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Old 06-26-2011
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Eye patientís pupils are unequal, miotic, and bilaterally irregular case

A 50-year-old man is examined in an institutional setting for a long-standing health problem. During the examination, the clinician notes a pupillary abnormality. Specifically, the patientís pupils are unequal, miotic, and bilaterally irregular. They do not react to light but do react to accommodation via provocation by a near stimulus. Based on these findings, which of the following is the most likely primary diagnosis?

Answer Choices
A. Adieís pupil
B. Oculomotor nerve palsy
C. Tertiary syphilis
D. Uncal herniation
E. Wilsonís disease
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  #2  
Old 06-26-2011
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It is C. Tertiary syphilis.

This finding is called Argyll Robertson pupils
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Old 06-26-2011
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Agreed ... i remebered it like this
ARP .... Argyll Robertson Pupil
ARP......Accomodation Reflex Positive.
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Old 06-26-2011
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i rememberd it by syphilis = prostitute = always accommodating
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Old 06-27-2011
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Option C (Tertiary syphilis) is correct. Argyll Robertson pupils are a feature of tertiary syphilis. The bilaterally irregular miotic pupils fail to react to light but do react to accommodation (provocation by a near stimulus).

Option A (Adieís pupil) is incorrect. Adieís pupil is a unilateral tonic pupil with poor light reactivity. This patientís disorder is present in both pupils. It is a nonspecific condition.

Option B (Oculomotor nerve palsy) is incorrect. Both pupils are dilated and react to light poorly or not at all. Along with other findings, this demonstrates dysfunction related to the Edinger-Westphal nucleus.

Option D (Uncal herniation) is incorrect. Transtentorial herniation causes Hutchinsonís pupil, which is a dilated pupil unreactive to light.

Option E (Wilsonís disease) is incorrect. In Wilsonís disease, the pupils are not abnormal but are surrounded by a rim of copper deposition known as a Kayser-Fleischer ring.
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Infectious-Diseases, Neurology-, Step-2-Questions

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