Question: In which of the following conditions is optokinetic stimulus testing useful?
1. Infantile nystagmus
2. Patients claiming complete blindness
3. Homonymous hemianopia
4. Internuclear ophthalmoplegia
5. Dorsal midbrain syndrome
6. Optic neuritis
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Question: Which of the following are correct?
1. A heterochromia iridis-associated acquired Horner syndrome is usually due to a lesion of the postganglionic neuron (third order).
2. Heterochromia iridis-associated acquired Horner syndrome only occurs in children?
3. In a patient with isolated heterochromia iridis-associated Horner syndrome, the lighter eye is the one with the oculosympathetic paresis.
4. When both Waardenburg and congenital Horner syndromes occur in the same individual the darker iris is the one with the oculosympathetic paresis.
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Question:
Which of the following are correct?
1. Heterochromia iridis in a child with Horner syndrome rules out neuroblastoma as a cause.
2. The most common cause of congenital Horner syndrome is a neuroblastoma.
3. Cervical neuroblastoma, a disease primarily of infants, has a favorable prognosis.
4. Cervical masses due to neuroblastoma, when felt, are commonly mistaken for infectious adenitis in children.
5. Cervical neuroblastoma in children almost always causes Horner syndrome.
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MRI showing a heterogeneously enhancing soft tissue lesion involving the root of neck
Question: Which of the following may reveal that the cause of anisocoria is not Horner syndrome?
1. Slit-lamp exam
2. The degree of anisocoria remains relatively constant in bright and dim illumination.
3. Repeat examinations of the patient on different days.
4. The absence of miosis on attempted near vision.
5. The failure of the pupil to constrict to light but does constrict with attempted near vision.
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Questions:
1. A positive Hydroxyamphetamine pharmacologic test for Horner Syndrome indicates a problem in which neuron of the sympathetic chain?
a. 1st order neuron (preganglionic)
b. 2nd order neuron (preganglionic)
c. 3rd order neuron (postganglionic)
2. When the difference in dilation is + or < 0.5 mm. how reliable is the Hydroxyamphetamine pharmacologic test for Horner Syndrome?
a. sensitivity of 100% and specificity of 100%
b. sensitivity of 93% and specificity of 83%
c. sensitivity of 83% and specificity of 73%
d. sensitivity of 73% and specificity of 63
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Questions:
1. How reliable is the Apraclonidine pharmacologic test for
Horner Syndrome?
a. less reliable than cocaine
b. at least as reliable as cocaine
c. more reliable than cocaine
2. In children up to what age may Apraclonidine cause lethargy, bradycardia, or a reduced respiratory rate for up to 2 hours?
a. 3 months
b. 6 months
c. 1 year
d. 2 years
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Questions:
1. How much anisocoria is necessary for the diagnosis of Horner’s syndrome to be made using cocaine drops?
a. 0.3 mm
b. 0.5 mm
c. 1.0 mm
d. 1.5 mm
2. What is the approximate mean odds ratio for the Cocaine pharmacologic test for Horner syndrome assuming a postcocaine anisocoria of at least 0.8mm?
a. 10:1
b. 100:1
c. 1,000:1
d. 10,000:1
3. Which of the following races may not dilate well with topical cocaine?
a. Asians
b. African Americans
c. Caucasians
d. Native Americans
4. Does the cocaine test for Horner syndrome result in a positive urinary test for cocaine?
a. Yes
b. No
Fig. 5.3. Right Horner’s Syndrome3
Question: Describe the appropriate steps to take in the emergency department when evaluating bilaterally swollen discs.
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Question: Describe the appropriate steps to take in evaluating sustained monocular vision loss in the emergency department.
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Question: Identify 7 symptoms or examination findings that are often associated with pathology that require immediate assessment to enable potential life and/or vision saving emergent therapy?