Free CPOA™ Practice Test: Sample Questions with Answers

1. Question 1

   During Goldmann applanation, the examiner adjusts the dial until the two fluorescein mires (semicircles) reach which endpoint?

   1. A. They separate completely with a wide visible gap
   2. B. One mire disappears while the other stays fully visible
   3. C. They merge into one thick, unbroken circular ring
   4. D. Their inner edges touch, alternating with each pulse
   Show answer to question 1

   Answer: D. Their inner edges touch, alternating with each pulse

   The correct endpoint is reached when the inner edges of the two fluorescein semicircles just touch and appear to overlap slightly with each ocular pulse. Too little applied force leaves a visible gap between them; too much force causes excessive overlap or merging.

2. Question 2

   If the ultrasound probe compresses the cornea during contact (applanation) A-scan biometry, the resulting axial length reading will be:

   1. A. Falsely long, risking an IOL power that is too weak
   2. B. Unaffected, since the probe only measures chamber depth
   3. C. Falsely short, risking an IOL power that is too strong
   4. D. Falsely short, but only affecting keratometry readings
   Show answer to question 2

   Answer: C. Falsely short, risking an IOL power that is too strong

   Pressing the probe against the cornea indents the globe and shortens the measured axial length; the calculation then selects a stronger IOL than the eye actually needs, risking a postoperative myopic surprise.

3. Question 3

   During the swinging flashlight test, a positive relative afferent pupillary defect in the left eye looks like:

   1. A. both pupils constricting equally each time
   2. B. the left pupil reacting more briskly than normal
   3. C. the left pupil appearing to dilate instead
   4. D. the left pupil staying fixed and unreactive
   Show answer to question 3

   Answer: C. the left pupil appearing to dilate instead

   Net light input to the brain briefly drops when the light swings onto the weaker eye, so instead of constricting further that pupil appears to dilate — the classic 'Marcus Gunn' finding of an afferent problem rather than a muscle problem.

4. Question 4

   A patient calls describing vision in one eye that suddenly went completely dark for about five minutes and then returned to normal on its own. How should the assistant triage this call?

   1. A. arrange urgent same-day evaluation for a possible TIA
   2. B. advise lubricating drops and a routine follow-up
   3. C. reassure the patient since vision returned to normal on its own
   4. D. schedule the next available annual eye exam
   Show answer to question 4

   Answer: A. arrange urgent same-day evaluation for a possible TIA

   Transient monocular vision loss that resolves on its own (amaurosis fugax) can warn of carotid disease or an impending stroke, so it is triaged as urgent same-day evaluation rather than reassured away just because vision returned.

5. Question 5

   A patient describes a high-velocity metal fragment striking the eye while grinding, with a visibly irregular pupil. This history and finding should prompt the assistant to:

   1. A. Attempt gentle irrigation with saline to flush the fragment out
   2. B. Instill a cycloplegic drop and send them home
   3. C. Apply a snug patch and follow up in one week
   4. D. Avoid touching the eye, shield it, and refer at once
   Show answer to question 5

   Answer: D. Avoid touching the eye, shield it, and refer at once

   A high-velocity mechanism plus an irregular pupil raises strong suspicion for a penetrating globe injury. Irrigating, patching snugly, or instilling drops could worsen a ruptured globe, so the eye is shielded without pressure and referred emergently.

6. Question 6

   During ongoing irrigation for a chemical eye injury, how does the assistant determine that irrigation has been adequate and can be stopped?

   1. A. after exactly two full minutes have elapsed by the clock
   2. B. as soon as the patient reports the stinging has stopped
   3. C. once one full bottle of irrigating solution has been completely used up
   4. D. when litmus paper shows the tear film pH is neutral on a repeat check
   Show answer to question 6

   Answer: D. when litmus paper shows the tear film pH is neutral on a repeat check

   Irrigation continues until ocular surface pH normalizes, checked with litmus paper against the tear film and confirmed again a few minutes later — not by a fixed clock time, symptom relief alone, or a set volume of fluid.

7. Question 7

   On an automated visual field printout, an elevated fixation-loss score most directly means the patient...

   1. A. Pressed the button with no stimulus shown
   2. B. Looked away from the fixation target
   3. C. Missed stimuli they should have seen
   4. D. Blinked exactly when stimuli appeared
   Show answer to question 7

   Answer: B. Looked away from the fixation target

   Fixation losses are commonly tracked with the Heijl-Krakau method: a stimulus is projected at the patient's calculated blind spot, and a response to it means the eye had drifted off the fixation target, since a steadily fixating eye should not detect light there.

8. Question 8

   Cycloplegic agents such as cyclopentolate dilate the pupil and blur near vision by:

   1. A. Directly and immediately stimulating the iris dilator muscle
   2. B. Blocking muscarinic receptors that focus the lens
   3. C. Increasing the eye's aqueous humor outflow
   4. D. Numbing the corneal trigeminal nerve reflex
   Show answer to question 8

   Answer: B. Blocking muscarinic receptors that focus the lens

   Cycloplegics block muscarinic (parasympathetic) receptors on the ciliary and sphincter muscles, which both dilates the pupil and paralyzes accommodation, useful for accurate refraction, especially in children.

9. Question 9

   Autorefractors reduce accommodative error ('instrument myopia') during measurement mainly by:

   1. A. Presenting a target that fogs to simulate distance
   2. B. Instilling a cycloplegic drop before every reading
   3. C. Asking the patient to stare hard at the fixation light
   4. D. Raising the room lighting so the pupil constricts
   Show answer to question 9

   Answer: A. Presenting a target that fogs to simulate distance

   Most autorefractors project a fixation target that intentionally blurs, or 'fogs,' to appear farther away, relaxing accommodation optically rather than pharmacologically.

10. Question 10

    An OCT scan shows a visible break or step in the retinal layers that was not there on a repeat scan of the same eye. This is most likely due to:

    1. A. Patient movement during the few seconds of the scan
    2. B. The scanner's laser being set too weak for that eye
    3. C. A normal anatomic variation in that retinal layer
    4. D. The fixation target being positioned too far away
    Show answer to question 10

    Answer: A. Patient movement during the few seconds of the scan

    Sudden discontinuities in an otherwise smooth retinal contour are a classic sign of a motion artifact; keeping the head steady against the rest for the brief capture window avoids this.

11. Question 11

    The Hirschberg test estimates the angle of a strabismus by evaluating:

    1. A. How much prism is needed to align the visual axes
    2. B. How far each eye can move in monocular duction
    3. C. Where the corneal light reflex falls in each eye
    4. D. How quickly convergence breaks on a near target
    Show answer to question 11

    Answer: C. Where the corneal light reflex falls in each eye

    The Hirschberg test shines a light at the patient and compares the position of the corneal light reflex relative to the pupil center in each eye; a decentered reflex indicates a manifest deviation, and its displacement gives a rough estimate of the angle.

12. Question 12

    A patient with an unusually thin central corneal thickness will tend to have Goldmann applanation readings that:

    1. A. Overestimate the true intraocular pressure
    2. B. Fluctuate randomly with no consistent pattern
    3. C. Exactly match the true intraocular pressure
    4. D. Underestimate the true intraocular pressure
    Show answer to question 12

    Answer: D. Underestimate the true intraocular pressure

    Goldmann tonometry was calibrated assuming an average corneal thickness and rigidity. A thinner cornea flattens more easily under less force, so the instrument records a value lower than the eye's actual pressure.

13. Question 13

    Random dot stereopsis tests (e.g., Random Dot E) are considered more rigorous than contour-based tests (e.g., Titmus circles) because they:

    1. A. Remove monocular cues, requiring true fusion
    2. B. Require no special glasses or filters at all
    3. C. Test distance rather than near stereoacuity
    4. D. Assess color vision along with depth perception
    Show answer to question 13

    Answer: A. Remove monocular cues, requiring true fusion

    Contour-based stereo targets (like the Titmus fly) have visible outlines that could partly be detected monocularly, while random-dot targets conceal the form within visual noise so it can only be perceived through genuine binocular disparity.

14. Question 14

    How does a contrast sensitivity chart such as the Pelli-Robson differ from a standard Snellen acuity chart?

    1. A. It keeps contrast fixed while decreasing letter size
    2. B. It tests color vision rather than letter recognition
    3. C. It keeps letter size fixed while lowering contrast
    4. D. It can only be scored after full pupil dilation
    Show answer to question 14

    Answer: C. It keeps letter size fixed while lowering contrast

    Snellen charts vary letter size at high contrast, while contrast sensitivity charts hold letter size constant and progressively lower the contrast between letters and background, revealing functional deficits that high-contrast acuity testing alone can miss.

15. Question 15

    Because a progressive addition lens (PAL) changes power continuously across its surface, the lensometer add reading is best taken:

    1. A. At the exact geometric center of the distance portion
    2. B. Anywhere within the lower half of the lens
    3. C. At the very bottom edge of the lens surface
    4. D. At the manufacturer's etched near reference mark
    Show answer to question 15

    Answer: D. At the manufacturer's etched near reference mark

    PAL manufacturers etch or emboss tiny reference marks locating the distance and near measurement points; reading anywhere else in the progressive corridor gives an inconsistent, unreliable add value.

Clinical Principles, Testing, and Procedures study guide →

1. Question 16

   On fluorescein evaluation of a rigid lens, central pooling with bearing at the mid-periphery indicates what kind of fit?

   1. A. A steep-fitting lens overall
   2. B. A flat-fitting lens overall
   3. C. A lens with the wrong diameter
   4. D. A well-aligned, ideal fit overall
   Show answer to question 16

   Answer: A. A steep-fitting lens overall

   Central pooling with peripheral touch is the classic fluorescein pattern of a steep-fitting rigid lens, since the lens vaults excessively over the corneal apex.

2. Question 17

   A patient is wearing a -3.00 D trial soft contact lens, and over-refraction with loose trial lenses shows an additional -0.75 D is needed for a clear view. What power should be ordered?

   1. A. -3.75 D
   2. B. -3.00 D
   3. C. -2.25 D
   4. D. -0.75 D
   Show answer to question 17

   Answer: A. -3.75 D

   The over-refraction result is added algebraically to the power of the trial lens that was on the eye when it was measured: -3.00 D + (-0.75 D) = -3.75 D.

3. Question 18

   A soft lens wearer is diagnosed with moderate GPC. Which management step is most appropriate as an initial approach?

   1. A. Continue the current wearing schedule and reassess in six months
   2. B. Reduce wear time, improve hygiene, or use daily disposables
   3. C. Add a topical antibiotic and resume wear the next day
   4. D. Switch immediately to overnight extended wear to rest the eyes
   Show answer to question 18

   Answer: B. Reduce wear time, improve hygiene, or use daily disposables

   Initial GPC management lowers the antigenic load on the tarsal conjunctiva — shortening wear time, improving cleaning, or moving to daily disposables — since GPC is inflammatory rather than infectious, so antibiotics do not address the cause.

4. Question 19

   Compared with a flatter base curve, a steeper base curve (smaller radius) on an otherwise identical lens will generally fit how?

   1. A. The lens fits looser, with more movement
   2. B. Only comfort changes, not the actual fit
   3. C. The fit is unaffected by base curve changes
   4. D. The lens fits tighter, with less movement
   Show answer to question 19

   Answer: D. The lens fits tighter, with less movement

   A steeper base curve has a smaller radius of curvature, increasing apical clearance and producing a tighter-fitting lens with less movement on blink.

5. Question 20

   Scleral lenses are typically filled with fluid before insertion using which type of solution?

   1. A. Hydrogen peroxide disinfecting solution
   2. B. Plain tap water for convenience
   3. C. A preservative-free saline solution
   4. D. A preserved multipurpose solution
   Show answer to question 20

   Answer: C. A preservative-free saline solution

   Because the fill fluid sits against the cornea for hours under the lens, preservative-free saline is used to avoid irritation or toxicity from preservatives or residual peroxide.

Contact Lenses study guide →

1. Question 21

   A patient's eyelashes brush against the back surface of her lenses. Which adjustment typically resolves this?

   1. A. Decrease the vertex distance even further
   2. B. Increase the vertex distance slightly
   3. C. Switch to a noticeably smaller lens
   4. D. Tighten the temples against the face
   Show answer to question 21

   Answer: B. Increase the vertex distance slightly

   Lash contact usually means the lenses sit too close to the eyes; increasing vertex distance by adjusting pad position or temple angle creates clearance without altering the prescription itself.

2. Question 22

   A +4.00 D lens has its optical center placed 5 mm away from the wearer's line of sight. How much prism does Prentice's rule predict at that point?

   1. A. 0.5 prism diopters
   2. B. 2.0 prism diopters
   3. C. 4.0 prism diopters
   4. D. 20 prism diopters
   Show answer to question 22

   Answer: B. 2.0 prism diopters

   Convert 5 mm to 0.5 cm, then multiply by the 4.00 D lens power: 0.5 x 4 = 2.0 prism diopters of unwanted, unprescribed prism.

3. Question 23

   Transpose -3.00 -2.00 x 045 into plus-cylinder notation.

   1. A. -5.00 -2.00 x 135
   2. B. -5.00 +2.00 x 045
   3. C. -5.00 +2.00 x 135
   4. D. -1.00 +2.00 x 135
   Show answer to question 23

   Answer: C. -5.00 +2.00 x 135

   Add the cylinder to the sphere (-3.00 + (-2.00) = -5.00), flip the cylinder's sign to +2.00, and rotate the axis 90 degrees so 045 becomes 135.

4. Question 24

   Compared to polycarbonate, Trivex lens material offers similar impact resistance but is generally chosen when the priority is:

   1. A. A lower per-lens material cost overall
   2. B. A significantly higher refractive index
   3. C. Sharper optics from a higher Abbe value
   4. D. Compatibility with glass-only frame styles
   Show answer to question 24

   Answer: C. Sharper optics from a higher Abbe value

   Trivex has a higher Abbe value, roughly 43 to 45, than polycarbonate's roughly 30, giving sharper optics with less chromatic aberration while still offering comparable impact resistance, useful when both safety and visual quality matter.

Ophthalmic Optics and Dispensing study guide →

1. Question 25

   An elderly patient presents with unexplained bruising in several stages of healing and appears fearful of their caregiver. This presentation should prompt the CPOA to:

   1. A. Document it in the chart but take no further action
   2. B. Alert the provider so possible abuse can be evaluated
   3. C. Ask the caregiver directly what happened to the patient
   4. D. Wait to see if the same pattern appears again next visit
   Show answer to question 25

   Answer: B. Alert the provider so possible abuse can be evaluated

   Signs like bruising in multiple healing stages plus fearfulness toward a caregiver are recognized indicators of possible elder abuse; staff should escalate the concern to the provider promptly rather than confronting the caregiver or waiting for it to recur.

2. Question 26

   A CPOA forgot to record a visual acuity result and, at the end of the day, writes in a plausible estimated number to complete the chart. This is best described as:

   1. A. Acceptable, since the estimate is likely close to accurate
   2. B. Acceptable, as long as the doctor is told about it later
   3. C. A problem only if the patient is somehow harmed by it
   4. D. A violation, since records must reflect actual findings
   Show answer to question 26

   Answer: D. A violation, since records must reflect actual findings

   Medical records must document what was actually observed or measured; entering a fabricated number, even a plausible one, compromises the chart's integrity and can affect future clinical decisions regardless of whether harm results.

3. Question 27

   Beyond explaining the purpose of a proposed treatment, a valid informed consent discussion must also cover:

   1. A. Its total cost and the office's refund policy
   2. B. The physician's total years of experience
   3. C. Its risks, benefits, and reasonable options
   4. D. A list of other patients' past outcomes
   Show answer to question 27

   Answer: C. Its risks, benefits, and reasonable options

   Informed consent requires enough information for the patient to make an educated choice, which means covering the risks, expected benefits, and reasonable alternatives to the proposed treatment, not billing details or the provider's résumé.

4. Question 28

   A routine calibration check comes back outside the acceptable tolerance range. The correct QA response is to:

   1. A. Keep using the instrument, since small drift rarely matters
   2. B. Pull it from use, document, and arrange recalibration
   3. C. Wait for the next scheduled check to see if it corrects
   4. D. Manually adjust patient results to compensate for it
   Show answer to question 28

   Answer: B. Pull it from use, document, and arrange recalibration

   An out-of-tolerance calibration result should trigger removing the instrument from clinical use and documenting corrective action, rather than continued use or informal manual adjustment of results.

Professional Issues study guide →

1. Question 29

   A patient with poorly controlled diabetes reports that their eyeglass prescription seems to change from week to week. This fluctuating refractive error is most likely caused by:

   1. A. Early cataract formation
   2. B. Lens swelling from glucose
   3. C. Diabetic macular edema
   4. D. Corneal neovascularization
   Show answer to question 29

   Answer: B. Lens swelling from glucose

   Rapid shifts in blood glucose change the osmotic gradient across the lens, causing it to swell or shrink and temporarily alter its refractive power. This effect resolves once glucose stabilizes, unlike cataract, macular edema, or corneal neovascularization, which are structural changes that do not fluctuate day to day.

2. Question 30

   During accommodation for a near target, what does the ciliary muscle do?

   1. A. It contracts, loosening zonules
   2. B. It relaxes, tightening the zonules
   3. C. It contracts, flattening the lens
   4. D. It relaxes, flattening the lens
   Show answer to question 30

   Answer: A. It contracts, loosening zonules

   Ciliary muscle contraction slackens the zonular fibers, letting the elastic lens round up and increase its refractive power for near focus.

Science of the Eye study guide →