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NBEO Part 1 Exam Questions and Answers (Latest Update 2024)
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NBEO Part 1 Exam Questions and Answers (Latest Update 2024)
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NBEO Part 1 Exam Questions andAnswers (Latest Update 2024)
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? - Correct Answer ✅ Isotretinoin, birth control pills, and diuretics,
among many other drugs, can cause myopia in some patients. Myopia
mostly 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.
An increased rate of molecular movement down its respective concentration
gradient via help from carrier proteins refers to which type of transportation?
- Correct Answer ✅ Facilitated diffusion is described as the net movement
of molecules down its concentration gradient whose rate of diffusion is
increased via the use of carrier proteins. Passive diffusion refers to the
movement of molecules through a plasma membrane from an area of high
concentration to an area of low concentration without the use of carrier
molecules. Active transport implies the movement of material against its
respective concentration gradient. This type of transport requires energy and
enlists the use of specific carrier proteins. Lastly, group translocation is
defined as the chemical modification of a molecule while it is being
transported into a cell; for example, sugars are often phosphorylated during
transportation.
A 24-year old female patient presents at your office complaining of side
effects that began when she started using Patanol to treat her ocular
allergies. She reports complete compliance with her eye drop administration.
Which of the following symptoms is MOST likely associated with olopatadine
(Patanol) use? - Correct Answer ✅ Topical antihistamines and mast cell
stabilizers such as Patanol (olopatadine) are commonly prescribed to relieve
the symptoms associated with ocular allergies. They are a very effective
class of medication due to their dual action mechanisms. Topical
antihistamines that possess this dual action are olopatadine (Patanol),
ketotifen fumarate (Zaditor), azelastine (Optivar), and epinastine (Elestat).
,NBEO Part 1 Exam Questions and
Answers (Latest Update 2024)
The aforementioned drops serve to alleviate itching and redness by blocking
H1 receptors as well as inhibiting mast cell and basophil degranulation. Side
effects of topical antihistamine/mast cell stabilizers include stinging upon
instillation, headaches, and adverse taste (don't forget to inform your
patients about punctual occlusion!). Tachycardia, depression, gastrointestinal
discomfort, and visual hallucinations have not been reported with Patanol
use.
A 63-year old female is seen at your office with a chief concern of blurry
vision in the morning that takes about an hour to resolve before she can see
clearly again. Biomicroscopy reveals endothelial guttata. You correctly
diagnose her with moderate Fuch's dystrophy. Which ophthalmic drop would
be of MOST benefit to her? - Correct Answer ✅ Sodium chloride is a topical
hyperosmotic agent used to relieve stromal edema caused by endothelial
decompensation. Topical steroids work well to decrease swelling caused by
inflammation. In the above case, the corneal edema is not mitigated by an
inflammatory response. Tobramycin and Vigamox would be of no benefit
since there is no active infection, and prescribing either of these would only
lead to corneal toxicity or increased pathogen resistance over time.
A deficiency of which vitamin leads to prolonged dark adaptation? - Correct
Answer ✅ A deficiency of vitamin A causes prolonged dark adaptation.
Vitamin A is classified as a retinoid, and its active form is retinol. Retinol is
necessary for the formation of rhodopsin, a pigment used by rods. Rods are
most active in situations with dim illumination. Less rhodopsin results in
fewer rods being able to respond in low levels of light, causing prolonged
dark adaption.
+1.50-1.50 x 090 is required to neutralize a reflex in retinoscopy with a
working distance of 50 cm. What is the resulting NET retinoscopy finding? -
Correct Answer ✅ A working distance of 50 cm creates a divergent wave
of 2.00 D that is neutralized by retinoscopy in addition to the patient's
refractive error. Therefore, + 2.00 D must be subtracted from the spherical
portion of the findings. To determine how much to subtract from the gross
findings, one must first calculate the reciprocal of the working distance in
meters. In our case, 1/0.5 = 2. Therefore +1.50 (the spherical gross findings)
,NBEO Part 1 Exam Questions and
Answers (Latest Update 2024)
-2 = -0.50-1.50 x 090. Remember NET is the final result, this is found after
the working distance has been accounted for by subtracting the working
distance from the spherical portion of the findings.
A ray of light traveling in water (n=1.33) strikes a flat, transparent surface
(n= 1.59) at an angle of 32 degrees from the normal. What is the angle of
refraction? - Correct Answer ✅ Snell's law of refraction states that when
light travels through a material that possesses an index of refraction greater
than 1.0, the light rays change direction and become bent (or refracted).
Snell's law is depicted as the following: n sin i= n' sin i' where n= the index
of refraction of the first medium, i= the angle of incidence, n'= the index of
the second medium, and i' = the angle of the refracted ray. All angles are
measured with respect to the normal, which lies perpendicular to the
interface between the different media. For the above example, 1.33(sin
32)=1.59 sin i', solving for i'= 26.31 degrees. It is important to commit the
index of refraction of water to memory; it is 1.33.
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? - Correct Answer ✅ 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.
Free radicals can cause severe damage to tissue. Which of the following
electrolytes can function as an antioxidant in the aqueous? - Correct
Answer ✅ The aqueous humor contains many electrolytes including Na+,
K+ , Cl-, HCO3-, glucose, lactate, amino acids, and ascorbate. Ascorbate is
found in high concentrations in the aqueous (20x greater when compared to
the concentration found in plasma). Ascorbate can serve as an antioxidant to
eradicate free radicals reducing potential damage from ultraviolet light.
Interesting note: the aqueous humor and tears of uncontrolled diabetics
display higher levels of glucose than those of non-diabetics.
, NBEO Part 1 Exam Questions and
Answers (Latest Update 2024)
A 12-year old male is sitting in your waiting room while his mother undergoes
her annual eye exam. While waiting, he eats a candy bar containing peanuts,
and, as luck would have it, he is deathly allergic to nuts. To counter
anaphylactic shock, what would be the BEST course of action? - Correct
Answer ✅ Anaphylactic shock is defined as a severe, multi-system, type I
hypersensitive, acute allergic reaction that may be life-threatening. Signs of
an allergic reaction include tingling, itching, hives, swelling of lips and
tongue, constriction of the airway, vasodilation, myocardial depression, and a
decrease in blood pressure. The EpiPen is injected intramuscularly to the
upper lateral thigh to ensure rapid delivery. Epinephrine (Adrenaline)
activates both alpha and beta adrenergic receptors causing an increase in
peripheral vascular resistance and allowing for an increase in blood pressure
and coronary artery perfusion. Adrenaline also serves to reverse vasodilation
and decrease urticaria and angioedema. For severe, life-threatening
reactions, Benadryl (diphenhydramine) will not work quickly enough. Topical
antihistamines have little if any systemic absorption and therefore will not be
effective in counteracting the anaphylaxis. While oral steroids may be useful
in the post-management of anaphylactic shock, they will not yield the
desired immediate response.
An elderly patient presents in your office with decreased visual acuity. He
remarks that he can read better without his glasses and his refraction
denotes a large myopic shift. Dilated fundus exam is unremarkable. Which of
the following slit lamp findings would MOST likely explain the above findings?
Bilateral corneal arcus
Bilateral limbal girdle of Vogt
Bilateral 3+ nuclear sclerosis of the lens
Bilateral crocodile shagreen - Correct Answer ✅ Nuclear sclerosis is
caused by changes to the optical clarity of the lens. As we age, proteins
precipitate out of the lens matrix, causing the lens to become cloudy and
altering its density. As time passes, the lens will also begin to change color
from clear to a yellow/brown in a process called lens brunescence. Cataracts
also generally cause a myopic shift with an increase in against-the-rule
astigmatism, leading to decreased distance vision but improved near vision.
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