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Viva Exam Questions With Correct Answers
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Viva Exam Questions With Correct Answers What precautions would you normally take before dilating a patient prior to indirect ophthalmoscopy? (10 things) - answer1. 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 acu...

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  • October 21, 2024
  • 36
  • 2024/2025
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©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM



Viva Exam Questions With Correct Answers


What precautions would you normally take before dilating a patient prior to indirect

ophthalmoscopy? (10 things) - 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

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


What would you do after assessing the eyes of a patient you have dilated? (4) - 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) - 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

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


ophthalmoscope technique? (4) - 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? - 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) - 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? - answer✔dosage


disposal

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


drug

date

Name the typical instruments used to examine the central 45 degrees of retina (5)? -

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) -

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)

- answer✔1. small fov, not good for assessing periphery

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