A Neurology Quiz - Visual Systems
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Neurology is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.
This is a Neurology Quiz about Visual Systems!
Questions and Answers
- 1.
A 73-year aid woman experienced worsening diplopia. MRI examinations showed bilateral roundish parasellar and intracavernous masses, with homogeneous contrast-enhancement. CerebraI angiography revealed bilateral aneurysms of the intracavernous carotid artery. The aneurism was compressing the nerve directly next to the mass. The diplopia was due to progressive bilateral paresis of which muscles?
- A.
Superior oblique
- B.
Inferior oblique
- C.
Lateral rectus
- D.
Medial, superior and inferior rectus, and inferior oblique
- E.
Superior and inferior oblique
Correct Answer
C. Lateral rectusExplanation
The diplopia experienced by the 73-year-old woman was due to progressive bilateral paresis of the lateral rectus muscles. The MRI examinations showed masses in the parasellar and intracavernous regions, which were compressing the intracavernous carotid artery. This compression was directly affecting the nerve next to the mass, leading to the weakness of the lateral rectus muscles.Rate this question:
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- 2.
A 26-year old woman presented with diplopia. The abduction of both eyes were normal. The adduction of both eyes were quite limited in each eye. MRI revealed a multifocal lesion in the pons bilaterally next to the midline. Which structure is most probably affected?
- A.
Medial lernruscus
- B.
Lateral lemniscus
- C.
Abducent nucleus
- D.
PPRF
- E.
Medial longitudinal fascicle
Correct Answer
E. Medial longitudinal fascicleExplanation
The patient's presentation of limited adduction of both eyes suggests a dysfunction in the medial longitudinal fascicle (MLF). The MLF is responsible for coordinating eye movements, specifically the conjugate movement of the eyes during horizontal gaze. Lesions in the MLF can result in internuclear ophthalmoplegia, which is characterized by impaired adduction of the affected eye and nystagmus in the contralateral abducting eye. Therefore, the most probable structure affected in this patient is the medial longitudinal fascicle.Rate this question:
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- 3.
A 56-year old male had a sexually transmitted disease 20 years ago after an unprotected sexual encounter. He now presents with neurological problems including cognitive and visual problems. On physical examination you would expect his pupils to:
- A.
React to light and accommodate
- B.
Not accommodate
- C.
Not react to light and not accommodate
- D.
Not react to light and accommodate
- E.
React to light
Correct Answer
D. Not react to light and accommodateExplanation
The patient's history of a sexually transmitted disease 20 years ago suggests the possibility of neurosyphilis, which can cause neurological problems including cognitive and visual problems. One of the characteristic signs of neurosyphilis is the Argyll Robertson pupil, which is a pupil that does not react to light but still accommodates (constricts) when focusing on near objects. Therefore, in this case, we would expect the patient's pupils to not react to light but still accommodate.Rate this question:
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- 4.
A young boy is brought to the clinic. He appears quite small for his age and complains of not being able to see as well as he used to. Visual field examination reveals a bi-temporal hemianopsia . You suspect a tumor located near which of the following?
- A.
Pituitary gland and stalk
- B.
Calcarine sulcus
- C.
Parieto-occipital sulcus
- D.
Nucleus of crania) nerve III
- E.
Pineal gland
Correct Answer
A. Pituitary gland and stalkExplanation
The young boy's symptoms of being small for his age and experiencing visual field loss, specifically a bi-temporal hemianopsia, suggest a tumor located near the pituitary gland and stalk. The pituitary gland is responsible for producing hormones that control growth and development, so a tumor in this area could affect the boy's growth and also compress the optic chiasm, resulting in visual field loss. The other options listed are not associated with the symptoms described.Rate this question:
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- 5.
A 52-year-old woman has difficulty reading small print in newspapers and magazines. Her ophthalmologist explains to her that she is suffering from a condition due to a loss of her ability to accommodate and focus on near objects. She most likely has which of the following?
- A.
Astigmatism
- B.
Cataracts
- C.
Optic atrophy
- D.
Macular degeneration
- E.
Presbyopia
Correct Answer
E. PresbyopiaExplanation
Presbyopia is the loss of ability to focus on near objects that typically occurs with age. This condition is characterized by difficulty reading small print and is commonly seen in individuals over the age of 40. Astigmatism refers to an irregularly shaped cornea, cataracts involve clouding of the lens, optic atrophy is the degeneration of the optic nerve, and macular degeneration affects the central vision. None of these conditions specifically explain the difficulty in focusing on near objects, making presbyopia the most likely diagnosis.Rate this question:
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- 6.
A 50-year old taxi driver is currently hospitalized after suffering from a stroke. During the history, he denied impairment of his vision. The significant findings on physical examination were decreased vision and decreased movement of the vertical movements of his left eye. He also had left homonymous hemianopsia. Based on the findings, his stroke was most likely due to lesion affecting the area supplied which artery?
- A.
Lenticulostriate arteries
- B.
Posterior cerebral arteries
- C.
Anterior cerebral arteries
- D.
Middle cerebral arteries
- E.
Anterior communicating arteries
Correct Answer
B. Posterior cerebral arteriesExplanation
The patient's symptoms of decreased vision, decreased movement of the vertical movements of his left eye, and left homonymous hemianopsia suggest that the stroke is affecting the posterior cerebral arteries. The posterior cerebral arteries supply the occipital lobe, which is responsible for vision processing. Lesions in this area can lead to visual impairments and eye movement abnormalities.Rate this question:
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- 7.
Imaging studies were ordered. If the deficits seen were due to the stroke, the lesion would most likely to be located in shaded area in:
- A.
A
- B.
B
- C.
C
- D.
D
- E.
E
Correct Answer
E. EExplanation
The question mentions that imaging studies were ordered to determine the location of the lesion causing the deficits. The correct answer, E, suggests that the lesion is most likely located in that area. The information provided does not give any specific details about the deficits or the imaging findings, so it is not possible to provide a more detailed explanation.Rate this question:
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- 8.
During a routine neurological examination you perform a corneal reflex text. When you touch the right eye of your patient there is no direct reflex but an intact consensual reflex. This suggests damage to which region of the nervous system?
- A.
Damage to the facial nerve fibers that innervate the ipsilateral orbicularis oculi muscles
- B.
Damage to the ipsilateral sensory fibers of cranial nerve VII
- C.
Damage to the ipsilateral sensory fibers of the ophthalmic branch of the trigeminal nerve
- D.
Damage to the ipsilateral motor fibers of the oculomotor nerve
- E.
Damage to the contralateral motor fibers of the abducens nerve
Correct Answer
A. Damage to the facial nerve fibers that innervate the ipsilateral orbicularis oculi musclesExplanation
The corneal reflex is mediated by the trigeminal nerve (cranial nerve V) and the facial nerve (cranial nerve VII). When the cornea is touched, sensory fibers from the ophthalmic branch of the trigeminal nerve send signals to the brainstem, which then activates the facial nerve to produce a blink response. In this case, there is no direct reflex when the right eye is touched, but there is an intact consensual reflex, suggesting that the sensory fibers of the trigeminal nerve are intact and the damage is localized to the facial nerve fibers that innervate the ipsilateral orbicularis oculi muscles.Rate this question:
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- 9.
A 21-year old professional female basketball player was advised by her coach to go to see her physician. She could not perform so well lately, she often did not notice the ball coming from the back and she had constant headaches. She said it was probably due to her emotional state, because she broke up with her boyfriend a few months ago. Even her period became very irregular the last few months. The coach wanted the doctor to prescribe some calming pills for her, but the doctor became suspicious that there were some other problems, since he found visual field loss on both temporal sides. His suspicion was confirmed later by MRI. Which of the following is most possible based on the symptoms?
- A.
Meningioma in the optic canal leading to compression of the optic nerve
- B.
Pituitary adenoma, causing compression of the optic chiasma and leading to hormonal deficiencies.
- C.
Carotid aneurysm leading to compression of the optic chiasma and constant headaches.
- D.
Multiple sclerosi5, causing degeneration of the optt C radiation leading to bitemporal hemia nopia.
- E.
Multiple sclerosis; based on her gender and young age, and the demyelination symptoms in both optic nerves
Correct Answer
B. Pituitary adenoma, causing compression of the optic chiasma and leading to hormonal deficiencies.Explanation
The symptoms described in the question, such as visual field loss on both temporal sides, irregular periods, and hormonal deficiencies, suggest a problem with the pituitary gland. The pituitary gland is responsible for producing hormones that regulate various bodily functions, including the menstrual cycle. A pituitary adenoma, a benign tumor of the pituitary gland, can cause compression of the optic chiasma, leading to visual field loss, as well as hormonal imbalances. This explanation is supported by the fact that the doctor confirmed the suspicion later with an MRI.Rate this question:
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- 10.
The electron micrograph below was taken of a section of the eye. The positions of the landmarks "Photoreceptor outer segments" and "Cap" (designating a capillary) are shown. Of the choices below, the arrow is pointing to the nucleus of which cell type?
- A.
Epithelial cell
- B.
Fibroblast
- C.
Mast cell
- D.
Melanocyte
- E.
Photoreceptor cell
Correct Answer
D. MelanocyteExplanation
The electron micrograph of the eye section shows the positions of the landmarks "Photoreceptor outer segments" and "Cap" (capillary). The arrow is pointing to the nucleus of a cell type, and the correct answer is Melanocyte.Rate this question:
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- 11.
Shown above is a drawing of a portion of the iris of the eye. What is the function of the structure located at the tip of the arrow?
- A.
Pigmentation of the iris
- B.
Pupil constriction
- C.
Movement of the lens
- D.
Supplies oxygen and nutrients to the iris
- E.
Pupil dilation
Correct Answer
B. Pupil constrictionExplanation
The structure located at the tip of the arrow is responsible for pupil constriction. Pupil constriction is an important function of the iris, as it helps regulate the amount of light entering the eye. When the pupil constricts, it becomes smaller, allowing less light to enter the eye. This is particularly important in bright environments, as it helps protect the retina from excessive light exposure and maintains optimal vision.Rate this question:
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- 12.
Which of the following statements about the choroid of the eye is INCORRECT?
- A.
There are many melanocytes in the choroid.
- B.
There are many venous plexuses in the choroid.
- C.
The anterior rim of the choroid becomes the ciliary body.
- D.
The choroid touches the neural retina
- E.
The choroid is mostly loose connective tissue
Correct Answer
D. The choroid touches the neural retinaExplanation
The choroid does not directly touch the neural retina. There is a layer called the Bruch's membrane that separates the choroid from the neural retina. The choroid is responsible for supplying blood and nutrients to the retina, but it does not make direct contact with it.Rate this question:
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- 13.
Oescemet's membrane is found in which structure of the eye?
- A.
Sclera
- B.
Retina
- C.
Iris
- D.
Ciliary body
- E.
Cornea
Correct Answer
E. CorneaExplanation
Descemet's membrane is a thin, transparent layer located in the cornea of the eye. It is a part of the posterior layer of the cornea and is composed of collagen fibers. It helps maintain the shape and integrity of the cornea, providing structural support and protection to the eye.Rate this question:
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- 14.
An astigmatism is caused by a region of unequal curvature in
- A.
The lens.
- B.
The cornea.
- C.
A or B.
- D.
The retina.
- E.
A or C.
Correct Answer
C. A or B.Explanation
An astigmatism is caused by a region of unequal curvature in either the lens or the cornea. This means that the surface of either the lens or the cornea is not perfectly spherical, leading to distorted vision. The unequal curvature causes light to be focused at different points on the retina, resulting in blurred or distorted images. Therefore, the correct answer is A or B.Rate this question:
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.JPG "The electron micrograph below was taken of a section of the eye. The positions of the landmarks \"Photoreceptor outer segments\" and \"Cap\" (designating a capillary) are shown. Of the choices below, the arrow is pointing to the nucleus of which cell type?")
.JPG "Shown above is a drawing of a portion of the iris of the eye. What is the function of the structure located at the tip of the arrow?")
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