Test 26  (neuro-ophthalmology) 

1. The following are features of melanoma-associated retinopathy:

a. central scotoma

b. night vision impairment 

c. abnormal electroretinogram

d. antibody to rods

e. presence of distant skin melanoma rather than 
    choroidal melanoma

Answera.F   b.T  c.T  d.T e.T
Melanoma-associated retinopathy is a paraneoplastic 
syndrome caused by a distant melanoma. The features 
include night vision impairment, abnormal electroretinogram and selective antibody to rods.

2. Features of cancer-associated retinopathy include:

a. narrowing of the retinal artery

b. abnormal electroretinogram

c. stationary bilateral visual loss

d. optic atrophy

e. the most common underlying cause is breast carcinoma

Answera.T   b.T   c.F  d.T  e.F
Cancer-associated retinopathy is a paraneoplastic 
syndrome caused by the presence of an underlying 
tumour most commonly oat cell carcinoma of the lung. 
The features are bilateral progressive visual loss, 
attenuation of the retinal blood vessels, optic atrophy and abnormal electroretinography.

3. In Leber's hereditary optic neuropathy:

a. visual recovery is usually poor

b. peripapillary telangiectasia is a late feature of 
    the disease

c. 14484 mutation at the mitochondria is associated 
    with a better visual prognosis

d. 17788 mutation is the most common mitochondrial
    mutation seen in this condition

e. only male patients are affected.

Answera.T  b.F  c.T  d.T  e.F.
Peripapillary telangiectasia is an early feature of this condition. Both male and female are affected, though male patients predominate.

4. The following are true about ocular myasthenia gravis:

a. thymomectomy is usually performed to improve 
    the ocular signs

b. application of ice to a ptotic eye may worsen the 
    symptom

c. the majority of myasthenic patients have ocular 
    involvement

d. squint operation should never be carried out on 
    myasthenic patients

e. single fibre electromyography of the orbicularis 
    oculi may show increased jitter

Answera.F  b.F  c.T  d.F  e.T
Thymomectomy is seldom carried out for pure ocular myasthenia gravis because of the morbidity of the operation. Ice test improves the palpebral fissure of a ptotic lid due to myasthenia gravis. In stable myasthenia, squint operation can be performed. 

5. True statements about non-arteritic ischaemic optic neuropathy 
     include:

a. more common in males than females

b. headache is not a feature

c. it is associated with an increased incidence of      
    hypertension and diabetes mellitus

d. optic nerve fenestration is beneficial

e. aspirin can improve the visual prognosis of the affected 
    eye

Answera.T   b.T  c.T  d.F  e.F
Optic nerve fenestration does not affect the visual prognosis and neither is the use of aspirin. However, aspirin has been shown to reduce the incidence of non-arteritic ischaemic optic neuropathy in the contralateral eye.

 
 

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