Viva ACTUAL Exam Questions and
CORRECT ANSWERS
What precautions would you normally take before dilating a patient prior to indirect
ophthalmoscopy? (10 things) - CORRECT ANSWER- 1. IOP
2. Examine the anterior chamber (van herricks grade 2 or less at risk so that's a ratio of 1: <.5
3. Che...
Viva ACTUAL Exam Questions and
CORRECT ANSWERS
What precautions would you normally take before dilating a patient prior to indirect
ophthalmoscopy? (10 things) - CORRECT ANSWER- ✔✔1. IOP
2. Examine the anterior chamber (van herricks grade 2 or less at risk so that's a ratio of 1: <.5
3. Check their visual acuity and pupil responses
4. 4d's: drug, dose, date, disposal
5. If the patient has had any prior adverse reactions to the drug
6. Marfan's Syndrome patients → could have a misaligned crystalline lens
7. Iris clipped intraocular lens
8. If patient is taking pilocarpine for glaucoma
9. For phenylepherine (sympathomimetic) it should also be noted that patients on trycyclic
antidepressants and MOA inhibitors could be at risk of a rise in blood pressure if drug
instilled, and take care with patients with systemic hypertension
10. Talk about the effects of the drugs and how long it will take to wear off
What would you do after assessing the eyes of a patient you have dilated? (4) - CORRECT
ANSWER- ✔✔1. IOP (if difference over 5mmHg between pre and post or between eyes,
keep an eye on patient till pressure drops)
2. Measure openness of anterior chamber
3. Inform patient about signs of adverse reactions that may occur, what precautions to take if
they were to occur, and talk through what activities patient should avoid. Also ask patient to
bring large brimmed hat, and sunglasses which will help with the photophobia.
Apart from patients who have extremely narrow angles, who else would you not dilate and
why? (6) - CORRECT ANSWER- ✔✔1. If IOP higher than 21mmHg
2. Patients with iris clipped lens, as you could rip the iris and displace the intraocular lens
3. Patients using pilocarpine for glaucoma (could be closing the trabecular meshwork and
causing increase in IOP in a patient with glaucoma)
4. Marfans syndrome patients with translated lens
5. Patients that may have had adverse reaction before
,6. For phenylephrine - tricyclic antidepressants, MAO inhibitors (do not use within 21 days
of MAO inhibitor), and hypertension → sympathomimetic could cause increase in blood
pressure
What could you use to dilate a patient prior to examining them with and indirect
ophthalmoscope technique? (4) - CORRECT ANSWER- ✔✔1. Tropicamide (.5% or 1%) -
1% for patients with darker iris, as pigment absorbs drug
2. Atropine - antimuscarinic
3. Phenylephrene (2.5% or 10%) (avoid 10% with young and elderly)
4. Combination of drugs - Tropicamide and phenylephrine (use lower concentrations)
5. Which drug gives maximal dilation? - CORRECT ANSWER- ✔✔If we were to use only
one drug it would be tropicamide 1%, as tropicamide works by acting as a antimuscarinic. It
acts as a competitive antagonist on muscarinic receptors to acetylcholine inhibiting the miotic
response of sphincter muscle, therefore giving an unopposed action by the dilator muscle. But
you can achieve maximal dilation by using combination of tropicamide and phenylephrene.
What could you do to speed up the dilation process? (5) - CORRECT ANSWER- ✔✔1- Turn
off the lights
2- Use a higher concentration of drug
3- Combination of drugs
4- Use topical anesthetic
5- Press up against lacrimal sac so drops don't drain out with tears
What are the '4 Ds' with regard to the safe use of ophthalmic drugs? - CORRECT ANSWER-
✔✔dosage
disposal
drug
date
Name the typical instruments used to examine the central 45 degrees of retina (5)? -
CORRECT ANSWER- ✔✔Head mounted BIO
Slit lamp BIO
, Indirect monocular
direct monocular
modified monocular
What are the advantages of direct ophthalmoscopy compared to indirect ophthalmoscopy? (6)
- CORRECT ANSWER- ✔✔1. High/medium mag
2. easy set up
3. portable
4. no dilation
5. image is erect
6. no additional lenses needed so cheaper
What are the disadvantages of direct ophthalmoscopy compared to indirect ophthalmoscopy?
(7) - CORRECT ANSWER- ✔✔1. small fov, not good for assessing periphery
2. no stereo vision = poor depth perception
3. wd is very close
4. dim light
5. mag easier to control with indirect, ametropia can affect the mag (myope more mag)
6. astigmatism can distort the image
7. not easy to see with central opacities
Compare and contrast the 78 D and 90 D hand held slit-lamp indirect (Volk) lenses -
CORRECT ANSWER- ✔✔The 78D volk lens will give a higher magnification but a smaller
field of view and can be held tiny bit farther away. It is good as a general diagnostic lens
The 90D volk lends gives a lower mag but larger fov and is better for small pupils.
78D - 0.93x mag 84 fov wd 8mm
90D - 0.75x mag 94 fov wd 6mm
Name some of the more common hand help slit-lamp indirect (Volk) lenses available, and
any specific advantages they have. (7) - CORRECT ANSWER- ✔✔1. 60D - highest mag,
lowest fov → good for macular and disc examination (more detail due to mag)
2. 78D - lower mag than 60D but higher fov than 60D → general diagnostic lens
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