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.
The ACMO exam has 160 questions and runs 4 hours 30 minutes.
These 10 free ACMO questions are organized by exam domain, so you can see how each part of the Advanced Competence in Medical Optometry blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Ocular disease (65-75%)
Question 1
During follow-up of a 72-year-old with treated open-angle glaucoma, the right-eye visual-field mean deviation changes from -3.4 to -7.2 dB. Two reliable, correctly refracted fields show additional generalized depression on total deviation, but the established superior nasal step is unchanged on pattern deviation. Comparable OCT scans show stable inferior retinal nerve fiber layer loss. Intraocular pressure remains 14-15 mmHg, within the established target. Nuclear cataract has increased, and best-corrected acuity has fallen from 20/25 to 20/60. What is the most defensible interpretation of the apparent field change?
Show answer & explanation
Correct answer: B - Cataract can explain the added depression; glaucoma progression remains unconfirmed.
Question 2
Six months after documented herpes simplex epithelial keratitis, a patient returns with blurred vision and photophobia in the same eye. Best-corrected acuity is 20/80. Examination shows central stromal haze and edema, fine keratic precipitates, and 1+ anterior chamber cells. The epithelium is intact, with no dendrite, epithelial defect, stromal necrosis, or suppurative infiltrate. Intraocular pressure is 16 mmHg. Which regimen addresses the current corneal process?
Show answer & explanation
Correct answer: A - Topical corticosteroid with antiviral coverage and close follow-up.
Question 3
Retinal photographs from a patient with type 2 diabetes show microaneurysms and scattered intraretinal hemorrhages in all four quadrants. No quadrant contains more than 15 hemorrhages, but definite venous beading is present in three quadrants. There is no retinal or disc neovascularization and no preretinal or vitreous hemorrhage. OCT shows no macular edema, and acuity is 20/20. Using the International Clinical Diabetic Retinopathy Severity Scale, how is this eye classified?
Show answer & explanation
Correct answer: A - Severe nonproliferative diabetic retinopathy
Question 4
Neither a topical fluoroquinolone nor subsequent antiviral treatment has relieved 12 days of severe pain in a soft-contact-lens wearer who swims in her lenses. Slit-lamp examination now shows irregular branching epitheliopathy and faint linear stromal infiltrates tracking along corneal nerves. The discomfort is striking relative to the limited surface findings, and no ring infiltrate is present. Which organism should now be specifically sought?
Show answer & explanation
Correct answer: D - Acanthamoeba species
Question 5
Two reliable 24-2 visual fields show a repeatable superior paracentral cluster of depressed points in a patient with glaucoma. OCT demonstrates corresponding inferior macular ganglion cell loss. Central acuity remains 20/20, and the patient has not noticed a scotoma. To define how closely the functional defect approaches fixation, which study adds the most useful information?
Show answer & explanation
Correct answer: C - A standard 10-2 threshold field
Question 6
Five weeks after uncomplicated cataract surgery, a 67-year-old without diabetes or prior uveitis reports painless central blur. Acuity has declined from 20/25 to 20/60. The cornea and posterior capsule are clear, and the anterior chamber is quiet. OCT shows intraretinal macular cysts without vitreomacular traction; fluorescein angiography shows petaloid macular leakage and late optic disc leakage. No treatment has yet been given for the macular changes. What is the appropriate initial approach?
Show answer & explanation
Correct answer: A - A topical NSAID plus a topical corticosteroid
Domain 2: Systemic conditions (25-35%)
Question 7
Evaluation of posterior uveitis in a 48-year-old identifies a reactive treponemal test and an RPR titer of 1:64. There is no history of syphilis treatment or penicillin allergy. The neurologic examination is normal. A lumbar puncture obtained before referral shows normal cell count and protein and a nonreactive CSF-VDRL. Which systemic regimen is indicated despite these cerebrospinal-fluid findings?
Show answer & explanation
Correct answer: D - Aqueous crystalline penicillin G, 18-24 million units/day intravenously for 10-14 days.
Question 8
At a hydroxychloroquine screening visit, a woman with systemic lupus erythematosus weighs 64 kg, down from 80 kg when treatment began. Her dose has remained 400 mg daily for seven years. Her lupus is controlled, renal function is normal, and she does not take tamoxifen. OCT, wide-pattern fundus autofluorescence, and reliable visual fields show no evidence of toxicity. Which dose assessment and recommendation is appropriate?
Show answer & explanation
Correct answer: C - 6.25 mg/kg/day; discuss dose reduction with the prescriber and maintain annual retinal screening.
Question 9
A 76-year-old develops sudden left-eye vision loss to counting fingers, with a relative afferent pupillary defect and pallid optic disc swelling. For the past week, chewing has produced jaw fatigue that resolves with rest; new scalp tenderness is also present. ESR is 18 mm/hour (laboratory reference 0-30) and CRP is 3 mg/L (reference below 5). Temporal artery biopsy is available in four days. Which action best protects the fellow eye?
Show answer & explanation
Correct answer: B - Arrange immediate high-dose intravenous corticosteroid treatment with urgent specialist coordination.
Question 10
A woman with a 15-year history of type 1 diabetes is ten weeks pregnant. Her two prepregnancy retinal examinations showed no retinopathy, and her A1C is 6.4%. The current dilated examination is also normal. She asks whether these reassuring findings allow her to keep her usual extended screening interval. Which surveillance plan fits this pregnancy?
Show answer & explanation
Correct answer: B - Reassess during pregnancy and for up to one year postpartum, according to retinal findings.
That's 10 of 1,030
The full bank has 1,020 more ACMO questions with explanations.