Neuro-ophthalmology and pupils: Kestenbaum procedure: 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: Kestenbaum procedure

Sample item

A 4-year-old has horizontal jerk nystagmus since infancy that reduces on convergence, with a head turn to the left that gives the best vision. What is the surgical principle if treatment is needed?

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

The answer and the reasoning

C. Shift the null zone to the primary position

The Kestenbaum procedure moves the eyes toward the null zone, so that the child can look straight ahead. It improves the head posture and does not abolish nystagmus. Refractive laser and convergence changes do not address the head turn.

Option by option

  • A. Correct the refractive error by laser

    Laser refractive surgery is not used to treat nystagmus in children.

  • B. Increase the amplitude of convergence

    Convergence is not the target in surgery for a null zone.

  • C. Shift the null zone to the primary position (correct)

    Correct. Moving the null zone to the primary position corrects the abnormal head posture.

  • D. Abolish the nystagmus fully

    Surgery cannot abolish the nystagmus and aims for a better position.

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 C, Shift the null zone to the primary position. The Kestenbaum procedure moves the eyes toward the null zone, so that the child can look straight ahead.

Why is "Correct the refractive error by laser" not the answer?

Laser refractive surgery is not used to treat nystagmus in children.

Why is "Increase the amplitude of convergence" not the answer?

Convergence is not the target in surgery for a null zone.

Why is "Abolish the nystagmus fully" not the answer?

Surgery cannot abolish the nystagmus and aims for a better position.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: Kestenbaum procedure in Ophthalmology. It improves the head posture and does not abolish nystagmus. Refractive laser and convergence changes do not address the head turn.

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: Kestenbaum procedure?

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.