A. ACTH (adrenocorticotropic hormone). ACTH secretion is diurnal and regulated by corticotropin releasing hormone. This secretion is increased during stress and highest in the morning.

C. Tryptophan is the sole precursor for the synthesis of serotonin. We acquire this amino acid through our diet only.

E. Vitamin C is soluble in water. To recall, “DEAK” are the four fat soluble vitamins.

C. Aspirin use in children leads to the development of Reye’s syndrome – a rapid degenerative brain disease that is marked with confusion, seizures, and multi-organ failure.

A. Loratidine is a second generation antihistamine. This question is here to demonstrate the mechanism of action of H2 blockers in treatment of stomach ulcers and acid reflux. We are also taught to remember H2 blockers from the “-tidine”. Here is one exception, do not forget on test day.

A/D. Both Ciprofloxacin and Ofloxacin are second generation Fluoroquinolones. Recall “CO2” for second generation and “Three LEVO clover” for third generation. There are no first generation Fluoroquinolones. This information is important as second generation target Gram Negative bacteria while later generations could be used to target both Negative and Positive.

C. Azithromycin is classified as a Macrolide. Recall “Buy AT 30, CEL at 50”. CEL stands for Chloramphenicol, Erythromycin (Macrolides), and Lincomycin. These meds target the 50s subunit. Doxycycline and Gentamicin target the 30s subunit. Sulfacetamide is a sulfonamide that inhibits DHP synthase.

B. Doxycycline must be digested after eating/with food. To recall, “PAT your stomach” for drug classes that must be taken with an empty stomach and include: Penicillins, Azithromycin (Macrolides), and Tetracycline. This is a trick question as Doxycycline, a Tetracycline, is the one exception that must be taken with food.

C. Cephalosporins are safe to use during pregnancy. To recall, “She is not FATS, she is PACking a baby”. FATS are not safe to use during pregnancy and includes: Fluoroquinolones, Aminoglycosides, Tetracyclines, and Sulfonamides. PAC is safe to use and includes: Penicillins, Azithromycin (Macrolides), and Cephalosporins.

B/C. Sumatriptan, a drug commonly used as a therapy for Migraines, functions as an anti-inflammatory and vasoconstrictor. Sumatriptan is an agonist of 5-HT1B and 1D receptors.

C. Bromocriptine, a dopamine agonist, is commonly used in treatment of Parkinsons. Amantadine is also considered a dopamine agonist used to treat Parkinsons.

A. Metformin is the only known DM drug that does not cause hypoglycemia. For this reason, Metformin is considered first line therapy for T2DM.

A. Naloxone, also known as Narcan, is administered to those experiencing an opioid overdose. Narcan acts as an opioid antagonist to reverse effects.

C. Sildenafil, also known as Viagra, functions by inhibiting phosphodiesterase-5 (PDE-5). PDE-5 breaks down cGMP which will lead to weakening of smooth muscle.

C. Nexium and its sister drug Prilosec are classified as Proton Pump Inhibitors. PPIs function by inhibiting H+/K+ ATPase proton pumps.These medications are used in treatment of peptic ulcer disease and GERD.

B. Zidovudine, also known as Retrovir, inhibits the viral RNA-dependent, DNA polymerase responsible for reverse transcription. RIbavirin is used in treatment of Hepatitis C. Foscarnet is used in treatment of CMV that is not responding to other antivirals. Natamycin is an antifungal.

B. It is not a HYPEROPIC shift but rather a MYOPIC shift. The remaining options are correct. Of note, the dry eye is from decreased secretion from the lacrimal gland.

B. Albuterol is a short acting Beta-2 agonist used as a rescue inhaler for Asthma and COPD. Other short acting agonists include Levalbuterol, Terbutaline, Metaproterenol (no longer used due to excessive cardiovascular effects) and Isoproterenol (nonspecific Beta agonist used in treatment of arrhythmias). Salmeterol is a long acting Beta-2 agonist used in maintenance therapy of the above conditions.

A. Trifluridine, also known as Viroptic, contains Thimerosal – a mercury-based preservative found in drops. The remaining options are oral medications used in treatment of herpes virus.

C. Pyrimethamine is NOT used in treatment of Tuberculosis. It is important to note that Isoniazid and Rifampin can be used in isolation for treatment of Latent TB. Active TB is treated with a combination of the RIPE medications.

B. Opsonization is the process by which complement proteins cover an antigen to initiate the immune system. Opsons alert the immune system to phagocytose the target cell.

D. Optic disc drusen are HYPERreflective on B scan ultrasound.

A. An INO is caused by a lesion of the medial longitudinal fasciculus (MLF). The MLF is responsible for coordinating the conjugate movement of eyes with associated head/neck movements. A lesion to the MLF causes an INO – loss of ipsilateral adduction and a contralateral nystagmus.

B. An optic nerve coloboma is caused by the incomplete closure of the fetal fissure during development. The degree of visual impairment varies depending on severity and location. The defect is most commonly located in the inferior nasal region of the disc.

C. The lesion is most likely located in the temporal lobe. To recall, think “pie in the sky”. If these findings were in the inferior field, it is suggestive of a lesion in the parietal lobe.

To answer this question, we need to identify the three cranial nerves that exit from the pons (or at the level of the pons). This is high-yield for the optometry boards because understanding the relationship between cranial nerves and the brainstem is essential for neuro-ophthalmology and clinical localization.

—

### Let’s review each option:

—

A) CN III (Oculomotor nerve)

* Incorrect
* CN III emerges from the midbrain, specifically the ventral surface between the cerebral peduncles (interpeduncular fossa).
* It controls most of the extraocular muscles, the levator palpebrae, and the pupil (via parasympathetic fibers), but it is not associated with the pons.

—

B) CN IV (Trochlear nerve)

* Incorrect
* CN IV is the only cranial nerve that exits dorsally, and it comes from the midbrain, just below the inferior colliculus.
* It innervates the superior oblique muscle. Despite its proximity, it does not exit from the pons.

—

C) CN V (Trigeminal nerve)

* Correct
* CN V is the only cranial nerve that exits directly from the pons itself.
* It comes out of the lateral surface of the pons and is both sensory (face, cornea, teeth) and motor (muscles of mastication).
* Important in optometry for sensory testing of the cornea and orbital region.

—

D) CN VI (Abducens nerve)

* Correct
* CN VI exits at the pontomedullary junction, close to the midline.
* It innervates the lateral rectus muscle, which abducts the eye.
* Damage can cause horizontal diplopia and esotropia (eye turns inward).
* Functionally and anatomically tied to the pons.

—

E) CN VIII (Vestibulocochlear nerve)

* Correct
* CN VIII also exits at the pontomedullary junction, just lateral to CN VII.
* It carries sensory information for hearing and balance from the inner ear.
* Clinically important for vestibular disorders and hearing tests.

—

F) CN IX (Glossopharyngeal nerve)

* Incorrect
* CN IX exits from the medulla, below the pontomedullary junction.
* It controls taste and sensation from the posterior third of the tongue, as well as swallowing and carotid body input.
* Not associated with the pons.

—

### Correct Answer Choices:

* C) CN V
* D) CN VI
* E) CN VIII

—

### Study Tip for Boards: Brainstem Levels and CN Origins

To remember where cranial nerves exit, break them down like this:

* Midbrain: CN III, CN IV
* Pons: CN V (directly), CN VI–VIII (at pontomedullary junction)
* Medulla: CN IX–XII

—

### Visual Mnemonic Tip:

Think of the cranial nerves coming out in order from top (midbrain) to bottom (medulla) like rungs on a ladder:

1. CN III & IV – top of the ladder (midbrain)
2. CN V–VIII – middle rungs (pons)
3. CN IX–XII – lower rungs (medulla)

—

### Final Answer:

✅ C) CN V
✅ D) CN VI
✅ E) CN VIII

A,C,E: Note the sizes above. Bowman’s is about 10um and Descemet’s begins at 5um and increases to about 15um with age.

A: The palpebral portion of the orbicularis oculi is responsible for spontaneous and reflex blinking. Voluntary blinking also includes the orbital portion of the orbicularis oculi

B: CNII, the oculomotor nerve, is responsible for innervating the levator muscle. CN VII, the facial nerve, closes the eye. CN I is the olfactory nerve. CN II is the optic nerve, CN IV is the trochlear nerve.

B: Inferior Oblique is the only muscle to originate from maxillary bone.

D: The Scleral Spur is the origin of the longitudinal muscle fibers. The muscle inserts into the anterior choroid.

C: The sclera is thinnest at recti muscle insertions with a thickness of about 0.3mm. The thickest is the posterior pole at about 1mm.

A: Vortex veins are responsible for draining most of the blood from the eye. There are often 4-6 vortex veins in each eye noted at mid-periphery.

D. The average human eye is about 24mm in length.

A: The weakest point of attachment is found at the macula. From weakest to strongest: Retinal vessels, Macula, Optic Nerve, Posterior lens, Ora Serrata/Vitreal Base. A PVD is most likely to occur at the base.

A/C/D. The three medications that may cause aplastic anemia include: Acetazolamide, Methazolamide, and Chloramphenicol. Additionally, Trimethoprim, Pyrimethamine and Methotrexate may also cause aplastic anemia.

B. Phenothiazines, a class of Antipsychotics, function as dopamine receptor antagonists (anti dopamine). Adverse effects include: Parkinson-like symptoms (recall TRAP), Pigmentation effects (pigment on endo, ASC, and HYPERpigmentation of RPE), Oculogyric Crisis.

C. Topiramate is clinically indicated for treatment of epilepsy to prevent seizures. It is important to know this medication as it may lead to blurred vision, diplopia, and nystagmus. More severe adverse effects include choroidal swelling leading to a myopic shift and acute angle closure glaucoma.

D. Chlamydia is the leading cause of ophthalmia neonatorum in the US. HSV and gonorrhea may also lead to development of this condition.

C. Along with Arlt’s lines other common findings in Trachoma include both follicular and papillary reactions of the palpebral conjunctiva, PAN, and potential SEIs. Dennie’s line are extra creases in adnexal skin in Atopic Dermatitis. Scheie’s line describes pigment in pigment dispersion syndrome. Stocker’s line represents the leading of a pterygium.The Hudson-Stahli line is iron deposition within the cornea that normally occurs with age.

A. Cobblestone papillae are found on the UPPER palpebral conjunctiva. VKC is a form of seasonal allergies that most often affects young males. These young males present with complaints of intense itching and photophobia. Slit lamp examination reveals cobblestone papillae of the upper lid, trantas dots with gelatinous masses at the limbus, and redness of the eye. In extreme cases, epithelial keratitis leads to thinning and eventual ulceration of cornea – a shield ulcer.

A. Macular dystrophy is the only corneal dystrophy that is autosomal recessive. The rest of the options are autosomal dominant.

D. The fine yellow-white rings of crystals in Schnyder’s are composed of cholesterol. Macular Dystrophy presents with multiple gray-white opacities composed of mucopolysaccharides. Granular Dystrophy presents with snowflake granules composed of hyaline. Lattice Dystrophy presents with lattice-like branches of amyloid. Calcium is associated with Band K, which affects Bowman’s layer.

A: Toxoplasmosis is the most common cause of posterior uveitis. Toxoplasmosis presents with unilateral vitritis in presence of a yellow-white retinal lesion near an old inactive scar. When looking within the eye, findings appear as “headlights in the fog”. Other conditions listed also lead to development of posterior uveitis.

B. Histoplasmosis does NOT cause vitritis. This is one major distinguishing factor when comparing to toxoplasmosis. Histoplasmosis is a fungal infection that is common to the Ohio-Mississippi River Valley.

D. Necrotizing without inflammation. This is a unique form of Scleritis where the patient presents with minimal pain and injection. Often associated with rheumatoid arthritis, SP leads to scleral thinning that gives a blue appearance.

B. The greatest threat to the patient’s vision is a CRAO. Elevated IOP leads to reversal of blood flow due to the change in perfusion pressure. Ischemic damage from CRAO is irreversible.

E. Cortical cataracts have been associated with hyperopic shifts in vision. Cerulean cataracts are congenital and present as small, blue-green opacities that rarely affect vision. Nuclear sclerosis is the most common aging cataract and most often leads to a myopic shift as the lens swells. Rosette cataracts are caused by trauma. PSC cataracts lead to reduced vision at distance and near, worse while reading with constricted pupils.

C. 1 mm of axial length corresponds to about 3 diopters. This emphasizes the importance of accurate A scan measurements prior to surgery.

A: Involutional, or aging, is the most common cause of entropion (an inward turning of the eyelid). Other causes include mechanical (tumor), cicatricial (trachoma, Stevens-Johnson, chemical burns), or congenital.

E. Canaliculitis is most often caused by Actinomyces israelii. First signs include a pouting puncta, epiphora, and sulfur granular discharge.

D. Demodex folliculorum and D. brevis are the most common mites found on the human eye lash. Phthirus and pediculus are parasites that are contagious and easily spread. If seen in children it is a red flag! Molluscum, a DNA pox virus, is a viral infection of the skin common in children and immunocompromised patients.

B. Cavernous hemangioma is the most common benign orbital tumor in adults. Cavernous hemangiomas develop slowly and lead to unilateral proptosis. Capillary hemangiomas are the most common benign orbital tumor in CHILDREN.

B. Involutional. The most common cause of ectropion is a laxity of the muscles needed to adhere the lid to the globe that develops with age. Congenital and Cicatricial are quite rare in occurrence. Paralytic ectropion is caused by Bell’s Palsy.

B,C,D: The clinical triad for CCF is chemosis, pulsatile proptosis (the globe appearing to pulse in and out of the orbit), and ocular bruit (the sound of blood “whooshing” in the eye). CCF results from an abnormal communication of the vascular system within the cavernous sinus. It is most commonly caused by head trauma and can lead to elevated IOP, diplopia, and sensation loss of the face.

A. The most common site of an orbital fracture is the maxillary bone; the posterior medial portion of the floor. The palatine and zygomatic bones are the other two bones that compose the floor of the orbit. Ethmoid and lamina papyracea are interchangeable and represent the THINNEST bone in the orbit. This bone prevents infections from moving into the sinuses.

C. In the case of a trapped inferior rectus, you would expect a POSITIVE forced duction. To perform a duction exam, you anesthetize the patient’s eye and use forceps (or two Q Tips) to move the eye. If the eye moves, it is most likely a palsy as the muscles are not restricted. This is a NEGATIVE forced duction. Limited upgaze and diplopia are due to the inferior rectus being stuck in a down position (no slack to move up). Hypoesthesia comes from possible damage to the infraorbital nerve. Crepitus is the “crunching” sound from bone fragments rubbing against the other.

A,B,D: Telangiectasia is a critical finding in Coat’s, BCC, and ocular rosacea. Although these may begin to appear as we age, it is important to rule out these conditions on assessment. Molluscum appears as an umbilicated nodule without telangiectasia.

D. Osteogenesis imperfecta is not correlated with angioid streaks. Recall PEPSI as the most common causes of angioid streaks. Pseudoxanthoma elasticum, Ehlers-Danlos syndrome, Paget’s Disease, Sickle-cell disease, and idiopathic.

C. Presence of a halo is a positive sign and will steer diagnosis towards benign. To recall, remember the phrase “To Find Small Ocular Melanomas, Use Helpful Hints Daily”: Thickness (elevation >2mm), Fluid (subretinal), Symptoms, Orange pigment (lipofuscin), Margins are irregular, Ultrasound Hollowness, Halo absence, Drusen present.

B,C,E: RP, Gyrate atrophy, and choroideremia lead to complaints of poor night vision (nyctalopia). Night blindness is a consequence of damage to the rod photoreceptors in the retina. It is important to note that nyctalopia is not limited to these three conditions.

B. Most tears, holes, and detachments occur in the superior temporal region of the retina.

A. Limbal blanching indicates that the chemical burn has resulted in ischemia. Although the remaining options are of major importance, limbal blanching has the most long term consequences on the health of the eye.

B. It is imperative you DO NOT perform gonio or scleral depression until at least 1 month post-injury to avoid rebleeds. The most common cause of a hyphema is trauma so be sure to assess for iris sphincter tears, iridodialysis, rosette cataracts, lens subluxation, and other common traumatic findings.

A. The vestibulo-ocular reflex has the shortest latency of all eye movements with a latency of 15msec. The purpose of the VOR is to stabilize the retinal image as the head moves so it must occur quickly.

E. -2.00 D. A far point that is reduced from infinity is more indicative for myopia. Using the equation 1/0.5m = 2.00 D. A +2.00 eye requires -2.00 D to return the far point to infinity.

D is the correct response, having hyperopic aniso > 1.00
Diopter can lead to amblyopia in the eye with higher prescription, in this case OS which is +7.00.

Norms include:
ANISO: H >1.00, A >1.50, M >3.00; ISO: H >5, A >2.50, M >8.

B. Anisometropic hyperopia is more likely to cause amblyopia as one eye never receives a clear image. In patient with aniso myopia, there is a point of clarity for either refractive error. Strabismus first presents with diplopia but with time can become suppressed. Eso = nasal, Exo = temporal. Deep amblyopia is considered 20/100 – 20/400.

D. The correct answer should be 60 since the clock dial equation is (lower number on the clock x30) which will give you in this case (2×30=60 degrees)

What is the Procedure of using a Lens Clock?
1) Multiply the smaller number (the lower number is always the number used in the clock dial equation) by 30 degree to find the orientation of the minus cylinder axis

C. Absolute hyperopia (hyperopia that cannot be neutralized with accommodation alone) is +3.00 D; the difference between the two values. Facultative hyperopia (amount of hyperopia neutralized by accommodation) is +2.00D; the total accommodative ability.

C. Accounting for your working distance (50cm = -2.00 D), the 90 (or vertical) meridian is plano while the 180 (or horizontal meridian) is -0.50 D. Using the most plus meridian as the sphere, the prescription should be plano -0.50 x 090.

B. Maxwell’s spot, as well as visuoscopy and Hidinger’s brush, are used to measure eccentric fixation. 4 BO test is used for ocular alignment, such as in microstrabismus syndrome. Bagolini lenses are used for ARC. W4D is used for sensory status.

D. Wold Sentence Copy is an example of a VMI test. The Beery VMI is another example. Piaget and Gardner, as well as Standing Angels in the Snow, are examples of tests of visual spatial skills. Visual analysis encompasses 6 sub-categories focused on analyzing images of different complexities.

D. The Critical Period for development of clear, binocular vision is between 7 and 8 years of age. This is why it is critical to provide thorough eye examinations to young children. The earlier the diagnosis, the better outcome to treatment.

C. Duane retraction syndrome Type 1 as there is only an issue of aBDuction of the right eye. To remember, recall that you “count the D’s” to determine the diagnosis.

A. 10 pd BI. As we are calculating the prism necessary for exophoria, it is recommended to use Sheard’s Criterion. The equation is Prism = ⅔ Phoria – ⅓ Compensating Fusional Vergence. In this case, the phoria is 18Δ and the compensating fusional vergence (positive fusional vergence for exophoric patients) is the blur point of the BO measurement. To alleviate phoria we expect to move images to the fovea. Therefore the 10Δ will be BI. Remember this is total and NOT per eye.

B. Accommodative esotropia is the most likely diagnosis at this time. There are a few pieces of information that are key. First, the infant is demonstrating an eye turn some of the time. This means there is either a stimulus to the eye turn or it may be a decompensated phoria. The second piece of evidence is the orthophoric position with +3.00D lenses. This indicates that when accommodation demand is low, the eye turn is not present (or reduced).

C. The calculated AC/A is 3.6. The equation of note is AC/A = PD(cm) + WD(m)[Phoria @ N – Phoria @ D]. When plugging in values, Exo is considered “-” and Eso is considered “+”. Therefore, AC/A = 6.4 + .4(-8-(-1)) = 3.6. CAREFUL that PD is in centimeters.

C. To the LEFT. Recall COWS – cold = opposite, warm = same. As we know nystagmus is named by the fast phase (not the slow fixation period). Thus, since the nystagmus is in the same direction with warm water, we know it is to the left.

D. Crossed diplopia. Recall that the right eye sees the red dots and the left eye sees the green dots. If the red dots were located to the right of the green, that is considered uncrossed (or ESO) diplopia. Red dots above or below the green are indicative of a hypertropia. A patient reporting only one set of lights indicates suppression of either eye. A report of 4 dots is what we hope for.

D. Sherrington’s Law states that reciprocal muscles in the SAME eye will both be innervated to provide stability of eye position and gaez. Hering’s law states that yoked muscles in both eyes will receive equal innervation. Donder’s and Listing’s refer to unique orientations of the eye in space and how the eye achieves these positions.

B. End-point nystagmus is noted in extreme position of gaze. It is not noted at other times. Caloric nystagmus refers to the use of warm or cold water to induce eye movement. Optokinetic is related to viewing fast moving or rotating objects as the eye attempts to fixate a target. Rotational refers to rotation of the individual’s body. Latent refers to nystagmus that appears when one eye is occluded.

D. One would expect a low NRA. This is due to the reduced fusional vergence needed to keep eyes aligned. All other findings can be found in a CI patient. Other findings include: reduced positive fusional vergence, and a low lag/lead of accommodation.

A/D. Both media opacities and higher refractive error at a longer test distance can both present with darker reflexes. The deviated eye in strabismus, as well as higher refractive error at 1 meter and retinoblastoma, present with brighter reflexes.

C. Undershooting is the most common saccadic error. Recall that saccades are rapid, yoked eye movements to quickly move an image to the fovea. These eye movements are important in reading and spotting tasks.

A/B/C. Topamax, Carbonic Anhydrase Inhibitors, and Pilocarpine are all known to carry the risk of myopic shift.

A. Acetylcysteine, also known as Mucomyst, functions by breaking disulfide bonds. This medication is also used in treatment of severe dry eye disease and corneal burns.

E. Naloxone is not known to cause PTC (otherwise known as Idiopathic Intracranial Hypertension). To recall, “SCANT” or “CATS-N”: Synthroid, Contraceptives, Accutane, Nalidixic Acid (in kids), Tetracyclines”

A. Durezol, a steroid, is most likely to cause a PSC rather than ASC. To recall, “I made ‘A PACT’ with ASC”: -Azines, Pilocarpine, Amiodarone, CAIs, Trimethoprim.

A. Most topical eye drops are formulated as WEAK BASES. This is for better penetration and bioavailability of the medicated drop.

B. Macugen is an anti-neoplastic agent that prevents angiogenesis through inhibition of VEGF. PEDF has the opposite effect and is required to be in the proper balance of concentration as VEGF.

C. Corneal melts are most common with either topical NSAIDs or anesthetics. Delayed wound healing is related to steroid use. Skin darkening is a side effect of prostaglandin analogs. Follicular conjunctivitis is an uncommon finding with Brimonidine and CL solutions.

D. The greatest threat to vision with chronic use of Plaquenil is Bull’s Eye Maculopathy.The mechanism of action is similar to that of steroids. Standard of care (DFE within 1 year of initiation of drug therapy) is as above, exception being a 24-2 for patients of Asian descent.

B. Triamcinolone, also known as Kenalog, is a steroid that is used in the treatment of many conditions. Including those in the questions, Kenalog is also used in treatment of Posterior Uveitis, Dermatoses, Multiple Sclerosis, and Arthritis. Chronic use can cause depigmentation of the eyelid in dark-skinned individuals.

B. Minocycline may cause a blue sclera. Other causes of a blue sclera include Scleromalacia Perforans, chronic topical steroid use, and thin scleras in newborn infants.

A. Erythromycin is applied topically for newborns to prevent opthalmia neonatorum.

B. Sulfonamides act by inhibiting DHP synthase, the first step of folic acid synthesis. Trimethoprim, Methotrexate, and Pyrimethamine all act by inhibiting DHF reductase, the second step of folic acid synthesis. Aminoglycasides and Tetracyclines function by binding and inhibiting 30s subunits. Penicillins and Cephalosporins inhibit transpeptidase.

A. Dilation withOUT cycloplegia. Phenylephrine is an adrenergic agonist that causes dilation with no effect on ciliary muscles. When used to differentiate, vessels will become blanched with episcleritis. With diagnosis of Horner’s Syndrome, it helps determine if lesion is pre- or post ganglionic. 10% Phenyl is used to break old or severe PAS.

C. Timolol may mask the signs of HYPOglycemia in Diabetic patients. Timolol is also known to mask signs and symptoms of hypothyroidism as well as increasing symptoms of muscle weakness in patients with myasthenia gravis. Long term drift describes an increase of IOP after chronic use of Timolol. Short term escape is an initial lowering of IOP before no longer having an effect. D describes the “crossover” effect.

B. Of the options, Scopolamine has the longest mydriatic effect. Recall, ASH CiTy for length of cycloplegia and mydriasis with the cholinergic antagonists.

D. Echothiophate, an irreversible drug, is used to diagnose and treat accommodative ET. Pilocarpine is reversible and considered a direct cholinergic agonist. The “-stigmine” drugs are used in the treatment of Myasthenia Gravis. Edrophonium is used to test for MG.

B. Betaxolol is β1 selective with limited β2 activity. It is also known for neuroprotective qualities although there is limited clinical evidence. Recall that Betaxolol is cardioselective. The remaining options are non-selective.

C. Beta blockers reduce IOP by decreasing aqueous production. Cholinergic agonist (i.e.Pilocarpine) affects IOP by increasing corneoscleral outflow. Alpha agonists both decrease aqueous production and increase uveoscleral outflow. CAIs decrease aqueous production. PGs increase uveoscleral outflow.

A/D. Alpha 1 and Beta 2 receptors in the eye are the targets for topical glaucoma meds. B1 receptors are located in the heart. Alpha 2 are located in the brain and peripheral nerves.

B. Combigan is composed of Timolol (B-blocker) and Brimonidine (Alpha agonist). Cosopt is a combination of Timolol (B-blocker) and Dorzolamide (CAI). Latanoprost (PG) and Netarsudil (Rho Kinase inhibitor) make up a newer glaucoma medication, Rhopressa. Brinzolamide (CAI) and Brimonidine (Alpha agonist) compose Simbrinza.

C/D: CAIs are known for several side effects. The most important to note include: metabolic acidosis, aplastic anemia, myopia shifts, bone marrow suppression, and depression. Other SE include metallic taste, tingling of limbs, thrombocytopenia, ED, and anorexia.

A/B/D. PG analogs, alpha agonists, and pilocarpine (a direct cholinergic agonist) all lower IOP by increasing aqueous outflow.

D. Muro 128 is used to reduce corneal edema in conditions such as Fuch’s. The remaining conditions can lead to ulceration of cornea with use of Muro 128.

A. Restasis, used in the treatment of dry eye, works by ceasing production of IL-2 leading to inhibition of T-cell activation. This is one of the final steps of the dry eye cascade.

C. Rifampin, a drug used in the treatment of Tuberculosis, is known to cause orange-pink discoloration of tears and urine.

B. The superior cervical ganglion contains SYMPATHETIC synapses only.

D. The image is displaced 9 cm to the left. The equation for this example is PrismPower = image displacement (in cm)/distance to screen (in m). This is why the answer is in centimeters. Next, we note that a prism moves images towards its apex. When the base is positioned to the right, the image moves to the left.

B. -4.08 D. You must first determine r by using the equation [Fair = -12.00 D = (1.50 – 1) / r]. You determine that r = -0.0417m. Using the new equation [Fwater = (1.50 – 1.33) / -0.0417m].

D. Purkinje image IV is the only image that is real and inverted. The remaining three are virtual and upright.

D. The power in the 180 meridian is -1.00. On an optical cross, +2.00DS falls on the 90 meridian. Subtract the astigmatic difference of -3.00 to find the resulting -1.00DS.