ABO WQE Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Intraretinal microvascular abnormalities in one quadrant: IRMA in one quadrant is a criterion for severe NPDR (the 4-2-1 rule), not proliferative disease.

Neovascularization elsewhere of one-quarter disc area, no hemorrhage: NVE counts as high risk only when it is at least one-half disc area and comes with vitreous or preretinal hemorrhage.

Neovascularization of the disc of one-third disc area, no hemorrhage: Correct. NVD of about one-quarter to one-third disc area or more meets the DRS high-risk criteria even without hemorrhage. PRP, or anti-VEGF therapy as in Protocol S, is indicated.

Venous beading in two quadrants: Venous beading in two or more quadrants defines severe NPDR, not high-risk PDR.

High-risk PDR (DRS): NVD at least one-quarter to one-third disc area; any NVD with hemorrhage; or NVE at least one-half disc area with hemorrhage.

Answer: B

Primary angle-closure suspect: PACS has iridotrabecular contact without PAS and with normal IOP. This patient has PAS and IOP of 26 mm Hg.

Primary angle closure: Correct. Iridotrabecular contact over at least 180° with PAS and raised IOP, but no glaucomatous optic neuropathy, is primary angle closure (PAC). LPI or lens extraction is indicated.

Primary angle-closure glaucoma: PACG requires glaucomatous optic neuropathy, and the discs, RNFL, and fields here are normal.

Plateau iris syndrome: This diagnosis requires a persistently closed angle after a patent iridotomy, and none has been performed.

ISGEO: PACS = contact only; PAC = contact plus PAS and/or high IOP; PACG = PAC plus glaucomatous optic neuropathy.

Answer: C

Pigment dispersion syndrome: PDS occurs in young myopes, with homogeneous pigment, midperipheral transillumination defects, and no capsular deposits.

Primary open-angle glaucoma: POAG has no capsular material or Sampaolesi line, and it is usually more symmetric.

Pseudoexfoliation glaucoma: Correct. The bull’s-eye capsular deposit, Sampaolesi line, poor dilation, and asymmetric high IOP are classic. Expect higher, more variable IOP, faster progression, and zonular weakness at cataract surgery (LOXL1 association).

True exfoliation of the lens capsule: True exfoliation is splitting of the capsule from infrared heat exposure (glassblowers), with curled scrolls and usually no glaucoma.

Pseudoexfoliation: target-pattern capsular material, Sampaolesi line, poor dilation, asymmetric high IOP, and weak zonules.

Answer: B

Hospital admission for intravenous antibiotics alone: EVS found no benefit from systemic antibiotics, and intravitreal therapy is essential.

Immediate pars plana vitrectomy with intravitreal antibiotics: Correct. In EVS, eyes presenting with light perception only did much better with immediate vitrectomy plus intravitreal antibiotics than with tap and inject.

Topical fortified antibiotics every hour: Topical antibiotics do not reach therapeutic vitreous levels.

Vitreous tap and intravitreal antibiotic injection in the office: Tap and inject was equivalent to vitrectomy only for eyes with hand-motion vision or better at presentation.

EVS: light perception only → immediate PPV plus intravitreal antibiotics; hand motions or better → tap and inject. Systemic antibiotics added no benefit.

Answer: C

Bandage contact lens and topical corticosteroid: Topical steroids can speed collagenolysis in a melting ulcer and do not treat the underlying systemic vasculitis.

Conjunctival resection adjacent to the ulcer alone: Resection removes a source of collagenases and is used for Mooren ulcer, but alone it does not control rheumatoid vasculitis.

Systemic immunosuppression with rheumatology: Correct. Peripheral ulcerative keratitis with scleritis in rheumatoid arthritis signals systemic vasculitis linked to higher mortality. It requires systemic immunosuppression, for example corticosteroids with a steroid-sparing or cytotoxic agent.

Topical cyclosporine and lubricants alone: Topical immunomodulation and lubrication are too weak for vasculitic PUK and do not address the systemic disease.

PUK with scleritis in rheumatoid arthritis is a sign of systemic vasculitis: treat systemically; local measures are only adjuncts.

Answer: D

Intrastromal voriconazole injection: Intrastromal injection is an adjunct for deep or refractory lesions, not first-line therapy for a 3-mm ulcer.

Oral voriconazole added to topical therapy: MUTT II found no benefit from adding oral voriconazole for severe filamentous fungal ulcers, and it added adverse events.

Penetrating keratoplasty without delay: Therapeutic keratoplasty is reserved for perforation or progression despite maximal medical therapy.

Topical natamycin 5% drops: Correct. For filamentous fungal keratitis, MUTT I showed better acuity and fewer perforations with topical natamycin than with topical voriconazole, especially for Fusarium.

Septate hyphae after plant trauma means filamentous fungus: topical natamycin first (MUTT I); oral voriconazole adds nothing (MUTT II).

Answer: B

Intraorbital right optic nerve: An intraorbital optic nerve lesion causes a central scotoma in the right eye only; the fellow-eye field would be normal.

Junction of the right optic nerve and chiasm: Correct. A central scotoma in one eye with a superotemporal defect respecting the vertical meridian in the other eye is a junctional scotoma. It localizes to the junction of the optic nerve and chiasm, often from a sellar or parasellar mass such as a meningioma.

Body of the optic chiasm: A lesion of the chiasm body gives bitemporal hemianopia without a unilateral central scotoma.

Left optic tract: A tract lesion gives an incongruous homonymous hemianopia, with any afferent pupillary defect in the eye with temporal field loss.

Central scotoma in one eye plus a temporal field defect respecting the vertical meridian in the other localizes to the optic nerve–chiasm junction: image the sella with contrast MRI.

Answer: D

Left inferior oblique: A left inferior oblique palsy also gives a right hypertropia (left hypotropia), but it is worse in right gaze and on right head tilt.

Left superior rectus: Left superior rectus weakness gives a right hypertropia (left hypotropia) worse in left gaze, especially up and left, and on left head tilt, not right tilt.

Right inferior rectus: A right inferior rectus palsy gives a right hypertropia that is worse in right gaze (down and right) and on left head tilt.

Right superior oblique: Correct. A right hypertropia that is worse in left gaze (especially down and left) and on right head tilt localizes to the right superior oblique, the classic result after closed head trauma.

Three-step test: which eye is high, which horizontal gaze worsens it, and which tilt worsens it. Right hyper, worse in left gaze and on right tilt, is a right superior oblique palsy.

Answer: B

Emergent repair within 24 hours: Emergent repair is for a trapdoor fracture with muscle entrapment and a nonresolving oculocardiac reflex (usually in children); forced ductions here are free.

Repair within about 2 weeks of injury: Correct. A floor fracture involving more than half the floor with early enophthalmos of at least 2 mm will produce a cosmetically significant globe malposition, so repair is done within about 2 weeks, before fibrosis sets in.

Reassess at 3 months and repair only for persistent diplopia: Waiting is right for small fractures with resolving diplopia, but this fracture size and early enophthalmos predict worsening that is harder to correct after scarring.

Observation without surgical repair: Observation suits small fractures without enophthalmos; this one already shows 3 mm.

Floor fracture timing: immediate for entrapment with oculocardiac reflex; within 2 weeks for large fractures or early enophthalmos/hypoglobus or nonresolving diplopia with restriction; otherwise observe.

Answer: B

Bilateral lateral rectus recessions alone: Recessions alone correct the primary deviation but leave the V-pattern and the oblique overaction.

Bilateral lateral rectus recessions with inferior oblique weakening: Correct. A V-pattern (upgaze minus downgaze 20Δ, above the 15Δ threshold) with clinically overacting inferior obliques is best treated by weakening the obliques at the same time as the horizontal surgery.

Bilateral lateral rectus recessions with infraplacement: Vertical transposition is used when the obliques are normal, and for a V-pattern the lateral recti are moved up, toward the open end of the V ("MALE" rule), not down.

Bilateral lateral rectus recessions with superior oblique weakening: Weakening the superior obliques treats an A-pattern and would worsen this V-pattern.

A- and V-patterns: if obliques are dysfunctional, operate on the obliques; if not, transpose the horizontal recti (medial recti toward the apex, lateral recti toward the empty space).

Answer: C

1. Corneal astigmatism (44.00 − 43.00 = 1.00 D WTR) equals the refractive cylinder, so the tear lens under a spherical RGP corrects it; start from the sphere power, −3.00 D.
2. Base curve 43.50 D vs flat K 43.00 D: the lens is 0.50 D steeper, which creates a +0.50 D tear lens.
3. SAM (steeper add minus): −3.00 + (−0.50) = −3.50 D.

−4.50 D: This uses the full power in the steep meridian (−4.00 D) before applying the tear lens. The spherical rigid lens and tear lens already neutralize the corneal cylinder.

−4.00 D: This uses the spherical equivalent (−3.50 D) before applying the tear lens. With a rigid lens on a cornea whose toricity matches the refraction, start from the sphere (flat-meridian) power.

−3.50 D: Correct. The tear lens neutralizes the 1.00 D of corneal astigmatism, leaving −3.00 D. A base curve 0.50 D steeper than flat K creates a +0.50 D tear lens, so steeper add minus: −3.00 + (−0.50) = −3.50 D.

−2.50 D: This applies "flatter add plus" to a lens fitted steeper than K, which reverses the tear-lens sign.

RGP power: start from the flat-meridian refraction (vertexed), then apply SAM-FAP for the tear lens.

Answer: A

1. Object vergence: U = 1/(−0.05 m) = −20.00 D (light diverging, travelling left to right).
2. Image vergence: V = U + P = −20.00 + 10.00 = −10.00 D.
3. Image distance: 1/(−10) = −0.10 m, so the image is 10 cm to the left of the lens, on the object side (virtual).
4. Transverse magnification = U/V = (−20)/(−10) = +2: erect and twice the object size.

Erect, magnified, and virtual: Correct. U = 1/(−0.05) = −20 D; V = U + P = −20 + 10 = −10 D. The image is 10 cm to the left of the lens (virtual), and magnification U/V = (−20)/(−10) = +2, so it is erect and 2×. This is how a simple magnifier works.

Erect, minified, and virtual: A minus lens gives an erect, minified, virtual image. This is a plus lens with the object inside its focal length.

Inverted, magnified, and real: This happens when the object is between F and 2F, beyond 10 cm from this lens.

Inverted, minified, and real: This happens when the object is beyond 2F (more than 20 cm from this lens).

An object inside the focal length of a plus lens gives an erect, magnified, virtual image: the simple magnifier.

Answer: C

Acute retinal necrosis: ARN occurs mainly in immunocompetent patients and causes marked vitritis, occlusive arteritis, and rapid, confluent peripheral necrosis.

Candida endophthalmitis: Candida produces fluffy white chorioretinal lesions that extend into the vitreous ("string of pearls"), usually with prominent vitritis.

Cytomegalovirus retinitis: Correct. Slowly progressive, hemorrhagic, granular retinitis along the vessels with minimal vitritis in a patient whose CD4 count is under 50 cells/μL is classic CMV retinitis.

Progressive outer retinal necrosis: PORN (from VZV) also occurs with severe immunosuppression, but it is extremely rapid, multifocal, and deep (outer retina), with few hemorrhages and early sparing around the vessels.

With CD4 under 50 cells/μL: CMV retinitis is slow, granular, and hemorrhagic with little vitritis; PORN is fulminant, multifocal, and outer-retinal.

Answer: C

Fuchs uveitis syndrome: Fuchs uveitis causes chronic, low-grade, usually painless inflammation with diffuse stellate KPs and diffuse (not sectoral) iris atrophy or heterochromia.

Glaucomatocyclitic crisis: Posner-Schlossman syndrome causes recurrent unilateral IOP spikes with minimal cells and a few fine KPs, but not sectoral iris atrophy or reduced corneal sensation.

Herpetic anterior uveitis: Correct. Unilateral anterior uveitis with high IOP (trabeculitis), reduced corneal sensation, and sectoral iris atrophy points to HSV or VZV. Treat with an oral antiviral plus a topical corticosteroid.

HLA-B27–associated anterior uveitis: HLA-B27 uveitis is acute and fibrinous, usually with low or normal IOP and no iris atrophy.

Unilateral anterior uveitis with high IOP, reduced corneal sensation, and sectoral iris atrophy suggests a herpetic cause.