Question 1

By what mechanism does cyclosporine (Restasis Ophthalmic)prevent corneal transplant rejection?

Accepted Answer

A)  It inhibits both cellular and humeral immune responses by inhibiting a proliferative factor needed for T-cell activity.
B)  It exclusively inhibits cellular immune responses by inhibiting a proliferative factor needed for T-cell activity.
C)  It exclusively inhibits humeral immune responses by inhibiting a proliferative factor needed for T-cell activity.
D)  It inhibits both cellular and humeral immune responses by inhibiting a proliferative factor needed for B-cell activity. A

Question 2

Absorption of topical corticosteroid antibiotic agents is affected by which of the following?

Accepted Answer

A)  Skin temperature and hydration
B)  Age of patient
C)  Gender of patient
D)  Ethnicity of patient A

Question 3

What is vernal conjunctivitis?

Accepted Answer

A)  Short-term swelling of the outer lining of the eyes due to allergies
B)  Long-term swelling of the outer lining of the eyes due to an upper respiratory infection
C)  Long-term swelling of the outer lining of the eyes due to an allergy
D)  Short-term swelling of the outer lining of the eyes due to gonococcal keratitis C

Question 4

What is the purpose of including a corticosteroid in topical otic anti-infective agents?

Accepted Answer

A)  To reduce inflammation and pruritus
B)  To reduce the chance of infection
C)  To improve hearing
D)  To reduce pain

Question 5

Which anti-infective otic agent contains a steroid preparation?

Accepted Answer

A)  neomycin (Myciguent) 
B)  ofloxacin (Floxin) 
C)  ciprofloxacin with hydrocortisone (Cipro HC Otic) 
D)  mupirocin (Bactroban)

Question 6

A patient has used carbamide peroxide (Debrox,Murine Ear)for 7 days to loosen excessive earwax in her left ear.She now presents with complaints of decreased hearing on the left side.What is the most likely etiology of this hearing loss?

Accepted Answer

A)  Damage to the tympanic membrane due to use of carbamide peroxide for 7 days
B)  Damage to the outer ear canal due to use of carbamide in the otic preparation
C)  Damage to the auditory nerve due to use of peroxide in the otic preparation
D)  Damage to the tympanic membrane due to its 8.5% solution

Question 7

Cerumenolytics are commonly used to dislodge excessive cerumen.Typically,an agent such as triethanolamine polypeptide oleate drops (Cerumenex)is placed in a patient's ear canal and held in place with a cotton plug to soften the earwax.The ear is then flushed with warm water.Under what circumstances can Cerumenex cause ear canal inflammation?

Accepted Answer

A)  When combined with a corticosteroid
B)  When left in the ear canal for 60 minutes
C)  When flushed with cold water
D)  When continued use occurs

Question 8

Topically applied antibiotics used to treat bacterial otic infections are not typically absorbed through the skin.Under what condition(s)does such an antibiotic find its way into the systemic circulation?

Accepted Answer

A)  When applied to a small area on a patient with third-degree burns
B)  When applied to denuded or abraded skin
C)  When applied to an area prepped with isopropyl alcohol
D)  When applied to an area that has been thoroughly cleaned and dried

Question 9

What is the best definition of a hordeolum?

Accepted Answer

A)  Infection of the sebaceous gland of the eyelash
B)  An isolated allergic reaction to pollen and/or dust
C)  A benign growth of the eyelash hair follicle
D)  An ingrown eyelash that causes chronic red eye

Question 10

Under normal physiological conditions,some patients develop an excessive amount of cerumen.Why may this become problematic for the patient?

Accepted Answer

A)  Excessive cerumen in the canal may be cosmetically displeasing.
B)  Excessive cerumen in the canal may create an unpleasant otic odor.
C)  Excessive cerumen in the canal may potentiate a middle ear infection.
D)  Excessive cerumen in the canal may create a loss in hearing.

Question 11

A patient currently using an ophthalmic mast cell stabilizer for an allergic eye disorder continues to complain of unremitting symptoms despite 4 weeks of therapy.What disease entity must be excluded?

Accepted Answer

A)  Acute open-angle glaucoma
B)  Herpes keratitis
C)  Gonococcal keratitis
D)  Macular degeneration

Question 12

Which ophthalmic preparation is contraindicated in a patient concurrently taking an aminoglycoside due to an effect on serum concentrations that may lead to toxicity?

Accepted Answer

A)  sulfacetamide ointment
B)  tobramycin ointment
C)  polymyxin B/bacitracin ointment
D)  ciprofloxacin drops

Question 13

What property of propylene glycol in an over-the-counter (OTC)otic preparation enhances its antibacterial effect?

Accepted Answer

A)  Propylene glycol creates a more basic pH in the ear canal.
B)  Propylene glycol creates a more acidic pH in the ear canal.
C)  Propylene glycol releases oxygen,which releases impacted bacteria as it bubbles.
D)  Propylene glycol prevents protein synthesis in the bacteria.

Question 14

Miotic ophthalmic preparations used to treat glaucoma cause iris sphincter muscle contraction,resulting in constriction of the pupil.By what mechanism does this decrease IOP?

Accepted Answer

A)  As the pupil constricts,the trabecular meshwork opens the canal of Schlemm,increasing the outflow of aqueous humor.
B)  As the pupil dilates,the trabecular meshwork relaxes and opens the canal of Schlemm,increasing the outflow of aqueous humor.
C)  An increase in aqueous humor causes increased pressure on the canal of Schlemm.Acting as a pressure release valve,the canal opens,increasing the outflow of aqueous humor.
D)  Nerve endings in the cornea are triggered by an increase of aqueous humor and intraocular pressure.This stimulation causes the canal of Schlemm to close,shutting off a negative feedback mechanism,increasing the outflow of aqueous humor.

Question 15

After 1 week of treatment of otitis externa with a topical antibacterial preparation,a patient has no significant improvement.What is the next best appropriate step in the treatment of this patient?

Accepted Answer

A)  Begin an oral antibiotic agent
B)  Discontinue use of the initially prescribed topical agent and prescribe a different preparation
C)  Suspect an immunodeficiency disorder and order a complete hematologic panel
D)  Suspect an overgrowth of nonsusceptible organisms and obtain cultures

Question 16

A patient presents with a red,painful right eye and complaints of purulent eye discharge.Culture of that discharge reveals Neisseria gonorrhoeae.The patient denies drug allergies.Which ophthalmic agent would be most effective for this patient?

Accepted Answer

A)  erythromycin ophthalmic preparation
B)  bacitracin ophthalmic preparation
C)  tobramycin ophthalmic preparation
D)  sulfacetamide ophthalmic preparation

Question 17

What health-care education should be given to a geriatric patient who is using a sulfacetamide solution for his left eye that was prescribed 2 months ago?

Accepted Answer

A)  If the solution has turned a dark color,it has lost its potency and should be discarded.
B)  It is not necessary to clean the left eye of debris prior to application.
C)  If the left eye becomes transiently irritated immediately following application,the solution should be discontinued.
D)  The solution should also be applied to the right eye for prophylaxis.

Question 18

Patients who frequently use tetrahydrozoline for temporary relief of eye redness may experience what adverse reaction?

Accepted Answer

A)  "Rebound" congestion
B)  Hyperlubrication
C)  Decreased eyelash distribution and growth
D)  Eyelid ecchymosis

Question 19

What is the most common adverse reaction to neomycin-containing otic preparations?

Accepted Answer

A)  Shortness of breath
B)  Headache
C)  Contact dermatitis
D)  Tachycardia and chest pain

Question 20

A 12-year-old patient presents with moderate left ear pain and serosanguineous discharge.On physical examination,blood is apparent in the external canal and the tympanic membrane appears perforated.Despite the patient's left ear pain,why should the health-care practitioner avoid prescribing benzocaine?

Accepted Answer

A)  Benzocaine is the least commonly prescribed otic analgesic.
B)  Benzocaine is contraindicated in patients with a perforated tympanic membrane.
C)  Repeated use of benzocaine decreases the risk of subsequent sensitization.
D)  Benzocaine is indicated only for adult patients with a perforated tympanic membrane.

Exam 5: Drugs Used in the Treatment of Eye and Ear Disorders

By what mechanism does cyclosporine (Restasis Ophthalmic) prevent corneal transplant rejection?