Neuro-ophthalmology and pupils: dissociated vertical deviation: 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.

Try it

Ophthalmology · Neuro-ophthalmology and pupils: dissociated vertical deviation

Sample item

A child operated for infantile esotropia has an eye that drifts upward when it is covered or when attention lapses, and it returns down on uncovering. The fellow eye shows no corresponding drop. What is this?

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

The answer and the reasoning

B. Dissociated vertical deviation

Dissociated vertical deviation is an upward drift of either eye that appears in infantile squint and does not obey Hering's law. It is independent of the horizontal gaze position, unlike inferior oblique overaction, which shows elevation in adduction.

Option by option

  • A. Brown syndrome

    Brown syndrome limits elevation in adduction because of a tight superior oblique tendon sheath.

  • B. Dissociated vertical deviation (correct)

    Correct. A spontaneous upward drift of a covered eye with no matching hypotropia is DVD.

  • C. Superior oblique palsy

    Superior oblique palsy produces a hypertropia that worsens on tilting the head to that side.

  • D. Inferior oblique overaction

    Inferior oblique overaction produces elevation specifically in adduction.

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.

More Ophthalmology questions

Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is B, Dissociated vertical deviation. Dissociated vertical deviation is an upward drift of either eye that appears in infantile squint and does not obey Hering's law.

Why is "Brown syndrome" not the answer?

Brown syndrome limits elevation in adduction because of a tight superior oblique tendon sheath.

Why is "Superior oblique palsy" not the answer?

Superior oblique palsy produces a hypertropia that worsens on tilting the head to that side.

Why is "Inferior oblique overaction" not the answer?

Inferior oblique overaction produces elevation specifically in adduction.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: dissociated vertical deviation in Ophthalmology. It is independent of the horizontal gaze position, unlike inferior oblique overaction, which shows elevation in adduction.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 and pupils: dissociated vertical deviation?

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.