FrontalCortex, Inc. is a non-profit corporation dedicated to neurology education.

The Fundus, Again!

Topic: Adult

Created on Saturday, November 8 2008 by rednucleus

Last modified on Saturday, November 8 2008.

A 41-year-old man has been referred by his GP as difficult-to-manage headache for the past 2 years. His GP says I’m concerned about his fundal appearance. Examination is totally unremarkable but his fundoscopy shows 2 left-sided whitish patches with black irregular margins, over which the retinal arterioles cross. His bloods, brain gadolinium MRI, and CSF are normal. What would you tell his GP?

A) Do visual evoked potentials

B) Arrange for brain CT scan with contrast

C) Ignore his fundal appearance

D) Do HIV serology

E) Re-MRI after 3 months

	= Go back to the top of the page.
	= Reload a different version of this question ().
	= Load a random question from the database.
	= Use this question as a template to create a totally NEW question.
	= Enter detailed rating for this question!
	= How users like you have rated this question.

This question was created on November 08, 2008 by rednucleus.
This question was last modified on November 08, 2008.

ANSWERS AND EXPLANATIONS

A) Do visual evoked potentials

This answer is incorrect.

He has no visual features, and the history is not biased towards multiple sclerosis so as to detect sub-clinical optic nerve involvement. (See References)


Please log in if you want to rate questions.

B) Arrange for brain CT scan with contrast

This answer is incorrect.

The contrast brain MRI is already normal-looking; why doing CT?! (See References)


Please log in if you want to rate questions.

C) Ignore his fundal appearance

This answer is correct.

The fundoscopic findings are suggestive of “old choroiditis;” this is a rather common incidental finding, mostly due to old subclinical toxoplasmosis, which has no relation with the chronic “tension” type headache in our patient. Neurologists do fundoscopy many times a day at work, and it is very likely that they encounter normal variants (like optic nerve head drusen, myelinated nerve fibers) or incidental benign findings unrelated to the patient’s disease (like ours). (See References)


Please log in if you want to rate questions.

D) Do HIV serology

This answer is incorrect.

Neither the complaint nor the fundal appearance are pointing towards HIV infection. (See References)


Please log in if you want to rate questions.

E) Re-MRI after 3 months

This answer is incorrect.

The brain imaging and CSF examination are normal; there is no advantage of re-doing the MRI after an interval. (See References)


Please log in if you want to rate questions.

References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

Advertising:


Please log in if you want to rate questions.

FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
adult
The Fundus, Again!
Question ID: 110808076
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 11/08/2008
Modified: 11/08/2008
Estimated Permutations: 120