Neuro-ophthalmology and pupils: Wernicke ophthalmoplegia: 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: Wernicke ophthalmoplegia

Sample item

A malnourished chronic alcoholic is confused and unsteady, with horizontal nystagmus and bilateral lateral rectus weakness. What should be given immediately?

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

The answer and the reasoning

D. Intravenous thiamine before glucose

Wernicke encephalopathy, with ophthalmoplegia, ataxia and confusion, is a thiamine deficiency state and needs parenteral thiamine, given before glucose so that the infusion does not precipitate worsening. Delay risks Korsakoff psychosis. It is a clinical diagnosis.

Option by option

  • A. Intravenous dextrose alone

    Glucose alone can worsen the deficiency by consuming remaining thiamine.

  • B. Intravenous steroid

    Steroid does not treat nutritional ophthalmoplegia.

  • C. Oral folic acid alone

    Folic acid alone does not correct thiamine deficiency.

  • D. Intravenous thiamine before glucose (correct)

    Correct. Thiamine treats Wernicke and should precede glucose.

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 thiamine before glucose. Wernicke encephalopathy, with ophthalmoplegia, ataxia and confusion, is a thiamine deficiency state and needs parenteral thiamine, given before glucose so that the infusion does not precipitate worsening.

Why is "Intravenous dextrose alone" not the answer?

Glucose alone can worsen the deficiency by consuming remaining thiamine.

Why is "Intravenous steroid" not the answer?

Steroid does not treat nutritional ophthalmoplegia.

Why is "Oral folic acid alone" not the answer?

Folic acid alone does not correct thiamine deficiency.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: Wernicke ophthalmoplegia in Ophthalmology. Delay risks Korsakoff psychosis. It is a clinical diagnosis.

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: Wernicke ophthalmoplegia?

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.