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 PAM questions are organized by exam domain, so you can see how each part of the Patient Assessment & Management Exam (PAM) blueprint is tested. Reveal the answer and explanation under each question.
A 15-year-old describes eight months of eyestrain and intermittent double vision while reading, but no symptoms at distance. Best-corrected acuity is 20/20 in each eye. Distance exophoria is 2 prism diopters and near exophoria is 10; near point of convergence breaks at 12 cm, near base-out fusional vergence breaks at 10 prism diopters, and the CISS score is 28. Monocular accommodative amplitudes, motility, and ocular health are normal. With the refractive correction optimized, which treatment addresses the demonstrated deficit?
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Correct answer: D - Office-based vergence and accommodative therapy with home reinforcement
Question 2
Spectacles provide 20/20 acuity with -8.00 -2.00 x 180 at a measured vertex distance of 12 mm. A custom soft toric contact lens is now being fitted. Ignore lens rotation and tear-lens power. After transferring both principal meridians to the corneal plane and rounding each to the nearest 0.25 D, which prescription is the appropriate optical starting point?
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Correct answer: C - -7.25 -1.75 x 180
Question 3
A 5-year-old with anisometropic amblyopia has worn the full cycloplegic spectacle correction consistently for 18 weeks. Best-corrected acuity has remained 20/60 in the right eye and 20/20 in the left at the last two visits. Alignment and ocular structures are normal, and patching has not been tried. Which initial occlusion prescription has established efficacy for this degree of amblyopia while minimizing treatment burden?
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Correct answer: B - Patch the left eye for 2 hours each day
Question 4
During a soft toric contact-lens follow-up, a patient reports that letters sharpen briefly after some blinks and blur after others. After adequate settling, the orientation mark moves unpredictably between 5 and 25 degrees to the examiner's left. Vision reaches 20/20 whenever the cylinder axis aligns with the required correction, and the ocular surface is healthy. How should the fitting problem be addressed?
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Correct answer: D - Refit the lens to obtain consistent rotational stability first
Question 5
A 68-year-old reports, 'The chart letters are clear, but faces and steps disappear in dim light.' Best-corrected acuity remains 20/25 in each eye. Repeated Pelli-Robson testing with matched correction, chart illumination, and distance yields 1.20 log contrast sensitivity, compared with 1.65 previously. Which interpretation reconciles the symptoms with the test results?
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Correct answer: D - Snellen acuity does not capture the demonstrated loss of contrast sensitivity
Domain 2: Normal Health / Disease / Trauma (60-70%)
Question 6
A 32-year-old has two days of unilateral tearing and photophobia. Slit-lamp examination reveals a branching epithelial ulcer with terminal bulbs that stains with fluorescein. Corneal sensation is reduced in the affected eye; there is no stromal infiltrate or anterior chamber reaction. Which topical medication should be started for this epithelial infection?
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Correct answer: B - Ganciclovir 0.15% gel, one drop five times daily
Question 7
An OCT report flags new inferior retinal nerve fiber layer thinning in a 56-year-old glaucoma suspect with -8.00 D myopia. Intraocular pressure, disc photographs, and reliable visual fields are unchanged. The new scan has poor signal, and its segmentation line visibly departs from the retinal nerve fiber layer in the flagged region. Before changing the diagnosis or treatment, the clinician should:
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Correct answer: A - Inspect the raw scans and repeat the affected OCT acquisition
Question 8
At an annual visit, a 71-year-old former smoker has several drusen measuring approximately 180 micrometers and associated pigmentary abnormalities in both maculae. Acuity remains 20/25, and OCT shows no intraretinal or subretinal fluid. There is no macular hemorrhage or geographic atrophy. Medication and supplement review reveals no contraindication to an AREDS2 formulation. Which recommendation has the strongest evidence for reducing the risk of progression?
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Correct answer: C - Use an AREDS2 formulation containing lutein and zeaxanthin
Question 9
At the start of treatment for anterior uveitis, 38 cells were counted in a 1 x 1 mm slit beam. One week later, using the same technique, the count is 9 cells. Aqueous flare remains 1+, and the patient is still using topical corticosteroid. Under Standardization of Uveitis Nomenclature criteria, this follow-up represents:
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Correct answer: A - Improvement by two grades, but not yet inactive disease
Question 10
A cleaner reaches the clinic minutes after liquid alkaline degreaser splashes into one eye. No irrigation has been performed. Clean tap water is immediately available, but sterile irrigating solution must be brought from another room. The eye is painful and tightly closed. Which action takes precedence over recording visual acuity or completing the history?
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Correct answer: B - Start copious irrigation with the available tap water
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The full bank has 1,020 more PAM questions with explanations.