Neuro-ophthalmology and pupils: early papilloedema: 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: early papilloedema

Sample item

A young woman with headaches is examined for early papilloedema. Which finding is generally the earliest sign on fundus examination?

AOptic atrophy with a pale discBLarge splinter haemorrhages with exudates in all quadrantsCA deep pathological cupDLoss of spontaneous venous pulsation at the disc

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

The answer and the reasoning

D. Loss of spontaneous venous pulsation at the disc

Early raised intracranial pressure abolishes the spontaneous pulsation of the central retinal vein, although it is absent in a minority of normal people. Disc hyperaemia and blurring of margins follow. Optic atrophy appears late, after prolonged swelling.

Option by option

A. Optic atrophy with a pale disc
Optic atrophy is a late consequence of chronic papilloedema.
B. Large splinter haemorrhages with exudates in all quadrants
Widespread haemorrhages and exudates mark an advanced acute stage and are not the earliest sign.
C. A deep pathological cup
A deep cup is a feature of glaucoma, whereas papilloedema fills the cup.
D. Loss of spontaneous venous pulsation at the disc (correct)
Correct. Loss of venous pulsation is one of the earliest changes in raised intracranial pressure.

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.

Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, Loss of spontaneous venous pulsation at the disc. Early raised intracranial pressure abolishes the spontaneous pulsation of the central retinal vein, although it is absent in a minority of normal people.

Why is "Optic atrophy with a pale disc" not the answer?

Optic atrophy is a late consequence of chronic papilloedema.

Why is "Large splinter haemorrhages with exudates in all quadrants" not the answer?

Widespread haemorrhages and exudates mark an advanced acute stage and are not the earliest sign.

Why is "A deep pathological cup" not the answer?

A deep cup is a feature of glaucoma, whereas papilloedema fills the cup.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: early papilloedema in Ophthalmology. Disc hyperaemia and blurring of margins follow. Optic atrophy appears late, after prolonged swelling.

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: early papilloedema?

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.