10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free PEPS questions are organized by exam domain, so you can see how each part of the Patient Encounters and Performance Skills (PEPS) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Clinical Assessment and Interpretation 29% of exam
Question 1
A 36-year-old develops bilateral distance blur and brow ache 12 days after starting topiramate for migraine prevention. Refraction has shifted from plano to approximately −4.50 D in each eye. Both anterior chambers are shallow centrally and peripherally, the angles are closed, and intraocular pressures are 36 and 38 mmHg. Previous examinations documented deep chambers. What mechanism ties the refractive shift to the angle findings?
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Correct answer: C - Ciliochoroidal effusion with anterior ciliary-body rotation and forward lens-iris displacement
Question 2
A 15-year-old reports that print separates into two images after sustained reading. Testing through the appropriate refractive correction shows 20/20 acuity in each eye, 2 prism diopters of exophoria at distance, and 12 prism diopters of exophoria at 40 cm. Near-point-of-convergence break is 14 cm. Near base-out fusional vergence blurs at 8 and breaks at 12 prism diopters. Monocular accommodative amplitude is 13 D in each eye, and the Convergence Insufficiency Symptom Survey score is 28. Which diagnosis best integrates these results?
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Correct answer: B - Convergence insufficiency
Question 3
Vertical diplopia begins when a patient starts wearing new spectacles. The right lens is +4.00 −2.00 × 180, and its optical center sits 4 mm above the right pupil in the habitual wearing position. The left optical center is correctly positioned, and no prism was prescribed. What unwanted prism does the right lens introduce at the patient’s line of sight?
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Correct answer: C - 0.8 prism diopters base up
Domain 2: Management and Documentation 25% of exam
Question 4
Six weeks after receiving the full cycloplegic prescription of +4.50 D in each eye, a 4-year-old has equal 20/25 acuity and straight eyes at distance and near while wearing the glasses. A 25-prism-diopter esotropia returns when the glasses are removed. The parents ask whether the persistent crossing means treatment has failed. Which management decision follows from the examination?
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Correct answer: D - Continue full-time wear of the full hyperopic correction, with ongoing acuity and alignment monitoring.
Question 5
A 66-year-old arrives 90 minutes after sudden, painless loss of vision in the right eye. Acuity is counting fingers, a right relative afferent pupillary defect is present, and the posterior retina is diffusely pale with a cherry-red fovea. There is no headache, scalp tenderness, or jaw claudication. Which disposition should take priority over further office-based testing?
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Correct answer: D - Activate emergency transfer to a stroke-capable emergency department and communicate the last-known-well time.
Question 6
After discussing laser and medication options, a 58-year-old with primary open-angle glaucoma chooses topical treatment. The medical history includes asthma treated with budesonide-formoterol and a recent exacerbation with wheezing. Renal function and resting pulse are normal. Which proposed prescription is contraindicated by this history?
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Correct answer: D - Timolol 0.5%: one drop in each affected eye twice daily
Domain 3: Skills 22% of exam
Question 7
During Goldmann applanation tonometry, an examiner obtains a reading of 27 mmHg after instilling excess fluorescein. The semicircles are centered and symmetric, but their fluorescent bands are unusually broad. Their inner edges have been brought into contact. Before accepting this pressure, the examiner should:
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Correct answer: A - Withdraw, dry the prism appropriately, and repeat with correctly sized fluorescein bands.
Question 8
Four-mirror gonioscopy is performed in dim illumination with a short beam kept off the pupil. With minimal lens pressure, the inferior posterior trabecular meshwork is hidden. Gentle indentation exposes the inferior scleral spur. Nasally, a broad iris adhesion remains attached to the angle despite indentation, while adjacent areas open. Which entry accurately records what the dynamic examination established?
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Correct answer: A - Inferior appositional closure with nasal peripheral anterior synechiae
Domain 4: Patient Education 13% of exam
Question 9
A 69-year-old former smoker has multiple large macular drusen, measuring approximately 160-190 micrometers, with associated pigment changes in both eyes. Acuity is 20/25 in each eye; there is no geographic atrophy, hemorrhage, or OCT evidence of fluid. The patient asks whether an eye vitamin will restore the retina. Which explanation accurately addresses both benefit and formulation?
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Correct answer: B - An AREDS2 formula without beta-carotene may lower progression risk, but it does not restore retinal tissue already lost.
Domain 5: Communication 11% of exam
Question 10
An established glaucoma patient’s pressure is above the agreed target despite a prescription for one drop of latanoprost each evening. The patient says, “I know the drops matter, but I probably use them only three nights a week.” There are no acute symptoms. Before choosing a new treatment, which response is most likely to uncover the reason the current plan is not working?
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Correct answer: A - “What gets in the way of using the drops on the nights you miss them?”
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