Neuro-ophthalmology: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Neuro-ophthalmology

Sample item

A 28-year-old woman has painful loss of vision in one eye, a central scotoma, a relative afferent pupillary defect and impaired colour vision. The optic disc looks normal. MRI shows periventricular white matter lesions. What is the recommended treatment?

AIntravenous methylprednisoloneBOral prednisolone alone in standard doseCObservation, since steroids offer no benefit of any kindDOptic nerve sheath fenestration

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravenous methylprednisolone

Acute demyelinating optic neuritis, often the first event of multiple sclerosis, is treated with a short course of high-dose intravenous methylprednisolone, which speeds visual recovery but does not alter the final acuity. Standard-dose oral prednisolone alone was associated with a higher recurrence rate in the Optic Neuritis Treatment Trial.

Option by option

A. Intravenous methylprednisolone (correct)
Correct. Intravenous steroids hasten recovery in optic neuritis.
B. Oral prednisolone alone in standard dose
Oral prednisolone alone in a standard dose raised the risk of recurrence.
C. Observation, since steroids offer no benefit of any kind
Steroids do hasten recovery, and MRI lesions raise the risk of multiple sclerosis, so observation alone is not preferred.
D. Optic nerve sheath fenestration
Sheath fenestration is a procedure for papilloedema from raised intracranial pressure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is A, Intravenous methylprednisolone. Acute demyelinating optic neuritis, often the first event of multiple sclerosis, is treated with a short course of high-dose intravenous methylprednisolone, which speeds visual recovery but does not alter the final acuity.

Why is "Oral prednisolone alone in standard dose" not the answer?

Oral prednisolone alone in a standard dose raised the risk of recurrence.

Why is "Observation, since steroids offer no benefit of any kind" not the answer?

Steroids do hasten recovery, and MRI lesions raise the risk of multiple sclerosis, so observation alone is not preferred.

Why is "Optic nerve sheath fenestration" not the answer?

Sheath fenestration is a procedure for papilloedema from raised intracranial pressure.

What concept does this question test?

It tests Neuro-ophthalmology in Ophthalmology. Standard-dose oral prednisolone alone was associated with a higher recurrence rate in the Optic Neuritis Treatment Trial.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuro-ophthalmology?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.