{"id":71,"date":"2025-11-05T14:16:28","date_gmt":"2025-11-05T21:16:28","guid":{"rendered":"https:\/\/novel.utah.edu\/test-your-knowledge\/?page_id=71"},"modified":"2026-01-29T16:50:52","modified_gmt":"2026-01-29T23:50:52","slug":"ocular-and-neurologic-evaluation","status":"publish","type":"page","link":"https:\/\/novel.utah.edu\/test-your-knowledge\/ocular-and-neurologic-evaluation\/","title":{"rendered":"Ocular and Neurologic Evaluation"},"content":{"rendered":"\n<p><strong><div class='ays-quiz-wrap'>\n            <div class='ays-quiz-container ays_quiz_classic_light   '\n                 data-quest-effect='none' \n                 data-hide-bg-image='false'\n                \n                \n                 id='ays-quiz-container-5'>\n                \n                \n                <div class='ays-questions-container'>\n                    <div class='ays-quiz-some-items-icons-wrap'><\/div>\n                    \n                    \n                    \n                    <form \n                        action='' \n                        method='post' \n                        autocomplete='off'\n                        id='ays_finish_quiz_5' \n                        class='ays-quiz-form enable_correction enable_questions_result '\n                    >\n            <input type='hidden' value='list' class='answer_view_class'>\n            <input type='hidden' value='list' class='answer_view_class_mobile'>\n            <input type='hidden' value='' class='ays_qm_enable_arrows'>\n            <div class='step active-step'>\n                <div class='ays-abs-fs ays-start-page'>\n                    \n                    \n                    <p class='ays-fs-title'>Ocular and Neurologic Evaluation<\/p>\n                    <div class='ays-fs-subtitle'><p><strong>Ocular and Neurologic Evaluation<\/strong> (Section B)tests you on the components of neuro-ophthalmologic examination in a clinical setting, modifications of examination techniques used in the evaluation of comatose, pediatric and non-organic visual loss subjects and applying relevant clinical and ancillary diagnostic techniques in a subject with visual disorder.<\/p>\n<\/div>\n                    <input type='hidden' name='ays_quiz_id' value='5'\/>\n                    <input type='hidden' name='ays_quiz_curent_page_link' class='ays-quiz-curent-page-link' value='https:\/\/novel.utah.edu\/test-your-knowledge\/wp-json\/wp\/v2\/pages\/71'\/>\n                    <input type='hidden' name='ays_quiz_questions' value='80,69,68,67,66,65,64,63,62,61,60,59,58,57,56,53,52,51,50,36,27,26,25,24,23,22,21,20,19,18,17,16,15,14,13,12,11,10,9,8'>\n                    \n                    <div class='ays_buttons_div'>\n                        <input type='button'   name='next' class='ays_next start_button action-button ' value='Begin' data-enable-leave-page=\"false\" \/>\n                        \n                    <\/div>\n                    \n                    \n                    \n                <\/div>\n            <\/div><div class='step  '\n                        data-question-id='80'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>1 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>What area of the face should an ophthalmologist check in this patient for a source of infection?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_1.jpg\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-80]' id='ays-answer-314-5' value='314'\/>\n\n                <label for='ays-answer-314-5' class='  ays_position_initial  '>Submandibular space<\/label><label for='ays-answer-314-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-80]' id='ays-answer-315-5' value='315'\/>\n\n                <label for='ays-answer-315-5' class='  ays_position_initial  '>Buccal space<\/label><label for='ays-answer-315-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-80]' id='ays-answer-316-5' value='316'\/>\n\n                <label for='ays-answer-316-5' class='  ays_position_initial  '>Inferior nasal concha<\/label><label for='ays-answer-316-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-80]' id='ays-answer-317-5' value='317'\/>\n\n                <label for='ays-answer-317-5' class='  ays_position_initial  '>Supraorbital foramen<\/label><label for='ays-answer-317-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[80]\" value=\"314,315,316,317\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['80'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMzE0IjoiMCIsIjMxNSI6IjEiLCIzMTYiOiIwIiwiMzE3IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2521037<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-183 size-full\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_2.jpg\" alt=\"\" width=\"223\" height=\"342\" srcset=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_2.jpg 223w, https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_2-196x300.jpg 196w\" sizes=\"auto, (max-width: 223px) 100vw, 223px\" \/><\/p>\n<p>Correct Answer:<b>\u00a0Buccal Space <\/b><\/p>\n<p>This patient likely has orbital cellulitis, based on the region and visible inflammation. In terms of a source of infection, the buccal space is particularly. As shown in the image on the right, the buccal space contains the infraorbital foramen, providing direct access to the orbit. A molar infection can easily spread from the buccal space up to the orbit.<\/p>\n<p>The submandibular space can become infected, resulting in cellulitis that can become deadly if the airway is obstructed.<\/p>\n<p>Nasal concha infections can become infected, known as concha bullosa, resulting in sinusitis.<\/p>\n<p>The supraorbital foramen contains the trigeminal nerve and would more likely result in sinusitis or neuralgia.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-183 size-full\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_2.jpg\" alt=\"\" width=\"223\" height=\"342\" srcset=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_2.jpg 223w, https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/12\/tyk_dental_infections_2-196x300.jpg 196w\" sizes=\"auto, (max-width: 223px) 100vw, 223px\" \/><\/p>\n<p>Correct Answer: <b>Buccal Space <\/b><\/p>\n<p>This patient likely has orbital cellulitis, based on the region and visible inflammation. In terms of a source of infection, the buccal space is particularly. As shown in the image on the right, the buccal space contains the infraorbital foramen, providing direct access to the orbit. A molar infection can easily spread from the buccal space up to the orbit.<\/p>\n<p>The submandibular space can become infected, resulting in cellulitis that can become deadly if the airway is obstructed.<\/p>\n<p>Nasal concha infections can become infected, known as concha bullosa, resulting in sinusitis.<\/p>\n<p>The supraorbital foramen contains the trigeminal nerve and would more likely result in sinusitis or neuralgia.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='69'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>2 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 50 year old woman reports that vision has gradually become indistinct in both eyes. Visual acuity is 20\/100 (6\/30, 0.2) in each eye. What SIMPLE maneuver would establish an optical cause for the subnormal vision?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-23_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-69]' id='ays-answer-270-5' value='270'\/>\n\n                <label for='ays-answer-270-5' class='  ays_position_initial  '>Pinhole examination<\/label><label for='ays-answer-270-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-69]' id='ays-answer-271-5' value='271'\/>\n\n                <label for='ays-answer-271-5' class='  ays_position_initial  '>Pupil examination<\/label><label for='ays-answer-271-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-69]' id='ays-answer-272-5' value='272'\/>\n\n                <label for='ays-answer-272-5' class='  ays_position_initial  '>Visual field examination<\/label><label for='ays-answer-272-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-69]' id='ays-answer-273-5' value='273'\/>\n\n                <label for='ays-answer-273-5' class='  ays_position_initial  '>Ophthalmoscopy<\/label><label for='ays-answer-273-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[69]\" value=\"270,271,272,273\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['69'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjcwIjoiMSIsIjI3MSI6IjAiLCIyNzIiOiIwIiwiMjczIjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459732<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Pinhole examination<\/b><\/p>\n<ul>\n<li>If you place a single or multiple pinhole occluder in front of each eye and discover that visual acuity markedly improves, you have assigned the problem to the optical segment. It may be an uncorrected refractive error or a defect in the cornea or lens that interferes with the formation of a point focus on the fovea. If visual acuity does not substantially improve with the pinhole test, then the problem lies in the retinocortical segment or the patient is unable or unwilling to cooperate with the pinhole test, providing a \u201cfalse negative\u201d result. If you do not have a pinhole occluder, make one by puncturing one or more millimeter holes in a piece of paper (more holes is better). Proper pupil, visual field, and ophthalmoscopic examinations provide a lot of information, but are not as well suited as the simple pinhole examination in solving this issue.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Pinhole examination<\/b><\/p>\n<ul>\n<li>If you place a single or multiple pinhole occluder in front of each eye and discover that visual acuity markedly improves, you have assigned the problem to the optical segment. It may be an uncorrected refractive error or a defect in the cornea or lens that interferes with the formation of a point focus on the fovea. If visual acuity does not substantially improve with the pinhole test, then the problem lies in the retinocortical segment or the patient is unable or unwilling to cooperate with the pinhole test, providing a \u201cfalse negative\u201d result. If you do not have a pinhole occluder, make one by puncturing one or more millimeter holes in a piece of paper (more holes is better). Proper pupil, visual field, and ophthalmoscopic examinations provide a lot of information, but are not as well suited as the simple pinhole examination in solving this issue.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='68'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>3 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>An 81 year old man with no prior ocular or neurologic problems awakens to discover that he cannot see except through a narrow channel in the center of his visual field in both eyes. Visual acuity is preserved. He is cognitively intact. These are the visual fields. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-22_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-68]' id='ays-answer-266-5' value='266'\/>\n\n                <label for='ays-answer-266-5' class='  ays_position_initial  '>Visual cortex<\/label><label for='ays-answer-266-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-68]' id='ays-answer-267-5' value='267'\/>\n\n                <label for='ays-answer-267-5' class='  ays_position_initial  '>Optic chiasm<\/label><label for='ays-answer-267-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-68]' id='ays-answer-268-5' value='268'\/>\n\n                <label for='ays-answer-268-5' class='  ays_position_initial  '>Optic nerves<\/label><label for='ays-answer-268-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-68]' id='ays-answer-269-5' value='269'\/>\n\n                <label for='ays-answer-269-5' class='  ays_position_initial  '>Retinas<\/label><label for='ays-answer-269-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[68]\" value=\"266,267,268,269\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['68'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjY2IjoiMSIsIjI2NyI6IjAiLCIyNjgiOiIwIiwiMjY5IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459731<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual cortex<\/b><\/p>\n<ul>\n<li>These constricted visual fields contain powerful localizing features--the \u201cstep-offs\u201d in the visual field defects along the vertical meridian that are identical in the corresponding hemifields. In other words, these are BILATERAL CONGRUOUS HOMONYMOUS HEMIANOPIAS. Although the responsible lesions could lie anywhere in the retrochiasmal portion of the visual pathway on both sides, the most common location would be in visual cortex, where a single event\u2014occlusion of the basilar artery or its two branches, the posterior cerebral arteries, could infarct both sides.<\/li>\n<li>Do not be surprised if the profound visual field loss is the patient\u2019s only new deficit\u2014that happens if the proximal posterior arterial circulation opens up quickly. Echocardiography showed an aortic valve vegetation, which could have been the source of emboli. Were the optic chiasm the site of damage, visual fields would have been variants of bitemporal hemianopia, not homonymous hemianopia. Bilateral optic nerve damage would cause visual field defect \u201cstep-offs\u201d along the horizontal meridian, not seen here. Bilateral simultaneous retinal events\u2014detachments or infarctions\u2014are exceedingly rare and would not cause such symmetrical visual field defects with borders aligned to the vertical meridian. By the way, the patient need not have infarcted both sides of visual cortex at the same time. He could have had an old unilateral homonymous hemianopia about which he was unaware and now experienced a second event affecting only one cerebral hemisphere.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual cortex<\/b><\/p>\n<ul>\n<li>These constricted visual fields contain powerful localizing features--the \u201cstep-offs\u201d in the visual field defects along the vertical meridian that are identical in the corresponding hemifields. In other words, these are BILATERAL CONGRUOUS HOMONYMOUS HEMIANOPIAS. Although the responsible lesions could lie anywhere in the retrochiasmal portion of the visual pathway on both sides, the most common location would be in visual cortex, where a single event\u2014occlusion of the basilar artery or its two branches, the posterior cerebral arteries, could infarct both sides.<\/li>\n<li>Do not be surprised if the profound visual field loss is the patient\u2019s only new deficit\u2014that happens if the proximal posterior arterial circulation opens up quickly. Echocardiography showed an aortic valve vegetation, which could have been the source of emboli. Were the optic chiasm the site of damage, visual fields would have been variants of bitemporal hemianopia, not homonymous hemianopia. Bilateral optic nerve damage would cause visual field defect \u201cstep-offs\u201d along the horizontal meridian, not seen here. Bilateral simultaneous retinal events\u2014detachments or infarctions\u2014are exceedingly rare and would not cause such symmetrical visual field defects with borders aligned to the vertical meridian. By the way, the patient need not have infarcted both sides of visual cortex at the same time. He could have had an old unilateral homonymous hemianopia about which he was unaware and now experienced a second event affecting only one cerebral hemisphere.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='67'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>4 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>This 22 year old woman consulted an eye specialist because she had had several near accidents while driving her car. She said that cars seemed to disappear and reappear. The eye examination was normal apart from these visual fields. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-21_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-67]' id='ays-answer-262-5' value='262'\/>\n\n                <label for='ays-answer-262-5' class='  ays_position_initial  '>Retina<\/label><label for='ays-answer-262-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-67]' id='ays-answer-263-5' value='263'\/>\n\n                <label for='ays-answer-263-5' class='  ays_position_initial  '>Optic nerve<\/label><label for='ays-answer-263-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-67]' id='ays-answer-264-5' value='264'\/>\n\n                <label for='ays-answer-264-5' class='  ays_position_initial  '>Optic chiasm<\/label><label for='ays-answer-264-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-67]' id='ays-answer-265-5' value='265'\/>\n\n                <label for='ays-answer-265-5' class='  ays_position_initial  '>Visual cortex<\/label><label for='ays-answer-265-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[67]\" value=\"262,263,264,265\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['67'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjYyIjoiMSIsIjI2MyI6IjAiLCIyNjQiOiIwIiwiMjY1IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459730<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Retina<\/b><\/p>\n<ul>\n<li>Look carefully at the shape of these defects, noting that they cross the vertical and horizontal meridians without a change in their width. In other words, there are no \u201cstep-offs.\u201d These are incomplete \u201cring defects,\u201d which are characteristic of outer retinal (pigment epithelium\/photoreceptor) dysfunction in genetic disorders called \u201cretinal dystrophies.\u201d Very rarely, these defects could be caused by paraneoplastic or idiopathic autoimmune retinopathies.<\/li>\n<li>Electroretinography will confirm loss of rod function. For most forms of these conditions, there is regrettably no effective treatment yet. The defects become gradually more extensive over ensuing years. Patients also have impaired dark adaptation, but it develops so slowly that they make accommodations and do not suspect a disease. Ophthalmoscopy typically discloses an atrophic retinal pigment epithelium, black spicules, and attenuated arterioles. But do not be surprised if ophthalmoscopy shows a normal-appearing retina! This diagnosis is often long in coming, especially if ophthalmoscopic abnormalities are subtle or absent. In that case, the deficit is often blamed on psychogenic causes. Optic neuropathies would cause defects that have \u201cstep-offs\u201d along the nasal horizontal meridian, a feature of nerve fiber bundle defects. Optic chiasm lesions and visual cortex lesions would show \u201cstep-offs\u201d along the vertical meridian.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Retina<\/b><\/p>\n<ul>\n<li>Look carefully at the shape of these defects, noting that they cross the vertical and horizontal meridians without a change in their width. In other words, there are no \u201cstep-offs.\u201d These are incomplete \u201cring defects,\u201d which are characteristic of outer retinal (pigment epithelium\/photoreceptor) dysfunction in genetic disorders called \u201cretinal dystrophies.\u201d Very rarely, these defects could be caused by paraneoplastic or idiopathic autoimmune retinopathies.<\/li>\n<li>Electroretinography will confirm loss of rod function. For most forms of these conditions, there is regrettably no effective treatment yet. The defects become gradually more extensive over ensuing years. Patients also have impaired dark adaptation, but it develops so slowly that they make accommodations and do not suspect a disease. Ophthalmoscopy typically discloses an atrophic retinal pigment epithelium, black spicules, and attenuated arterioles. But do not be surprised if ophthalmoscopy shows a normal-appearing retina! This diagnosis is often long in coming, especially if ophthalmoscopic abnormalities are subtle or absent. In that case, the deficit is often blamed on psychogenic causes. Optic neuropathies would cause defects that have \u201cstep-offs\u201d along the nasal horizontal meridian, a feature of nerve fiber bundle defects. Optic chiasm lesions and visual cortex lesions would show \u201cstep-offs\u201d along the vertical meridian.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='66'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>5 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 50 year old woman noticed \u201csomething wrong with my vision\u201d over the past several months. The examination is normal apart from these visual fields. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-20_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-66]' id='ays-answer-258-5' value='258'\/>\n\n                <label for='ays-answer-258-5' class='  ays_position_initial  '>Optic tract<\/label><label for='ays-answer-258-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-66]' id='ays-answer-259-5' value='259'\/>\n\n                <label for='ays-answer-259-5' class='  ays_position_initial  '>Lateral geniculate body<\/label><label for='ays-answer-259-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-66]' id='ays-answer-260-5' value='260'\/>\n\n                <label for='ays-answer-260-5' class='  ays_position_initial  '>Meyer\u2019s Loop<\/label><label for='ays-answer-260-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-66]' id='ays-answer-261-5' value='261'\/>\n\n                <label for='ays-answer-261-5' class='  ays_position_initial  '>Optic radiations<\/label><label for='ays-answer-261-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[66]\" value=\"258,259,260,261\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['66'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjU4IjoiMCIsIjI1OSI6IjAiLCIyNjAiOiIwIiwiMjYxIjoiMSJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459729<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic radiations <\/b><\/p>\n<ul>\n<li>This an incomplete left homonymous hemianopia in which the visual field defects have essentially the same extent in both eyes, earning the term \u201ccongruous.\u201d Congruity, a term applied only to INCOMPLETE HOMONYMOUS HEMIANOPIAS, reflects the fact that axons derived from corresponding visual field points in the retinas of both eyes have come to lie next to one another and will therefore be harmed together by single lesions. That \u201cneighborliness\u201d of corresponding axons takes place gradually as the optic radiations proceed backwards toward the visual cortex. Thus, the lesion in this patient is likely to lie in the POSTERIOR part of the optic radiations.<\/li>\n<li>Of course, it could also lie within the visual cortex (but that was not one of your choices here!).<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic radiations <\/b><\/p>\n<ul>\n<li>This an incomplete left homonymous hemianopia in which the visual field defects have essentially the same extent in both eyes, earning the term \u201ccongruous.\u201d Congruity, a term applied only to INCOMPLETE HOMONYMOUS HEMIANOPIAS, reflects the fact that axons derived from corresponding visual field points in the retinas of both eyes have come to lie next to one another and will therefore be harmed together by single lesions. That \u201cneighborliness\u201d of corresponding axons takes place gradually as the optic radiations proceed backwards toward the visual cortex. Thus, the lesion in this patient is likely to lie in the POSTERIOR part of the optic radiations.<\/li>\n<li>Of course, it could also lie within the visual cortex (but that was not one of your choices here!).<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='65'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>6 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 25 year old patient underwent visual field examination after undergoing brain surgery. He had no visual symptoms and the examination was normal apart from these visual field results. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-19_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-65]' id='ays-answer-254-5' value='254'\/>\n\n                <label for='ays-answer-254-5' class='  ays_position_initial  '>Sella turcica<\/label><label for='ays-answer-254-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-65]' id='ays-answer-255-5' value='255'\/>\n\n                <label for='ays-answer-255-5' class='  ays_position_initial  '>Right optic tract<\/label><label for='ays-answer-255-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-65]' id='ays-answer-256-5' value='256'\/>\n\n                <label for='ays-answer-256-5' class='  ays_position_initial  '>Right anterior temporal lobe<\/label><label for='ays-answer-256-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-65]' id='ays-answer-257-5' value='257'\/>\n\n                <label for='ays-answer-257-5' class='  ays_position_initial  '>Right visual cortex<\/label><label for='ays-answer-257-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[65]\" value=\"254,255,256,257\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['65'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjU0IjoiMCIsIjI1NSI6IjAiLCIyNTYiOiIxIiwiMjU3IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459728<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right anterior temporal lobe<\/b><\/p>\n<p>These visual field defects have the following distinctive features: they are wedge-shaped in both eyes with one border aligned to the vertical meridian, the other extending out radially. You can see why they are called \u201chomonymous hemianopic pie-in-the-sky\u201d defects. They represent damage to the post-geniculate axons that curve around the anterior portion of the temporal horn of the lateral ventricle (\u201cMeyer\u2019s loop\u201d) before joining up with the remaining axons of the optic radiations. If these defects had had borders aligned to the horizontal meridian, you would have called them \u201chomonymous quadrantanopias,\u201d and properly blamed the damage on a visual cortex lesion. In this case, the patient had undergone laser ablation of the anterior temporal lobe for intractable seizures. By the way, ablation extending beyond 4cm posterior to the anterior temporal tip is bound to cause such \u201cpie-in-the-sky\u201d visual field defects. The good news is that patients will not be impaired by them (or even notice them) unless the ablation extends back more than 6cm from the anterior temporal tip, in which case the root of the optic radiations may be damaged and the radial border of the homonymous defects will stretch closer to the horizontal meridian. Procedures in this region can also damage the anterior choroidal artery and its supply of the optic tract.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right anterior temporal lobe<\/b><\/p>\n<p>These visual field defects have the following distinctive features: they are wedge-shaped in both eyes with one border aligned to the vertical meridian, the other extending out radially. You can see why they are called \u201chomonymous hemianopic pie-in-the-sky\u201d defects. They represent damage to the post-geniculate axons that curve around the anterior portion of the temporal horn of the lateral ventricle (\u201cMeyer\u2019s loop\u201d) before joining up with the remaining axons of the optic radiations. If these defects had had borders aligned to the horizontal meridian, you would have called them \u201chomonymous quadrantanopias,\u201d and properly blamed the damage on a visual cortex lesion. In this case, the patient had undergone laser ablation of the anterior temporal lobe for intractable seizures. By the way, ablation extending beyond 4cm posterior to the anterior temporal tip is bound to cause such \u201cpie-in-the-sky\u201d visual field defects. The good news is that patients will not be impaired by them (or even notice them) unless the ablation extends back more than 6cm from the anterior temporal tip, in which case the root of the optic radiations may be damaged and the radial border of the homonymous defects will stretch closer to the horizontal meridian. Procedures in this region can also damage the anterior choroidal artery and its supply of the optic tract.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='64'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>7 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 74 year old woman reports being suddenly aware of a haze in the far peripheral field of her left eye. These visual fields were astutely performed on the Goldmann kinetic perimeter after ophthalmoscopy and standard static perimetry had been negative. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-18_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-64]' id='ays-answer-250-5' value='250'\/>\n\n                <label for='ays-answer-250-5' class='  ays_position_initial  '>Visual cortex<\/label><label for='ays-answer-250-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-64]' id='ays-answer-251-5' value='251'\/>\n\n                <label for='ays-answer-251-5' class='  ays_position_initial  '>Optic radiations<\/label><label for='ays-answer-251-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-64]' id='ays-answer-252-5' value='252'\/>\n\n                <label for='ays-answer-252-5' class='  ays_position_initial  '>Optic nerve<\/label><label for='ays-answer-252-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-64]' id='ays-answer-253-5' value='253'\/>\n\n                <label for='ays-answer-253-5' class='  ays_position_initial  '>Retina<\/label><label for='ays-answer-253-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[64]\" value=\"250,251,252,253\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['64'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjUwIjoiMSIsIjI1MSI6IjAiLCIyNTIiOiIwIiwiMjUzIjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459727<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual cortex<\/b><\/p>\n<ul>\n<li>No one would fault you for guessing \u201cretina,\u201d thinking that there was an overlooked abnormality--a retinal inflammation, separation, or scar. But that was not the case here. The defect derives from the other end of the visual system. Limited to the peripheral temporal field of the left eye, it is easy to miss unless you remember that the temporal field is normally more extensive than the nasal field. Standard static perimetry, which samples at most the central 30 degrees of the visual field, will always miss this defect. It is called a \u201ctemporal crescent defect,\u201d and it occurs when a lesion\u2014nearly always an infarct--damages the far anterior visual cortex in the opposite cerebral hemisphere<\/li>\n<li>Factoid: this is the only retrochiasmal visual field defect that is not a homonymous hemianopia! By the way, if a lesion can selectively damage the far anterior visual cortex, it can also selectively spare it. If you play the next video, you will see a \u201ctemporal crescent-sparing homonymous hemianopia\u201d caused by a lesion that damaged only the mid-portion and posterior portion of visual cortex.<\/li>\n<li>Patients who have this defect will be able to see in the periphery of the damaged hemifield and believe that they are safe to drive. Not really!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual cortex<\/b><\/p>\n<ul>\n<li>No one would fault you for guessing \u201cretina,\u201d thinking that there was an overlooked abnormality--a retinal inflammation, separation, or scar. But that was not the case here. The defect derives from the other end of the visual system. Limited to the peripheral temporal field of the left eye, it is easy to miss unless you remember that the temporal field is normally more extensive than the nasal field. Standard static perimetry, which samples at most the central 30 degrees of the visual field, will always miss this defect. It is called a \u201ctemporal crescent defect,\u201d and it occurs when a lesion\u2014nearly always an infarct--damages the far anterior visual cortex in the opposite cerebral hemisphere<\/li>\n<li>Factoid: this is the only retrochiasmal visual field defect that is not a homonymous hemianopia! By the way, if a lesion can selectively damage the far anterior visual cortex, it can also selectively spare it. If you play the next video, you will see a \u201ctemporal crescent-sparing homonymous hemianopia\u201d caused by a lesion that damaged only the mid-portion and posterior portion of visual cortex.<\/li>\n<li>Patients who have this defect will be able to see in the periphery of the damaged hemifield and believe that they are safe to drive. Not really!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='63'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>8 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 55 year old woman is reporting a new \u201cblur spot in the vision of my right eye\u201d since yesterday. She admits to heavy alcoholic intake. Medications include hydrochlorothiazide and simvastatin. This is the appearance of her visual fields. The right optic disc looks like this and the left optic disc is normal but cupless. There is a right afferent pupil defect. Among the following choices, what is the most likely cause?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-17_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-63]' id='ays-answer-246-5' value='246'\/>\n\n                <label for='ays-answer-246-5' class='  ays_position_initial  '>Intracranial tumor compressing the optic nerve<\/label><label for='ays-answer-246-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-63]' id='ays-answer-247-5' value='247'\/>\n\n                <label for='ays-answer-247-5' class='  ays_position_initial  '>Nutritional deficiency optic neuropathy<\/label><label for='ays-answer-247-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-63]' id='ays-answer-248-5' value='248'\/>\n\n                <label for='ays-answer-248-5' class='  ays_position_initial  '>Leber hereditary optic neuropathy<\/label><label for='ays-answer-248-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-63]' id='ays-answer-249-5' value='249'\/>\n\n                <label for='ays-answer-249-5' class='  ays_position_initial  '>Ischemic optic neuropathy<\/label><label for='ays-answer-249-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[63]\" value=\"246,247,248,249\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['63'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjQ2IjoiMCIsIjI0NyI6IjAiLCIyNDgiOiIwIiwiMjQ5IjoiMSJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459726<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Ischemic optic neuropathy<\/b><\/p>\n<ul>\n<li>The defect in the right eye has a substantial border aligned to the horizontal meridian in the nasal field. That feature marks it as a \u201cnerve fiber bundle defect\u201d that involves the upper arcuate bundles made up of retinal ganglion cell axons that converge upon the upper pole of the optic disc. This arcuate bundle can be damaged in many conditions, including optic nerve compression, inflammation, ischemia, trauma, congenital dysplasia, and retinal artery or vein occlusion. It is typically spared by hereditary (Leber, OPA 1), metabolic (nutritional and vitamin deficiency, alcoholism), and toxic (ethambutol and others) conditions, which usually damage the maculopapillar bundles to create central or centrocecal scotomas in both eyes. The swelling of the right optic nerve and the arcuate nerve fiber bundle visual field defects suggest suggest five choices: 1) inflammation (\u201cpapillitis,\u201d \u201coptic neuritis\u201d); 2) an orbital tumor; 3) an intracranial tumor entering the optic canal; 4) cancerous infiltration of the optic nerve; 5) optic nerve ischemia. Inflammation is a distinct possibility. So are tumors compressing the optic nerve in the orbit if they involve the nerve near the eye or the optic canal. So are intracranial tumors if they have entered the optic canal, a phenomenon especially common with sphenoid meningiomas.<\/li>\n<li>However, the sudden onset of vision loss and her medication list suggesting an arteriosclerotic risk profile favor a diagnosis of ischemic optic neuropathy. If she had a symptom complex to suggest polymyalgia rheumatica or cranial arteritis, you would have to consider the diagnosis of \u201carteritic ischemic optic neuropathy\u201d and order a blood sedimentation rate and C-reactive protein (\u201cacute phase reactants\u201d), place the patient on prophylactic corticosteroid, and consider performing a temporal artery ultrasound looking for the characteristic \u201chalo sign\u201d of arteritis. However, even if the ultrasound is negative, you would likely move ahead with performing a temporal artery biopsy if the acute phase reactants are elevated or the patient has systemic symptoms of an arteritis. Otherwise\u2014and most likely\u2014she has non-arteritic ischemic optic neuropathy (NAION), a bland infarct in the optic disc caused by hypoperfusion. You would be more certain of that diagnosis in follow-up. If visual function improves, you would favor a diagnosis of papillitis.<\/li>\n<li>If visual function improves, you would favor a diagnosis of papillitis. If visual function worsens, worry about inflammation, a compressive tumor, or cancer infiltrating the optic nerve. If visual function remains unchanged, your presumptive diagnosis of NAION was probably correct. There are two reasons to make a diagnosis of NAION. First, it suggests that the patient has \u201csmall vessel\u201d arterial disease, which may require prophylactic treatment. Second, there is a concern for overtreated systemic hypertension that results in low blood pressure and optic disc hypoperfusion especially during the early morning hours, which could also precipitate NAION in the unaffected eye. Monitoring of blood pressure to rule out nocturnal hypotension might reduce the chance that the second eye would be affected, a visually devastating occurrence. By the way, you should be asking whether orbit and brain imaging is indicated here. Strictly speaking, no, but the truth is that it will often be done in order to rule out those other choices without having to wait for the clinical course to establish visual stability.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Ischemic optic neuropathy<\/b><\/p>\n<ul>\n<li>The defect in the right eye has a substantial border aligned to the horizontal meridian in the nasal field. That feature marks it as a \u201cnerve fiber bundle defect\u201d that involves the upper arcuate bundles made up of retinal ganglion cell axons that converge upon the upper pole of the optic disc. This arcuate bundle can be damaged in many conditions, including optic nerve compression, inflammation, ischemia, trauma, congenital dysplasia, and retinal artery or vein occlusion. It is typically spared by hereditary (Leber, OPA 1), metabolic (nutritional and vitamin deficiency, alcoholism), and toxic (ethambutol and others) conditions, which usually damage the maculopapillar bundles to create central or centrocecal scotomas in both eyes. The swelling of the right optic nerve and the arcuate nerve fiber bundle visual field defects suggest suggest five choices: 1) inflammation (\u201cpapillitis,\u201d \u201coptic neuritis\u201d); 2) an orbital tumor; 3) an intracranial tumor entering the optic canal; 4) cancerous infiltration of the optic nerve; 5) optic nerve ischemia. Inflammation is a distinct possibility. So are tumors compressing the optic nerve in the orbit if they involve the nerve near the eye or the optic canal. So are intracranial tumors if they have entered the optic canal, a phenomenon especially common with sphenoid meningiomas.<\/li>\n<li>However, the sudden onset of vision loss and her medication list suggesting an arteriosclerotic risk profile favor a diagnosis of ischemic optic neuropathy. If she had a symptom complex to suggest polymyalgia rheumatica or cranial arteritis, you would have to consider the diagnosis of \u201carteritic ischemic optic neuropathy\u201d and order a blood sedimentation rate and C-reactive protein (\u201cacute phase reactants\u201d), place the patient on prophylactic corticosteroid, and consider performing a temporal artery ultrasound looking for the characteristic \u201chalo sign\u201d of arteritis. However, even if the ultrasound is negative, you would likely move ahead with performing a temporal artery biopsy if the acute phase reactants are elevated or the patient has systemic symptoms of an arteritis. Otherwise\u2014and most likely\u2014she has non-arteritic ischemic optic neuropathy (NAION), a bland infarct in the optic disc caused by hypoperfusion. You would be more certain of that diagnosis in follow-up. If visual function improves, you would favor a diagnosis of papillitis.<\/li>\n<li>If visual function improves, you would favor a diagnosis of papillitis. If visual function worsens, worry about inflammation, a compressive tumor, or cancer infiltrating the optic nerve. If visual function remains unchanged, your presumptive diagnosis of NAION was probably correct. There are two reasons to make a diagnosis of NAION. First, it suggests that the patient has \u201csmall vessel\u201d arterial disease, which may require prophylactic treatment. Second, there is a concern for overtreated systemic hypertension that results in low blood pressure and optic disc hypoperfusion especially during the early morning hours, which could also precipitate NAION in the unaffected eye. Monitoring of blood pressure to rule out nocturnal hypotension might reduce the chance that the second eye would be affected, a visually devastating occurrence. By the way, you should be asking whether orbit and brain imaging is indicated here. Strictly speaking, no, but the truth is that it will often be done in order to rule out those other choices without having to wait for the clinical course to establish visual stability.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='62'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>9 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>An 80 year old man complains of reduced vision in \u201cmy right eye\u201d that started 3 days ago. An optometric examination 3 months ago had been normal. Examination now is normal apart from these visual field defects. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-16_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-62]' id='ays-answer-242-5' value='242'\/>\n\n                <label for='ays-answer-242-5' class='  ays_position_initial  '>Visual Cortex<\/label><label for='ays-answer-242-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-62]' id='ays-answer-243-5' value='243'\/>\n\n                <label for='ays-answer-243-5' class='  ays_position_initial  '>Parietal Lobe<\/label><label for='ays-answer-243-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-62]' id='ays-answer-244-5' value='244'\/>\n\n                <label for='ays-answer-244-5' class='  ays_position_initial  '>Meyer&#039;s Loop<\/label><label for='ays-answer-244-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-62]' id='ays-answer-245-5' value='245'\/>\n\n                <label for='ays-answer-245-5' class='  ays_position_initial  '>Optic Tract<\/label><label for='ays-answer-245-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[62]\" value=\"242,243,244,245\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['62'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjQyIjoiMSIsIjI0MyI6IjAiLCIyNDQiOiIwIiwiMjQ1IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459725<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual cortex<\/b><\/p>\n<ul>\n<li>This is a right superior homonymous quadrantanopia\u2014a defect pattern that is exquisitely localizing\u2014to the left inferior visual cortex or its adjacent incoming axons. Notice three features of these defects: 1) they are on the same side of visual space (\u201chomonymous\u201d); 2) the defect borders are aligned to the vertical meridian (\u201chemianopic\u201d); and 3) the defect borders are aligned to the horizontal meridian. Defects with borders aligned to BOTH MERIDIANS can arise only from lesions limited to the upper or lower banks of the calcarine fissure, a brain groove that separates the superior from the inferior primary visual cortex. In this patient, the lesion lies in the lower bank<\/li>\n<li>Although it is true that a lesion of the inferior portion of the optic radiations would cause a homonymous hemianopia that preferentially affects the superior field, it would not produce visual field defects aligned to the horizontal meridian because the superior and inferior optic radiation axons do not become distinct until they reach the calcarine fissure in the occipital lobe. By the way, you should not apply the term \u201cquadrantanopia\u201d unless the defects are homonymous hemianopias with borders aligned to both the vertical and the horizontal meridian. True quadrantanopias are almost always caused by infarctions in the domain of the posterior cerebral artery, which serves the upper and lower calcarine banks with separate branches. In this patient, MRI revealed restricted diffusion in the lower bank, indicating fresh infarction; the lower branch of the posterior cerebral artery must have been occluded. Embolism is always a consideration, with the heart as a source.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual cortex<\/b><\/p>\n<ul>\n<li>This is a right superior homonymous quadrantanopia\u2014a defect pattern that is exquisitely localizing\u2014to the left inferior visual cortex or its adjacent incoming axons. Notice three features of these defects: 1) they are on the same side of visual space (\u201chomonymous\u201d); 2) the defect borders are aligned to the vertical meridian (\u201chemianopic\u201d); and 3) the defect borders are aligned to the horizontal meridian. Defects with borders aligned to BOTH MERIDIANS can arise only from lesions limited to the upper or lower banks of the calcarine fissure, a brain groove that separates the superior from the inferior primary visual cortex. In this patient, the lesion lies in the lower bank<\/li>\n<li>Although it is true that a lesion of the inferior portion of the optic radiations would cause a homonymous hemianopia that preferentially affects the superior field, it would not produce visual field defects aligned to the horizontal meridian because the superior and inferior optic radiation axons do not become distinct until they reach the calcarine fissure in the occipital lobe. By the way, you should not apply the term \u201cquadrantanopia\u201d unless the defects are homonymous hemianopias with borders aligned to both the vertical and the horizontal meridian. True quadrantanopias are almost always caused by infarctions in the domain of the posterior cerebral artery, which serves the upper and lower calcarine banks with separate branches. In this patient, MRI revealed restricted diffusion in the lower bank, indicating fresh infarction; the lower branch of the posterior cerebral artery must have been occluded. Embolism is always a consideration, with the heart as a source.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='61'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>10 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 25 year old man noticed slowly failing vision in his right eye. He had no pre-existing medical problems. Visual acuity was 20\/25 (6\/7, 0.9) in the right eye and 20\/20 (6\/6, 1.0) in the left eye. There was a mild afferent pupil defect in the right eye. The rest of the examination was normal. Here are his visual fields. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-15_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-61]' id='ays-answer-238-5' value='238'\/>\n\n                <label for='ays-answer-238-5' class='  ays_position_initial  '>Optic nerves<\/label><label for='ays-answer-238-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-61]' id='ays-answer-239-5' value='239'\/>\n\n                <label for='ays-answer-239-5' class='  ays_position_initial  '>Optic chiasm<\/label><label for='ays-answer-239-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-61]' id='ays-answer-240-5' value='240'\/>\n\n                <label for='ays-answer-240-5' class='  ays_position_initial  '>Lateral geniculate bodies<\/label><label for='ays-answer-240-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-61]' id='ays-answer-241-5' value='241'\/>\n\n                <label for='ays-answer-241-5' class='  ays_position_initial  '>Visual cortex<\/label><label for='ays-answer-241-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[61]\" value=\"238,239,240,241\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['61'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjM4IjoiMCIsIjIzOSI6IjEiLCIyNDAiOiIwIiwiMjQxIjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459724<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Optic chiasm<\/b><\/p>\n<ul>\n<li>This is the most easily recognized visual field abnormality\u2014a bitemporal hemianopia. It is the signature of an extrinsic or intrinsic lesion compressing, inflaming, infarcting, or expanding the optic chiasm.<\/li>\n<li>Actually, the most common cause of chiasmal damage is a mass lesion: pituitary adenoma, meningioma, and aneurysm in adults; craniopharyngioma and pilocytic astrocytoma in children. Why do such lesions produce this defect pattern? Because the crossing axons in the optic chiasm are especially vulnerable to any kind of insult! Patients are slow to notice the defects because the nasal field of each eye almost completely covers the temporal field of the other eye. Although they may eventually sense that peripheral vision is compromised, more often patients present with decreased vision in one eye because the lesion also compromises the function of an optic nerve. Visual fields may show a combination of nerve fiber bundle defects and temporal hemianopic defects (\u201cjunction pattern\u201d).<\/li>\n<li>This patient had a pituitary tumor.<\/li>\n<li>The serum prolactin level was normal, eliminating prolactinoma as the type of adenoma. Tip: prolactinomas are treated initially with cabergoline, a dopamine agonist that can dramatically shrink the tumor and restore normal pituitary function, but the medication must be taken indefinitely or the tumor will recur. In this patient, transsphenoidal surgery yielded complete recovery of vision. Early diagnosis of this condition unquestionably improves visual outcome!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic chiasm<\/b><\/p>\n<ul>\n<li>This is the most easily recognized visual field abnormality\u2014a bitemporal hemianopia. It is the signature of an extrinsic or intrinsic lesion compressing, inflaming, infarcting, or expanding the optic chiasm.<\/li>\n<li>Actually, the most common cause of chiasmal damage is a mass lesion: pituitary adenoma, meningioma, and aneurysm in adults; craniopharyngioma and pilocytic astrocytoma in children. Why do such lesions produce this defect pattern? Because the crossing axons in the optic chiasm are especially vulnerable to any kind of insult! Patients are slow to notice the defects because the nasal field of each eye almost completely covers the temporal field of the other eye. Although they may eventually sense that peripheral vision is compromised, more often patients present with decreased vision in one eye because the lesion also compromises the function of an optic nerve. Visual fields may show a combination of nerve fiber bundle defects and temporal hemianopic defects (\u201cjunction pattern\u201d).<\/li>\n<li>This patient had a pituitary tumor.<\/li>\n<li>The serum prolactin level was normal, eliminating prolactinoma as the type of adenoma. Tip: prolactinomas are treated initially with cabergoline, a dopamine agonist that can dramatically shrink the tumor and restore normal pituitary function, but the medication must be taken indefinitely or the tumor will recur. In this patient, transsphenoidal surgery yielded complete recovery of vision. Early diagnosis of this condition unquestionably improves visual outcome!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='60'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>11 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 35 year old man reports slowly progressive vision loss in both eyes of many months\u2019 duration. Visual acuity is 20\/200 (6\/60, 0.1) in both eyes. There is no afferent pupil defect. Optic discs show mild temporal pallor, but the examination is otherwise normal. These are the visual fields. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-14_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-60]' id='ays-answer-234-5' value='234'\/>\n\n                <label for='ays-answer-234-5' class='  ays_position_initial  '>Retina<\/label><label for='ays-answer-234-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-60]' id='ays-answer-235-5' value='235'\/>\n\n                <label for='ays-answer-235-5' class='  ays_position_initial  '>Optic nerve<\/label><label for='ays-answer-235-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-60]' id='ays-answer-236-5' value='236'\/>\n\n                <label for='ays-answer-236-5' class='  ays_position_initial  '>Optic chiasm<\/label><label for='ays-answer-236-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-60]' id='ays-answer-237-5' value='237'\/>\n\n                <label for='ays-answer-237-5' class='  ays_position_initial  '>Visual cortex<\/label><label for='ays-answer-237-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[60]\" value=\"234,235,236,237\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['60'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjM0IjoiMCIsIjIzNSI6IjEiLCIyMzYiOiIwIiwiMjM3IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459723<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic nerve<\/b><\/p>\n<ul>\n<li>The visual field defects are \u201ccecocentral scotomas\u201d (also called \u201ccentrocecal scotomas\u201d) because they affect the visual field that lies between fixation and the physiologic blind spot. Whenever you encounter this pattern of visual field loss in both eyes, think mitochondria of retinal ganglion cells. The unmyelinated axons of those ganglion cells lie in the temporal portion of the optic disc, which is why that portion of the optic disc eventually appears pale.<\/li>\n<li>The pathology thins out the retinal nerve fiber layer around the fovea and between the fovea and the optic disc, which will be evident on optical coherence tomography (OCT). Toxic, metabolic (including nutritional deficiency), and hereditary conditions are behind this damage. Consider these common causes: ethambutol toxicity, thiamine (B1) and hydroxycobalamin (B12) deficiencies, alcoholism, starvation diets, non-adherence to vitamin supplementation after bariatric surgery, hereditary dominant (OPA 1) and Leber optic neuropathies.<\/li>\n<\/ul>\n<p>This patient admitted to severe alcoholism. Treatment consisted of heavy thiamine dosing and abstinence. Vision is more likely to recover if the patient is adherent to the treatment regimen, if the optic discs have not developed pallor, and if OCT does not show thinning. Hence the importance of early diagnosis, especially in patients taking ethambutol, where scrupulous monitoring of visual acuity and color vision is advisable, so that the medication can be discontinued at the first sign of optic nerve toxicity.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic nerve<\/b><\/p>\n<ul>\n<li>The visual field defects are \u201ccecocentral scotomas\u201d (also called \u201ccentrocecal scotomas\u201d) because they affect the visual field that lies between fixation and the physiologic blind spot. Whenever you encounter this pattern of visual field loss in both eyes, think mitochondria of retinal ganglion cells. The unmyelinated axons of those ganglion cells lie in the temporal portion of the optic disc, which is why that portion of the optic disc eventually appears pale.<\/li>\n<li>The pathology thins out the retinal nerve fiber layer around the fovea and between the fovea and the optic disc, which will be evident on optical coherence tomography (OCT). Toxic, metabolic (including nutritional deficiency), and hereditary conditions are behind this damage. Consider these common causes: ethambutol toxicity, thiamine (B1) and hydroxycobalamin (B12) deficiencies, alcoholism, starvation diets, non-adherence to vitamin supplementation after bariatric surgery, hereditary dominant (OPA 1) and Leber optic neuropathies.<\/li>\n<\/ul>\n<p>This patient admitted to severe alcoholism. Treatment consisted of heavy thiamine dosing and abstinence. Vision is more likely to recover if the patient is adherent to the treatment regimen, if the optic discs have not developed pallor, and if OCT does not show thinning. Hence the importance of early diagnosis, especially in patients taking ethambutol, where scrupulous monitoring of visual acuity and color vision is advisable, so that the medication can be discontinued at the first sign of optic nerve toxicity.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='59'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>12 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 35 year old woman reports new vision loss. The examination is normal except that she consistently fails to identify any visual targets presented alone in her left hemifield, whereas she always identifies them when they are presented in her right hemifield. Formal visual field testing discloses these visual field abnormalities. Brain MRI is certifiably normal. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-13_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-59]' id='ays-answer-230-5' value='230'\/>\n\n                <label for='ays-answer-230-5' class='  ays_position_initial  '>Optic Tract<\/label><label for='ays-answer-230-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-59]' id='ays-answer-231-5' value='231'\/>\n\n                <label for='ays-answer-231-5' class='  ays_position_initial  '>Optic Radiations<\/label><label for='ays-answer-231-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-59]' id='ays-answer-232-5' value='232'\/>\n\n                <label for='ays-answer-232-5' class='  ays_position_initial  '>Visual Cortex<\/label><label for='ays-answer-232-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-59]' id='ays-answer-233-5' value='233'\/>\n\n                <label for='ays-answer-233-5' class='  ays_position_initial  '>Somewhere in the retrochiasmal visual pathway<\/label><label for='ays-answer-233-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[59]\" value=\"230,231,232,233\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['59'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjMwIjoiMCIsIjIzMSI6IjAiLCIyMzIiOiIwIiwiMjMzIjoiMSJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459722<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Somewhere in the <\/b><b>retrochiasmal<\/b><b> visual pathway<\/b><\/p>\n<ul>\n<li>Although this seems a relatively evasive answer, it is correct. You are looking at a complete homonymous hemianopia identified on confrontation and formal visual field testing. When a homonymous hemianopia is COMPLETE, you can localize it to the retrochiasmal visual pathway, but not to a specific region within that pathway! As the MRI is certifiably normal, you will wonder if the defect is of psychogenic origin. That presumption is difficult to disprove clinically. Some clinicians have developed maneuvers, such as having patients rapidly switch fixation back and forth between single targets displayed in opposite hemifields, but I have had a hard time convincing myself that I can exclude psychogenic \u201chomonymous hemianopia.\u201d Be careful here, as there are several retrochiasmal lesions that are either invisible on MRI or so subtle that they may be overlooked.<\/li>\n<li>Among those lesions are: 1) Recent hypoxic-ischemic injury owing to sudden systemic hypotension (MRI visual cortex volume loss may develop months later); 2) Creutzfeldt-Jakob disease, a prion protein disorder that may show subtle relevant MRI abnormalities only months later (positron emission tomography would earlier show a metabolically low visual cortex region); 3) focal encephalitis, also called \u201ccerebritis\u201d (small areas of high T2\/FLAIR or cortical enhancement may be overlooked or dismissed); 4) Alzheimer disease with predominant volume loss in posterior cerebral hemisphere (relatively more MRI volume loss on the side opposite to the hemianopia may be overlooked); 5) focal metabolic encephalopathy in nonketotic hyperglycemia or mitochondrial cytopathy (which can be evanescent); and 6) optic tract lesion (because it is a narrow structure wedged between midbrain and temporal lobe, lesions here are often overlooked). This patient had signal abnormalities in the right optic tract and in the cervical spinal cord consistent with multiple sclerosis.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Somewhere in the <\/b><b>retrochiasmal<\/b><b> visual pathway<\/b><\/p>\n<ul>\n<li>Although this seems a relatively evasive answer, it is correct. You are looking at a complete homonymous hemianopia identified on confrontation and formal visual field testing. When a homonymous hemianopia is COMPLETE, you can localize it to the retrochiasmal visual pathway, but not to a specific region within that pathway! As the MRI is certifiably normal, you will wonder if the defect is of psychogenic origin. That presumption is difficult to disprove clinically. Some clinicians have developed maneuvers, such as having patients rapidly switch fixation back and forth between single targets displayed in opposite hemifields, but I have had a hard time convincing myself that I can exclude psychogenic \u201chomonymous hemianopia.\u201d Be careful here, as there are several retrochiasmal lesions that are either invisible on MRI or so subtle that they may be overlooked.<\/li>\n<li>Among those lesions are: 1) Recent hypoxic-ischemic injury owing to sudden systemic hypotension (MRI visual cortex volume loss may develop months later); 2) Creutzfeldt-Jakob disease, a prion protein disorder that may show subtle relevant MRI abnormalities only months later (positron emission tomography would earlier show a metabolically low visual cortex region); 3) focal encephalitis, also called \u201ccerebritis\u201d (small areas of high T2\/FLAIR or cortical enhancement may be overlooked or dismissed); 4) Alzheimer disease with predominant volume loss in posterior cerebral hemisphere (relatively more MRI volume loss on the side opposite to the hemianopia may be overlooked); 5) focal metabolic encephalopathy in nonketotic hyperglycemia or mitochondrial cytopathy (which can be evanescent); and 6) optic tract lesion (because it is a narrow structure wedged between midbrain and temporal lobe, lesions here are often overlooked). This patient had signal abnormalities in the right optic tract and in the cervical spinal cord consistent with multiple sclerosis.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='58'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>13 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 67 year old man notices \u201csomething wrong with my vision\u201d as he awakens from heart surgery. Yet visual acuities are normal, there are no pupillary abnormalities, confrontation visual fields are full, and the eyes appear structurally normal. A neurologist pronounces the examination normal. Once the patient has recuperated enough for formal visual examination, this result appears. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-12_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-58]' id='ays-answer-226-5' value='226'\/>\n\n                <label for='ays-answer-226-5' class='  ays_position_initial  '>Retina<\/label><label for='ays-answer-226-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-58]' id='ays-answer-227-5' value='227'\/>\n\n                <label for='ays-answer-227-5' class='  ays_position_initial  '>Optic Nerve<\/label><label for='ays-answer-227-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-58]' id='ays-answer-228-5' value='228'\/>\n\n                <label for='ays-answer-228-5' class='  ays_position_initial  '>Optic Chiasm<\/label><label for='ays-answer-228-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-58]' id='ays-answer-229-5' value='229'\/>\n\n                <label for='ays-answer-229-5' class='  ays_position_initial  '>Visual Cortex<\/label><label for='ays-answer-229-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[58]\" value=\"226,227,228,229\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['58'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjI2IjoiMCIsIjIyNyI6IjAiLCIyMjgiOiIwIiwiMjI5IjoiMSJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459721<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual Cortex<\/b><\/p>\n<ul>\n<li>These small defects in the left hemifields are confined to the central degrees of the visual field. They are called \u201chomonymous hemianopic paracentral scotomas.\u201d Because they lie so close to the fixation point, they cause troublesome visual symptoms. They slow reading speed, as the patient consistently misses the first part of each word. You will be surprised to discover that the lesion occupied the entire back half of the visual cortex on the right side! Why would such a large lesion cause such small defects? Because the human brain devotes the entire posterior half of visual cortex to the central 10 degrees of the visual field, a phenomenon called the \u201cmagnification factor.\u201d It testifies to the importance of \u201cfoveal vision\u201d in primates.<\/li>\n<li>Such paracentral defects are routinely overlooked on standard static perimetry protocols, in which the test points are spaced far enough apart (\u201c6 degrees of separation\u201d) to miss the defects. Protocols that sample the central 10 degrees with test points at closer intervals are more likely to find these defects. In this patient, the defects were caused by posterior cerebral artery infarction, possibly related to embolism during the heart surgery.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual Cortex<\/b><\/p>\n<ul>\n<li>These small defects in the left hemifields are confined to the central degrees of the visual field. They are called \u201chomonymous hemianopic paracentral scotomas.\u201d Because they lie so close to the fixation point, they cause troublesome visual symptoms. They slow reading speed, as the patient consistently misses the first part of each word. You will be surprised to discover that the lesion occupied the entire back half of the visual cortex on the right side! Why would such a large lesion cause such small defects? Because the human brain devotes the entire posterior half of visual cortex to the central 10 degrees of the visual field, a phenomenon called the \u201cmagnification factor.\u201d It testifies to the importance of \u201cfoveal vision\u201d in primates.<\/li>\n<li>Such paracentral defects are routinely overlooked on standard static perimetry protocols, in which the test points are spaced far enough apart (\u201c6 degrees of separation\u201d) to miss the defects. Protocols that sample the central 10 degrees with test points at closer intervals are more likely to find these defects. In this patient, the defects were caused by posterior cerebral artery infarction, possibly related to embolism during the heart surgery.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='57'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>14 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 29 year old woman noticed a defect in the vision of \u201cmy left eye\u201d of uncertain duration. Optometric and ophthalmologic examinations were negative. The patient sought care from a neurologist for numbness in the legs, but the examination was normal. Because the vision defect persisted, the patient returned to the optometrist, who now performed a formal visual field examination that yielded this result. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-11_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-57]' id='ays-answer-222-5' value='222'\/>\n\n                <label for='ays-answer-222-5' class='  ays_position_initial  '>Optic chiasm<\/label><label for='ays-answer-222-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-57]' id='ays-answer-223-5' value='223'\/>\n\n                <label for='ays-answer-223-5' class='  ays_position_initial  '>Optic Tract<\/label><label for='ays-answer-223-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-57]' id='ays-answer-224-5' value='224'\/>\n\n                <label for='ays-answer-224-5' class='  ays_position_initial  '>Optic Radiations<\/label><label for='ays-answer-224-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-57]' id='ays-answer-225-5' value='225'\/>\n\n                <label for='ays-answer-225-5' class='  ays_position_initial  '>Visual Cortex<\/label><label for='ays-answer-225-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[57]\" value=\"222,223,224,225\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['57'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjIyIjoiMCIsIjIyMyI6IjEiLCIyMjQiOiIwIiwiMjI1IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459720<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic Tract<\/b><\/p>\n<ul>\n<li>These visual field defects are confined to the left hemifields in both eyes and they have borders aligned to the vertical meridian, defining them as an incomplete \u201chomonymous hemianopia.\u201d But notice also that the defects in the two eyes are not of the same extent. If you overlaid them, they would not superimpose. This difference in the size of the two defects is called \u201cincongruity.\u201d If that incongruity is a true representation\u2014and not simply an inconsistency in patient performance on the test\u2014then the lesion must lie in the optic tract, where axons from corresponding points in the retinas of the two eyes have not yet come to lie close to one another.<\/li>\n<li>After all, the optic tract is early in the retrochiasmal portion of the visual pathway, which carries out the transformation of visual representation in the brain from monocular to hemifield. As the axons proceed farther posteriorly, through the lateral geniculate bodies and optic radiations to visual cortex, axons from corresponding retinal points become neighbors and incomplete homonymous hemianopias become more congruous. By the way, why did the patient say that she had lost vision \u201cin my left eye?\u201d Because patients will almost always blame a homonymous hemianopia on the eye on the side of the hemianopia! In this patient, brain MRI disclosed enhancement in the right optic tract and other signal abnormalities consistent with multiple sclerosis.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Optic Tract<\/b><\/p>\n<ul>\n<li>These visual field defects are confined to the left hemifields in both eyes and they have borders aligned to the vertical meridian, defining them as an incomplete \u201chomonymous hemianopia.\u201d But notice also that the defects in the two eyes are not of the same extent. If you overlaid them, they would not superimpose. This difference in the size of the two defects is called \u201cincongruity.\u201d If that incongruity is a true representation\u2014and not simply an inconsistency in patient performance on the test\u2014then the lesion must lie in the optic tract, where axons from corresponding points in the retinas of the two eyes have not yet come to lie close to one another.<\/li>\n<li>After all, the optic tract is early in the retrochiasmal portion of the visual pathway, which carries out the transformation of visual representation in the brain from monocular to hemifield. As the axons proceed farther posteriorly, through the lateral geniculate bodies and optic radiations to visual cortex, axons from corresponding retinal points become neighbors and incomplete homonymous hemianopias become more congruous. By the way, why did the patient say that she had lost vision \u201cin my left eye?\u201d Because patients will almost always blame a homonymous hemianopia on the eye on the side of the hemianopia! In this patient, brain MRI disclosed enhancement in the right optic tract and other signal abnormalities consistent with multiple sclerosis.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='56'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>15 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 72 year old man noticed a stable defect in the vision of his left eye of uncertain duration. He made visits to an optometrist and ophthalmologist, which consistently disclosed normal visual acuities, pupillary reflexes, confrontation visual fields, clear ocular media, and normal-appearing retinas and optic discs. Eventually this visual field examination result emerged. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-10_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-56]' id='ays-answer-218-5' value='218'\/>\n\n                <label for='ays-answer-218-5' class='  ays_position_initial  '>Retina<\/label><label for='ays-answer-218-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-56]' id='ays-answer-219-5' value='219'\/>\n\n                <label for='ays-answer-219-5' class='  ays_position_initial  '>Optic Nerve<\/label><label for='ays-answer-219-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-56]' id='ays-answer-220-5' value='220'\/>\n\n                <label for='ays-answer-220-5' class='  ays_position_initial  '>Optic Radiations<\/label><label for='ays-answer-220-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-56]' id='ays-answer-221-5' value='221'\/>\n\n                <label for='ays-answer-221-5' class='  ays_position_initial  '>Visual Cortex<\/label><label for='ays-answer-221-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[56]\" value=\"218,219,220,221\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['56'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjE4IjoiMCIsIjIxOSI6IjAiLCIyMjAiOiIwIiwiMjIxIjoiMSJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459719<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual Cortex<\/b><\/p>\n<ul>\n<li>Notice three features of these visual field defects: 1) confined to the left hemifields in both eyes; 2) have discrete borders along the vertical meridian; 3) spare the central 10 degrees of the visual fields. These features define a \u201cmacular-sparing homonymous hemianopia,\u201d one of the most localizing of all visual field defects! This pattern always derives from a lesion in the visual cortex that spares the posterior portion of that cortex, the termination point of axons carrying visual information from the central 10 degrees of the visual field.<\/li>\n<li>The patient was slow to notice these defects because of macular sparing, which allowed him to read at nearly normal speed and to ignore the more peripheral scotomas. He thought he could drive safely. However, in most jurisdictions, the finding of macular-sparing homonymous hemianopia would preclude a patient from being issued a driving license! The cause of these defects was an ischemic stroke in the distribution of the right posterior cerebral artery.<\/li>\n<li>The defects are permanent. He had atrial fibrillation and required long term rate control and anticoagulation to prevent future stroke.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Visual Cortex<\/b><\/p>\n<ul>\n<li>Notice three features of these visual field defects: 1) confined to the left hemifields in both eyes; 2) have discrete borders along the vertical meridian; 3) spare the central 10 degrees of the visual fields. These features define a \u201cmacular-sparing homonymous hemianopia,\u201d one of the most localizing of all visual field defects! This pattern always derives from a lesion in the visual cortex that spares the posterior portion of that cortex, the termination point of axons carrying visual information from the central 10 degrees of the visual field.<\/li>\n<li>The patient was slow to notice these defects because of macular sparing, which allowed him to read at nearly normal speed and to ignore the more peripheral scotomas. He thought he could drive safely. However, in most jurisdictions, the finding of macular-sparing homonymous hemianopia would preclude a patient from being issued a driving license! The cause of these defects was an ischemic stroke in the distribution of the right posterior cerebral artery.<\/li>\n<li>The defects are permanent. He had atrial fibrillation and required long term rate control and anticoagulation to prevent future stroke.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='53'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>16 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 54 year old woman is brought to you for anisocoria. As you can see, the left pupil is larger than the right pupil. The right pupil does not constrict to light; the left pupil constricts normally. Which maneuver should you next perform to help with the diagnosis?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-5_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-53]' id='ays-answer-206-5' value='206'\/>\n\n                <label for='ays-answer-206-5' class='  ays_position_initial  '>Assessment of right pupil constriction to a near target<\/label><label for='ays-answer-206-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-53]' id='ays-answer-207-5' value='207'\/>\n\n                <label for='ays-answer-207-5' class='  ays_position_initial  '>Biomicroscopic (slit lamp) examination for iris defects<\/label><label for='ays-answer-207-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-53]' id='ays-answer-208-5' value='208'\/>\n\n                <label for='ays-answer-208-5' class='  ays_position_initial  '>Instillation of apraclonidine 0.5% onto both eyes<\/label><label for='ays-answer-208-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-53]' id='ays-answer-209-5' value='209'\/>\n\n                <label for='ays-answer-209-5' class='  ays_position_initial  '>Instillation of cocaine 10% onto both eyes<\/label><label for='ays-answer-209-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[53]\" value=\"206,207,208,209\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['53'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjA2IjoiMSIsIjIwNyI6IjAiLCIyMDgiOiIwIiwiMjA5IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459716<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Assessment of right pupil constriction to a near target <\/b><\/p>\n<ul>\n<li>Whenever a pupil does not constrict properly to direct light, you should assess whether it constricts to a target placed within reading distance. Why? Because if the pupil constricts poorly to direct light, but much better to a target placed within reading distance, you will diagnose \u201clight-near dissociation,\u201d a phenomenon of great clinical value. In the presence of anisocoria, it signifies a lesion in either the midbrain\/pretectum or the ciliary ganglion\/ciliary nerves. A dorsal midbrain\/pretectum region lesion causes anisocoria and light-near dissociation by asymmetric interruption of afferent input to the Edinger-Westphal (parasympathetic) nuclei. An irregular (oval) pupil and slow (tonic) constriction to a near target should not be present. And other signs of dorsal midbrain syndrome\u2014especially upgaze deficiency\u2014will always be present! You could not be ashamed if you chose, as an answer here, to perform biomicroscopic examination in search of iris defects. However, light-near dissociation and tonicity will not be present in iris sphincter dysfunction. If you presumptively diagnose a tonic pupil, you could instill a few drops of dilute (0.1%) pilocarpine in both eyes to search for postganglionic parasympathetic iris sphincter denervation supersensitivity. But as pilocarpine 0.1% is not commercially available, you would have to dilute 1% pilocarpine, a maneuver full of errors and a risk of contamination. And some patients with preganglionic third nerve lesions will display denervation supersensitivity, misleading you from the correct localization. In summary, then, your clinical diagnosis of Adie tonic pupil should be based on finding pupil ovality, tonicity, and light-near dissociation. To be even more certain of the diagnosis, make sure that there are no signs of a preganglionic third nerve palsy. A small pupil with light-near dissociation would prompt consideration of syphilis-- the Argyll Robertson (AR) pupil. Some people (including this observer) believe that the AR pupil is actually a chronic Adie pupil caused by syphilitic involvement of the ciliary ganglion. But you should initiate an evaluation for syphilis ONLY if there are other neurologic signs typical of this disease! Apraclonidine and cocaine are topical agents used when the patient has anisocoria and both pupils constrict normally to light.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Assessment of right pupil constriction to a near target <\/b><\/p>\n<ul>\n<li>Whenever a pupil does not constrict properly to direct light, you should assess whether it constricts to a target placed within reading distance. Why? Because if the pupil constricts poorly to direct light, but much better to a target placed within reading distance, you will diagnose \u201clight-near dissociation,\u201d a phenomenon of great clinical value. In the presence of anisocoria, it signifies a lesion in either the midbrain\/pretectum or the ciliary ganglion\/ciliary nerves. A dorsal midbrain\/pretectum region lesion causes anisocoria and light-near dissociation by asymmetric interruption of afferent input to the Edinger-Westphal (parasympathetic) nuclei. An irregular (oval) pupil and slow (tonic) constriction to a near target should not be present. And other signs of dorsal midbrain syndrome\u2014especially upgaze deficiency\u2014will always be present! You could not be ashamed if you chose, as an answer here, to perform biomicroscopic examination in search of iris defects. However, light-near dissociation and tonicity will not be present in iris sphincter dysfunction. If you presumptively diagnose a tonic pupil, you could instill a few drops of dilute (0.1%) pilocarpine in both eyes to search for postganglionic parasympathetic iris sphincter denervation supersensitivity. But as pilocarpine 0.1% is not commercially available, you would have to dilute 1% pilocarpine, a maneuver full of errors and a risk of contamination. And some patients with preganglionic third nerve lesions will display denervation supersensitivity, misleading you from the correct localization. In summary, then, your clinical diagnosis of Adie tonic pupil should be based on finding pupil ovality, tonicity, and light-near dissociation. To be even more certain of the diagnosis, make sure that there are no signs of a preganglionic third nerve palsy. A small pupil with light-near dissociation would prompt consideration of syphilis-- the Argyll Robertson (AR) pupil. Some people (including this observer) believe that the AR pupil is actually a chronic Adie pupil caused by syphilitic involvement of the ciliary ganglion. But you should initiate an evaluation for syphilis ONLY if there are other neurologic signs typical of this disease! Apraclonidine and cocaine are topical agents used when the patient has anisocoria and both pupils constrict normally to light.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='52'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>17 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>24 year old man reports gradually losing vision in both eyes and being bothered by sunshine. Your examination shows a visual acuity of 20\/60 (6\/18, 0.3) in both eyes with normal pupil size and constriction to light, full confrontation visual fields, and a normal-appearing optic fundus. With either eye being tested, he identifies only the Ishihara Pseudoisochromatic control plate (pictured here). Formal perimetry yields unreliable results. What is the most likely cause for these abnormalities?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-3_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-52]' id='ays-answer-202-5' value='202'\/>\n\n                <label for='ays-answer-202-5' class='  ays_position_initial  '>Psychogenic vision loss<\/label><label for='ays-answer-202-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-52]' id='ays-answer-203-5' value='203'\/>\n\n                <label for='ays-answer-203-5' class='  ays_position_initial  '>Bilateral optic neuropathy<\/label><label for='ays-answer-203-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-52]' id='ays-answer-204-5' value='204'\/>\n\n                <label for='ays-answer-204-5' class='  ays_position_initial  '>Photoreceptor disorder<\/label><label for='ays-answer-204-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-52]' id='ays-answer-205-5' value='205'\/>\n\n                <label for='ays-answer-205-5' class='  ays_position_initial  '>Congenital dyschromatopsia<\/label><label for='ays-answer-205-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[52]\" value=\"202,203,204,205\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['52'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjAyIjoiMCIsIjIwMyI6IjAiLCIyMDQiOiIxIiwiMjA1IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459715<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Photoreceptor disorder<\/b><\/p>\n<ul>\n<li>You cannot be faulted for judging the sensitivity to light, impaired visual acuity and color vision, and unreliable formal visual field results as manifestations of a psychogenic disorder. But organic causes could be at work! A bilateral optic neuropathy is not it because Ishihara color vision is too poor. Congenital dyschromatopsia would not cause degraded visual acuity. You must consider a diagnosis of cone dystrophy--even if the optic fundus examination appears normal, as it often does in that condition. You would settle the issue with an electroretinogram (ERG), which should show abnormalities in cone function. Optical coherence tomography might also show a disordered outer retina. Were you thrown off by the normal confrontation visual fields? Don\u2019t be. That technique is insensitive to central scotomas. Why is he bothered by sunshine? Patients with cone dystrophy often complain of being aversive to normal daylight (\u201chemeraopia\u201d) because the disordered cone function cannot transduce light into neural signals. The lack of a family history should not dissuade you from the diagnosis. For now, there are no proven treatments for cone dystrophy, which can become apparent at any age. Visual acuity will gradually decline over time. Two extremely rare conditions\u2014autoimmune retinopathy and cancer-associated (paraneoplastic) retinopathy\u2014should be excluded in the proper setting. Diagnosis depends on demonstrating anti-retinal antibodies in addition to the typical ERG abnormalities.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Photoreceptor disorder<\/b><\/p>\n<ul>\n<li>You cannot be faulted for judging the sensitivity to light, impaired visual acuity and color vision, and unreliable formal visual field results as manifestations of a psychogenic disorder. But organic causes could be at work! A bilateral optic neuropathy is not it because Ishihara color vision is too poor. Congenital dyschromatopsia would not cause degraded visual acuity. You must consider a diagnosis of cone dystrophy--even if the optic fundus examination appears normal, as it often does in that condition. You would settle the issue with an electroretinogram (ERG), which should show abnormalities in cone function. Optical coherence tomography might also show a disordered outer retina. Were you thrown off by the normal confrontation visual fields? Don\u2019t be. That technique is insensitive to central scotomas. Why is he bothered by sunshine? Patients with cone dystrophy often complain of being aversive to normal daylight (\u201chemeraopia\u201d) because the disordered cone function cannot transduce light into neural signals. The lack of a family history should not dissuade you from the diagnosis. For now, there are no proven treatments for cone dystrophy, which can become apparent at any age. Visual acuity will gradually decline over time. Two extremely rare conditions\u2014autoimmune retinopathy and cancer-associated (paraneoplastic) retinopathy\u2014should be excluded in the proper setting. Diagnosis depends on demonstrating anti-retinal antibodies in addition to the typical ERG abnormalities.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='51'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>18 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 6 month old boy is sent to you because his parents have noticed that their child\u2019s eyes have been \u201cinwardly crossed\u201d since birth. They had hoped for spontaneous improvement, but that has not happened. Your examination discloses that the child fixes and follows with each eye when either eye is occluded. You find a comitant esotropia when the child views distant and near targets. Ocular ductions are full and there is no nystagmus. The refractive error is plano, ophthalmoscopy is normal, and both pupils constrict normally to light without afferent pupil defect. The likely cause of this abnormality is\u2026<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-2_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-51]' id='ays-answer-198-5' value='198'\/>\n\n                <label for='ays-answer-198-5' class='  ays_position_initial  '>Sixth nerve palsy<\/label><label for='ays-answer-198-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-51]' id='ays-answer-199-5' value='199'\/>\n\n                <label for='ays-answer-199-5' class='  ays_position_initial  '>Accommodative esotropia<\/label><label for='ays-answer-199-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-51]' id='ays-answer-200-5' value='200'\/>\n\n                <label for='ays-answer-200-5' class='  ays_position_initial  '>Infantile esotropia<\/label><label for='ays-answer-200-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-51]' id='ays-answer-201-5' value='201'\/>\n\n                <label for='ays-answer-201-5' class='  ays_position_initial  '>Sensory esotropia<\/label><label for='ays-answer-201-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[51]\" value=\"198,199,200,201\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['51'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMTk4IjoiMCIsIjE5OSI6IjAiLCIyMDAiOiIxIiwiMjAxIjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459714<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Infantile esotropia<\/b><\/p>\n<ul>\n<li>If your observation is correct that ocular ductions are full and the esotropia is comitant (the misalignment is of the same amount in right and left gaze), the abnormality is not likely to be a sixth nerve palsy. Why not? Because sixth nerve palsy should show an abduction deficit (although it could be mild) and produce an incomitant esotropia with greatest amount in ipsilateral gaze. Yes, sixth nerve palsy can eventually develop full ductions and become a comitant esotropia, but that would be highly unusual in a 6 month old child. Accommodative esotropia is ruled out by the plano refraction. Sensory esotropia, a diagnosis applied when the misalignment represents a breakdown of fusion owing to an underlying vision deficit, is an unlikely choice because the examination shows apparently good vision in each eye, a normal fundus examination, and no afferent pupil defect. Of course, these conclusions depend on a skillful, thorough examination and reliable findings\u2014not easy in such a young child. Be careful!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Infantile esotropia<\/b><\/p>\n<ul>\n<li>If your observation is correct that ocular ductions are full and the esotropia is comitant (the misalignment is of the same amount in right and left gaze), the abnormality is not likely to be a sixth nerve palsy. Why not? Because sixth nerve palsy should show an abduction deficit (although it could be mild) and produce an incomitant esotropia with greatest amount in ipsilateral gaze. Yes, sixth nerve palsy can eventually develop full ductions and become a comitant esotropia, but that would be highly unusual in a 6 month old child. Accommodative esotropia is ruled out by the plano refraction. Sensory esotropia, a diagnosis applied when the misalignment represents a breakdown of fusion owing to an underlying vision deficit, is an unlikely choice because the examination shows apparently good vision in each eye, a normal fundus examination, and no afferent pupil defect. Of course, these conclusions depend on a skillful, thorough examination and reliable findings\u2014not easy in such a young child. Be careful!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='50'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>19 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 70 year old woman reports that she has new diplopia. When she closes either eye, the second image disappears. Eye movements are full without nystagmus. The first examiner performs the cover test and finds no refixational movements in the uncovered eye. The second examiner finds that there is an outward refixational movement of the uncovered eye. Why was there a difference in the results of the two examinations?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-ex-1_23.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-50]' id='ays-answer-194-5' value='194'\/>\n\n                <label for='ays-answer-194-5' class='  ays_position_initial  '>The first examiner is correct; the second examiner misinterpreted the test result because the patient had poor fixation of the target<\/label><label for='ays-answer-194-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-50]' id='ays-answer-195-5' value='195'\/>\n\n                <label for='ays-answer-195-5' class='  ays_position_initial  '>The first examiner is correct; the second examiner did not properly occlude the covered eye<\/label><label for='ays-answer-195-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-50]' id='ays-answer-196-5' value='196'\/>\n\n                <label for='ays-answer-196-5' class='  ays_position_initial  '>The second examiner is correct; the first examiner failed to instruct the patient to make the viewed target \u201ccome into focus.\u201d<\/label><label for='ays-answer-196-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-50]' id='ays-answer-197-5' value='197'\/>\n\n                <label for='ays-answer-197-5' class='  ays_position_initial  '>The second examiner is correct; the first examiner failed to properly occlude the covered eye<\/label><label for='ays-answer-197-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[50]\" value=\"194,195,196,197\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['50'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMTk0IjoiMCIsIjE5NSI6IjAiLCIxOTYiOiIxIiwiMTk3IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459713<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>The second examiner is correct; the first examiner failed to instruct the patient to make the viewed target \u201ccome into focus.\u201d<\/b><\/p>\n<ul>\n<li>This is the most common technical error in using the cover test. If patients do not understand to bring the viewed target into focus, they will fail to execute a refixational movement to place the viewed target onto the fovea. In that circumstance, ocular misalignment in any plane will be overlooked. The single Maddox rod test, which does not depend on refixational eye movements, would reveal the ocular misalignment.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>The second examiner is correct; the first examiner failed to instruct the patient to make the viewed target \u201ccome into focus.\u201d<\/b><\/p>\n<ul>\n<li>This is the most common technical error in using the cover test. If patients do not understand to bring the viewed target into focus, they will fail to execute a refixational movement to place the viewed target onto the fovea. In that circumstance, ocular misalignment in any plane will be overlooked. The single Maddox rod test, which does not depend on refixational eye movements, would reveal the ocular misalignment.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='36'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>20 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 38 year old woman complains of new headache and blurred vision in both eyes over the past week. In the emergency room, blood pressure is found to be 180\/110 mm Hg. She has previously been normotensive and not known to have any systemic, neurologic, or ophthalmic issues. Visual acuities are 20\/400 (6\/120, 0.05) in each eye. There is no afferent pupil defect, intraocular pressures are normal, media are clear, and both optic fundi have the appearance seen in the left eye here. What is causing the vision loss?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/NOVEL-tyk-ft-dv-9_21.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-36]' id='ays-answer-138-5' value='138'\/>\n\n                <label for='ays-answer-138-5' class='  ays_position_initial  '>Bilateral ischemic retinopathy<\/label><label for='ays-answer-138-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-36]' id='ays-answer-139-5' value='139'\/>\n\n                <label for='ays-answer-139-5' class='  ays_position_initial  '>Bilateral non-arteritic ischemic optic neuropathy<\/label><label for='ays-answer-139-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-36]' id='ays-answer-140-5' value='140'\/>\n\n                <label for='ays-answer-140-5' class='  ays_position_initial  '>Bilateral lateral geniculate infarction<\/label><label for='ays-answer-140-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-36]' id='ays-answer-141-5' value='141'\/>\n\n                <label for='ays-answer-141-5' class='  ays_position_initial  '>Posterior reversible encephalopathy syndrome<\/label><label for='ays-answer-141-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[36]\" value=\"138,139,140,141\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['36'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMTM4IjoiMCIsIjEzOSI6IjAiLCIxNDAiOiIwIiwiMTQxIjoiMSJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2461352<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Posterior reversible encephalopathy syndrome<\/b><\/p>\n<ul>\n<li>The abnormalities in the optic fundus\u2014cotton wool spots, retinal hemorrhages, optic disc swelling\u2014are the result of retinal vasospasm, microinfarction, and vascular incompetence. But they do not account for the profound loss of vision. In acute systemic hypertension, the optic disc surface vessels often leak and cause an engorged appearance of the discs, but the optic disc tissue is rarely infarcted. Instead, the vision loss comes from vascular leakage in the occipital lobe white matter, where binocular profound vision loss can occur in a condition known as \u201cposterior reversible encephalopathy syndrome\u201d (PRES).<\/li>\n<li>If blood pressure is lowered, these abnormalities disappear rapidly and normal function is restored. If there is a delay, infarction may occur, leaving the patient with persistent retrogeniculate vision impairment. The optic fundus abnormalities\u2014often dramatic\u2014are a distraction. The real action is elsewhere and must be detected with brain imaging, preferably MRI. PRES occurs in two main settings: use of calcineurin inhibitors to prevent graft rejection or to treat intractable autoimmune phenomena, and in sudden systemic hypertension, often during or after pregnancy. By the way, intracranial pressure is generally not much elevated in PRES; lumbar puncture is not indicated. This patient had acute glomerulonephritis as the cause of elevated blood pressure.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Posterior reversible encephalopathy syndrome<\/b><\/p>\n<ul>\n<li>The abnormalities in the optic fundus\u2014cotton wool spots, retinal hemorrhages, optic disc swelling\u2014are the result of retinal vasospasm, microinfarction, and vascular incompetence. But they do not account for the profound loss of vision. In acute systemic hypertension, the optic disc surface vessels often leak and cause an engorged appearance of the discs, but the optic disc tissue is rarely infarcted. Instead, the vision loss comes from vascular leakage in the occipital lobe white matter, where binocular profound vision loss can occur in a condition known as \u201cposterior reversible encephalopathy syndrome\u201d (PRES).<\/li>\n<li>If blood pressure is lowered, these abnormalities disappear rapidly and normal function is restored. If there is a delay, infarction may occur, leaving the patient with persistent retrogeniculate vision impairment. The optic fundus abnormalities\u2014often dramatic\u2014are a distraction. The real action is elsewhere and must be detected with brain imaging, preferably MRI. PRES occurs in two main settings: use of calcineurin inhibitors to prevent graft rejection or to treat intractable autoimmune phenomena, and in sudden systemic hypertension, often during or after pregnancy. By the way, intracranial pressure is generally not much elevated in PRES; lumbar puncture is not indicated. This patient had acute glomerulonephritis as the cause of elevated blood pressure.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='27'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>21 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 65 year old woman had a cardiac arrest with brief loss of consciousness. When she regained full consciousness, she began to complain that \u201cmy vision is just not normal.\u201d Yet visual acuity was normal and there were no abnormalities of eye movements or alignment. Visual fields were full to finger displays. The neurologic examination was normal except that her walking was tentative. She had difficulty when asked to pick objects out of an array. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-20_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-27]' id='ays-answer-102-5' value='102'\/>\n\n                <label for='ays-answer-102-5' class='  ays_position_initial  '>Frontal lobes<\/label><label for='ays-answer-102-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-27]' id='ays-answer-103-5' value='103'\/>\n\n                <label for='ays-answer-103-5' class='  ays_position_initial  '>Temporal lobes<\/label><label for='ays-answer-103-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-27]' id='ays-answer-104-5' value='104'\/>\n\n                <label for='ays-answer-104-5' class='  ays_position_initial  '>Parietal lobes<\/label><label for='ays-answer-104-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-27]' id='ays-answer-105-5' value='105'\/>\n\n                <label for='ays-answer-105-5' class='  ays_position_initial  '>Occipital lobes<\/label><label for='ays-answer-105-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[27]\" value=\"102,103,104,105\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['27'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMTAyIjoiMCIsIjEwMyI6IjAiLCIxMDQiOiIxIiwiMTA1IjoiMCJ9fQ==';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459712<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Parietal lobes<\/b><\/p>\n<ul>\n<li>This patient is simply unable to point accurately to objects in an array. Also, she forgets which ones she has already identified, so she miscounts. Her problem derives from a combination of visuospatial and attentional dysfunction. The term \u201csimultanagnosia\u201d has been applied to this deficit. The lesions lie in the inferior parietal lobules on both sides, interrupting the integration of visual and somatosensory information and the application of attention appropriate to the task. Called Balint syndrome, or Balint-Holmes syndrome, it most often arises acutely from biparietal stroke, usually in the setting of systemic hypotension (\u201cwatershed\u201d or \u201cborder zone\u201d infarction).<\/li>\n<li>When these deficits appear chronically, the most common cause is the \u201cvisual variant\u201d of Alzheimer disease, sometimes known as \u201cposterior cortical atrophy.\u201d<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Parietal lobes<\/b><\/p>\n<ul>\n<li>This patient is simply unable to point accurately to objects in an array. Also, she forgets which ones she has already identified, so she miscounts. Her problem derives from a combination of visuospatial and attentional dysfunction. The term \u201csimultanagnosia\u201d has been applied to this deficit. The lesions lie in the inferior parietal lobules on both sides, interrupting the integration of visual and somatosensory information and the application of attention appropriate to the task. Called Balint syndrome, or Balint-Holmes syndrome, it most often arises acutely from biparietal stroke, usually in the setting of systemic hypotension (\u201cwatershed\u201d or \u201cborder zone\u201d infarction).<\/li>\n<li>When these deficits appear chronically, the most common cause is the \u201cvisual variant\u201d of Alzheimer disease, sometimes known as \u201cposterior cortical atrophy.\u201d<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='26'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>22 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 70 year old woman awakens to discover something wrong with her sight. When you examine her, you discover that although Snellen visual acuity is normal, she claims that she cannot read. Yet she completed high school and was employed as a cashier before retiring, and she seems to have no language problems, either in expression or comprehension. Surprisingly, she can spell to dictation. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-19_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-26]' id='ays-answer-98-5' value='98'\/>\n\n                <label for='ays-answer-98-5' class='  ays_position_initial  '>Right occipital-temporal lobe<\/label><label for='ays-answer-98-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-26]' id='ays-answer-99-5' value='99'\/>\n\n                <label for='ays-answer-99-5' class='  ays_position_initial  '>Left occipital-temporal lobe<\/label><label for='ays-answer-99-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-26]' id='ays-answer-100-5' value='100'\/>\n\n                <label for='ays-answer-100-5' class='  ays_position_initial  '>Right occipital-parietal lobe<\/label><label for='ays-answer-100-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-26]' id='ays-answer-101-5' value='101'\/>\n\n                <label for='ays-answer-101-5' class='  ays_position_initial  '>Left occipital-parietal lobe<\/label><label for='ays-answer-101-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[26]\" value=\"98,99,100,101\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['26'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiOTgiOiIwIiwiOTkiOiIxIiwiMTAwIjoiMCIsIjEwMSI6IjAifX0=';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459711<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Left occipital-temporal lobe<\/b><\/p>\n<ul>\n<li>She is demonstrating the manifestations of \u201calexia without agraphia,\u201d also known as \u201cpure alexia.\u201d It is a recognition disturbance for written language (and often other familiar symbols). It is not an aphasia (language disturbance). Written information cannot reach the posterior portion of the angular gyrus in the left temporal lobe. This disconnection happens most often when a lesion\u2014almost always an ischemic stroke in the domain of the posterior cerebral artery\u2014damages the left medial occipital lobe, causing a right homonymous hemianopia, and extends anteriorly enough to damage the splenium of the corpus callosum to interrupt transmission of visual information from the intact right visual cortex to the left angular gyrus. Patients can spell, understand spoken language, and express themselves normally, because those functions are generated in the angular gyrus without needing transmission from the visual cortex. Which critical neuro-ophthalmic abnormality was bound to be present (although not always!) and not mentioned in the vignette? A complete right homonymous hemianopia. This patient did have a left posterior cerebral artery stroke with forward extension into the splenial region.<\/li>\n<li>Over time, her reading deficit gradually improved, but she still hesitated. The homonymous hemianopia was permanent.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Left occipital-temporal lobe<\/b><\/p>\n<ul>\n<li>She is demonstrating the manifestations of \u201calexia without agraphia,\u201d also known as \u201cpure alexia.\u201d It is a recognition disturbance for written language (and often other familiar symbols). It is not an aphasia (language disturbance). Written information cannot reach the posterior portion of the angular gyrus in the left temporal lobe. This disconnection happens most often when a lesion\u2014almost always an ischemic stroke in the domain of the posterior cerebral artery\u2014damages the left medial occipital lobe, causing a right homonymous hemianopia, and extends anteriorly enough to damage the splenium of the corpus callosum to interrupt transmission of visual information from the intact right visual cortex to the left angular gyrus. Patients can spell, understand spoken language, and express themselves normally, because those functions are generated in the angular gyrus without needing transmission from the visual cortex. Which critical neuro-ophthalmic abnormality was bound to be present (although not always!) and not mentioned in the vignette? A complete right homonymous hemianopia. This patient did have a left posterior cerebral artery stroke with forward extension into the splenial region.<\/li>\n<li>Over time, her reading deficit gradually improved, but she still hesitated. The homonymous hemianopia was permanent.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='25'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>23 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 35 year old man suddenly developed the inability to move his eyes to the right. He has been entirely healthy, taking no medications, and lacking any family history of neurologic disorders. You find that his eyes have normal sight, appear structurally normal, but do not move beyond mid position to the right, even with the doll\u2019s eye (\u201coculocephalic\u201d) maneuver. There are no other neurologic abnormalities. For example, vertical eye movements are completely normal. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-18_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-25]' id='ays-answer-94-5' value='94'\/>\n\n                <label for='ays-answer-94-5' class='  ays_position_initial  '>Right cerebral hemisphere<\/label><label for='ays-answer-94-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-25]' id='ays-answer-95-5' value='95'\/>\n\n                <label for='ays-answer-95-5' class='  ays_position_initial  '>Left cerebral hemisphere<\/label><label for='ays-answer-95-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-25]' id='ays-answer-96-5' value='96'\/>\n\n                <label for='ays-answer-96-5' class='  ays_position_initial  '>Right pons<\/label><label for='ays-answer-96-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-25]' id='ays-answer-97-5' value='97'\/>\n\n                <label for='ays-answer-97-5' class='  ays_position_initial  '>Left pons<\/label><label for='ays-answer-97-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[25]\" value=\"94,95,96,97\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['25'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiOTQiOiIwIiwiOTUiOiIwIiwiOTYiOiIxIiwiOTciOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459710<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right pons<\/b><\/p>\n<ul>\n<li>This patient has a palsy of right horizontal conjugate gaze (\u201cgaze palsy\u201d) that involves saccades, pursuit, and the vestibulo-ocular reflex. Although you could postulate lesions affecting the extraocular muscles or the neuromuscular junction activated in right gaze, such a symmetrical deficit of conjugate gaze to one side will virtually always originate within the brain. If volitional and reflex gaze are both completely impaired, expect to find the lesion in the pons. You should be surprised that there are no other neurologic deficits--seventh nerve palsy, internuclear ophthalmoplegia, nystagmus, ataxia, skew deviation, or limb weakness. However, a lesion confined to a small area in the tegmental pons\u2014in the location of the sixth nerve nucleus-- might not produce any obvious accompanying signs (although you should look for them as \u201cfellow travelers\u201d). This patient had a hemorrhage from a right pontine tegmental cavernous malformation (\u201ccavernoma\u201d).<\/li>\n<li>The only effective treatment is surgical excision, which is hazardous. No treatment was undertaken in this case. The patient\u2019s deficits gradually resolved enough to give him partial restoration of right gaze. He was advised to avoid any activity that would generate increased intracranial pressure (like weight-lifting, evacuative straining, and standing on his head!)<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Right pons<\/b><\/p>\n<ul>\n<li>This patient has a palsy of right horizontal conjugate gaze (\u201cgaze palsy\u201d) that involves saccades, pursuit, and the vestibulo-ocular reflex. Although you could postulate lesions affecting the extraocular muscles or the neuromuscular junction activated in right gaze, such a symmetrical deficit of conjugate gaze to one side will virtually always originate within the brain. If volitional and reflex gaze are both completely impaired, expect to find the lesion in the pons. You should be surprised that there are no other neurologic deficits--seventh nerve palsy, internuclear ophthalmoplegia, nystagmus, ataxia, skew deviation, or limb weakness. However, a lesion confined to a small area in the tegmental pons\u2014in the location of the sixth nerve nucleus-- might not produce any obvious accompanying signs (although you should look for them as \u201cfellow travelers\u201d). This patient had a hemorrhage from a right pontine tegmental cavernous malformation (\u201ccavernoma\u201d).<\/li>\n<li>The only effective treatment is surgical excision, which is hazardous. No treatment was undertaken in this case. The patient\u2019s deficits gradually resolved enough to give him partial restoration of right gaze. He was advised to avoid any activity that would generate increased intracranial pressure (like weight-lifting, evacuative straining, and standing on his head!)<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='24'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>24 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 66 year old man awakens from heart surgery with eyes deviated to the right. When you tell the patient to look to the left, neither eye moves beyond straight ahead gaze (\u201cprimary gaze position\u201d) to the left. Yet when you move the patient\u2019s head to the right, the eyes cross into left gaze. Vertical eye movements are intact and the eyes are aligned. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-17_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-24]' id='ays-answer-90-5' value='90'\/>\n\n                <label for='ays-answer-90-5' class='  ays_position_initial  '>Right cerebral hemisphere<\/label><label for='ays-answer-90-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-24]' id='ays-answer-91-5' value='91'\/>\n\n                <label for='ays-answer-91-5' class='  ays_position_initial  '>Left cerebral hemisphere<\/label><label for='ays-answer-91-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-24]' id='ays-answer-92-5' value='92'\/>\n\n                <label for='ays-answer-92-5' class='  ays_position_initial  '>Right pons<\/label><label for='ays-answer-92-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-24]' id='ays-answer-93-5' value='93'\/>\n\n                <label for='ays-answer-93-5' class='  ays_position_initial  '>Left pons<\/label><label for='ays-answer-93-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[24]\" value=\"90,91,92,93\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['24'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiOTAiOiIxIiwiOTEiOiIwIiwiOTIiOiIwIiwiOTMiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459709<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right cerebral hemisphere<\/b><\/p>\n<p>In order to answer this question correctly, you had to know three things: 1) horizontal saccades are generated in the cerebral hemispheres and that they move the eyes toward the opposite side; 2) This patient is displaying a dissociation between loss of volitional leftward horizontal saccades and preservation of the leftward vestibulo-ocular reflex (\u201csupranuclear ophthalmoplegia\u201d); and 3) the vestibulo-ocular reflex pathway is confined motorically to the brainstem. Acute right hemisphere lesions (usually infarcts or hemorrhages), especially if they involve the parietal lobe or its efferent pathway, often produce ipsilateral gaze deviation and a supranuclear gaze disturbance, as described here. These phenomena may be manifestations of \u201cmotor neglect.\u201d In fact, sensory aspects of hemispatial neglect are usually present, including extinction to double simultaneous stimulation in the visual, auditory, and tactile domains. Extinction of the visual field in one hemifield could, by itself, reflect a subtle homonymous hemianopia. But the presence of multimodal--visual, auditory, and tactile--extinction favors neglect over a topographic disorder of vision such as a homonymous hemianopia. Patients with homonymous hemianopias rapidly develop the ability to explore into their deficient hemifield and will bisect a line segment in the midline, especially if cued. Patients with hemispatial neglect consistently ignore stimuli in one hemifield and bisect a line segment more toward the side of the lesion. When the lesion is severe, neglect will extend to lack of awareness of contralateral limbs (\u201canosognosia\u201d). Fortunately, the manifestations of neglect gradually lessen with time, but may never completely disappear. This patient had a right parietal infarct.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right cerebral hemisphere<\/b><\/p>\n<p>In order to answer this question correctly, you had to know three things: 1) horizontal saccades are generated in the cerebral hemispheres and that they move the eyes toward the opposite side; 2) This patient is displaying a dissociation between loss of volitional leftward horizontal saccades and preservation of the leftward vestibulo-ocular reflex (\u201csupranuclear ophthalmoplegia\u201d); and 3) the vestibulo-ocular reflex pathway is confined motorically to the brainstem. Acute right hemisphere lesions (usually infarcts or hemorrhages), especially if they involve the parietal lobe or its efferent pathway, often produce ipsilateral gaze deviation and a supranuclear gaze disturbance, as described here. These phenomena may be manifestations of \u201cmotor neglect.\u201d In fact, sensory aspects of hemispatial neglect are usually present, including extinction to double simultaneous stimulation in the visual, auditory, and tactile domains. Extinction of the visual field in one hemifield could, by itself, reflect a subtle homonymous hemianopia. But the presence of multimodal--visual, auditory, and tactile--extinction favors neglect over a topographic disorder of vision such as a homonymous hemianopia. Patients with homonymous hemianopias rapidly develop the ability to explore into their deficient hemifield and will bisect a line segment in the midline, especially if cued. Patients with hemispatial neglect consistently ignore stimuli in one hemifield and bisect a line segment more toward the side of the lesion. When the lesion is severe, neglect will extend to lack of awareness of contralateral limbs (\u201canosognosia\u201d). Fortunately, the manifestations of neglect gradually lessen with time, but may never completely disappear. This patient had a right parietal infarct.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='23'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>25 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 15 year old boy notices that when he looks upward, his eyes ache and that he gets double vision. You find that with attempted upward gaze, his eyes do not move upward, but instead they converge! The responsible lesion lies in the\u2026<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-16_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-23]' id='ays-answer-86-5' value='86'\/>\n\n                <label for='ays-answer-86-5' class='  ays_position_initial  '>Posterior commissure<\/label><label for='ays-answer-86-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-23]' id='ays-answer-87-5' value='87'\/>\n\n                <label for='ays-answer-87-5' class='  ays_position_initial  '>Anterior commissure<\/label><label for='ays-answer-87-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-23]' id='ays-answer-88-5' value='88'\/>\n\n                <label for='ays-answer-88-5' class='  ays_position_initial  '>Interstitial nucleus of Cajal (INC)<\/label><label for='ays-answer-88-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-23]' id='ays-answer-89-5' value='89'\/>\n\n                <label for='ays-answer-89-5' class='  ays_position_initial  '>Rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF)<\/label><label for='ays-answer-89-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[23]\" value=\"86,87,88,89\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['23'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiODYiOiIxIiwiODciOiIwIiwiODgiOiIwIiwiODkiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459708<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Posterior commissure<\/b><\/p>\n<ul>\n<li>This is an important neuro-ophthalmic landmark! Lying at the junction of the thalamus and midbrain, it mediates upward gaze by connecting the rostral interstitial nuclei of the medial longitudinal fasciculus (RIMLF) and interstitial nucleus of Cajal (INC) on both sides.<\/li>\n<li>A lesion here SELECTIVELY interferes with upward gaze, sparing downward gaze, which is mediated more ventrally. When this commissure is damaged by an intrinsic lesion of the caudal thalamus or pretectal or tectal midbrain regions, or by an extrinsic lesion like a pinealoma, expect elements of a \u201cdorsal midbrain syndrome\u201d (also called \u201cpretectal syndrome,\u201d \u201cSylvian aqueduct syndrome,\u201d or \u201cParinaud syndrome\u201d if you are French, \u201cKoerber-Salus-Elschnig syndrome\u201d if you are German). The clinical features of this syndrome include lid retraction (\u201cCollier\u2019s sign\u201d), dilated pupils with light-near dissociation, and sometimes esotropia, exotropia, or skew deviation. Why does a lesion here cause such a diverse set of clinical phenomena? Disruption of upgaze produces a \u201cspill-over\u201d activation of all extraocular muscles, pulling the eyes backwards into the orbit. Because the medial recti are the most powerful muscles, the eyes tend to converge. Dilated pupils with light-near dissociation (\u201ctectal pupils\u201d) are attributed to interruption of the pupillary light reflex pathway in the dorsal midbrain. Esotropia and exotropia result from disruption of the vergence pathway in that region, and skew deviation results from interruption of the vestibulo-ocular pathway as it reaches the midbrain. This patient had a pinealoma.<\/li>\n<li>Early diagnosis favors a better outcome of treatment. By the way, even with early diagnosis of pineal tumor, some features of a dorsal midbrain syndrome\u2014especially upgaze deficiency and convergence-retraction--often linger. Why is this fact important? Because if upgaze deficiency and convergence-retraction are detected long after treatment, they should not be taken as signs of tumor recurrence or of a complication of radiotherapy, even if not previously documented!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Posterior commissure<\/b><\/p>\n<ul>\n<li>This is an important neuro-ophthalmic landmark! Lying at the junction of the thalamus and midbrain, it mediates upward gaze by connecting the rostral interstitial nuclei of the medial longitudinal fasciculus (RIMLF) and interstitial nucleus of Cajal (INC) on both sides.<\/li>\n<li>A lesion here SELECTIVELY interferes with upward gaze, sparing downward gaze, which is mediated more ventrally. When this commissure is damaged by an intrinsic lesion of the caudal thalamus or pretectal or tectal midbrain regions, or by an extrinsic lesion like a pinealoma, expect elements of a \u201cdorsal midbrain syndrome\u201d (also called \u201cpretectal syndrome,\u201d \u201cSylvian aqueduct syndrome,\u201d or \u201cParinaud syndrome\u201d if you are French, \u201cKoerber-Salus-Elschnig syndrome\u201d if you are German). The clinical features of this syndrome include lid retraction (\u201cCollier\u2019s sign\u201d), dilated pupils with light-near dissociation, and sometimes esotropia, exotropia, or skew deviation. Why does a lesion here cause such a diverse set of clinical phenomena? Disruption of upgaze produces a \u201cspill-over\u201d activation of all extraocular muscles, pulling the eyes backwards into the orbit. Because the medial recti are the most powerful muscles, the eyes tend to converge. Dilated pupils with light-near dissociation (\u201ctectal pupils\u201d) are attributed to interruption of the pupillary light reflex pathway in the dorsal midbrain. Esotropia and exotropia result from disruption of the vergence pathway in that region, and skew deviation results from interruption of the vestibulo-ocular pathway as it reaches the midbrain. This patient had a pinealoma.<\/li>\n<li>Early diagnosis favors a better outcome of treatment. By the way, even with early diagnosis of pineal tumor, some features of a dorsal midbrain syndrome\u2014especially upgaze deficiency and convergence-retraction--often linger. Why is this fact important? Because if upgaze deficiency and convergence-retraction are detected long after treatment, they should not be taken as signs of tumor recurrence or of a complication of radiotherapy, even if not previously documented!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='22'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>26 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 33 year old woman is brought to the emergency department with a history of recent confusion and frequent falls in the past week. She underwent bariatric surgery two months ago for morbid obesity. Blood pressure is 170\/100. Temperature in normal. Your examination shows difficulty with recent memory, impaired tandem gait, saccadic pursuit in all gaze directions, and the abnormalities shown in this video. What is the likely cause of these abnormalities?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-15_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-22]' id='ays-answer-82-5' value='82'\/>\n\n                <label for='ays-answer-82-5' class='  ays_position_initial  '>Infectious meningoencephalitis<\/label><label for='ays-answer-82-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-22]' id='ays-answer-83-5' value='83'\/>\n\n                <label for='ays-answer-83-5' class='  ays_position_initial  '>Hypertensive encephalopathy<\/label><label for='ays-answer-83-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-22]' id='ays-answer-84-5' value='84'\/>\n\n                <label for='ays-answer-84-5' class='  ays_position_initial  '>Wernicke encephalopathy<\/label><label for='ays-answer-84-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-22]' id='ays-answer-85-5' value='85'\/>\n\n                <label for='ays-answer-85-5' class='  ays_position_initial  '>Osmotic demyelination syndrome<\/label><label for='ays-answer-85-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[22]\" value=\"82,83,84,85\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['22'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiODIiOiIwIiwiODMiOiIwIiwiODQiOiIxIiwiODUiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459707<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Wernicke encephalopathy<\/b><\/p>\n<ul>\n<li>You are looking at gaze-evoked horizontal jerk nystagmus on side gaze and upbeat nystagmus on upgaze. This form of nystagmus is a common feature of Wernicke encephalopathy, a deficiency of thiamine (vitamin B1), which is a co-factor in many metabolic pathways critical to central nervous system function. The classic clinical triad consists of a confusional state, ataxia, and ophthalmoplegia, but only a minority of patients have all three components. Nystagmus is actually more common than ophthalmoplegia (which, in Wernicke encephalopathy, usually means reduced conjugate gaze or abduction deficits). So look for nystagmus, even when no other neurologic manifestations are present. In the past, the common setting for Wernicke encephalopathy was alcohol binge drinking, but with the growth of bariatric surgery, it is seen in those patients, especially if they are not adherent to vitamin supplementation regimens. (This patient had not been taking the supplements because she could not afford them. Other patients fail to absorb them because they are vomiting.) The manifestations of Wernicke encephalopathy usually develop from 4 to 8 weeks after surgery. Treatment is prompt administration of thiamine 500 mg intravenously three times a day for 3 days, followed by thiamine 250 mg intravenously or intramuscularly once daily for 5 days to prevent permanent amnestic dementia (Korsakoff syndrome). The ophthalmic manifestations often resolve within days of treatment, but ataxia and cognitive impairment often endure. The neuropathology consists of capillary proliferation, microhemorrhages, and neuronal and glial loss. It is prominent in the thalamus, mammillary bodies, and periventricular regions of the brainstem, including the sixth nerve nuclei. In this patient, T2 and FLAIR MRI sequences showed high signal in the dorsomedial thalamus and mammillary bodies.<\/li>\n<li>These MRI abnormalities are specific for Wernicke encephalopathy, but a negative MRI occurs in at least 50% of cases. Blood tests (whole blood thiamine, erythrocyte transketolase, and thiamine pyrophosphate levels), which should be drawn before administering thiamine, can help confirm the diagnosis, but may also be normal. So, whenever you see this kind of nystagmus after bariatric surgery or with a history of binge drinking, the presumptive diagnosis is Wernicke encephalopathy! The other answer choices here are reasonable, but less apt. Infectious meningoencephalitis is always an important consideration, eliciting further prompt evaluation with imaging, lumbar puncture, and other studies. Hypertensive encephalopathy, which typically manifests with homonymous visual field loss, cognitive impairment, and seizures, discloses high T2\/FLAIR MRI signal in the posterior cerebral hemispheres (\"posterior reversible encephalopathy syndrome, or PRES\"), and does not typically cause nystagmus. Osmotic demyelination syndrome (formerly called \u201ccentral pontine myelinolysis\u201d) occurs after rapid correction of hyponatremia usually following heavy alcohol intake. The increase in extracellular sodium results in rapid escape of intracellular water and cellular dysfunction, most often affecting the pons. Patients present with impaired consciousness and quadriparesis. MRI should show symmetrical high T2\/FLAIR sign in the central pons and sometimes in the lateral geniculate bodies.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Wernicke encephalopathy<\/b><\/p>\n<ul>\n<li>You are looking at gaze-evoked horizontal jerk nystagmus on side gaze and upbeat nystagmus on upgaze. This form of nystagmus is a common feature of Wernicke encephalopathy, a deficiency of thiamine (vitamin B1), which is a co-factor in many metabolic pathways critical to central nervous system function. The classic clinical triad consists of a confusional state, ataxia, and ophthalmoplegia, but only a minority of patients have all three components. Nystagmus is actually more common than ophthalmoplegia (which, in Wernicke encephalopathy, usually means reduced conjugate gaze or abduction deficits). So look for nystagmus, even when no other neurologic manifestations are present. In the past, the common setting for Wernicke encephalopathy was alcohol binge drinking, but with the growth of bariatric surgery, it is seen in those patients, especially if they are not adherent to vitamin supplementation regimens. (This patient had not been taking the supplements because she could not afford them. Other patients fail to absorb them because they are vomiting.) The manifestations of Wernicke encephalopathy usually develop from 4 to 8 weeks after surgery. Treatment is prompt administration of thiamine 500 mg intravenously three times a day for 3 days, followed by thiamine 250 mg intravenously or intramuscularly once daily for 5 days to prevent permanent amnestic dementia (Korsakoff syndrome). The ophthalmic manifestations often resolve within days of treatment, but ataxia and cognitive impairment often endure. The neuropathology consists of capillary proliferation, microhemorrhages, and neuronal and glial loss. It is prominent in the thalamus, mammillary bodies, and periventricular regions of the brainstem, including the sixth nerve nuclei. In this patient, T2 and FLAIR MRI sequences showed high signal in the dorsomedial thalamus and mammillary bodies.<\/li>\n<li>These MRI abnormalities are specific for Wernicke encephalopathy, but a negative MRI occurs in at least 50% of cases. Blood tests (whole blood thiamine, erythrocyte transketolase, and thiamine pyrophosphate levels), which should be drawn before administering thiamine, can help confirm the diagnosis, but may also be normal. So, whenever you see this kind of nystagmus after bariatric surgery or with a history of binge drinking, the presumptive diagnosis is Wernicke encephalopathy! The other answer choices here are reasonable, but less apt. Infectious meningoencephalitis is always an important consideration, eliciting further prompt evaluation with imaging, lumbar puncture, and other studies. Hypertensive encephalopathy, which typically manifests with homonymous visual field loss, cognitive impairment, and seizures, discloses high T2\/FLAIR MRI signal in the posterior cerebral hemispheres (\"posterior reversible encephalopathy syndrome, or PRES\"), and does not typically cause nystagmus. Osmotic demyelination syndrome (formerly called \u201ccentral pontine myelinolysis\u201d) occurs after rapid correction of hyponatremia usually following heavy alcohol intake. The increase in extracellular sodium results in rapid escape of intracellular water and cellular dysfunction, most often affecting the pons. Patients present with impaired consciousness and quadriparesis. MRI should show symmetrical high T2\/FLAIR sign in the central pons and sometimes in the lateral geniculate bodies.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='21'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>27 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 65 year old man has recently been diagnosed with a brain tumor. He is referred to you for ophthalmic features that might be associated with that diagnosis. You find that as he follows your moving finger and penlight toward his right side, his eyes move in small steps. The eyes move smoothly in all other directions of gaze. The optokinetic drum elicits normal-amplitude nystagmus when the stripes are moved horizontally to the patient\u2019s left, upward, and downward. But when the stripes are moved in the direction of the patient\u2019s right side, no nystagmus occurs. Where is the brain tumor?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-14_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-21]' id='ays-answer-78-5' value='78'\/>\n\n                <label for='ays-answer-78-5' class='  ays_position_initial  '>Right parietal lobe<\/label><label for='ays-answer-78-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-21]' id='ays-answer-79-5' value='79'\/>\n\n                <label for='ays-answer-79-5' class='  ays_position_initial  '>Left parietal lobe<\/label><label for='ays-answer-79-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-21]' id='ays-answer-80-5' value='80'\/>\n\n                <label for='ays-answer-80-5' class='  ays_position_initial  '>Right occipital lobe<\/label><label for='ays-answer-80-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-21]' id='ays-answer-81-5' value='81'\/>\n\n                <label for='ays-answer-81-5' class='  ays_position_initial  '>Left occipital lobe<\/label><label for='ays-answer-81-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[21]\" value=\"78,79,80,81\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['21'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNzgiOiIxIiwiNzkiOiIwIiwiODAiOiIwIiwiODEiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459706<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right parietal lobe<\/b><\/p>\n<p>In order to get the correct answer here, you must be aware that pursuit is mediated by a pathway that starts in the parietal lobe and generates pursuit eye movements ipsilaterally. When you move the optokinetic drum, you generate an obligatory pursuit movement in the direction of the moving stripes (the patient must be paying attention!). Each pursuit movement is met by an oppositely-directed conjugate saccadic movement that restores the eye position to straight ahead. You can use this device to generate repetitive jerk nystagmus. If you consistently see a discrepancy in nystagmus amplitude between rightwardly and leftwardly directed stripes, you must conclude that there is a unidirectional pursuit deficit caused by a lesion in the ipsilateral parietal lobe. By the way, the patient will not notice this pursuit deficit.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right parietal lobe<\/b><\/p>\n<p>In order to get the correct answer here, you must be aware that pursuit is mediated by a pathway that starts in the parietal lobe and generates pursuit eye movements ipsilaterally. When you move the optokinetic drum, you generate an obligatory pursuit movement in the direction of the moving stripes (the patient must be paying attention!). Each pursuit movement is met by an oppositely-directed conjugate saccadic movement that restores the eye position to straight ahead. You can use this device to generate repetitive jerk nystagmus. If you consistently see a discrepancy in nystagmus amplitude between rightwardly and leftwardly directed stripes, you must conclude that there is a unidirectional pursuit deficit caused by a lesion in the ipsilateral parietal lobe. By the way, the patient will not notice this pursuit deficit.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='20'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>28 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 24 year old man suffers severe head trauma from a fall. Weeks later, he reports lingering diplopia to his caregivers at a rehabilitation center. Your examination shows a comitant esotropia with full ocular ductions. He is wheelchair-bound. He has saccadic pursuit and gaze-evoked horizontal nystagmus, lingering cognitive impairment, ataxia of speech and extremities, and spastic quadriplegia. Where is the lesion causing the esotropia?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-13_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-20]' id='ays-answer-74-5' value='74'\/>\n\n                <label for='ays-answer-74-5' class='  ays_position_initial  '>Diencephalon<\/label><label for='ays-answer-74-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-20]' id='ays-answer-75-5' value='75'\/>\n\n                <label for='ays-answer-75-5' class='  ays_position_initial  '>Both sixth nerves<\/label><label for='ays-answer-75-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-20]' id='ays-answer-76-5' value='76'\/>\n\n                <label for='ays-answer-76-5' class='  ays_position_initial  '>Both third nerves<\/label><label for='ays-answer-76-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-20]' id='ays-answer-77-5' value='77'\/>\n\n                <label for='ays-answer-77-5' class='  ays_position_initial  '>Both fourth nerves<\/label><label for='ays-answer-77-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[20]\" value=\"74,75,76,77\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['20'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNzQiOiIxIiwiNzUiOiIwIiwiNzYiOiIwIiwiNzciOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459705<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Diencephalon<\/b><\/p>\n<p>This patient has suffered severe damage to all parts of his brain, but the comitant esotropia with full ocular ductions suggests diencephalic dysfunction. There has been a breakdown of fusion, such that the balance between convergence and divergence has been upset. A lesion in the cerebral hemispheres could also upset that balance, but you were not offered that answer option here. Bilateral sixth nerve palsy is a common mistaken explanation for esotropia, but that should reduce abduction and cause more esotropia on side gaze than in primary gaze position (\u201cincomitant esotropia\u201d). Bilateral third nerve palsy would cause an exotropia. Bilateral fourth nerve palsy would cause a right hypertropia in left gaze and a left hypertropia in right gaze, features not present here.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Diencephalon<\/b><\/p>\n<p>This patient has suffered severe damage to all parts of his brain, but the comitant esotropia with full ocular ductions suggests diencephalic dysfunction. There has been a breakdown of fusion, such that the balance between convergence and divergence has been upset. A lesion in the cerebral hemispheres could also upset that balance, but you were not offered that answer option here. Bilateral sixth nerve palsy is a common mistaken explanation for esotropia, but that should reduce abduction and cause more esotropia on side gaze than in primary gaze position (\u201cincomitant esotropia\u201d). Bilateral third nerve palsy would cause an exotropia. Bilateral fourth nerve palsy would cause a right hypertropia in left gaze and a left hypertropia in right gaze, features not present here.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='19'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>29 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 24 year old woman reports that her vision has recently become blurred and that she is having trouble with her balance. When she covers either eye, vision improves. Your examination reveals that visual function is apparently normal, and eye movements are full. But when you cover her right eye, her left eye moves down slightly. When you cover her left eye, there is no movement of the right eye. This phenomenon occurs in all positions of eccentric gaze. You also notice some conjugate horizontal oscillations of the eyes in extremes of horizontal gaze and vertical oscillations in upgaze.\u00a0 Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-12_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-19]' id='ays-answer-70-5' value='70'\/>\n\n                <label for='ays-answer-70-5' class='  ays_position_initial  '>Semicircular canals<\/label><label for='ays-answer-70-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-19]' id='ays-answer-71-5' value='71'\/>\n\n                <label for='ays-answer-71-5' class='  ays_position_initial  '>Otolith<\/label><label for='ays-answer-71-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-19]' id='ays-answer-72-5' value='72'\/>\n\n                <label for='ays-answer-72-5' class='  ays_position_initial  '>Vestibular nerve<\/label><label for='ays-answer-72-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-19]' id='ays-answer-73-5' value='73'\/>\n\n                <label for='ays-answer-73-5' class='  ays_position_initial  '>Midbrain<\/label><label for='ays-answer-73-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[19]\" value=\"70,71,72,73\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['19'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNzAiOiIwIiwiNzEiOiIwIiwiNzIiOiIwIiwiNzMiOiIxIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459704<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Midbrain<\/b><\/p>\n<ul>\n<li>You should find this combination of neuro-ophthalmic abnormalities challenging. Why? First, the complaint of blurred vision suggests that something is wrong with the visual pathway. But patients will often interpret mild misalignment of the eyes as blurred vision. The clue that the blurred vision is actually diplopia comes from the fact that covering either eye improves vision! Second, when eye movements are full, many examiners will assume that there is no disorder of ocular alignment. Not true. This patient has a vertical misalignment (\u201chypertropia\u201d) discovered with the cover test. The challenge here is that the misalignment is small, so difficult to see. You could use the Maddox rod, which might show a consistent vertical displacement of the two images. Third, the oscillations of the eyes, present only in extremes of gaze, will often go unnoticed. This pattern of oscillations--called \u201cnystagmus\u201d-- is important evidence of brainstem (rather than semicircular canal or otolith) dysfunction. The lesion is affecting one side of the pathway carrying the vertical vestibulo-ocular reflex. That pathway travels from the medulla to the rostral midbrain and diencephalon. A unilateral or asymmetric lesion here creates an abnormal \u201cocular tilt reaction,\u201d which includes torsional displacement of the eyes and vertical misalignment.<\/li>\n<li>The patient may notice torsional displacement of the environment, and will report the vertical misalignment of the eyes (called \u201cskew deviation\u201d) as diplopia or blurred vision<\/li>\n<li>In this case, the cause proved to be multiple sclerosis. The brainstem did not show any MRI signal abnormalities, but there were characteristic T2\/FLAIR signal abnormalities in the cerebral white matter.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Midbrain<\/b><\/p>\n<ul>\n<li>You should find this combination of neuro-ophthalmic abnormalities challenging. Why? First, the complaint of blurred vision suggests that something is wrong with the visual pathway. But patients will often interpret mild misalignment of the eyes as blurred vision. The clue that the blurred vision is actually diplopia comes from the fact that covering either eye improves vision! Second, when eye movements are full, many examiners will assume that there is no disorder of ocular alignment. Not true. This patient has a vertical misalignment (\u201chypertropia\u201d) discovered with the cover test. The challenge here is that the misalignment is small, so difficult to see. You could use the Maddox rod, which might show a consistent vertical displacement of the two images. Third, the oscillations of the eyes, present only in extremes of gaze, will often go unnoticed. This pattern of oscillations--called \u201cnystagmus\u201d-- is important evidence of brainstem (rather than semicircular canal or otolith) dysfunction. The lesion is affecting one side of the pathway carrying the vertical vestibulo-ocular reflex. That pathway travels from the medulla to the rostral midbrain and diencephalon. A unilateral or asymmetric lesion here creates an abnormal \u201cocular tilt reaction,\u201d which includes torsional displacement of the eyes and vertical misalignment.<\/li>\n<li>The patient may notice torsional displacement of the environment, and will report the vertical misalignment of the eyes (called \u201cskew deviation\u201d) as diplopia or blurred vision<\/li>\n<li>In this case, the cause proved to be multiple sclerosis. The brainstem did not show any MRI signal abnormalities, but there were characteristic T2\/FLAIR signal abnormalities in the cerebral white matter.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='18'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>30 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 62 year old woman with new diplopia is found to have the clinical features of a left third nerve palsy. She also mentions that her right hand seems newly weak. Your examination confirms that fine finger movements of the right hand are relatively poor, but she has normal coordination in all four limbs. The right nasolabial fold is depressed and the right lower facial muscles are relatively weak. Speech is distinct, but she has circumduction of her right leg when she walks. Deep tendon reflexes are accentuated in the right extremities relative to the left extremities. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-10_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-18]' id='ays-answer-66-5' value='66'\/>\n\n                <label for='ays-answer-66-5' class='  ays_position_initial  '>Red nucleus<\/label><label for='ays-answer-66-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-18]' id='ays-answer-67-5' value='67'\/>\n\n                <label for='ays-answer-67-5' class='  ays_position_initial  '>Substantia nigra<\/label><label for='ays-answer-67-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-18]' id='ays-answer-68-5' value='68'\/>\n\n                <label for='ays-answer-68-5' class='  ays_position_initial  '>Cerebral peduncle<\/label><label for='ays-answer-68-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-18]' id='ays-answer-69-5' value='69'\/>\n\n                <label for='ays-answer-69-5' class='  ays_position_initial  '>Superior cerebellar peduncle<\/label><label for='ays-answer-69-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[18]\" value=\"66,67,68,69\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['18'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNjYiOiIwIiwiNjciOiIwIiwiNjgiOiIxIiwiNjkiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459703<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Cerebral peduncle<\/b><\/p>\n<p>This is a classic \u201cWeber syndrome\u201d of third nerve palsy and contralateral hemiparesis. It arises from a lesion in the left third nerve fascicles as they pass through the cerebral peduncle, which carries corticopontine fibers that cross in the rostral pons and corticospinal fibers that cross in the medullary pyramids to innervate musculature on the opposite side of the body. Although most third nerve palsies have no accompanying neurologic abnormalities, occurring in the subarachnoid segment of the third nerve, you should recognize this particular \u201cthird nerve palsy plus\u201d syndrome because it implies a lesion of the ventral midbrain, usually an infarction in the domain of an occluded paramedian arterial perforator, but inflammations and cancers can also do this. Aneurysm is not a consideration, but rarely Weber syndrome may be an early sign of rostral basilar thrombosis, so prompt vascular imaging and surveillance is necessary. MRI may show restricted diffusion in the ventral midbrain, yet very often the stroke is too small to show up. Even so, assume there is a stroke and direct your attention to future stroke prevention caused by disorders affecting small arterial vessels.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Cerebral peduncle<\/b><\/p>\n<p>This is a classic \u201cWeber syndrome\u201d of third nerve palsy and contralateral hemiparesis. It arises from a lesion in the left third nerve fascicles as they pass through the cerebral peduncle, which carries corticopontine fibers that cross in the rostral pons and corticospinal fibers that cross in the medullary pyramids to innervate musculature on the opposite side of the body. Although most third nerve palsies have no accompanying neurologic abnormalities, occurring in the subarachnoid segment of the third nerve, you should recognize this particular \u201cthird nerve palsy plus\u201d syndrome because it implies a lesion of the ventral midbrain, usually an infarction in the domain of an occluded paramedian arterial perforator, but inflammations and cancers can also do this. Aneurysm is not a consideration, but rarely Weber syndrome may be an early sign of rostral basilar thrombosis, so prompt vascular imaging and surveillance is necessary. MRI may show restricted diffusion in the ventral midbrain, yet very often the stroke is too small to show up. Even so, assume there is a stroke and direct your attention to future stroke prevention caused by disorders affecting small arterial vessels.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='17'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>31 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 40 year old woman yesterday had the sudden onset of left periocular pain. Her eye care provider found left ptosis, mydriasis, and adduction, supraduction, and infraduction deficits. Her medical history is unremarkable. Given these clinical signs, what is the most likely location of the aneurysm?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-10_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-17]' id='ays-answer-62-5' value='62'\/>\n\n                <label for='ays-answer-62-5' class='  ays_position_initial  '>Junction of basilar and posterior cerebral arteries<\/label><label for='ays-answer-62-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-17]' id='ays-answer-63-5' value='63'\/>\n\n                <label for='ays-answer-63-5' class='  ays_position_initial  '>Junction of posterior cerebral and posterior communicating arteries<\/label><label for='ays-answer-63-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-17]' id='ays-answer-64-5' value='64'\/>\n\n                <label for='ays-answer-64-5' class='  ays_position_initial  '>Junction of internal carotid and posterior communicating arteries<\/label><label for='ays-answer-64-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-17]' id='ays-answer-65-5' value='65'\/>\n\n                <label for='ays-answer-65-5' class='  ays_position_initial  '>Junction of internal carotid and middle cerebral arteries<\/label><label for='ays-answer-65-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[17]\" value=\"62,63,64,65\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['17'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNjIiOiIwIiwiNjMiOiIwIiwiNjQiOiIxIiwiNjUiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459702<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Junction of internal carotid and posterior communicating arteries<\/b><\/p>\n<ul>\n<li>The combination of neuro-ophthalmic deficits described here suggests a left third nerve palsy. Intracranial aneurysm is an uncommon--but the most feared--cause of third nerve palsy. When an aneurysm causes a third nerve palsy, it is of the extradural \u201cberry\u201d type, in which focal congenital defects in the intima and media at arterial branch points cause bubble-like expansion that worsens with aging, systemic hypertension, and other conditions that weaken arterial walls. Berry aneurysms are prone to rupture with a mortality rate of 50%. But mere expansion without rupture is sufficient to cause third nerve palsy if the expanded aneurysm measures at least 3 millimeters in diameter. The third nerve is most likely to be compressed by an expanding (or ruptured) aneurysm at the junction of the internal carotid and posterior communicating aneurysm<\/li>\n<li>Less common sites of aneurysms are the junction of basilar and superior cerebellar arteries and the junction of the basilar and posterior cerebral arteries<\/li>\n<li>Modern computed tomographic (CT) angiography and magnetic resonance (MR) angiography are about 96% likely to detect aneurysms that cause third nerve palsies, provided the interpreting radiologist is experienced enough to detect the often subtle abnormalities. If you suspect a recent-onset third nerve palsy, you must order such a non-invasive vascular imaging study immediately, particularly in a patient in whom the most common ischemic palsy is less favored, because rupture of an expanding aneurysm could be imminent\u2014and fatal!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Junction of internal carotid and posterior communicating arteries<\/b><\/p>\n<ul>\n<li>The combination of neuro-ophthalmic deficits described here suggests a left third nerve palsy. Intracranial aneurysm is an uncommon--but the most feared--cause of third nerve palsy. When an aneurysm causes a third nerve palsy, it is of the extradural \u201cberry\u201d type, in which focal congenital defects in the intima and media at arterial branch points cause bubble-like expansion that worsens with aging, systemic hypertension, and other conditions that weaken arterial walls. Berry aneurysms are prone to rupture with a mortality rate of 50%. But mere expansion without rupture is sufficient to cause third nerve palsy if the expanded aneurysm measures at least 3 millimeters in diameter. The third nerve is most likely to be compressed by an expanding (or ruptured) aneurysm at the junction of the internal carotid and posterior communicating aneurysm<\/li>\n<li>Less common sites of aneurysms are the junction of basilar and superior cerebellar arteries and the junction of the basilar and posterior cerebral arteries<\/li>\n<li>Modern computed tomographic (CT) angiography and magnetic resonance (MR) angiography are about 96% likely to detect aneurysms that cause third nerve palsies, provided the interpreting radiologist is experienced enough to detect the often subtle abnormalities. If you suspect a recent-onset third nerve palsy, you must order such a non-invasive vascular imaging study immediately, particularly in a patient in whom the most common ischemic palsy is less favored, because rupture of an expanding aneurysm could be imminent\u2014and fatal!<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='16'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>32 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 57 year old man reports episodes of vertical diplopia that have become much more frequent within the past few months. Your examination shows a left hypertropia that increases on right gaze and disappears on left gaze. In right gaze, the hypertropia is greater in the upgaze position than in the downgaze position. The left hypertropia is also greater on left head tilt than on right head tilt. Double Maddox Rod testing shows 5 degrees of excyclodeviation. This misalignment pattern is caused by a lesion in the\u2026<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-8_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-16]' id='ays-answer-58-5' value='58'\/>\n\n                <label for='ays-answer-58-5' class='  ays_position_initial  '>Superior oblique muscle\/tendon<\/label><label for='ays-answer-58-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-16]' id='ays-answer-59-5' value='59'\/>\n\n                <label for='ays-answer-59-5' class='  ays_position_initial  '>Neuromuscular junction<\/label><label for='ays-answer-59-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-16]' id='ays-answer-60-5' value='60'\/>\n\n                <label for='ays-answer-60-5' class='  ays_position_initial  '>Fourth nerve fascicles<\/label><label for='ays-answer-60-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-16]' id='ays-answer-61-5' value='61'\/>\n\n                <label for='ays-answer-61-5' class='  ays_position_initial  '>Fourth nerve nucleus<\/label><label for='ays-answer-61-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[16]\" value=\"58,59,60,61\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['16'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNTgiOiIxIiwiNTkiOiIwIiwiNjAiOiIwIiwiNjEiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459701<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Superior oblique muscle\/tendon<\/b><\/p>\n<ul>\n<li>The pattern of ocular misalignment fulfills the features of the Bielshowsky \u201cthree-step test,\u201d a strong indication of a \u201cfourth nerve palsy.\u201d In addition, the fact that the hypertropia in left gaze is greater when the patient is looking up than when he is looking down is critical to localizing the lesion: it lies in the superior oblique muscle or its tendon.<\/li>\n<li>Why does this part of the body give out? Consider that the anatomy of the superior oblique muscle and its tendon is awkward: the muscle passes forward along the medial orbital wall, passes through a sleeve of dura called the trochlea, and must turn more than 90 degrees to insert onto the top of the eye.<\/li>\n<li>It should not be surprising that the efficiency of its pulling power might decline as the years go by! Sometimes the diplopia in this condition can be palliated with a spectacle prism. But because of the incomitance, the prism is usually an imperfect or temporary solution, and eye muscle surgery the answer. Fortunately, a minor procedure (weakening of the inferior oblique muscle) is likely to provide relief of diplopia. Acquired causes of \u201cfourth nerve palsy,\u201d including trauma, tumor, and inflammation, would cause a hypertropia that is greater in downgaze than in upgaze. If you selected \u201cneuromuscular junction\u201d as your choice, you could hardly be faulted here, because myasthenia gravis can produce any pattern of ocular misalignment. In fact, the intermittency of the diplopia is likely to send you toward that diagnosis, but when the misalignment obeys the features of the three-step test, myasthenia is a less likely diagnosis. By the way, myasthenia gravis is not the only cause of intermittent diplopia. Here are other reasons for this phenomenon: 1) diplopia is present only in certain fields of gaze, and 2) fusion is breaking down because of fatigue or CNS depressants, which convert a phoria to a tropia.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Superior oblique muscle\/tendon<\/b><\/p>\n<ul>\n<li>The pattern of ocular misalignment fulfills the features of the Bielshowsky \u201cthree-step test,\u201d a strong indication of a \u201cfourth nerve palsy.\u201d In addition, the fact that the hypertropia in left gaze is greater when the patient is looking up than when he is looking down is critical to localizing the lesion: it lies in the superior oblique muscle or its tendon.<\/li>\n<li>Why does this part of the body give out? Consider that the anatomy of the superior oblique muscle and its tendon is awkward: the muscle passes forward along the medial orbital wall, passes through a sleeve of dura called the trochlea, and must turn more than 90 degrees to insert onto the top of the eye.<\/li>\n<li>It should not be surprising that the efficiency of its pulling power might decline as the years go by! Sometimes the diplopia in this condition can be palliated with a spectacle prism. But because of the incomitance, the prism is usually an imperfect or temporary solution, and eye muscle surgery the answer. Fortunately, a minor procedure (weakening of the inferior oblique muscle) is likely to provide relief of diplopia. Acquired causes of \u201cfourth nerve palsy,\u201d including trauma, tumor, and inflammation, would cause a hypertropia that is greater in downgaze than in upgaze. If you selected \u201cneuromuscular junction\u201d as your choice, you could hardly be faulted here, because myasthenia gravis can produce any pattern of ocular misalignment. In fact, the intermittency of the diplopia is likely to send you toward that diagnosis, but when the misalignment obeys the features of the three-step test, myasthenia is a less likely diagnosis. By the way, myasthenia gravis is not the only cause of intermittent diplopia. Here are other reasons for this phenomenon: 1) diplopia is present only in certain fields of gaze, and 2) fusion is breaking down because of fatigue or CNS depressants, which convert a phoria to a tropia.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='15'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>33 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 10 year old boy complains of severe right ear pain of one week\u2019s duration. Diplopia started two days ago. Examination shows cloudiness and redness of the right eardrum (tympanum). He has reduced abduction of the right eye and esotropia. The optic fundus examination is normal. Imaging shows opacification of the right petrous apex. The lesion causing the neuro-ophthalmic abnormality likely to lie in\u2026<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-6_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-15]' id='ays-answer-54-5' value='54'\/>\n\n                <label for='ays-answer-54-5' class='  ays_position_initial  '>Subarachnoid space<\/label><label for='ays-answer-54-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-15]' id='ays-answer-55-5' value='55'\/>\n\n                <label for='ays-answer-55-5' class='  ays_position_initial  '>Dorello\u2019s canal<\/label><label for='ays-answer-55-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-15]' id='ays-answer-56-5' value='56'\/>\n\n                <label for='ays-answer-56-5' class='  ays_position_initial  '>Cavernous sinus<\/label><label for='ays-answer-56-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-15]' id='ays-answer-57-5' value='57'\/>\n\n                <label for='ays-answer-57-5' class='  ays_position_initial  '>Transverse-sigmoid (dural) sinus junction<\/label><label for='ays-answer-57-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[15]\" value=\"54,55,56,57\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['15'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNTQiOiIwIiwiNTUiOiIxIiwiNTYiOiIwIiwiNTciOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459700<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Dorello\u2019s<\/b><b> canal<\/b><\/p>\n<ul>\n<li>The likely cause of the diplopia is a right sixth nerve palsy. His ear abnormalities are likely caused by an infected middle ear (\u201cotitis media\u201d) with spread of the infection to the mastoid region. How can you connect that infection with the sixth nerve palsy? By assuming that the infection has spread through the petrous bone to its apex, where the bone forms the lateral wall of Dorello\u2019s canal, the narrow space through which the sixth nerve travels to get from the subarachnoid space into the cavernous sinus.<\/li>\n<li>The association between middle ear infection and sixth nerve palsy was described long ago by Gradenigo and is now known as \u201cGradenigo\u2019s syndrome.\u201d The sixth nerve in the tight space of Dorello\u2019s canal is vulnerable to a \u201ccompartment syndrome\u201d as infections and cancers come from a lateral source in the petrous bone, from a medial source in the clivus (a favorite site for cancer metastasis), and from an inferior source in the sphenoid sinus (infections and cancer). You cannot be faulted here if you chose \u201ctransverse-sigmoid (dural) sinus junction\u201d as your answer. Mastoid inflammation from middle ear infections can cause venous sinus thrombosis at the transverse-sigmoid junction, raising intracranial pressure and causing a secondary sixth nerve palsy. Why does high intracranial pressure cause a sixth nerve palsy? Because the high pressure drives the brain downward, tugging on the sixth nerve where it is tethered in Dorello\u2019s canal. But in such cases, papilledema is usually present (and it was not in this boy). By the way, low intracranial pressure also drives the brain downward, which is why sixth nerve palsy also occurs in intracranial hypotension. A final tip: when intracranial pressure goes up, you might instead encounter a comitant esotropia with full ocular ductions, representing a breakdown in \u201cocular fusion.\u201d<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Dorello\u2019s<\/b><b> canal<\/b><\/p>\n<ul>\n<li>The likely cause of the diplopia is a right sixth nerve palsy. His ear abnormalities are likely caused by an infected middle ear (\u201cotitis media\u201d) with spread of the infection to the mastoid region. How can you connect that infection with the sixth nerve palsy? By assuming that the infection has spread through the petrous bone to its apex, where the bone forms the lateral wall of Dorello\u2019s canal, the narrow space through which the sixth nerve travels to get from the subarachnoid space into the cavernous sinus.<\/li>\n<li>The association between middle ear infection and sixth nerve palsy was described long ago by Gradenigo and is now known as \u201cGradenigo\u2019s syndrome.\u201d The sixth nerve in the tight space of Dorello\u2019s canal is vulnerable to a \u201ccompartment syndrome\u201d as infections and cancers come from a lateral source in the petrous bone, from a medial source in the clivus (a favorite site for cancer metastasis), and from an inferior source in the sphenoid sinus (infections and cancer). You cannot be faulted here if you chose \u201ctransverse-sigmoid (dural) sinus junction\u201d as your answer. Mastoid inflammation from middle ear infections can cause venous sinus thrombosis at the transverse-sigmoid junction, raising intracranial pressure and causing a secondary sixth nerve palsy. Why does high intracranial pressure cause a sixth nerve palsy? Because the high pressure drives the brain downward, tugging on the sixth nerve where it is tethered in Dorello\u2019s canal. But in such cases, papilledema is usually present (and it was not in this boy). By the way, low intracranial pressure also drives the brain downward, which is why sixth nerve palsy also occurs in intracranial hypotension. A final tip: when intracranial pressure goes up, you might instead encounter a comitant esotropia with full ocular ductions, representing a breakdown in \u201cocular fusion.\u201d<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='14'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>34 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 55 year old man has new diplopia and ptosis. Examination shows an incomitant esotropia in which image separation is greatest in right gaze, together with a right Horner syndrome. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-5_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-14]' id='ays-answer-50-5' value='50'\/>\n\n                <label for='ays-answer-50-5' class='  ays_position_initial  '>Brainstem<\/label><label for='ays-answer-50-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-14]' id='ays-answer-51-5' value='51'\/>\n\n                <label for='ays-answer-51-5' class='  ays_position_initial  '>Subarachnoid space<\/label><label for='ays-answer-51-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-14]' id='ays-answer-52-5' value='52'\/>\n\n                <label for='ays-answer-52-5' class='  ays_position_initial  '>Cavernous sinus<\/label><label for='ays-answer-52-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-14]' id='ays-answer-53-5' value='53'\/>\n\n                <label for='ays-answer-53-5' class='  ays_position_initial  '>Orbit<\/label><label for='ays-answer-53-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[14]\" value=\"50,51,52,53\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['14'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNTAiOiIwIiwiNTEiOiIwIiwiNTIiOiIxIiwiNTMiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459699<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Cavernous sinus<\/b><\/p>\n<p>An incomitant esotropia with image separation greatest in right gaze suggests a right abduction deficit, even if you cannot see it. Many processes can cause an abduction deficit, but when you add an ipsilateral Horner syndrome, you are closing in on the place where the oculosympathetic pathway and the sixth nerve pathway come together\u2014the cavernous sinus. In the cavernous sinus, the sixth nerve is the only cranial nerve lying within the venous lake (the other cranial nerves travel in the outer dural wall). The sixth nerve passes inferolateral to the carotid artery. On the outer wall of the carotid artery, you will find the oculosympathetic nerve. The combination of sixth nerve palsy and Horner syndrome is common with lesions arising within the cavernous sinus, including aneurysms and metastases.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Cavernous sinus<\/b><\/p>\n<p>An incomitant esotropia with image separation greatest in right gaze suggests a right abduction deficit, even if you cannot see it. Many processes can cause an abduction deficit, but when you add an ipsilateral Horner syndrome, you are closing in on the place where the oculosympathetic pathway and the sixth nerve pathway come together\u2014the cavernous sinus. In the cavernous sinus, the sixth nerve is the only cranial nerve lying within the venous lake (the other cranial nerves travel in the outer dural wall). The sixth nerve passes inferolateral to the carotid artery. On the outer wall of the carotid artery, you will find the oculosympathetic nerve. The combination of sixth nerve palsy and Horner syndrome is common with lesions arising within the cavernous sinus, including aneurysms and metastases.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='13'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>35 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A lesion in the ciliary ganglion on one side is likely to cause which of the following ipsilateral abnormalities?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-4_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-13]' id='ays-answer-46-5' value='46'\/>\n\n                <label for='ays-answer-46-5' class='  ays_position_initial  '>Ptosis and supraduction deficit<\/label><label for='ays-answer-46-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-13]' id='ays-answer-47-5' value='47'\/>\n\n                <label for='ays-answer-47-5' class='  ays_position_initial  '>Ptosis and miosis<\/label><label for='ays-answer-47-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-13]' id='ays-answer-48-5' value='48'\/>\n\n                <label for='ays-answer-48-5' class='  ays_position_initial  '>Mydriasis and light-near dissociation<\/label><label for='ays-answer-48-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-13]' id='ays-answer-49-5' value='49'\/>\n\n                <label for='ays-answer-49-5' class='  ays_position_initial  '>Mydriasis, adduction deficit, and lack of pupil constriction to light or upon viewing a near target<\/label><label for='ays-answer-49-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[13]\" value=\"46,47,48,49\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['13'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNDYiOiIwIiwiNDciOiIwIiwiNDgiOiIxIiwiNDkiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459698<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Mydriasis and light-near dissociation<\/b><\/p>\n<p>A lesion of the ciliary ganglion in the orbit interrupts the parasympathetic supply to the iris sphincter and ciliary muscle, creating a pupil that does not constrict to light or to a target viewed at close range. Within weeks, pupil constriction to a target viewed at close range (\u201cthe near response\u201d) is reestablished, but that constriction occurs slowly, creating the term \u201ctonic pupil.\u201d When gaze is redirected from a near to a distant target, pupil dilation is also slow. You might also note that the affected pupil is slightly oval and that the tonic constriction is segmental. Why do those phenomena occur? Because a lesion of the ciliary ganglion affects its nerve outflow segmentally; that is, one part of the iris sphincter is damaged more than other parts. Query: if you are confronted with a unilaterally dilated pupil, how would you know that it might be caused by a relatively acute ciliary ganglionopathy (before development of light-near dissociation and tonic features) rather than by exposure to a topical parasympatholytic agent? There are two clues: 1) in the short term, ciliary denervation causes asymmetric enlargement of the pupil (it has an oval shape) because the denervation is segmental, whereas parasympatholytic agents cause symmetric enlargement of the pupil (it has a round shape); and 2) a ciliary denervated pupil will constrict following instillation of pilocarpine 1%, whereas a pupil that is dilated because of topical exposure to a parasympatholytic agent will constrict minimally after instillation of pilocarpine 1%. Finally, here is a comment about the other answer choices. The combination of ptosis and supraduction deficit could represent a lesion of the superior division of the somatic portion of the third cranial nerve, which would occur intracranially, not in the orbit. The combination of ptosis and miosis suggests Horner syndrome, which arises from a lesion of the oculosympathetic pathway, which does not include the ciliary ganglion. The combination of mydriasis, adduction deficit, and lack of constriction to light or a near target is suggestive of a lesion of the intracranial third nerve that affects its inferior division.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Mydriasis and light-near dissociation<\/b><\/p>\n<p>A lesion of the ciliary ganglion in the orbit interrupts the parasympathetic supply to the iris sphincter and ciliary muscle, creating a pupil that does not constrict to light or to a target viewed at close range. Within weeks, pupil constriction to a target viewed at close range (\u201cthe near response\u201d) is reestablished, but that constriction occurs slowly, creating the term \u201ctonic pupil.\u201d When gaze is redirected from a near to a distant target, pupil dilation is also slow. You might also note that the affected pupil is slightly oval and that the tonic constriction is segmental. Why do those phenomena occur? Because a lesion of the ciliary ganglion affects its nerve outflow segmentally; that is, one part of the iris sphincter is damaged more than other parts. Query: if you are confronted with a unilaterally dilated pupil, how would you know that it might be caused by a relatively acute ciliary ganglionopathy (before development of light-near dissociation and tonic features) rather than by exposure to a topical parasympatholytic agent? There are two clues: 1) in the short term, ciliary denervation causes asymmetric enlargement of the pupil (it has an oval shape) because the denervation is segmental, whereas parasympatholytic agents cause symmetric enlargement of the pupil (it has a round shape); and 2) a ciliary denervated pupil will constrict following instillation of pilocarpine 1%, whereas a pupil that is dilated because of topical exposure to a parasympatholytic agent will constrict minimally after instillation of pilocarpine 1%. Finally, here is a comment about the other answer choices. The combination of ptosis and supraduction deficit could represent a lesion of the superior division of the somatic portion of the third cranial nerve, which would occur intracranially, not in the orbit. The combination of ptosis and miosis suggests Horner syndrome, which arises from a lesion of the oculosympathetic pathway, which does not include the ciliary ganglion. The combination of mydriasis, adduction deficit, and lack of constriction to light or a near target is suggestive of a lesion of the intracranial third nerve that affects its inferior division.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='12'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>36 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 45 year old man has the acute onset of right facial pain and ptosis. Examination shows right ptosis and miosis. Where in the oculosympathetic pathway is the lesion most likely to be?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-3_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-12]' id='ays-answer-42-5' value='42'\/>\n\n                <label for='ays-answer-42-5' class='  ays_position_initial  '>First-order neuronal projection<\/label><label for='ays-answer-42-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-12]' id='ays-answer-43-5' value='43'\/>\n\n                <label for='ays-answer-43-5' class='  ays_position_initial  '>Second-order neuronal projection<\/label><label for='ays-answer-43-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-12]' id='ays-answer-44-5' value='44'\/>\n\n                <label for='ays-answer-44-5' class='  ays_position_initial  '>Third-order neuronal projection<\/label><label for='ays-answer-44-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-12]' id='ays-answer-45-5' value='45'\/>\n\n                <label for='ays-answer-45-5' class='  ays_position_initial  '>Ciliary ganglion or ciliary nerves<\/label><label for='ays-answer-45-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[12]\" value=\"42,43,44,45\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['12'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiNDIiOiIwIiwiNDMiOiIwIiwiNDQiOiIxIiwiNDUiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459697<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Third-order neuronal projection<\/b><\/p>\n<ul>\n<li>The first-order neuronal projection extends from the hypothalamus to the upper thoracic spinal cord. Lesions in the hypothalamus are rare and usually cause other neurologic manifestations. Lesions in the brainstem that cause Horner syndrome usually lie in the medulla and never cause Horner syndrome alone. Spinal cord lesions would also be expected to cause other neurologic manifestations. The second-order neuronal projection extends from the spinal cord to the superior cervical ganglion in the neck. Lesions here could cause Horner syndrome in isolation, but almost never acutely. The third order neuronal projection extends from the superior cervical ganglion to the eye. Acute Horner syndrome with ipsilateral facial or neck pain is most commonly caused by cervical carotid dissection, which damages the oculosympathetic axons lying on the outer edge of the vessel wall. The deformation of the carotid artery wall also causes turbulent flow, which may generate emboli that can cause cerebral stroke. The risk of stroke rapidly declines within the first 10 days after the dissection. Patients are usually placed acutely on prophylactic aspirin. The ciliary ganglion and nerves do not lie within the oculosympathetic pathway.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Third-order neuronal projection<\/b><\/p>\n<ul>\n<li>The first-order neuronal projection extends from the hypothalamus to the upper thoracic spinal cord. Lesions in the hypothalamus are rare and usually cause other neurologic manifestations. Lesions in the brainstem that cause Horner syndrome usually lie in the medulla and never cause Horner syndrome alone. Spinal cord lesions would also be expected to cause other neurologic manifestations. The second-order neuronal projection extends from the spinal cord to the superior cervical ganglion in the neck. Lesions here could cause Horner syndrome in isolation, but almost never acutely. The third order neuronal projection extends from the superior cervical ganglion to the eye. Acute Horner syndrome with ipsilateral facial or neck pain is most commonly caused by cervical carotid dissection, which damages the oculosympathetic axons lying on the outer edge of the vessel wall. The deformation of the carotid artery wall also causes turbulent flow, which may generate emboli that can cause cerebral stroke. The risk of stroke rapidly declines within the first 10 days after the dissection. Patients are usually placed acutely on prophylactic aspirin. The ciliary ganglion and nerves do not lie within the oculosympathetic pathway.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='11'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>37 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A patient with a left Horner syndrome, together with hypertropia and ipsilateral ataxia, is most likely to have a lesion in:<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-2_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-11]' id='ays-answer-38-5' value='38'\/>\n\n                <label for='ays-answer-38-5' class='  ays_position_initial  '>Hypothalamus<\/label><label for='ays-answer-38-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-11]' id='ays-answer-39-5' value='39'\/>\n\n                <label for='ays-answer-39-5' class='  ays_position_initial  '>Thalamus<\/label><label for='ays-answer-39-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-11]' id='ays-answer-40-5' value='40'\/>\n\n                <label for='ays-answer-40-5' class='  ays_position_initial  '>Pons<\/label><label for='ays-answer-40-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-11]' id='ays-answer-41-5' value='41'\/>\n\n                <label for='ays-answer-41-5' class='  ays_position_initial  '>Medulla<\/label><label for='ays-answer-41-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[11]\" value=\"38,39,40,41\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['11'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMzgiOiIwIiwiMzkiOiIwIiwiNDAiOiIwIiwiNDEiOiIxIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459696<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Medulla<\/b><\/p>\n<ul>\n<li>The combination of Horner syndrome, hypertropia (from skew deviation), and ataxia is strong evidence of a lesion in the dorsolateral medulla. In that region, infarction is the overwhelmingly likely cause, secondary to occlusion of the ipsilateral vertebral artery and its posterior inferior cerebellar artery branch. A stroke in this territory, known as the \u201cWallenberg syndrome,\u201d may also damage the inferior cerebellum. If the infarction is large, the cerebellum may swell enough to compress the medulla, creating a neurological emergency. The damaged cerebellum may have to be surgically excised. This is the most common brainstem stroke at any age, but especially in young adults. The underlying lesion may be idiopathic or traumatic dissection of the vertebral artery. By the way, can you guess whether the right eye or the left eye was the higher eye? Answer: the right eye. Use this rule: in skew deviation, the higher eye will always be on the side opposite to a medullary or caudal pontine lesion, whereas the higher eye will be on the same side as a rostral pontine or midbrain lesion.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Medulla<\/b><\/p>\n<ul>\n<li>The combination of Horner syndrome, hypertropia (from skew deviation), and ataxia is strong evidence of a lesion in the dorsolateral medulla. In that region, infarction is the overwhelmingly likely cause, secondary to occlusion of the ipsilateral vertebral artery and its posterior inferior cerebellar artery branch. A stroke in this territory, known as the \u201cWallenberg syndrome,\u201d may also damage the inferior cerebellum. If the infarction is large, the cerebellum may swell enough to compress the medulla, creating a neurological emergency. The damaged cerebellum may have to be surgically excised. This is the most common brainstem stroke at any age, but especially in young adults. The underlying lesion may be idiopathic or traumatic dissection of the vertebral artery. By the way, can you guess whether the right eye or the left eye was the higher eye? Answer: the right eye. Use this rule: in skew deviation, the higher eye will always be on the side opposite to a medullary or caudal pontine lesion, whereas the higher eye will be on the same side as a rostral pontine or midbrain lesion.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='10'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>38 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A lesion in the left optic tract would cause which of the following disturbances in the pupils?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK-ft-ap-1_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-10]' id='ays-answer-34-5' value='34'\/>\n\n                <label for='ays-answer-34-5' class='  ays_position_initial  '>Left afferent pupil defect<\/label><label for='ays-answer-34-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-10]' id='ays-answer-35-5' value='35'\/>\n\n                <label for='ays-answer-35-5' class='  ays_position_initial  '>Right afferent pupil defect<\/label><label for='ays-answer-35-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-10]' id='ays-answer-36-5' value='36'\/>\n\n                <label for='ays-answer-36-5' class='  ays_position_initial  '>Left light-near dissociation<\/label><label for='ays-answer-36-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-10]' id='ays-answer-37-5' value='37'\/>\n\n                <label for='ays-answer-37-5' class='  ays_position_initial  '>Right light-near dissociation<\/label><label for='ays-answer-37-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[10]\" value=\"34,35,36,37\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['10'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMzQiOiIwIiwiMzUiOiIxIiwiMzYiOiIwIiwiMzciOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459695<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right afferent pupil defect <\/b><\/p>\n<p>A lesion in the optic tract is apt to cause a contralateral afferent pupil defect because axons coming from that eye and crossing into the opposite optic tract outnumber non-crossing axons. Such an afferent pupil defect is more likely to occur if the lesion damages the optic tract severely enough to cause a complete or nearly complete homonymous hemianopia. Why is this phenomenon important clinically? Because the combination of a unilateral complete homonymous hemianopia and an ipsilateral afferent pupil defect localizes the lesion to the contralateral optic tract, provided there is no evidence of an optic neuropathy on the side of the afferent pupil defect. Without that afferent pupil defect, you might not be able to localize a complete homonymous hemianopia to a particular region in the retrochiasmal visual pathway. Light-near dissociation occurs with lesions of the dorsal midbrain, not from lesions in the optic tract.<\/p>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Right afferent pupil defect <\/b><\/p>\n<p>A lesion in the optic tract is apt to cause a contralateral afferent pupil defect because axons coming from that eye and crossing into the opposite optic tract outnumber non-crossing axons. Such an afferent pupil defect is more likely to occur if the lesion damages the optic tract severely enough to cause a complete or nearly complete homonymous hemianopia. Why is this phenomenon important clinically? Because the combination of a unilateral complete homonymous hemianopia and an ipsilateral afferent pupil defect localizes the lesion to the contralateral optic tract, provided there is no evidence of an optic neuropathy on the side of the afferent pupil defect. Without that afferent pupil defect, you might not be able to localize a complete homonymous hemianopia to a particular region in the retrochiasmal visual pathway. Light-near dissociation occurs with lesions of the dorsal midbrain, not from lesions in the optic tract.<\/p>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='9'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>39 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 14 year old girl suffers head trauma in an automobile accident. When she recovers consciousness, she reports diplopia. Examination shows a right hypertropia in primary gaze position that increases on left gaze but converts to a left hypertropia on right gaze. The responsible lesion is likely to be in the:<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/tyk_ft_af_7_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-9]' id='ays-answer-30-5' value='30'\/>\n\n                <label for='ays-answer-30-5' class='  ays_position_initial  '>Thalamus<\/label><label for='ays-answer-30-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-9]' id='ays-answer-31-5' value='31'\/>\n\n                <label for='ays-answer-31-5' class='  ays_position_initial  '>Midbrain<\/label><label for='ays-answer-31-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-9]' id='ays-answer-32-5' value='32'\/>\n\n                <label for='ays-answer-32-5' class='  ays_position_initial  '>Cavernous sinus<\/label><label for='ays-answer-32-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-9]' id='ays-answer-33-5' value='33'\/>\n\n                <label for='ays-answer-33-5' class='  ays_position_initial  '>Orbit<\/label><label for='ays-answer-33-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[9]\" value=\"30,31,32,33\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['9'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMzAiOiIwIiwiMzEiOiIxIiwiMzIiOiIwIiwiMzMiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459694<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_previous action-button  ' value='Previous' \/><i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow  ays_display_none\"><\/i>\n                        <input type='button' name='next' class='ays_next action-button  ' value='Next' \/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer:<b>\u00a0Midbrain<\/b><\/p>\n<ul>\n<li>When the right eye is higher in left gaze and the left eye is higher on right gaze, you are looking at BILATERAL fourth nerve palsies, especially in the setting of head trauma. In concussive head trauma, the brain moves more than its coverings, including the dura. As a result, the dorsal midbrain slams into the rigid, knife-like inner margin of the tentorium cerebelli at exactly the place where the crossing fourth nerves exit from the brainstem. The fourth nerves are often injured together, although usually asymmetrically.<\/li>\n<li>Bilateral fourth nerve palsies create this pattern of \u201calternating hypertropia,\u201d a large (at least 10 degrees) excyclodeviation, and an esotropia in downgaze. Imaging generally does not show a pertinent abnormality, although sometimes there is hemorrhage in the caudal dorsal midbrain.<\/li>\n<li>Recovery is delayed for months and is of variable degree. Eye muscle surgery may eventually be necessary.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Midbrain<\/b><\/p>\n<ul>\n<li>When the right eye is higher in left gaze and the left eye is higher on right gaze, you are looking at BILATERAL fourth nerve palsies, especially in the setting of head trauma. In concussive head trauma, the brain moves more than its coverings, including the dura. As a result, the dorsal midbrain slams into the rigid, knife-like inner margin of the tentorium cerebelli at exactly the place where the crossing fourth nerves exit from the brainstem. The fourth nerves are often injured together, although usually asymmetrically.<\/li>\n<li>Bilateral fourth nerve palsies create this pattern of \u201calternating hypertropia,\u201d a large (at least 10 degrees) excyclodeviation, and an esotropia in downgaze. Imaging generally does not show a pertinent abnormality, although sometimes there is hemorrhage in the caudal dorsal midbrain.<\/li>\n<li>Recovery is delayed for months and is of variable degree. Eye muscle surgery may eventually be necessary.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step  '\n                        data-question-id='8'\n                        data-type='radio'\n                        data-required='false'>\n                        \n                        \n                        <p class='ays-question-counter animated'>40 \/ 40<\/p>\n                        <p class='ays_user_points_container'><\/p>\n                        \n                        <div class='ays-abs-fs'>\n                            \n                            \n                            \n                            \n                            <div class='ays_quiz_question'>\n                                <p>A 19 year old woman reports new imbalance. When she tries to walk, she falls to her right side. She is extremely nauseated, and has been vomiting. Your examination shows a left-beating (jerk) horizontal-rotary nystagmus in primary (straight ahead) gaze position that intensifies on left gaze but is still slightly present on right gaze. The head impulse test appears to be positive when you rapidly move her head to the right. Where is the lesion?<\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"https:\/\/novel.utah.edu\/test-your-knowledge\/wp-content\/uploads\/sites\/7\/2025\/11\/TYK_ft_ap_11_20.png\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" \" ><\/div>\n                            <div class='ays-quiz-answers ays_list_view_container  '><input class='ays_quiz_answer_view_class_mobile' data-quiz-id='5' type='hidden' value='ays_list_view_container'>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-8]' id='ays-answer-26-5' value='26'\/>\n\n                <label for='ays-answer-26-5' class='  ays_position_initial  '>Right vestibular nerve<\/label><label for='ays-answer-26-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-8]' id='ays-answer-27-5' value='27'\/>\n\n                <label for='ays-answer-27-5' class='  ays_position_initial  '>Left vestibular nerve<\/label><label for='ays-answer-27-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-8]' id='ays-answer-28-5' value='28'\/>\n\n                <label for='ays-answer-28-5' class='  ays_position_initial  '>Right medulla<\/label><label for='ays-answer-28-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='radio' name='ays_questions[ays-question-8]' id='ays-answer-29-5' value='29'\/>\n\n                <label for='ays-answer-29-5' class='  ays_position_initial  '>Left medulla<\/label><label for='ays-answer-29-5' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><input type=\"hidden\" name=\"ays_answers_order[8]\" value=\"26,27,28,29\" \/><script>\n            if(typeof window.quizOptions_5 === 'undefined'){\n                window.quizOptions_5 = [];\n            }\n            window.quizOptions_5['8'] = 'eyJxdWVzdGlvbl9hbnN3ZXIiOnsiMjYiOiIxIiwiMjciOiIwIiwiMjgiOiIwIiwiMjkiOiIwIn19';<\/script><\/div>\n                            <div class=\"ays-quiz-question-note-message-box\"><p>https:\/\/collections.lib.utah.edu\/details?id=2459733<\/p>\n<\/div>\n                            \n                            <div class='ays_buttons_div'><i class=\"ays_fa ays_fa_arrow_left ays_previous action-button  ays_arrow ays_display_none\"><\/i>\n                            <input type='button' name='next' class='ays_previous action-button  '  value='Previous' \/><i class='ays_display_none ays_fa ays_fa_flag_checkered ays_finish action-button ays_arrow ays_next_arrow '><\/i><input type='submit' name='ays_finish_quiz' class='  ays_next ays_finish action-button ' value='See Result'\/><\/div>\n                            \n                            <div class='wrong_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right vestibular nerve<\/b><\/p>\n<ul>\n<li>The new imbalance, unidirectional horizontal rotary nystagmus, and the positive head impulse test strongly suggest an acute right peripheral vestibulopathy. It has upset the balance between the right and left vestibular pathway inputs. The right-sided lesion produces a drift of the eyes toward the right, which is met by compensatory leftwardly directed saccades, making up a left jerk nystagmus. The nystagmus remains left-beating in all three positions of horizontal gaze, a feature relatively unique to acute peripheral vestibulopathy.<\/li>\n<li>The positive head impulse test, which can be difficult to interpret in the presence of nystagmus, supports a peripheral lesion.<\/li>\n<li>The vestibular imbalance explains why the patient falls to her right. A common cause for this condition is \u201cvestibular neuritis\/neuronitis,\u201d attributed to a virus. It can be frightening to patients and examiners and very unpleasant. In that condition, there is good evidence of reactivation of herpes simplex type 1 virus in the vestibular ganglia. A large trial showed no benefit of anti-viral therapy, but symptoms resolved more quickly in patients treated with prednisone 1mg\/kg for 10 days. Therefore, steroid is often prescribed once the diagnosis is ascertained. Meclizine is also often prescribed for nausea. In this patient, the manifestations rapidly lessened and disappeared completely within 10 days.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='right_answer_text ' style='display:none'>\n                                <p>Correct Answer: <b>Right vestibular nerve<\/b><\/p>\n<ul>\n<li>The new imbalance, unidirectional horizontal rotary nystagmus, and the positive head impulse test strongly suggest an acute right peripheral vestibulopathy. It has upset the balance between the right and left vestibular pathway inputs. The right-sided lesion produces a drift of the eyes toward the right, which is met by compensatory leftwardly directed saccades, making up a left jerk nystagmus. The nystagmus remains left-beating in all three positions of horizontal gaze, a feature relatively unique to acute peripheral vestibulopathy.<\/li>\n<li>The positive head impulse test, which can be difficult to interpret in the presence of nystagmus, supports a peripheral lesion.<\/li>\n<li>The vestibular imbalance explains why the patient falls to her right. A common cause for this condition is \u201cvestibular neuritis\/neuronitis,\u201d attributed to a virus. It can be frightening to patients and examiners and very unpleasant. In that condition, there is good evidence of reactivation of herpes simplex type 1 virus in the vestibular ganglia. A large trial showed no benefit of anti-viral therapy, but symptoms resolved more quickly in patients treated with prednisone 1mg\/kg for 10 days. Therefore, steroid is often prescribed once the diagnosis is ascertained. Meclizine is also often prescribed for nausea. In this patient, the manifestations rapidly lessened and disappeared completely within 10 days.<\/li>\n<\/ul>\n\n                            <\/div>\n                            <div class='ays_questtion_explanation' style='display:none'>\n                                \n                            <\/div>\n                            <div class='ays-quiz-additonal-box'>\n                                \n                                \n                            <\/div>   \n                            \n                            \n                        <\/div>\n                    <\/div><div class='step ays_thank_you_fs'>\n            <div class='ays-abs-fs ays-end-page'>\n            <div style='text-align:center;'><div data-class='lds-ellipsis' data-role='loader' class='ays-loader'><div><\/div><div><\/div><div><\/div><div><\/div><\/div><\/div><div class='ays_quiz_results_page'><div class='ays_score_message'><\/div><div class='ays_conditions_message'><\/div><div class='ays_interval_message'><\/div><div class='ays_message'><\/div><div class='ays_woo_block'><\/div><p class='ays_score ays_score_display_none animated'>Your score is<\/p><p class='ays_average'>The average score is 60%<\/p><div class='ays-progress third'>\n                <span class='ays-progress-value third'>0%<\/span>\n                <div class='ays-progress-bg third'>\n                    <div class='ays-progress-bar third' style='width:0%;'><\/div>\n                <\/div>\n            <\/div><p class='ays_restart_button_p'><button type='button' class='action-button ays_restart_button '>\n                    <i class='ays_fa ays_fa_undo'><\/i>\n                    <span>Restart quiz<\/span>\n                <\/button><\/p><\/div><\/div><\/div><style> div#ays-quiz-container-5 * { box-sizing: border-box; } #ays-quiz-container-5 [id^='ays_finish_quiz_'] div.step div.ays-abs-fs { width: 90%; } \/* Styles for Internet Explorer start *\/ #ays-quiz-container-5 #ays_finish_quiz_5 { } 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.ays-questions-container .ays-field input~label[for^='ays-answer-'], div#ays-quiz-container-5 .ays-questions-container .ays-modern-dark-question *, div#ays-quiz-container-5 .ays-questions-container .ays_quiz_question, div#ays-quiz-container-5 .ays-questions-container .ays_quiz_question *{ word-break: break-word; } #ays-quiz-container-5 .ays-quiz-timer p { font-size: 16px; } #ays-quiz-container-5 section.ays_quiz_redirection_timer_container hr, #ays-quiz-container-5 section.ays_quiz_timer_container hr { margin: 0; } #ays-quiz-container-5 section.ays_quiz_timer_container.ays_quiz_timer_red_warning .ays-quiz-timer { color: #ff0000; } #ays-quiz-container-5 .ays_thank_you_fs p { text-align: center; } #ays-quiz-container-5 .information_form input[type='text'], #ays-quiz-container-5 .information_form input[type='url'], #ays-quiz-container-5 .information_form input[type='number'], #ays-quiz-container-5 .information_form input[type='email'], #ays-quiz-container-5 .information_form input[type='tel'], #ays-quiz-container-5 .information_form textarea, #ays-quiz-container-5 .information_form select, #ays-quiz-container-5 .information_form option { color: initial !important; outline: none; margin-left: 0; background-image: unset; } #ays-quiz-container-5 .information_form input[type='checkbox'] { margin: 0 10px; outline: initial; -webkit-appearance: auto; -moz-appearance: auto; position: initial; width: initial; height: initial; border: initial; background: initial; } #ays-quiz-container-5 .information_form input[type='checkbox']::after { content: none; } #ays-quiz-container-5 .wrong_answer_text{ color:#ff4d4d; } #ays-quiz-container-5 .right_answer_text{ color:#33cc33; } #ays-quiz-container-5 .right_answer_text p { font-size:16px; } #ays-quiz-container-5 .wrong_answer_text p { font-size:16px; } #ays-quiz-container-5 .ays_questtion_explanation p { font-size:16px; } #ays-quiz-container-5 .wrong_answer_text *:not(strong):not(a) { text-transform:none; text-decoration: none; letter-spacing: 0px; font-weight: normal; } #ays-quiz-container-5 .ays_questtion_explanation *:not(strong):not(a) { text-transform:none; text-decoration: none; letter-spacing: 0px; font-weight: normal; } #ays-quiz-container-5 .right_answer_text *:not(strong):not(a) { text-transform:none; text-decoration: none; letter-spacing: 0px; font-weight: normal; } #ays-quiz-container-5 .ays-quiz-question-note-message-box p { font-size:14px; } #ays-quiz-container-5 .ays-quiz-question-note-message-box *:not(strong):not(a) { text-transform:none; text-decoration: none; letter-spacing: 0px; font-weight: normal; } #ays-quiz-container-5 .ays_cb_and_a, #ays-quiz-container-5 .ays_cb_and_a * { color: rgb(0,0,0); text-align: center; } #ays-quiz-container-5 iframe { \/*min-height: 450px;*\/ } #ays-quiz-container-5 label.ays_for_checkbox, #ays-quiz-container-5 span.ays_checkbox_for_span { color: initial !important; display: block; } \/* Quiz textarea height *\/ #ays-quiz-container-5 textarea { height: 100px; min-height: 100px; } \/* Quiz rate and passed users count *\/ #ays-quiz-container-5 .ays_quizn_ancnoxneri_qanak, #ays-quiz-container-5 .ays_quiz_rete_avg{ color:#fff; background-color:#000000; } #ays-quiz-container-5 .ays-questions-container > .ays_quizn_ancnoxneri_qanak { padding: 5px 20px; } #ays-quiz-container-5 div.for_quiz_rate.ui.star.rating .icon { color: rgba(0,0,0,0.35); } #ays-quiz-container-5 .ays_quiz_rete_avg div.for_quiz_rate_avg.ui.star.rating .icon { color: rgba(255,255,255,0.5); } #ays-quiz-container-5 .ays_quiz_rete .ays-quiz-rate-link-box .ays-quiz-rate-link { color: #000000; } \/* Loaders *\/ #ays-quiz-container-5 div.lds-spinner, #ays-quiz-container-5 div.lds-spinner2 { color: #000000; } #ays-quiz-container-5 div.lds-spinner div:after, #ays-quiz-container-5 div.lds-spinner2 div:after { background-color: #000000; } #ays-quiz-container-5 .lds-circle, #ays-quiz-container-5 .lds-facebook div, #ays-quiz-container-5 .lds-ellipsis div{ background: #000000; } #ays-quiz-container-5 .lds-ripple div{ border-color: #000000; } #ays-quiz-container-5 .lds-dual-ring::after, #ays-quiz-container-5 .lds-hourglass::after{ border-color: #000000 transparent #000000 transparent; } \/* Stars *\/ #ays-quiz-container-5 .ui.rating .icon, #ays-quiz-container-5 .ui.rating .icon:before { font-family: Rating !important; } \/* Progress bars *\/ #ays-quiz-container-5 #ays_finish_quiz_5 .ays-progress { border-color: rgba(0,0,0,0.8); } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-progress-bg { background-color: rgba(0,0,0,0.3); } #ays-quiz-container-5 .ays-progress-value { color: #000000; text-align: center; } #ays-quiz-container-5 .ays-progress-bar { background-color: #5d6cf9; } #ays-quiz-container-5 .ays-question-counter .ays-live-bar-wrap { direction:ltr !important; } #ays-quiz-container-5 .ays-live-bar-fill{ color: #000000; border-bottom: 2px solid rgba(0,0,0,0.8); text-shadow: 0px 0px 5px #fff; } #ays-quiz-container-5 .ays-live-bar-fill.ays-live-fourth, #ays-quiz-container-5 .ays-live-bar-fill.ays-live-third, #ays-quiz-container-5 .ays-live-bar-fill.ays-live-second { text-shadow: unset; } #ays-quiz-container-5 .ays-live-bar-percent{ display:none; } \/* Music, Sound *\/ #ays-quiz-container-5 .ays_music_sound { color:rgb(0,0,0); } \/* Dropdown questions scroll bar *\/ #ays-quiz-container-5 blockquote { border-left-color: #000000 !important; } \/* Quiz Password *\/ #ays-quiz-container-5 .ays-start-page > input[id^='ays_quiz_password_val_'], #ays-quiz-container-5 .ays-quiz-password-toggle-visibility-box { width: 100%; margin: 0 auto; } \/* Question hint *\/ #ays-quiz-container-5 .ays_question_hint_container .ays_question_hint_text { background-color:#fff; box-shadow: 0 0 15px 3px rgba(201,201,201,0.6); max-width: 270px; color: #000000; } #ays-quiz-container-5 .ays_question_hint_container .ays_question_hint_text p { max-width: unset; } #ays-quiz-container-5 .ays-quiz-additonal-box { display: flex; justify-content: flex-end; align-items: center; position: relative; } #ays-quiz-container-5 .ays_quiz_results .ays_user_points_container { position: absolute; top: 0; right: 0; left: 0; bottom: 0; text-align: center; font-size: 16px; margin: 0.625em; } \/* Quiz Export PDF *\/ #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box { background-color:#fff; box-shadow: 0 0 15px 3px rgba(201,201,201,0.6); box-shadow: 0.025px 0.025px 1px 1px rgba(201,201,201,0.2), 0px 2px 1px 0px rgba(201,201,201,0.14), 0px 2px 5px 0 rgba(201,201,201,0.12); max-width: 190px; color: #000000; } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box .ays-export-quiz-dropdown-item:hover, #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box .ays-export-quiz-dropdown-item:focus { background-color: rgba(93,108,249,0.3); } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box .ays-export-quiz-dropdown-item:active { background-color: rgba(93,108,249,1); } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box .ays-export-quiz-dropdown-item { color: #000000; display: flex; justify-content: space-between; align-items: center; font-size: 14px; background-image: unset; box-shadow: unset; border-radius: unset; } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box .ays-export-quiz-dropdown-item .ays-export-quiz-dropdown-item-icon { margin-left: 10px; } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-img-icon-content-div svg path { stroke: #000000; } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-img-icon-content-div svg circle { fill: rgba(93,108,249,0.3); } #ays-quiz-container-5 .ays-export-quiz-button-container .ays-export-quiz-button-more-box .ays-export-quiz-dropdown-item-icon svg path { fill: rgba(0,0,0,1); } #ays-quiz-container-5 .ays-quiz-additonal-box svg { position: revert; } #ays-quiz-container-5 .ays_questions_hint_max_width_class { max-width: 80%; } \/* Information form *\/ #ays-quiz-container-5 .ays-form-title{ color:rgb(0,0,0); } \/* Quiz timer *\/ #ays-quiz-container-5 div.ays-quiz-redirection-timer, #ays-quiz-container-5 div.ays-quiz-timer{ color: #000000; text-align: center; } #ays-quiz-container-5 div.ays-quiz-after-timer * , #ays-quiz-container-5 div.ays-quiz-redirection-timer *, #ays-quiz-container-5 div.ays-quiz-timer * { text-align: center; } #ays-quiz-container-5 div.ays-quiz-timer.ays-quiz-message-before-timer:before { display: inline-block; font-weight: 500; text-align: center; width: auto; margin-right: 5px; } \/* Quiz buttons *\/ #ays-quiz-container-5 input#ays-submit, #ays-quiz-container-5 #ays_finish_quiz_5 .action-button, #ays-quiz-container-5 #ays_finish_quiz_5 .step[data-type='fill_in_blank'] .action-button.ays_check_answer, #ays-quiz-container-5 #ays_finish_quiz_5 .step[data-type='checkbox'] .action-button.ays_check_answer, div#ays-quiz-container-5 #ays_finish_quiz_5 .action-button.ays_restart_button, #ays-quiz-container-5 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn, #ays-quiz-container-5 .ays-quiz-category-selective-submit-bttn { background-color: #5d6cf9; color:#ffffff; font-size: 18px; padding: 14px 36px; border-radius: 8px; white-space: nowrap; letter-spacing: 0; box-shadow: unset; white-space: normal; word-break: break-word; background-image: unset; width: auto; border: unset; min-height: unset; line-height: normal; text-shadow: unset; } #ays-quiz-container-5 input#ays-submit, #ays-quiz-container-5 #ays_finish_quiz_5 input.action-button, #ays-quiz-container-5 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn, #ays-quiz-container-5 .ays-quiz-category-selective-submit-bttn { } div#ays-quiz-container-5 #ays_finish_quiz_5 .action-button.ays_check_answer { padding: 5px 10px; font-size: 18px; } #ays-quiz-container-5 #ays_finish_quiz_5 .action-button.ays_download_certificate { white-space: nowrap; padding: 5px 10px; } #ays-quiz-container-5 #ays_finish_quiz_5 .action-button.ays_arrow { color:#ffffff!important; white-space: nowrap; padding: 5px 10px; } #ays-quiz-container-5 input#ays-submit:hover, #ays-quiz-container-5 input#ays-submit:focus, #ays-quiz-container-5 #ays_finish_quiz_5 .action-button:hover, #ays-quiz-container-5 #ays_finish_quiz_5 .action-button:focus, #ays-quiz-container-5 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn:hover, #ays-quiz-container-5 .ays-quiz-category-selective-submit-bttn:focus { box-shadow: 0 0 0 2px #ffffff; background-color: #5d6cf9; } #ays-quiz-container-5 .ays_restart_button { color: #ffffff; } #ays-quiz-container-5 .ays_restart_button_p { display: flex; justify-content: center; flex-wrap: wrap; } #ays-quiz-container-5 .ays_buttons_div { justify-content: center; } #ays-quiz-container-5 .step:first-of-type .ays_buttons_div { justify-content: center !important; } #ays-quiz-container-5 .ays_quiz_results_page .ays_score span { visibility: visible; } #ays-quiz-container-5 input[type='button'], #ays-quiz-container-5 input[type='submit'] { color: #ffffff !important; outline: none; } div#ays-quiz-container-5 .ays-quiz-questions-nav-wrap .ays-quiz-questions-nav-item .ays_questions_nav_question:focus-visible, div#ays-quiz-container-5 input[type='button']:focus-visible, div#ays-quiz-container-5 input[type='submit']:focus-visible { outline: -webkit-focus-ring-color auto 1px; } #ays-quiz-container-5 #ays_finish_quiz_5 i.ays_early_finish.action-button[disabled]:hover, #ays-quiz-container-5 #ays_finish_quiz_5 i.ays_early_finish.action-button[disabled]:focus, #ays-quiz-container-5 #ays_finish_quiz_5 i.ays_early_finish.action-button[disabled], #ays-quiz-container-5 #ays_finish_quiz_5 i.ays_arrow.action-button[disabled]:hover, #ays-quiz-container-5 #ays_finish_quiz_5 i.ays_arrow.action-button[disabled]:focus, #ays-quiz-container-5 #ays_finish_quiz_5 i.ays_arrow.action-button[disabled] { color: #aaa !important; } #ays-quiz-container-5 .ays_finish.action-button{ margin: 10px 5px; } #ays-quiz-container-5 .ays-share-btn.ays-share-btn-branded { color: #fff; margin-bottom: 5px; display: inline-block; } #ays-quiz-container-5 .ays-quiz-question-title-text-to-speech-icon { cursor: pointer; position: absolute; left: 0px; top: 0px; z-index: 1; } div#ays-quiz-container-5.ays-quiz-container .ays-quiz-question-title-text-to-speech-icon svg path { fill: #000000; } \/* Question answers *\/ #ays-quiz-container-5 .ays-field { border-color: #dddddd; border-style: solid; border-width: 1px; box-shadow: none;flex-direction: row-reverse; } #ays-quiz-container-5 .ays-quiz-answers .ays-field:hover{ opacity: 1; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field label.ays_answer_caption[for^='ays-answer-'] { z-index: 1; position:initial;bottom:0;} #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field input~label[for^='ays-answer-'] { padding: 5px; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field { margin-bottom: 12px; position: relative; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays_grid_view_container .ays-field.ays_grid_view_item { \/* width: calc(50% - 6px); *\/ width:calc(100% \/2 - 4px);; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field.ays_grid_view_item:nth-child(odd) { margin-right: 6px; }#ays-quiz-container-5 #ays_finish_quiz_5 .ays-field.ays_grid_view_item:nth-child(odd) { margin-right: 6px; }#ays-quiz-container-5 img.ays-quiz-check-button-right-wrong-icon { position: absolute; right: 15px; bottom: 15px; } #ays-quiz-container-5 img.ays-quiz-check-button-right-wrong-icon[data-type='style-9'] { width: 20px; } #ays-quiz-container-5 .ays_quiz_results .step[data-type='fill_in_blank'] img.ays-quiz-check-button-right-wrong-icon { right: 10px; bottom: 40px; } #ays-quiz-container-5 .ays_quiz_results .step[data-type='fill_in_blank'] .ays_fieldset img.ays-quiz-check-button-right-wrong-icon { right: 15px; bottom: 20px; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field input:checked+label:before { border-color: #5d6cf9; background: #5d6cf9; background-clip: content-box; } #ays-quiz-container-5 .ays-quiz-answers div.ays-text-right-answer { color: #000000; } \/* Answer maximum length of a text field *\/ #ays-quiz-container-5 .ays_quiz_question_text_message{ color: #000000; text-align: left; font-size: 12px; } div#ays-quiz-container-5 div.ays_quiz_question_text_error_message { color: #ff0000; } \/* Questions answer image *\/ #ays-quiz-container-5 .ays-answer-image { width:15em; height:150px; object-fit: cover; } \/* Questions answer right\/wrong icons *\/ #ays-quiz-container-5 .ays-field input~label.answered.correct:after{ content: ''; } #ays-quiz-container-5 .ays-field input~label.answered.wrong:after{ content: ''; } #ays-quiz-container-5 .ays-quiz-answers .ays-field label.answered[for^='ays-answer-']::after{ content: none!important; } #ays-quiz-container-5 .ays-field label.answered:last-of-type:after{ height: auto; left: 10px;top: 10px;} \/* Dropdown questions *\/ #ays-quiz-container-5 .select2-container--default .select2-search--dropdown .select2-search__field:focus, #ays-quiz-container-5 .select2-container--default .select2-search--dropdown .select2-search__field { outline: unset; padding: 0.75rem; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field .select2-container--default .select2-selection--single { border-bottom: 2px solid #5d6cf9; background-color: #5d6cf9; } #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered, #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__placeholder, #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow { \/*color: #a29306;*\/ color: #ffffff; line-height: 40px; padding-left: 8px; padding-right: 20px; } #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered, #ays-quiz-container-5 .select2-container--default .select2-results__option--highlighted[aria-selected] { background-color: #5d6cf9; } #ays-quiz-container-5 .ays-field .select2-container--default, #ays-quiz-container-5 .ays-field .select2-container--default .selection, #ays-quiz-container-5 .ays-field .select2-container--default .dropdown-wrapper, #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered, #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered .select2-selection__placeholder, #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow, #ays-quiz-container-5 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow b[role='presentation'] { font-size: 16px !important; } #ays-quiz-container-5 .select2-container--default .select2-results__option { padding: 6px; } \/* Dropdown questions scroll bar *\/ #ays-quiz-container-5 .select2-results__options::-webkit-scrollbar { width: 7px; } #ays-quiz-container-5 .select2-results__options::-webkit-scrollbar-track { background-color: rgba(93,108,249,0.35); } #ays-quiz-container-5 .select2-results__options::-webkit-scrollbar-thumb { transition: .3s ease-in-out; background-color: rgba(93,108,249,0.55); } #ays-quiz-container-5 .select2-results__options::-webkit-scrollbar-thumb:hover { transition: .3s ease-in-out; background-color: rgba(93,108,249,0.85); } .ays-quiz-wrap #ays-quiz-container-5 + .ays-quiz-powered-by-container{ width:750px; margin: 20px auto; } .ays-quiz-wrap #ays-quiz-container-5 + .ays-quiz-powered-by-container{ width:750px; margin: 20px auto; } \/* WooCommerce product *\/ #ays-quiz-container-5 .ays-woo-block { background-color: rgba(93,108,249,0.8); } #ays-quiz-container-5 .ays-woo-product-block h4.ays-woo-product-price > a, #ays-quiz-container-5 .ays-woo-product-block h4.ays-woo-product-title > a { color: #000000; } #ays-quiz-container-1 .ays-woo-product-block h4.ays-woo-product-price > a { text-decoration: unset; } \/* Audio \/ Video *\/ #ays-quiz-container-5 .mejs-container .mejs-time{ box-sizing: unset; } #ays-quiz-container-5 .mejs-container .mejs-time-rail { padding-top: 15px; } #ays-quiz-container-5 .mejs-container .mejs-mediaelement video { margin: 0; } \/* Limitation *\/ #ays-quiz-container-5 .ays-quiz-limitation-count-of-takers { padding: 50px; } #ays-quiz-container-5 div.ays-quiz-results-toggle-block span.ays-show-res-toggle.ays-res-toggle-show, #ays-quiz-container-5 div.ays-quiz-results-toggle-block span.ays-show-res-toggle.ays-res-toggle-hide{ color: #000000; } #ays-quiz-container-5 div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle { border: 1px solid #000000; } #ays-quiz-container-5 div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle { border: 1px solid #000000; } #ays-quiz-container-5 div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle:after{ background: #000000; } #ays-quiz-container-5.ays_quiz_elegant_dark div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle:after, #ays-quiz-container-5.ays_quiz_rect_dark div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle:after{ background: #000; } \/* Hestia theme (Version: 3.0.16) | Start *\/ #ays-quiz-container-5 .mejs-container .mejs-inner .mejs-controls .mejs-button > button:hover, #ays-quiz-container-5 .mejs-container .mejs-inner .mejs-controls .mejs-button > button { box-shadow: unset; background-color: transparent; } #ays-quiz-container-5 .mejs-container .mejs-inner .mejs-controls .mejs-button > button { margin: 10px 6px; } \/* Hestia theme (Version: 3.0.16) | End *\/ \/* Go theme (Version: 1.4.3) | Start *\/ #ays-quiz-container-5 label[for^='ays-answer']:before, #ays-quiz-container-5 label[for^='ays-answer']:before { -webkit-mask-image: unset; mask-image: unset; } #ays-quiz-container-5 .ays_question_report { text-align: right; } div#ays-quiz-container-5 .ays_question_report .ays-quiz-open-report-window { fill: #000000; } #ays-quiz-container-5 .ays-export-quiz-button-container { position: relative; right: 100px; top: -5px; right: -5px; margin: 0; z-index: 1000; display: flex; justify-content: flex-end; } #ays-quiz-container-5.ays_quiz_classic_light .ays-field input:checked+label.answered:before, #ays-quiz-container-5.ays_quiz_classic_dark .ays-field input:checked+label.answered:before { background-color: #5d6cf9 !important; } #ays-quiz-container-5.ays_quiz_classic_light .ays-field input:checked+label.answered.correct:before, #ays-quiz-container-5.ays_quiz_classic_dark .ays-field input:checked+label.answered.correct:before { background-color: #27ae60 !important; } #ays-quiz-container-5.ays_quiz_classic_light .ays-field input:checked+label.answered.wrong:before, #ays-quiz-container-5.ays_quiz_classic_dark .ays-field input:checked+label.answered.wrong:before { background-color: #cc3700 !important; } \/* Go theme (Version: 1.4.3) | End *\/ #ays-quiz-container-5 .ays_quiz_results fieldset.ays_fieldset .ays_quiz_question .wp-video { width: 100% !important; max-width: 100%; } #ays-quiz-container-5 .step[data-type='upload_file'] .ays-quiz-answers.ays_grid_view_container { display: block; } \/* Classic Dark \/ Classic Light *\/ \/* Dropdown questions right\/wrong styles *\/ #ays-quiz-container-5.ays_quiz_classic_dark .correct_div, #ays-quiz-container-5.ays_quiz_classic_light .correct_div{ border-color: green !important; opacity: 1 !important; background-color: rgba(39,174,96,0.4) !important; } #ays-quiz-container-5.ays_quiz_classic_dark .correct_div .selected-field, #ays-quiz-container-5.ays_quiz_classic_light .correct_div .selected-field { padding: 0px 10px 0px 10px; color: green !important; } #ays-quiz-container-5.ays_quiz_classic_dark .wrong_div, #ays-quiz-container-5.ays_quiz_classic_light .wrong_div{ border-color: red !important; opacity: 1 !important; background-color: rgba(243,134,129,0.4) !important; } #ays-quiz-container-5.ays_quiz_classic_dark .ays-field.checked_answer_div.wrong_div input:checked~label, #ays-quiz-container-5.ays_quiz_classic_light .ays-field.checked_answer_div.wrong_div input:checked~label { background-color: rgba(243,134,129,0.4) !important; } #ays-quiz-container-5 .ays_question_result .ays-field .ays_quiz_hide_correct_answer:after{ content: '' !important; } #ays-quiz-container-5 .ays_question_result .ays_quiz_question .ays-quiz-fill-in-blank-input { color: #000000 !important; } #ays-quiz-container-5 .ays_quiz_results .step.ays_question_result:last-child { padding-bottom: 20px; } #ays-quiz-container-5 .ays-quiz-close-full-screen { fill: #000000; } #ays-quiz-container-5 .ays-quiz-open-full-screen { fill: #000000; } #ays-quiz-container-5 .ays_quiz_login_form p{ color: #000000; } \/* Personality Test | Start *\/ #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-description p { text-align: left; padding: 0; } #ays-quiz-container-5 .ays-quiz-personality-result-box { background: white; border-radius: 17px; box-shadow: 0px 0px 20px rgba(98, 85, 165, 0.1); \/*padding: 30px 3% 40px;*\/ padding: 20px 30px; margin: 30px 0; font-size: 16px; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-title { color: #413A5C; font-size: 23px; margin: 0; text-align: left; font-weight: bold; } div#ays-quiz-container-5.ays-quiz-container .ays-quiz-personality-result-box .ays-quiz-personality-result-description { margin: 0; font-size: 16px; text-align: left; color: #413A5C; } div#ays-quiz-container-5.ays-quiz-container .ays-quiz-personality-result-box .ays-quiz-personality-result-description * { color: #413A5C; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-progress { width: 100%; background-color: rgba(128, 126, 137, 0.1); border-radius: 15px; position: relative; display: flex; \/* justify-content: flex-end; *\/ margin-top: 1rem; margin-bottom: 1rem; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-progress-end { justify-content: flex-end; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-bar { height: 30px; border-radius: 15px; color: white; font-size: 18px; padding: 3px 15px 0; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-percentages { position: absolute; width: 100%; padding: 4px 15px; top: 0; -ms-flex-pack: justify; justify-content: space-between; display: -ms-flexbox; display: flex; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-keyword-box div, #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-text-dark-purple { color: #413A5C; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-text-white { color: #ffffff; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-text-percentage { font-weight: bolder; } #ays-quiz-container-5 .ays-quiz-personality-result-box .ays-quiz-personality-result-keyword-box { display: -ms-flexbox; display: flex; -ms-flex-pack: justify; justify-content: space-between; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-purple .ays-quiz-personality-result-bar { background-color: #6255A5; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-purple .ays-quiz-personality-result-keyword-text-color { color: #6255A5; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-yellow .ays-quiz-personality-result-bar { background-color: #F2C94C; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-yellow .ays-quiz-personality-result-keyword-text-color { color: #F2C94C; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-green .ays-quiz-personality-result-bar { background-color: #88D29D; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-green .ays-quiz-personality-result-keyword-text-color { color: #88D29D; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-red .ays-quiz-personality-result-bar { background-color: #E5A69D; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-red .ays-quiz-personality-result-keyword-text-color { color: #E5A69D; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-blue .ays-quiz-personality-result-bar { background-color: #03A9F4; } #ays-quiz-container-5 .ays-quiz-personality-result-box.ays-quiz-personality-result-box-blue .ays-quiz-personality-result-keyword-text-color { color: #03A9F4; } #ays-quiz-container-5 .ays-quiz-personality-result-box div:before, #ays-quiz-container-5 .ays-quiz-personality-result-box div:after { content: unset; } \/* Personality Test | End *\/ \/* report questions modal start *\/ .ays-modal-reports { display: none; position: fixed; z-index: 9999; left: 0; top: 0; width: 100%; height: 100%; overflow: auto; background-color: rgba(0, 0, 0, 0.4); animation-duration: .5s; background-color: rgba(0, 0, 0, 0.4); } #ays-quiz-question-report-modal-5 .ays-modal-content-reports { background-color: #fefefe; margin: 10% auto; border: 1px solid #888; max-width: 500px; width: 100%; border-radius: 10px; padding: 20px; box-sizing: border-box; position: relative; } #ays-quiz-question-report-modal-5 .ays-modal-content-reports label{ display: block; margin-bottom: 10px; font-weight: bold; letter-spacing: normal; } #ays-quiz-question-report-modal-5 .ays-modal-content-reports textarea { display: block; width: 100%; height: 100px; padding: 5px; box-sizing: border-box; border-radius: 5px; border: 1px solid #ccc; max-width: 100%; max-height: 500px; resize: vertical; transition: unset; } #ays-quiz-question-report-modal-5 .ays-modal-content-reports input.ays-quiz-submit-question-report { background-color: #0073aa; color: #fff !important; border: none; border-radius: 5px; padding: 10px 20px; cursor: pointer; margin-top: 20px; line-height: normal; letter-spacing: normal; box-shadow: unset; background-image: unset; } #ays-quiz-question-report-modal-5 .ays-close-reports-window { color: #aaa; font-weight: bold; position: absolute; top: 1%; right: 1%; } #ays-quiz-question-report-modal-5 .ays-close-reports-window img { box-shadow: unset; } #ays-quiz-question-report-modal-5 .ays-quiz-preloader img { box-shadow: unset; } #ays-quiz-question-report-modal-5 .ays-close-reports-window img:hover, #ays-quiz-question-report-modal-5 .ays-close-reports-window img:focus { cursor: pointer; } #ays-quiz-question-report-modal-5 .ays-quiz-question-report-error { display: none; font-size: 13px; color: #f00; text-align: left; } #ays-quiz-question-report-modal-5 .ays-quiz-question-report-textarea-label, #ays-quiz-question-report-modal-5 .ays-quiz-question-report-title { text-align: left; } #ays-quiz-question-report-modal-5 .ays_quiz_modal_overlay { width: 100%; height: 100%; position: fixed; top: 0; left: 0; position: absolute; z-index: 1000000000; flex-direction: column; } #ays-quiz-question-report-modal-5 .ays-quiz-container .ays-quiz-user-c\u0570oosing-anonymous-assessment { margin: 10px 0; } \/* report questions modal end *\/ @media screen and (max-width: 768px){ #ays-quiz-container-5{ max-width: 100%; } div#ays-quiz-container-5 [id^='ays_finish_quiz_'] div.step div.ays-abs-fs { width: 90%; } div#ays-quiz-container-5.ays_quiz_modern_light .step, div#ays-quiz-container-5.ays_quiz_modern_dark .step { padding-right: 0px !important; padding-top: 0px !important; } div#ays-quiz-container-5.ays_quiz_modern_light div.step[data-question-id], div#ays-quiz-container-5.ays_quiz_modern_dark div.step[data-question-id] { background-size: cover !important; background-position: center center !important; } div#ays-quiz-container-5.ays_quiz_modern_light .ays-abs-fs:not(.ays-start-page):not(.ays-end-page), div#ays-quiz-container-5.ays_quiz_modern_dark .ays-abs-fs:not(.ays-start-page):not(.ays-end-page) { width: 100%; } #ays-quiz-container-5 .ays_quiz_question p { font-size: 16px; } #ays-quiz-container-5 .select2-container, div#ays-quiz-container-5 .ays-questions-container form .ays-quiz-answers .ays-field * { font-size: 15px; } div#ays-quiz-container-5 input#ays-submit, div#ays-quiz-container-5 #ays_finish_quiz_5 .action-button, div#ays-quiz-container-5 #ays_finish_quiz_5 .step[data-type='fill_in_blank'] .action-button.ays_check_answer, div#ays-quiz-container-5 #ays_finish_quiz_5 .action-button.ays_restart_button, #ays-quiz-container-5 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn, #ays-quiz-container-5 .ays-quiz-category-selective-submit-bttn { font-size: 18px; } div#ays-quiz-container-5 div.ays-questions-container div.ays-woo-block { width: 100%; } \/* Quiz title \/ mobile font size *\/ div#ays-quiz-container-5 .ays-fs-title { font-size: 20px; } \/* Question explanation \/ mobile font size *\/ #ays-quiz-container-5 .ays_questtion_explanation p { font-size:16px; } \/* Wrong answers \/ mobile font size *\/ #ays-quiz-container-5 .wrong_answer_text p { font-size:16px; } \/* Right answers \/ mobile font size *\/ #ays-quiz-container-5 .right_answer_text p { font-size:16px; } \/* Note text \/ mobile font size *\/ div#ays-quiz-container-5 .ays-quiz-question-note-message-box p { font-size:14px; } div#ays-quiz-container-5 .ays-quiz-question-note-message-box *:not(strong) { text-transform:none; } div#ays-quiz-container-5 .ays_questtion_explanation *:not(strong) { text-transform:none; } div#ays-quiz-container-5 .right_answer_text *:not(strong) { text-transform:none; } #ays-quiz-container-5 div.ays-quiz-personality-result-box .ays-quiz-personality-result-title { font-size: 18px; } \/* Personality Test *\/ #ays-quiz-container-5 div.ays-quiz-personality-result-box .ays-quiz-personality-result-bar { font-size: 14px; padding: 6px 10px 0; } #ays-quiz-container-5 .ays-image-question-img img { height: auto ; } #ays-quiz-container-5 .ays-field { flex-direction: row-reverse; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field label.ays_answer_caption[for^='ays-answer-'] { z-index: 1; position:initial;position:initial;bottom:0;:0; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays_grid_view_container .ays-field.ays_grid_view_item { width:calc(100% \/2 - 4px); } #ays-quiz-container-5 .ays-answer-image { width:15em; } #ays-quiz-container-5 #ays_finish_quiz_5 .ays-field.ays_grid_view_item:nth-child(odd) { margin-right: 6px; } } \/* Custom css styles *\/ \/* ===== AYS \u2192 Chip Column (Option B: existing classes only) ===== *\/\/* Parent: transparent, column, no wrap *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers.ays_list_view_container { display: block !important; background: transparent !important; margin: 0 !important; padding: 0 !important; border: 0 !important;}\/* Each item: full-width row *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item { display: block !important; margin: 0 0 .5rem 0 !important; padding: 0 !important; border: 0 !important; background: transparent !important; position: relative !important;}\/* Radio: visually hidden, accessible *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"] { position: absolute !important; inline-size: 1px !important; block-size: 1px !important; margin: 0 !important; padding: 0 !important; border: 0 !important; clip: rect(0 0 0 0) !important; clip-path: inset(50%) !important; overflow: hidden !important; white-space: nowrap !important; opacity: 0 !important;}\/* Chip label: full width, left-align, 5px radius, leading disc *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) { --chip-bg: #ffffff; --chip-fg: #0f172a; --chip-br: #cbd5e1; --chip-bg-hover: #f8fafc; --chip-disc: #e5e7eb; --chip-disc-br: #d1d5db; --chip-checked-bg: #ffffff; --chip-checked-br: #1d4ed8; --chip-checked-fg: #1d4ed8; --chip-disc-checked: #1d4ed8; --chip-check-fg: #ffffff; display: grid !important; grid-template-columns: 28px 1fr !important; align-items: center !important; width: 100% !important; min-height: 44px !important; font-size: 16px !important; line-height: 1.25 !important; text-align: left !important; gap: .5rem !important; padding: .5rem .75rem !important; border-radius: 5px !important; border: 1px solid var(--chip-br) !important; background: var(--chip-bg) !important; color: var(--chip-fg) !important; cursor: pointer !important; user-select: none !important; transition: box-shadow .15s ease, border-color .15s ease, background-color .15s ease, color .15s ease !important; \/* neutralize plugin\u2019s padding-left *\/ padding-left: .75rem !important;}\/* Leading disc (default) *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image)::before { content: \"\" !important; width: 18px !important; height: 18px !important; border-radius: 9999px !important; background: var(--chip-disc) !important; border: 1px solid var(--chip-disc-br) !important; display: inline-block !important; justify-self: center !important;}\/* Clear ::after by default (we\u2019ll inject glyphs conditionally) *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image)::after { content: \"\" !important;}\/* Hover *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image):hover { background: var(--chip-bg-hover) !important;}\/* Focus-visible ring *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:focus-visible + label[for^=\"ays-answer-\"]:not(.ays_answer_image) { outline: 3px solid #1d4ed8 !important; outline-offset: 2px !important;}\/* Checked: blue border\/text; disc filled blue with white check *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image) { background: var(--chip-checked-bg) !important; border-color: var(--chip-checked-br) !important; color: var(--chip-checked-fg) !important; box-shadow: 0 0 0 4px color-mix(in srgb, var(--chip-checked-br), transparent 70%) !important;}[id^=\"ays-quiz-container-\"].ays_quiz_classic_light .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image)::before,[id^=\"ays-quiz-container-\"].ays_quiz_classic_dark .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image)::before { background: var(--chip-disc-checked) !important; border-color: var(--chip-disc-checked) !important; background: #000 !important; border-color: #000 !important;}[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image)::after { content: \"\u2713\" !important; color: var(--chip-check-fg) !important; font-weight: 700 !important; font-size: 12px !important; line-height: 1 !important; grid-column: 1 \/ 2 !important; justify-self: center !important; position: relative !important; left: -18px !important; \/* overlay on disc *\/}\/* Hide image label *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label.ays_answer_image { display: none !important;}\/* Results: selected & correct (green with \u2713) *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.correct { --chip-checked-br: #16a34a; --chip-checked-fg: #166534; --chip-disc-checked: #16a34a; --chip-checked-fg: #000; --chip-disc-checked: #000; background-color: var(--chip-disk-checked) !important; border-color: var(--chip-checked-br) !important; color: var(--chip-checked-fg) !important;}[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.correct::after { content: \"\u2713\" !important;}\/* Results: selected & wrong (red with \u2715) *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.wrong { --chip-checked-br: #dc2626; --chip-checked-fg: #b91c1c; --chip-disc-checked: #dc2626; --chip-checked-fg: #000; --chip-disc-checked: #000; border-color: var(--chip-checked-br) !important; color: var(--chip-checked-fg) !important;}[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.wrong::after { content: \"\u2715\" !important;}\/* NEW: Correct (unselected) = green border only, transparent bg, no glyph *\/[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:not(:checked) + label.answered.correct { background: transparent !important; border-color: #16a34a !important; color: inherit !important; box-shadow: none !important;}#ays-quiz-container-10.ays_quiz_classic_dark .correct_div, #ays-quiz-container-10.ays_quiz_classic_light .correct_div[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:not(:checked) + label.answered.correct::before { background: transparent !important; border-color: #16a34a !important;}[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:not(:checked) + label.answered.correct::after { content: \"\" !important;}\/* Dark theme tokens *\/[id^=\"ays-quiz-container-\"].ays_quiz_classic_dark .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) { --chip-bg: #0b0f14; --chip-fg: #e5e7eb; --chip-br: #334155; --chip-bg-hover: #111827; --chip-disc: #374151; --chip-disc-br: #4b5563;}\/* Reduced motion *\/@media (prefers-reduced-motion: reduce) { [id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) { transition: none !important; }}\/* High-contrast mode *\/@media (forced-colors: active) { [id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) { border: 1px solid CanvasText !important; } [id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image) { outline: 2px solid Highlight !important; }}\/* --- CARRY OVER FROM CHATGPT VERSION -->\/* --- Question Text -> font-size set in panel Question Styles > Question font size --- *\/[id^=\"ays-quiz-container-\"] .ays_quiz_question p { font-weight: 400; line-height: 1.3;}\/* --- Paragraph & Box-sizing normalization --- *\/[id^=\"ays-quiz-container-\"] p { margin: 0.625em !important; line-height: 1.5;}[id^=\"ays-quiz-container-\"] p:last-child { padding-bottom: 1em;}[id^=\"ays-quiz-container-\"] li { margin-bottom: 1rem;}\/* --- Background reset for checked answer divs --- *\/[id^=\"ays-quiz-container-\"] .ays-field.checked_answer_div input:checked ~ label:not(.ays_answer_image) { background-color: inherit !important;}\/* --- Background reset for double stacking Checked \/ Label --- *\/[id^=\"ays-quiz-container-\"] [id^=\"ays_finish_quiz_\"] .ays-field.checked_answer_div input:checked ~ label:not(.ays_answer_image),#ays-quiz-container-10.ays_quiz_classic_light .ays-field.checked_answer_div.wrong_div input:checked ~ label,[id^=\"ays-quiz-container-\"].ays_quiz_classic_dark .ays-field.checked_answer_div.wrong_div input:checked ~ label { background-color: transparent !important;}\/* --- Background reset for double stacking Hover Checked \/ Label --- *\/[id^=\"ays-quiz-container-\"] .ays-field:hover label[for^=\"ays-answer-\"] { background: transparent !important;}\/* Applies to ALL quiz containers globally; beats exact-ID selectors *\/[id^=\"ays-quiz-container-\"]:not(#_) .ays-field input[type=\"radio\"]:checked + label.answered.correct::before, [id^=\"ays-quiz-container-\"]:not(#_) .ays-field input[type=\"radio\"]:checked + label.answered.wrong::before { \/* your intended filled disc when the correct option is SELECTED *\/ background: var(--chip-disc-checked, #16a34a) !important; \/* green *\/ border-color: var(--chip-disc-checked, #16a34a) !important; background: black !important; \/* black *\/ border-color: black !important;} \/* RTL direction styles *\/ <\/style>\n            <style>\n                #ays-quiz-container-5 p {\n                    margin: 0.625em;\n                }\n                \n                #ays-quiz-container-5.ays_quiz_classic_light .enable_correction .ays-field.checked_answer_div input:checked+label,\n                #ays-quiz-container-5.ays_quiz_classic_dark .enable_correction .ays-field.checked_answer_div input:checked+label {\n                    \/* background-color: transparent; *\/\n                }\n                #ays-quiz-container-5 .ays-field.checked_answer_div input:checked~label:not(.ays_answer_image) {\n                    background-color: rgba(93,108,249,0.6);\n                }\n                #ays-quiz-container-5.ays-quiz-container.ays_quiz_classic_light .ays-questions-container .ays-field:hover label[for^='ays-answer-'],\n                #ays-quiz-container-5 .ays-field:hover{\n                    background: rgba(93,108,249,0.8);\n                    color: #fff;\n                    transition: all .3s;\n                }\n                #ays-quiz-container-5 #ays_finish_quiz_5 .action-button:hover,\n                #ays-quiz-container-5 #ays_finish_quiz_5 .action-button:focus,\n                #ays-quiz-container-5 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn:hover,\n                #ays-quiz-container-5 .ays-quiz-category-selective-submit-bttn:focus {\n                    box-shadow: 0 0 0 2px rgba(255, 255, 255, 0.5), 0 0 0 3px #ffffff;\n                    background: #5d6cf9;\n                }\n            <\/style><script>\n                if(typeof aysQuizOptions === 'undefined'){\n                    var aysQuizOptions = [];\n                }\n                aysQuizOptions['5']  = '{"quiz_version":"31.8.3.100","core_version":"6.9","php_version":"8.1.2-1ubuntu2.22","color":"#5d6cf9","bg_color":"#fff","text_color":"#000000","height":450,"width":750,"enable_logged_users":"off","information_form":"disable","form_name":"off","form_email":"off","form_phone":"off","image_width":"","image_height":"","enable_correction":"on","enable_progress_bar":"on","enable_questions_result":"on","randomize_questions":"off","randomize_answers":"off","enable_questions_counter":"on","enable_restriction_pass":"off","enable_restriction_pass_users":"off","restriction_pass_message":"","restriction_pass_users_message":"","user_role":[],"ays_users_search":[],"custom_css":"\/* ===== AYS \u2192 Chip Column (Option B: existing classes only) ===== *\/\r\n\r\n\/* Parent: transparent, column, no wrap *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers.ays_list_view_container {\r\n  display: block !important;\r\n  background: transparent !important;\r\n  margin: 0 !important;\r\n  padding: 0 !important;\r\n  border: 0 !important;\r\n}\r\n\r\n\/* Each item: full-width row *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item {\r\n  display: block !important;\r\n  margin: 0 0 .5rem 0 !important;\r\n  padding: 0 !important;\r\n  border: 0 !important;\r\n  background: transparent !important;\r\n  position: relative !important;\r\n}\r\n\r\n\/* Radio: visually hidden, accessible *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"] {\r\n  position: absolute !important;\r\n  inline-size: 1px !important;\r\n  block-size: 1px !important;\r\n  margin: 0 !important;\r\n  padding: 0 !important;\r\n  border: 0 !important;\r\n  clip: rect(0 0 0 0) !important;\r\n  clip-path: inset(50%) !important;\r\n  overflow: hidden !important;\r\n  white-space: nowrap !important;\r\n  opacity: 0 !important;\r\n}\r\n\r\n\/* Chip label: full width, left-align, 5px radius, leading disc *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n  --chip-bg: #ffffff;\r\n  --chip-fg: #0f172a;\r\n  --chip-br: #cbd5e1;\r\n  --chip-bg-hover: #f8fafc;\r\n\r\n  --chip-disc: #e5e7eb;\r\n  --chip-disc-br: #d1d5db;\r\n\r\n  --chip-checked-bg: #ffffff;\r\n  --chip-checked-br: #1d4ed8;\r\n  --chip-checked-fg: #1d4ed8;\r\n\r\n  --chip-disc-checked: #1d4ed8;\r\n  --chip-check-fg: #ffffff;\r\n\r\n  display: grid !important;\r\n  grid-template-columns: 28px 1fr !important;\r\n  align-items: center !important;\r\n\r\n  width: 100% !important;\r\n  min-height: 44px !important;\r\n  font-size: 16px !important;\r\n  line-height: 1.25 !important;\r\n  text-align: left !important;\r\n\r\n  gap: .5rem !important;\r\n  padding: .5rem .75rem !important;\r\n  border-radius: 5px !important;\r\n  border: 1px solid var(--chip-br) !important;\r\n  background: var(--chip-bg) !important;\r\n  color: var(--chip-fg) !important;\r\n  cursor: pointer !important;\r\n  user-select: none !important;\r\n  transition: box-shadow .15s ease, border-color .15s ease, background-color .15s ease, color .15s ease !important;\r\n\r\n  \/* neutralize plugin\u2019s padding-left *\/\r\n  padding-left: .75rem !important;\r\n}\r\n\r\n\/* Leading disc (default) *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image)::before {\r\n  content: \"\" !important;\r\n  width: 18px !important;\r\n  height: 18px !important;\r\n  border-radius: 9999px !important;\r\n  background: var(--chip-disc) !important;\r\n  border: 1px solid var(--chip-disc-br) !important;\r\n  display: inline-block !important;\r\n  justify-self: center !important;\r\n}\r\n\r\n\/* Clear ::after by default (we\u2019ll inject glyphs conditionally) *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image)::after {\r\n  content: \"\" !important;\r\n}\r\n\r\n\/* Hover *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image):hover {\r\n  background: var(--chip-bg-hover) !important;\r\n}\r\n\r\n\/* Focus-visible ring *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:focus-visible + label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n  outline: 3px solid #1d4ed8 !important;\r\n  outline-offset: 2px !important;\r\n}\r\n\r\n\/* Checked: blue border\/text; disc filled blue with white check *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n  background: var(--chip-checked-bg) !important;\r\n  border-color: var(--chip-checked-br) !important;\r\n  color: var(--chip-checked-fg) !important;\r\n  box-shadow: 0 0 0 4px color-mix(in srgb, var(--chip-checked-br), transparent 70%) !important;\r\n}\r\n\r\n[id^=\"ays-quiz-container-\"].ays_quiz_classic_light .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image)::before,\r\n[id^=\"ays-quiz-container-\"].ays_quiz_classic_dark .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image)::before {\r\n  background: var(--chip-disc-checked) !important;\r\n  border-color: var(--chip-disc-checked) !important;\r\n  background: #000 !important;\r\n  border-color: #000 !important;\r\n}\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image)::after {\r\n  content: \"\u2713\" !important;\r\n  color: var(--chip-check-fg) !important;\r\n  font-weight: 700 !important;\r\n  font-size: 12px !important;\r\n  line-height: 1 !important;\r\n  grid-column: 1 \/ 2 !important;\r\n  justify-self: center !important;\r\n  position: relative !important;\r\n  left: -18px !important; \/* overlay on disc *\/\r\n}\r\n\r\n\/* Hide image label *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label.ays_answer_image {\r\n  display: none !important;\r\n}\r\n\r\n\/* Results: selected & correct (green with \u2713) *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.correct {\r\n  --chip-checked-br: #16a34a;\r\n  --chip-checked-fg: #166534;\r\n  --chip-disc-checked: #16a34a;\r\n  --chip-checked-fg: #000;\r\n  --chip-disc-checked: #000;\r\n  background-color: var(--chip-disk-checked) !important;\r\n  border-color: var(--chip-checked-br) !important;\r\n  color: var(--chip-checked-fg) !important;\r\n}\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.correct::after {\r\n  content: \"\u2713\" !important;\r\n}\r\n\r\n\/* Results: selected & wrong (red with \u2715) *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.wrong {\r\n  --chip-checked-br: #dc2626;\r\n  --chip-checked-fg: #b91c1c;\r\n  --chip-disc-checked: #dc2626;\r\n  --chip-checked-fg: #000;\r\n  --chip-disc-checked: #000;\r\n  border-color: var(--chip-checked-br) !important;\r\n  color: var(--chip-checked-fg) !important;\r\n}\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label.answered.wrong::after {\r\n  content: \"\u2715\" !important;\r\n}\r\n\r\n\/* NEW: Correct (unselected) = green border only, transparent bg, no glyph *\/\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:not(:checked) + label.answered.correct {\r\n  background: transparent !important;\r\n  border-color: #16a34a !important;\r\n  color: inherit !important;\r\n  box-shadow: none !important;\r\n}\r\n\r\n#ays-quiz-container-10.ays_quiz_classic_dark .correct_div, #ays-quiz-container-10.ays_quiz_classic_light .correct_div\r\n\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:not(:checked) + label.answered.correct::before {\r\n  background: transparent !important;\r\n  border-color: #16a34a !important;\r\n}\r\n[id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:not(:checked) + label.answered.correct::after {\r\n  content: \"\" !important;\r\n}\r\n\r\n\/* Dark theme tokens *\/\r\n[id^=\"ays-quiz-container-\"].ays_quiz_classic_dark .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n  --chip-bg: #0b0f14;\r\n  --chip-fg: #e5e7eb;\r\n  --chip-br: #334155;\r\n  --chip-bg-hover: #111827;\r\n  --chip-disc: #374151;\r\n  --chip-disc-br: #4b5563;\r\n}\r\n\r\n\/* Reduced motion *\/\r\n@media (prefers-reduced-motion: reduce) {\r\n  [id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n    transition: none !important;\r\n  }\r\n}\r\n\r\n\/* High-contrast mode *\/\r\n@media (forced-colors: active) {\r\n  [id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n    border: 1px solid CanvasText !important;\r\n  }\r\n  [id^=\"ays-quiz-container-\"] .ays-quiz-answers .ays-field.ays_list_view_item input[type=\"radio\"]:checked + label[for^=\"ays-answer-\"]:not(.ays_answer_image) {\r\n    outline: 2px solid Highlight !important;\r\n  }\r\n}\r\n\r\n\r\n\/* --- CARRY OVER FROM CHATGPT VERSION -->\r\n\r\n\/* --- Question Text -> font-size set in panel Question Styles > Question font size --- *\/\r\n[id^=\"ays-quiz-container-\"] .ays_quiz_question p { \r\n  font-weight: 400;\r\n  line-height: 1.3;\r\n}\r\n\r\n\/* --- Paragraph & Box-sizing normalization --- *\/\r\n[id^=\"ays-quiz-container-\"] p {\r\n  margin: 0.625em !important;\r\n  line-height: 1.5;\r\n}\r\n\r\n[id^=\"ays-quiz-container-\"] p:last-child {\r\n  padding-bottom: 1em;\r\n}\r\n\r\n[id^=\"ays-quiz-container-\"] li {\r\n  margin-bottom: 1rem;\r\n}\r\n\r\n\r\n\/* --- Background reset for checked answer divs --- *\/\r\n[id^=\"ays-quiz-container-\"] .ays-field.checked_answer_div input:checked ~ label:not(.ays_answer_image) {\r\n    background-color: inherit !important;\r\n}\r\n\r\n\/* --- Background reset for double stacking Checked \/ Label --- *\/\r\n[id^=\"ays-quiz-container-\"] [id^=\"ays_finish_quiz_\"] .ays-field.checked_answer_div input:checked ~ label:not(.ays_answer_image),\r\n#ays-quiz-container-10.ays_quiz_classic_light .ays-field.checked_answer_div.wrong_div input:checked ~ label,\r\n[id^=\"ays-quiz-container-\"].ays_quiz_classic_dark .ays-field.checked_answer_div.wrong_div input:checked ~ label { \r\n    background-color: transparent !important;\r\n}\r\n\r\n\/* --- Background reset for double stacking Hover Checked \/ Label --- *\/\r\n[id^=\"ays-quiz-container-\"] .ays-field:hover label[for^=\"ays-answer-\"] {\r\n    background: transparent !important;\r\n}\r\n\r\n\r\n\r\n\/* Applies to ALL quiz containers globally; beats exact-ID selectors *\/\r\n[id^=\"ays-quiz-container-\"]:not(#_)\r\n  .ays-field input[type=\"radio\"]:checked\r\n  + label.answered.correct::before,\r\n  [id^=\"ays-quiz-container-\"]:not(#_)\r\n  .ays-field input[type=\"radio\"]:checked\r\n  + label.answered.wrong::before  {\r\n  \/* your intended filled disc when the correct option is SELECTED *\/\r\n  background: var(--chip-disc-checked, #16a34a) !important; \/* green *\/\r\n  border-color: var(--chip-disc-checked, #16a34a) !important;\r\n  background: black !important; \/* black *\/\r\n  border-color: black !important;\r\n}","limit_users":"off","limitation_message":"","redirect_url":"","redirection_delay":0,"answers_view":"list","enable_rtl_direction":"off","enable_logged_users_message":"","questions_count":"","enable_question_bank":"off","enable_live_progress_bar":"off","enable_percent_view":"off","enable_average_statistical":"on","enable_next_button":"on","enable_previous_button":"on","enable_arrows":"off","timer_text":"","quiz_theme":"classic_light","enable_social_buttons":"off","final_result_text":"","enable_pass_count":"off","hide_score":"off","rate_form_title":"","box_shadow_color":"#c9c9c9","quiz_border_radius":"8","quiz_bg_image":"","quiz_border_width":"1","quiz_border_style":"solid","quiz_border_color":"#000","quiz_loader":"default","quest_animation":"none","enable_bg_music":"off","quiz_bg_music":"","answers_font_size":15,"show_create_date":"off","show_author":"off","enable_early_finish":"off","answers_rw_texts":"on_passing","disable_store_data":"off","enable_background_gradient":"off","background_gradient_color_1":"#000","background_gradient_color_2":"#fff","quiz_gradient_direction":"vertical","redirect_after_submit":"off","submit_redirect_url":"","submit_redirect_delay":"0","progress_bar_style":"third","enable_exit_button":"off","exit_redirect_url":"","image_sizing":"cover","quiz_bg_image_position":"center center","custom_class":"","enable_social_links":"off","social_links":{"linkedin_link":"","facebook_link":"","twitter_link":"","vkontakte_link":"","instagram_link":"","youtube_link":"","behance_link":""},"show_quiz_title":"on","show_quiz_desc":"on","show_login_form":"off","mobile_max_width":"","limit_users_by":"ip","explanation_time":"4","enable_clear_answer":"off","show_category":"off","show_question_category":"off","answers_padding":"5","answers_border":"on","answers_border_width":"1","answers_border_style":"solid","answers_border_color":"#dddddd","ans_img_height":"150","ans_img_caption_style":"outside","ans_img_caption_position":"bottom","answers_box_shadow":"off","answers_box_shadow_color":"#000","show_answers_caption":"on","answers_margin":12,"ans_right_wrong_icon":"none","display_score":"by_percentage","enable_rw_asnwers_sounds":"off","quiz_bg_img_in_finish_page":"off","finish_after_wrong_answer":"off","after_timer_text":"","enable_enter_key":"on","show_rate_after_rate":"on","buttons_text_color":"#ffffff","buttons_position":"center","buttons_size":"large","buttons_font_size":"18","buttons_width":"","buttons_left_right_padding":"36","buttons_top_bottom_padding":"14","buttons_border_radius":"8","enable_audio_autoplay":"off","enable_leave_page":"on","show_only_wrong_answer":"off","pass_score":0,"pass_score_message":"<h4 style=\"text-align: center;\">Congratulations!<\/h4>\r\n<p style=\"text-align: center;\">You passed the quiz!<\/p>","fail_score_message":"<h4 style=\"text-align: center;\">Oops!<\/h4>\r\n<p style=\"text-align: center;\">You have not passed the quiz!\r\nTry 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quiz is 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