- Which PAM This Cheat Sheet Covers
- The Exam at a Glance
- Test-Day Rules and Tools
- Content Map: Two Domains, Four Task Lenses
- Question Style and Scoring Facts
- Eligibility, Registration and Money
- Reading Pass-Rate Numbers Without Fooling Yourself
- Sequencing Your Review Around the Blueprint
- Quick Answers (FAQ)
- PAM is NBEO Part II: 350 questions in two 175-question sessions, seven testing hours in a single day.
- Normal Health / Disease / Trauma carries 60-70% of the outline; Refractive / Sensory / Oculomotor carries 30-40%.
- NBEO's scale runs 100-900, and scores above 300 pass; scores are equated, not curved.
- Session 1 cannot be revisited after the break, so commit to answers before you leave it.
Which PAM This Cheat Sheet Covers
"PAM" is a crowded acronym, so let's pin it down. On this page, PAM means the Patient Assessment and Management (PAM) examination, Part II of the National Board of Examiners in Optometry (NBEO) sequence. It is a full entry-to-profession licensure examination for optometry candidates. It is not a standalone TMOD registration, not Part III PEPS, and not an independent board certification. If you are looking for a broader orientation, see our explainers on what PAM is and what PAM stands for.
Everything below is drawn from NBEO's current published materials, verified October 14, 2026. NBEO's current materials live at optometry.org; the legacy nbeo.org equivalency page is only a history anchor, not the blueprint. Treat this page as a quick-reference layer and always confirm details against the official sources before registering.
The Exam at a Glance
| Item | What to Know |
|---|---|
| Governing body | National Board of Examiners in Optometry (NBEO) |
| Official name | Part II Patient Assessment and Management (PAM) |
| Total questions | 350, delivered as two sessions of 175 |
| Testing time | Seven hours in one day, split into two 3.5-hour sessions |
| Extra morning time | 15 minutes for the tutorial and non-disclosure agreement (not question-timer time) |
| Break between sessions | Optional, up to 45 minutes |
| Embedded TMOD | Approximately 120 items within the 350, not added on top |
| Pass/fail decisions | Overall PAM and TMOD each receive a separate decision |
| Delivery | Pearson VUE centers in the USA, Puerto Rico and Canada |
| Fee | $1,490 for administrations beginning August 2026; $400 added for late registration |
One nuance worth memorizing: the content matrix footnote says 120 TMOD items, while the outline and program description qualify the figure as approximate. Treat it as "approximately 120." Standalone TMOD is a different registration pathway from the full PAM examination you are preparing for here.
Test-Day Rules and Tools
Identification and Format
- Testing is closed-book.
- Bring two current, signed physical IDs, with at least one being a government-issued photo ID. Names must match your registration.
- You register and pay through NBEO, then schedule your seat with Pearson VUE.
What You Get on Screen and at the Desk
- An on-screen basic calculator
- A searchable generic/trade drug equivalence list
- An abbreviation list
- A supplied scratch booklet
Timing Traps
- After the inter-session break, Session 1 cannot be revisited. Flag and resolve within the session, not afterward.
- Unscheduled breaks do not stop the clock. Use the optional break of up to 45 minutes between sessions for your real rest.
- The 15 minutes for the tutorial and NDA, and the break, are not question-timer minutes. Your two 3.5-hour windows are the working time.
For the complete logistics, including scheduling windows and deadlines, see our guide to PAM exam dates and scheduling.
Content Map: Two Domains, Four Task Lenses
NBEO's outline divides content into two top-level areas. A separate matrix then cross-classifies the same content by clinical task. The matrix categories are intersecting dimensions, not four additional domains, so do not add them to the domain percentages.
Domain 1: Refractive / Sensory Processes / Oculomotor Processes (30-40%)
This area covers optics, binocular function and the sensory and motor systems that make clear single vision work. The outline uses the wording "Accommodative / Vergence / Oculomotor Anomalies," and that outline wording controls over the matrix's slightly different phrasing.
- Refractive status and correction decisions
- Accommodative, vergence and oculomotor anomalies
- Sensory processing considerations that affect diagnosis and management
Domain 2: Normal Health / Disease / Trauma (60-70%)
This is the largest portion of the exam by a wide margin. It covers recognizing normal ocular and systemic health, diagnosing disease, and managing trauma and its consequences.
- Differentiating normal variants from pathology
- Diagnosing and managing ocular disease
- Responding to trauma presentations
The Task-Dimension Matrix
| Matrix Dimension | Range |
|---|---|
| Clinical Correlation of Basic Science Principles | 11-17% |
| Diagnosis | 26-34% |
| Treatment / Management | 40-57% |
| Legal Issues / Ethics / Public Health | 4-10% |
Clinical Presentation (history, signs, symptoms) is assessed inside the cases but carries no separate percentage. The ranges are published as ranges; do not normalize them into a single clean split. The practical read: Treatment / Management is the single heaviest task lens, so "what do you do next, and why" deserves more review time than "what is it." For the full breakdown, read our guide to all PAM content areas.
Key Takeaway
Think in two layers: the domain tells you what body of knowledge is in play, and the task lens tells you what the question wants you to do with it. A disease-domain question will most often ask about management, and the second layer is where many points are won or lost.
Question Style and Scoring Facts
Case-Based Items
Image-intensive patient cases generally carry three to six associated items, and individual items offer anywhere from three to ten response options. Expect to read a presentation, examine imaging or findings, and then answer a short chain of linked questions.
Single-Answer and Multiple-Response
Both formats appear. Some multiple-response items can require up to four correct selections, and you earn credit only by choosing all and only the requested correct options. Partial selections do not earn partial credit, so read the stem for how many answers it asks for before you click.
Score Scale
- NBEO reports on a 100-900 scale.
- NBEO's Scoring & Reporting page says scores above 300 pass. Hold that wording exactly; do not convert it to a raw percentage of correct answers.
- Scores are equated across forms, not curved. Your result does not depend on how other candidates in your session performed.
- NBEO prohibits recalled-item distribution and does not allow superscoring.
For a deeper treatment of the boundary and what it means for your preparation, see PAM passing score explained.
Eligibility, Registration and Money
Who Can Sit
- Eligibility begins in the academic year of graduation from an ACOE program with Accredited, Accredited with Conditions or Preliminary Approval status, with institutional confirmation.
- Graduates of Accredited or Accredited with Conditions programs are eligible.
- Other candidates need direct sponsorship from a qualifying optometric program or a state optometry licensure board.
The eligibility policy section was last updated May 18, 2025, and the Candidate Agreement is dated August 1, 2025. The full walkthrough is in our PAM requirements guide.
Cost Snapshot
| Charge | Amount | Note |
|---|---|---|
| Examination fee | $1,490 | Administrations beginning August 2026 |
| Late registration | +$400 | Added on top of the exam fee |
| Practice Databank (optional) | $199 for one month | $149 for an additional month, subject to registration and administration-date conditions |
The practice databank fees are preparation charges, not part of the exam fee. The databank contains NBEO-owned questions and is administered by Test Run, an independent third party. Buying or completing it does not guarantee a pass. The broader cost picture is covered in our PAM cost breakdown.
Retakes, Validity and Licensure
- After six attempts, special approval or remediation is required.
- NBEO says scores do not expire.
- PAM is a licensure examination result, not a separately renewable specialty credential. Individual licensing boards can attach their own acceptance conditions, so check with the state where you plan to practice.
Reading Pass-Rate Numbers Without Fooling Yourself
Two published figures circulate, and they measure different things. Mixing them up is one of the most common errors candidates make.
| Figure | Population | Period |
|---|---|---|
| 89.4% (published by UC Berkeley and Ferris State) | National first-time Part II PAM candidates, regardless of graduation status | Academic year 2025-2026 (September 1-August 31) |
| 87.96% (NBEO-authored report hosted by ASCO) | 1,628 qualifying U.S. graduates who attempted all three NBEO parts at least once | October 1, 2024-September 30, 2025 |
These cover different populations and different time windows, so they cannot be pooled or read as a trend line. The university numbers are university publications of NBEO outcomes, not an issuer-hosted national dataset. Older university rows also disagree with each other, so avoid inferring any long-run trend. For the full discussion, see what the PAM pass-rate data shows, and for how to interpret difficulty, how hard the PAM exam is.
Sequencing Your Review Around the Blueprint
General study technique matters less here than allocation. Let the blueprint drive the calendar: Domain 2 holds 60-70% of the outline and Treatment / Management is the heaviest task lens, so most of your hours belong there. A simple sequence keeps Domain 1 from being neglected while still weighting the larger area.
Domain 1 Foundations
- Refractive, accommodative, vergence and oculomotor anomalies, so the 30-40% area is secure early
- Practice the calculator and scratch-booklet workflow for optics problems
Domain 2 Diagnosis
- Normal-versus-pathology differentiation across ocular and systemic presentations
- Work through image-based cases with three to six linked items
Domain 2 Management and Trauma
- Treatment and management decisions, the heaviest task lens
- Drug name matching and therapeutic logic, since the equivalence list won't teach it
Integration and Stamina
- Full-length 175-question sessions to rehearse the 3.5-hour pace and no-return rule
- Quick review of legal, ethics and public health topics (4-10%)
For a fuller plan, including how to schedule around your registration date, see our PAM study guide. When you are ready to test yourself against realistic question styles, try the PAM practice test, or review how our practice question bank mirrors the multiple-response format.
Key Takeaway
Rehearse the format as deliberately as the content. Multiple-response items that demand all and only the correct options, plus a one-way Session 1, reward candidates who have practiced committing to answers under time pressure.
Quick Answers (FAQ)
There are 350 questions delivered in two sessions of 175. Approximately 120 TMOD items are embedded within those 350 rather than added to them, and overall PAM and TMOD receive separate pass/fail decisions.
NBEO reports scores on a 100-900 scale and states that scores above 300 pass. Scores are equated across forms rather than curved, and the page does not translate this into a raw percentage correct.
No. Session 1 cannot be revisited once the inter-session break begins, so finish your flagged items before you leave it. The optional break lasts up to 45 minutes, and unscheduled breaks do not stop the clock.
The fee is $1,490 for administrations beginning August 2026, and late registration adds $400. You register and pay through NBEO, then schedule with Pearson VUE. The optional practice databank is a separate charge.
NBEO says scores do not expire. PAM is a licensure examination result rather than a renewable specialty certification, though individual licensing boards may impose their own acceptance conditions, so confirm with your target state.
This one-page review is a starting point, not a substitute for NBEO's own documents. Before you register, read the current content outline, content matrix and test day instructions on optometry.org, then return to our PAM cheat sheet as a fast refresher in the final weeks.