Review of Cornea
Jobson Professional Publications Group

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Steroids: Use with Caution - and with Confidence - By William Potter

Exam Questions

1. Topical ophthalmic steroid use can cause which of the following adverse effects:
    A. Elevation of intraocular pressure.
    B. Cataractogenesis.
    C. Potentiation of infection.
    D. All of the above.
2. “Soft” steroids are:
    A. Never as effective as more potent topical steroids.
    B. Less likely to induce secondary glaucoma or cataract (when used properly).
    C. Contraindicated for ocular allergy.
    D. Indicated for posterior blepharitis.
3. Steroid dosages are tapered carefully mainly because:
    A. Preservative allergies appear early in treatment.
    B. The patient will become fatigued at q.i.d dosage.
    C. Rebound inflammation is more problematic with rapid withdrawal.
    D. Glaucoma is more likely to be induced at full dosages.
4. Tapering from difluprednate or prednisolone to loteprednol offers:
    A. Extended immunosuppression periods with less risk for cataract and glaucom
    B. Better cost profile and insurance approval.
    C. Long term self-dosing without follow-up.
    D. Better access to generic equivalents.
5. Q.i.d. initial dosing of steroids for anterior uveitis often fails because:
    A. The level of medication is too low to suppress inflammatory cells.
    B. Patient compliance is poor at q.i.d. dosages.
    C. Generic versions lack potency to give relief.
    D. Oral steroids are required most often.
6. Low-dose topical prednisolone for uveitis would most likely:
    A. Contribute to rebound inflammation and lengthen the duration of steroid therapy.
    B. Resolve inflammation without undue steroid risks.
    C. Cause glaucoma within a week.
    D. Potentiate herpes simplex exacerbation.
7. Topical steroids should be given for allergy with caution and patient counseling because:
    A. Profound relief can lead the patient to demand refills.
    B. Recurrent allergy could require frequent dosing over time.
    C. Refills can lead the patient to unsupervised steroid use.
    D. All of the above.
8. The best reason for using topical ocular steroids in the treatment of allergic conjunctivitis is:
    A. The presence of grade 2 conjunctival chemosis.
    B. Itching and discomfort that is presently limiting work or school productivity.
    C. They make it easier to keep cats in the house.
    D. They work better than mast cell stabilizers in the long run.
9. Infiltration of eosinophils into the ocular adnexae indicate:
    A. That current therapy is working, and the patient is comfortable.
    B. An acute change that represents cellulitis.
    C. That dosages of mast cell stabilizer/antihistamine combinations should be increased.
    D. A chronic change that may require immunosuppression with steroids.
10. Separate dosing of antibiotic and steroid does NOT have the advantage of:
    A. Convenience for the patient.
    B. More customized tapering of steroid dosage.
    C. Easy limitation of antibiotic dosage when it is not needed.
    D. Avoidance of aminoglycoside toxicity.
11. With cautious follow-up and stable corneal findings, contact lens wear may be resumed when steroid dosage is reduced to:
    A. q.i.d.
    B. t.i.d.
    C. b.i.d.
    D. q.d.
12. Antibiotic-alone therapy for marginal keratitis is not optimal because:
    A. Fluoroquinolones may have “holes” in the gram-positive spectrum.
    B. Broad-spectrum antibiotics cause toxicity in addition to germ killing.
    C. The condition is primarily inflammatory, as a reaction to Staph. exotoxin.
    D. Doctors typically give a dosing schedule that is too infrequent.
13. Posterior blepharitis is primarily considered:
    A. A bacterial condition.
    B. An inflammatory condition.
    C. A viral condition.
    D. A self-resolving nuisance that requires no treatment.
14. Azithromycin 1% is evolving as an immune-modulating agent because:
    A. It is the best broad-spectrum antibiotic.
    B. Its DuraSite medium cures dry eye.
    C. Common colds are very responsive to it.
    D. It suppresses inflammatory mediators such as matrix metalloproteinase.
15. Steroids are contraindicated in herpes simplex keratitis, EXCEPT:
    A. When used concurrently with an antiviral.
    B. In the presence of subepithelial haze and stromal involvement.
    C. In the presence of follicular conjunctivitis.
    D. In the presence of pre-auricular node adenopathy.
16. Soft steroids are ideal for keratitis associated with herpes zoster because:
    A. They have a lesser tendency to cause cataracts and glaucoma with the extended dosing that is sometimes needed.
    B. They have no risk for exacerbating herpes simplex.
    C. They are all unpreserved and tend to be less irritating.
    D. They contain antibiotics that perform dual action.
17. A practitioner should challenge the efficacy of prescribed soft steroids IF:
    A. Uveitis develops during treatment.
    B. Intraocular pressure increases.
    C. Corneal staining increases.
    D. The patient improves rapidly.
18. Topical steroids are indicated in treatment of dry eye:
    A. Unless cyclosporine therapy works immediately.
    B. If corneal staining and discomfort are experienced acutely.
    C. When herpes simplex infection occurs simultaneously.
    D. As first-line therapy.
19. The dual action of anti-inflammatories for dry eye includes:
    A. Reduced secondary conjunctival inflammation and reconditioning of tear glands.
    B. Elevated intraocular pressure and a greater likelihood of cataract development.
    C. Control of allergy and environmental factors.
    D. Preservative-free lubrication and comfort.
20. In general, proper steroid prescribing:
    A. Limits patient suffering, and enhances work and school productivity.
    B. Can limit or arrest scarring that is associated with inflammatory conditions.
    C. Prevents rebound inflammation if dosage is tapered correctly.
    D. All of the above.

Evaluation Questions

21. The goal statement was achieved:
    A. Very Well
    B. Adequately
    C. Poor
22. The information presented was:
    A. Very Useful
    B. Useful
    C. Not Very Useful
23. The difficulty of the course was:
    A. Complex
    B. Appropriate
    C. Basic
24. Your knowledge of the subject was increased:
    A. Greatly
    B. Somewhat
    C. Hardly
25. The quality of the course was:
    A. Excellent
    B. Fair
    C. Poor

26. Comments on this program:


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