Neurology: idiopathic intracranial hypertension: practice question

A General Medicine 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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General Medicine · Neurology: idiopathic intracranial hypertension

Sample item

A 27-year-old obese woman has daily headaches worse on lying down, transient visual obscurations and bilateral papilloedema. MRI and MR venography are normal and lumbar puncture shows an opening pressure of 38 cm of CSF with normal composition. What is the first-line drug to add to weight loss?

AOral prednisoloneBAcetazolamideCImmediate optic nerve sheath fenestrationDPropranolol

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

The answer and the reasoning

B. Acetazolamide

Idiopathic intracranial hypertension typically affects obese women of childbearing age and threatens vision through papilloedema. Weight loss and acetazolamide, a carbonic anhydrase inhibitor that reduces CSF production, are first-line. Shunting or optic nerve sheath fenestration is reserved for progressive visual loss despite medical therapy.

Option by option

A. Oral prednisolone
Steroids are not recommended, cause weight gain and can worsen the condition on withdrawal.
B. Acetazolamide (correct)
Correct. Acetazolamide lowers CSF production and protects vision.
C. Immediate optic nerve sheath fenestration
Surgery is held back for failed medical therapy or rapidly deteriorating vision.
D. Propranolol
Propranolol can be used for headache prevention but does not lower 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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Acetazolamide. Idiopathic intracranial hypertension typically affects obese women of childbearing age and threatens vision through papilloedema.

Why is "Oral prednisolone" not the answer?

Steroids are not recommended, cause weight gain and can worsen the condition on withdrawal.

Why is "Immediate optic nerve sheath fenestration" not the answer?

Surgery is held back for failed medical therapy or rapidly deteriorating vision.

Why is "Propranolol" not the answer?

Propranolol can be used for headache prevention but does not lower intracranial pressure.

What concept does this question test?

It tests Neurology: idiopathic intracranial hypertension in General Medicine. Weight loss and acetazolamide, a carbonic anhydrase inhibitor that reduces CSF production, are first-line. Shunting or optic nerve sheath fenestration is reserved for progressive visual loss despite medical therapy.

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 Neurology: idiopathic intracranial hypertension?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.