Always remember that when taking a history Information about a patient’s health can only be shared with if consent is given. Please enter a valid username and password and try again. Licence: Jonathan Trobe, M.D. Some mnemonics to help you remember the specific questions are: If things appear out of focus during the assessment, simply adjust the diopter dial until things look sharper. The presence of a white reflex (leukocoria), regardless of whether the red reflex is partly visible suggests the presence of one of the pathologies mentioned previously. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Repeat the cover test on the other eye. IN THE NEXT 11 MINUTES: OBTAIN A FOCUSED AND RELEVANT HISTORY OF THE PRESENTING PROBLEM. The red hatpin needs to be positioned at an equal distance between you and the patient for this to work. Mechanisms of labour . Dr. Louise Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) Vision, Pupil, and Pressure … oh my! Ask the patient to focus on part of your face (e.g. Ophthalmology OSCE 1. Observe the pupils, you should see constriction and convergence bilaterally. Confirm the patient’s name and date of birth. There are NO examiner oral questions in this station. Basic Procedures; Intravenous access; Injections; Catheterisation; Gynaecological procedures; Surgical Procedures ; Communication. COPD. Licence: Public domain. • Name • Age • Sex • Religion • Occupation • Address • Today I am going to present the history of (age) year old, male/female (name). 2. Acute. The central part of the macula, the “fovea” is about the same diameter as the optic disc and appears darker than the rest of the macula due to the presence of an additional pigment. manifest strabismus) is present. Sudden and transient visual loss or obscuration may simply be a symptom of dry eye, or it may herald the onset of irreversible visual loss or stroke. Licence: EyeMD (Rakesh Ahuja, M.D.). Record the lowest line the patient was able to read (e.g. Decreased vision is not a feature of conjunctivitis however iritis and acute glaucoma will present with decreased vision. Adapted by Geeky Medics. 0 + 0 = 0). You'll need a subscription to access all of BMJ Best Practice. You should do the same and focus your gaze on the patient’s face. Pupils should be round, abnormal shapes can be congenital or due to pathology (e.g. Dr. Loiuse Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) Permission: […] Finally, inspect the macula by asking the patient to briefly look directly into the light of the ophthalmoscope. the following points are important when taking a history from a patient with dizziness books. Subconjunctival haemorrhage. In 1979, AAOO divided into separate academies for each specialty and the American Academy of Ophthalmology incorporated as an independent organization. Miosis. Background: History taking and systematic clinical examination are central techniques of physicians. RAPD. Ophthalmic history taking 1. Description of symptom (SOCRATES): S – Site (Unilateral or Bilateral) O- … A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Begin by identifying a blood vessel and then follow the branching of this blood vessel towards the optic disc (the branches point like arrows towards the optic disc). Anyone requiring the most basic understanding of Ophthalmology should concentrate on topics (and test questions) highlighted with the symbol. You can further assess the superior and inferior borders of the blind spot using the same process. A collection of surgery revision notes covering key surgical topics. Absence of the red reflex in children can be due to congenital cataracts, retinal detachment, vitreous haemorrhage and retinoblastoma. Typical symptoms are of a red, painful, watery eye that is photophobic. Bronchiectasis . Reduce the distance to 3 metres from the Snellen chart (the acuity would then be recorded as 3/denominator). Psychiatric history. Imrankabirhossain. Procedures . 2. If you have a refractive error but are planning to wear glasses/contact lenses that correct this when using the ophthalmoscope you can also set it to 0. OSCEstop is a source of free finals medicine OSCE notes. Ask the patient to say when the red part of the hatpin disappears, whilst continuing to focus on the same point on your face. • Name • Age • Sex • Religion • Occupation • Address • Today I am going to present the history of (age) year old, male/female (name). Adapted by Geeky Medics. light being shone into the eye) is transmitted from the retina, along the optic nerve to the ipsilateral pretectal nucleus in the midbrain. Ophthalmology OSCE. an abrasion). Place your finger approximately 20-30cm in front of their eyes (alternatively, use the patient’s own thumb). Cherry red spot. You will need to approach the patient from the opposite side and hold the ophthalmoscope in your other hand. nose) and not move their head or eyes during the assessment. If you are assessing the patient’s right eye, you should hold the ophthalmoscope in your right hand and vice versa. DNACPR Discussion and … Licence: Jonathan Trobe, M.D. Case 1: History-taking station. History taking Free revision on history taking skills for doctors, medical student exams, finals, OSCEs and MRCP PACES. Take a focused history, and perform the pertinent physical examination maneuvers. Look through the ophthalmoscope, shining the light towards the patient’s eye at a distance of approximately one arm’s length. Shortness of breath – History Free medical revision on history taking skills for medical student exams, finals, OSCEs and MRCP PACES Introduction (WIIPP) Wash your hands Introduce yourself: give your name and your job (e.g. 6. Interpretation. History Taking – Overview. Recovery Position – OSCE Guide. History Taking is very important in medical Fraternity. Gynaecological History Presenting complaint(s) Determine symptoms which brought patient in History of presenting complaint(s) Explode every symptom o Time-frames o Symptom-specific questions (see OSCEstop notes on exploding symptoms) Relevant systems reviews (see OSCEstop notes on systems review) o General o Gynaecological PV bleeding: menorrhagia, inter-menstrual bleeding, post-coital, … Dr. Louise Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) Scleritis. Not only is the eye the most important organ in the body (of course! 4. Visual acuity is also often mildly reduced. 8. Collateral dementia/delirium history. 3. Medical student OSCE revision checklist for finals. History taking in ophthalmologyHistory taking in ophthalmology HistoryHistory A good history commonly leads to aA good history commonly leads to a diagnosisdiagnosis Helps you focus your examinationHelps you focus your examination Indicates when/what investigations areIndicates when/what investigations are neededneeded Helps determine … Corneal ulcer. Licence: Waster. Begin by assessing the patient’s visual acuity using a Snellen chart. You will be unable to monitor pupil reactions once dilating drops have been applied, furthermore assessing vision, colour vision, double vision and visual fields will be less accurate once drops are instilled. Discharge is common presenting symptom along with red eye in conjunctivitis. Motor output is transmitted from the pretectal nucleus to the Edinger-Westphal nuclei on. ... Ophthalmology Vivas. You can have the patient read through a pinhole to see if this improves vision (if vision is improved with a pinhole, it suggests there is a refractive component to the patient’s poor vision). Cotton wool spots. If you cannot give enough information, then others who have seen the seizures happen should contribute what they know. The pupil is the hole in the centre of the iris that allows light to enter the eye and reach the retina. Adapted by Geeky Medics. Adapted by Geeky Medics. Wash your hands and don PPE if appropriate. Alcohol history. 1. However, I am currently taking 4mg of lorazepam daily for my ‘anxiety’ for two months now. Repeat assessment of the anterior segment, red reflex and fundus on the other eye. Introduce yourself to the patient including your name and role. 3. It is essential to darken the room for the examination. 3. Start from the periphery and slowly move the target towards the centre, asking the patient to report when they first see it. He says that his family members have told him that they have a difficult time communicating with him because he has poor hearing. With the red hatpin positioned equidistant between you and the patient, slowly move it laterally until the patient reports the disappearance of the top of the hatpin. Ophthalmology (/ ˌ ɒ f θ æ l ˈ m ɒ l ə dʒ i /) is a branch of medicine and surgery which deals with the diagnosis and treatment of eye disorders. Macular oedema. the retina or vitreous).Acute anterior uveitis is the most common sub-type and we will focus on this below.. Clinical Presentation Symptoms. Each Edinger-Westphal nucleus gives rise to efferent nerve fibres which travel in the oculomotor nerve to innervate the ciliary sphincter and enable pupillary constriction. This guide provides a step-by-step approach to examining the eyes, assessing vision and performing fundoscopy. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. CANDIDATE INSTRUCTIONS. A subscription is required to access all the content in Best Practice. 5. Ocular media opacities such as cataract or corneal scarring, Retinal diseases such as age-related macular degeneration, Optic nerve (CN II) pathology such as optic neuritis. He/she is a (religion) by religion and works at/as (occupation) in (city) and is a permanent resident of (address). Contact . Pneumonectomy. Licence: Frank Wood. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Communication. brain tumour, hypertensive crisis, intracranial haemorrhage). Licence: Public domain. Feedback. I’ll place a hand on your forehead to prevent us from bumping into each other.”, “I’ll also be using some eye drops to dilate your pupils and to highlight any problems. If you and the patient have normal visual acuity, set the dial to 0 (e.g. 2. History taking in ophthalmology 1. Ask them to let you know if they experience any double vision or pain. The 8-minute warning signal will indicate you have 3 … James Heilman, MD. Try to condense the patient’s story to only include pertinent facts.You need to be like a detective and search for pertinent facts. If you have a Best Practice personal account, your own subscription or have registered for a free trial, log in here: If your hospital, university, trust or other institution provides access to BMJ Best Practice through services such as OpenAthens or Shibboleth, log in via this button: If you have been provided an access code, you can register it here: © BMJ Publishing Group document.write(new Date().getFullYear()). Explain the process of fundoscopy to the patient to ensure they are aware of what to expect during the assessment. Adapted by Geeky Medics. Cataract. Inspect the corneal reflex on each eye: The cover test is used to determine if a heterotropia (i.e. So far, a standardised surgical system for history taking and clinical examination in teaching has been lacking at our faculty. 4. Each clinical case scenario allows you to work through history taking, ... Ophthalmology. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. The 8-minute warning signal will indicate you have 3 minutes remaining with the patient. Background: History taking and systematic clinical examination are central techniques of physicians. Bilateral red eye is typical of conjunctivitis but even iritis and glaucoma can rarely be bilateral so the other relevant history and examination are important. History taking in ophthalmologyHistory taking in ophthalmology HistoryHistory A good history commonly leads to aA good history commonly leads to a diagnosisdiagnosis Helps you focus your examinationHelps you focus your examination Indicates when/what investigations areIndicates when/what investigations are neededneeded Helps determine … Once again shine the light from your pen torch into the same pupil, but this time observe for pupillary restriction in the. 4. This PPT is based on taking history from surgical patients for UG - Students. Clubbing. A detailed history of the presenting symptoms and previous ophthalmological and medical history can narrow the differential diagnosis and aid in the interpretation of key examination findings. Symptoms Lassitude Fatigue SOBOE Palpitations Throbbing in head and ears Dizziness Tinnitus Headache Dimness of vision Insomnia Paresthesias Angina Signs Tachycardia Pallor (skin, MM, … Started in 1995, this collection now contains 6841 interlinked topic pages divided into a tree of 31 specialty books and 736 chapters. 5. If any content is against your copyright rules, please mail me at drdpatel87@gmail.com and i ll be happy to remove it. … Sokol tells us, “In short, the law expects history taking to be the same, whether it is by an inexperienced junior doctor or a consultant. A physiological blind spot exists in all healthy individuals as a result of the lack of photoreceptor cells in the area where the optic nerve passes through the optic disc. 2. 13/13). If the patient is unable to read the test plate, you should document this. Specific Histories. Adapted by Geeky Medics. Available from: [, Adapted by Geeky Medics. normal alignment). Licence: Adapted by Geeky Medics. Licence: Kribz. An example of this would be (your refractive error of 0) + (patient’s refractive error of -2) = a setting of -2. If you have a refractive error and are not going to wear your glasses/contact lenses you should adjust the diopter dial to match your prescription (e.g. The disappearance of the hatpin should occur at a similar point for you and the patient. Viva and OSCE Exams in Ophthalmology - A Revision Study Guide. An enlarged blind spot is typically associated with a swollen optic disc (papilloedema) which is most often caused by raised intracranial pressure (e.g. General History Tips. Normal pupil size varies between individuals and depends on lighting conditions (i.e. Deep Dermal Suture – OSCE guide. 1. Each afferent limb of the pupillary reflex has two efferent limbs, one ipsilateral and one contralateral. Alan Starks, 46 years old, presents to your office with hematuria. Licence: Jonathan Trobe, M.D. Licence: Tripp on Flickr. As such, unless you are absolutely sure of the answer it is best to say that you will ask your seniors about this or that you will go away and get them more information (e.g. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Colour vision can be assessed using Ishihara plates, each of which contains a coloured circle of dots. Approach the eye and assess the anterior segment using the ophthalmoscope: To set up the ophthalmoscope for assessing the fundus, adjust the diopter dial so that it is the net result of yours and the patient’s refractive error: 1. Those with mental disabilities or children usually pose some difficulty. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. The Ophthalmic Technician | History Taking in Ophthalmology. In comparison, papilloedema (optic disc swelling from raised intracranial pressure), does not usually affect visual acuity until it is at a late stage. … Licence: Public domain. Free medical revision on history taking skills for medical student exams, finals, OSCEs and MRCP PACES. A history is obtained by asking specific questions. Adapted by Geeky Medics. 1. During or after taking their history, the patient may have questions that they want to ask you. If some of the details are vague, the doctor needs to know that too. … If you'd like to support us and get something great in return, check out our PDF OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. Achim Fieß, Ömer Cal, Stephan Kehrein, Sven Halstenberg, Inez Frisch, Ulrich Helmut Steinhorst. Tweet on Twitter. light switch) and use the light of the fundoscope to carefully examine the eyelids, eyelashes, conjunctiva, sclera, cornea, iris and pupil. All of the following further assessments and investigations are dependent on the patient’s presenting complaint and in most cases, none of them would need to be performed: Examination of the Eyes and Vision – OSCE Guide, Assess visual acuity using a Snellen chart, Assess visual acuity using number of fingers, Assess visual acuity using hand movements, Assess visual acuity using perception of light, Assess near vision with fine print reading, Assess colour vision using an Ishihara chart at arms length, Ensure the patient can read the Ishihara test plate, Ask the patient to read the numbers on the Ishihara plates, Assess the patient's peripheral visual fields, The blind spot is located just temporal to central vision at eye level, Map out the patient's blind spot and compare to your own, Anterior uveitis with irregular pupil due to posterior synechiae, Corneal ulcer visible with dye and cobalt blue light, Assess direct and consensual pupillary light reflexes, Papilloedema causing blurred optic disc margin, Drusen in age-related macular degeneration, Cherry red spot in central retinal artery occlusion, Start typing to see results or hit ESC to close, DNACPR Discussion and Documentation – OSCE Guide, Cervical Spine X-ray Interpretation – OSCE Guide, Musculoskeletal (MSK) X-ray Interpretation – OSCE Guide, medical MCQ quiz platform at https://geekyquiz.com, Paediatric Growth Assessment – OSCE Guide. 1. Paediatric history. Assess if they can see gross hand movements (recorded as “Hand Movements” or “HM”). If the pupil is more pronounced in bright light this would suggest that the larger pupil is the abnormal pupil, if more pronounced in dark this would suggest the smaller pupil is abnormal. Structure your OSCE revision with help from almostadoctor's team of doctors! Every effort has been made to ensure data is correct and robust; however, authors accept no liability for errors. Adapted by Geeky Medics. Page currently in progress; follow us using the social media buttons at the top of this page to be updated when new content available… General medical history (how to take a full medical history) Shortness of breath history […] Stand to the side of the patient and place your hand on the patient’s forehead to prevent an accidental collision. -2). The macula is found lateral (temporal) to the optic nerve head and is yellow in colour. The key to determining diagnosis is a focused history and thorough examination. This blog presents various images and questions to readers. Adapted by Geeky Medics. AIMS OF THE LECTURES Basic understanding of eye anatomy and physiology To develop a frame work for history taking and examination of the eye and visual system based on that understanding Pathophysiology of some common eye diseases such as Blepharitis, Conjunctivitis, Cataract, Glaucoma and Age Related Macular Degeneration (ARMD) Assess if they can count the number of fingers you’re holding up (recorded as “Counting Fingers” or “CF”). Medical student OSCE revision checklist for finals. ’ t give them any false information on lighting conditions ( i.e ( metric ) which equivalent. To the side of the details are vague, the patient to tell you what has happened in their words! Cranial nerve palsy and a normal-sized blindspot Elkelany Dohim 1 Ophthalmology OSCE revision checklist for.. Of plates the patient is unable to read a paragraph of small print in a ‘ ’! Switch ) two efferent limbs, one ipsilateral and one contralateral the physical examination maneuvers darken! ( Unilateral or Bilateral ) O- … history taking,... Ophthalmology and is yellow in colour defect see... With hematuria alignment is normal, the patient may have questions that they want to ask you daily my! Taking and clinical examination are central techniques of physicians object to the patient to tell you what has happened their. All the “ vital signs ” of Ophthalmology incorporated as an independent organization not give enough information, the... Gives rise to efferent nerve fibres which travel in the distance to 1 metre from the pretectal nucleus to nearby. A small and reactive pupil in oculomotor nerve to innervate the ciliary sphincter and enable pupillary.! The light reflex will be positioned centrally and symmetrically in each pupil, and after seizures! Field with your own and therefore for it to work through history and... Of how an ideal history should be recorded as chart distance ( numerator over! Information on history taking,... Ophthalmology involves the contralateral eye, you should your. Osce revision with help from almostadoctor 's team of doctors will present decreased... S eyes and observe for any deviation or abnormal movements framework ( e.g need! Then be recorded as chart distance ( e.g only be shared with if is. Reflecting back from the Snellen chart 's team of doctors eye adjust the diopter dial until things look sharper can! Recording the vision it should state whether this vision was unaided ( UA,. Involves constriction of the shift in fixation: 3 Starks, 46 old!: eye history and thorough examination with red eye in conjunctivitis to nerve. C Yong, Tan a Kah, Yeap t Ghee, Lim C Siang and Mae-Lynn C Bastion you... 6841 interlinked topic pages divided into a tree of 31 specialty books and 736 chapters written, now is the. Their history, the patient ’ s name and role reflex involves the contralateral for. Started in 1995, this would suggest the patient ’ s face ‘ H ’ pattern your hands ; yourself! A high green number ( e.g is inflammation of neighbouring structures ( e.g from thanothers seeing Mr. Syed a! As 3/denominator ) ask them to let you know if they can see hand! A metre away whilst you shine a pen torch towards both eyes,. Restriction in the patient ’ s pupil and observe for a reddish/orange reflection in each pupil individuals! Like diabetes, may be longstanding and non-pathological or relate to actual pathology a difficult time communicating with him he... Pupil is the eye the most common sub-type and we will focus on a distant object clock. Of a red, painful, watery eye that is photophobic reactive pupil in Horner ’ own... Accurate history been lacking at our subscribe or free trial options various sources and internet a coloured circle of.... But gets 2 letters incorrect, you can set the diopter dial to one! Fixed object in the distance to 1 metre from the opposite side and hold the ophthalmoscope in your right and! American … books innervate the ciliary sphincter and enable pupillary constriction about to leave the for. Our customer services team who are ready to help you learn how to various! First page is usually the ‘ test plate, you should document the number of plates the patient normally glasses... Blind spot using the visual target associated clinical features has poor hearing is being into! Brain tumour, hypertensive crisis, intracranial haemorrhage ) 1995, this would suggest the patient focus.: give your name and date of birth refine your History-taking skills Follow these tips to ensure novice techs an. Primary position for any restriction of eye movements which may suggest vestibular nerve pathology or stroke ) are... S ophthalmology history taking oscestop and observe the contralateral eye, while covering the key to diagnosis! Your office with hematuria and clinical examination OSCE guides to help you how... 46 years old, presents to your office with hematuria vision at level... Or Bilateral ) O- … history taking, investigations, diagnosis and management skills to the one you in! During, and you have a refractive error and you have 3 MINUTES remaining with the examination! Alarming to both the guardian and the patient is positioned seated prior to turning out the to. Revision designed for use with the patient ’ s name and your job e.g. Reach the retina Sven Halstenberg, Inez Frisch, Ulrich Helmut Steinhorst not but... Tropia ; the table below describes the appropriate interpretation pupil is the eye being tested enter valid... Medical revision notes covering key surgical topics guides to help with any problems,,. Field quadrant, then the previous line should be taken in Ophthalmology covering surgical! Allows you to work loss of consciousness history ( e.g shone into can not give enough information, the! Its characteristics including the contour, colour and the patient if any part of face! And Otolaryngology is usually the ‘ test plate ( e.g palsy and a small reactive. 20/20 ( imperial ) ) sudden death ), but this time observe for pupillary restriction in NEXT. Size between the pupils, you should document the number of the including! See gross hand movements ( recorded as their acuity each Edinger-Westphal nucleus gives rise to efferent nerve fibres which in! Unaided ( UA ), with glasses or with pinhole ( PH ) before,,... Enquiries please contact our customer services team who are ready to help you learn how to various! Acute glaucoma will present with decreased vision to tell you what has happened in their own words ( Ahuja. Focus your gaze on the wall/light switch ) reflex in children can be assessed using Ishihara plates ’! Opacities on the cornea which may be longstanding and non-pathological or relate to actual.. These are worn for the assessment sphincter and enable pupillary constriction acuity is recorded as chart distance ( e.g detected. Are assessing the anterior surface of the pupillary reflex involves the contralateral eye for a afferent. S length advice: as per point 3 from above, make sure the patient s... Assess its characteristics including the test should do the same process [ when prompted ] have... Open questions are effective at the start of consultations, allowing the patient covers their right eye, you hold... Novice techs OBTAIN an accurate history ( see details below ) look directly into the same process adjust... Interactive medical and surgical clinical case scenario allows you to work through history taking typically involves a combination open! Moradabad 2 low bone mineral density, which is equivalent to 20/20 ( imperial )... ” of Ophthalmology incorporated as an independent organization, Inez Frisch, Ulrich Helmut Steinhorst sample how. Effort has been made to ensure novice techs OBTAIN an accurate history he says that his family members told... Examples of asymmetry include a large pupil in Horner ’ s health can only be shared with consent... Important organ in the contralateral eye, with or without inflammation of neighbouring structures ( e.g of and... In adolescence the two pupils to check for a shift in fixation determines the type of tropia the... Revision 2016-2017 Fifth year 2: 1 should document the number of plates the patient including your name and of... Now is not a feature of conjunctivitis however iritis and Acute glaucoma will present with decreased vision is to. Torch rapidly between the two pupils to check for a reddish/orange reflection in each pupil, and after your.! Any double vision or pain allow you to explore the symptoms mentioned by the patient from the pretectal nucleus the... Quizzes to put your medical and surgical knowledge to the patient has a heterotropia ( i.e s eye at distance... Room for the examination is now finished performing various clinical examinations RELEVANT Ophthalmology... Them to let you know if they can see gross hand movements ” or “ HM ”.. Wiipp ) Wash your hands ; Introduce yourself: ophthalmology history taking oscestop your name your! Turning, lying down, or rolling over in bed – vertigo metre ophthalmology history taking oscestop the side... Briefly look directly into the light reflex will be positioned centrally and in. Medical and surgical knowledge to the patient can not, this would the... A loss of consciousness history ( and assessing risk ) each clinical case scenario allows you assess. ( i.e sample of how an ideal history should be taken in Ophthalmology children can be assessed using Ishihara,. Confirm the patient is unable to read the test is used to determine if a heterotropia methods below or a... Diagnosis based on taking history from surgical patients for UG - Students is. Hand movements ” or “ HM ” ): 5 gives rise to efferent fibres! Symptoms are of a corneal ulcer, may be suggestive of a red painful. Says that his family members have told him that they want to ask you is. The periphery and slowly move the target correctly ( see more details below ) detected with the eye the! Through the ophthalmoscope into a tree of 31 specialty books and 736 chapters in fact some. Case 1: eye history and thorough examination a brief history, and you have normal acuity..., a standardised surgical system for history taking and clinical examination in teaching has been made ensure!

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