NBEO PART 1 ALL FINAL EXAMS LATEST
QUESTIONS AND ANSWERS SURE A+
✔✔A 31-year old male patient presents to your office for a photorefractive keratectomy
(PRK) pre-operative examination. As you review his required ocular medication
schedule, which of the following prescribed drops must you remember to tell him to
"shake well" before instillation?
Zymaxid®
FreshKote®
Pred Forte®
Acular® - ✔✔Pred Forte® is an ocular medication that is in suspension form; therefore,
it is important to shake this medication well before use. Other forms of prednisolone that
are suspensions include Pred Mild®, Econopred®, and Econopred Plus®.
On the other hand, there are prednisolone ocular medications that are solutions, making
shaking of the bottle unnecessary. These include AK-Pred®, Inflamase Mild®, and
Inflamase Forte®.
Zymaxid® is a 4th generation fluoroquinolone antibiotic that is bottled in solution form,
as well as Acular®, which is an ocular non-steroidal anti-inflammatory drug (NSAID).
FreshKote® is a prescription artificial tear that also does not need to be shaken before
use.
,✔✔A 32-year old female is seen at your office complaining of a recent onset of blurred
vision, only at a distance. A thorough case history reveals that she recently began
taking a new medication which you correctly assume has induced myopia. Which of the
following medications is MOST likely to be the culprit?
Tums® (calcium carbonate)
Accutane® (isotretinoin)
Tylenol® (acetaminophen)
Omega III fish oil capsules - ✔✔Isotretinoin, birth control pills, and diuretics, among
many other drugs, can cause myopia in some patients. Myopia most likely results from
corneal swelling, which steepens the curvature of the cornea. Drugs that cause swelling
of the lens, accommodative spasm, or edema of the ciliary body will also result in
myopia. A reduction in the dose of the medication or cessation of the offending drug will
usually result in reversal of nearsightedness. Fish oil, Tylenol®, and Tums® have not
been shown to have a correlation with transient myopia development.
✔✔A chin fissure is a dominant trait. If a father who is homozygous-dominant for this
trait and a mother who is homozygous-recessive for this trait mate, what are the
chances that their first child will have a chin fissure?
50%
0%
25%
100%
75% - ✔✔Because the father is homozygous-dominant, it is indicated that he possesses
a dominant gene pair for the chin fissure trait (FF). On the other hand, the mother is
homozygous-recessive for this trait; therefore, phenotypically she would have a "normal
chin" because she has an identical gene pair that does not code for a chin fissure (ff).
Each child would receive an allele from each parent, but the pair of genes would not be
identical (this is termed heterozygous (Ff)).
However, because they would inherit a dominant form of the allele, this is the form of
the gene that would influence the phenotype, resulting in the appearance of a chin
fissure.
✔✔A constant ringing of the ears is known as which of the following terms?
Malleus
Sinusitis
Otitis media
Tinnitus - ✔✔Tinnitus is caused by damage to hair cells in the inner ear from exposure
to excessive noise, medications (like aspirin), aging, and some diseases. Sound waves
cause the hair cells to bend, releasing a neurotransmitter and causing action potentials
of the auditory nerve. Sometimes the hair cells break or are left in the "on" position,
causing the perception of ringing.
Otitis media is an infection or inflammation of the middle ear.
Sinusitis is an inflammation of the sinuses.
,The malleus, also known as the hammer, is one of the tiny bones in the ear that help to
transmit and amplify sound to the auditory nerve.
✔✔A contracting muscle that develops tension but does not shorten displays which type
of muscle tension?
Isometric
Isovelocity
Isotonic
Isovolume - ✔✔Isometric contraction occurs when a muscle is contracting but is not
shortening. This type of muscle tension is used for load-bearing situations such as
holding a plate of food in front of you. Muscles that shorten but maintain the same
amount of tension are said to display isotonic contraction. An isovelocity contraction
follows when the force of the contraction varies while the velocity remains constant.
✔✔During gestation, when does the secondary vitreous begin to develop?
The 20th week of gestation
The 30th week of gestation
The 9th week of gestation
The 1st week of gestation - ✔✔The primary vitreous develops at around the third week
of gestation. It is formed by mesoderm. The secondary vitreous begins to develop
during the ninth embryonic week and later becomes the mature vitreous. The secondary
vitreous stems from primary vitreal cells and retinal glial cells and therefore originates
from neuroectoderm. The secondary vitreous expands to fill the globe while compacting
the primary vitreous in the center of the globe.
✔✔A central retinal artery occlusion (CRAO) causes tremendous damage to the retina.
How will the electroretinogram (ERG) of a person who has suffered a CRAO be
affected?
The a-wave will remain while the b-wave will disappear
Both the a-wave and the b-wave will remain
Both the a-wave and the b-wave will disappear
The a-wave will disappear while the b-wave will remain - ✔✔A central retinal artery
occlusion will cause a loss of the b-wave which is formed by responses from the bipolar
and Muller cells, both of which are nourished by the central retinal artery. The a-wave
results from excitation of the photoreceptors. The a-wave will not be lost in the event of
a CRAO due to the fact that photoreceptors receive their oxygen supply via the choroid.
✔✔A patient is concerned with an acute reduction of the acuity in the right eye. You
correctly diagnose central serous retinopathy, and confirm your diagnosis with an
optical coherence tomography (OCT). What is the standard treatment protocol?
Monitor monthly for resolution
Refer for intravitreal steroid injection
Treat the patient with prism as they are likely to develop diplopia
Refer for laser treatment of the retina
, Refer for cryotherapy of the retina - ✔✔CSR is more commonly seen in middle-aged
males under high-stress, who are very anxious, or with type A personalities. This
condition causes fluid to leak from the choriocapillaries into the subretinal area, causing
a serous detachment of the neurosensory retina. There is an associated loss of the
foveal reflex, a hyperopic shift, a potential relative scotoma, and metamorphopsia.
Flourescein angiography will reveal hyperfluorescence that appears like a smoke-stack.
Evaluation of the posterior pole will typically display a blister-like elevation of the
neurosensory retina. The patient is monitored monthly and intervention is rarely
required, as most cases of CSR will resolve within roughly 6 months.
✔✔According to the Keith-Wagener-Barker method of classification, hypertensive
retinopathy is categorized as stage four when which ocular sign is present?
Hard exudates in a star configuration
Swelling of the optic disc
Flame hemorrhages
Retinal edema - ✔✔Grading of hypertensive retinopathy according to the Keith-
Wagener-Barker system is as follows:
Stage 1- narrowing of the retinal arteries
Stage 2- stage 1, plus focal constriction of the retinal vasculature (arteriovenous
nicking)
Stage 3- stage 2, plus retinal hemorrhages, hard exudates (likely in a star
configuration), cotton wool spots, and retinal edema
Stage 4- stage 3, plus swelling of the optic disc. This patient must be hospitalized
immediately.
✔✔Bipolar cells receive information from photoreceptors. Which type of
neurotransmitter do bipolar cells respond to?
Glycine
Glutamate
Serotonin
Dopamine - ✔✔Bipolar cells respond to glutamate released by photoreceptor cells.
Glutamate release in the dark causes on-center bipolar cells to hyperpolarize (inhibition)
and off-center bipolar cells to depolarize (excitation).
✔✔Drusen typically deposit between which layers of the retina?
The inner and outer plexiform layers
The ganglion cell layer and the nerve fiber layer
The retinal pigment epithelium and Bruch's membrane
The inner and outer nuclear layers - ✔✔Drusen deposits collect between the retinal
pigment epithelium (RPE) and Bruch's membrane. The retinal pigment epithelium plays
a very important role in phagocytosis of shed outer segments of photoreceptors. If the
RPE fails to rid the retina of this debris, it will begin to accumulate, which can have a
significant impact on vision and may lead to macular degeneration.
✔✔Midget ganglion cells receive information pre-synaptically from which cells?
QUESTIONS AND ANSWERS SURE A+
✔✔A 31-year old male patient presents to your office for a photorefractive keratectomy
(PRK) pre-operative examination. As you review his required ocular medication
schedule, which of the following prescribed drops must you remember to tell him to
"shake well" before instillation?
Zymaxid®
FreshKote®
Pred Forte®
Acular® - ✔✔Pred Forte® is an ocular medication that is in suspension form; therefore,
it is important to shake this medication well before use. Other forms of prednisolone that
are suspensions include Pred Mild®, Econopred®, and Econopred Plus®.
On the other hand, there are prednisolone ocular medications that are solutions, making
shaking of the bottle unnecessary. These include AK-Pred®, Inflamase Mild®, and
Inflamase Forte®.
Zymaxid® is a 4th generation fluoroquinolone antibiotic that is bottled in solution form,
as well as Acular®, which is an ocular non-steroidal anti-inflammatory drug (NSAID).
FreshKote® is a prescription artificial tear that also does not need to be shaken before
use.
,✔✔A 32-year old female is seen at your office complaining of a recent onset of blurred
vision, only at a distance. A thorough case history reveals that she recently began
taking a new medication which you correctly assume has induced myopia. Which of the
following medications is MOST likely to be the culprit?
Tums® (calcium carbonate)
Accutane® (isotretinoin)
Tylenol® (acetaminophen)
Omega III fish oil capsules - ✔✔Isotretinoin, birth control pills, and diuretics, among
many other drugs, can cause myopia in some patients. Myopia most likely results from
corneal swelling, which steepens the curvature of the cornea. Drugs that cause swelling
of the lens, accommodative spasm, or edema of the ciliary body will also result in
myopia. A reduction in the dose of the medication or cessation of the offending drug will
usually result in reversal of nearsightedness. Fish oil, Tylenol®, and Tums® have not
been shown to have a correlation with transient myopia development.
✔✔A chin fissure is a dominant trait. If a father who is homozygous-dominant for this
trait and a mother who is homozygous-recessive for this trait mate, what are the
chances that their first child will have a chin fissure?
50%
0%
25%
100%
75% - ✔✔Because the father is homozygous-dominant, it is indicated that he possesses
a dominant gene pair for the chin fissure trait (FF). On the other hand, the mother is
homozygous-recessive for this trait; therefore, phenotypically she would have a "normal
chin" because she has an identical gene pair that does not code for a chin fissure (ff).
Each child would receive an allele from each parent, but the pair of genes would not be
identical (this is termed heterozygous (Ff)).
However, because they would inherit a dominant form of the allele, this is the form of
the gene that would influence the phenotype, resulting in the appearance of a chin
fissure.
✔✔A constant ringing of the ears is known as which of the following terms?
Malleus
Sinusitis
Otitis media
Tinnitus - ✔✔Tinnitus is caused by damage to hair cells in the inner ear from exposure
to excessive noise, medications (like aspirin), aging, and some diseases. Sound waves
cause the hair cells to bend, releasing a neurotransmitter and causing action potentials
of the auditory nerve. Sometimes the hair cells break or are left in the "on" position,
causing the perception of ringing.
Otitis media is an infection or inflammation of the middle ear.
Sinusitis is an inflammation of the sinuses.
,The malleus, also known as the hammer, is one of the tiny bones in the ear that help to
transmit and amplify sound to the auditory nerve.
✔✔A contracting muscle that develops tension but does not shorten displays which type
of muscle tension?
Isometric
Isovelocity
Isotonic
Isovolume - ✔✔Isometric contraction occurs when a muscle is contracting but is not
shortening. This type of muscle tension is used for load-bearing situations such as
holding a plate of food in front of you. Muscles that shorten but maintain the same
amount of tension are said to display isotonic contraction. An isovelocity contraction
follows when the force of the contraction varies while the velocity remains constant.
✔✔During gestation, when does the secondary vitreous begin to develop?
The 20th week of gestation
The 30th week of gestation
The 9th week of gestation
The 1st week of gestation - ✔✔The primary vitreous develops at around the third week
of gestation. It is formed by mesoderm. The secondary vitreous begins to develop
during the ninth embryonic week and later becomes the mature vitreous. The secondary
vitreous stems from primary vitreal cells and retinal glial cells and therefore originates
from neuroectoderm. The secondary vitreous expands to fill the globe while compacting
the primary vitreous in the center of the globe.
✔✔A central retinal artery occlusion (CRAO) causes tremendous damage to the retina.
How will the electroretinogram (ERG) of a person who has suffered a CRAO be
affected?
The a-wave will remain while the b-wave will disappear
Both the a-wave and the b-wave will remain
Both the a-wave and the b-wave will disappear
The a-wave will disappear while the b-wave will remain - ✔✔A central retinal artery
occlusion will cause a loss of the b-wave which is formed by responses from the bipolar
and Muller cells, both of which are nourished by the central retinal artery. The a-wave
results from excitation of the photoreceptors. The a-wave will not be lost in the event of
a CRAO due to the fact that photoreceptors receive their oxygen supply via the choroid.
✔✔A patient is concerned with an acute reduction of the acuity in the right eye. You
correctly diagnose central serous retinopathy, and confirm your diagnosis with an
optical coherence tomography (OCT). What is the standard treatment protocol?
Monitor monthly for resolution
Refer for intravitreal steroid injection
Treat the patient with prism as they are likely to develop diplopia
Refer for laser treatment of the retina
, Refer for cryotherapy of the retina - ✔✔CSR is more commonly seen in middle-aged
males under high-stress, who are very anxious, or with type A personalities. This
condition causes fluid to leak from the choriocapillaries into the subretinal area, causing
a serous detachment of the neurosensory retina. There is an associated loss of the
foveal reflex, a hyperopic shift, a potential relative scotoma, and metamorphopsia.
Flourescein angiography will reveal hyperfluorescence that appears like a smoke-stack.
Evaluation of the posterior pole will typically display a blister-like elevation of the
neurosensory retina. The patient is monitored monthly and intervention is rarely
required, as most cases of CSR will resolve within roughly 6 months.
✔✔According to the Keith-Wagener-Barker method of classification, hypertensive
retinopathy is categorized as stage four when which ocular sign is present?
Hard exudates in a star configuration
Swelling of the optic disc
Flame hemorrhages
Retinal edema - ✔✔Grading of hypertensive retinopathy according to the Keith-
Wagener-Barker system is as follows:
Stage 1- narrowing of the retinal arteries
Stage 2- stage 1, plus focal constriction of the retinal vasculature (arteriovenous
nicking)
Stage 3- stage 2, plus retinal hemorrhages, hard exudates (likely in a star
configuration), cotton wool spots, and retinal edema
Stage 4- stage 3, plus swelling of the optic disc. This patient must be hospitalized
immediately.
✔✔Bipolar cells receive information from photoreceptors. Which type of
neurotransmitter do bipolar cells respond to?
Glycine
Glutamate
Serotonin
Dopamine - ✔✔Bipolar cells respond to glutamate released by photoreceptor cells.
Glutamate release in the dark causes on-center bipolar cells to hyperpolarize (inhibition)
and off-center bipolar cells to depolarize (excitation).
✔✔Drusen typically deposit between which layers of the retina?
The inner and outer plexiform layers
The ganglion cell layer and the nerve fiber layer
The retinal pigment epithelium and Bruch's membrane
The inner and outer nuclear layers - ✔✔Drusen deposits collect between the retinal
pigment epithelium (RPE) and Bruch's membrane. The retinal pigment epithelium plays
a very important role in phagocytosis of shed outer segments of photoreceptors. If the
RPE fails to rid the retina of this debris, it will begin to accumulate, which can have a
significant impact on vision and may lead to macular degeneration.
✔✔Midget ganglion cells receive information pre-synaptically from which cells?
