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NBEO Part 3 Questions and Correct Answers
TED Ans: Plan: Educated pt on today's findings. Informed that
TED is an autoimmune disease causing thyroid hormone
imbalance in the body. Recommended use of ATs to improve
dryness, Tepezza to reduce inflammation, and discontinue
smoking. Referred to PCP for CT imaging and T3/T4/TSH blood
work. RTC in 3 months for F/U.
Edu: TED is an autoimmune disease that causes your body's
antibodies to attack the thyroid gland. This results in an imbalance
of thyroid hormones and increase in inflammation in the tissues
around the eyes. The inflammation causes swelling and muscle
restriction, giving the appearance of the eye being pushed forward.
As a result, I would like to refer you to an endocrinologist to
monitor your thyroid functions. I suggest using ATs to help with
lid exposure and to discontinue smoking as it makes the condition
significantly worse. I would also like to get a head CT scan to look
for any muscle enlargement and a blood work panel to access
T3/T4/TSH levels. I'd like to see you back in 3 months for a F/U.
DTU: NaFl stain (lagophthalmos), RNFL OCT (ON edema), HVF
(compression on optic tract), forced duction (restriction in EOMs),
Maddox rod (diplopia), ophthalmometer (proptosis), CT (thickened
EOMs), T3/T4/TSH (thyroid function)
MG Ans: Plan: Educated on condition. Started pyridostigmine
30mg PO TID. Refer to PCP for ACH receptor antibody and
T3/T4/TSH blood work. RTC in 1 month for F/U.
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, 2 | Page
Edu: Myasthenia graves in autoimmmune condition affecting the
muscle receptor of the eye. These locations are blocked,
preventing the muscle from contracting as well. I'm going to refer
you to your PCP for ACH receptor antibody and T3/T4/TSH to
determine if this is caused by MG or thyroid issues. I'd also like
them to check for any thymus issues. I'll start you on a medication
called pyridostigmine 30mg 3 times a day and see you back in 1
month to monitor the condition or sooner if your symptoms
worsen. If you feel that you have any trouble breathing or
swallowing, please call right away and we'll see you sooner.
DTU: MRD 1 (degree of ptosis), ACh receptor antibody (r/o MG), ice
test (r/o MG), CT (r/o thymoma), ANA/rheumatoid factor (r/o
autoimmune disease), thyroid test (r/o thyroid disease)
Orbital cellulitis Ans: Plan: Educated pt on today's findings.
Informed that it is an infection of the entire orbit of the eye.
Referred to ER for immediate hospitalization and IV antibiotics.
Edu: Orbital cellulitis is a bacterial infection of the tissues in the
eye and in the orbit. This is a serious vision threatening issue that
can greatly worsen if not treated immediately, so I am referring
you to the ER for immediate medical attention.
DTU: ophthalmometry (proptosis), preauricular lymphadenopathy
(r/o viral cause), CT (r/o foreign body or sinus disease), CBC (r/o
inflammatory disease), blood culture (isolate pathogen)
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, 3 | Page
Preseptal cellulitis Ans: Plan: Educated pt on today's findings.
Informed that preseptal cellulitis is an acute infection of tissues
anterior to the orbital septum. Recommended starting Keflex
500mg PO BID x 10 days and warm compresses BID x 10-15min.
RTC in 3 days or sooner if S/S worsen.
Edu: Preseptal cellulitis is an infection of the tissues and eyelids
near the front of the eye. This is usually due to a clogged oil gland
that has become inflamed. I'm going to prescribe an oral antibiotic
called Keflex to control the infection and also warm compresses to
help release anything that may be clogging the glands. I'd like to
see you back in 2-3 days to monitor the progress or sooner if you
feel that things are getting worse.
DTU: ophthalmometry (proptosis), preauricular lymphadenopathy
(r/o viral cause)
Ocular Migraine Ans: Plan: Educated pt on condition. Advised on
avoidance of triggers. Assured that ocular health is unremarkable.
Consider referral to neuroophthalmologist if symptoms persist.
RTC in 1 month.
Edu: Ocular migraines can occur from a multitude of factors and
triggers. The best thing to do is try to avoid excessive stress,
reduce caffeine intake, get more sleep, and eat a healthy balanced
diet. Your eye health is normal and I don't see anything of concern.
If the symptoms continue, I'll refer you to a neuroophthalmologist.
I'll see you back in 1 month for a follow up.
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, 4 | Page
DTU: CT/MRI (r/o tumors, stroke, compressive lesions), HVF (r/o
tumors/vision defects/scotomas), RNFL OCT (r/o ON
edema/atrophy)
Endophthalmitis Ans: Plan: Educated pt on condition. Referred to
ophthalmologist for immediate follow up. RTC in 1 month.
Edu: Endophthalmitis is a bacterial infection of the eye, usually
due to a complication of cataract surgery. This is a serious ocular
emergency that needs immediate medical attention, so I'm going to
refer you back to the cataract surgeon as soon as possible for a
follow up.
DTU: B-scan (r/o vitritis), culture (r/o pathogen)
Xanthelasma Ans: Plan: Educated pt on today's findings. Informed
that xanthelasma is a collection of lipid deposits under the skin.
Benign if >40 years old. If <40 years old, ordered cholesterol
panels and carotid doppler. RTC in 1 year.
Uveitis Ans: Plan: Educated pt on condition. Informed that uveitis
is an inflammation of the anterior uvea. Started on Pred Acetate
q2h x 1 week, QID x 1 week, then taper. Started on cyclopentolate
BID x 1 week. Discussed possibility of ordering HLA-B27, ACE, PPD,
FTA-ABS, and lyme antibody testing if condition reoccurs. RTC in 1
week.
© 2025 All rights reserved
NBEO Part 3 Questions and Correct Answers
TED Ans: Plan: Educated pt on today's findings. Informed that
TED is an autoimmune disease causing thyroid hormone
imbalance in the body. Recommended use of ATs to improve
dryness, Tepezza to reduce inflammation, and discontinue
smoking. Referred to PCP for CT imaging and T3/T4/TSH blood
work. RTC in 3 months for F/U.
Edu: TED is an autoimmune disease that causes your body's
antibodies to attack the thyroid gland. This results in an imbalance
of thyroid hormones and increase in inflammation in the tissues
around the eyes. The inflammation causes swelling and muscle
restriction, giving the appearance of the eye being pushed forward.
As a result, I would like to refer you to an endocrinologist to
monitor your thyroid functions. I suggest using ATs to help with
lid exposure and to discontinue smoking as it makes the condition
significantly worse. I would also like to get a head CT scan to look
for any muscle enlargement and a blood work panel to access
T3/T4/TSH levels. I'd like to see you back in 3 months for a F/U.
DTU: NaFl stain (lagophthalmos), RNFL OCT (ON edema), HVF
(compression on optic tract), forced duction (restriction in EOMs),
Maddox rod (diplopia), ophthalmometer (proptosis), CT (thickened
EOMs), T3/T4/TSH (thyroid function)
MG Ans: Plan: Educated on condition. Started pyridostigmine
30mg PO TID. Refer to PCP for ACH receptor antibody and
T3/T4/TSH blood work. RTC in 1 month for F/U.
© 2025 All rights reserved
, 2 | Page
Edu: Myasthenia graves in autoimmmune condition affecting the
muscle receptor of the eye. These locations are blocked,
preventing the muscle from contracting as well. I'm going to refer
you to your PCP for ACH receptor antibody and T3/T4/TSH to
determine if this is caused by MG or thyroid issues. I'd also like
them to check for any thymus issues. I'll start you on a medication
called pyridostigmine 30mg 3 times a day and see you back in 1
month to monitor the condition or sooner if your symptoms
worsen. If you feel that you have any trouble breathing or
swallowing, please call right away and we'll see you sooner.
DTU: MRD 1 (degree of ptosis), ACh receptor antibody (r/o MG), ice
test (r/o MG), CT (r/o thymoma), ANA/rheumatoid factor (r/o
autoimmune disease), thyroid test (r/o thyroid disease)
Orbital cellulitis Ans: Plan: Educated pt on today's findings.
Informed that it is an infection of the entire orbit of the eye.
Referred to ER for immediate hospitalization and IV antibiotics.
Edu: Orbital cellulitis is a bacterial infection of the tissues in the
eye and in the orbit. This is a serious vision threatening issue that
can greatly worsen if not treated immediately, so I am referring
you to the ER for immediate medical attention.
DTU: ophthalmometry (proptosis), preauricular lymphadenopathy
(r/o viral cause), CT (r/o foreign body or sinus disease), CBC (r/o
inflammatory disease), blood culture (isolate pathogen)
© 2025 All rights reserved
, 3 | Page
Preseptal cellulitis Ans: Plan: Educated pt on today's findings.
Informed that preseptal cellulitis is an acute infection of tissues
anterior to the orbital septum. Recommended starting Keflex
500mg PO BID x 10 days and warm compresses BID x 10-15min.
RTC in 3 days or sooner if S/S worsen.
Edu: Preseptal cellulitis is an infection of the tissues and eyelids
near the front of the eye. This is usually due to a clogged oil gland
that has become inflamed. I'm going to prescribe an oral antibiotic
called Keflex to control the infection and also warm compresses to
help release anything that may be clogging the glands. I'd like to
see you back in 2-3 days to monitor the progress or sooner if you
feel that things are getting worse.
DTU: ophthalmometry (proptosis), preauricular lymphadenopathy
(r/o viral cause)
Ocular Migraine Ans: Plan: Educated pt on condition. Advised on
avoidance of triggers. Assured that ocular health is unremarkable.
Consider referral to neuroophthalmologist if symptoms persist.
RTC in 1 month.
Edu: Ocular migraines can occur from a multitude of factors and
triggers. The best thing to do is try to avoid excessive stress,
reduce caffeine intake, get more sleep, and eat a healthy balanced
diet. Your eye health is normal and I don't see anything of concern.
If the symptoms continue, I'll refer you to a neuroophthalmologist.
I'll see you back in 1 month for a follow up.
© 2025 All rights reserved
, 4 | Page
DTU: CT/MRI (r/o tumors, stroke, compressive lesions), HVF (r/o
tumors/vision defects/scotomas), RNFL OCT (r/o ON
edema/atrophy)
Endophthalmitis Ans: Plan: Educated pt on condition. Referred to
ophthalmologist for immediate follow up. RTC in 1 month.
Edu: Endophthalmitis is a bacterial infection of the eye, usually
due to a complication of cataract surgery. This is a serious ocular
emergency that needs immediate medical attention, so I'm going to
refer you back to the cataract surgeon as soon as possible for a
follow up.
DTU: B-scan (r/o vitritis), culture (r/o pathogen)
Xanthelasma Ans: Plan: Educated pt on today's findings. Informed
that xanthelasma is a collection of lipid deposits under the skin.
Benign if >40 years old. If <40 years old, ordered cholesterol
panels and carotid doppler. RTC in 1 year.
Uveitis Ans: Plan: Educated pt on condition. Informed that uveitis
is an inflammation of the anterior uvea. Started on Pred Acetate
q2h x 1 week, QID x 1 week, then taper. Started on cyclopentolate
BID x 1 week. Discussed possibility of ordering HLA-B27, ACE, PPD,
FTA-ABS, and lyme antibody testing if condition reoccurs. RTC in 1
week.
© 2025 All rights reserved
