Neuro-ophthalmology and pupils: investigation after diagnosing myasthenia: 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: investigation after diagnosing myasthenia

Sample item

A 32-year-old woman with fatigable ptosis and diplopia is found to have antibodies against the acetylcholine receptor. Which investigation is essential next?

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

The answer and the reasoning

D. CT or MRI of the chest to look for a thymoma

Myasthenia gravis is associated with thymic hyperplasia or thymoma, so every patient with newly diagnosed disease should have chest imaging. Thymectomy may be indicated. Ocular symptoms may precede generalised weakness, so follow-up is needed.

Option by option

  • A. Carotid Doppler

    Carotid Doppler is for embolic retinal events and has no link to myasthenia.

  • B. Lumbar puncture

    Lumbar puncture is for raised intracranial pressure or infection and not for this diagnosis.

  • C. MRI of the orbit for optic neuritis

    An orbital MRI looks for optic nerve disease, which is not the problem here.

  • D. CT or MRI of the chest to look for a thymoma (correct)

    Correct. Chest imaging for a thymoma is routine in newly diagnosed myasthenia.

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 D, CT or MRI of the chest to look for a thymoma. Myasthenia gravis is associated with thymic hyperplasia or thymoma, so every patient with newly diagnosed disease should have chest imaging.

Why is "Carotid Doppler" not the answer?

Carotid Doppler is for embolic retinal events and has no link to myasthenia.

Why is "Lumbar puncture" not the answer?

Lumbar puncture is for raised intracranial pressure or infection and not for this diagnosis.

Why is "MRI of the orbit for optic neuritis" not the answer?

An orbital MRI looks for optic nerve disease, which is not the problem here.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: investigation after diagnosing myasthenia in Ophthalmology. Thymectomy may be indicated. Ocular symptoms may precede generalised weakness, so follow-up is needed.

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: investigation after diagnosing myasthenia?

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.