COT Surgical Assisting Procedures 5 — Questions and Answers
Question 1: In the ophthalmic OR, the technician is responsible for proper positioning of the operating microscope. Which adjustment ensures the surgeon has adequate working distance?
- Adjusting the objective lens focal length and XY positioning (Correct answer)
- Changing the eyepiece diopter settings
- Increasing the coaxial illumination intensity
- Rotating the beam splitter for assistant viewing
Correct answer: Adjusting the objective lens focal length and XY positioning
The objective lens determines the focal length (working distance), typically 175–200 mm, and must be positioned so the surgeon operates comfortably without postural strain.
Question 2: When a surgeon requests intracameral preservative-free lidocaine during cataract surgery, the technician draws it from a single-use vial because:
- Preserved formulations are toxic to corneal endothelium (Correct answer)
- Preserved lidocaine causes pupil dilation
- Multi-dose vials cannot be opened on the sterile field
- Preservatives increase viscosity, blocking phaco aspiration
Correct answer: Preserved formulations are toxic to corneal endothelium
Benzalkonium chloride and other preservatives are cytotoxic to corneal endothelial cells; only preservative-free preparations are safe for intracameral injection.
Question 3: During glaucoma tube-shunt surgery, the technician should cover the tube with a patch graft to prevent which complication?
- Tube erosion through the conjunctiva (Correct answer)
- Hypotony maculopathy immediately postoperatively
- Choroidal hemorrhage during IOP fluctuation
- Corneal decompensation from tube contact
Correct answer: Tube erosion through the conjunctiva
Without a protective patch graft (pericardium, sclera, or cornea), the silicone tube can erode through the overlying conjunctiva, risking infection and endophthalmitis.
Question 4: Which action by the ophthalmic technician is appropriate when the surgeon calls for 'more viscoelastic' during IOL implantation?
- Load a fresh viscoelastic cannula and hand it handle-first to the surgeon (Correct answer)
- Inject BSS through the side-port to supplement the OVD
- Add the OVD directly to the irrigation bottle
- Aspirate residual OVD first to make room before adding more
Correct answer: Load a fresh viscoelastic cannula and hand it handle-first to the surgeon
A pre-loaded cannula handed handle-first maintains the sterile transfer technique and allows the surgeon to inject immediately without repositioning.
Question 5: After cataract surgery, the technician applies a patch and shield. The primary purpose of the rigid shield is to:
- Protect the eye from external pressure and accidental rubbing (Correct answer)
- Maintain moisture over the corneal surface postoperatively
- Hold the wound edges together while sutures dissolve
- Prevent light exposure that could damage the new IOL
Correct answer: Protect the eye from external pressure and accidental rubbing
A rigid Fox shield deflects physical contact from pillows, fingers, or clothing, preventing accidental pressure on the fresh surgical wound.
Question 6: A chalazion clamp is used during incision and curettage of a chalazion. What is its function?
- To evert the eyelid and provide hemostasis around the lesion (Correct answer)
- To excise the chalazion with a sharp circular motion
- To dilate the meibomian gland orifice for drainage
- To measure the size of the granuloma before incision
Correct answer: To evert the eyelid and provide hemostasis around the lesion
The chalazion clamp stabilizes and everts the eyelid while its ring compresses blood vessels to minimize bleeding during the procedure.
Question 7: When scrubbing in for ophthalmic surgery, the technician should perform a surgical hand scrub for a minimum of how many minutes according to standard protocol?
- 3 to 5 minutes using an antiseptic agent (Correct answer)
- 30 seconds with alcohol-based handrub only
- 10 minutes using plain soap
- 1 minute if wearing two pairs of sterile gloves
Correct answer: 3 to 5 minutes using an antiseptic agent
Standard surgical scrub protocol requires 3–5 minutes with an antiseptic solution (e.g., chlorhexidine or povidone-iodine) to reduce resident and transient skin flora.
COT Surgical Assisting Procedures 5
In the ophthalmic OR, the technician is responsible for proper positioning of the operating microscope.
Which adjustment ensures the surgeon has adequate working distance?