21 Pharmacology, Microbiology & Surgical Assisting Practice Questions & Answers

1. 1. A patient receives a drop of phenylephrine before a dilated examination. Compared with a cycloplegic agent, what effect should the technician expect?

   • A.Pupil constriction with an increase in depth of focus
   • B.Pupil dilation with accommodation essentially intact✓ Answer
   • C.Pupil dilation with near vision blurred by cycloplegia
   • D.Minimal pupil change with a clear drop in tear output

   Phenylephrine is a sympathomimetic that stimulates the iris dilator muscle, so the pupil enlarges while the ciliary muscle is untouched and accommodation is preserved. Cycloplegics work by blocking muscarinic receptors on the ciliary muscle, which is why they both dilate the pupil and blur near vision. Confusing the two effects is the classic error.

   Source: AAO Ophthalmic Medical Assisting independent study course, basics of ophthalmic pharmacology (mydriatics and cycloplegics)Report a problem with this question

2. 2. Soon after a cycloplegic drop is instilled for a pediatric refraction, the child becomes flushed and warm, complains of a dry mouth and seems disoriented. What is the most likely explanation?

   • A.A vasovagal response to the instillation itself
   • B.Adrenergic stimulation typical of phenylephrine
   • C.An allergic reaction to the preservative in the bottle
   • D.Systemic absorption of the anticholinergic drug✓ Answer

   Cycloplegics are antimuscarinic drugs, and the systemic picture of blocked muscarinic receptors is dry mouth, flushed warm skin, fast pulse and confusion. Children absorb proportionally more drug for their body size, so the lowest effective concentration, one drop at a time and punctal occlusion reduce the risk. The reaction must be reported to the ophthalmologist and documented.

   Source: AAO Ophthalmic Medical Assisting independent study course, systemic effects of anticholinergic cycloplegicsReport a problem with this question

3. 3. Why does gently pressing at the inner corner of the closed lids for a couple of minutes after a drop reduce systemic side effects?

   • A.It pushes the drop into the anterior chamber much more quickly
   • B.It blocks drainage into the nose, where the drug would reach the bloodstream✓ Answer
   • C.It triggers reflex tearing that dilutes the drug on the surface
   • D.It squeezes the meibomian glands so the drop stays on the eye longer

   Tears and any drug in them drain through the puncta and canaliculi into the nose, where the richly vascular mucosa absorbs the drug directly into the circulation without passing through the liver first. Occluding the puncta and keeping the lids gently closed keeps more drug on the eye and less in the bloodstream, which matters most for drugs with cardiac or respiratory effects.

   Source: AAO Ophthalmic Medical Assisting independent study course, technique for instilling drops and punctal occlusionReport a problem with this question

4. 4. A topical anesthetic drop has just been used for a procedure on the surface of the eye. Which instruction best protects the cornea afterwards?

   • A.Keep the eye patched for the whole of the rest of the day
   • B.Blink hard several times to spread the drop evenly
   • C.Use the same anesthetic at home whenever it stings
   • D.Avoid rubbing the eye until normal sensation returns✓ Answer

   Topical anesthesia removes the corneal sensation and the protective blink and pain reflexes, so a patient can scrape the epithelium by rubbing and never feel it. For the same reason a bottle of topical anesthetic is never dispensed for home use, because repeated application is toxic to the epithelium and can lead to a non-healing defect.

   Source: AAO Ophthalmic Medical Assisting independent study course, topical anesthetic agentsReport a problem with this question

5. 5. A soft contact lens wearer needs fluorescein instilled so the cornea can be examined. What should be done first?

   • A.Remove the contact lens before instilling the dye✓ Answer
   • B.Use a wetting drop and place the dye at the limbus
   • C.Instill the dye over the lens and rinse it afterwards
   • D.Instill an anesthetic first so the lens can stay in

   Fluorescein is absorbed by the hydrogel material of a soft lens and stains it, and rinsing does not reliably remove it. The lens is taken out before the dye goes in, and the patient is told to leave it out until the dye has cleared from the tear film. Fluorescein pools where the epithelium is missing, which is what makes an abrasion or ulcer visible in blue light.

   Source: AAO Ophthalmic Medical Assisting independent study course, diagnostic dyes and fluorescein stainingReport a problem with this question

6. 6. Which statement correctly pairs a class of pressure-lowering eye drop with the way it works?

   • A.A beta-blocker lowers pressure by reducing aqueous production✓ Answer
   • B.A prostaglandin analogue lowers pressure by reducing production
   • C.A miotic lowers pressure by reducing aqueous production
   • D.A carbonic anhydrase inhibitor works by increasing outflow

   Every pressure-lowering drug either makes less aqueous or lets more of it leave the eye. Beta-blockers and carbonic anhydrase inhibitors suppress secretion by the ciliary epithelium, while prostaglandin analogues increase uveoscleral outflow and miotics pull open the trabecular route. Knowing the route also explains the cautions, such as avoiding a beta-blocker in a patient with asthma or a slow heart rate.

   Source: AAO Ophthalmic Medical Assisting independent study course, medications used to lower intraocular pressureReport a problem with this question

7. 7. The ophthalmologist has ordered a specific drop for one eye. What is the safest way for the technician to confirm the right medication is being used?

   • A.Read the bottle label and match it to the order, the patient and the eye✓ Answer
   • B.Rely on the cap colour, which is standardized for every drug class
   • C.Ask the patient which drop was given at their previous visit
   • D.Use the bottle that another technician left ready at that lane

   Cap colour is an industry convention, not a guarantee, and it varies between manufacturers and generic versions, so a look-alike bottle is easy to grab. The label is the only reliable identification, and it is checked against the order for the right patient, drug, strength, eye, route and time before instillation, with an allergy check and documentation afterwards.

   Source: Institute for Safe Medication Practices guidance on medication identification and verificationReport a problem with this question

8. 8. While instilling a drop from a multidose bottle, the technician lets the dropper tip touch the patient's lashes. What is the main concern?

   • A.The bottle is contaminated and may carry organisms to others✓ Answer
   • B.The volume of drop delivered will be too small to be effective
   • C.The preservative is neutralized and the drug loses its potency
   • D.The patient may become allergic to the plastic of the dropper

   Touching lids, lashes or the ocular surface transfers organisms into the bottle, which then becomes a fomite that is carried from patient to patient with every later use. The tip is held above the lower lid pocket without contact, the bottle is discarded or dedicated to that patient if contact occurs, and any bottle used on an obviously infected eye is not returned to general use.

   Source: CDC infection prevention guidance on handling multidose ophthalmic medicationsReport a problem with this question

9. 9. A technician's hands are visibly soiled after assisting with a minor procedure. What should be done before the next patient?

   • A.Use an alcohol rub, which works even on visibly soiled hands
   • B.Wash with soap and running water rather than an alcohol rub✓ Answer
   • C.Put on gloves, since gloves take the place of hand hygiene
   • D.Rinse with water alone and dry thoroughly with a paper towel

   Alcohol rubs kill organisms but do not remove organic soil, and protein and blood physically shield microbes from the alcohol, so soap and running water are required whenever hands are visibly dirty. Hand hygiene is still the single most effective way to interrupt transmission in a clinic, and gloves are an addition to it, never a replacement.

   Source: CDC Guideline for Hand Hygiene in Health-Care SettingsReport a problem with this question

10. 10. Which statement about the major groups of microorganisms is correct?

    • A.A virus can reproduce only inside a living host cell✓ Answer
    • B.A fungus is a bacterium with an unusually thick wall
    • C.A bacterium can reproduce only inside a living host cell
    • D.A protozoan is a virus visible under a light microscope

    A virus has no machinery of its own for making energy or protein, so it must take over a host cell to replicate, which is why antibiotics do nothing for a viral conjunctivitis. Bacteria are free-living single cells that divide on their own, fungi are a separate kingdom of yeasts and moulds, and protozoa such as the amoeba linked to contaminated lens water are single-celled organisms, not viruses.

    Source: AAO Ophthalmic Medical Assisting independent study course, microorganisms and infection controlReport a problem with this question

11. 11. A patient has a red watery eye with follicles and a tender preauricular node, and epidemic keratoconjunctivitis is suspected. What best protects the patients seen afterwards?

    • A.Leave the examination room empty for an hour before the next patient
    • B.Change gloves but continue to use the same tonometer prism as before
    • C.Disinfect what the patient touched with a product effective against adenovirus✓ Answer
    • D.Wipe down the chin rest with a dry paper tissue between patients

    Adenovirus spreads by contact with hands and with objects the patient touched, survives a long time on dry surfaces and resists many alcohol-based products, so the disinfectant has to be one labelled as effective against it and used for the wetting time the manufacturer specifies. Hand hygiene, single-use tonometer tips and cleaning the chin rest, headrest, door handles and pens are what break the chain.

    Source: CDC infection control guidance for adenoviral keratoconjunctivitis in eye care settingsReport a problem with this question

12. 12. The ophthalmologist wants a conjunctival culture from an eye that also needs a topical anesthetic and antibiotic drops. What sequence should the assistant prepare?

    • A.Collect later in the visit once the anesthetic wears off
    • B.Collect the specimen before any drop is placed in the eye✓ Answer
    • C.Give the antibiotic first so treatment is not delayed
    • D.Anesthetize first so the swab is comfortable, then collect

    Antibiotics suppress growth and anesthetics and their preservatives are bacteriostatic, so a specimen taken after either one can grow nothing even when the eye is infected, and a false-negative culture is worse than no culture. The sample is taken first with sterile technique, plated or transported as instructed, and labelled at the moment of collection rather than later.

    Source: AAO Ophthalmic Medical Assisting independent study course, assisting with conjunctival and corneal specimen collectionReport a problem with this question

13. 13. What determines whether a reusable instrument needs cleaning, high-level disinfection or full sterilization?

    • A.How long the instrument sat unused between two patients
    • B.Whether the previous patient appeared to have an infection
    • C.How costly the instrument would be to replace if damaged
    • D.What the item contacts, from intact skin to sterile tissue✓ Answer

    Processing is decided by risk of contact, not by appearances or cost: an item that enters sterile tissue must be sterilized, an item touching mucous membranes or the tear film needs at least high-level disinfection, and an item touching only intact skin needs cleaning and low-level disinfection. Every level starts with removing visible debris, and the level chosen never depends on whether a given patient looked infected, because infection is often invisible.

    Source: Spaulding classification, CDC Guideline for Disinfection and Sterilization in Healthcare FacilitiesReport a problem with this question

14. 14. A needle has just been used during a minor office procedure. What is the correct way to handle it?

    • A.Hand it to a colleague who will carry it to the disposal room
    • B.Place it uncapped in a sharps container at the point of use✓ Answer
    • C.Recap it carefully using both hands before discarding it
    • D.Bend it so that it cannot be reused, then put it in the red bag

    Most needlestick injuries happen while recapping, bending or carrying a used sharp, so the device goes straight into a puncture-resistant container kept within reach of where it was used, disposed of by the person who used it. A red bag holds soft biohazardous waste and will not stop a needle, and containers are replaced before they overfill.

    Source: OSHA Bloodborne Pathogens Standard, handling and disposal of contaminated sharpsReport a problem with this question

15. 15. While setting up a sterile tray, which action contaminates the sterile field?

    • A.Opening the outer flap of the wrapper away from you first
    • B.Placing instruments in the middle of the draped surface
    • C.Holding the sterile package above waist level while opening
    • D.Reaching across the draped tray to set an instrument down✓ Answer

    Only sterile may touch sterile, and an unsterile arm passing over the field can shed skin scale, lint or droplets onto it, so items are added from the side and the field is never reached across or turned away from. The outer border of the drape and anything below table level count as unsterile, and moisture soaking through a drape contaminates it as well.

    Source: AORN guidance on establishing and maintaining the sterile fieldReport a problem with this question

16. 16. Immediately before an eye operation begins, the whole team stops for a final check. What must that check confirm?

    • A.The patient's identity, the planned procedure and which eye is involved✓ Answer
    • B.That the temperature in the operating room is within its range
    • C.That the instrument count from the previous case was correct
    • D.That the patient has completed all the preoperative paperwork

    The final pause exists to catch a wrong patient, wrong procedure or wrong eye before anything irreversible happens, and it also covers consent, positioning, the implant to be used and any antibiotic given. Everyone stops what they are doing and actively agrees out loud; silence is not agreement, and any team member who is unsure can halt the case.

    Source: The Joint Commission Universal Protocol for preventing wrong site, wrong procedure and wrong person surgeryReport a problem with this question

17. 17. A wrapped instrument pack leaves the steam sterilizer with the indicator tape stripes darkened. What does that darkening establish?

    • A.That every microorganism inside the pack has been destroyed
    • B.That both the cycle time and the temperature were verified
    • C.That the pack may now be stored indefinitely without rewrapping it
    • D.Only exposure to the process, not that the contents are sterile✓ Answer

    External chemical indicators change colour on contact with heat and steam, which shows the pack went through a cycle and separates processed from unprocessed packs, but says nothing about whether lethal conditions reached the inside. Only a biological indicator, which challenges the cycle with resistant bacterial spores and then tests whether they grow, demonstrates that the load was actually sterilized, and it is run according to policy and with every implant load.

    Source: CDC Guideline for Disinfection and Sterilization, monitoring of sterilization with chemical and biological indicatorsReport a problem with this question

18. 18. Instruments returning from a procedure carry dried blood and tissue. Why must they be cleaned before they are sterilized?

    • A.Debris makes the instruments harder to count on the tray
    • B.Cleaning shortens the cycle so more packs can be processed
    • C.Blood dulls the finish and voids the manufacturer's warranty
    • D.Debris shields organisms from the sterilant so they survive✓ Answer

    Sterilization only works where the steam or gas actually reaches the surface, and dried protein forms a barrier that lets organisms underneath survive an otherwise correct cycle. Instruments are therefore decontaminated and cleaned first, with hinged instruments opened and multi-part instruments taken apart, then rinsed with distilled or sterile water so detergent residue does not remain and cause severe postoperative inflammation.

    Source: AAMI and CDC guidance on cleaning and decontamination prior to sterilizationReport a problem with this question

19. 19. Staff remain in the room during an office laser treatment. What is the essential protection for them?

    • A.Standing behind the patient instead of beside the laser head
    • B.Protective eyewear matched to the wavelength of the laser in use✓ Answer
    • C.Dimming the room lights while the laser is being fired
    • D.Ordinary tinted sunglasses worn throughout the procedure

    Laser eyewear works by filtering one band of wavelengths, so goggles that protect against one laser can be effectively transparent to another and give a false sense of safety; tinted sunglasses filter nothing at these energies. Protection also means a warning sign on a closed door, covered windows, no reflective instruments in the beam path, the foot pedal under the operator's control alone, and the key removed with the unit in standby when it is left unattended.

    Source: ANSI Z136 laser safety standard, control measures and laser protective eyewearReport a problem with this question

20. 20. A surgeon running late asks the assistant to obtain the patient's informed consent for cataract surgery. What is the appropriate response?

    • A.Ask a family member to give the consent on the patient's behalf
    • B.Have the patient sign now and let the surgeon explain afterwards
    • C.Describe the risks and the benefits and then have the patient sign
    • D.The surgeon must obtain it; the assistant may witness the signing✓ Answer

    Informed consent is a conversation about the nature of the operation, its risks and benefits, the alternatives and the right to refuse, and only the physician performing the surgery can hold it and answer what the patient asks. The assistant works under the ophthalmologist's delegation and within the practice act that applies, so the role here is to witness the signature, confirm the form is complete and tell the surgeon if the patient still has questions.

    Source: Informed consent doctrine and ophthalmic assistant practice under physician delegationReport a problem with this question

21. 21. How should fine ophthalmic scissors and forceps be handled on the surgical tray?

    • A.Stacked in a pile to save space on the small surgical tray
    • B.Wiped on a dry gauze sponge and returned to the pile again
    • C.Laid out singly with tips protected, never piled together✓ Answer
    • D.Kept soaking in saline through the case so tissue cannot dry

    Microsurgical tips are measured in fractions of a millimetre and bend, burr or misalign if instruments rest on one another, and a damaged tip can tear tissue before anyone notices. Each instrument is laid separately with tip guards or a mat, wiped with a moistened sponge rather than left in saline, which pits and corrodes the metal, and passed handle first with the tips visible and directed away from the receiving hand.

    Source: AAO Ophthalmic Medical Assisting independent study course, care and handling of microsurgical instrumentsReport a problem with this question

Practice questions based on the IJCAHPO core certification content areas for the Certified Ophthalmic Assistant and on standard ophthalmic clinical practice references. COA, COT, and COMT are marks of the International Joint Commission on Allied Health Personnel in Ophthalmology; this site is not affiliated with or endorsed by IJCAHPO. Ophthalmic assistants work under the delegation of a supervising ophthalmologist and permitted tasks vary by state and by practice — confirm your own scope, and check the current exam requirements and content outline with IJCAHPO before testing. About IJCAHPO certification →