Pharmacology & Therapeutics (No=321)

Which of the following anti-fungal agents act by interfering with the cell wall of the fungi:
5-fluorocytosine
Griseofluvin
Cyclohexidine
Amphotericin B

Your answer was CORRECT

Explanation
 Polyene antifungal drugs (Amphotericin, nystatin, and pimaricin) interact with sterols in the
cell membrane to form channels through which small molecules leak from the inside of the
fungal cell to the outside.
 Azole antifungal drugs (Fluconazole, itraconazole, and ketoconazole) inhibit cytochrome
P450-dependent enzymes (particularly C14-demethylase) involved in the biosynthesis of
ergosterol, which is required for fungal cell membrane structure and function.
 Grisan (Griseofluvin) binds to tubulin, preventing microtubule assembly.
 Glutaramide (Cycloheximide) inhibits protein synthesis at ribosomal level.
 Antimetabolite antifungal drugs (5-Fluorocytosine) acts as an inhibitor of both DNA and RNA
synthesis via the intracytoplasmic conversion of 5-fluorocytosine to 5-fluorouracil.
 
Which is FALSE regarding acyclovir:

it can be administered both topically and orally

it inhibits DNA polymerase

it acts against all herpes viruses

it is a guanine derivative

it can be used long-term for prophylaxis

Your answer was INCORRECT

Explanation
Acyclovir acts against the herpes group of viruses but it is not effective against all herpes viruses;
it has minimal action against cytomegalovirus.

 
What is the drug of choice for a corneal ulcer caused by filamentous fungi?

topical clotrimazole

topical flucytosine
topical natamycin
topical amphotericin

oral ketoconazole

Your answer was CORRECT

Explanation
Natamycin is the preferred treatment for filamentous fungal keratitis. Filamentous fungi are also
called molds, and examples include Fusarium, Aspergillus and Penicillium. They are more
common in tropical climates. Yeasts (e.g. Candida) are the most common fungi causing infection
in temperate climates.

Superficial phototherapeutic keratectomy is indicated in the treatment of all of the following

conditions EXCEPT:

granular dystrophy

Fleck dystrophy

epithelial basement membrane dystrophy

Reis-Buckler's dystrophy

Your answer was INCORRECT

Explanation
Superficial phototherapeutic keratectomy uses the excimer laser to ablate the superficial layers of
the cornea including the epithelium, Bowman's layer +-superficial stroma to remove dystrophic or
scarred tissue. Granular and Reis-Buckler dystrophies are associated with recurrent erosions,
which are treated by superficial keratectomy or phototherapeutic keratectomy. Epithelial basement
membrane dystrophy (also called map-dot-fingerprint or Cogan microcystic dystrophy) is an
abnormality in epithelial maturation, turnover, and production of basement membrane. Removal
of damaged epithelium and anterior basement membrane is effective and can be done with
phototherapeutic keratectomy. Fleck dystrophy is a non-progressive, usually asymptomatic
stromal dystrophy with gray-white opacities in the stroma. The epithelium and Bowman's layer
are not affected.

Which single-dose oral agent has been shown to be as effective as a standard 7-week course of
topical tetracycline for the treatment of active trachoma?

azithromycin

flucloxacillin

ceftazidime

rifampin
erythromycin

Your answer was CORRECT

Explanation
Azithromycin has a long tissue half-life of 2 to 4 days, rendering it useful as a single-dose agent.
This enhances compliance relative to the traditional prolonged topical treatment of Chlamydia,
and also offers the advantage of treating extraocular reservoirs of Chlamydia.

Medications important in the treatment of ocular toxoplasmosis include all EXCEPT:

sulfadiazine

prednisolone

pyrimethamine

folic acid

Your answer was CORRECT

Explanation
Pyrimethamine and sulfadiazine are antimicrobial agents effective against Toxoplasma.
Prednisolone reduces inflammatory tissue destruction.
Pyrimethamine blocks synthesis of folinic acid, so folinic acid must be given as well (folinic acid,
not folic acid!). Note that folinic acid is synthesized from dietary folic acid, so folic acid
administration is not sufficient.

Local anaesthetics work by:

exciting potassium channels

exciting sodium channels

blocking potassium channels

blocking sodium channels

Your answer was CORRECT

Explanation
Local anaesthetics work by blocking sodium channels and therefore preventing the propagation of
an action potential across the nerve.
A 15-year-old soft contact lens wearer presents with severe pain in her right eye after wearing her
daily disposable contact lenses overnight for 1 week. Her eye is pictured in the image above.
Which is the LEAST appropriate therapy:

topical levofloxacin

topical cefuroxime

topical vancomycin and tobramycin

topical moxifloxacin

Your answer was CORRECT

Explanation
The history and image suggest a Pseudomonas aeruginosa corneal ulcer. Initial antimicrobial
therapy should provide broad-spectrum coverage for both Gram-positive and Gram-negative
microbes. Combination therapy with a cephalosporin or vancomycin for Gram-positive coverage
and an aminogylcoside (tobramycin or gentamicin) provide excellent coverage. Monotherapy with
fourth generation fluoroquinolones (moxifloxacin and levofloxacin) is also used and has been
shown to provide coverage against both Gram-positive and Gram-negative microbes.
Monotherapy with a cephalosporin (cefuroxime) does not provide adequate Gram-negative
coverage.

Which of the following is a folate antagonist?

azathioprine

mitomycin C

cyclophosphamide

cyclosporine

methotrexate

Your answer was CORRECT

Explanation
Methotrexate is a folate antagonist.
Azathioprine is a purine analogue.
Cyclophosphamide is an alkylating agent.
Cyclosporin is a T-cell inhibitor which suppresses IL-2.
Mitomycin C is a DNA crosslinker.

All of the following antibiotics inhibit cell wall synthesis EXCEPT:

gentamicin
cephalosporins

vancomycin
penicillins

Your answer was CORRECT

Explanation
Penicillins, cephalosporins and vancomycin all inhibit cell wall synthesis. Aminoglycosides such
as gentamicin inhibit bacterial protein synthesis.

Which is TRUE of prostaglandin analogues:

they increase IOP mainly by an effect on the central nervous system

they lower IOP mainly by decreasing aqueous production

they lower IOP mainly by increasing uveoscleral flow

they increase IOP mainly by increasing aqueous production

Your answer was CORRECT

Explanation
Prostaglandin analogues lower IOP mainly by increasing uveoscleral flow.

All statements are true of the prostaglandins EXCEPT:

leukotrienes produce increased vascular permeability

non-steroidal anti-inflammatory drugs reduce prostaglandins production by inhibiting

cyclooxygenase

thromboxane A2 causes both vasoconstriction and platelet aggregation

they cause pain when applied directly to the nerve endings

Your answer was CORRECT

Explanation
Prostaglandins sensitise the nerve endings to pain but do not themselves produce pain.
Cyclooxygenase is the rate determining enzyme in their production and is inhibited by non-
steroidal anti-inflammatory drugs. Thromboxane A2 causes both vasoconstriction and platelet
aggregation. Leukotrienes are involved in allergic reaction and inflammation. They produce
bronchoconstriction, vasoconstriction and increased vascular permeability

Chlorambucil is a:

immune modulator of interleukin 2

cytotoxic anti-metabolite

cytotoxic alkylating agent

cytostatic anti-inflammatory

Your answer was CORRECT

Explanation
Cyclophosphamide and chlorambucil are both cytotoxic alkylating agents. They act by creating
cross-linkage between DNA strands that result in inhibition of transcription of messenger RNA.
Chlorambucil is the slowest acting of all the alkylating agents.

Which of the following treatment modalities is the most controversial in the management of
keratoconus:

hard contact lens fitting

penetrating keratoplasty

corneal cross-linking
 spectacle correction

photorefractive keratectomy

Your answer was CORRECT

Explanation
Photorefractive keratectomy (PRK) with the excimer laser has been used by some groups to treat
patients with keratoconus to help reduce corneal surface irregularities and improve vision.
However, it remains a relatively contraindicated (and therefore controversial) treatment because
laser ablation with PRK can further weaken the cornea, which is already thinned in keratoconus,
thus potentially leading to progression of the disease.

Cyclosporin:

suppresses mainly the humoral immunity

is derived from bacteria

decreases the production of interleukin-2 (IL-2)

causes bone marrow suppression as its major adverse effect

Your answer was CORRECT

Explanation
Cyclosporin is derived from a soil fungus. It suppresses mainly the cell-mediated immune
reactions and the humoral immunity is only little affected. It works by binding to proteins within
the cells called cyclophilin which inhibits the production of a number of interleukins especially
IL-2. IL-2 is the primary chemical stimulus for T-lymphocyte proliferation. Cyclosporin, unlike
other immunosuppressants, does not cause bone marrow suppression. Its main adverse effect is
nephrotoxicity. It is metabolised by the liver and excreted in the bile.

Atropine:
increases sweating
causes paralysis of the iris dilator muscle
has a sedative effect
causes ciliary body contraction
increases gastric emptying

Your answer was CORRECT

Explanation
Atropine is a cholinergic antagonist. It causes:
 delayed gastric emptying
 reduced sweating
 sedation when administered systematically
 cycloplegia via ciliary body paralysis
 mydriasis via iris sphincter muscle paralysis

A steroid molecule attached to which of the following compounds will be MOST likely to
penetrate the cornea to reach the anterior chamber:

alcohol

acetate
phosphate

sulphate

Your answer was CORRECT

Explanation
For drugs to penetrate the cornea, they must be biphasic - i.e. both hydrophilic and hydrophobic.
To achieve this, steroid molecules such as prednisolone, dexamethasone and rimoxalone are
combined with other compounds (usually bases) such as phosphate and acetate. Acetate
compounds penetrate the cornea best, but they must be in suspension form, meaning patients must
remember to shake the bottle before administration. Alcohol is the next best penetrant, followed
by phosphate. The advantage of these latter varieties is that they can be made into solutions, which
are easier to apply.

This question came in the 2014 FRCOphth.

Which drug is a cholinesterase inhibitor?

cocaine

tropicamide

pilocarpine

physostigmine

Your answer was CORRECT

Explanation
Physostigmine is a cholinesterase inhibitor.

Pilocarpine is a direct-acting parasympathomimetic (acetylcholine receptor agonist).

Tropicamide is a competitive parasympatholytic (muscarinic acetylcholine receptor antagonist).

Cocaine is an indirect acting sympathomimetic, which acts by inhibiting the reuptake of
catecholamines at the synpase, including noradrenaline.

Which antibiotic is NOT a good choice for chlamydia infection:

rifampicin

erythromycin

cephalosporin

tetracycline

Your answer was CORRECT

Explanation
Chlamydia is an obligate intracellular organism and antibiotics such as cephalosporins that target
bacterial cell walls will have little effect.

A patient develops bilateral acute-onset eye pain and vomiting, corneal oedema and a mid-dilated
pupil. He has recently commenced a new medication, which you suspect may be to blame.

What is the most likely drug?

pilocarpine

lithium

vigabatrin

timolol

topiramate

Your answer was CORRECT

Explanation
Topiramate can produce a secondary acute-angle closure glaucoma, which is typically bilateral.
The proposed mechanism of myopia and secondary angle closure is choroidal effusion and
forward rotation of the iris-lens diaphragm.
 Which metabolic disease can manifest as shown in the figure above?
Fabry's disease
Tay-Sachs disease
Alport's syndrome
Refsum's disease

Your answer was CORRECT

Explanation
The figure above shows vortex keratopathy or corneal verticillata, which is a whorl-like deposition
of material in the corneal epithelium.

Vortex keratopathy can be caused by:

 Fabry's disease
 Drugs
o amiodarone
o chlorpromazine
o chloroquine
o indomethacin
o meperidine
o tamoxifen

Fabry disease is characterised by:

 X-linked recessive inheritance
 Deficiency in alpha-galactosidase enzyme
 Peripheral neuropathy
 GI symptoms
 Cardiac and renal impairment
 Skin: widespread angiokeratomas
 Ocular:
o vortex keratopathy
 o cataract
o retinal vessel tortuosity
 
All of the following drugs impair accommodation EXCEPT:

topical atropine

topical cocaine

phenothiazine

topical pilocarpine

Your answer was CORRECT

Explanation
Accommodation occurs under parasympathetic control. It is impaired by parasympathetic
antagonists e.g. atropine, cylopentolate, tropicamide and phenothiazine. Pilocarpine is a
parasympathomemetic and enhances accommodation.

 
First-line treatment of Vogt-Koyanagi-Harada (VKH) syndrome is:

azathioprine

iv acyclovir

high dose steroids

ciclosporin

Your answer was CORRECT

Explanation
High dose steroids are the first line treatment for VKH syndrome. Steroid-resistant patients may
require ciclosporin. Prognosis depends on early recognition and prompt treatment.

 
A 32-year-old lady with a background history of multiple sclerosis reports deteriorating right
vision to 6/12. She has flare in the anterior chamber and moderate vitritis with cystoid macular
oedema on OCT. Her optic discs are of normal colour and contour.

What is the most appropriate initial treatment?

intravenous ganciclovir

oral acetazolamide and oral steroid

intense topical steroid and oral acetazolamide

intravenous methylprednisolone
Your answer was CORRECT
Explanation
This patient has intermediate uveitis, which is unlikely to respond to topical steroid, and oral
steroid is the preferred treatment option. Oral acetazolamide may improve CMO.

 
The side-effects of tropicamide include all of the following EXCEPT:

pyrexia

skin erythema

bradycardia
gastrointestinal disturbance

Your answer was CORRECT

Explanation
Tropicamide is a muscarinic antagonist, thereby blocking the parasympathetic pathway. It can
cause tachycardia (not bradycardia). It can precipitate angle closure, exacerbate ataxic dysarthria
and cerebellar signs and increase the risk of seizure.

 
Periocular steroid injection should be avoided in which of the following conditions?

1. intermediate uveitis and CMO associated with sarcoidosis

2. necrotizing scleritis associated with rheumatoid arthritis

3. CMO following complicated cataract surgery

4. ocular toxoplasmosis with immunocompromise

2 and 4
1 and 2

4 only

1, 2, 3, and 4

1, 2, and 3

Your answer was CORRECT

Explanation
Steroids should be used judiciously in infectious uveitis, such as toxoplasmosis where they have
the potential to aggravate the condition. Periocular steroids can also lead to further melting and
perforation in necrotizing scleritis. Steroids should also be used with caution in patients who are
immunocompromised.

 
Which of the following best describes the mode of action of tetracycline:

inhibits protein synthesis

inhibits cell membrane synthesis

inhibits nucleic acid synthesis

inhibits cell wall synthesis

Your answer was CORRECT

Explanation
Tetracyclines inhibit protein synthesis by their action on aminoacyltransferase RNA and the
messanger RNA-ribosome complex. They have a broad spectrum of activity against Gram-
positive and Gram-negative bacteria and Chlamydia.

 
What is the most effective treatment for the condition shown in the image above?

bandage contact lens

anterior stromal puncture

deep anterior lamellar keratoplasty

penetrating keratoplasty

Descemet's membrane endothelial keratoplasty

Your answer was CORRECT

Explanation
The condition shown is Fuchs' endothelial dystrophy, which is best treated by endothelial
keratoplasty techniques including DMEK, DSAEK or DSEK. These techniques result in quicker
and better visual rehabilitation and better preservation of cornea architecture by comparison to
traditional penetrating keratoplasty.

 
Which of the following best describes the mode of action of sulphonamides:
 inhibit protein synthesis

inhibit cell membrane synthesis

inhibit cell wall synthesis

inhibit nucleic acid synthesis

Your answer was CORRECT

Explanation
Sulphonamides act by inhibiting folate metabolism, which is essential for bacterial DNA synthesis
and survival.

 
Which of the following treatments is MOST effective for ocular cicatricial pemphigoid?
lysis of membranes
dapsone
topical steroid drops
topical cyclosporine

Your answer was CORRECT

Explanation
Ocular cicatricial pemphigoid is characterised by:
 a chronic disease affecting mucosal surfaces
 typically elderly population
 usually bilateral (but may be asymmetric)
 chronic conjunctivitis
 dry eyes
 sub-conjunctival fibrosis
 decreased goblet cells
 obstruction of ducts of the lacrimal and accessory lacrimal glands
 symblepharon
 shortening of the fornices
 ankyloblepharon
 keratinization of the conjunctival epithelium
 corneal neovascularization and scarring
 conjunctival scrapings show lymphocytes, plasma cells, and eosinophils
 IgA at the level of the basement membrane on immunofluorescent stains
 extraocular mucosal and skin lesions are common
 differential: drugs including antivirals, miotics (both direct and indirect), epinephrine, and
timolol; chemical burns; radiation treatment; ocular rosacea and Stevens-Johnson syndromel;
conjunctival carcinoma
 Treatment:
o oral dapsone therapy
o systemic prednisone for acute exacerbations
 o cyclophosphamide when treatment failure or intolerance develops with dapsone
 
Which statement is FALSE regarding ciprofloxacin:

it is effective against Pseudomonas

it is effective against Staphylococcus

it is a fluoroquinolone antibiotic

it acts on DNA polymerase

Your answer was CORRECT

Explanation
Ciprofloxacin is a fluoroquinolone antibiotic. It inhibits bacterial DNA synthesis by its action on
bacterial DNA gyrase. It is effective against many species of Pseudomonas, Staphylococcus and
Haemophilus.

 
All of the following are produced from arachidonic acid EXCEPT:

prostaglandins

leukotrienes

thromboxane

fibrinogen

Your answer was CORRECT

Explanation
Fibrinogen is a plasma protein produced in the liver. Prostaglandins, thromboxane and
leukotrienes are all eiconsanoids, produced from arachidonic acid. Prostaglandins and
thromboxane require cyclo-oxygenase, while leukotrienes require lipoxygenase.

 
Which of the following best describes the mode of action of gentamicin:

inhibits cell membrane synthesis

inhibits cell wall synthesis

inhibits protein synthesis

inhibits nucleic acid synthesis

Your answer was CORRECT

Explanation
Gentamicin is an aminoglycoside and it prevents protein synthesis by preventing the reading of
codons from messenger RNA.

 
Which of the following drugs is most likely to cause Stevens-Johnson syndrome:

phenothiazines

penicillin

amiodarone

sulphonamides

Your answer was CORRECT

Explanation
Stevens-Johnson syndrome can occur as a consequence of a severe drug reaction and is typically
associated with sulphonamides.

 
A 29-year-old man presents with a 1-week history of bilateral eye redness, discharge, and itching.
He recently suffered a respiratory infection. Vision is 6/5 bilaterally and his left eye is shown in
the figure above.

Which is the most suitable treatment?

topical steroid therapy

cool compresses
oral antihistamine

topical chloramphenicol drops qds

topical mast cell stabilizer

Your answer was CORRECT

Explanation
The figure shows adenoviral conjunctivitis. Therapy is mainly supportive. Cool compresses and
lubrication can be recommended. There is little evidence to support the use of topical antibiotics.
The use of topical steroids is controversial and is only indicated for the presence of a conjunctival
membrane or pseudomembrane, marked foreign body sensation and chemosis, and reduced vision
due to epithelial and sub-epithelial keratitis.

 
Which statement is true about chloroquine:

it causes reversible toxic maculopathy

it is safer than hydroxychloroquine at equivalent dose

it binds to the melanin of the RPE

it causes posterior subcapsular cataract

Your answer was CORRECT

Explanation
Chloroquine is more toxic to the retina dose-for-dose than hydroxychloroquine. It can cause
corneal deposition and anterior subcapsular cataract neither of which is of visual significance. It is
bound to the melanin in the retinal pigment epithelium which is believed to be the reason for its
toxicity. It causes Bull's eye maculopathy which may progress despite stopping the medication

Contact lens fitting is usually most challenging for patients with:

pellucid marginal degeneration

keratoglobus

prior LASIK surgery

keratoconus

Your answer was CORRECT

Explanation

Figure: Corneal shapes in various ectasias

Corneal protrusion above the area of corneal thinning makes contact lens fitting especially
difficult in pellucid degeneration. Scleral contact lenses have been tried with some success.

Which drug is a direct-acting parasympathomimetic?

cocaine

physostigmine

pilocarpine
tropicamide

Your answer was CORRECT

Explanation
Pilocarpine is a direct-acting parasympathomimetic (acetylcholine receptor agonist).

Physostigmine is a cholinesterase inhibitor.

Tropicamide is a competitive parasympatholytic (muscarinic acetylcholine receptor antagonist).

Cocaine is an indirect acting sympathomimetic, which acts by inhibiting the reuptake of

catecholamines at the synpase, including noradrenaline.

Which antibiotic is LEAST likely to be effective in the treatment of Cat-scratch neuroretinitis:

rifampicin

erythromycin

co-amoxiclav
doxycycline

Your answer was CORRECT

Explanation
Cat-scratch disease is caused by Bartonella henselae, a Gram-negative rod. It is transmitted by a
scratch or bite from an infected cat. Neuroretinitis is the most common ocular manifestation.
Treatment is with oral doxycycline or oral erythromycin, with or without rifampicin.

Which of the following is FALSE regarding the aminoglycosides:

they are useful against streptococci

they can cause ototoxicity

they inhibit protein synthesis

drug monitoring is recommended

Your answer was CORRECT

Explanation
Aminoglycosides such as gentamycin inhibit protein synthesis by interfering with the reading of
codons from messenger RNA. They require aerobic transport mechanisms to enter cells and are
therefore ineffective against anaerobes and streptococci, which do not exhibit oxidative transport
mechanisms. They can cause ototoxicity and nephrotoxicity necessitating drug dose monitoring.

Which glucocorticoid agent listed below has the greatest systemic potency?

cortisone

dexamethasone
hydrocortisone
methylprednisolone

prednisone

Your answer was CORRECT

Explanation
The glucocorticoid agents in order of systemic potency (highest first):
dexamethasone, methylprednisolone, prednisolone, hydrocortisone, cortisone.

Parasympathetic agonists instilled topically to the eye can cause all EXCEPT:

conjunctival toxicity

bradycardia

reduced salivation
iris cysts

Your answer was CORRECT

Explanation
Parasympathetic agonists such as pilocarpine can cause conjunctival toxicity, iris cysts and
cataracts locally. Systemically, they can cause muscarinic effects including increased salivation,
bradycardia, sweating and vomiting.

What is the prophylactic dose of acyclovir in herpes simplex eye disease?

400mg twice per day

400mg 5 times per day

200mg twice per day

800mg 5 times per day

Your answer was CORRECT

Explanation
The prophylactic dose of acyclovir is 400mg BD, as per the Herpetic Eye Disease Study (HEDS).

This question appeared in the 2014 FRCOphth Part 2.

Which of the following drugs is a cytochrome P450 enzyme inhibitor:

phenytoin

chloramphenicol

nicotine

rifampicin

Your answer was CORRECT

Explanation
Chloramphenicol is a P450 enzyme inhibitor while the other options supplied are all P450 enzyme
inducers.

Which is FALSE regarding topical steroid preparations?

phosphate preparations are generally more soluble in water than acetate preparations

phosphate preparations are more potent than acetate preparations

suspensions must be shaken to be effective

topical prednisolone can be formulated as a suspension

Your answer was CORRECT

Explanation
Acetate preparations (suspensions) are more potent than phosphate preparations. Other statements
are true.

Over-treatment of HSV keratitis with topical antivirals can lead to all of the following problems
EXCEPT:
sterile corneal ulceration

bacterial superinfection

punctate keratitis with photophobia

follicular conjunctivitis

Your answer was CORRECT

Explanation
Over-treatment with topical anti-virals is common and should be avoided. Bacterial superinfection
is not a complication of overtreatment.
Which statement is FALSE regarding aminoglycosides:

they are not as effective against systemic infection if given orally

they are effective against streptococci

they require aerobic transport mechanisms to enter the bacterial wall

they act on messenger RNA

Your answer was CORRECT

Explanation
Aminoglycosides require aerobic transport mechanisms to enter the bacterial cell and are therefore
not effective against Streptococcus and strict anaerobes which do not have oxidative transport
mechanisms. All other statements are true.

Which statement is FALSE of drug metabolism:

Phase II may involve the addition of glucuronate

Phase II involves reducing the water solubility

Cytochrome P450 enzymes carry out Phase I metabolism but not Phase II
Phase I involves oxidation reactions

Your answer was CORRECT

Explanation
Phase I drug metabolism involves oxidation reactions and can be carried out by the cytochrome
P450 enzymes. Phase II metabolism involves conjugation reactions, such as the addition of
glucuronate, glutamine and acetate groups. This conjugation makes the molecules more water
soluble for excretion.

A patient has noticed xanthopsia, photopsia and pain on eye movements since commencing a
recent medication.

What is the most likely cause?

vigabatrin

digoxin
rifampicin

ethambutol

hydroxychloroquine
Your answer was CORRECT
Explanation
Digoxin causes xanthopsia (yellow-blue discoloration of vision) and rarely photopsia and pain on
eye movements.

Which statement about lignocaine is FALSE:

toxicity causes drowsiness and slurred speech

it has a local vasodilatory effect

it inhibits the uptake of potassium into nerve cell membranes

it is alkaline in solution

Your answer was CORRECT

Explanation
Lignocaine blocks the uptake of sodium into nerves (not potassium). Lignocaine toxicity causes
tingling around the mouth, followed by drowsiness and slurred speech which leads to convulsions
and then coma.

Cyclophosphamide is a:

immune modulator of interleukin 2

cytostatic anti-inflammatory

cytotoxic alkylating agent

cytotoxic anti-metabolite

Your answer was CORRECT

Explanation
Cyclophosphamide and chlorambucil are both cytotoxic alkylating agents. They act by creating
cross-linkage between DNA strands that result in inhibition of transcription of messenger RNA.
Chlorambucil is the slowest acting of all the alkylating agents.

A patient is suffering from halitosis and hypertrophy of gingival tissue by the molar teeth. Which
drug is most likely to blame?

anti-TNF alpha

azathioprine
ciclosporin A
methotrexate

Your answer was INCORRECT

Explanation
Drug-induced gingival overgrowth can be caused by 3 classes of drugs: cyclosporin A (which
produces the most hyperplasia), calcium channel blockers such as nifedipine, and anti-convulsants
like phenytoin.

This question appeared in the 2014 FRCOphth Part 2.

All of the following will influence the diffusion coefficient of a drug EXCEPT:

the degree of ionization of the drug

the thickness of the cell membrane

the lipid solubility of the drug

the molecular size of the drug

Your answer was CORRECT

Explanation
The diffusion coefficient of a drug is determined by its lipid solubility, ionization and molecular
size. The thickness of the cell membrane will affect the rate of diffusion as per Fick's law, but it
has no influence on an individual drug's diffusion coefficient.

Which statement is FALSE regarding oxybuprocaine?

has some degree of antimicrobial action

inhibits epithelial healing

cannot be used systemically

has a longer anaesthetic effect than tetracaine

Your answer was CORRECT

Explanation
Oxybuprocaine is bacteriostatic so proxymethocaine is preferred for corneal scrapes. It is toxic
and cannot be used systemically. Tetracaine has a longer anaesthetic effect than oxybuprocaine.
Regarding antiobiotic usage:

fusidic acid is ineffective against staphylococcus aureus infection

intravenous vancomycin is useful in treating post-operative endophthalmitis

gentamicin is effective against Gram negative bacteria

rifampicin is only effective against tuberculosis

Your answer was CORRECT

Explanation
Fusidic acid is effective against Staphylococcus aureus but resistance can occur. Vancomycin is
ineffective against endophthalmitis when given intravenously as the drug penetration into the
vitreous cavity is poor. Gentamicin is effective against mainly Gram negative bacteria (less so
against Gram positives).

Regarding drug metabolism:

lipid-soluble beta-antagonists cause bad dreams more often than watersoluble beta-
antagonists
drugs with a high affinity for plasma protein have a very large volume of distribution

hepatic drug metabolism often involves conversion of a water-soluble into a more lipid-soluble
drug

renal failure significantly increases the plasma protein binding of drugs

Your answer was CORRECT

Explanation
Lipid soluble drugs enters the blood brain barriers more readily and therefore have more central
nervous system side effects. A highly plasma protein binding drug stays in the vascular
component and therefore has a volume of distribution of about 4-5 liters. Hepatic drug metabolism
often converts a lipid-soluble drug into a watersoluble one. Renal failure causes decreased plasma
protein concentration and therefore less binding for drugs.

What is the most characteristic side-effect of oral cyclophosphamide?

secondary malignancies
secondary infections
haemorrhagic cystitis
haemolytic anemia

Your answer was INCORRECT

 Explanation
Haemorrhagic cystitis is a characteristic side-effect of cyclophosphamide. Adequate hydration is
important to prevent this complication.

Side-effects of cyclophosphamide include:

 nausea and vomiting
 bone marrow suppression
 haemorrhagic cystitis
 fibrosis of the bladder
 GI upset
 hair loss
 lethargy

Which topical agent might be used to treat the condition shown in the image above?

N-acetylcysteine

dexamethasone

penicillamine

ethylenediaminetetraacetic acid (EDTA)

Your answer was CORRECT

Explanation
EDTA chelates calcium found in band keratopathy. The corneal epithelium must first be scraped
away to expose the calcium which is in Bowman's layer to the EDTA.

Note: penicillamine binds heavy metal ions, such as iron, copper, and lead and can be helpful in
the systemic treatment of Wilson's disease and haemochromatosis.

A 33-year-old woman was treated 1 week previously with trimethoprim for a urinary tract
infection. She presents with acute blistering of the mucosa of her mouth and throat with severe
bilateral conjunctivitis. There is also milder blistering of the skin.

What is the most likely diagnosis?

Stevens-Johnson syndrome
epidermolysis bullosa
linear IgA disease
mucus membrane pemphigoid
toxic epidermal necrolysis

Your answer was CORRECT

Explanation
The features and the history are suggestive of Stevens-Johnson syndrome which can be triggered
by various antibiotics.

An important differential is toxic epidermal necrolysis. While SJS is restricted mainly to mucosal
surfaces with milder bullous involvement of the skin, toxic epidermal necrolysis is characterised
by wisdspread blistering with sloughing of more than 30% of the skin. Fever and involvement of
lungs, bladder and GI tract are common with a high mortality.

The most common precipitants of SJS are:

 drugs: sulphonamides, penicillin, phenytoin
 viruses: HSV, HIV
 malignancy

Which anti-human immunodeficiency virus (HIV) agent is most likely to cause peripheral
neuropathy:
didanosine (ddI)
ritonavir
zidovudine (AZT)
zalcitabine (ddC)

Your answer was INCORRECT

Explanation
The most prominent side-effects of HIV medications are as follows:
 ritonavir: nausea and diarrhea
 zidovudine (AZT): cytopoenia
 didanosine (ddI): pancreatitis
 zalcitabine (ddC): peripheral neuropathy

Cyclosporin is a:

cytotoxic antimetabolite

immune modulator of interleukin 2

cytostatic anti-inflammatory

cytotoxic alkylating agent

Your answer was CORRECT

Explanation
Cyclosporine and FK506, a related agent, are potent immune modulators that have very specific
activity against the production of interleukin-2 and interleukin-2 receptors and inhibit proliferation
of lymphocytes.

A patient is taking multiple immunosuppressants for a systemic inflammatory disorder. Which

side-effect is LEAST likely to be attritable to cyclosporin:
hirsutism
gingival hyperplasia
bladder fibrosis
increased risk of squamous cell carcinoma
nephrotoxicity

Your answer was CORRECT

Explanation
Haemorrhagic cysitis and bladder fibrosis are seen with cyclophosphamide.
Side-effects of cyclosporin include:
 neurotoxicity
 nephrotoxicity
 hepatoxicity
 gingival hyperplasia
 hirsutism
 increased risk squamous cell carcinoma
 nausea/vomiting
 A patient with sarcoid chorioretinitis is treated with high-dose oral and topical steroids.

Complications as a result of steroid treatment include all of the following EXCEPT:

glaucoma
retinal neovascularization
scleromalacia
cataract

Your answer was CORRECT

Explanation
Ocular side-effects of steroids include:
 cataract
 glaucoma
 scleral thinning
 delayed wound healing.
Retinal neovascularization may occur with sarcoid, but this is a result of inflammation and
ischemia, not a consequence of steroid therapy.

Side-effects of immunosuppressives or biologic therapies include all EXCEPT:

HIV infection with rituximab

TB with anti-TNF therapies

worsening of diabetes with tacrolimus

hypertension with calcineurin inhibitors

haemolytic anaemia with azathioprine

Your answer was CORRECT

Explanation
Rituximab is an anti-CD20 monoclonal antibody. It increases the risk of Hepatitis B infection and
viral infection but has no known role in increasing susceptibility to HIV infection. Other options
above are true.

Acyclovir:

is active against all viruses within the herpes family

should be dosed twice daily as maximum

is more effective against herpes simplex keratitis if given orally than topically

inhibits DNA polymerase

Your answer was CORRECT
Explanation
Acyclovir acts by inhibiting DNA polymerase. It is not effective against cytomegalovirus, a
member of the herpes family. Both topical and oral acyclovir are effective against herpes simplex
keratitis. It is usually dosed 5x per day.

Regarding therapeutic management of uveitis which statement is TRUE:

rituximab (anti-CD20) inhibits antibody secreting plasma cells

anti-TNF blockade is a mainstay of early treatment of Behcet's disease

colcichine is effective in the treatment of uveitis

calcineurin inhibitors include mycophenolate mofetil and azathioprine

Your answer was CORRECT

Explanation
Colchicine may be helpful in Behcet's disease for treating mouth and genital ulcers but has no
significant role in the management of Behcet's (or other forms of) uveitis.

Tacrolimus and cyclosporine are calcineurin inhibitors. Azathioprine and mycophenolate inhibit
purine synthesis.

Rituximab inhibits B-cells, but not antibody-secreting plasma cells which do not express CD-20.

What is the mode of action of the imidazole antimicrobials:

inhibits cell membrane synthesis

inhibits mitochondrial oxidation

inhibits protein synthesis

inhibits folate synthesis

Your answer was CORRECT

Explanation
The imidazoles are antimycotic agents which inhibit the synthesis of sterols which are an
important constituent in fungal cell membranes.

Which medication is likely to increase the risk of myopathy in patients taking simvastatin?
trimethoprim

cefuroxime

erythromycin
amoxicillin

Your answer was CORRECT

Explanation
Erythromycin and clarithromycin are known to increase the risk of myopathy in patients taking
simvastatin.

Regarding pilocarpine which statement is FALSE:

it has no effect on aqueous secretion

it causes pupillary contraction

it draws on the scleral spur and opens the trabecular meshwork

it facilitates aqueous drainage

Your answer was CORRECT

Explanation
Pilocarpine facilitates aqueous drainage by constricting the iris and by opening the meshwork
from its action on the ciliary muscle. It also reduces aqueous secretion by reducing blood flow to
the ciliary body.

 
Which of the following is commonly added to penicillin to prevent its inactivation by beta-
lactamase enzymes:

glucuronic acid

clavulanic acid

hyaluronic acid

fucidic acid

Your answer was CORRECT

Explanation
Clavulanic acid is a beta-lactamase inhibitor commonly added to amoxicillin (co-amoxiclav) to
prevent its degradation by bacterial beta-lactamase enzymes.
 
Which of the following medications reduces lid retraction caused by thyroid eye disease:
pilocarpine

atropine

guanethidine
physostigmine

ecothiopate

Your answer was CORRECT

Explanation
Guanethidine is a sympatholytic (reduces the release of catecholamines) which can reduce lid
retraction in thyroid eye disease.

Physostigmine and ecothiopate are both parasympathomimetics, which work by inhibiting

anticholinesterase activity at the synapse.

Pilocarpine is a direct muscurinic.

Atropine, cyclopentolate and tropicamide are competitive parasympatholyic drugs (competitive

acetylcholine antagonists) acting at the post-synaptic cell membrane.

 
The most common side-effect of topical cyclosporine is:
transient blurred vision
epiphora
hirsuitness
gingival hyperplasia
ocular stinging or burning

Your answer was CORRECT

Explanation
Ocular burning occurs in approximately 15% of patients using topical cyclosporine. All of the
other answers are less frequent side effects.

Side-effects of systemic cyclosporine:

 neurotoxicity
 nephrotoxicity
 hepatoxicity
 gingival hyperplasia
 hirsutism
 increased risk squamous cell carcinoma
 nausea/vomiting
 
All of the following antibiotics inhibit cell wall synthesis EXCEPT:

ciprofloxacin
cefuroxime

fusidic acid

vancomycin

amoxicillin

Your answer was CORRECT

Explanation
Ciprofloxacin impedes DNA gyrase thus inhibiting DNA replication. All other options in the
question above affect bacterial cell wall synthesis.

 
What is the mode of action of sulfadiazine:

blocks the production of dihydrofolate from para-aminobenzoic acid

inhibits cell wall synthesis

inhibits protein synthesis

inhibits dihydrofolate reductase

Your answer was CORRECT

Explanation
Sulfadiazine blocks the production of dihydrofolate from para-aminobenzoic acid. Pyrimethamine
(another anti-Toxoplasma antibiotic) inhibits dihydrofolate reductase.

 
Which of the following best describes the mechanism of rituximab?

anti-IL-2

interferon agonist

anti-CD20
anti-TNF-alpha

Your answer was CORRECT

Explanation
Rituximab is a monoclonal antibody against the CD20 protein, which is primarily found on the
surface of B cells. Infliximab and etanercept are anti-TNF agents. Cyclosporin and tacrolimus
decrease levels of IL-2.

This question appeared in the 2014 FRCOphth Part 2.

 
Which of the following drugs is a photosensitizer:
gentamicin
amiodarone
corticosteroids
isoniazid

Your answer was CORRECT

Explanation
Photosensitising agents absorb visible and UV radiation.

Common photosensitising drugs:

 Antibiotics
o Tetracyclines
o Fluoroquinolones (e.g. ciprofloxacin)
o Sulfonamides
 NSAIDS (e.g. ibuprofen, naproxen, celecoxib)
 Diuretics
o Furosemide
o Bumetanide
o Hydrochlorothiazide
 Retinoids
o Isotretinoin
o Acitretin
 Hypoglycaemics
o Sulfonylureas (e.g. glipizide)
 Neurolepics
o Phenothiazines (e.g. chlorpromazine)
o Thioxanthenes (e.g. chlorprothixene)
 PDT Pro-photosensitisers
o Photofrin
o 5-aminolevulinic acid
 Other drugs
o Amiodarone
o Diltiazem
o Quinine
 o Quinidine
o Hydroxychloroquine
o Enalapril
o Dapsone
o Voriconazole
 
A patient with a psychiatric history develops a pigmentary retinopathy. What is the most likely
cause?

lithium

thioridazine
olanzapine

carbamazepine

Your answer was CORRECT

Explanation
Thioridazine is a phenothiazine anti-psychotic agent known to cause a pigmentary retinopathy.
Toxicity manifests as decreased vision, nyctalopia, and dyschromatopsia. Mild, nonspecific
macular pigmentary changes are seen initially and may be followed by salt-and-pepper pigmentary
loss. In severe cases, generalized changes may occur, including vascular attenuation, optic
atrophy, and diffuse pigmentary alterations, with virtually complete loss of the choriocapillaris
and RPE.

This question appeared in the 2014 FRCOphth Part 2.

 
Tetracycline is associated with which ocular side-effect:
corneal opacification

glaucoma

cataract

papilloedema
retinal toxicity

Your answer was CORRECT

Explanation
Tetracycline is associated with papilloedema.

 
Which of the following is a recognized side-effect of acetazolamide:
hyperkalaemia

metabolic alkalosis

hypernatraemia

renal calculi

Your answer was CORRECT

Explanation
Acetazolamide is a carbonic anhydrase inhibitor. It can cause metabolic acidosis, hypokalaemia,
hyponatraemia, renal calculi, fatigue, paraesthesia of limbs and Steven-Johnson's syndrome.

 
Which statement is FALSE regarding the beta-blockers:

they decrease the intraocular pressure by increasing the aqueous outflow

they have negative inotropic and chronotropic effects

those with intrinsic sympathetic activities are less likely to cause bradycardia

they cause hypotension

Your answer was CORRECT

Explanation
Beta-blockers decrease IOP by decreasing aqueous production. Other options supplied are true.

 
Which of the following aminoglycosides is most likely to induce allergic reaction when applied to
the eye:

gentamicin

tobramycin

neomycin
amikacin

Your answer was CORRECT

Explanation
Allergic conjunctivitis is most common with topical neomycin, occurring in up to 8% of patients.

 
Which drug is most likely to cause binasal field defects?
 vigabatrin
hydroxychloroquine
amiodarone
tamoxifen

Your answer was CORRECT

Explanation
Vigabatrin is a selective inhibitor of GABA-transaminase, and is used as a second- or third-line
anti-epileptic. In rare instances, it can cause an idiosyncratic (rather than dose-related) optic
neuropathy. Central vision remains unaffected, but signs include:
 optic nerve pallor
 RNFL atrophy
 concentric peripheral field loss with temporal and macular sparing (bi-nasal field defects)
Vigabatrin optic neuropathy is irreversible. The Royal College of Ophthalmologists guidance on
vigabtrin is for baseline perimetry (static supra-threshold such as the Humphrey 120 or Goldman)
to be performed before initiating treatment, then repeated 6 monthly for 5 years and then annually
thereafter.

This question came in the 2014 FRCOphth.

 
Which of the following best describes the mode of action of the fluoroquinolones:

inhibit nucleic acid synthesis

inhibit protein synthesis

inhibit cell membrane synthesis

inhibit cell wall synthesis

Your answer was CORRECT

Explanation
Fluoroquinolones such as ciprofloxacin inhibit DNA replication by their action on bacterial DNA
gyrase.

 
Allowing 5 minutes between two eye drops works on the principle of:

saturation kinetics

pharmacokinetics
pharmacodynamics

bioavailability

Your answer was CORRECT

Explanation
Allowing time between drops ensures sufficient absorption, that is, it is a pharmacokinetic
consideration. Pharmacokinetics deals with the liberation, absorption, distribution, metabolism
and excretion of drugs. Pharmacodynamics refers to the physiological mechanisms whereby drugs
perform their actions. Bioavailability refers to the concentration of a drug reaching the circulation
(thus an iv drug has a bioavailability of 100%).

 
Which of the following medications acts on sympathetic and parasympathetic autonomic ganglia?

tropicamide

acetylcholine
pilocarpine

atropine

phenylephrine

Your answer was CORRECT

Explanation
Acetylcholine (miochol) acts on all sympathetic and parasympathetic autonomic ganglia. It also
acts on parasympathetic peripheral nerve endings. It has a very short half-life but a fast onset,
which is useful in producing miosis for 20 minutes during complicated cataract surgery.

 
Which statement is FALSE regarding chloramphenicol:

it is effective against both Gram-positive and Gram-negative bacteria

it inhibits peptidyltransferase

it acts by inhibiting bacterial protein synthesis

it is bactericidal

Your answer was CORRECT

Explanation
Chloramphenicol acts by inhibiting bacterial peptidyltransferase necessary for protein synthesis. It
is effective against both Gram-positive and Gram-negative bacteria. It is bacteriostatic rather than
bactericidal. It is one of the commonest topical antibiotics available. Its systemic use is limited by
its potential to cause a fatal aplastic anaemia.

 
A 58-year-old woman presents with a painful, red eye for 4 weeks with severe headache over the
past 3 days. Examination shows deep scleral injection, which does not blanche with phenylephrine
10%. Underlying blue uveal tissue is seen nasally.

All of the following treatments may be appropriate EXCEPT:

cyclosporine

NSAIDs

peri-ocular steroids
cyclophosphamide

Your answer was CORRECT

Explanation
Acute therapy should consist of oral prednisone 1 to 2 mg/kg/day with the eventual addition of
cytotoxic immunosuppressives. A thorough investigation for associated systemic vasculitides
should be completed. Periocular corticosteroids should be avoided initially (especially in
necrotising disease with scleral thinning) because deposteroids may enhance collagenase activity
in polymorphonuclear leukocytes and result in further scleral melting and necrosis.

 
Which antibiotic inhibits protein synthesis by binding to the 30S ribosome subunit:
chloramphenicol
tetracycline
sulphonamide
erythromycin
rifampicin

Your answer was CORRECT

Explanation
 Macrolides (such as erythromycin) and chloramphenicol inhibit protein synthesis by binding to
the 50S subunit of the bacterial ribosome.
 Tetracyclines and aminoglycosides inhibit protein synthesis by binding to the 30S subunit of
bacterial ribosomes.
 Sulphonamide inhibits biosynthesis of folic acid.
 Rifampin inhibits RNA synthesis by inhibiting DNA-dependent RNA polymerase
 
Which organ system is most likely to develop toxicity from the imidazole class of antifungal
agents?
haematopoietic

cardiovascular

central nervous system

renal
hepatic

Your answer was CORRECT

Explanation
The imidazole class of antifungal agents (e.g. fluconazole and voriconazole) cause hepatotoxicity.
Liver enzymes should be monitored during long-term therapy.

 
Potential adverse effects of the pharmacologic management of toxoplasmosis include all of the
following EXCEPT:

pseudomembranous colitis

microcytic anaemia
Stevens-Johnson syndrome

aplastic anaemia

aggravation of diabetes mellitus

Your answer was CORRECT

Explanation
Clindamycin is clearly associated with pseudomembranous colitis. Sulfa drugs can cause Stevens-
Johnson syndrome, as well as either haemolytic or aplastic anaemia. Pyrimethamine can cause
aplastic anaemia (hence, the concurrent use of folinic acid). Steroid therapy can aggravate
diabetes.

 
What is the mode of action of pyrimethamine:

inhibits dihydrofolate reductase

inhibits cell wall synthesis

blocks the production of dihydrofolate from para-aminobenzoic acid

inhibits protein synthesis

Your answer was CORRECT

Explanation
Pyrimethamine inhibits dihydrofolate reductase. Sulfadiazine (another anti-Toxoplasma antibiotic)
blocks the production of dihydrofolate from para-aminobenzoic acid.

 
Which is FALSE regarding topical steroid eye drops:

prednisolone phosphate has better corneal penetration than prednisolone acetate

they can cause cataract

they can cause increased intraocular pressure

they must enter the cell in order to have an effect

Your answer was CORRECT

Explanation
Prednisolone acetate is more lipophilic and therefore penetrates the cornea better than
prednisolone phosphate. Other options are true.

 
Which treatment is most likely to be effective in multifocal choroiditis due to cryptococcus
neoformans?

fluconazole

rifampicin

azithromycin

ivermectin

Your answer was CORRECT

Explanation
Cryptococcus neoformans is an encapsulated yeast. It is present in pigeon droppings and enters the
body through inhalation. Infection usually occurs in patients with cell-mediated immune
compromise (e.g. HIV). Ocular involvement usually occurs secondary to meningitis.
Manifestations include papilloedema, ophthalmoplegia, optic neuropathy, nerve palsy, multifocal
choroiditis, keratitis and conjunctivitis. Treatment is with: amphotericin, fluconazole and
itraconazole.

 
An intravenous drug abuser presents with a history of reduced vision and floaters for several
weeks in his right eye. Examination reveals vision of OD 6/60 with hypopyon, intense vitritis and
creamy-white chorioretinal lesions at the disc and macula.

What is the most effective initial treatment for this condition?

intravenous amphotericin

oral fluconazole and oral steroids

pars plana vitrectomy with intravitreal amphotericin

pars plana vitrectomy with intravitreal cefuroxime and gentamicin
intravitreal cefuroxime and gentamicin

Your answer was CORRECT

Explanation
Endogenous fungal endophthalmitis with vitreous involvement should be treated with pars plana
vitrectomy combined with intravitreal amphotericin. Medical management (such as oral
fluconazole, oral variconazole or intravenous amphotericin) is indicated for systemic disease and
ocular disease without vitreous involvement. Oral steroids are contraindicated in fungal infections.

 
Which topical corticosteroid is LEAST likely to induce intraocular pressure elevation:
prednisolone acetate

dexamethasone alcohol

loteprednol etabonate
prednisolone phosphate

Your answer was CORRECT

Explanation
Loteprednol has a lower propensity to induce IOP elevation and may be a good choice in steroid
responders.

 
Prednisone is a:
cytotoxic alkylating agent

immune modulator of interleukin 2

cytostatic anti-inflammatory

cytotoxic antimetabolite

Your answer was CORRECT

Explanation
Prednisone is a cytostatic anti-inflammatory agent that is a nonspecific immunosuppressive.

 
Which drug and side-effect pair is NOT correctly matched:

corticosteroids: osteoporosis
azathioprine: diarrhea

tacrolimus: gingival hyperplasia

cyclosporine: bone marrow suppression

Your answer was CORRECT

Explanation
Cyclosporin and tacrolimus both inhibit interleukin-2. They do not cause bone marrow
suppression (unlike other immunomodulators such as azathioprine and methotrexate) but they can
cause hypertension, hyperlipidameia, glucose intolerance, hirsutism and gingival hyperplasia.

 
Which of the following medications causes halitosis and gingival hyperplasia?

ciclosporin

tacrolimus

mycophenylate mofetil

methotrexate

azathioprine

Your answer was CORRECT

Explanation
Ciclosporin can cause halitosis and gingival hyperplasia. Other side effects include nausea,
vomiting, abdominal pain and diarrhoea.

 
Methotrexate is a:

cytotoxic anti-metabolite
cytotoxic alkylating agent

cytostatic anti-inflammatory

immune modulator of interleukin 2

Your answer was CORRECT

Explanation
Azathioprine and methotrexate both inhibit purine ring biosynthesis. In addition, methotrexate
inhibits the synthesis of deoxythymidine monophosphate nucleotide.
 
Corneal crystalline deposits are a side-effect of which topical medication?

ciprofloxacin

levofloxacin

apraclonidine

fucithalmic acid

brimonidine

Your answer was CORRECT

Explanation

Figure: Ciprofloxacin-induced corneal crystalline precipitates

Prolonged use of ciprofloxacin may cause corneal crystalline deposits. These are probably due to
precipitation of drug, which requires low pH for solubility.

 
A patient on cyclophosphamide is most likely to develop:
bone marrow suppression
hepatitis

haemorrhagic cystitis

bladder carcinoma

Your answer was INCORRECT

Explanation
Cyclophosphamide is an alkylating agent that interferes with DNA replication by forming
intrastrand and interstrand DNA cross-links. The most common side effect is bone-marrow
suppression, particularly granulopoiesis and lymphopoiesis, which is almost universal.
Haemorrhagic cystitis is also common, occurring in up to 10% of patients. Other side-effects
include bladder cancer, hepatic toxicity, amenorrhoea and azoospermia (usually reversible).

This question appeared in the 2014 FRCOphth Part 2.

 
Which is TRUE of parasympathetic antagonists administered topically to the eye:

they cause ciliary muscle contraction

they activate muscarinic receptors

they decrease lacrimal secretions

they produce miosis

Your answer was CORRECT

Explanation
Parasympathetic antagonists inhibit acetylcholine muscarinic receptors by definition. They
produce mydriasis, cycloplegia and they reduce lacrimal secretions.

Which statement about drugs used to treat ocular toxoplasmosis is TRUE?

sulfadiazine inhibits the dihydrofolate reductase enzyme

pyrimethamine blocks the production of dihydrofolate from para-aminobenzoic acid

systemic and periocular corticosteroids are contraindicated during active infection

clindamycin can effectively kill Toxoplasma organisms

Your answer was CORRECT

Explanation
 Pyrimethamine actually inhibits dihydrofolate reductase. Sulfadiazine blocks the production of
dihydrofolate from para-aminobenzoic acid. Clindamycin is an antibiotic that can effectively kill
Toxoplasma organisms. Systemic and periocular steroids can be used in the treatment of ocular
toxoplasmosis in immunocompetent patients.

Ocular effects of adrenergic agonists include all EXCEPT:

mydriasis
ciliary muscle relaxation
contraction of Muller's muscle
dilation of conjunctival and episcleral vessels
increased outflow of aqueous

Your answer was CORRECT

Explanation
Adrenergic agonists cause:
 mydriasis
 ciliary muscle relaxation
 increased aqueous formation (though selective alpha-2 stimulation will reduce formation)
 increased aqueous outflow
 constriction of conjunctival and episcleral vessels
 contraction of Muller's muscle

Systemic corticosteroid therapy for uveitis may be responsible for all of the following EXCEPT:

osteoporosis

vitreous opacification
central serous retinopathy

depression

raised IOP

Your answer was CORRECT

Explanation
Steroids may cause cataract but have no role in causing vitreous opacification. Other options are
true.

Which is NOT true regarding ocular drug delivery:

addition of polyvinyl alcohol reduces the viscosity of a drop

preservatives can enhance drug delivery
 particulate suspensions can be used in the delivery of steroids

the corneal epithelium presents a greater barrier to hydrophilic than lipophilic drugs

Your answer was CORRECT

Explanation
Addition of polyvinyl alcohol will tend to increase the viscosity of a drop, therefore allowing it to
linger longer in the eye. Other options are true.

Put the following mydriatics in order from shortest to longest acting:

tropicamide, cyclopentolate, homatropine, atropine
cyclopentolate, tropicamide, atropine, homatropine
tropicamide, cyclopentolate, atropine, homatropine
cyclopentolate, tropicamide, homatropine, atropine

Your answer was CORRECT

Explanation
The mydriatic durations are as follows:
 Tropicamide: duration 6 hours
 Cyclopentolate: duration 24 hours
 Homatropine: duration 2 days
 Atropine: duration up to 2 weeks
 Which of the following is NOT an appropriate therapy for the condition shown above:
debridement of corneal lesions
acyclovir 800 mg five times daily
valacyclovir 500 mg twice a day
acyclovir ointment five times daily

Your answer was CORRECT

Explanation
Primary HSV keratitis can be treated by:
 Debridement
 Topical treatment:
o trifluridine (Viroptic) nine times/day
o vidarabine 3% ophthalmic ointment five times/day
o acyclovir 3% ophthalmic ointment five times/day
 Oral treatment (severe cases) with:
o acyclovir 400mg 5 times daily
o famciclovir 500 mg twice daily
o valacyclovir 500 to 1000 mg twice daily for 5 days
Note: acyclovir 800 mg five times daily is the dosing for herpes zoster ophthalmicus

Ethambutol is associated with which ocular side-effect:

corneal deposits

nystagmus
 optic neuritis
retinal toxicity

Your answer was CORRECT

Explanation
Ethambutol and isoniazid, both anti-tuberculous medications, are known to be associated with
optic neuritis.

Stimulation of adrenergic receptors causes:

decreased aqueous outflow

contraction of Muller's muscle

significant ciliary muscle relaxation

dilatation of conjunctival vessels

Your answer was CORRECT

Explanation
An adrenergic agonist causes contraction of Muller's muscle, which can be used to relieve ptosis
in Horner's syndrome. Adrenergic stimulation only causes slight ciliary muscle relaxation.
Adrenergic stimulation tends to increase aqueous outflow and cause conjunctival vessel
constriction.

The concentration of adrenaline at the adrenergic synapse is:

controlled mainly by the activity of the enzyme COMT
decreased by cocaine
increased by noradrenaline receptor blockers
decreased by mono-amineoxidase-inhibitors

Your answer was CORRECT

Explanation
The concentration of adrenaline in the synaptic cleft is increased by:
 cocaine which inhibits adrenaline uptake
 MAO inhibitors which block the metabolism of adrenaline
 noradrenaline receptor blockers and partial agonists of noradrenaline (as they prevent the
binding and uptake of adrenaline at the post-synaptic receptor).
Note that COMT is involved in the metabolism of adrenaline intracellularly not at the neuronal
synapse.
The actions of the following antibiotics are correct EXCEPT:

fusidic acid interferes with protein synthesis

sulphonamides interferes with folic acid synthesis

chloramphenicol inhibits bacterial protein synthesis

tetracycline inhibits bacterial cell wall synthesis

metronidazole interferes with DNA synthesis

Your answer was CORRECT

Explanation
Tetracycline interferes with bacterial protein synthesis. All other statements are true.

Which statement about topical eye drops is FALSE:

betaxolol is a selective beta-1 blocker

apraclodine is an alpha-2 partial agonist

timolol is a non-selective beta-1 and beta-2 blocker

phenylephrine is a non-selective beta-agonist

Your answer was CORRECT

Explanation
Phenylephrine is a non-selective alpha-agonist. Other options are true.

Which statement regarding the rate of diffusion of a drug across a membrane is FALSE:

it is increased the more hydrophilic the drug

it is inversely proportional to the thickness of the membrane

it is directly proportional to the difference in concentration across the membrane

it is decreased the more ionized the drug

Your answer was CORRECT

Explanation
 According to Fick's Law:

Rate of diffusion = diffusion coefficient x concentration gradient / membrane thickness

The diffusion coefficient itself is a function of lipid solubility, ionization and molecular size.

Which of the following drugs is NOT used in the treatment of HIV/AIDS virus:
T-20
combivir
etanercept
lamivudine
efavirenz

Your answer was CORRECT

Explanation
All of the above are used in the treatment of HIV except etanercept which is used in the treatment
of rheumatoid arthritis, psoriasis, psoriatic arthritis and ankylosing spondylitis. It is an anti-TNF
alpha drug which suppresses the immune system and therefore would not be used in a patient with
HIV.
 Lamivudine is a nucleoside reverse transcriptase inhibitor
 Efavirenz is a non-nucleoside reverse transcriptase inhibitor
 Zidovudine and Lamivudine are packaged together as combibir
 T-20 is a fusion inhibitor; it sticks to gp41 to prevent HIV entering the cell

Which anti-human immunodeficiency virus (HIV) agent is most likely to cause cytopenia:
zalcitabine (ddC)
didanosine (ddI)
zidovudine (AZT)
ritonavir

Your answer was CORRECT

Explanation
The most prominent side-effects of HIV medications are as follows:
 ritonavir: nausea and diarrhea
 zidovudine (AZT): cytopoenia
 didanosine (ddI): pancreatitis
 zalcitabine (ddC): peripheral neuropathy

Histamine causes:

bronchodilatation

vasoconstriction
increased gastric acid secretion
negative chronotropic action

Your answer was CORRECT

Explanation
Histamine causes: bronchoconstriction, vasodilation and increased gastric acid secretion. It has a
positive chronotropic action resulting from a direct effect on heart receptors and by baroreceptor
reflex due to vasodilatation.

What treatment is indicated in multifocal choroiditis due to Brucellosis?

tetracycline

ciprofloxacin

ethambutol

flucloxacillin

Your answer was CORRECT

Explanation
Brucellosis is usually treated with tetracycline, doxycyline or rifampicin.

The enzyme activity of thiopurine methyltransferase (TPMT) is usually checked before the
commencement of:
cyclophosphamide

methotrexate

azathioprine

ciclosporin

Your answer was CORRECT

Explanation
TMPT metabolises azathioprine. The risk of myelosuppression on azathioprine is increased in
those patients with reduced activity of this enzyme.

Note: allopurinol interacts with the TMPT pathway, hence patients on allopurinol need a lower
dose of azathioprine.
Topical corticosteroids are best withheld in which of the following scenarios:

1. active dendritic epithelial keratitis

2. disciform keratitis
3. presumed fungal keratitis
4. pseudodendritic epithelial keratitis
1, 2, 3, and 4

1 and 3
4 only

2 and 4

1, 2, and 3

Your answer was CORRECT

Explanation
Steroids can exacerbate both active dendritic epithelial keratitis, where live virus proliferates, and
fungal keratitis. Note: pseudodendritic epithelial keratitis caused by herpes zoster and disciform
keratitis caused by HSV are both primarily inflammatory conditions, and respond well to steroid
treatment.

Cephalosporins work by:

inhibiting folate biosynthesis

inhibiting protein synthesis

inhibiting DNA synthesis

inhibiting cell wall synthesis

Your answer was CORRECT

Explanation
Cephalosporins prevent bacterial cell wall synthesis.

Which antibiotic impedes DNA gyrase?

trimethoprim

chloramphenicol

ofloxacin

gentamicin
Your answer was CORRECT
Explanation

Table: Antibiotic mechanisms of action

As per the table above, ofloxacin impedes DNA gyrase thereby affecting DNA replication.
Trimethoprim inhibits folate synthesis. Chloramphenicol inhibits protein synthesis by affecting the
50S ribosomal. Gentamicin (an aminoglycoside) inhibits protein synthesis by affecting the 30S
ribosomal subunit.

Which drug is most likely to cause macular toxicity in aphakic eyes:

latanoprost
timolol

epinephrine

acetazolamide

Your answer was CORRECT

Explanation
Epinephrine causes macular oedema in 20-30% of aphakic eyes undergoing treatment for
glaucoma and is therefore contraindicated in these circumstances.

Which antibiotic does NOT inhibit bacterial cell wall synthesis:

ciprofloxacin
cephalosporins

benzylpenicillin

vancomycin

Your answer was CORRECT

Explanation
Ciprofloxacin is a quinolone antibiotic, which blocks DNA synthesis by inhibiting DNA gyrase.
Meanwhile penicillins, cephalosporins and vancomycin all inhibit cell wall synthesis.

Which antibiotic hinders bacterial protein synthesis by inhibiting the 50S ribosomal subunit?

gentamicin

chloramphenicol
tetracycline

trimethoprim

Your answer was CORRECT

Explanation
Table. Antibiotic mechanisms of action

As per the table above, chloramphenicol inhibits protein synthesis by affecting the 50S ribosomal
subunit. Tetracyclines and aminoglycosides (such as gentamicin) inhibit protein synthesis by
binding to the 30S ribosomal subunit. Trimethoprim inhibits folate synthesis.

All of the following drugs can cause accommodative disturbance EXCEPT:

amiodarone
levodopa
amitriptyline
neostigmine

Your answer was CORRECT

 Explanation
Amitriptyline (a tricyclic antidepressant) can produce anticholinergic effects, neostigmine is a
parasympathomimetic (acetylcholinesterase inhibitor) and levodopa (a precursor of catecholamine
neurotransmitters, used in Parkinson's) has cholinergic effects; thus all these drugs can affect the
accommodative mechanism.

Amiodarone has no effect on accommodation.

Amiodarone can cause:

 corneal verticallata or vortex keratopathy
 optic neuropathy (like AION)
 anterior subcapsular cataract

Which is FALSE regarding topical eye drops:

brimonidine is a selective alpha-1 agonist

hydroxyamphetamine increases the release of noradrenaline from nerve terminals

epinephrine stimulates both alpha and beta receptors

phenylephrine stimulates alpha receptors

cocaine prevents the reuptake of noradrenaline at nerve endings

Your answer was CORRECT

Explanation
Brimonidine is a selective alpha-2 agonists. The other options are true.

In which situation can you stop oral prednisolone safely without the need for taper in a healthy
adult?
60mg mane daily for 3 days
30mg mane daily for a month
20mg mane daily for 3 weeks after stopping long-term therapy 6 months ago
20mg daily evening for 2 weeks

Your answer was CORRECT

Explanation
Gradual tapering of steroids should be considered if:
 40mg daily in the morning for more than 1 week
 repeated evening doses
 received more than 3 weeks of treatment
 taken a short course but within a year of stopping longterm treatment
All of the following are true of IOP-lowering agents EXCEPT:

beta-blockers decrease aqueous production by their effect on the ciliary body

pilocarpine increases aquous outlflow by direct mechanical effect on the ciliary body muscle

apraclonidine decreases aqueous formation

prostaglandin analogues reduce IOP by increasing trabecular outflow

Your answer was CORRECT

Explanation
Prostaglandin analogues reduce IOP by increasing uveoscleral outflow. Other options are true.

Which of the following is FALSE about ocular drug delivery:

an increased blink rate increases topical drug absorption

an acidic or alkaline pH can increase drug absorption

ointments have a longer corneal contact time than drops

an acidic or alkaline pH can increase drug clearance

Your answer was CORRECT

Explanation
An increased blink rate reduces the topical drug absorption by increasing clearance. Eye drop
solutions are often made more acidic or alkaline in order to ensure the drug (whether weak acid or
weak base) is more un-ionised and therefore lipid soluble to increase corneal absorption.
However, acidic and alkaline pH will also tend to initiate irritation and lacrimation, increasing
drug clearance.

Which antibiotic has an effect on folate synthesis?

gentamicin

doxycycline

ofloxacin

co-trimaxozole

Your answer was CORRECT

Explanation
Table: Antibiotic mechanisms of action

As per the table above, co-trimaxazole (which comprises trimethoprim and sulfamethoxazole) is
an inhibitor of folate synthesis. Ofloxacin impedes DNA gyrase thus inhibiting DNA replication.
Both doxycycline (a tetracycline) and gentamicin (an aminoglycoside) inhibit protein synthesis by
affecting the 30S ribosomal subunit.

 
Chloroquine causes which ocular side effect:

retinal degeneration
third nerve palsy

Steven's Johnson syndrome

angle closure glaucoma

optic neuritis

Your answer was CORRECT

Explanation
Chloroquine binds to melanin in the RPE cells leading to long-term retinal toxicity.

 
Which is true of local anaesthetics:

their effects are weakened by administration with sodium bicarbonate

their action is shortened by concurrent adrenaline administration

they inhibit voltage-gated sodium channels

they are weak acids

Your answer was CORRECT

Explanation
Local anaesthetics inhibit voltage-gated sodium channels, preventing initiation of an action
potential. They are weak bases. Local anaesthetic activity can be enhanced by altering the pH of a
drug preparation to maximise the amount of drug in the unionised (unprotonated) form. Local
acidosis such as caused by wound infection greatly reduces the action of local anesthetics. Sodium
bicarbonate on the other hand makes local anaesthetic more hydrophobic thereby increasing its
cellular penetration. This increases its potency. The use of adrenaline causes vasoconstriction and
decreases the rate of removal of LA by the blood.

Which statement is FALSE regarding cocaine:

it increases body temperature

it inhibits the reuptake of monoamines at the synaptic space

it causes tachycardia and hypertension

it induces miosis of the pupil

it has an anaesthetic effect when applied locally

Your answer was INCORRECT

Explanation
Cocaine causes pupil dilation not constriction. Other options are true.
Which is FALSE regarding alpha-adrenergic agonists:
alpha-2 receptors are located mostly on the presynaptic nerve endings

apraclonidine is primarily an alpha-1 agonist

alpha-1 agonists cause a rise in IOP

alpha-1 receptors mediate excitatory responses

Your answer was CORRECT

Explanation
Alpha-1 agonists are excitatory, principally causing smooth muscle contraction, as in the
contraction of the dilator pupillae muscle. This dilatation causes an early rise in IOP. Alpha-2
agonists occur mainly on the presynaptic nerve endings and are inhibitory as they prevent further
release of neurotransmitter. Alpha-2 agonists such as clonidine cause a reduction in IOP and this is
thought to be mediated centrally by the stimulation of the medullopontine sympathetic nerve and
by reducing aqueous production locally. Apraclonidine is a partial alpha-2 agonist; it has relatively
less effect on alpha-1 receptors.

Amiodarone is commonly associated with which ocular side-effect:

nystagmus

herpetic keratitis

corneal opacification
glaucoma

Your answer was CORRECT

Explanation
Amiodarone can commonly cause corneal opacification known as vortex keratopathy.

A patient has recently commenced a new medication under her GP and has developed: reduced
corneal sensation and corneal verticallata.

What is the most likely cause?

lithium

quinine

amiodarone
tamoxifen

hydroxychloroquine
Your answer was CORRECT
Explanation
Amiodarone is a common cause of corneal verticallata (vortex keratopathy). It can also cause
reduced corneal sensation and more rarely may lead to optic neuropathy.

Side-effects of systemic corticosteroid therapy include all of the following EXCEPT:

hypertension

hypoglycaemia
avascular necrosis of the hip

gastric ulceration

hirsutism

Your answer was CORRECT

Explanation
Systemic corticosteroid therapy has been associated with numerous systemic complications
including exacerbation of hypertension, diabetes mellitus, osteoporosis, gastric ulceration,
hirsutism, weight gain, capillary fragility, and cushingoid appearance.

A patient is suffering from the following symptoms since commencing a recent medication: dry
eyes, inflamed conjunctiva, corneal ulceration, mouth ulceration and target skin lesions.

What is the most likely drug?

amiodarone

ethambutol

digoxin

hydroxychloroquine

co-trimoxazole

Your answer was CORRECT

Explanation
The clinical features described are consistent with Stevens-Johnson syndrome, which can be
caused by many drugs, including the sulpha antibiotics.
Which medication is LEAST likely to cause the condition pictured above:

apraclonidine

atropine

neomycin

ketorolac

Your answer was CORRECT

Explanation
The figure shows a case of contact dermatitis associated with allergy to a topical medication.
Patients often have an accompanying follicular conjunctivitis. Allergies occur with topical
ophthalmic medications, most commonly: atropine, neomycin, apraclonidine, and dipivefrin.

The effects of corticosteroids include all EXCEPT:

inhibiting the peripheral utilisation of glucose
increasing the catabolism of immunoglobulins
promoting the breakdown of proteins
increasing the amount of lymphoid cells in spleen and lymph nodes

Your answer was INCORRECT

 Explanation
Corticosteroids are used to control inflammation because of their ability to reduce immune
responses. Some of these abilities include:
 reducing the lymphoid contents within the lymph nodes and spleen
 decreasing certain prostaglandins production such as leukotriene
 reducing the macrophage-mediated lysosomal contents
 impairing the function of macrophages and increasing the catabolism of immunoglobulins.
Inhibition of peripheral glucose utilisation (resulting in impaired glucose tolerance and diabetes)
and increased protein breakdown are some of the known side effects of corticosteroids.

All of the following antibiotics inhibit bacterial cell wall synthesis EXCEPT:

Erythromycin

Ceftriaxone

Vancomycin

Flucloxacillin

Your answer was CORRECT

Explanation
Macrolides such as erythromycin inhibit protein synthesis by binding to a subunit of the bacterial
ribosome. Penicillins (e.g. flucloxacillin), vancomycin and cephalosporins all work by inhibiting
cell wall synthesis.

Systemic side-effects of beta-adrenergic blockade include all EXCEPT:

syncope

bronchodilation
central nervous system depression

bradycardia

Your answer was CORRECT

Explanation
Beta-blockers cause bronchospasm not bronchodilation. Other options are true.

Topical anticholinesterase on the eye can cause:

sphincter pupillae muscle constriction

ciliary muscle relaxation

raised intraocular pressure

retraction of the upper lids

Your answer was INCORRECT

Explanation
Anticholinesterases inactivate the enzyme cholinesterase, which breaks down acetylcholine in the
synapse. They therefore allow the chemical transmitter acetylcholine to persist and produce
intense effect, stimulating the parasympathetic pathway. Effects include: sphincter muscle
constriction and ciliary muscle contraction with increased accommodation. Upper lid retraction is
a sympathetic pathway defects.

Which of the following is NOT appropriate for the management of posterior uveitis associated
with Behcet's disease:

systemic corticosteroids

azathioprine

colchicine
anti-TNF agents

Your answer was INCORRECT

Explanation
Colchicine is helpful for ulcers and arthritis in Behcet's disease but has no role in alleviating
uveitis, which requires aggressive immunosuppression with a combination of steroids,
azathioprine and either cyclosporine or anti-TNF agents such as infliximab.

Phase II drug metabolism:

involves conjugation reactions

involves hydrolysis of drugs

decreases drug water solubility

prevents drug excretion by the kidneys or liver

Your answer was CORRECT

Explanation
Phase II drug metabolism involves a conjugation reaction and the addition of glucuronic acid is
the most common. The process increases drug water solubility and facilitates drug excretion by
the kidneys or liver.
Which immunosuppressant has an enhanced effect with allopurinol?
methotrexate

ciclosporin

azathioprine

tacrolimus

cyclophosphamide

Your answer was INCORRECT

Explanation
Patients on allopurinol require a reduced dose of azathioprine.

Which organ system is most likely to develop toxicity from the polyene class of antifungal agents?
hepatic

haematopoietic

cardiovascular

renal

central nervous system

Your answer was INCORRECT

Explanation
Polyenes include amphotericin B and natamycin. Polyenes can cause renal toxicity.

Which statement is TRUE regarding tamoxifen?

ocular toxicity is usually idiosyncratic not dose-related

it may cause deposition of black crystals in the retina

it is an anti-progesterone agent

it may reduce vision by maculopathy secondary to cystoid macular oedema

Your answer was INCORRECT

Explanation
Tamoxifen is an antogonist of the oestrogen receptor. It can cause extensive retinal lesions and
macula oedema with visual impairment when used in high-doses. Less extensive retinal changes
may be observed in patients on low-doses for long periods. Isolated (white) retinal crystals may be
observed in patients without visual symptoms.

This question appeared in the 2014 FRCOphth Part 2.

Which of the following is a recognized side-effect of systemic chloramphenicol administration:

idiopathic thrombocytopaenic purpura

aplastic anaemia
haemolytic anaemia

thrombocytopaenia

Your answer was INCORRECT

Explanation
Chloramphenicol is one of the commonest topical antibiotics in use in ophthalmology but its
systemic use is limited by its potential to cause a fatal aplastic anaemia.

What is the average time to onset of action of botulinum toxin?

3 weeks

48 to 72 hours
1 week

immediately

6 to 12 hours

Your answer was CORRECT

Explanation
Average onset is 2 to 3 days. Peak effect usually occurs 2 to 3 weeks after injection.

A local anaesthetic would be expected to penetrate tissues best:

when the solution is warmed

when administered with a vasodilator

when the tissue is inflamed

when in an alkaline solution

Your answer was INCORRECT
Explanation
Local anaesthetics are weak bases and penetrate tissues best when they are in an alkaline solution
where a greater proportion is non-ionised (lipophilic). Anaesthetics penetrate inflamed tissue
poorly because it is an acidic environment. Warming an anaesthetic reduces the pain involved in
instilling it but does not affect its penetrating ability. Anaesthetics are often administered together
with vasoconstrictors to retard vascular absorption.

All are true of Botulinum toxin EXCEPT:

it can be used as treatment for essential blepharospasm

it can be inactivated by heating

it prevents the release of acetylcholine from the nerve terminal

it is produced by Clostridium perfringens

Your answer was CORRECT

Explanation
Botulinum toxin is produced by Clostridium botulinum. It is an exotoxin and is therefore
denatured by heat. It produces its effect by inhibiting exocytosis of acetylcholine from cholinergic
terminals.

Which medication is most commonly used in cases of filamentous fungal keratitis caused by
Fusarium spp?

Amphotericin B

Miconazole

Natamycin

Flucytosine

Your answer was CORRECT

Explanation
Natamycin is a polyene antifungal that is the treatment of choice for filamentous fungi.

Miconazole is the drug of choice for Paecilomyces lilacinus.

Topical amphotericin is used for infections caused by Aspergillus and Candida spp.

Flucytosine is used as an adjunctive agent for treatment of Candida spp.

All of the following agents are active against Pseudomonas EXCEPT:

ciprofloxacin

gentamicin

benzylpenicillin
neomycin

Your answer was INCORRECT

Explanation
Pseudomonas is naturally resistant to penicillins and most beta-lactam derived antibiotics.
Pseudomonas is sensitive to aminoglycoside and quinolone antibiotics.

Longterm systemic steroid therapy can cause all of the following EXCEPT:

hyperglycaemia

hypertension

osteroporosis

hyperkalaemia

Your answer was CORRECT

Explanation
Longterm steroids can cause hypokalaemia, not hyperkalaemia. Other options above are true.

All are true of acetazolamide EXCEPT:

its site of action is the non-pigmented ciliary epithelium
it is a carbonic anhydrase inhibitor
it can cause hyperkalaemia
it can cause renal stones
it reduces intra-ocular pressure by reducing aqueous production

Your answer was CORRECT

Explanation
Acetazolamide is a carbonic anhydrase inhibitor which reduces IOP by its effect on the non-
pigmented ciliary epithelium secretory function. Acetazolamide has a number of side effects
including:
 hypokalaemia
 acidosis
 fatigue
 paraesthesia
 dermatitis
 renal stones

All of the following drugs can cause the corneal appearance shown in the figure above EXCEPT:
lithium
amiodarone
tamoxifen
indomethacin
chloroquine

Your answer was CORRECT

Explanation
Vortex keratopathy or corneal verticillata is a whorl-like deposition of material in the corneal
epithelium.

Vortex keratopathy can be caused by:

 Fabry's disease
 Drugs
o amiodarone
o chlorpromazine
o chloroquine
o indomethacin
o meperidine
o tamoxifen
 A pure H-1 histamine agonist would cause all EXCEPT:
increased gastric acid secretion
increased vascular permeability
capillary dilatation
bronchospasm

Your answer was INCORRECT

Explanation
H1 receptors cause:
 increased vascular permeability
 arteriolar and capillary dilatation
 smooth muscle contraction
 bronchospasm
 CNS depressant

H2 receptors cause:
 increased pepsin and acid secretion
 increased myocardial stroke volume