Loading a preset: This affects what settings are changed when you select one of your preset colours.
If you’re tired of your brush options changing when you only want to change the color, this is an easy fix.

Sounds: Disable certain events from activating sounds.

Graphics: Settings that affect visibility of the cursor and your own username, disable the on-hover tooltips (showing shortcuts) and image previews in chat (not recommended).

Tools: Having this checked will send your tool back to the previous tool after using the eyedropper.
(default hotkey: TAB)

Sync these options: These options affect what tool options stay unchanged when you swap tools.
Any settings checked will be maintained across all tools.

Hotkeys:

On the hotkeys tab you can change a wide variety of hotkeys, with up to two key bindings per action.
You cannot dual-bind any keys, and you can use any combination of keys (ctrl/alt/shift+KEY) instead of a singular keypress.