Q.1 Which cranial nerve is primarily responsible for pupillary constriction?
Optic nerve (CN II)
Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Abducens nerve (CN VI)
Explanation - The parasympathetic fibers that control pupillary constriction travel with the oculomotor nerve.
Correct answer is: Oculomotor nerve (CN III)
Q.2 A lesion of the right optic nerve will cause which type of visual field defect?
Left homonymous hemianopia
Right monocular blindness
Bitemporal hemianopia
Left superior quadrantanopia
Explanation - Damage to the optic nerve before the chiasm causes complete blindness in the affected eye.
Correct answer is: Right monocular blindness
Q.3 Internuclear ophthalmoplegia (INO) is caused by a lesion in which structure?
Optic chiasm
Medial longitudinal fasciculus (MLF)
Lateral geniculate body
Superior colliculus
Explanation - INO results from a lesion in the MLF, disrupting communication between cranial nerves III and VI.
Correct answer is: Medial longitudinal fasciculus (MLF)
Q.4 Argyll Robertson pupil is characteristically seen in which disease?
Multiple sclerosis
Syphilis
Glaucoma
Myasthenia gravis
Explanation - Argyll Robertson pupils accommodate but do not react to light, classically associated with neurosyphilis.
Correct answer is: Syphilis
Q.5 Which cranial nerve palsy causes vertical diplopia that worsens when looking down stairs?
CN III
CN IV
CN VI
CN V
Explanation - Trochlear nerve palsy affects the superior oblique muscle, leading to vertical diplopia, worse on downgaze.
Correct answer is: CN IV
Q.6 Bitemporal hemianopia is usually caused by a lesion where?
Optic nerve
Optic chiasm
Optic tract
Visual cortex
Explanation - Compression of the optic chiasm, often by a pituitary adenoma, leads to bitemporal hemianopia.
Correct answer is: Optic chiasm
Q.7 Papilledema is most commonly associated with which condition?
Hypertension
Raised intracranial pressure
Diabetes
Optic neuritis
Explanation - Papilledema results from swelling of the optic disc due to increased intracranial pressure.
Correct answer is: Raised intracranial pressure
Q.8 Which cranial nerve innervates the lateral rectus muscle?
CN III
CN IV
CN VI
CN V
Explanation - The abducens nerve (CN VI) controls the lateral rectus muscle, responsible for eye abduction.
Correct answer is: CN VI
Q.9 Marcus Gunn pupil is best detected using which test?
Cover test
Red reflex test
Swinging flashlight test
Visual acuity test
Explanation - A relative afferent pupillary defect (Marcus Gunn pupil) is detected with the swinging flashlight test.
Correct answer is: Swinging flashlight test
Q.10 Which condition is characterized by transient visual obscurations associated with papilledema?
Optic neuritis
Idiopathic intracranial hypertension
Retinal detachment
Glaucoma
Explanation - Raised intracranial pressure in IIH causes papilledema with transient visual obscurations.
Correct answer is: Idiopathic intracranial hypertension
Q.11 The main neurotransmitter of the parasympathetic pathway in pupillary constriction is:
Norepinephrine
Acetylcholine
Serotonin
Dopamine
Explanation - Acetylcholine mediates pupillary constriction through muscarinic receptors.
Correct answer is: Acetylcholine
Q.12 Lesion of the right optic tract will cause which defect?
Right monocular blindness
Left homonymous hemianopia
Right homonymous hemianopia
Bitemporal hemianopia
Explanation - A lesion of the right optic tract causes contralateral (left) homonymous hemianopia.
Correct answer is: Left homonymous hemianopia
Q.13 Which condition is most commonly associated with optic neuritis?
Multiple sclerosis
Tuberculosis
Hypertension
Diabetes
Explanation - Optic neuritis is strongly associated with multiple sclerosis.
Correct answer is: Multiple sclerosis
Q.14 Which syndrome involves ptosis, miosis, and anhidrosis?
Horner’s syndrome
Adie’s pupil
Argyll Robertson pupil
Parinaud’s syndrome
Explanation - Horner’s syndrome is due to sympathetic pathway disruption, presenting with ptosis, miosis, and anhidrosis.
Correct answer is: Horner’s syndrome
Q.15 Which muscle is affected in oculomotor nerve palsy?
Superior rectus
Inferior rectus
Medial rectus
All of the above
Explanation - CN III innervates the superior, inferior, and medial rectus, inferior oblique, and levator palpebrae muscles.
Correct answer is: All of the above
Q.16 Parinaud’s syndrome is caused by a lesion in which part of the brain?
Medulla
Midbrain (dorsal)
Pons
Thalamus
Explanation - Parinaud’s syndrome results from dorsal midbrain lesions, often due to pineal tumors.
Correct answer is: Midbrain (dorsal)
Q.17 What is the most common cause of unilateral proptosis in adults?
Thyroid eye disease
Orbital cellulitis
Orbital tumor
Pseudotumor
Explanation - Although bilateral is more common, thyroid eye disease can cause unilateral proptosis.
Correct answer is: Thyroid eye disease
Q.18 A dilated, poorly reactive pupil in a patient with headache may indicate compression of which nerve?
CN II
CN III
CN IV
CN VI
Explanation - Compression of the oculomotor nerve affects parasympathetic fibers, causing a dilated, poorly reactive pupil.
Correct answer is: CN III
Q.19 In myasthenia gravis, which ocular feature is most common?
Papilledema
Optic neuritis
Ptosis
Miosis
Explanation - Myasthenia gravis commonly presents with fluctuating ptosis and diplopia due to fatigable muscle weakness.
Correct answer is: Ptosis
Q.20 Which visual field defect is associated with pituitary macroadenoma?
Bitemporal hemianopia
Homonymous hemianopia
Monocular blindness
Central scotoma
Explanation - Pituitary macroadenomas compress the optic chiasm, causing bitemporal hemianopia.
Correct answer is: Bitemporal hemianopia
Q.21 Which artery supplies the optic nerve head?
Central retinal artery
Posterior ciliary arteries
Ophthalmic artery
Middle cerebral artery
Explanation - The optic nerve head is mainly supplied by the short posterior ciliary arteries.
Correct answer is: Posterior ciliary arteries
Q.22 Which imaging modality is most useful in diagnosing optic nerve glioma?
CT scan
Ultrasound
MRI
X-ray
Explanation - MRI provides detailed imaging of the optic nerve and is preferred for optic nerve glioma diagnosis.
Correct answer is: MRI
Q.23 Adie’s pupil reacts poorly to light but better to accommodation due to damage in which structure?
Ciliary ganglion
Optic nerve
Superior colliculus
Edinger-Westphal nucleus
Explanation - Adie’s pupil is caused by damage to postganglionic parasympathetic fibers in the ciliary ganglion.
Correct answer is: Ciliary ganglion
Q.24 Which test helps distinguish myasthenia gravis-related ptosis from other causes?
Cover test
Ice pack test
Swinging flashlight test
Visual evoked potential
Explanation - The ice pack test improves ptosis in myasthenia gravis by decreasing acetylcholine breakdown.
Correct answer is: Ice pack test
Q.25 Which condition typically shows a central scotoma?
Optic neuritis
Retinal detachment
Pituitary tumor
Papilledema
Explanation - Optic neuritis often presents with central scotoma due to involvement of central optic nerve fibers.
Correct answer is: Optic neuritis