100+ Free NBEO Part III Practice Questions

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Question 1

Score: 0/0

Which is an appropriate professionalism response if you make a mistake during a PEPS encounter?

Leave the station early

Acknowledge the error transparently, correct it appropriately, document the corrective action, and proceed with the encounter; do not interrupt the patient simulation unless safety requires it; examiners score honesty and recovery, not perfection

Hide the error

Blame the patient

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2026 Statistics

Key Facts: NBEO Part III Exam

Total Stations (10 encounters + 2 skills)

NBEO 2026 PEPS Candidate Guide

~15 min

Time Per Station

NBEO 2026 PEPS Candidate Guide

29%

Heaviest Domain (Interpretation and Assessment)

NBEO PEPS Blueprint

~$1,795

Exam Fee

NBEO published rates

NCCTO Charlotte

Only Testing Location

NBEO

Aug 2024

PEPS Format Launch

NBEO Part III Restructure

NBEO Part III PEPS is a 12-station performance exam at NCCTO Charlotte: 10 patient-encounter stations (one drawn from each of 9 clinical categories plus a repeat) and 2 performance-skill stations (anterior and posterior segment). Each station gets approximately 15 minutes. Scoring is weighted across 5 competency domains: Interpretation and Assessment (29%), Management and Documentation (25%), Skills (22%), Patient Education (13%), and Communication and Professionalism (11%). One of the 10 encounter stations is unscored and used for item pretesting.

Sample NBEO Part III Practice Questions

Try these sample questions to test your NBEO Part III exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1During a PEPS patient encounter station, a 60-year-old presents with sudden monocular vision loss, RAPD, pale retina, and cherry-red spot at the macula. What ICD-10 code and immediate disposition should you document?

A.H40.10 - Open-angle glaucoma; routine follow-up

B.H34.10 - Central retinal artery occlusion; urgent emergency department transfer for stroke workup with ESR/CRP first to rule out GCA

C.H53.4 - Visual field defect; observe

D.H35.30 - AMD; AREDS

Explanation: Central retinal artery occlusion (CRAO) is coded under H34.1- and is a stroke equivalent requiring urgent transfer to the ED for carotid imaging, echocardiogram, and brain imaging. ESR/CRP is checked emergently to rule out giant cell arteritis (would require immediate IV steroids). Accurate ICD-10 coding and prompt referral are scored in the Management and Documentation domain of PEPS.

2At a PEPS performance-skills station, you are required to demonstrate Goldmann applanation tonometry. Which step is critical for infection control between patients?

A.Wipe the prism with dry gauze

B.Disinfect the applanation prism per manufacturer guidance (e.g., 10-minute soak in 10% bleach or 70% isopropyl alcohol followed by rinse), and perform hand hygiene before and after every patient

C.Reuse the same fluorescein strip across patients

D.Skip hand hygiene if you wore gloves

Explanation: PEPS scores infection control as part of Communication and Professionalism. Applanation prisms must be disinfected per CDC/manufacturer guidance (10% bleach or 70% isopropyl alcohol, then rinsed with sterile water and dried) between patients to prevent transmission of adenovirus, HSV, prion, and other pathogens. Hand hygiene before and after every patient contact is mandatory regardless of glove use.

3What is the correct insertion technique for a Goldmann three-mirror gonioscopy lens at the PEPS skills station?

A.Insert dry without coupling fluid

B.Apply topical anesthetic, fill the lens concavity with goniogel or hypromellose coupling solution, instruct patient to look up, place the inferior edge against the lower fornix, then tilt up and seat the lens with the patient looking straight ahead

C.Use saline only without anesthetic

D.Press firmly to indent the cornea

Explanation: Proper Goldmann gonio lens insertion: anesthetize the cornea with proparacaine, fill the lens with coupling solution (goniogel or hypromellose), have the patient look up, place the lower edge of the lens in the inferior fornix, then ask the patient to look straight ahead while you tilt the lens up to seat it on the cornea. Avoid excessive pressure (causes indentation, false-open angle, artifactual TM compression).

4A PEPS patient encounter presents with a 1-week history of redness, light sensitivity, and decreased vision in one eye. Slit-lamp shows ciliary flush, 3+ AC cells, fine KPs, and posterior synechiae forming. What is your assessment and plan within the 15-minute station?

A.Conjunctivitis; topical antibiotic

B.Acute non-granulomatous anterior uveitis; topical prednisolone acetate 1% every 1-2 hours, cyclopentolate 1% TID for cycloplegia and synechiae prevention, monitor IOP, workup HLA-B27 if recurrent, follow up in 3-5 days

C.Acute angle closure; latanoprost

D.Endophthalmitis; intravitreal antibiotics

Explanation: Findings (ciliary flush, AC cells, fine KPs, forming posterior synechiae) define acute non-granulomatous anterior uveitis. Plan: topical prednisolone acetate 1% every 1-2 hours to suppress inflammation, cyclopentolate 1% TID for cycloplegia (reduces pain, prevents/breaks synechiae), IOP monitoring (steroid response and inflammatory glaucoma), HLA-B27/spondyloarthropathy workup if recurrent, follow up in 3-5 days. PEPS scores both correct assessment and structured documentation.

5Which patient-education statement best explains glaucoma drop technique for a newly diagnosed patient at a PEPS encounter station?

A.Apply drops anywhere on the eye whenever convenient

B.Wash hands, tilt head back, pull lower lid down to form a pocket, instill one drop, close eye gently for 1-2 minutes and press gently on the inner corner (punctal occlusion) to reduce systemic absorption, wait 5 minutes between different drops

C.Use 5 drops at once to make sure one gets in

D.Discontinue drops as soon as IOP comes down

Explanation: Proper drop technique improves efficacy and reduces systemic side effects. Key points to teach: hand hygiene, head back with lower lid pulled down, one drop only (the eye holds 7-10 microliters, drops are 25-50 microliters), close eye gently for 1-2 minutes with punctal occlusion to maximize ocular absorption and minimize systemic absorption (important with timolol), wait 5 minutes between different drops, never stop chronic glaucoma drops without consulting the doctor.

6At a PEPS encounter station, a 55-year-old reports flashes and floaters that started 3 days ago. What are the key elements of the focused history?

A.Family history of cancer only

B.Onset, duration, laterality, presence and number of floaters, photopsia pattern (peripheral arc vs central), vision changes, curtain or shadow in periphery, history of trauma or surgery, myopia/axial length, prior PVD or retinal tear, anticoagulation use, systemic vascular history

C.Diet only

D.Sleep habits only

Explanation: Flashes and floaters demand a focused history to risk-stratify for retinal break/detachment: onset, laterality, floater number (shower vs single), photopsia pattern (peripheral arc = vitreoretinal traction; central = migraine aura), vision changes, curtain/shadow (warning for detachment), trauma, surgery (especially cataract), myopia/axial length (high myopia increases risk), prior PVD or tears, anticoagulation, systemic vascular disease. This focused history demonstrates clinical reasoning, scored in PEPS Communication and Professionalism plus Clinical Interpretation.

7Which performance skill at the PEPS skills station requires you to identify Schwalbe line, trabecular meshwork (pigmented and non-pigmented bands), scleral spur, ciliary body band, and iris insertion?

A.Goldmann applanation tonometry

B.Gonioscopy with a Goldmann three-mirror, four-mirror Posner/Sussman, or Zeiss-style lens

C.Binocular indirect ophthalmoscopy

D.Dilated slit-lamp biomicroscopy

Explanation: Gonioscopy requires identification of angle structures from anterior to posterior: Schwalbe line (peripheral termination of Descemet membrane), trabecular meshwork (anterior non-pigmented and posterior pigmented), scleral spur (white line), ciliary body band (brown/gray), and iris root insertion. Grade angle using Shaffer (0-4) or Spaeth systems. Examiners score whether you can name the structures, grade the angle, and identify any neovascularization, peripheral anterior synechiae, recession, or pigmentation abnormalities.

8Per the 2026 PEPS Candidate Guide, approximately how many minutes are allotted for each patient encounter station after the 3-minute preliminary information review?

A.5 minutes

B.Approximately 15 minutes

C.30 minutes

D.60 minutes

Explanation: Per the 2026 PEPS Candidate Guide, candidates have approximately 15 minutes per station to complete the encounter (subjective history, review of objective data, ordering ancillary tests, documenting diagnosis with ICD-10, providing assessment and plan, and counseling). The 3 minutes of preliminary information review occurs before the encounter timer starts. Performance skills stations also have approximately 15 minutes.

9Which competency domain receives the highest weight in PEPS scoring per the NBEO blueprint?

A.Communication and Professionalism (11%)

B.Clinical Interpretation and Assessment (29%)

C.Patient Education (13%)

D.Skills (22%)

Explanation: Per the PEPS blueprint: Clinical Interpretation and Assessment is the heaviest-weighted domain at 29%, followed by Management and Documentation (25%), Skills (22%), Patient Education (13%), and Communication and Professionalism (11%). Candidates should prioritize accurate differential diagnosis and clinical reasoning during preparation since it carries the most points.

10At a PEPS skills station you must demonstrate binocular indirect ophthalmoscopy (BIO). Which lens power is most commonly used for routine peripheral retinal examination?

A.14 D lens (highest magnification, narrow field)

B.20 D lens (standard for routine BIO with balanced field and magnification)

C.40 D lens (widest field, lowest magnification, mainly for premature infants)

D.78 D lens (used at the slit lamp, not for BIO)

Explanation: The 20 D lens is the standard for routine BIO, providing a balanced field of view and magnification (~3x). The 14 D lens gives higher magnification (~4.5x) with narrower field for detailed central exam. The 28-30 D lens gives wider field (~2x). The 40 D lens is for small pupils or premature infant exams (ROP screening). The 78 D and 90 D lenses are used at the slit lamp, not for BIO. Proper BIO requires scleral depression to view peripheral retina.

About the NBEO Part III Exam

NBEO Part III PEPS (Patient Encounters and Performance Skills) is the final clinical examination for U.S. optometry licensure. It uses 10 patient-encounter stations and 2 performance-skills stations (anterior and posterior segment) to assess clinical reasoning, examination skills, management, documentation, patient education, and professionalism. Administered exclusively at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, NC, the exam launched its restructured PEPS format in August 2024.

Questions

12 scored questions

Time Limit

~15 minutes per station for 12 stations (full-day administration)

Passing Score

Criterion-referenced cut-off across stations and domains

Exam Fee

Approximately $1,795 (NBEO published rate) (NBEO (National Board of Examiners in Optometry))

NBEO Part III Exam Content Outline

29%

Clinical Interpretation and Assessment

Differential diagnosis from history, exam findings, and images; selecting and interpreting ancillary tests (OCT, fields, fundus photos, topography) across the 9 PEPS clinical categories

25%

Management and Documentation

Treatment selection, follow-up intervals, referral triage, prescriptions, ICD-10 diagnosis coding, and clear documentation of plan and rationale

22%

Performance Skills

Gonioscopy, Goldmann applanation tonometry, slit-lamp biomicroscopy (undilated and dilated), and binocular indirect ophthalmoscopy at the two skills stations

13%

Patient Education

Counseling on diagnosis, prognosis, medication mechanism and side effects, warning signs, lifestyle, and follow-up adherence

11%

Communication and Professionalism

History-taking communication, empathy, informed consent, hand hygiene between encounters, and infection-control etiquette with simulated patients

How to Pass the NBEO Part III Exam

What You Need to Know

Passing score: Criterion-referenced cut-off across stations and domains
Exam length: 12 questions
Time limit: ~15 minutes per station for 12 stations (full-day administration)
Exam fee: Approximately $1,795 (NBEO published rate)

Keys to Passing

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

NBEO Part III Study Tips from Top Performers

1Memorize the 9 PEPS clinical categories and rehearse a structured workup template for each so you can move quickly during the 15-minute station

2Drill the 4 core skills (Goldmann applanation, gonioscopy, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy) until each is reproducible in under 5 minutes with proper infection control

3Practice writing a 4-line SOAP assessment-and-plan (Dx with ICD-10, treatment, follow-up interval, patient education) within 5 minutes of finishing the encounter

4Rehearse hand hygiene and lens disinfection as a habit between every station; examiners score whether you do it, not whether you remember when prompted

5Build a short script for high-yield patient-education topics: glaucoma drop technique, diabetic retinopathy follow-up, sudden flashes/floaters warning signs, AMD home Amsler grid use

6Memorize ICD-10 codes for the most common PEPS diagnoses (H40 glaucoma codes, E11.3 diabetic retinopathy, H35 AMD codes, H10 conjunctivitis codes, H53.4 field defects)

7Use timed mock encounters with a partner playing a standardized patient; aim for 12-15 reps before exam day to build the 15-minute rhythm

8Review the 2026 PEPS Candidate Guide and the PEPS Site Information and Equipment Guide so you know exactly which slit-lamp, BIO lens, gonio lens, and tonometer model is provided at NCCTO

Frequently Asked Questions

What is the NBEO Part III PEPS exam?

PEPS (Patient Encounters and Performance Skills) is the restructured NBEO Part III clinical licensure exam launched in August 2024, replacing the legacy Clinical Skills Examination. It is a 12-station performance exam delivered at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, NC. Candidates rotate through 10 patient-encounter stations and 2 performance-skills stations to demonstrate clinical reasoning, examination skills, management, and professionalism.

How is PEPS organized?

Twelve stations total: 10 patient-encounter stations and 2 performance-skills stations (anterior segment and posterior segment). The 10 encounter stations cover one case from each of 9 clinical categories plus one repeated category. Each station is approximately 15 minutes, with 3 minutes of preliminary information before the timer starts on encounters. One of the 10 patient encounter stations is unscored and used for item statistics.

How is PEPS scored?

Scoring is criterion-referenced and weighted across 5 competency domains: Clinical Interpretation and Assessment (29%), Management and Documentation (25%), Skills (22%), Patient Education (13%), and Communication and Professionalism (11%). Each scoreable item is graded yes/no (was the action performed) and on performance quality. A candidate must reach the overall cut-off across domains to pass. NBEO does not publish a fixed percentage threshold.

What clinical skills are tested at the performance stations?

The two performance skills stations cover core in-office optometric skills: Goldmann applanation tonometry, gonioscopy, slit-lamp biomicroscopy (undilated and dilated), and binocular indirect ophthalmoscopy. Candidates must demonstrate proper technique, lens handling, infection control, patient positioning, and accurate findings. Standardized patients and trained examiners observe and score each step.

How much does Part III PEPS cost?

The PEPS examination fee is approximately $1,795 per NBEO published rates, which reflects the cost of standardized patients, equipment, and the dedicated NCCTO facility. This does not include travel and lodging to Charlotte, NC. Retake fees are charged per administration, and NBEO enforces a six-attempt lifetime cap on each NBEO exam.

How should I study for PEPS?

Build clinical fluency in the 9 PEPS clinical categories (anterior segment, posterior segment, glaucoma, neuro, refractive/binocular, contact lens, pediatric, systemic, urgent care). Practice ICD-10 coding for common diagnoses, write out structured assessment-and-plan notes within 15 minutes, and rehearse the four skills (gonio, GAT, slit-lamp, BIO) repeatedly under timed conditions. Drill hand hygiene and equipment cleaning between encounters until automatic.

What infection-control expectations are scored?

Hand hygiene before and after every patient contact, cleaning instruments (gonio lens, BIO lens, applanation tip) between uses, and avoiding cross-contamination of supplies are scored in the Communication and Professionalism domain. PEPS uses standardized patients and a controlled environment, but examiners score whether candidates demonstrate the same infection control they would in a real clinic, including disposable supplies and proper PPE when indicated.