Neuro-ophthalmology and pupils: idiopathic orbital inflammation: 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: idiopathic orbital inflammation

Sample item

A 40-year-old has sudden painful proptosis, red eyelids and limited eye movements in one eye, without fever or sinusitis. CT shows diffuse enlargement of muscles including their tendons, and symptoms improve within 48 hours of oral prednisolone. What is the diagnosis?

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

The answer and the reasoning

D. Idiopathic orbital inflammatory disease

Idiopathic orbital inflammation, orbital pseudotumour, presents with acute pain and a dramatic steroid response, with muscle enlargement involving the tendons. In thyroid eye disease the tendons are spared and the course is painless. Orbital cellulitis needs antibiotics and shows fever and sinus disease.

Option by option

  • A. Orbital cellulitis

    Orbital cellulitis has fever, leucocytosis and sinus infection.

  • B. Carotid-cavernous fistula

    A carotid-cavernous fistula gives pulsation, a bruit and dilated conjunctival vessels.

  • C. Thyroid eye disease

    Thyroid eye disease is usually painless and spares the muscle tendons.

  • D. Idiopathic orbital inflammatory disease (correct)

    Correct. Painful, tendon-involving enlargement with rapid steroid response is idiopathic orbital inflammation.

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, Idiopathic orbital inflammatory disease. Idiopathic orbital inflammation, orbital pseudotumour, presents with acute pain and a dramatic steroid response, with muscle enlargement involving the tendons.

Why is "Orbital cellulitis" not the answer?

Orbital cellulitis has fever, leucocytosis and sinus infection.

Why is "Carotid-cavernous fistula" not the answer?

A carotid-cavernous fistula gives pulsation, a bruit and dilated conjunctival vessels.

Why is "Thyroid eye disease" not the answer?

Thyroid eye disease is usually painless and spares the muscle tendons.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: idiopathic orbital inflammation in Ophthalmology. In thyroid eye disease the tendons are spared and the course is painless. Orbital cellulitis needs antibiotics and shows fever and sinus disease.

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: idiopathic orbital inflammation?

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.