JCAHPO Assisting with Interventions & Procedures 3 — Questions and Answers
Question 1: When setting up for a minor lid laceration repair, the assistant should ensure the sterile field includes which item to close the wound?
- Cryotherapy unit
- Appropriate suture material and needle driver (Correct answer)
- Retinal cryoprobe
- Phacoemulsification handpiece
Correct answer: Appropriate suture material and needle driver
Lid laceration repair requires appropriate suture material (commonly absorbable for deep tissue and non-absorbable for skin) and a needle driver.
Question 2: Which anesthetic technique is typically used for enucleation or evisceration of the eye?
- Topical proparacaine drops only
- General anesthesia or retrobulbar/peribulbar block (Correct answer)
- Subconjunctival injection of BSS
- Topical EMLA cream applied to the eyelids
Correct answer: General anesthesia or retrobulbar/peribulbar block
Enucleation or evisceration requires general anesthesia or a retrobulbar/peribulbar nerve block to achieve adequate anesthesia and akinesia of the globe.
Question 3: During a strabismus surgery, the assistant notes the surgeon needs a recession procedure. What does this involve?
- Strengthening a muscle by removing a segment and reattaching it closer to the limbus
- Weakening a muscle by detaching it and reattaching it further from the limbus (Correct answer)
- Transposing a muscle to a new position on the globe
- Injecting botulinum toxin directly into the muscle belly
Correct answer: Weakening a muscle by detaching it and reattaching it further from the limbus
A recession weakens a muscle by moving its insertion point posteriorly (further from the limbus), reducing its pull on the eye.
Question 4: What is the purpose of performing a corneal pachymetry measurement before LASIK surgery?
- To measure corneal curvature for topography mapping
- To determine corneal thickness and ensure adequate residual stromal bed after ablation (Correct answer)
- To calculate the axial length for IOL power
- To assess tear film break-up time
Correct answer: To determine corneal thickness and ensure adequate residual stromal bed after ablation
Pachymetry measures corneal thickness to confirm there is sufficient stroma remaining after the planned ablation depth, preventing post-LASIK ectasia.
Question 5: When preparing a patient for a Schirmer tear test during a pre-operative evaluation, the assistant should:
- Instill fluorescein dye before placing the strips
- Place standardized filter paper strips over the lower lid margin without anesthetic for the basic test (Correct answer)
- Use anesthetic drops and then place the strips nasally in the upper fornix
- Irrigate the nasolacrimal duct before beginning the test
Correct answer: Place standardized filter paper strips over the lower lid margin without anesthetic for the basic test
The basic Schirmer I test uses standardized filter paper strips placed over the lower lid margin without anesthetic to measure both reflex and basal tear secretion.
Question 6: A pterygium excision has been performed. Which adjunct therapy is most commonly used intraoperatively to reduce recurrence risk?
- Topical cyclosporine application
- Mitomycin C (MMC) applied to the bare sclera (Correct answer)
- Subconjunctival triamcinolone injection
- Oral doxycycline administration
Correct answer: Mitomycin C (MMC) applied to the bare sclera
Mitomycin C is an antimetabolite applied to the bare sclera during pterygium excision to inhibit fibroblast proliferation and significantly reduce recurrence rates.
Question 7: When assisting with a corneal foreign body removal using a spud or needle, what position should the patient be in?
- Seated upright with chin tilted downward
- Positioned at the slit lamp with the head stabilized in the headrest and chin rest (Correct answer)
- Lying supine on an examination table
- Standing with the head tilted to the side of the affected eye
Correct answer: Positioned at the slit lamp with the head stabilized in the headrest and chin rest
The patient should be positioned at the slit lamp with the head fully stabilized in the headrest and chin rest to provide the physician with magnified visualization and patient stability during the procedure.
JCAHPO Assisting with Interventions & Procedures 3
When setting up for a minor lid laceration repair, the assistant should ensure the sterile field includes which item to close the wound?