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100+ Free AOBOO Ophthalmology & Otolaryngology-HNS Practice Questions

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~89.4% five-year first-time pass rate (AOBOO ophthalmology written exam) Pass Rate
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A 68-year-old man presents with sudden painless loss of vision in the right eye on awakening. Fundoscopy reveals a cherry-red spot at the macula with diffuse retinal pallor. Which artery is most likely occluded?

A
B
C
D
to track
2026 Statistics

Key Facts: AOBOO Ophthalmology & Otolaryngology-HNS Exam

150

Written Exam Questions

AOBOO Ophthalmology/Otolaryngology written exam

3 hours

Written Exam Length

Remotely proctored via MonitorEDU

$1,500 / $2,000

Written / Oral Exam Fees

AOBOO 2026 fee schedule

500

Passing Scaled Score

AOA 200-800 scale

~89.4%

5-Yr First-Time Pass Rate

AOBOO ophthalmology written exam

$200/yr

OCC Component 3 Fee

AOA longitudinal assessment

AOBOO-HNS certifies osteopathic ophthalmologists and otolaryngologists through a 150-question, 3-hour, remotely proctored written exam (MonitorEDU) plus an oral exam. Passing requires a scaled score of 500+ on the AOA 200-800 scale; AOBOO publishes a ~89.4% five-year first-time pass rate for the ophthalmology written exam. The written exam fee is $1,500 and the oral exam fee is $2,000; OCC Component 3 longitudinal assessment is $200/year. Ophthalmology and otolaryngology-HNS use separate written exams but share a single specialty board.

Sample AOBOO Ophthalmology & Otolaryngology-HNS Practice Questions

Try these sample questions to test your AOBOO Ophthalmology & Otolaryngology-HNS exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old man presents with sudden painless loss of vision in the right eye on awakening. Fundoscopy reveals a cherry-red spot at the macula with diffuse retinal pallor. Which artery is most likely occluded?
A.Central retinal vein
B.Central retinal artery
C.Posterior ciliary artery
D.Ophthalmic artery
Explanation: Central retinal artery occlusion (CRAO) classically presents as sudden painless monocular vision loss with a cherry-red spot at the macula (intact choroidal blood supply at the fovea where the retina is thinnest) and diffuse retinal pallor from inner-retinal ischemia. CRAO is an ocular stroke equivalent — urgent stroke workup and carotid imaging are indicated, and GCA must be ruled out in patients over 50 (ESR, CRP, temporal artery biopsy).
2Which of the following is the FIRST-LINE topical therapy for primary open-angle glaucoma?
A.Beta-blocker (timolol)
B.Alpha-2 agonist (brimonidine)
C.Prostaglandin analog (latanoprost)
D.Carbonic anhydrase inhibitor (dorzolamide)
Explanation: Prostaglandin analogs (latanoprost, travoprost, bimatoprost, tafluprost) are first-line topical therapy for primary open-angle glaucoma due to once-daily dosing, the largest IOP-lowering effect (25-33%), and a favorable systemic safety profile. Mechanism is increased uveoscleral outflow. Side effects include iris darkening, periocular hyperpigmentation, and eyelash growth. Selective laser trabeculoplasty (SLT) is also acceptable first-line per the LiGHT trial.
3A 25-year-old soft contact lens wearer presents with severe right eye pain, photophobia, and a ring-shaped corneal infiltrate. Symptoms began after swimming in a lake. Which organism is most likely responsible?
A.Pseudomonas aeruginosa
B.Acanthamoeba
C.Herpes simplex virus
D.Staphylococcus aureus
Explanation: Acanthamoeba keratitis is classically associated with soft contact lens wear and exposure to fresh water (lakes, hot tubs, tap water). The hallmark sign is a ring-shaped stromal infiltrate, and pain is typically out of proportion to clinical findings. Diagnosis is by confocal microscopy, calcofluor white staining, or culture on non-nutrient agar with E. coli overlay. Treatment is prolonged topical biguanide (PHMB or chlorhexidine), often combined with propamidine.
4A 72-year-old presents with metamorphopsia and decreased central vision. OCT shows subretinal fluid and a pigment epithelial detachment. Fluorescein angiography demonstrates choroidal neovascularization. What is the first-line treatment?
A.Photodynamic therapy with verteporfin
B.Intravitreal anti-VEGF injection
C.Macular laser photocoagulation
D.Observation
Explanation: Neovascular (wet) age-related macular degeneration is first-line treated with intravitreal anti-VEGF therapy — aflibercept, ranibizumab, bevacizumab (off-label), faricimab (anti-VEGF + anti-Ang2). Loading doses are typically monthly x 3, followed by maintenance dosing (monthly, treat-and-extend, or PRN). Anti-VEGF stabilizes or improves vision in the majority and prevents disciform scarring.
5A 4-year-old presents with leukocoria and strabismus of the right eye. Examination reveals a chalky-white intraocular mass. Which gene is most commonly implicated?
A.TP53
B.RB1
C.NF1
D.VHL
Explanation: Retinoblastoma is the most common primary intraocular malignancy of childhood, caused by biallelic inactivation of the RB1 tumor suppressor gene on chromosome 13q14. Leukocoria (white pupillary reflex) and strabismus are the most common presenting signs. Treatment is multidisciplinary: enucleation for large unilateral tumors with no salvageable vision, systemic/intra-arterial/intravitreal chemotherapy, laser, cryotherapy, and external beam radiation in select cases.
6A 30-year-old woman with relapsing-remitting MS presents with painful loss of vision in her left eye over 2 days. Examination shows decreased visual acuity, dyschromatopsia, and a relative afferent pupillary defect. Which treatment best addresses the acute episode?
A.Oral prednisone 60 mg daily
B.IV methylprednisolone 1 g daily for 3 days
C.Plasmapheresis
D.Observation
Explanation: Acute optic neuritis associated with multiple sclerosis is treated with IV methylprednisolone 1 g daily for 3 days, often followed by an oral prednisone taper. The Optic Neuritis Treatment Trial (ONTT) demonstrated that IV steroids accelerate visual recovery but do not change final visual outcome, and that oral prednisone alone is associated with a HIGHER rate of recurrent optic neuritis and should be AVOIDED as monotherapy.
7Which of the following anatomic findings is pathognomonic for acute angle-closure glaucoma on examination?
A.Constricted pupil with photophobia
B.Mid-dilated non-reactive pupil with corneal edema
C.Cup-to-disc ratio of 0.4
D.Posterior synechiae
Explanation: Acute angle-closure glaucoma classically presents with a mid-dilated, fixed, vertically oval, non-reactive pupil due to ischemic iris sphincter paralysis from very high IOP (often 40-80+ mmHg). Corneal edema (steamy cornea) is also typical from endothelial dysfunction. Immediate management includes topical pilocarpine, beta-blockers, alpha-agonists, topical/oral CAIs, and laser peripheral iridotomy once the cornea clears.
8A 60-year-old diabetic presents 4 days after uncomplicated phacoemulsification with severe pain, decreased vision (light perception only), and a hypopyon. The most likely diagnosis is acute postoperative endophthalmitis. Per the Endophthalmitis Vitrectomy Study (EVS), which management is most appropriate?
A.Intravitreal antibiotics with deferred vitrectomy
B.Immediate pars plana vitrectomy with intravitreal antibiotics
C.Intravenous antibiotics alone
D.Observation and topical antibiotics
Explanation: The Endophthalmitis Vitrectomy Study (EVS) demonstrated that for acute postoperative endophthalmitis after cataract surgery in eyes with LIGHT PERCEPTION ONLY vision, immediate pars plana vitrectomy plus intravitreal antibiotics (vancomycin + ceftazidime or amikacin) significantly improves visual outcomes compared with intravitreal antibiotics alone. For better than hand motion vision, intravitreal antibiotics alone are equivalent.
9A 78-year-old presents with sudden loss of vision in the right eye, jaw claudication, scalp tenderness, and headache. ESR is 92 mm/hr. What is the most appropriate immediate management?
A.Schedule temporal artery biopsy in 2 weeks
B.Start high-dose IV methylprednisolone immediately, then biopsy within 1-2 weeks
C.Oral aspirin 81 mg daily
D.Order MRI brain before any treatment
Explanation: Giant cell (temporal) arteritis with arteritic anterior ischemic optic neuropathy is an ophthalmic emergency. Initiate high-dose IV methylprednisolone (1 g daily x 3 days) IMMEDIATELY upon clinical suspicion to prevent fellow-eye involvement (occurs in up to 50% if untreated). Temporal artery biopsy can be done within 1-2 weeks without affecting yield. ESR and CRP support the diagnosis but do not replace clinical urgency.
10Which clinical sign supports the diagnosis of keratoconus on slit-lamp examination?
A.Krukenberg spindle
B.Fleischer ring
C.Kayser-Fleischer ring
D.Hassall-Henle bodies
Explanation: Keratoconus is a progressive ectatic corneal disorder. Classic slit-lamp signs include the Fleischer ring (iron deposition in the basal epithelium at the base of the cone), Vogt striae (vertical stress lines in deep stroma), and apical thinning. Munson sign (V-shaped bulging of the lower lid on downgaze) and Rizzuti sign (lateral conical reflection) are external signs. Corneal cross-linking (CXL) halts progression.

About the AOBOO Ophthalmology & Otolaryngology-HNS Exam

The AOBOO-HNS administers two parallel primary certification pathways for osteopathic physicians (DOs): one for ophthalmology and one for otolaryngology-head and neck surgery. Each pathway requires passing a 150-question, 3-hour, remotely proctored (MonitorEDU) written exam, followed by an oral examination. Ophthalmology content spans external disease and cornea, glaucoma, retina and vitreous, cataract and refractive, pediatric ophthalmology and strabismus, and neuro-ophthalmology. Otolaryngology-HNS content spans otology and neurotology, rhinology and sinus, laryngology, head and neck oncology, pediatric ENT, facial plastics, and sleep medicine. Both incorporate osteopathic principles and practice (OPP). Initial certification requires a COCA-accredited DO degree, AOA-approved internship, and completion of an AOA/ACGME-accredited residency in the respective specialty.

Questions

150 scored questions

Time Limit

3 hours written (150 MCQs, remotely proctored via MonitorEDU) plus separate oral exam component

Passing Score

Scaled score of 500 or higher (AOA 200-800 scale)

Exam Fee

$1,500 written + $2,000 oral (AOBOO 2026) (American Osteopathic Boards of Ophthalmology and Otolaryngology - Head and Neck Surgery (AOBOO-HNS))

AOBOO Ophthalmology & Otolaryngology-HNS Exam Content Outline

~12-15% (Ophth)

External Disease and Cornea

Bacterial keratitis (Pseudomonas, fortified vancomycin + tobramycin), HSV epithelial vs stromal keratitis (topical antiviral, avoid steroids in dendritic), Acanthamoeba keratitis (contact lens, ring infiltrate, PHMB/chlorhexidine), fungal keratitis (natamycin), dry eye (TFBUT, Schirmer, MGD, lifitegrast, cyclosporine), keratoconus (Kmax progression, CXL), Fuchs endothelial dystrophy (DMEK), corneal transplant rejection (Khodadoust line).

~10-12% (Ophth)

Glaucoma

Primary open-angle glaucoma (OCT RNFL thinning, GDx, visual field — paracentral/nasal step/arcuate), acute angle closure (mid-dilated pupil, IOP 50+, pilocarpine + laser PI), normal-tension glaucoma, pigment dispersion, pseudoexfoliation, neovascular glaucoma (PRP + anti-VEGF), prostaglandin analogs first-line, SLT (LiGHT trial first-line option), MIGS (iStent, Hydrus, Xen), trabeculectomy + MMC, tube shunts (Baerveldt, Ahmed).

~12-15% (Ophth)

Retina and Vitreous

Diabetic retinopathy (DRSS, PRP for high-risk PDR, anti-VEGF for CSME/DME — Protocol T), AMD (dry/geographic atrophy, wet/CNV anti-VEGF aflibercept/ranibizumab/bevacizumab/faricimab), CRVO/BRVO (anti-VEGF, observe), retinal detachment (Schaffer sign, scleral buckle vs PPV vs pneumatic retinopexy), macular hole, ERM, central serous chorioretinopathy, endophthalmitis (post-cataract Strep epidermidis, EVS — vitrectomy if light perception only).

~10-12% (Ophth)

Pediatric, Neuro-Ophth, and Cataract/Refractive

Amblyopia (deprivation/strabismic/refractive — patching, atropine penalization), ROP (zone/stage/plus disease, laser vs anti-VEGF BEAT-ROP), retinoblastoma (leukocoria, RB1), optic neuritis (MS association, IV methylprednisolone, ONTT), papilledema vs IIH (LP opening pressure), AION (GCA must rule out — ESR/CRP/temporal biopsy), III/IV/VI palsies, Horner (apraclonidine reversal), phacoemulsification, IOL calculation (SRK/T, Barrett Universal II), premium IOLs, LASIK/PRK/SMILE.

~10-12% (ENT)

Otology and Neurotology

Acute otitis media (S pneumoniae, H influenzae, M catarrhalis — amoxicillin), otitis externa (Pseudomonas — fluoroquinolone drops; malignant OE in diabetics — IV antipseudomonal), cholesteatoma (mastoidectomy), otosclerosis (stapedotomy), sudden SNHL (oral steroids ± intratympanic dex, MRI to rule out vestibular schwannoma), Meniere (low Na diet, diuretic, intratympanic gentamicin), BPPV (Dix-Hallpike, Epley posterior canal), Bell palsy (oral prednisolone + valacyclovir), Ramsay Hunt (vesicles + facial palsy).

~10-12% (ENT)

Rhinology, Sinus, and Allergy

Acute rhinosinusitis (viral most common; bacterial if >10 days or worsening — amoxicillin-clavulanate), chronic rhinosinusitis with/without nasal polyps (CRSwNP — INCS, oral steroids, FESS, biologics — dupilumab/omalizumab/mepolizumab), allergic rhinitis (intranasal steroids first-line), epistaxis (Kiesselbach anterior; posterior — SPA ligation/embolization), inverted papilloma (Krouse staging, malignant potential), sinonasal SCC, CSF rhinorrhea (beta-2 transferrin).

~10-12% (ENT)

Laryngology and Head & Neck Oncology

Dysphonia workup (laryngoscopy), vocal cord paralysis (idiopathic, post-thyroidectomy, intubation), laryngopharyngeal reflux (empiric PPI BID 8-12 weeks), AJCC 8th edition staging — separate HPV+ vs HPV- oropharyngeal SCC (p16+ better prognosis), oral cavity SCC, laryngeal SCC, thyroid cancer (papillary — well-differentiated, lobectomy vs total; medullary — RET, calcitonin/CEA; anaplastic), salivary gland tumors (pleomorphic adenoma, Warthin, mucoepidermoid, adenoid cystic), TORS for HPV+ oropharynx.

~8-10% (ENT)

Pediatric ENT, Facial Plastics, Sleep

Tonsillectomy indications (Paradise criteria, OSA), pediatric OSA (polysomnography, AHI >=1 in children — adenotonsillectomy first-line), adult OSA (AHI 5-15 mild/15-30 mod/30+ severe; CPAP first-line, UPPP, MMA, hypoglossal nerve stimulation/Inspire for AHI 15-65 with low BMI), DISE, laryngomalacia, subglottic stenosis (Cotton-Myer grading), cleft lip (~3 months) and palate (~9-12 months) repair, facial trauma (Le Fort I/II/III, NOE, ZMC), rhinoplasty.

~5%

Osteopathic Principles & Practice (OMM/OMT)

Galbreath maneuver and Eustachian tube dysfunction, frontal/maxillary/supraorbital/infraorbital release for sinus congestion, suboccipital release for tension-type headache, OA/AA decompression for vertigo or cervicogenic dizziness, lymphatic pump techniques post-tonsillectomy/sinusitis, five osteopathic models (biomechanical, respiratory-circulatory, neurologic, metabolic-energy, behavioral) in surgical and rehabilitative care.

How to Pass the AOBOO Ophthalmology & Otolaryngology-HNS Exam

What You Need to Know

  • Passing score: Scaled score of 500 or higher (AOA 200-800 scale)
  • Exam length: 150 questions
  • Time limit: 3 hours written (150 MCQs, remotely proctored via MonitorEDU) plus separate oral exam component
  • Exam fee: $1,500 written + $2,000 oral (AOBOO 2026)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

AOBOO Ophthalmology & Otolaryngology-HNS Study Tips from Top Performers

1Master AAO BCSC sections 7 (Glaucoma), 8 (External Disease and Cornea), 12 (Retina), and 11 (Lens and Cataract) for ophthalmology — high-yield slides, OCT/visual fields, and angiograms appear frequently. Drill IOL calculation (SRK/T, Barrett Universal II), severe AS/AMD/DR therapy thresholds, and ROP zone/stage/plus disease criteria.
2For otolaryngology, learn AAO-HNS clinical practice guidelines verbatim: tonsillectomy in children, acute otitis externa, sudden SNHL, BPPV (Epley for posterior canal), allergic rhinitis, hoarseness/dysphonia, and OSA in adults. AAO-HNS CPGs are the most heavily quoted source for ENT written exam stems.
3AJCC 8th edition staging is high-yield for head and neck oncology — memorize separate staging for HPV+ vs HPV- oropharyngeal SCC, the new clinical and pathologic N category rules, and depth-of-invasion criteria for oral cavity SCC. Thyroid cancer subtypes (papillary, follicular, medullary RET, anaplastic) and salivary gland histology must be locked in.
4Pharmacology pearls: amoxicillin-clavulanate for bacterial rhinosinusitis >10 days; fluoroquinolone ear drops for otitis externa (avoid systemic in pediatrics); IV antipseudomonal for malignant otitis externa in diabetics; oral prednisolone + valacyclovir for Bell palsy within 72 hours; anti-VEGF (aflibercept, ranibizumab, bevacizumab, faricimab) for wet AMD/DME/RVO; intratympanic gentamicin/dexamethasone for Meniere.
5Memorize OMM applications: Galbreath maneuver for Eustachian tube dysfunction, frontal/maxillary/supraorbital/infraorbital release for sinusitis, suboccipital release for tension headache, OA/AA decompression for vertigo, lymphatic pump techniques post-operative. Expect 5-10% of the written exam to be OPP/OMM content explicitly.

Frequently Asked Questions

Who is eligible for the AOBOO-HNS certification exams?

Candidates must hold a COCA-accredited DO degree, have completed an AOA-approved internship, and have completed an AOA/ACGME-accredited residency in either ophthalmology or otolaryngology-HNS. An unrestricted US medical license and program director attestation of satisfactory training are required. Adherence to the AOA Code of Ethics is mandatory. Ophthalmology and otolaryngology candidates apply through their respective AOBOO-HNS pathway.

How is the AOBOO written exam structured?

The AOBOO written exam consists of 150 multiple-choice questions delivered over 3 hours in a remotely proctored online format via MonitorEDU. Ophthalmology and otolaryngology-HNS have separate written exams, each covering the core specialty content plus osteopathic principles and practice. A passing scaled score of 500 (200-800 scale) is required to advance to the oral examination component.

What is the fee for the AOBOO exams?

The AOBOO written exam fee is $1,500, and the oral exam fee is $2,000. Re-examination fees are equal to the original exam fees. OCC Component 3 longitudinal assessment requires a $200 annual fee, with a $50 late fee after the first deadline. Total typical costs for written plus oral exam total $3,500, exclusive of board review courses and question banks.

When is the AOBOO written exam offered?

The AOBOO ophthalmology written exam is offered once per year, generally every spring, remotely proctored online by MonitorEDU. Application deadlines are typically set 45 days before the exam window opens, with a final cutoff 15 days before. The otolaryngology-HNS written exam follows a similar annual cycle. Specific 2026 dates are posted on the AOBOO important dates page.

What is the pass rate for the AOBOO written exam?

The AOBOO ophthalmology written exam has a published 5-year first-time pass rate of approximately 89.4%. Otolaryngology-HNS written exam first-time pass rates are similarly strong for residency-trained candidates. Pass rates are lower for retakers and candidates whose training included gaps. AOBOO publishes pass-rate summaries periodically.

What topics are emphasized on the ophthalmology and otolaryngology written exams?

Ophthalmology content emphasizes external disease/cornea, glaucoma, retina and vitreous, cataract and refractive, pediatric ophthalmology and strabismus, neuro-ophthalmology, and uveitis. Otolaryngology-HNS emphasizes otology and neurotology, rhinology and sinus, laryngology, head and neck oncology, pediatric ENT, facial plastics and reconstruction, and sleep medicine. Both exams include osteopathic principles and practice (OPP/OMM) questions.

How does the oral examination work?

After passing the written exam, candidates complete the oral examination — a case-based, scenario-driven evaluation of clinical reasoning and management. Examiners present clinical vignettes, imaging, and surgical decision-making scenarios across the breadth of the specialty. The oral exam fee is $2,000 with the same fee on retake. Failing the oral exam requires reapplication for the next cycle per AOBOO policy.

What is OCC Component 3 and why does it matter?

Osteopathic Continuous Certification (OCC) Component 3 is the longitudinal assessment that diplomates complete annually to maintain AOBOO certification. The fee is $200/year with a $50 late fee. Items are not timed and are delivered quarterly online; diplomates must complete all assigned items each quarter. OCC replaces the older 10-year recertification examination for many AOA boards including AOBOO-HNS.