Neuro-ophthalmology and pupils: pituitary apoplexy: 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: pituitary apoplexy

Sample item

A man with a known pituitary adenoma develops a sudden severe headache, vomiting, bilateral visual loss and a partial third nerve palsy. He is hypotensive. Which management step is most urgent along with imaging?

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

The answer and the reasoning

D. Intravenous hydrocortisone with fluid resuscitation

Haemorrhage or infarction of a pituitary adenoma can cause acute adrenal insufficiency, so steroid replacement is life-saving. Urgent MRI confirms the diagnosis, and transsphenoidal decompression is considered when vision is deteriorating or consciousness is impaired. Delay risks permanent blindness.

Option by option

  • A. Observation for 4 weeks

    Waiting for weeks risks irreversible loss of vision and adrenal crisis.

  • B. Oral bromocriptine alone

    Bromocriptine alone is too slow for an acute haemorrhagic event.

  • C. Panretinal photocoagulation

    Retinal laser has no role in compressive visual loss.

  • D. Intravenous hydrocortisone with fluid resuscitation (correct)

    Correct. Hydrocortisone and fluids treat the acute hypocortisolism of pituitary apoplexy.

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, Intravenous hydrocortisone with fluid resuscitation. Haemorrhage or infarction of a pituitary adenoma can cause acute adrenal insufficiency, so steroid replacement is life-saving.

Why is "Observation for 4 weeks" not the answer?

Waiting for weeks risks irreversible loss of vision and adrenal crisis.

Why is "Oral bromocriptine alone" not the answer?

Bromocriptine alone is too slow for an acute haemorrhagic event.

Why is "Panretinal photocoagulation" not the answer?

Retinal laser has no role in compressive visual loss.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: pituitary apoplexy in Ophthalmology. Urgent MRI confirms the diagnosis, and transsphenoidal decompression is considered when vision is deteriorating or consciousness is impaired. Delay risks permanent blindness.

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: pituitary apoplexy?

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.