Nose and paranasal sinuses: superior orbital fissure syndrome: practice question

A ENT 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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ENT · Nose and paranasal sinuses: superior orbital fissure syndrome

Sample item

After a fracture of the lateral orbital wall in a road accident, a man has ptosis, complete ophthalmoplegia, a dilated fixed pupil and numbness of the forehead. Visual acuity is normal. Which syndrome is this?

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

The answer and the reasoning

A. Superior orbital fissure syndrome

Structures passing through the superior orbital fissure, namely cranial nerves III, IV, VI and the ophthalmic division of V, are damaged, giving ophthalmoplegia, ptosis, a fixed dilated pupil and forehead anaesthesia. When the optic nerve is also involved with visual loss, it is called orbital apex syndrome.

Option by option

  • A. Superior orbital fissure syndrome (correct)

    Correct. Nerves III, IV, VI and V1 are affected while the optic nerve is spared, with normal vision.

  • B. Cavernous sinus thrombosis

    Cavernous sinus thrombosis is infective with fever, chemosis and bilateral progression, not post-traumatic.

  • C. Orbital apex syndrome

    Orbital apex syndrome has the same findings plus optic nerve damage and visual loss.

  • D. Horner syndrome

    Horner syndrome gives mild ptosis, miosis and anhidrosis, not ophthalmoplegia with a dilated pupil.

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 ENT question

What is the answer to this ENT question?

The best answer is A, Superior orbital fissure syndrome. Structures passing through the superior orbital fissure, namely cranial nerves III, IV, VI and the ophthalmic division of V, are damaged, giving ophthalmoplegia, ptosis, a fixed dilated pupil and forehead anaesthesia.

Why is "Cavernous sinus thrombosis" not the answer?

Cavernous sinus thrombosis is infective with fever, chemosis and bilateral progression, not post-traumatic.

Why is "Orbital apex syndrome" not the answer?

Orbital apex syndrome has the same findings plus optic nerve damage and visual loss.

Why is "Horner syndrome" not the answer?

Horner syndrome gives mild ptosis, miosis and anhidrosis, not ophthalmoplegia with a dilated pupil.

What concept does this question test?

It tests Nose and paranasal sinuses: superior orbital fissure syndrome in ENT. When the optic nerve is also involved with visual loss, it is called orbital apex syndrome.

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 Nose and paranasal sinuses: superior orbital fissure syndrome?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT 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.