A. Wavefront provides less low level aberrations thus allowing the patient to achieve 20/20 without spectacle correction

D. Standard fluorescent lighting

E. Pink cap indicates steroids. Red cap is mydriatic. Blue and yellow caps are glaucoma drugs.

A. Paradoxical type 1 anomalous retinal correspondence. harmonious ARC, the objective angle is equal to the subjective angle. In unharmonious ARC, the subjective angle is less than the objective angle. If the localization of the subjective and objective angles is crossed or uncrossed it is called paradoxical ARC. paradoxical type 1 is when the angle of anomaly is greater than the objective angle. Paradoxical type 2 is when the objective deviation is less than the subjective deviation.

A. Acids = Coagulation/denaturation/precipitation of proteins. Alkali = Saponification of fatty acids within cell membranes

C. RSR. When performing Park’s 3 step we are only concerned with the muscle that makes the deviation WORSE not better. A left hypertrophia muscles affected are either the right IR, SO or left SR, IO.

D. The glands of wolfring are located in the tarsal conjunctiva and are assistant lacrimal glands along with the glands of Kruse that provide aqueous layer to the tear film.

F. Curvature of the field.

E. Aniridia is a loss or lack of iris. Synechia will only present when an iris is present.

C.

C. +8.00
Don’t let the plus cyl format fool you. Transpose this power into minus cyl form = +5.00 – 1.00 x 090. In minus cyl format, the base curve is the most plus curve. In plus cyl format, the base curve is the most minus curve. The flatter of the two meridians is the most plus of the two.
The base curve is the front surface of the lens and gives the lens its shape.

C. Nebular corneal opacity is a faint opacity which results due to superficial scars involving Bowman’s layer and superficial stroma.

A. Confusion. Occurs when very different images are formed simultaneously on corresponding retinal points in the two eyes. Diplopia occurs when different images are formed simultaneously on non-corresponding retinal points in the two eyes.

D. Meibomian gland. Goblet cells secrete mucus, moll and wolfring secrete aqueous layer

D. Sclera contains the lowest level of GAGs in the eye. The cornea, particularly the stroma of the cornea, contains the highest level of GAGs in the eye

B. +2.00-2.00X180 without doing any math we know there is 2.00D of cylinder on this patient. So options A and D are eliminated. WTH astigmatism means there is more power on the 090 corneal axis. ATH astigmatism means there is more power on the 180 corneal axis. In this case the higher power is on the 090 so the patient is WTH astigmatism. The standard plano power of an eye is 60D so the 090 axis will have plano power and -2.00 on the 180 axis.

C. Deuteranomaly

B. RAM GAP. Red add minus because the lens is over plused or under minused. Green add plus because the lens is under plused or over minused

D. FT28 has a seg drop of 5mm. FT40 has a seg drop of 20. Round 22 has a seg drop of 11 mm Round 38 has a seg drop of 19 mm

C. Direct is erect and INdirect is INverted. Remember this mnemonic and you will get these questions right every time.

C. 140 millisec: Vestibulo ocular nystagmus is 16 millisec, and OKN is 140 millisec

B. Simple myopic with the rule

C. Corneal stroma thinning is affected in both Keratoconus and PMN. Note on the topography the red indicated corneal steeping and blue is corneal flattening.

D.

B. Post rotational nystagmus. OKAN describes the reflex eye movement that is seen after the stoppage of a barany chair stimulation in ambient room lighting that is enriched with objects.

C. Posner Schlossman Syndrome, also known as glaucomatocyclitis crisis, presents as an acute unilateral nongranulomatous anterior uveitis due to inflammation in the trabecular meshwork. These episodes are recurring and self-limiting each time and with the slit lamp biomicroscope, the practitioner will be able to see fine keratic precipitates. In addition herpes and Fuch’s Heterochromic Iridocyclitis result in a unilateral chronic non-granulomatous anterior uveitis.

Any type of systemic condition would result in a bilateral uveitis. Keep in mind the ones to cause a chronic granulomatous anterior uveitis include sarcoidosis, tuberculosis, syphilis, lyme disease and herpes amongst others. All five of these conditions may also result in a panuveitis and/or posterior uveitis.

B. Malleus, incus, stapes

D. 332X

C. 867 mm

C. 15.5 mm Hg is the average IOP found in non glaucoma patients under the age of 50.

A. Oligodendrocytes are the myelinating cells of the CNS that enable fast saltatory impulse propagation. Schwann Cells are myelinating cells of the PNS that provide the same function of the Oligodendrocytes but only to the PNS. Altho oligodendrocytes are a type of glial cells, the answer is not specific to only the CNS. Astrocytes are a sub type of glial cell that are star shaped and process envelope synapse made by the neuron.

E. All of the above affect the response

C. scopolamine is the go to drug for motion sickness

C.

B,E,G. Ferry’s line is corneal epithelial iron deposits, Stocker’s line is caused by pterygium, Kayser- fleischer ring is caused by wilson’s disease

A. 1.5mm x 22=33PD

B. 2.4 further. -1.50=x25^2 x=-2.4mm

C. Temporal. Plus lenses are thicker in the center. Minus lenses are thicker in the periphery. Draw the lens in a lens cross with this key in mind.

D. The mediastinum is a space in the thorax that contains a group of organs, vessels, nerves, lymphatics and their surrounding connective tissue. It lies in the midline of the chest between the pleura of each lung and extends from the sternum to the vertebral column

A.D.F. (15/5)(400)=20/1200=6/x

D. +3+-3=0D

D. Acid fast staining
The pathogen causing tuberculosis is mycobacterium tuberculosis. The structure of this bacteria includes mycolic acid and a key characteristic of these long fatty acids is that it resists gram staining. Rose Bengal stains borders of herpes simplex and also aids in visualizing dead devitalized cells in the conjunctiva & cornea.

C. Scopolamine. Scopolamine reaches maximum mydriasis the fastest due to the fact that it crosses the blood brain barrier

D. Glomerulus. Blood is filtered at the glomerular capillaries. Water and solutes are filtered to the glomerular capsule.

B. Erythromycin.

A,D. Non-Strabismic are visual disorders that affect the subject’s binocular vision and visual performance, especially when performing tasks requiring near vision. They occur when the accommodative and/or vergence response of the visual system is defective. Strabismus is usually unilateral condition or tropia

A. ONL. The photoreceptor receives its signal from the RPE so the OS portion of the photoreceptor is like a dendrite and collects the photon. Interpretation occurs where a nucleus is present. ONL is the first layer of nuclear location in the retina.

D. Room illumination. Room illumination is important when doing duochrome. If the illumination is too bright then you can cause a pinhole effect on the patient thus creating a false reading.

A. Elasticity. Extensibility: the ability to be extended or stretched. Compliance the property of a material undergoing elastic deformation or (of a gas) change in volume when subjected to an applied force. Contractility is the ability of muscle cells to forcefully shorten.

C. Vestibule is controlled by linear VOR. Semicircular canals are controlled by angular VOR

B. 1) opening of Na+ channels 2) opening of calcium channels 3) Calcium channels inactivated and potassium flow out

C. Main regulators of calcium in the blood. Calcitonin is a hormone that your thyroid gland makes and releases to help regulate calcium levels in your blood by decreasing it. Calcitriol is used to treat and prevent low levels of calcium and bone disease in patients whose kidneys or parathyroid glands. Parathyroid Hormone stimulates release of calcitonin from the parathyroid glands.

A. Horner’s syndrome. Patients pupils will have anisocoria with the ptotic eye having the smaller pupil. The anisocoria is more prominent in the dark, indicating pathology of the pupillary dilator. The smaller pupil takes a longer time to dilate when a bright source of light is moved away from the eye. This phenomenon is called dilation lag

A. Cerebrospinal fluid. Interstitial fluid is fluid found within the space around a cell. It comes from blood vessel leakage. Cerebrospinal fluid is colorless fluid produced by the spinal cord that surrounds the CNS not space around cells.

B. MRI. MRI stands for Magnetic Resonance imaging. Magnets and metal objects never work well together.

A. 7.95 degrees ; d=A(n-a) -> d= 15(1.53-1)

D. Metabolic alkalosis is directly a result of too much alkaline in the blood or lack of acid in the body. Stomach acid is the greatest contributor to metabolic acid in the body. If constant vomiting occurs the body becomes more basic due to this amount of acidic loss.

B,D. Krukenberg spindles are associated with pigment loss of the iris. Iris transillumination and pigment dispersion syndrome are key indications of krukenberg spindles. Lens cataracts can cause some loss of pigment but are not a direct cause. Weiss’ ring is caused by trauma where the iris pressed up against the lens of the eye.

C. The smaller the zone of inhibition the more bacterial resistant a drug is. The larger the zone of inhibition the more effective a drug is on the bacterial

D. P wave. It represents the electrical depolarization of the atria of the heart.

D. Vomiting. Metabolic alkalosis a disorder that elevates the serum bicarbonate, can result from several mechanisms: intracellular shift of hydrogen ions; gastrointestinal loss of hydrogen ions; excessive renal hydrogen ion loss; administration and retention of bicarbonate ions; or volume contraction.

C. Real erect 1.25 mm object. Real objects create real images. We first have to find the object vergence ( L’=L+F ; (100/25)=L+(5)-> 4=L+5 -> L=-1 ; then we find the magnification of the system ; M= obj/img ; M=(-1/4)-> M= -0.25 ; M=obj/image ; 0.25=obj/5 -> 1.25 mm

B.+43.056D

B and E. Propylthiouracil and methimazole
→ Propylthiouracil blocks the synthesis of thyroid hormones by blocking peripheral conversion of T4 to T3 as well as blocking oxidation of iodine in the thyroid. Those with liver issues have to be careful as it carries a black box warning of hepatotoxicity.
→ Methimazole blocks the synthesis of thyroid hormones by blocking oxidation of iodine in the thyroid. Adverse effects include being teratogenic as well as agranulocytosis.
Levothyroxine, also known as Synthroid, is used for low thyroid levels (think Hashimoto’s Thyroiditis). Remember with low thyroid levels, we expect to see increased TSH and decreased T3 & T4 data in their bloodwork results.
Glyburide and Pioglitazone are both used for treatment of diabetes mellitus.
Glyburide is a sulfonylurea so careful utilizing it for patients with sensitivities to sulfa! Other sulfonylureas include chlorpropamide and glipizide and all of these block K+ channels on beta cells of the pancreas to promote insulin release.
Pioglitazone is a thiazolidinedione that acts on peroxisome proliferator activated receptors (PPAR-gamma) to increase insulin sensitivity.

C. +3.125D, 1.6mm

C and D. The autonomic nervous system is composed of neurons that control input of the visceral organs, secretory glands, and smooth muscles. However, the autonomic nervous system is not a voluntary input system. Such examples of these would be the first two options listed.

A. Greater wing of sphenoid. Great Z is a lateral play, Front Less, SMEL medial, My Pal Get’s Z on the floor

B. horopter.

D. Antidiuretic Hormone (ADH) helps regulate the amount of water in your body. It works to control the amount of water your kidneys reabsorb as they filter out waste from your blood. This hormone is also called arginine vasopressin

A. SA node is the start node.

A. Sherrington’s law of innervation is concerned with the contraction and relaxation of the muscles in the same eye. Hering’s law is the muscle innervation between 2 eyes. Remember sherring the same eye.

C. Parotid gland. The human parotid duct (Stensen’s duct) is a single duct arising from the anterior border of the parotid gland. In adults, the parotid duct is about 6–8 cm long. It crosses the masseter muscle and turns medially at almost a right angle to traverse the buccal fat pad and buccinator muscle.

B. Hruby lens

B. Upright Y suture. The embryonic nucleus has no sutures. Sutures are only located in the fetal nucleus

C. 10.5D. 100/8=12.5D far point; Near point 2D. Aof A is near – far point : -12.5-2=10.5D

B. 67D ; (-5.25)/[1-(0.012)(-5.25)] = -4.93D; 1.333-1.000/-4.93= 67.54D

A. Chest X-Ray. The patient is experiencing the signs of sarcoidosis. In addition we would run a ACE test

D. SA is the start node-> AV node-> bundle of his -> purkinje fibers

D. will occur at any wavelength

B. less myopia.
By increasing the vertex distance of the lenses, he is effectively inducing more plus power. Since the chief complaint is mainly for distance, we know presbyopia isn’t the best answer in this case as these patients have difficulties seeing at near. Given his age, its not a new finding since his habitual prescription has an add already built in.

A. Further from blue, it is the safest (red)

C. 1D hyperopia. Patient FP vergence is -2.50D corrected. Patients FP vergence uncorrected is -1.50. Comparing the difference between these numbers will give you the total ametropia of the patient

H. 19 and 39 cm behind the eye.

A. Nd Yag

A. Renal Medulla. Renal pelvis is F. Renal column is B. Calyces is E

B. 2D of hyperopia. Real object vergence is -2.00D hitting a +4.00D len . -2.00D-+4.00D=+2.00D

C. Nizatidine. Similar to Ranitidine but principally metabolized in the kidney and bioavailability is 100%. Famotidine is similar to ranitidine but more potent. Cimetidine low dose given to patient with hepatic or renal failure. Ranitidine is longer acting and more potent than Cimetidine.

E. SPCA and SPCN are located in 4 quadrants of the peripheral retina. The LPCN are located at 3 and 9 o’clock positions in the peripheral retina

A. OD and OS. Fixating the eye will absorb all light on the macula. Deviating eye will glow because light is focused on the non macula area.

C. Positron Emission Tomography is a scan that is used to analyze the metabolic activity of tissue. Because of this, PET scans are more helpful in determining the stage of cancer in an organ.

A. Adalimumab – neutralization of TNF-alpha bioactivity by preventing the interaction of TNF-alpha with the cell surface TNF receptors

D. 48.75 cm +40X

B.The Edinger Westphal nucleus contains fibers that form the tectotegmental tract. The pretectal nucleus is not part of this tract. Pay close attention to the wording of this question. The tectotegmental tract is defined as the pretectal fibers projecting to both ipsilateral and contralateral edinger-westphal nuclei.

C. Propranolol. Is used to directly treat heart issues. Timolol is an ocular beta blocker used to treat glaucoma.

C. III. Grade 1: Mild, generalized constriction of retinal arterioles. Grade 2: Definite focal narrowing of retinal arterioles + AV nicking. Grade 3: Grade 2 + flame-shaped hemorrhages + cotton-wool spots + hard exudates. Grade 4: Severe Grade 3 retinopathy + papilledema or retinal edema.

A. 1. phase 2 looking for dose-response curve; phase 1 to determine toxicity and phase 3 prove efficacy

A. Tachycardia is an adrenergic agonists response or cholinergic antagonistic response due. Cholinergic agonists promote parasympathetic responses. Think you use your cholen to relax and go to the bathroom. I.E. miosis, SLUDGE, bradycardia, vasodilation, bronchoconstriction.

A. Want to treat choroidal layer so need to get past retinal layer. Higher wavelength will penetrate further.

C. The outer retinal layers contain the photoreceptors to bipolar cells located in the inner nuclear layer, but does not include the ganglion cell layer.

F. Polyamide

C. Type O can only receive type O. AB is considered the universal recipient.

C. vertex the power of the eye. This will help you find the patients far point F=16.00, L={16/(1-(0.014)(16)} = 48.5 mm behind the corneal apex.

B. Angiotensin II is a biochemical in the body that promotes expansion of the plasma volume by promoting the release of renal sodium and water absorption. This will cause vasodilation of the body blood vessels.

B. Sherrington law : when one set of muscles is stimulated, muscles opposing the action of the first are simultaneously inhibited.

B. Sulfacetamide. Sulfa drugs are directly linked to SJS symptoms or exacerbating SJS. Because of this they should be avoided at all times in patients even suspected of SJS.

C. 12 D ; 3X=F/4 ; F=12D

C. population inversion

B. CN3. Levator muscle is innervated by CN3. Muscle of mullers is a sympathetic innervation

A. 100-280. This is known as the UV-C spectrum area. Cornea absorbs the UV-C and some UV-B. UV-B is mostly absorbed by the aqueous and the lens of the eye.

C. Rifampin is a common medicine used to treat LTBI. It kills the sleeping TB germs before they make you sick.

B. Laser JJJ Short time and bigger size will cause the least amount of damage

B. 40/20= 2MAR

C. Megalocornea is determined by corneal diameter of greater than 10mm, abnormal axial length, and can lead to congenital glaucoma.

A. Type 1. Human scleral tissue contains approximately 50% collagen by weight, consisting predominantly of type I collagen. There is little or no evidence for the presence of substantial quantities of type II, type III or other collagen types.

A. 090:180. Plus lens induces plus cylinder on the axis. Panto induces on 180, faceform on 090. Since the answer has to be in minus cylinder form minus lens is induced on 090 for panto and faceform on 180.

D. 7000 ml. 500 x 14=7000 .Minute ventilation = tidal volume x respiratory rate

A. Pupillary capture. YAG capsulotomy is the procedure of removing the capsular bag that is posterior to the IOL. Pupillary capture is an unusual complication of posterior chamber intraocular lens implantation and may occur in the early or late postoperative period

D. Misoprostol. Prostaglandin produces uterine contraction not used during pregnancy. Omeprazole Inhibits H+/K+ ATPase proton pump. Nizatidine H2 receptor antagonist. Cimetidine H2 receptor antagonist

B. troxler effect. Low temporal frequency stimuli is most noticeable in the peripheral vision

A. Clindamycin works primarily by binding to the 50s ribosomal subunit of bacteria. This agent disrupts protein synthesis by interfering with the transpeptidation reaction, which thereby inhibits early chain elongation.

C. Lacks a middle lobe. The left lung only has 2 lobes in order to allow the heart to fit. Right lung has 3 lobes.

A. Theophylline is used to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung disease. It is the only one that inhibits Cytochrome P450

A. Rheumatoid arthritis. Chrysiasis is the phenomenon of bluish to slate-gray skin pigmentation induced by prolonged treatment with gold salts. The most common etiology is the administration of gold salts to patients with rheumatoid arthritis.

B. Blue- yellow affect macular region. Red green affects ONH

A. Non- hodgkins lymphoma has a poorer outcome in patients than the other options listed. All prognosis are good if caught early, however the most aggressive cancer of the ones listed is non-hodgkin’s lymphoma.

B. Cornea is the main protector of the eye from UV light. Particularly UV-C and some UV-B. The lens absorbs UV-B and UV-A. The retina does not absorb any UV light.

D. Telescope.

A. Angle Kappa. Angle lambda is the angle between pupillary axis and line of sight. Angle alpha is the angle between optic axis and visual axis. Angle gamma is the angle between fixation axis and the optical axis.

A. B1 is found on the heart. B2 found on the lungs

B. Bacteriostatic. The number of bacteria does not grow as more of the drug is administered. C. is bactericidal since the number of bacteria decreases as the amount of drug and increase of time with the drug occurs.

C. Pulmonary vein carries oxygenated blood to the heart. Pulmonary artery carries deoxygenated blood to the heart.

D. +55.75D

C. Echothiophate. Is a cholinergic agonist used in diagnosis myasthenia gravis. This drug directly increases the amount of Ach released by the parasympathetic nervous system.

C. 50 percent.

C. tertiary. Tertiary forms zonules that are located in the posterior chamber. Primary vitreous is dissolved upon development of the orbital.

A. Trimethaphan counteracts cholinergic transmission at the ganglion type of nicotinic receptors of the autonomic ganglia and therefore blocks both the sympathetic nervous system and the parasympathetic nervous system

B. Latanoprostene bundo is a combination drug that works on both the trabecular meshwork and the uveal scleral outflow. It is made up of prostaglandin and nitric oxide. Prostaglandin works on the uveal scleral outflow and nitric oxide works on the Trabecular meshwork.

E. Of the non ionizing, UV-B causes the most damage (low wavelength)

C. Bipolar cells. The inner neuroblastic layer forms amacrine, ganglion, and muller cells. The outer neuroblastic layer formes photoreceptor, bipolar, and horizontal

A. I. Purkinje image 1 is focused on the anterior aspect of the cornea. II is the posterior aspect of the cornea. III is the anterior aspect of the lens. IV is the posterior aspect of the lens as well as the only image that is inverted and real

A. Secondary hypogastrinemia. Omeprazole caused hypergastrinemia

A. Intorsion of the eye. CN4 innervates the SO. The SO primary function is intorsion

A. less than. As you move a minus les closer to the eye, the effective power increases; this mean it gains more plus power. We compensate for this effective power by prescribing less power as we get closer to the eye which is why contact lenses are more plus compared to the glasses prescription.

D. Trifluridine (Viroptic) is a fluorinated pyrimidine nucleoside which irreversibly inhibits thymidylate synthase and specific DNA polymerases, necessary for the conversion of dUMP to dTMP in the process of DNA synthesis

A. 10.18mm ; (0.07/6)(8.73)(20/20)= 10.18mm

A. Stargardt’s disease is directly caused by a mutation in the ABCA4 membrane protein and is responsible for moving all trans retinal from the photoreceptor to the cytoplasm

B. can lessen edema. When we decrease diameter there is less surface area covering the cornea as well as having a flatter contact lens. This can increase the movement of the lens

C. Konio cells. Magno cells are sensitive to fast movements and large details. Parvo cells are sensitive to red green and fine details.

D.

E. Increase myopia and with the rule astigmatism. Remember panto tilt increases the power of the 180 axis

B. CN2 innervates smell. Anosmia is the loss of smell

C. 48 diopters. At birth a baby has 48 diopters of power. This is lost at a rate of 2 diopters per year until the age of 2.

E. +18.37 DS.

C. absent or minimal lid crease is the main factor in determining if a ptosis is congenital or mechanical. During the development phase of the human eye all muscles and tendons must develop properly to show a lid crease. If there is a malformation then the lid crease is not going to show.

C. 155mm HG under open eye conditions will oxygen partial pressure be a factor

C. Homopolysaccharide. They are made up of repeating sugar units that do not differentiate on the side chain. Heteropolysaccharides are hyaluronic acid which is found in areas of high impact. These polysaccharides are aligned in a lattice style structure causing an increase in surface area for flexion.

C. 120 days.

A. Primary focal length coincides with the far point of a lens. If the far point of a lens is at infinity then the power of the lens is plano.

D. 20/500 ; (10/8)(400)=500

B. Minus.
Minus lens makes barrel distortion. Plus lens makes pincushion distortion.

A,B,E. Pyogenesis is defined as the production of heat. Dehydration is a main adverse effect of heat conduction due to the increased lacrimation of the sweat glands. Fever is self explanatory. If the body produces too much heat it can lead to severe brain damage and thus shut off major motor functions in the body

D. Submandibular lymph node. lateral 2/3 of the upper lid and the lateral 1/3 of the lower lid lymphatics drain into the preauricular lymph node. The medial 1/3 of the upper eyelid and the medial 2/3 of the lower lid lymphatics drain into the submandibular node.

C. Iris root is the thinnest portion of the iris. Because of this it is the most easily susceptible portion of the iris to be torn.

B. 555. Hue null point is set to 555 which will appear less saturated than any other point

D. The Mie theory is a complete mathematical–physical theory of the scattering of electromagnetic wave by homogeneous spherical particles, developed by Gustav Mie in 1908. In contrast to Rayleigh scattering, the Mie theory embraces all possible ratios of the particle radius to wavelength.

A. Not possible. Cannot have two light wavelength at the same time.

A. Dorzolamide. Travatan is a prostaglandin that acts on the uveoscleral outflow mechanism. Dorzolamide is a CAI that works on the production of aqueous humor. Imagine the eye as a sink that is turned out and the drain is clogged. Prostaglandin will clean out the drain but the water is still overflowing. The only other logical thing to do is to shut off the water or reduce the amount of water coming in. This same principal can be applied to the effect of travatan on the aqueous humor mechanism.

D. 67 degree mirror. The more angled the mirror the more anterior the structure you will see. Trapezoid or 73 degree mirror is used to see the equator of the eye.

B. Zyrtec is a second generation antihistamine that has an off label treatment for eyelid myokymia. However there is no understanding to why this works.

B. Ciliary muscle when stimulated will pull on the scleral spur thus opening the Uveal scleral outflow pathway