NBEO Part 1 Exam Study Questions
with Correct Answers 2026 Update
A 32-year old female is seen at your office complaining of a recent onset of
blurred vision, only at a distance. A thorough case history reveals that she recently
began taking a new medication which you correctly assume has induced myopia.
Which of the following medications is MOST likely to be the culprit? -Correct
Answer ✔-Isotretinoin, birth control pills, and diuretics, among many other drugs,
can cause myopia in some patients. Myopia mostly likely results from corneal
swelling, which steepens the curvature of the cornea. Drugs that cause swelling of
the lens, accommodative spasm, or edema of the ciliary body will also result in
myopia. A reduction in the dose of the medication or cessation of the offending
drug will usually result in reversal of nearsightedness. Fish oil, Tylenol, and Tums
have not been shown to have a correlation with transient myopia development.
An increased rate of molecular movement down its respective concentration
gradient via help from carrier proteins refers to which type of transportation? -
Correct Answer ✔-Facilitated diffusion is described as the net movement of
molecules down its concentration gradient whose rate of diffusion is increased via
the use of carrier proteins. Passive diffusion refers to the movement of molecules
through a plasma membrane from an area of high concentration to an area of low
concentration without the use of carrier molecules. Active transport implies the
movement of material against its respective concentration gradient. This type of
transport requires energy and enlists the use of specific carrier proteins. Lastly,
group translocation is defined as the chemical modification of a molecule while it
is being transported into a cell; for example, sugars are often phosphorylated
during transportation.
A 24-year old female patient presents at your office complaining of side effects
that began when she started using Patanol to treat her ocular allergies. She
reports complete compliance with her eye drop administration. Which of the
following symptoms is MOST likely associated with olopatadine (Patanol) use? -
Correct Answer ✔-Topical antihistamines and mast cell stabilizers such as Patanol
,(olopatadine) are commonly prescribed to relieve the symptoms associated with
ocular allergies. They are a very effective class of medication due to their dual
action mechanisms. Topical antihistamines that possess this dual action are
olopatadine (Patanol), ketotifen fumarate (Zaditor), azelastine (Optivar), and
epinastine (Elestat). The aforementioned drops serve to alleviate itching and
redness by blocking H1 receptors as well as inhibiting mast cell and basophil
degranulation. Side effects of topical antihistamine/mast cell stabilizers include
stinging upon instillation, headaches, and adverse taste (don't forget to inform
your patients about punctual occlusion!). Tachycardia, depression, gastrointestinal
discomfort, and visual hallucinations have not been reported with Patanol use.
A 63-year old female is seen at your office with a chief concern of blurry vision in
the morning that takes about an hour to resolve before she can see clearly again.
Biomicroscopy reveals endothelial guttata. You correctly diagnose her with
moderate Fuch's dystrophy. Which ophthalmic drop would be of MOST benefit to
her? -Correct Answer ✔-Sodium chloride is a topical hyperosmotic agent used to
relieve stromal edema caused by endothelial decompensation. Topical steroids
work well to decrease swelling caused by inflammation. In the above case, the
corneal edema is not mitigated by an inflammatory response. Tobramycin and
Vigamox would be of no benefit since there is no active infection, and prescribing
either of these would only lead to corneal toxicity or increased pathogen
resistance over time.
A deficiency of which vitamin leads to prolonged dark adaptation? -Correct
Answer ✔-A deficiency of vitamin A causes prolonged dark adaptation. Vitamin A
is classified as a retinoid, and its active form is retinol. Retinol is necessary for the
formation of rhodopsin, a pigment used by rods. Rods are most active in situations
with dim illumination. Less rhodopsin results in fewer rods being able to respond
in low levels of light, causing prolonged dark adaption.
+1.50-1.50 x 090 is required to neutralize a reflex in retinoscopy with a working
distance of 50 cm. What is the resulting NET retinoscopy finding? -Correct Answer
✔-A working distance of 50 cm creates a divergent wave of 2.00 D that is
neutralized by retinoscopy in addition to the patient's refractive error. Therefore, +
,2.00 D must be subtracted from the spherical portion of the findings. To
determine how much to subtract from the gross findings, one must first calculate
the reciprocal of the working distance in meters. In our case, 1/0.5 = 2. Therefore
+1.50 (the spherical gross findings) -2 = -0.50-1.50 x 090. Remember NET is the
final result, this is found after the working distance has been accounted for by
subtracting the working distance from the spherical portion of the findings.
A ray of light traveling in water (n=1.33) strikes a flat, transparent surface (n= 1.59)
at an angle of 32 degrees from the normal. What is the angle of refraction? -
Correct Answer ✔-Snell's law of refraction states that when light travels through a
material that possesses an index of refraction greater than 1.0, the light rays
change direction and become bent (or refracted). Snell's law is depicted as the
following: n sin i= n' sin i' where n= the index of refraction of the first medium, i=
the angle of incidence, n'= the index of the second medium, and i' = the angle of
the refracted ray. All angles are measured with respect to the normal, which lies
perpendicular to the interface between the different media. For the above
example, 1.33(sin 32)=1.59 sin i', solving for i'= 26.31 degrees. It is important to
commit the index of refraction of water to memory; it is 1.33.
A central retinal artery occlusion (CRAO) causes tremendous damage to the retina.
How will the electroretinogram (ERG) of a person who has suffered a CRAO be
affected? -Correct Answer ✔-A central retinal artery occlusion will cause a loss of
the b-wave which is formed by responses from the bipolar and Muller cells, both
of which are nourished by the central retinal artery. The a-wave results from
excitation of the photoreceptors. The a-wave will not be lost in the event of a
CRAO due to the fact that photoreceptors receive their oxygen supply via the
choroid.
Free radicals can cause severe damage to tissue. Which of the following
electrolytes can function as an antioxidant in the aqueous? -Correct Answer ✔-
The aqueous humor contains many electrolytes including Na+, K+ , Cl-, HCO3-,
glucose, lactate, amino acids, and ascorbate. Ascorbate is found in high
concentrations in the aqueous (20x greater when compared to the concentration
found in plasma). Ascorbate can serve as an antioxidant to eradicate free radicals
, reducing potential damage from ultraviolet light. Interesting note: the aqueous
humor and tears of uncontrolled diabetics display higher levels of glucose than
those of non-diabetics.
A 12-year old male is sitting in your waiting room while his mother undergoes her
annual eye exam. While waiting, he eats a candy bar containing peanuts, and, as
luck would have it, he is deathly allergic to nuts. To counter anaphylactic shock,
what would be the BEST course of action? -Correct Answer ✔-Anaphylactic shock
is defined as a severe, multi-system, type I hypersensitive, acute allergic reaction
that may be life-threatening. Signs of an allergic reaction include tingling, itching,
hives, swelling of lips and tongue, constriction of the airway, vasodilation,
myocardial depression, and a decrease in blood pressure. The EpiPen is injected
intramuscularly to the upper lateral thigh to ensure rapid delivery. Epinephrine
(Adrenaline) activates both alpha and beta adrenergic receptors causing an
increase in peripheral vascular resistance and allowing for an increase in blood
pressure and coronary artery perfusion. Adrenaline also serves to reverse
vasodilation and decrease urticaria and angioedema. For severe, life-threatening
reactions, Benadryl (diphenhydramine) will not work quickly enough. Topical
antihistamines have little if any systemic absorption and therefore will not be
effective in counteracting the anaphylaxis. While oral steroids may be useful in the
post-management of anaphylactic shock, they will not yield the desired
immediate response.
An elderly patient presents in your office with decreased visual acuity. He remarks
that he can read better without his glasses and his refraction denotes a large
myopic shift. Dilated fundus exam is unremarkable. Which of the following slit
lamp findings would MOST likely explain the above findings?
Bilateral corneal arcus
Bilateral limbal girdle of Vogt
Bilateral 3+ nuclear sclerosis of the lens
Bilateral crocodile shagreen -Correct Answer ✔-Nuclear sclerosis is caused by
changes to the optical clarity of the lens. As we age, proteins precipitate out of the
lens matrix, causing the lens to become cloudy and altering its density. As time
passes, the lens will also begin to change color from clear to a yellow/brown in a
with Correct Answers 2026 Update
A 32-year old female is seen at your office complaining of a recent onset of
blurred vision, only at a distance. A thorough case history reveals that she recently
began taking a new medication which you correctly assume has induced myopia.
Which of the following medications is MOST likely to be the culprit? -Correct
Answer ✔-Isotretinoin, birth control pills, and diuretics, among many other drugs,
can cause myopia in some patients. Myopia mostly likely results from corneal
swelling, which steepens the curvature of the cornea. Drugs that cause swelling of
the lens, accommodative spasm, or edema of the ciliary body will also result in
myopia. A reduction in the dose of the medication or cessation of the offending
drug will usually result in reversal of nearsightedness. Fish oil, Tylenol, and Tums
have not been shown to have a correlation with transient myopia development.
An increased rate of molecular movement down its respective concentration
gradient via help from carrier proteins refers to which type of transportation? -
Correct Answer ✔-Facilitated diffusion is described as the net movement of
molecules down its concentration gradient whose rate of diffusion is increased via
the use of carrier proteins. Passive diffusion refers to the movement of molecules
through a plasma membrane from an area of high concentration to an area of low
concentration without the use of carrier molecules. Active transport implies the
movement of material against its respective concentration gradient. This type of
transport requires energy and enlists the use of specific carrier proteins. Lastly,
group translocation is defined as the chemical modification of a molecule while it
is being transported into a cell; for example, sugars are often phosphorylated
during transportation.
A 24-year old female patient presents at your office complaining of side effects
that began when she started using Patanol to treat her ocular allergies. She
reports complete compliance with her eye drop administration. Which of the
following symptoms is MOST likely associated with olopatadine (Patanol) use? -
Correct Answer ✔-Topical antihistamines and mast cell stabilizers such as Patanol
,(olopatadine) are commonly prescribed to relieve the symptoms associated with
ocular allergies. They are a very effective class of medication due to their dual
action mechanisms. Topical antihistamines that possess this dual action are
olopatadine (Patanol), ketotifen fumarate (Zaditor), azelastine (Optivar), and
epinastine (Elestat). The aforementioned drops serve to alleviate itching and
redness by blocking H1 receptors as well as inhibiting mast cell and basophil
degranulation. Side effects of topical antihistamine/mast cell stabilizers include
stinging upon instillation, headaches, and adverse taste (don't forget to inform
your patients about punctual occlusion!). Tachycardia, depression, gastrointestinal
discomfort, and visual hallucinations have not been reported with Patanol use.
A 63-year old female is seen at your office with a chief concern of blurry vision in
the morning that takes about an hour to resolve before she can see clearly again.
Biomicroscopy reveals endothelial guttata. You correctly diagnose her with
moderate Fuch's dystrophy. Which ophthalmic drop would be of MOST benefit to
her? -Correct Answer ✔-Sodium chloride is a topical hyperosmotic agent used to
relieve stromal edema caused by endothelial decompensation. Topical steroids
work well to decrease swelling caused by inflammation. In the above case, the
corneal edema is not mitigated by an inflammatory response. Tobramycin and
Vigamox would be of no benefit since there is no active infection, and prescribing
either of these would only lead to corneal toxicity or increased pathogen
resistance over time.
A deficiency of which vitamin leads to prolonged dark adaptation? -Correct
Answer ✔-A deficiency of vitamin A causes prolonged dark adaptation. Vitamin A
is classified as a retinoid, and its active form is retinol. Retinol is necessary for the
formation of rhodopsin, a pigment used by rods. Rods are most active in situations
with dim illumination. Less rhodopsin results in fewer rods being able to respond
in low levels of light, causing prolonged dark adaption.
+1.50-1.50 x 090 is required to neutralize a reflex in retinoscopy with a working
distance of 50 cm. What is the resulting NET retinoscopy finding? -Correct Answer
✔-A working distance of 50 cm creates a divergent wave of 2.00 D that is
neutralized by retinoscopy in addition to the patient's refractive error. Therefore, +
,2.00 D must be subtracted from the spherical portion of the findings. To
determine how much to subtract from the gross findings, one must first calculate
the reciprocal of the working distance in meters. In our case, 1/0.5 = 2. Therefore
+1.50 (the spherical gross findings) -2 = -0.50-1.50 x 090. Remember NET is the
final result, this is found after the working distance has been accounted for by
subtracting the working distance from the spherical portion of the findings.
A ray of light traveling in water (n=1.33) strikes a flat, transparent surface (n= 1.59)
at an angle of 32 degrees from the normal. What is the angle of refraction? -
Correct Answer ✔-Snell's law of refraction states that when light travels through a
material that possesses an index of refraction greater than 1.0, the light rays
change direction and become bent (or refracted). Snell's law is depicted as the
following: n sin i= n' sin i' where n= the index of refraction of the first medium, i=
the angle of incidence, n'= the index of the second medium, and i' = the angle of
the refracted ray. All angles are measured with respect to the normal, which lies
perpendicular to the interface between the different media. For the above
example, 1.33(sin 32)=1.59 sin i', solving for i'= 26.31 degrees. It is important to
commit the index of refraction of water to memory; it is 1.33.
A central retinal artery occlusion (CRAO) causes tremendous damage to the retina.
How will the electroretinogram (ERG) of a person who has suffered a CRAO be
affected? -Correct Answer ✔-A central retinal artery occlusion will cause a loss of
the b-wave which is formed by responses from the bipolar and Muller cells, both
of which are nourished by the central retinal artery. The a-wave results from
excitation of the photoreceptors. The a-wave will not be lost in the event of a
CRAO due to the fact that photoreceptors receive their oxygen supply via the
choroid.
Free radicals can cause severe damage to tissue. Which of the following
electrolytes can function as an antioxidant in the aqueous? -Correct Answer ✔-
The aqueous humor contains many electrolytes including Na+, K+ , Cl-, HCO3-,
glucose, lactate, amino acids, and ascorbate. Ascorbate is found in high
concentrations in the aqueous (20x greater when compared to the concentration
found in plasma). Ascorbate can serve as an antioxidant to eradicate free radicals
, reducing potential damage from ultraviolet light. Interesting note: the aqueous
humor and tears of uncontrolled diabetics display higher levels of glucose than
those of non-diabetics.
A 12-year old male is sitting in your waiting room while his mother undergoes her
annual eye exam. While waiting, he eats a candy bar containing peanuts, and, as
luck would have it, he is deathly allergic to nuts. To counter anaphylactic shock,
what would be the BEST course of action? -Correct Answer ✔-Anaphylactic shock
is defined as a severe, multi-system, type I hypersensitive, acute allergic reaction
that may be life-threatening. Signs of an allergic reaction include tingling, itching,
hives, swelling of lips and tongue, constriction of the airway, vasodilation,
myocardial depression, and a decrease in blood pressure. The EpiPen is injected
intramuscularly to the upper lateral thigh to ensure rapid delivery. Epinephrine
(Adrenaline) activates both alpha and beta adrenergic receptors causing an
increase in peripheral vascular resistance and allowing for an increase in blood
pressure and coronary artery perfusion. Adrenaline also serves to reverse
vasodilation and decrease urticaria and angioedema. For severe, life-threatening
reactions, Benadryl (diphenhydramine) will not work quickly enough. Topical
antihistamines have little if any systemic absorption and therefore will not be
effective in counteracting the anaphylaxis. While oral steroids may be useful in the
post-management of anaphylactic shock, they will not yield the desired
immediate response.
An elderly patient presents in your office with decreased visual acuity. He remarks
that he can read better without his glasses and his refraction denotes a large
myopic shift. Dilated fundus exam is unremarkable. Which of the following slit
lamp findings would MOST likely explain the above findings?
Bilateral corneal arcus
Bilateral limbal girdle of Vogt
Bilateral 3+ nuclear sclerosis of the lens
Bilateral crocodile shagreen -Correct Answer ✔-Nuclear sclerosis is caused by
changes to the optical clarity of the lens. As we age, proteins precipitate out of the
lens matrix, causing the lens to become cloudy and altering its density. As time
passes, the lens will also begin to change color from clear to a yellow/brown in a
