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This 7-year-old boy presented with a history of keeping his chin down and looking up when he concentrates on seeing clearly. This has been present since birth. His vision with chin down and looking up is between 20/40 and 20/30 without correction. Refraction is: OD + 1.50 – 0.75 X 5 and OS + 1.50 – 1.00 X 180. He does not wear glasses. He has a slow, low amplitude horizontal nystagmus which disappears in upgaze. The remainder of his eye examination is normal. He is otherwise healthy, is doing satisfactorily in school, and has no complaints.

1.	The chin down position is assumed by this boy because:
	a. it gets the attention of his parents b. his neck muscles feel better c. his vision is better d. no particular reason e. none of the above
2.	Of the following statements, the most likely to be true is:
	a. This head posture is the sign of frontal lobe pathology. b. The head posture is the sign of serious neurological disease. c. His head posture would likely be normal if he wore his glasses. d. A neck brace is indicated. e. The boy has congenital nystagmus with a null point in upgaze.
3.	This boy could be treated with:
	a. Atropine drops 1% in each eye on the weekends b. orthoptic exercises c. base up prism over both eyes d. bilateral superior rectus recession e. none of the above

For answers to the above, click here on or after January 26, 2010.