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Optometry Board Practice Test for the NBEO® Part 1 Test #1 – Ocular Motility & Binocular Vision This test is comprised of 34 items. This is PRACTICE mode. There is no countdown timer and answers are shown after each question. |
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Which eye movement has the shortest latency?
A. The vestibulo-ocular reflex has the shortest latency of all eye movements with a latency of 15msec. The purpose of the VOR is to stabilize the retinal image as the head moves so it must occur quickly.
A. The vestibulo-ocular reflex has the shortest latency of all eye movements with a latency of 15msec. The purpose of the VOR is to stabilize the retinal image as the head moves so it must occur quickly.
If the furthest distance a patient can see clearly is 50 cm in front of the eye, what is the refractive correction you expect this patient will need?
E. -2.00 D. A far point that is reduced from infinity is more indicative for myopia. Using the equation 1/0.5m = 2.00 D. A +2.00 eye requires -2.00 D to return the far point to infinity.
E. -2.00 D. A far point that is reduced from infinity is more indicative for myopia. Using the equation 1/0.5m = 2.00 D. A +2.00 eye requires -2.00 D to return the far point to infinity.
A child presents to the office with complaints of blurred vision. Subjective refraction reveals a refractive error of +4.00 -0.75 x 180. Cycloplegic refraction results in +7.00 -1.00 x 180. What are the latent and manifest hyperopia, respectively?
D. Latent hyperopia (refractive error that is correctable with accommodation) is +3.00 D. Manifest hyperopia (refractive error that is present in subjective refraction) is +4.00 D.
D. Latent hyperopia (refractive error that is correctable with accommodation) is +3.00 D. Manifest hyperopia (refractive error that is present in subjective refraction) is +4.00 D.
A patient presents with distance refraction of +5.00 D. Accommodative testing reveals amplitude of accommodation of +2.00 D. What are the absolute and facultative hyperopia, respectively?
C. Absolute hyperopia (hyperopia that cannot be neutralized with accommodation alone) is +3.00 D; the difference between the two values. Facultative hyperopia (amount of hyperopia neutralized by accommodation) is +2.00D; the total accommodative ability.
C. Absolute hyperopia (hyperopia that cannot be neutralized with accommodation alone) is +3.00 D; the difference between the two values. Facultative hyperopia (amount of hyperopia neutralized by accommodation) is +2.00D; the total accommodative ability.
You perform retinoscopy on a patient with astigmatism. You neutralize the vertical meridian at +2.00 D and the horizontal meridian at +1.50 D. Your working distance is 50 cm. What is the patient’s refractive error?
C. Accounting for your working distance (50cm = -2.00 D), the 90 (or vertical) meridian is plano while the 180 (or horizontal meridian) is -0.50 D. Using the most plus meridian as the sphere, the prescription should be plano -0.50 x 090.
C. Accounting for your working distance (50cm = -2.00 D), the 90 (or vertical) meridian is plano while the 180 (or horizontal meridian) is -0.50 D. Using the most plus meridian as the sphere, the prescription should be plano -0.50 x 090.
An astigmatic patient states the 2 o’clock and 8 o’clock lines are the most clear on a clock dial. What axis does this indicate?
D. The correct answer should be 60 since the clock dial equation is (lower number on the clock x30) which will give you in this case (2×30=60 degrees)
D. The correct answer should be 60 since the clock dial equation is (lower number on the clock x30) which will give you in this case (2×30=60 degrees)
Which law states that agonist and antagonist extraocular muscles of the SAME EYE are innervated at the same time?
D. Sherrington’s Law states that reciprocal muscles in the SAME eye will both be innervated to provide stability of eye position and gaez. Hering’s law states that yoked muscles in both eyes will receive equal innervation. Donder’s and Listing’s refer to unique orientations of the eye in space and how the eye achieves these positions.
D. Sherrington’s Law states that reciprocal muscles in the SAME eye will both be innervated to provide stability of eye position and gaez. Hering’s law states that yoked muscles in both eyes will receive equal innervation. Donder’s and Listing’s refer to unique orientations of the eye in space and how the eye achieves these positions.
You conduct caloric testing on a patient in office. You slowly pour warm water into the patient’s left ear. In which direction will the eye move during the fast phase of the induced nystagmus in a patient with a functional vestibular system?
C. To the LEFT. Recall COWS – cold = opposite, warm = same. As we know nystagmus is named by the fast phase (not the slow fixation period). Thus, since the nystagmus is in the same direction with warm water, we know it is to the left.
C. To the LEFT. Recall COWS – cold = opposite, warm = same. As we know nystagmus is named by the fast phase (not the slow fixation period). Thus, since the nystagmus is in the same direction with warm water, we know it is to the left.
During extraocular muscle testing, you note a small oscillation of the eyes in far left gaze. This is an example of which type of nystagmus?
B. End-point nystagmus is noted in extreme position of gaze. It is not noted at other times. Caloric nystagmus refers to the use of warm or cold water to induce eye movement. Optokinetic is related to viewing fast moving or rotating objects as the eye attempts to fixate a target. Rotational refers to rotation of the individual’s body. Latent refers to nystagmus that appears when one eye is occluded.
B. End-point nystagmus is noted in extreme position of gaze. It is not noted at other times. Caloric nystagmus refers to the use of warm or cold water to induce eye movement. Optokinetic is related to viewing fast moving or rotating objects as the eye attempts to fixate a target. Rotational refers to rotation of the individual’s body. Latent refers to nystagmus that appears when one eye is occluded.
Which of the following statements regarding saccades is INCORRECT?
C. Undershooting is the most common saccadic error. Recall that saccades are rapid, yoked eye movements to quickly move an image to the fovea. These eye movements are important in reading and spotting tasks.
C. Undershooting is the most common saccadic error. Recall that saccades are rapid, yoked eye movements to quickly move an image to the fovea. These eye movements are important in reading and spotting tasks.
A patient presents with complaints of vertical double vision. You immediately note the patient has a right head tilt. You see the patient has a right hypertropia in primary gaze and conduct EOM testing. Testing reveals a right hypertropia that is more significant in left gaze. Which extraocular muscle is likely affected?
B. There is an issue with the Superior Oblique of the right eye. To answer this question, you must implement Parks 3-Step. First, we note right hyper in primary gaze which indicates either RIR/RSO or LIO/LSR. Next is the head tilt. The patient is tilted to the right meaning RSR/RSO or LIO/LIR. Last, which gaze is the hyper worse? In this case left gaze which indicates RIO/RSO or LSR/LIR. RSO is the only muscle in all three.
B. There is an issue with the Superior Oblique of the right eye. To answer this question, you must implement Parks 3-Step. First, we note right hyper in primary gaze which indicates either RIR/RSO or LIO/LSR. Next is the head tilt. The patient is tilted to the right meaning RSR/RSO or LIO/LIR. Last, which gaze is the hyper worse? In this case left gaze which indicates RIO/RSO or LSR/LIR. RSO is the only muscle in all three.
Which of the following is measured under associated conditions?
A. Fixation disparity is measured under ASSOCIATED conditions. Associated is defined as when two eyes are focused on the same target and fusing images. The other options rely on disassociating the eyes to complete measurements.
A. Fixation disparity is measured under ASSOCIATED conditions. Associated is defined as when two eyes are focused on the same target and fusing images. The other options rely on disassociating the eyes to complete measurements.
A patient presents with a 1Δ exophoria at distance and 8Δ exophoria at exactly 40 cm. If the patient’s pupillary distance(PD) is 64mm, what is the calculated AC/A?
C. The calculated AC/A is 3.6. The equation of note is AC/A = PD(cm) + WD(m)[Phoria @ N – Phoria @ D]. When plugging in values, Exo is considered “-” and Eso is considered “+”. Therefore, AC/A = 6.4 + .4(-8-(-1)) = 3.6. CAREFUL that PD is in centimeters.
C. The calculated AC/A is 3.6. The equation of note is AC/A = PD(cm) + WD(m)[Phoria @ N – Phoria @ D]. When plugging in values, Exo is considered “-” and Eso is considered “+”. Therefore, AC/A = 6.4 + .4(-8-(-1)) = 3.6. CAREFUL that PD is in centimeters.
Which of the following statements regarding fusional vergence is FALSE?
C. Minus lenses indirectly test NEGATIVE fusional vergence. Adding minus lenses increases accommodation and convergence. In order to maintain images on the fovea,negative fusional vergence is required to overcome the changes. Prisms directly test the direction of their apex.
C. Minus lenses indirectly test NEGATIVE fusional vergence. Adding minus lenses increases accommodation and convergence. In order to maintain images on the fovea,negative fusional vergence is required to overcome the changes. Prisms directly test the direction of their apex.
A patient presents with an 18Δ exophoria at near and is symptomatic for double vision. Vergence testing reveals near base out of 6/8/10 and near base in of 10/12/12. Calculate the expected total prism necessary to alleviate patient symptoms?
A. 10 pd BI. As we are calculating the prism necessary for exophoria, it is recommended to use Sheard’s Criterion. The equation is Prism = ⅔ Phoria – ⅓ Compensating Fusional Vergence. In this case, the phoria is 18Δ and the compensating fusional vergence (positive fusional vergence for exophoric patients) is the blur point of the BO measurement. To alleviate phoria we expect to move images to the fovea. Therefore the 10Δ will be BI. Remember this is total and NOT per eye.
A. 10 pd BI. As we are calculating the prism necessary for exophoria, it is recommended to use Sheard’s Criterion. The equation is Prism = ⅔ Phoria – ⅓ Compensating Fusional Vergence. In this case, the phoria is 18Δ and the compensating fusional vergence (positive fusional vergence for exophoric patients) is the blur point of the BO measurement. To alleviate phoria we expect to move images to the fovea. Therefore the 10Δ will be BI. Remember this is total and NOT per eye.
All the following test the accuracy of accommodative response, EXCEPT:
B. The minus lens test is the only option that does not measure accuracy but instead measures amplitude.
B. The minus lens test is the only option that does not measure accuracy but instead measures amplitude.
What is the minimum expected amplitude of accommodation of a 10 year old patient?
B. 12.5 D. Hofstetter defines three equations: 1. Average Amp of ACC = 18.5 – 0.3(Age), 2. Minimum Amp of Acc = 15 – 0.25(age), 3. Maximum Amp of Acc = 25 – 0.4(age). For this problem, we use equation 2.
B. 12.5 D. Hofstetter defines three equations: 1. Average Amp of ACC = 18.5 – 0.3(Age), 2. Minimum Amp of Acc = 15 – 0.25(age), 3. Maximum Amp of Acc = 25 – 0.4(age). For this problem, we use equation 2.
Which of the following findings is NOT indicative of a convergence insufficiency?
D. One would expect a low NRA. This is due to the reduced fusional vergence needed to keep eyes aligned. All other findings can be found in a CI patient. Other findings include: reduced positive fusional vergence, and a low lag/lead of accommodation.
D. One would expect a low NRA. This is due to the reduced fusional vergence needed to keep eyes aligned. All other findings can be found in a CI patient. Other findings include: reduced positive fusional vergence, and a low lag/lead of accommodation.
Which of the following findings is NOT indicative of an accommodative insufficiency?
C. One would expect a high LAG of accommodation as the patient does not have the ability to accommodate. The remaining options are expected findings in AI.
C. One would expect a high LAG of accommodation as the patient does not have the ability to accommodate. The remaining options are expected findings in AI.
Of the following refractive errors, which is most likely to develop into amblyopia if left untreated?
D is the correct response, having hyperopic aniso > 1.00
Diopter can lead to amblyopia in the eye with higher prescription, in this case OS which is +7.00.
Norms include:
ANISO: H >1.00, A >1.50, M >3.00; ISO: H >5, A >2.50, M >8.
D is the correct response, having hyperopic aniso > 1.00
Diopter can lead to amblyopia in the eye with higher prescription, in this case OS which is +7.00.
Norms include:
ANISO: H >1.00, A >1.50, M >3.00; ISO: H >5, A >2.50, M >8.
Which of the following statements regarding amblyopia is FALSE?
B. Anisometropic hyperopia is more likely to cause amblyopia as one eye never receives a clear image. In patient with aniso myopia, there is a point of clarity for either refractive error. Strabismus first presents with diplopia but with time can become suppressed. Eso = nasal, Exo = temporal. Deep amblyopia is considered 20/100 – 20/400.
B. Anisometropic hyperopia is more likely to cause amblyopia as one eye never receives a clear image. In patient with aniso myopia, there is a point of clarity for either refractive error. Strabismus first presents with diplopia but with time can become suppressed. Eso = nasal, Exo = temporal. Deep amblyopia is considered 20/100 – 20/400.
uring an exam, you note that a patient’s angle of anomaly is equal to that of the objective angle of deviation. This is an example of ________.
B. This is the definition of Harmonious ARC. Unharmonious ARC is when the angle of anomaly is less than the objective angle and occurs mostly post-strab surgery. Paradoxical is split into two types: Type 1 is subjective angle greater than objective – Type 2 is an eccentric fixation in the opposite direction of what is expected.
B. This is the definition of Harmonious ARC. Unharmonious ARC is when the angle of anomaly is less than the objective angle and occurs mostly post-strab surgery. Paradoxical is split into two types: Type 1 is subjective angle greater than objective – Type 2 is an eccentric fixation in the opposite direction of what is expected.
Which of the following tests can be used to measure eccentric fixation?
B. Maxwell’s spot, as well as visuoscopy and Hidinger’s brush, are used to measure eccentric fixation. 4 BO test is used for ocular alignment, such as in microstrabismus syndrome. Bagolini lenses are used for ARC. W4D is used for sensory status.
B. Maxwell’s spot, as well as visuoscopy and Hidinger’s brush, are used to measure eccentric fixation. 4 BO test is used for ocular alignment, such as in microstrabismus syndrome. Bagolini lenses are used for ARC. W4D is used for sensory status.
A mother presents with her 14 month old baby with concern of an eye turn. HIrschberg testing reveals the reflex of the right eye to be displaced nasally 0.5mm and the left to be displaced nasally 1.5mm. What is the tentative diagnosis?
D. 22Δ LET. The normal Hberg position is at 0.5mm nasal. Any 1mm displacement past that is equal to 22Δ.
D. 22Δ LET. The normal Hberg position is at 0.5mm nasal. Any 1mm displacement past that is equal to 22Δ.
You perform the Bruckner test on a young patient and note unequal red reflexes. The darker reflex may indicate which of the following? (PICK 2)
A/D. Both media opacities and higher refractive error at a longer test distance can both present with darker reflexes. The deviated eye in strabismus, as well as higher refractive error at 1 meter and retinoblastoma, present with brighter reflexes.
A/D. Both media opacities and higher refractive error at a longer test distance can both present with darker reflexes. The deviated eye in strabismus, as well as higher refractive error at 1 meter and retinoblastoma, present with brighter reflexes.
You are conducting a 4BO test on a suspected microstrabismus. You place the loose prism in front of the right eye and note an outward movement of the left eye that does NOT refixate. What is your conclusion?
C. Suppression of the left eye. Placing a loose 4BO in front of the right eye causes a small movement of the right eye toward the apex of the prism. Due to yoked muscles movement, the left eye will also move. If the left eye is not suppressing, it should quickly re-fixated to target. If there is NO movement of either eye with lens placement, it is a suppression of the right eye. If the left eye does not refixate after a right eye shift, the left eye is considered suppressed.
C. Suppression of the left eye. Placing a loose 4BO in front of the right eye causes a small movement of the right eye toward the apex of the prism. Due to yoked muscles movement, the left eye will also move. If the left eye is not suppressing, it should quickly re-fixated to target. If there is NO movement of either eye with lens placement, it is a suppression of the right eye. If the left eye does not refixate after a right eye shift, the left eye is considered suppressed.
You are conducting Worth 4 Dot testing in a bright room. The young patient reports seeing two red dots to the left of three green lights. If the red lens is over the right eye, what is your conclusion?
D. Crossed diplopia. Recall that the right eye sees the red dots and the left eye sees the green dots. If the red dots were located to the right of the green, that is considered uncrossed (or ESO) diplopia. Red dots above or below the green are indicative of a hypertropia. A patient reporting only one set of lights indicates suppression of either eye. A report of 4 dots is what we hope for.
D. Crossed diplopia. Recall that the right eye sees the red dots and the left eye sees the green dots. If the red dots were located to the right of the green, that is considered uncrossed (or ESO) diplopia. Red dots above or below the green are indicative of a hypertropia. A patient reporting only one set of lights indicates suppression of either eye. A report of 4 dots is what we hope for.
A mother presents with her 8 month old baby with concerns about an intermittent eye turn. The mother reports the right eye appears to turn inward while the infant watches videos on the iPad. Testing reveals orthophoria when conducted with +3.00 D lenses and a 20Δ right esotropia without lenses. Which of the following is MOST LIKELY diagnosis?
B. Accommodative esotropia is the most likely diagnosis at this time. There are a few pieces of information that are key. First, the infant is demonstrating an eye turn some of the time. This means there is either a stimulus to the eye turn or it may be a decompensated phoria. The second piece of evidence is the orthophoric position with +3.00D lenses. This indicates that when accommodation demand is low, the eye turn is not present (or reduced).
B. Accommodative esotropia is the most likely diagnosis at this time. There are a few pieces of information that are key. First, the infant is demonstrating an eye turn some of the time. This means there is either a stimulus to the eye turn or it may be a decompensated phoria. The second piece of evidence is the orthophoric position with +3.00D lenses. This indicates that when accommodation demand is low, the eye turn is not present (or reduced).
Which of the following tests measures a patient’s visual-motor integration skills?
D. Wold Sentence Copy is an example of a VMI test. The Beery VMI is another example. Piaget and Gardner, as well as Standing Angels in the Snow, are examples of tests of visual spatial skills. Visual analysis encompasses 6 sub-categories focused on analyzing images of different complexities.
D. Wold Sentence Copy is an example of a VMI test. The Beery VMI is another example. Piaget and Gardner, as well as Standing Angels in the Snow, are examples of tests of visual spatial skills. Visual analysis encompasses 6 sub-categories focused on analyzing images of different complexities.
The critical period for ocular development ends at ___.
D. The Critical Period for development of clear, binocular vision is between 7 and 8 years of age. This is why it is critical to provide thorough eye examinations to young children. The earlier the diagnosis, the better outcome to treatment.
D. The Critical Period for development of clear, binocular vision is between 7 and 8 years of age. This is why it is critical to provide thorough eye examinations to young children. The earlier the diagnosis, the better outcome to treatment.
A 10 yo patient presents with complaints of double vision on lateral gaze. On examination of extraocular muscles, you note the patient cannot abduct their right eye past midline with a narrowing of palpebral aperture on adduction of the same eye. Which of the following is the most likely tentative diagnosis?
C. Duane retraction syndrome Type 1 as there is only an issue of aBDuction of the right eye. To remember, recall that you “count the D’s” to determine the diagnosis.
C. Duane retraction syndrome Type 1 as there is only an issue of aBDuction of the right eye. To remember, recall that you “count the D’s” to determine the diagnosis.
By the age of ____, a child should be able to draw and identify a square?
E, 4.5 years is roughly when a child should be able to draw and identify a square. Some important shapes to know include: Straight line near the end of 2 years of age, Circle at 3 years, and Triangle near 5 years.
E, 4.5 years is roughly when a child should be able to draw and identify a square. Some important shapes to know include: Straight line near the end of 2 years of age, Circle at 3 years, and Triangle near 5 years.
Accommodation reaches adult levels by ______ of age.
A. Accommodative response is present at birth and reaches maturity at about 3 months of age. It is important to review key ocular motor and visual development milestones.
A. Accommodative response is present at birth and reaches maturity at about 3 months of age. It is important to review key ocular motor and visual development milestones.
A child demonstrating an understanding of object permanence indicates that the child has entered which developmental stage according to Piaget?
B. According to Piaget, object permanence indicates the beginning of the pre-operational stage (2-7 years). There are four stages: sensorimotor (0-2 years), pre-operational (2-7 years), concrete operations (7-12), and formal operations (12 years and older). Object permanence is the knowledge that an object still exists even if it is not in the same room.
B. According to Piaget, object permanence indicates the beginning of the pre-operational stage (2-7 years). There are four stages: sensorimotor (0-2 years), pre-operational (2-7 years), concrete operations (7-12), and formal operations (12 years and older). Object permanence is the knowledge that an object still exists even if it is not in the same room.