Archives for October 2019

Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 4

Questions:
32. What are ocular disorders that keep a large pupil from constricting?
33. How does one test for pharmacologic mydriasis from topical agents?
34. What are two conditions that cause mydriasis via the parasympathetic nervous system?
35. What are the clinical symptoms and signs of Adie tonic pupil?
36. What explains the light-near dissociation classically found in Adie tonic pupil syndrome?
37. What topical drop is used to confirm the presence of Adie pupil syndrome?
38. Is isolated mydriasis likely to be caused by a third nerve paresis?
39. What may happen to the size of the pupil over time in the Adie syndrome?
40. Do all third nerve paresis have pupillary involvement?
41. What may the workup for an isolated third nerve palsy with mydriasis reveal?

Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 3

Questions:
13. What are the characteristics of physiologic anisocoria?
14. What are the ocular causes of anisocoria?
15. What are the signs of Horner Syndrome?
16. What neurologic symptoms and signs can be associated with Horner syndrome?
17. Which eye drops can be used to establish the diagnosis of Horner syndrome?
18. What is the mechanism of action of cocaine when used to test Horner syndrome?
19. What is observed when testing for Horner syndrome with cocaine?
20. What is the mechanism of action of apraclonidine when used to test Horner syndrome?
21. What is observed when testing for Horner syndrome with apraclonidine?
22. What eye drop is used to localize which order neuron is involved in Horner syndrome?
23. What is the mechanism of hydroxyamphetamine when used to test Horner syndrome?
24. What is observed when hydroxyamphetamine is used to test Horner syndrome?
25. What is the classic cause of a first-order neuron Horner syndrome?
26. What does the combination of an ipsilateral Horner syndrome (first-order) and contralateral superior oblique palsy (fourth nerve palsy) suggest?
27. What does the combination of an ipsilateral Horner syndrome (third-order) and an abducens paresis (sixth nerve palsy) suggest?
28. What should be the presumed cause of an acute painful Horner syndrome?
29. If the localization of a Horner syndrome is unknown what imaging tests should be done?
30. In a young child with an isolated Horner syndrome, a workup should be done for what condition?
31. What tests should be done in a child with a Horner syndrome without a surgical history to explain it?

Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 2

Questions:
 
5. Which order neuron is involved when the Horner syndrome is caused by a tumor in the apex of a lung?
  6. Do patients with a third-order Horner syndrome usually have anhidrosis?
  7. What neurotransmitter is released at the neuromuscular junction that results in pupillary constriction?
  8. What neurotransmitter is released at the neuromuscular junction that results in pupillary dilation?
  9. Why do lesions of the geniculate nucleus, the optic radiations, or the visual cortex not affect pupillary size or pupillary reactivity?
10. What is the course of the parasympathetic fibers for pupillary constriction from the Edinger-Westphal nucleus to the ciliary ganglion?
11. What is the ratio of postganglionic parasympathetic fibers that innervate the ciliary muscle to those that innervate the pupillary sphincter muscle?
12. What specific steps should be followed in examining a patient with anisocoria?

____________________________________________________

Neuro-ophthalmology Illustrated Chapter 12 – The Pupil 1

Questions:
1. When examining the pupils, what 6 items should be recorded?
2. Does a relative afferent pupillary defect cause anisocoria?
3. If there is no relative afferent pupillary defect in a patient is suspected of having optic neuropathy (regardless of the cause) does that rule-out this diagnosis?
4. If a patient has severe bilateral optic neuropathy will the pupils respond to near stimuli?

Neuro-ophthalmology Illustrated Chapter 11 – Abnormal Visual Perceptions: Hallucinations and Illusions 4

Questions:
42. What are the common hallucinogens?
43. What common hallucinogen can be responsible for delayed impressions of déjà vu or flashbacks that may occur years after even a single-use?
44. Are all anticholinergic agents (including atropine, scopolamine, and cyclopentolate) hallucinogens?
45. What antiparkinsonian agents can cause hallucinations?
46. Can antidepressants cause hallucinations?
47. Can antipsychotics cause hallucinations?
48. What is the visual symptom of toxic levels of Digoxin?
49. Can erectile dysfunction medications cause hallucinations?
50. Can withdrawal from benzodiazepines produce hallucinations?