COT - Certified Ophthalmic Technician Surgical Assisting Procedures Questions and Answers — Questions and Answers
Question 1: While setting up the instrument tray for a chalazion excision, a sterile cotton-tipped applicator rolls off the edge of the sterile drape but is caught before it hits the floor. What is the most appropriate action for the surgical assistant to take?
- Use the applicator since it did not touch the floor.
- Ask the surgeon if the applicator is still considered sterile.
- Discard the applicator and obtain a new sterile one. (Correct answer)
- Place the applicator on a separate part of the tray to be used last.
Correct answer: Discard the applicator and obtain a new sterile one.
Any item that breaches the boundary of the sterile field is considered contaminated, regardless of whether it touched an obviously non-sterile surface like the floor. The principle of asepsis requires erring on the side of caution to prevent surgical site infections.
Question 2: During a cataract extraction procedure, the surgeon needs to create a continuous circular opening in the anterior lens capsule. Which of the following instruments would the surgeon most likely request for this specific step, known as capsulorhexis?
- Sinskey hook
- Utrata forceps (Correct answer)
- Bishop-Harmon forceps
- Westcott scissors
Correct answer: Utrata forceps
Utrata forceps, also known as capsulorhexis forceps, are specifically designed with fine, grasping tips to grip and tear the anterior lens capsule in a controlled, circular manner to perform a capsulorhexis. A cystotome, a type of bent needle, can also be used for this step.
Question 3: A technician is preparing a patient for cataract surgery. The patient has signed the consent form, but while reviewing the procedure, they state, "I'm a little nervous because I don't really understand what the doctor is going to do with the new lens." What is the technician's most appropriate response?
- Reassure the patient that the surgeon is very experienced and they shouldn't worry.
- Provide the patient with a brochure about cataract surgery to read while they wait.
- Pause all preparations and inform the surgeon that the patient has further questions and may not fully understand the procedure. (Correct answer)
- Proceed with the pre-operative preparations as consent has already been signed.
Correct answer: Pause all preparations and inform the surgeon that the patient has further questions and may not fully understand the procedure.
Informed consent is a communication process, not just a signature on a form. If a patient expresses a lack of understanding, it indicates that true informed consent has not been achieved. The technician's duty is to stop the process and notify the surgeon, who is ultimately responsible for ensuring the patient fully comprehends the procedure, risks, and benefits before moving forward.
Question 4: A retrobulbar block is a type of local anesthesia used for intraocular surgery. Where is the anesthetic agent injected to achieve this block?
- Into the space between the sclera and Tenon's capsule (sub-Tenon's).
- Under the skin of the eyelid (subcutaneous).
- Into the cone-shaped area behind the globe, containing the optic nerve and extraocular muscles. (Correct answer)
- Directly into the vitreous cavity.
Correct answer: Into the cone-shaped area behind the globe, containing the optic nerve and extraocular muscles.
A retrobulbar injection places anesthetic into the retrobulbar space, which is the muscle cone located behind the eye (globe). This effectively blocks sensory and motor nerves to the eye, providing profound anesthesia and akinesia (lack of movement) for surgery.
Question 5: Which of the following is a critical step in preparing a patient's eye immediately before an intravitreal injection to minimize the risk of endophthalmitis?
- Application of a pressure patch to lower IOP.
- Instillation of a miotic agent to constrict the pupil.
- Measurement of the injection site with calipers.
- Application of povidone-iodine to the ocular surface and lids. (Correct answer)
Correct answer: Application of povidone-iodine to the ocular surface and lids.
The application of an antiseptic, most commonly povidone-iodine, to the ocular surface, eyelids, and lashes is the most important step in preventing post-injection endophthalmitis. This significantly reduces the bacterial load on and around the eye before the needle enters the globe.
Question 6: After a minor surgical procedure, a technician is cleaning reusable, heat-sensitive ophthalmic instruments. Which method is most appropriate for processing these instruments?
- Placing them in a steam autoclave on a standard cycle.
- Soaking them in a high-level disinfectant (e.g., glutaraldehyde) for the manufacturer-recommended time. (Correct answer)
- Wiping them thoroughly with an alcohol prep pad.
- Rinsing them under hot tap water and allowing them to air dry.
Correct answer: Soaking them in a high-level disinfectant (e.g., glutaraldehyde) for the manufacturer-recommended time.
For heat-sensitive instruments that cannot undergo steam sterilization (autoclaving), soaking in a high-level chemical disinfectant like glutaraldehyde is the appropriate method. This process kills microorganisms, including bacteria, viruses, and fungi, making the instruments safe for reuse. Steam autoclaving would damage the instruments, while alcohol wipes and tap water are insufficient for proper disinfection.
COT - Certified Ophthalmic Technician Surgical Assisting Procedures Questions and Answers
While setting up the instrument tray for a chalazion excision, a sterile cotton-tipped applicator rolls off the edge of the sterile drape but is caught before it hits the floor.
What is the most appropriate action for the surgical assistant to take?