction, elevation, extorsion
D. Adduction, depression, intorsion

back 40

A. Abduction, depression, intorsion

front 41

Injury to the oculomotor nerve causes _____ of the pupil.

A. Constriction
B. Hippus
C. Normal size
D. Dilation

back 41

D. Dilation

front 42

Diplopia that is worse when looking at near objects rather than far objects suggests:

A. Trochlear palsy
B. Oculomotor palsy
C. Abducens palsy
D. Vestibular dysfunction

back 42

B. Oculomotor palsy

front 43

Diagonal diplopia that worsens when looking up and medially is most consistent with:

A. Abducens palsy
B. Trochlear palsy
C. Oculomotor palsy
D. Horner syndrome

back 43

C. Oculomotor palsy

front 44

Herniation of the medial temporal lobe over the tentorium cerebelli can compress the:

A. Oculomotor nerve
B. Optic tract
C. Trochlear nerve
D. Trigeminal 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
B. EMG and NCS
C. CT perfusion and PET
D. CTA and MRA

back 45

D. CTA and MRA

front 46

Aneurysmal oculomotor palsy classically involves the:

A. Corneal reflex
B. Pupil
C. Facial sensation
D. Visual field

back 46

B. Pupil

front 47

Pupil-sparing oculomotor palsy is most likely caused by:

A. Uncal herniation
B. Cavernous sinus tumor
C. Diabetes or microvascular neuropathy
D. Posterior communicating aneurysm

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
B. Thyroid eye disease
C. Orbital floor fracture
D. Myasthenia gravis

back 48

A. Posterior communicating aneurysm

front 49

Horizontal diplopia after elevated intracranial pressure most likely reflects injury to:

A. Trochlear nerve
B. Oculomotor nerve
C. Optic nerve
D. Abducens nerve

back 49

D. Abducens nerve

front 50

The oculomotor nuclei are located at the level of the:

A. Superior colliculi and red nuclei
B. Inferior colliculi and SCP decussation
C. Facial colliculi and vestibular nuclei
D. Obex and pyramidal decussation

back 50

A. Superior colliculi and red nuclei

front 51

Relative to the cerebral aqueduct, the oculomotor nuclei lie:

A. Dorsal to tectum
B. Lateral to crus cerebri
C. Ventral to periaqueductal gray
D. Within the red nucleus

back 51

C. Ventral to periaqueductal gray

front 52

The abducens nuclei lie:

A. In the rostral midbrain
B. In the upper medulla
C. In the lateral tegmentum
D. On the floor of the fourth ventricle

back 52

D. On the floor of the fourth ventricle

front 53

The abducens nuclei are located in the:

A. Upper/mid pons
B. Mid/lower pons
C. Upper medulla
D. Cervicomedullary junction

back 53

B. Mid/lower pons

front 54

The dorsal subnuclei of the oculomotor nucleus innervate the:

A. Ipsilateral Medial rectus
B. Ipsilateral Inferior rectus
C. Contralateral Inferior rectus
D. Contralateral Medial rectus

back 54

B. Ipsilateral Inferior rectus

front 55

The intermediate subnuclei of the oculomotor nucleus innervate the ipsilateral:

A. Ipsilateral Medial oblique
B. Ipsilateral Inferior oblique
C. Contralateral Inferior oblique
D. Contralateral Medial oblique

back 55

B. Ipsilateral Inferior oblique

front 56

The ventral subnuclei of the oculomotor nucleus innervate the:

A. Ipsilateral Medial rectus
B. Ipsilateral Inferior rectus
C. Contralateral Inferior rectus
D. Contralateral 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
B. Bilateral sides
C. Contralateral side
D. Side of gaze only

back 57

B. Bilateral sides

front 58

The central caudal subnucleus supplies the levator palpebrae superioris:

A. Bilaterally
B. Ipsilaterally
C. Contralaterally
D. With no decussation

back 58

A. Bilaterally

front 59

A nuclear lesion affecting the medial subnucleus would most directly weaken the:

A. Ipsilateral superior rectus
B. Bilateral superior recti
C. Ipsilateral medial rectus
D. Contralateral superior rectus

back 59

D. Contralateral superior rectus

front 60

Which is a supranuclear cause of diplopia?

A. Orbital fracture
B. Oculomotor palsy
C. Internuclear ophthalmoplegia
D. Myasthenia gravis

back 60

C. Internuclear ophthalmoplegia

front 61

Which is also listed as a supranuclear cause of diplopia?

A. Skew deviation
B. Superior oblique myositis
C. Cavernous sinus lesion
D. Thyroid eye disease

back 61

A. Skew deviation

front 62

Which additional category is included among supranuclear causes of diplopia in this material?

A. Neuromuscular junction disease
B. Ingestion of toxins
C. Orbital pseudotumor
D. Ocular trauma

back 62

B. Ingestion of toxins

front 63

In mild dysconjugate gaze, patients may have only:

A. Complete ophthalmoplegia
B. Monocular blindness
C. Polyopia
D. Visual blurring

back 63

D. Visual blurring

front 64

Monocular diplopia or polyopia is not caused by:

A. Ophthalmologic disease
B. Visual cortex disorders
C. Eye movement abnormalities
D. Psychiatric conditions

back 64

C. Eye movement abnormalities

front 65

In oculomotor nerve palsy, the eye typically rests in a:

A. Down and out position
B. Up and out position
C. Down and in position
D. Midline fixed position

back 65

A. Down and out position

front 66

Complete ptosis requiring manual lid elevation is most suggestive of:

A. Trochlear palsy
B. Horner syndrome
C. Oculomotor palsy
D. Abducens 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
B. Adduction and elevation
C. Depression and extorsion
D. Depression and intorsion

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
B. Trochlear palsy
C. Abducens palsy
D. Internuclear ophthalmoplegia

back 69

B. Trochlear palsy

front 70

Vertical diplopia in trochlear nerve palsy is usually worst when the eye looks:

A. Downward and nasally
B. Upward and temporally
C. Straight ahead only
D. Laterally and upward

back 70

A. Downward and nasally

front 71

Which finding supports trochlear nerve palsy?

A. Affected eye has esotropia
B. Diplopia improves on downgaze
C. Affected eye has hypertropia
D. Head tilt toward lesion helps

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
B. Myasthenia gravis
C. Oculomotor fascicular lesion
D. Congenital trochlear palsy

back 72

D. Congenital trochlear palsy

front 73

Vertical disparity of the eyes due to a supranuclear lesion is called:

A. Esotropia
B. Skew deviation
C. Exotropia
D. Phoria

back 73

B. Skew deviation

front 74

Skew deviation can result from lesions in the:

A. Cerebellum, brainstem, or inner ear
B. Orbit, retina, or lens
C. Cortex, chiasm, or tract
D. Pons, cord, or cortex

back 74

A. Cerebellum, brainstem, or inner ear

front 75

Lesions of the abducens nerve classically produce:

A. Vertical diplopia
B. Monocular diplopia
C. Horizontal diplopia
D. Torsional diplopia

back 75

C. Horizontal diplopia

front 76

Diplopia that improves at near but worsens at distance most strongly suggests:

A. Oculomotor palsy
B. Trochlear palsy
C. Abducens palsy
D. Horner syndrome

back 76

C. Abducens palsy

front 77

Diplopia that worsens when the affected eye abducts is most consistent with:

A. Trochlear palsy
B. Abducens palsy
C. Oculomotor palsy
D. Skew deviation

back 77

B. Abducens palsy

front 78

The abducens nerve is especially vulnerable to:

A. Downward traction from elevated ICP
B. Medial traction from aneurysm
C. Upward herniation from edema
D. Lateral stretch from trauma

back 78

A. Downward traction from elevated ICP

front 79

A pontine infarct affecting abducens pathways most likely causes:

A. Contralateral adduction weakness
B. Bilateral ptosis
C. Ipsilateral abduction weakness
D. Contralateral vertical diplopia

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
B. CN VII nucleus
C. CN IX nucleus
D. CN XII 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
B. The contralateral optic tract
C. Both optic tracts
D. The lateral geniculate only

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
B. Extrageniculate; brachium
C. Retinogeniculate; crus
D. Spinothalamic; tegmentum

back 82

B. Extrageniculate; brachium

front 83

The pupillary light reflex reaches the:

A. Pretectal area
B. Lateral geniculate body
C. Superior salivatory nucleus
D. Solitary nucleus

back 83

A. Pretectal area

front 84

Relative to the oculomotor nuclei, the Edinger-Westphal nuclei lie:

A. Ventral and posterior
B. Lateral and inferior
C. Dorsal and anterior
D. Medial and caudal

back 84

C. Dorsal and anterior

front 85

Which list gives all three components of accommodation?

A. Dilation, divergence, blinking
B. Constriction, lens accommodation, convergence
C. Miosis, abduction, convergence
D. Adduction, constriction, tearing

back 85

B. Constriction, lens accommodation, convergence

front 86

The accommodation response is initiated by visual signals relayed to the:

A. Pretectal area
B. Superior colliculus
C. Visual cortex
D. Red nucleus

back 86

C. Visual cortex

front 87

The descending sympathetic pathway for pupillary dilation activates preganglionic neurons in the:

A. Dorsal horn
B. Edinger-Westphal nucleus
C. Intermediolateral column
D. Ciliary ganglion

back 87

C. Intermediolateral column

front 88

Preganglionic sympathetic fibers reach the paravertebral chain through the:

A. Gray rami communicantes
B. White rami communicantes
C. Internal carotid plexus
D. Dorsal roots

back 88

B. White rami communicantes

front 89

Postganglionic sympathetic fibers to the pupillary dilator arise from the:

A. Ciliary ganglion
B. Pterygopalatine ganglion
C. Stellate ganglion
D. Superior cervical 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
B. Ciliary muscle
C. Pupillary dilator muscle
D. Medial rectus muscle

back 90

C. Pupillary dilator muscle

front 91

The sympathetic pathway also innervates Müller’s muscle, which:

A. Constricts the pupil
B. Elevates the upper eyelid
C. Depresses the lower eyelid
D. Adducts the globe

back 91

B. Elevates the upper eyelid

front 92

Asymmetry of pupil size is called:

A. Anisocoria
B. Amblyopia
C. Astigmatism
D. Hemianopia

back 92

A. Anisocoria

front 93

Injury to the Edinger-Westphal nuclei can cause a:

A. Bilaterally constricted pupil
B. Unilaterally dilated pupil
C. Bilateral Marcus Gunn pupil
D. Small reactive pupil

back 93

B. Unilaterally dilated pupil

front 94

Ptosis in Horner syndrome is due to denervation of:

A. Levator palpebrae superioris
B. Superior rectus
C. Müller’s muscle
D. Orbicularis oculi

back 94

C. Müller’s muscle

front 95

Miosis in Horner syndrome is caused by loss of sympathetic input to the:

A. Pupillary constrictor
B. Pupillary dilator
C. Ciliary muscle
D. Superior tarsal muscle

back 95

B. Pupillary dilator

front 96

Anisocoria that is more obvious in the dark suggests:

A. Oculomotor lesion
B. Marcus Gunn pupil
C. Horner syndrome
D. Pontine lesion

back 96

C. Horner syndrome

front 97

Pupillary dilation after hydroxyamphetamine drops indicates a:

A. Postganglionic lesion
B. Preganglionic lesion
C. Optic tract lesion
D. Midbrain lesion

back 97

B. Preganglionic lesion

front 98

The absence of anhidrosis favors a _____ sympathetic lesion.

A. Central
B. Preganglionic
C. Diffuse
D. Postganglionic

back 98

D. Postganglionic

front 99

Bilateral small but light-reactive pupils are most consistent with lesions of the:

A. Midbrain
B. Pons
C. Optic nerves
D. Cavernous sinus

back 99

B. Pons

front 100

An absent direct response with a normal consensual response is characteristic of:

A. Horner syndrome
B. Argyll Robertson pupils
C. Marcus Gunn pupils
D. Oculomotor palsy

back 100

C. Marcus Gunn pupils

front 101

Marcus Gunn pupils result from injury to the:

A. Optic nerve, retina, or eye
B. Oculomotor nerve, iris, or lens
C. Optic chiasm, tract, or cortex
D. Pons, medulla, or cerebellum

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
B. Usually
C. Sometimes
D. Never

back 102

D. Never

front 103

The best bedside test for Marcus Gunn pupils is the:

A. Doll’s eye test
B. Swinging flashlight test
C. Cover-uncover test
D. Head impulse test

back 103

B. Swinging flashlight test

front 104

During the swinging flashlight test, paradoxical dilation every few seconds suggests:

A. Horner syndrome
B. Pontine pupils
C. Marcus Gunn pupils
D. Oculomotor palsy

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
B. Only if bilateral
C. Only with retinal detachment
D. No

back 105

D. No

front 106

Benign anisocoria is usually defined by a pupil asymmetry of:

A. Less than 0.6 mm
B. Less than 1.5 mm
C. Greater than 0.6 mm
D. Greater than 2.0 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
B. Cocaine
C. Opiates
D. Amphetamines

back 107

C. Opiates

front 108

Barbiturate overdose classically causes:

A. Bilateral fixed dilated pupils
B. Bilateral small pupils
C. Unilateral blown pupil
D. Alternating anisocoria

back 108

B. Bilateral small pupils

front 109

A dilated pupil constricts with 1% pilocarpine. This finding supports:

A. Muscarinic blockade
B. Sympathetic overactivity
C. Optic neuropathy
D. Parasympathetic lesion

back 109

D. Parasympathetic lesion

front 110

The classic light-near dissociation pupil associated with neurosyphilis is the:

A. Argyll Robertson pupil
B. Adie tonic pupil
C. Marcus Gunn pupil
D. Horner 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
B. Adie myotonic pupil
C. Marcus Gunn pupil
D. Midbrain corectopia

back 111

B. Adie myotonic pupil

front 112

A pupil that is irregular and off-center suggests the rare disorder:

A. Adie myotonic pupil
B. Argyll Robertson pupil
C. Midbrain corectopia
D. Horner syndrome

back 112

C. Midbrain corectopia

front 113

Opening of the eye is mediated primarily by:

A. Levator and Müller muscles
B. Orbicularis and levator
C. Superior rectus and levator
D. Orbicularis and superior tarsal

back 113

A. Levator and Müller muscles

front 114

Eye closure is produced by the _____ muscle innervated by _____.

A. Levator palpebrae; CN III
B. Müller; sympathetics
C. Frontalis; CN VII
D. Orbicularis oculi; CN VII

back 114

D. Orbicularis oculi; CN VII

front 115

Mild ptosis is most suggestive of:

A. Myasthenia gravis
B. Horner syndrome
C. Oculomotor palsy
D. Facial nerve palsy

back 115

B. Horner syndrome

front 116

Ptosis that worsens with sustained upgaze most strongly suggests:

A. Horner syndrome
B. Oculomotor lesion
C. Myasthenia gravis
D. Cavernous sinus syndrome

back 116

B. Oculomotor lesion

front 117

Bilateral ptosis without loss of consciousness suggests a dorsal lesion affecting the:

A. Central caudal nucleus
B. Red nucleus
C. Edinger-Westphal nucleus
D. Pretectal area

back 117

A. Central caudal nucleus

front 118

The cavernous sinus lies between the _____ and _____ layers of dura.

A. Arachnoid and meningeal
B. Periosteal and dural
C. Dural and pial
D. Periosteal and arachnoid

back 118

B. Periosteal and dural

front 119

Within the cavernous sinus, the nerve closest to the carotid siphon is the:

A. Oculomotor nerve
B. Trochlear nerve
C. Abducens nerve
D. Ophthalmic nerve

back 119

C. Abducens nerve

front 120

The orbital apex is the region where orbital _____ converge.

A. Nerves, arteries, and veins
B. Muscles, nerves, and lens
C. Veins, ducts, and retina
D. Arteries, chiasm, and veins

back 120

A. Nerves, arteries, and veins

front 121

Cavernous sinus syndrome classically disrupts:

A. CN II, III, IV
B. CN III, V1, V2
C. CN II, IV, VI
D. CN III, IV, VI

back 121

D. CN III, IV, VI

front 122

The first nerve typically affected by a cavernous carotid aneurysm is the:

A. Oculomotor nerve
B. Trochlear nerve
C. Abducens nerve
D. Optic 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
B. Saccadic, smooth, vestibular
C. Horizontal, torsional, pursuit
D. Fixation, blinking, vergence

back 123

A. Horizontal, vertical, vergence

front 124

Stable viewing of a moving target is mediated by:

A. Vergence
B. Saccades
C. Vestibulo-ocular reflex
D. Smooth pursuit

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
B. Medulla; midbrain
C. Midbrain; pons
D. Midbrain; medulla

back 125

C. Midbrain; pons

front 126

The tract interconnecting eye movement nuclei with vestibular nuclei is the:

A. Medial longitudinal fasciculus
B. Trigeminothalamic tract
C. Medial lemniscus
D. Spinothalamic tract

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
B. Muscarinic blockade
C. Adie myotonic pupil
D. Edinger-Westphal injury

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