Pupil: Adie tonic pupil: 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 · Pupil: Adie tonic pupil

Sample item

A young woman has a dilated right pupil with poor light response, slow tonic constriction to near and absent knee jerks. Which test is diagnostic?

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

The answer and the reasoning

C. Constriction to dilute 0.1 percent pilocarpine

Adie pupil is due to denervation of the ciliary ganglion with cholinergic supersensitivity, so dilute pilocarpine constricts it but not a normal pupil. Absent deep tendon reflexes complete Holmes-Adie syndrome.

Option by option

  • A. Failure to dilate with cocaine

    Cocaine testing is used for Horner syndrome.

  • B. Failure to dilate with hydroxyamphetamine

    Hydroxyamphetamine localises Horner lesions.

  • C. Constriction to dilute 0.1 percent pilocarpine (correct)

    Correct. Denervation supersensitivity is shown by dilute pilocarpine.

  • D. Constriction with physostigmine

    Physostigmine is not the diagnostic test.

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, Constriction to dilute 0.1 percent pilocarpine. Adie pupil is due to denervation of the ciliary ganglion with cholinergic supersensitivity, so dilute pilocarpine constricts it but not a normal pupil.

Why is "Failure to dilate with cocaine" not the answer?

Cocaine testing is used for Horner syndrome.

Why is "Failure to dilate with hydroxyamphetamine" not the answer?

Hydroxyamphetamine localises Horner lesions.

Why is "Constriction with physostigmine" not the answer?

Physostigmine is not the diagnostic test.

What concept does this question test?

It tests Pupil: Adie tonic pupil in Ophthalmology. Absent deep tendon reflexes complete Holmes-Adie 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 Pupil: Adie tonic pupil?

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.