Office Hour Final Review Questions

A 68 year old female presents with paralysis of the lower left side of her face. On

testing, you find she is able to raise her eyebrows on both sides of her face.

What is the most likely site of the lesion that could account for this presentation?

A. Left trigeminal ganglion

B. Superior Salivary Nucleus

C. Left Stylomastoid Foramen

D. Motor Cortex

D. Motor Cortex

While testing cranial nerve function, you ask the patient to raise their

eyebrows. Which motor branch of CNVII are you testing?

a) Temporal

b) Cervical

c) Buccal

d) Mandibular

e) Zygomatic

a) Temporal

Adie’s Tonic Pupil will most likely (select all that apply)

a) Affect near response

b) Be caused by damage to the Edinger-Westphal nucleus

c) Appear with loss of corneal sensitivity

a) Affect near response

c) Appear with loss of corneal sensitivity

True or False: The frontal eye fields are involved in the pupillary light reflex

False

True or False: The sensory fibers in the short ciliary nerve synapse in the

ciliary ganglion

False

Damage to the pterygopalatine ganglion would lead to

a) Dry Mouth

b) Loss of Hearing

c) Decreased Lacrimation

d) Inability to Raise Eyebrows

c) Decreased Lacrimation

A postganglionic Horner’s Syndrome could arise from

a lesion in the:

A) Cavernous sinus

B) Apex of the lung

C) Brainstem

D) Hypothalamus

A) Cavernous sinus

Sympathetic fibers reach the iris dilator via the short ciliary nerves?

A) TRUE

B) FALSE

B) FALSE

CN II passes through the Superior Orbital Fissure

A) True

B) False

B) False

The cavernous sinus is an important venous drainage space through which

several critical vessels and nerves pass through. The superior aspect is bordered

by the optic chiasm. The lateral borders are formed by the temporal lobes of the

cerebrum. The inferior border is formed by the:

A) Maxillary Bones

B) Ethmoid Bones

C) Temporal Bones

D) Sphenoid Bones

D) Sphenoid Bones

At the medial orbital margin, the orbital septum lies _________ relative to the

lacrimal sac and the medial palpebral ligament.

A) Anterior

B) Posterior

B) Posterior

Dextroversion would activate which of the following muscles?

A) Right LR and Left LR

B) Right MR and Left LR

C) Right LR and Left MR

D) Right MR and Left MR

C) Right LR and Left MR

Your patient presents with a loss of eyelashes on both the upper and lower

eyelids. What is your differential diagnosis?

A) Poliosis

B) Trichiasis

C) Madarosis

D) Distichiasis

C) Madarosis

An internal hordeolum can be caused by an infection of which

gland?

A) Meibomian gland

B) Zeis gland

C) Moli gland

D) Accessory lacrimal gland

A) Meibomian gland

One possible cause of ectropion is:

A) an overactive muscle of Riolan

B) an underactive muscle of Riolan

C) an overactive muscle of Muller

D) an underactive muscle of Muller

B) an underactive muscle of Riolan

Ocular findings of Grave’s Disease involves inflammation of the orbit and periorbital

tissues characterized by (select 2)

A) proptosis

B) ptosis

C) EOM enlargement

D) optic neuritis

E) orbital cellulitis

A) proptosis

C) EOM enlargement

The cavernous sinus (select 3):

A) Contains valves to ensure unidirectional flow of blood

B) Receives venous drainage from the superior and inferior ophthalmic veins

C) Contains the mandibular division of CN V

D) Contains the maxillary division of CN V

E) May be vulnerable to thrombus formation in the case of infections spreading

from the orbit

B) Receives venous drainage from the superior and inferior ophthalmic veins

D) Contains the maxillary division of CN V

E) May be vulnerable to thrombus formation in the case of infections spreading

from the orbit

True or False: The foveal avascular zone is approximately 5mm in diameter

A) True

B) False

B) False - FAZ is 0.5 mm

A patient has a nasopharyngeal carcinoma that has metastasized to the apex of

the orbit and is compressing the nerves outside the Annulus of Zinn. Which of

the following nerves are most likely to be affected? (Select 3)

A) Inferior division of the oculomotor nerve

B) Lacrimal nerve

C) Frontal nerve

D) Trochlear nerve

E) Abducens nerve

B) Lacrimal nerve

C) Frontal nerve

D) Trochlear nerve

Before performing tonometry in the clinic, you instill a drop of topical anesthetic

to block corneal sensation. Which of the following nerves are involved in

carrying sensation from the cornea to the brainstem? (Select 2)

A) Frontal nerve

B) Nasociliary nerve

C) Oculomotor nerve

D) Short ciliary nerves

E) Infraorbital nerve

B) Nasociliary nerve

D) Short ciliary nerves

Which of these cranial nerves have both sensory and motor functions? (Select 2)

A) CN I

B) CN VII

C) CN III

D) CN VIII

E) CN V

B) CN VII

E) CN V

Which neural structure is NOT involved in the pupillary near reflex?

A) Pretectal olivary nucleus

B) Lateral geniculate nucleus

C) Edinger Westphal nucleus

D) Frontal eye fields

A) Pretectal olivary nucleus

The first order (central) neurons in the sympathetic pathway to the eye have

their cell bodies located in the:

A) Ciliary ganglion

B) Brainstem

C) Hypothalamus

D) Superior cervical ganglion

C) Hypothalamus

The cell bodies of the postganglionic parasympathetic nerves supplying

the lacrimal gland are located in the

a) Geniculate ganglion

b) Pterygopalatine ganglion

c) Trigeminal ganglion

d) Ciliary ganglion

e) Superior cervical ganglion

b) Pterygopalatine ganglion

True or False: The presence of a positive Hutchinson’s sign in the context of

Herpes Zoster Ophthalmicus indicates a low likelihood of corneal

involvement

a) True

b) False

b) False

Which of the following statements are true regarding

Argyll-Robertson syndrome? (choose 2)

a) It is usually associated with neurosyphilis

b) It is caused by a lesion at the level of the Edinger-Westphal nucleus

c) Is it usually caused by a lesion in the neural tissue surrounding the

cerebral aqueduct

d) The pupillary near response is usually absent

e) It causes ptosis

a) It is usually associated with neurosyphilis

c) Is it usually caused by a lesion in the neural tissue surrounding the

cerebral aqueduct

A 48 year old male presents with paralysis of the entire left side of his face.

What is the most likely site of the lesion that could account for this

presentation?

a) Right facial motor nucleus

b) Motor cortex

c) Left stylomastoid foramen

d) Left trigeminal ganglion

e) Right internal acoustic meatus

c) Left stylomastoid foramen

Which of the following veins drain blood from structures within

the eyeball? (choose 3)

a) Vortex Veins

b) Anterior Ciliary Veins

c) Central Retinal Vein

d) Lacrimal Vein

e) Infraorbital Vein

a) Vortex Veins

b) Anterior Ciliary Veins

c) Central Retinal Vein

Arteritic Anterior Ischemic Optic Neuropathy: (circle 3)

a) Is associated with Giant Cell Arteritis

b) Is a serious medical and ocular emergency

c) Predominantly occurs in younger patients (<50 years of age)

d) Is more common than non-arteritic form of anterior ischemic optic neuropathy

e) May be associated with symptoms of headache, temporal pain, scalp

tenderness and jaw claudication

a) Is associated with Giant Cell Arteritis

b) Is a serious medical and ocular emergency

e) May be associated with symptoms of headache, temporal pain, scalp

tenderness and jaw claudication