ABO WQE practice questions: free board-style MCQs with answers and a scored practice test

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ABO WQE practice questions with answers

Free WQE practice questions from OphthoMentor's public library, one from each of the 13 BCSC sections in section order, then a second from the first two. Pick an answer to see whether it is right, then read the explanation; each question links to its own page. Every item is an original single-best-answer question written in the board style of the ABO's written exam, and none is a released WQE item.

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1. Question 1 · General medicine

   Polymyalgia rheumatica

   A patient taking prednisone for polymyalgia rheumatica has no headache or visual disturbance. Which advice about giant cell arteritis is most appropriate?

   • AUnder 1 in 100 develop it, routine review needs no specific warning
   • BAbout 1 in 10 develop it, report scalp or jaw pain
   • CAbout 1 in 10 develop it, arrange temporal artery biopsy now
   • DAbout half develop it, arrange temporal artery biopsy now

   Show the answer and explanationAnswer and explanation

   Answer: B. About 1 in 10 develop it, report scalp or jaw pain

   Polymyalgia rheumatica, a common inflammatory disease of older adults, causes proximal aching and morning stiffness of the neck, shoulders and hips. About 10% of patients develop giant cell arteritis, so they should be asked about, and told to report, symptoms such as scalp tenderness and jaw claudication, along with any visual disturbance. Prednisone typically brings dramatic relief within 2 to 3 days and, without relapses, can usually be tapered off in about a year. Methotrexate may reduce the corticosteroid requirement when longer treatment is needed.

   Clinical pearl: Absence of morning stiffness helps exclude polymyalgia rheumatica, and the classic sign is that the patient cannot lift the arms beyond 90°.

2. Question 2 · Fundamentals

   What has caused these changes in the front of the eye?

   Four days after a single operation in which the medial, inferior and superior rectus muscles of her right eye were recessed, a 62-year-old woman returns with aching and blurred vision. Acuity is 20/125 (0.16). The cornea is hazy with epithelial edema and folds, cells and flare fill the chamber without hypopyon, the pupil is oval and sluggish, and the pressure is 8 mmHg. The conjunctival incisions are closed and clean. What has caused these changes in the front of the eye?

   • AInfection entering through an occult scleral perforation
   • BOcclusion of the short posterior ciliary arteries
   • CLoss of the anterior ciliary arterial supply
   • DInjury to the short ciliary nerves

   Show the answer and explanationAnswer and explanation

   Answer: C. Loss of the anterior ciliary arterial supply

   Each rectus muscle carries one to four anterior ciliary arteries, and the superior, medial and inferior recti usually carry them in pairs. These vessels emerge from the muscles, pierce the sclera and join the long posterior ciliary supply at the major arterial circle, which helps perfuse the anterior segment. Disinserting two or more recti can therefore leave the front of the eye ischemic, as recessing three at one sitting did here. The corneal edema, chamber reaction, oval sluggish pupil and low pressure reflect that ischemia. Staged surgery or a vessel-sparing technique lowers the risk. A fornix rather than limbal incision may also help. The risk is greatest in older patients with vascular disease such as diabetes, in whom even two recti may be enough. Severe ischemia can progress to anterior segment necrosis and phthisis.

   Clinical pearl: Anterior segment ischemia can also follow scleral buckling, through the same shared anterior and posterior ciliary circulation.

3. Question 3 · Clinical optics

   Vergence and lensmaker's equations

   A resident uses the vergence equation to predict where a +10.00 D lens will image a distant point source on its axis. On the optical bench, parallel rays that pass through the outer zone of the lens cross the axis in front of the predicted focus. For which rays is the vergence equation strictly valid?

   • ARays passing through the nodal points of the lens
   • BRays near the axis making small angles with it
   • CRays entering parallel to the optic axis
   • DMonochromatic rays at any angle to the axis

   Show the answer and explanationAnswer and explanation

   Answer: B. Rays near the axis making small angles with it

   The vergence and lensmaker's equations are deduced from Snell's law using small-angle trigonometric approximations, which hold only in the paraxial regime: rays traveling close to the optic axis and forming small angles with it. Gaussian optics is the linear-algebra treatment of this regime. Peripheral rays fall outside the approximation. With positive spherical aberration they focus anterior to the central, paraxial rays, as seen on the bench. Aberration is the departure of real systems from this idealized paraxial imaging.

   Clinical pearl: Wavefront theory is a standard way to analyze imaging beyond the paraxial regime, especially aberrations.

4. Question 4 · Pathology & tumors

   Management: Primary enucleation with 12 mm of optic nerve

   Primary enucleation with 12 mm of optic nerve is performed on the left eye of a 2-year-old boy with retinoblastoma. The right eye is normal. Sections show a 4-mm focus of tumor replacing the peripapillary choroid and tumor within the optic nerve extending 2 mm behind the lamina cribrosa. The inked nerve end and the sclera are free of tumor, and there is no extrascleral extension. Preoperative magnetic resonance imaging showed no orbital or intracranial disease. Which postoperative management is most appropriate?

   • ASystemic chemotherapy as adjuvant treatment
   • BExamination and imaging surveillance without treatment
   • CSystemic chemotherapy plus orbital radiotherapy
   • DOrbital exenteration followed by observation

   Show the answer and explanationAnswer and explanation

   Answer: A. Systemic chemotherapy as adjuvant treatment

   Massive choroidal invasion (3 mm or more), anterior chamber involvement, extrascleral extension and postlaminar optic nerve invasion each raise metastatic risk, and iris neovascularization, sometimes with angle closure, is associated with such high-risk histology. When massive choroidal or retrolaminar nerve invasion is found most centers give adjuvant systemic chemotherapy. A Children's Oncology Group study found risk greatest when peripapillary choroidal invasion over 3 mm coexists with postlaminar invasion of at least 1.5 mm, as here, supporting more intensive adjuvant chemotherapy for that cohort.

   Clinical pearl: Aim for at least 10 mm of optic nerve when enucleating for retinoblastoma. A long stump gives the best chance of removing postlaminar tumor with a clear margin.

5. Question 5 · Neuro-ophthalmology

   Normal pressure with an abnormal nerve: investigation

   Referred with suspected normal-tension glaucoma, a 56-year-old man reports numbness in both feet. He had a total gastrectomy for cancer eight years ago and takes no injections or supplements. Acuity is 20/40 (0.5) in each eye. Pressures have ranged from 13 to 15 mm Hg over several visits, central corneal thickness is normal and the angles are open. Both discs show cup-disc ratios of 0.6 with temporal pallor, and fields show symmetric central scotomas. Which investigation is most likely to identify the cause of his optic neuropathy?

   • ATwenty-four-hour ambulatory blood pressure monitoring
   • BSerum vitamin B12 level
   • CCarotid duplex ultrasound imaging
   • DDiurnal intraocular pressure phasing

   Show the answer and explanationAnswer and explanation

   Answer: B. Serum vitamin B12 level

   Normal pressure with an abnormal nerve does not establish normal-tension glaucoma: other optic neuropathies, including toxic causes such as methanol and nutritional causes such as vitamin B12 deficiency, can mimic it with progressive field loss and need different treatment. Dominant optic atrophy is another adult mimic, because its temporal pallor comes with temporal excavation of the cup, so a lifelong history, a similarly affected relative and a blue-yellow color defect are worth seeking before the glaucoma label sticks. The work-up therefore includes a history of diet, surgery, medication and toxin exposure, plus, in selected patients like this one, bloods such as B12, folate and a full blood count. Gastrectomy removes the intrinsic factor needed to absorb B12, and with numb feet, temporal pallor and central scotomas it makes deficiency the leading suspect. Neurologic and optic nerve damage can occur without anemia, and when the level is low-normal, methylmalonic acid and homocysteine are more sensitive tests. Liver stores last several years, so deficiency can surface long after gastric surgery or a change to a vegan diet.

   Clinical pearl: Before labeling normal-tension glaucoma, also ask about systemic beta-blockers: one started after the damage occurred can mask raised pressure and mimic the condition.

6. Question 6 · Pediatrics & strabismus

   Which habitual head position would let her fuse?

   Photographs prompt referral of an 11-year-old girl because her right eye looks divergent. With the head straight there is 20 prism diopters of exotropia at 6 meters. The right eye abducts fully but stops 4 mm short of the nasal canthus on attempted adduction, and its fissure narrows by 3 mm as she tries. Vertical movements of both eyes are full, there is no vertical deviation in any gaze, and the fellow eye moves fully. Which habitual head position would let her fuse?

   • AFace turn to the right
   • BChin elevation with the head back
   • CFace turn to the left
   • DHead tilt onto the right shoulder

   Show the answer and explanationAnswer and explanation

   Answer: C. Face turn to the left

   Full abduction, poor adduction, fissure narrowing on attempted adduction and exotropia in primary position identify Duane syndrome in the right eye. Her deviation is smallest where the right eye does not have to adduct, which is in right gaze. To hold her eyes there while looking straight ahead, she rotates her face to the left, away from the affected side.

   Clinical pearl: When Duane syndrome combines poor abduction with esotropia, the face turns toward the affected eye, sparing it from abducting.

7. Question 7 · Oculoplastics

   Chalazion-like nodule: mechanism

   A 71-year-old woman has a firm yellowish nodule on the margin of the lower lid, with loss of the lashes around it. It has been present for eight months and has been curetted twice as a presumed chalazion, recurring each time. The conjunctiva of that eye is injected and has not responded to topical treatment. A further procedure under local anesthesia is planned. How should tissue be obtained at this procedure?

   • ATake a full-thickness tarsal biopsy for permanent sections
   • BTake a shave biopsy of the nodule surface
   • CCurette the lesion again and examine contents
   • DTake an incisional biopsy for frozen section diagnosis

   Show the answer and explanationAnswer and explanation

   Answer: A. Take a full-thickness tarsal biopsy for permanent sections

   A chalazion-like nodule that keeps recurring and destroys lashes, with chronic one-sided conjunctival injection, is sebaceous carcinoma until proven otherwise, and chronic unilateral blepharitis should also raise suspicion. The tumor arises deep in the tarsal meibomian glands or in the Zeis glands at the margin, so shave samples or curettings may show only chronic inflammation. A full-thickness lid biopsy, or a full-thickness punch of the tarsal plate, sent for permanent sections gives the diagnosis.

   Clinical pearl: Because histologic misdiagnosis of sebaceous carcinoma occurs, tell the pathologist the clinical suspicion and request immunostains, lipid stains on tissue kept out of paraffin processing, or expert review when warranted.

8. Question 8 · Cornea & external disease

   Cornea's sensory supply: mechanism

   Ten weeks after a vesicular eruption over the left forehead and upper lid, a painless, white, quiet eye has a horizontally oval lower central epithelial defect with smooth rolled edges over grey stroma. The lids close fully on gentle closure and the blink is complete. Which mechanism best explains the failure of the epithelium to heal?

   • ALoss of trigeminal trophic support to the epithelium
   • BContinuing viral replication in the corneal epithelium
   • CImmune stromal inflammation driven by viral antigen
   • DExposure of the surface from incomplete lid closure

   Show the answer and explanationAnswer and explanation

   Answer: A. Loss of trigeminal trophic support to the epithelium

   The cornea's sensory supply comes mainly from the trigeminal ophthalmic division, which the rash involved. Corneal nerves are trophic as well as sensory: without them epithelial turnover slows, blinking and tear secretion fall, and an anaesthetic cornea may first show an interpalpebral horizontal band of punctate staining, then defects that fail to close, typically horizontal oval lower erosions over grey stroma. Up to half of patients have reduced corneal sensation after ophthalmic zoster, although fewer develop neurotrophic keratopathy, so test sensation in any painless defect. Cocaine and methamphetamine use are also associated with reduced corneal sensation and neurotrophic ulceration. Left unprotected, a denervated cornea may become infected or go on to hypopyon ulceration, melting and perforation. Trigeminal damage from skull base tumours or their surgery produces the same picture, and lubrication alone often fails to close the defect. Test sensation with a cotton wisp before any anaesthetic drop is instilled.

   Clinical pearl: Reduced corneal sensation can persist for a year or more after ophthalmic zoster, so neurotrophic breakdown can begin months after the rash has healed.

9. Question 9 · Uveitis

   Fragment entering the eye: investigation

   A metallic fragment that entered the eye while steel was being hammered lies in the posterior vitreous, and its surgical removal is planned for the same day. Which additional measure most reduces the risk of endophthalmitis?

   • AIntravitreal antibiotic given during fragment removal
   • BHourly topical antibiotic drops after fragment removal
   • COral antibiotic for seven days after surgery
   • DSubconjunctival antibiotic depot after fragment removal

   Show the answer and explanationAnswer and explanation

   Answer: A. Intravitreal antibiotic given during fragment removal

   A fragment entering the eye carries surface and environmental organisms straight into the vitreous cavity, so penetrating trauma with a retained intraocular foreign body is at the high-risk end of the endophthalmitis spectrum, and the drug must be delivered where the inoculum lies. In a randomized trial of penetrating eye injuries, intraocular antibiotic given at repair reduced endophthalmitis, and the benefit was concentrated in eyes with a retained foreign body. That benefit applies to this risk profile and does not justify routine intravitreal prophylaxis for every ocular procedure. A soiled object that perforates the eye and withdraws is also high risk, even when imaging shows no retained fragment and the vitreous is quiet, so a low threshold for intravitreal antibiotic at repair is reasonable there too, although the evidence is limited.

   Clinical pearl: When removing a retained intraocular foreign body from a contaminated injury, give prophylactic intravitreal antibiotic at the same operation.

10. Question 10 · Glaucoma

    Woman has been diagnosed with primary open-angle glaucoma

    A woman has been diagnosed with primary open-angle glaucoma on the basis of open angles, inferior rim notches and matching superior arcuate defects that repeat on retesting. What finding at this visit would overturn the primary open-angle diagnosis?

    • AFlecks of material on the lens capsule
    • BFurther deepening of the arcuate defect
    • COpen-angle glaucoma in her brother
    • DA fall in pressure on topical treatment

    Show the answer and explanationAnswer and explanation

    Answer: A. Flecks of material on the lens capsule

    An open angle with concordant rim notching and repeatable arcuate defects establishes an open-angle glaucomatous neuropathy, but not its cause. The primary label is given by exclusion and stands only while a deliberate search for secondary mechanisms remains negative: exfoliation, pigment dispersion, inflammation, trauma, corticosteroid use by any route, lens particles, previous intraocular surgery, raised episcleral venous pressure, and new vessels in the still-open angle of early neovascular glaucoma. Exfoliative material on the anterior capsule or pupil margin moves the eye out of the primary category. Pressure level does not.

    Clinical pearl: Examine the dilated lens capsule and pupil margin at follow-up visits, not only at diagnosis, because exfoliative material may become visible only later.

11. Question 11 · Lens & cataract

    Pars plana vitrectomy in a phakic eye: diagnosis

    Two years after pars plana vitrectomy with gas tamponade for a macular hole, a 64-year-old man reports that distance vision has dimmed while he now reads small print without his glasses. Refraction has moved from +1.50 D to -1.00 D, and acuity is 20/40 (0.5) improving to 20/30 (0.7) with pinhole. He used topical prednisolone drops for six weeks after surgery. Oncoming headlights dazzle him. The macula is flat on optical coherence tomography. Which lens change accounts for both his refractive shift and the dimming?

    • AProgressive sclerosis deep within the lens nucleus
    • BA posterior subcapsular plaque on the visual axis
    • CCortical spokes extending inward from the lens equator
    • DA fibrous plaque beneath the anterior lens capsule

    Show the answer and explanationAnswer and explanation

    Answer: A. Progressive sclerosis deep within the lens nucleus

    Pars plana vitrectomy in a phakic eye, particularly with gas tamponade, is strongly associated with nuclear sclerosis, linked to increased vitreous oxygen tension: within 2 years, 80%–100% of such eyes develop a visually significant nuclear cataract, though this is less frequent before age 50. A sclerosing nucleus pulls the eye toward myopia, so his refraction has traveled 2.50 D and he reads small print unaided while distance vision dims and headlights dazzle. The flat macula and the pinhole gain point to an optical cause rather than macular disease. Nuclear cataract is the commonest complication of vitrectomy in a phakic eye, so it belongs in consent. Raised intraocular oxygen tension after vitrectomy has also been linked to open-angle glaucoma in later years.

    Clinical pearl: Compare today's refraction with the one recorded before retinal surgery, because a documented myopic drift turns a vague complaint of dimming into measurable nuclear change.

12. Question 12 · Retina & vitreous

    76-year-old woman with bilateral geographic atrophy

    A 76-year-old woman with bilateral geographic atrophy has just received her first monthly intravitreal injection of pegcetacoplan in the right eye, where the atrophy still spares the foveal center. Acuity is 20/32 (0.6) in the right eye and 20/100 (0.2) in the left. Soft drusen surround the atrophic areas, and tomography shows no fluid or hemorrhage in either eye. Her next injection is booked in four weeks, and she asks how to look after her eyes in between. What advice best protects her vision between visits?

    • AReport only pain or redness after each injection
    • BAmsler self-testing with urgent review for distortion
    • CRely on acuity checks at each injection visit
    • DNo self-testing, since atrophy changes too slowly

    Show the answer and explanationAnswer and explanation

    Answer: B. Amsler self-testing with urgent review for distortion

    Eyes with geographic atrophy can convert to neovascular disease, and in the complement-inhibitor trials new neovascularization appeared more often in treated eyes than with sham. Conversion is painless and may occur between injections, so she should test each eye regularly at home with an Amsler grid and seek urgent assessment for any new distortion, blur or scotoma, because active neovascularization calls for anti-VEGF treatment. Risk factors such as smoking should also be addressed.

    Clinical pearl: Avacincaptad pegol, the other intravitreal complement inhibitor for geographic atrophy, shares this neovascular signal and also causes transient intraocular pressure rises after injection.

13. Question 13 · Refractive surgery

    Mechanism: After uncomplicated phacoemulsification

    After uncomplicated phacoemulsification aimed at emmetropia, an eye that had myopic laser in situ keratomileusis 18 years earlier, with a stable refraction until the cataract developed, is left at +1.75 D with a centered implant. Which mechanism best accounts for this refraction?

    • AAxial length measured shorter than its true value
    • BOverestimation of central corneal power by keratometry
    • CPosterior corneal steepening induced by the prior ablation
    • DProgressive hyperopic drift of the original ablation

    Show the answer and explanationAnswer and explanation

    Answer: B. Overestimation of central corneal power by keratometry

    Keratometers measure curvature on a paracentral ring and convert it to total power using an assumed relationship between front and back surfaces. After myopic ablation the center is flatter than that ring, and the front surface has changed while the back has not, so both assumptions push the reading above the true central power. An implant calculated from that inflated value is too weak, leaving the eye hyperopic. Adjusted calculation methods are therefore needed.

    Clinical pearl: The clinical history method, which derives current central power from the preoperative keratometry and the refractive change the laser induced, has proved less accurate after excimer surgery than certain no-history methods.

14. Question 14 · General medicine

    Management: Standard four-drug intensive treatment

    Three weeks into standard four-drug intensive treatment for pulmonary tuberculosis, a 41-year-old woman who wears soft contact lenses finds that her lenses have turned orange-pink and her tears look tinged. Both eyes are red and sticky, with crusted lid margins and conjunctival injection. Acuity is 20/20 (1.0) in each eye, color vision and pupils are normal, and the optic discs look healthy. Which of her antituberculous drugs is the most likely cause?

    • AIsoniazid
    • BPyrazinamide
    • CEthambutol
    • DRifampin

    Show the answer and explanationAnswer and explanation

    Answer: D. Rifampin

    Rifampin tints tears pink or orange, which can discolor soft contact lenses (rifampin prescribing information), and it can cause blepharoconjunctivitis. Listed ocular effects also include conjunctival hyperemia, exudative conjunctivitis and increased tearing. All current antituberculous drugs have toxic effects, especially hepatic and neurologic ones, so patients need careful monitoring throughout treatment. A few patients taking isoniazid or ethambutol develop optic neuropathy, which would show as falling acuity, color vision or visual field. Her normal visual function and discs argue against it.

    Clinical pearl: Rifampin clears nasal carriage of Staphylococcus aureus, but bacteria quickly become resistant when it is used alone, so it is usually given adjunctively.

15. Question 15 · Fundamentals

    How should his macular edema be managed from now on?

    For eight years a 46-year-old man has had chronic noninfectious posterior uveitis with recurrent cystoid macular edema in the left eye. Topical corticosteroid drops never controlled it. Biodegradable dexamethasone implants have controlled the edema each time, but it returns about four months after each one, and he has received five in three years. Systemic immunomodulatory therapy was stopped last year after severe hepatotoxicity. He is pseudophakic, the pressure has stayed at 16 mmHg through every implant, and the retinal periphery is quiet. How should his macular edema be managed from now on?

    • Arepeat the dexamethasone implant at each recurrence
    • Bgive intravitreal triamcinolone at each recurrence
    • Cstart topical difluprednate between recurrences
    • Dinsert a fluocinolone acetonide intravitreal implant

    Show the answer and explanationAnswer and explanation

    Answer: D. insert a fluocinolone acetonide intravitreal implant

    The edema responds to corticosteroid every time and returns as each dexamethasone implant is spent. Its biodegradable polymer dissolves as it releases drug, giving clinical efficacy of about 3 months. A nonbiodegradable fluocinolone acetonide intravitreal implant, approved for chronic noninfectious posterior uveitis, releases about 0.2 µg/day for up to 36 months. A surgically placed 0.59-mg pars plana fluocinolone implant shares that indication and releases drug for about 30 months. Intraocular corticosteroids can raise pressure, and the response depends on the duration of therapy. Giving short-acting depots only once symptoms return leaves the eye inflamed for part of every cycle and can cause a stepwise, saw-tooth decline in acuity. In phakic eyes a long-acting implant makes cataract likely.

    Clinical pearl: Pressure that stayed normal through short-acting corticosteroid implants does not ensure it will stay normal over months of fluocinolone release, so periodic checks must continue.

WQE questions by subject area

Free ABO WQE practice test: 26 questions, scored by subspecialty

A free WQE practice test with 26 original board-style questions, two from each of the 13 subspecialties in BCSC order, and none of them among the 15 above. Answer every question without feedback, as at the test center, then score it to see your result by subspecialty with the answer and explanation for every question. Aim for a little over a minute a question, the WQE's own pace. No account is needed.

1. Question 1 · General medicine

   Three episodes of complete darkening of the left eye, each lasting about a minute, bring a 74-year-old woman to the eye clinic. For a month she has had a new left temporal headache and stiffness of the shoulders on waking. Acuity is 20/25 (0.8) in each eye. Pupils, optic discs and retinal arterioles look normal, with no visible embolus. Her pulse is regular, and no carotid bruit is heard. Which investigation is most urgent?

   • A.Carotid duplex ultrasonography of the neck
   • B.Erythrocyte sedimentation rate and C-reactive protein
   • C.Echocardiography to look for a cardiac embolic source
   • D.Diffusion-weighted magnetic resonance imaging of the brain
2. Question 2 · Fundamentals

   For three weeks a 31-year-old woman has noticed that her right pupil is larger than her left and that near work blurs on that side. In light the right pupil measures 6 mm and reacts poorly, with some segments of the sphincter contracting while others stay still. Lid position and ductions are normal. One drop of pilocarpine 0.12% in each eye constricts the right pupil briskly and leaves the left unchanged. Why does the right pupil constrict briskly to the dilute drop?

   • A.compression of the preganglionic oculomotor fibers
   • B.pharmacologic blockade of the iris sphincter muscarinic receptors
   • C.blunt traumatic tears of the iris sphincter muscle
   • D.postganglionic parasympathetic denervation of the sphincter
3. Question 3 · Clinical optics

   Over 5 months, a 52-year-old man has needed three new pairs of glasses. His refraction has moved from −1.00 D sphere in each eye to −2.75 D sphere in each eye, with essentially no change in cylinder power or axis. Corneal topography is unchanged, the anterior chambers are deep, both crystalline lenses are clear, and the fundi look normal. How should his changing refraction be managed?

   • A.Arrange a diabetes workup with blood glucose testing
   • B.Dispense the new spectacle correction and review him in one year
   • C.Attribute the change to nuclear sclerotic cataract and observe
   • D.Refer for keratoconus screening with repeat corneal topography
4. Question 4 · Pathology & tumors

   A 74-year-old man undergoes repeat penetrating keratoplasty in his right eye. His first graft, placed for pseudophakic bullous keratopathy after a complicated cataract operation, clouded within 2 years. The explanted button shows Bowman layer anteriorly. Its posterior face is lined, in place of endothelium, by a sheet of squamous cells resembling the anterior covering of the button. Underlying Descemet membrane is of normal thickness, and there are no spindle cells, collagenous tissue, or new basement membrane. The left cornea is clear. Which process best accounts for the posterior lining?

   • A.Fibrous ingrowth from stromal keratocytes
   • B.Endothelial metaplasia of iridocorneal endothelial syndrome
   • C.Endothelial epithelialization in posterior polymorphous dystrophy
   • D.Epithelial downgrowth from the surface
5. Question 5 · Neuro-ophthalmology

   A 76 year old woman noticed painless loss of vision in her right eye on waking four hours ago. Right acuity is counting fingers with a relative afferent pupillary defect. The posterior retina is whitened around a cherry-red fovea, the disc is not swollen, and no embolus is visible. The left eye is normal. She has treated hypertension, her pulse is regular, and she denies headache, jaw pain on chewing and scalp tenderness. Which blood tests should be sent most urgently?

   • A.Sedimentation rate, C-reactive protein and platelets
   • B.Fasting lipid profile and glycated hemoglobin
   • C.Antiphospholipid antibodies and a full thrombophilia screen
   • D.Homocysteine level and serum protein electrophoresis
6. Question 6 · Pediatrics & strabismus

   Born at 26 weeks' gestation and treated with laser for retinopathy of prematurity, an 18-year-old woman is referred because her right eye looks turned outward in photographs. While she fixates a penlight, the right corneal reflex lies well nasal to the corneal center. Cover-uncover and alternate cover testing produce no refixation movement at distance or near. Acuity is 20/30 (0.7) right and 20/20 (1.0) left. In the right fundus, traction at the posterior pole has displaced the fovea temporally. Which explanation accounts for the outward appearance of her right eye?

   • A.Intermittent exotropia under good control
   • B.Negative angle kappa from a nasally placed fovea
   • C.Large positive angle kappa from macular dragging
   • D.Eccentric fixation from strabismic amblyopia
7. Question 7 · Oculoplastics

   On the first morning after right lateral orbitotomy for excision of a lacrimal gland mass, a 47-year-old woman is alert and fully oriented. Her only treatment is chloramphenicol ointment and oral paracetamol (acetaminophen). The right pupil measures 7 mm and does not constrict to light or to a near target. It has been like this since she woke from anesthesia. Lid height is symmetric and ductions are full. Distance acuity is 20/20 (1.0) right, but even with her usual reading glasses she cannot read small print with that eye, although the left eye reads it easily. What best accounts for the pupil and the reading difficulty?

   • A.Compression of the third nerve by orbital hematoma
   • B.Raised intracranial pressure after the orbitotomy
   • C.Injury to the ciliary ganglion during surgery
   • D.Inadvertent contact with a topical mydriatic agent
8. Question 8 · Cornea & external disease

   After failing a school vision screen, an 11-year-old girl has corrected acuity of 20/40 (0.5) right and 20/20 (1.0) left. Her father has similar corneal changes and uses drops for raised eye pressure. In the right cornea, clustered blisterlike vesicles and a pair of parallel ridged bands lie at the level of Descemet membrane, with mild stromal edema. The left shows a few round lesions at the same level. Corneal diameters are 11.5 mm, pressures are 24 and 16 mm Hg, and gonioscopy shows a few peripheral iridocorneal adhesions on the right. What is the most likely diagnosis?

   • A.Primary congenital glaucoma with Haab striae
   • B.Iridocorneal endothelial syndrome
   • C.Posterior polymorphous corneal dystrophy
   • D.Fuchs endothelial corneal dystrophy
9. Question 9 · Uveitis

   A 13-year-old boy has three days of pain, photophobia, and redness in the left eye. Vision is 20/60 (0.3) left. There are 3+ anterior chamber cells with fibrin and a small hypopyon, fine keratic precipitates, and early posterior synechiae. The right eye is quiet. For the past year he has had heel pain at the Achilles insertion, morning stiffness of the lower back, and an intermittently swollen knee. He is otherwise well, and antinuclear antibody is negative. Which course is his uveitis most likely to follow?

   • A.Chronic painless uveitis in both eyes
   • B.Recurrent acute attacks in one eye at a time
   • C.Attacks that follow his joint flares
   • D.Chronic uveitis needing immunosuppression
10. Question 10 · Glaucoma

    Six weeks after laser in situ keratomileusis for −7.00 D myopia, vision in the right eye of a 31-year-old woman has fallen to 20/60 (0.3). Interface haze was treated with topical dexamethasone 0.1%, hourly at first and four times daily since. Goldmann applanation reads 12 mm Hg right and 13 mm Hg left. The right eye shows an optically clear fluid-filled space between flap and stromal bed. The right cup-to-disc ratio is 0.6, recorded as 0.3 before surgery. What best explains the combination of findings in the right eye?

    • A.Corticosteroid pressure rise with falsely low applanation
    • B.Normal-tension glaucoma with an accurate applanation reading
    • C.Ischemic optic neuropathy from suction during flap creation
    • D.Congenital myopic disc tilt misread as new cupping
11. Question 11 · Lens & cataract

    Cataract is linked with systemic, ocular, familial and environmental factors that differ in the strength and consistency of their association across populations. Which factor is most strongly associated with cataract development?

    • A.Treated systemic hypertension
    • B.Long-standing type 2 diabetes
    • C.Maternal history of cataract
    • D.Low degree of myopia
12. Question 12 · Retina & vitreous

    A first episode of central serous chorioretinopathy has resolved without treatment within four months, and acuity is back to 20/20 (1.0). What proportion of such patients go on to have a further episode?

    • A.Up to 50%
    • B.About 5%
    • C.About 15%
    • D.More than 90%
13. Question 13 · Refractive surgery

    Since laser in situ keratomileusis 14 days ago, a 41-year-old man has used hourly topical prednisolone for a diffuse interface haze. The haze is now denser and vision has fallen from 20/20 (1.0) to 20/40 (0.5). The eye is white, the anterior chamber is quiet, and the flap edge is intact. Tonometry now reads 34 mmHg, against 15 mmHg before surgery. Anterior-segment optical coherence tomography shows a thin cleft of fluid within the lamellar interface. Which change to his treatment is needed today?

    • A.Stop the corticosteroid and lower intraocular pressure
    • B.Continue the corticosteroid and add pressure-lowering drops
    • C.Increase corticosteroid frequency and review in one week
    • D.Taper the corticosteroid over the next month
14. Question 14 · General medicine

    Vogt-Koyanagi-Harada disease has been quiet for 4 months in a 31-year-old teacher taking mycophenolate mofetil and prednisone 10 mg daily. It is early autumn, and she asks which vaccines she should have, saying she would prefer the nasal spray for influenza because she dislikes needles. She has no memory of chickenpox, her childhood vaccination record has been lost, and she is not pregnant. She has no known vaccine allergy. Which vaccine should you recommend to her now?

    • A.Intranasal live attenuated influenza vaccine
    • B.Two doses of varicella vaccine
    • C.Injected inactivated influenza vaccine
    • D.Single dose of measles-mumps-rubella vaccine
15. Question 15 · Fundamentals

    An infant has three separate retinoblastomas, two in the right eye and one in the left, while no relative across three generations has had an eye tumor and dilated examination of both parents shows normal retinas. Which genetic event most probably underlies this tumor pattern?

    • A.two acquired variants within one retinal cell
    • B.a variant carried constitutionally by an unaffected parent
    • C.a new germline variant present from conception
    • D.postzygotic mosaicism confined to ocular tissue
16. Question 16 · Clinical optics

    During phoropter refraction of a 21-year-old woman, rapid involuntary oscillations of both eyes appear when the opaque occluder is dialed over her left eye, and the acuity of her right eye falls from 20/20 (1.0) with both eyes open to 20/60 (0.3). The oscillations stop as soon as both eyes are uncovered, and the anterior segments and fundi are normal. How should the left eye be handled while the right eye is refracted?

    • A.Occlude the right eye instead and refract the left first
    • B.Keep the occluder and refract the right eye through a pinhole
    • C.Keep the occluder and add plus sphere over the right eye
    • D.Fog the left eye with an adequate plus lens
17. Question 17 · Pathology & tumors

    Seen for neurofibromatosis type 1 surveillance, a 6-year-old boy has acuity of 20/25 (0.8) in each eye, full color vision, equally reacting pupils and no proptosis. Magnetic resonance imaging shows fusiform enlargement of the left intraorbital optic nerve with an intact dural sheath. He has no headache and no endocrine symptoms, and growth and development are on centile. Which histologic appearance would this lesion show?

    • A.Whorled syncytial cells containing psammoma bodies
    • B.Bipolar hairlike cells with Rosenthal fibers
    • C.Pleomorphic cells with mitoses and necrosis
    • D.Arachnoid cap cells within the dural sheath
18. Question 18 · Neuro-ophthalmology

    A 46-year-old man develops an abrupt severe headache with vomiting. The right upper lid is down, the right eye fails to adduct, elevate or depress, and the right pupil is 5 mm and sluggish. Acuity is reduced in both eyes with loss temporal to fixation on each side. Blood pressure is 82/50 mmHg, serum sodium is low, and he is drowsy. Which treatment should be given first?

    • A.Urgent transsphenoidal surgical decompression of the sella
    • B.Intravenous corticosteroid replacement therapy
    • C.Intravenous hypertonic saline infusion
    • D.Intravenous thyroid hormone replacement
19. Question 19 · Pediatrics & strabismus

    A pediatrician cannot obtain a red reflex in either eye of a 6-week-old girl and refers her. Both lenses carry dense central opacities, the corneas are clear, and both irides look normal. She was born at term, her head circumference is below the third centile, and she failed her newborn hearing screen in both ears. A cardiologist has documented a congenital heart defect, and she has received no medications. Her mother traveled from abroad during the first trimester and has no record of childhood vaccination. Which cause best accounts for her lens opacities?

    • A.Inherited lens opacity of dominant pattern
    • B.Corticosteroid exposure after preterm birth
    • C.Rubella infection transmitted across the placenta
    • D.Anterior segment dysgenesis of both eyes
20. Question 20 · Oculoplastics

    A patient with deeply pigmented skin is listed for lower lid entropion repair. About six lashes, scattered along the lid margin and misdirected at their roots, rub the cornea and have regrown within weeks of two epilations. Which treatment for the regrowing lashes is preferred alongside the entropion repair?

    • A.Cryotherapy to the affected lid margin
    • B.Full-thickness wedge resection of the segment
    • C.Lubricant ointment with clinic review
    • D.Electrolysis of the misdirected lash follicles
21. Question 21 · Cornea & external disease

    A 7-year-old boy with coarse facial features, short stature, restricted shoulder and elbow movement and an enlarged liver and spleen is referred by his paediatrician. Acuity is 20/20 (1.0) in each eye, both corneas are clear and the optic discs are healthy. Two of his mother's brothers had the same facial and skeletal changes and died in early adult life. His parents and his sister are well. Which disorder accounts for his features and his family history?

    • A.Hunter syndrome
    • B.Hurler syndrome
    • C.Morquio syndrome
    • D.Maroteaux-Lamy syndrome
22. Question 22 · Uveitis

    Ten days after a febrile illness with sore throat, a 29-year-old woman has had five days of blurred vision in both eyes. Acuity is 20/40 (0.5) right and 20/50 (0.4) left. There are trace anterior chamber and vitreous cells in each eye, and both fundi show several flat cream-colored plaques across the posterior pole. While she is in the clinic she develops a severe occipital headache, slurred speech, and weakness of the right arm. What should be arranged first for these new symptoms?

    • A.Immediate lumbar puncture for cerebrospinal fluid
    • B.Immediate high-dose intravenous corticosteroid therapy
    • C.Urgent carotid duplex and echocardiography
    • D.Emergency neurologic imaging of the brain
23. Question 23 · Glaucoma

    Fibrillar deposits are seen on both lens capsules of a 74-year-old woman whose intraocular pressure is 16 mm Hg on two agents, with discs and fields stable over three years. Blood pressure measured twice today is 168/96 mm Hg. She smokes 15 cigarettes daily, her lipids were last checked a decade ago, and she has not seen her family doctor for several years. Which referral is most appropriate at this visit?

    • A.Refer for modifiable vascular risk review
    • B.Refer for 24-hour ambulatory pressure monitoring
    • C.Refer for carotid duplex ultrasonography
    • D.Refer for overnight sleep-apnea testing
24. Question 24 · Lens & cataract

    A 58-year-old man reports six months of painless vision loss in his left eye. Visual acuity is hand motions, and a dense nuclear cataract obscures any view of the fundus. Pupillary examination shows a grade 3 relative afferent pupillary defect in the left eye. The right eye is phakic with 20/20 (1.0) vision and a normal pupillary light reflex. He asks what to expect from cataract surgery in the left eye. What should he be told about his likely visual result after surgery?

    • A.A favorable potential-acuity test indicates a good visual recovery
    • B.Longstanding amblyopia accounts for his pupillary defect
    • C.The dense cataract accounts for his pupillary defect
    • D.Coexisting optic-nerve or retinal disease may limit his recovery
25. Question 25 · Retina & vitreous

    Twelve days after emergency bowel resection, a 62-year-old man reports four days of floaters and blurring in both eyes. He has a central venous catheter, is on parenteral nutrition, and has had broad-spectrum antibiotics since surgery. He has no lung disease and has not received corticosteroids. Acuity is 20/40 (0.5) on each side. Several creamy yellow-white lesions lie deep at both posterior poles, with moderate cells in the vitreous. No pigmented scars are seen. Which infection best accounts for these bilateral deep lesions?

    • A.Toxoplasmic retinochoroiditis
    • B.Endogenous candidal chorioretinitis
    • C.Endogenous bacterial endophthalmitis
    • D.Endogenous mold endophthalmitis
26. Question 26 · Refractive surgery

    A 40-year-old woman with rheumatoid arthritis requests laser in situ keratomileusis for −4.00 D in each eye, stable for 3 years. Her arthritis has been in remission for 4 years on unchanged therapy, and her rheumatologist confirms no recent flare. She has no dryness or irritation, and her lids, conjunctiva and tear film are healthy without staining. Corrected acuity is 20/20 (1.0), topography is regular, and central corneal thickness is 550 µm. How should the surgeon proceed with her request?

    • A.Treat one eye at a time after physician liaison
    • B.Decline surgery because she has rheumatoid arthritis
    • C.Treat both eyes on one day with routine consent
    • D.Choose lenticule extraction to spare her corneal nerves

ABO WQE at a glance

WQE question banks compared

Question counts, prices and free access as listed on each provider's own pages on September 26, 2026. OphthoMentor publishes this page and is one of the products compared, so check each provider's current terms before you buy.

As listed on September 26, 2026, in US dollars (OphthoMentor's are its current one-time package prices); temporary discount codes excluded. OphthoMentor publishes this page.

What is the ABO WQE, and what comes after it?

When is the WQE in 2027, and what does it cost?

• Arrive 30 minutes early with one government-issued ID.
• Arriving more than 15 minutes late can mean refused entry and a forfeited attempt and fee.
• Accept the on-screen non-disclosure agreement within 5 minutes.
• Expect no result at the center; the ABO sends results within 6–8 weeks.

What types of questions are on the WQE, and what is the exam format?

What is the WQE passing score?

What is the WQE pass rate?

Who is eligible to take the WQE?

• A degree from an accredited US or Canadian MD or DO school; international medical graduates also need ECFMG certification.
• An accredited US or Canadian PGY-1 year with primary patient-care responsibility, completed before residency.
• An ACGME-approved ophthalmology residency of at least 36 months, or an RCPSC-accredited Canadian program of at least 48 months.
• A valid, unrestricted medical license in the US, a US territory or a Canadian province, with any licensing-board action reported within 60 days.

WQE vs OKAP: how are the two exams different?

• Purpose: the OKAP is an in-training exam with no passing score; the WQE is a certification exam with a pass mark.
• Length: 260 questions on the OKAP; 250 on the WQE.
• Structure: the OKAP is spread equally across the 13 BCSC sections; the WQE covers ophthalmology under 8 major headings, according to the AAO.
• Scoring: the OKAP is norm-referenced, with percentile ranks by training year; the WQE is criterion-referenced, 700 on a 200–1000 scale.
• Delivery: the OKAP is taken online at your institution with a program proctor (March 11–14, 2027); the WQE at a Pearson test center (September 18, 2027).
• Fee: $390 per resident for the US OKAP, paid by the program; $2,250 for the 2027 WQE.

How should you use a question bank for the WQE?

A WQE study plan for September 18, 2027

This timeline assumes you finish a US residency in 2027 and sit the WQE on Saturday, September 18, 2027; adjust it for a different graduation date.

1. March 11–14, 2027Sit the PGY-4 OKAP as a checkpoint; in the JAMA Ophthalmology cohort, a PGY-4 scaled score of 550 corresponded to 94% of candidates passing the WQE.
2. Spring 2027 (PGY-4)Register through the ABO Portal when registration opens, request any ADA accommodations with your application, and get the free ABO content outline.
3. Late April 2027Use your OKAP Keyword Report and subtest scores to list weak topics, then map them onto the WQE outline.
4. 16 weeks outWork through your question bank by subspecialty in untimed mode, weakest areas first, reading every explanation and logging missed facts.
5. 10 weeks outOnce your training is complete and your fee is paid, book your Pearson test time and location, and switch to mixed, timed blocks.
6. 4 weeks outTake a long timed mock exam to build stamina for a session of about five hours, then focus on weak-topic drills and spaced-repetition review.
7. Final weekReview your missed-facts list rather than new material, have one government-issued ID ready and plan to arrive 30 minutes early.

ABO WQE FAQ