Neuro-ophthalmology and pupils: spasmus nutans: 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 and pupils: spasmus nutans

Sample item

A 12-month-old has small-amplitude, rapid, asymmetric pendular nystagmus with intermittent head nodding and a head tilt. Although spasmus nutans is usually benign, what must be done?

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

The answer and the reasoning

C. MRI of the brain and orbits

Spasmus nutans is a benign self-limiting triad of nystagmus, head nodding and torticollis. Optic pathway or chiasmal glioma can mimic it, so neuroimaging is needed to exclude a tumour.

Option by option

  • A. Karyotyping

    Karyotyping is not relevant to this presentation.

  • B. Electroretinography only

    Electroretinography tests retinal function and does not exclude a glioma.

  • C. MRI of the brain and orbits (correct)

    Correct. Imaging excludes an optic pathway glioma mimic.

  • D. Reassurance with no investigation

    Reassurance without imaging may miss a tumour that mimics the picture.

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.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is C, MRI of the brain and orbits. Spasmus nutans is a benign self-limiting triad of nystagmus, head nodding and torticollis.

Why is "Karyotyping" not the answer?

Karyotyping is not relevant to this presentation.

Why is "Electroretinography only" not the answer?

Electroretinography tests retinal function and does not exclude a glioma.

Why is "Reassurance with no investigation" not the answer?

Reassurance without imaging may miss a tumour that mimics the picture.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: spasmus nutans in Ophthalmology. Optic pathway or chiasmal glioma can mimic it, so neuroimaging is needed to exclude a tumour.

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 and pupils: spasmus nutans?

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.