Dr. Ritesh Mahajan 2. Licence: Public domain. 2. Communication. Ask the patient to keep their head still whilst following your finger with their eyes. Anterior uveitis. Available from: [. Session Structure • Introduction and Describing Aim &Objectives • Chief complaint • History of present illness • Past medical history • Systemic enquiry • Family history • Drug history • Social history 1. Ophthalmology is a specialty in which diagnoses are most often made based on observational skills and visual cues. This … Description of symptom (SOCRATES): S – Site (Unilateral or Bilateral) O- … Some mnemonics to help you remember the specific questions are: He says that his family members have told him that they have a difficult time communicating with him because he has poor hearing. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Adapted by Geeky Medics. 4. Ophthalmic history taking 1. While some of the important topics to cover when taking a history are specific to a loss of consciousness history (e.g. Available from: [. Divided up by system - with links to all of our revision resources. If the patient has a refractive error and you have a refractive error set the dial to the net refractive error. Licence: Frank Wood. History taking & examination in ENT 1. 6. Reduce the distance to 1 metre from the Snellen chart (1/denominator). Dr. Loiuse Gooch, ward doctor) Identity: confirm you’re speaking to the correct patient (name and date of birth) Permission: […] Repeat assessment of the anterior segment, red reflex and fundus on the other eye. Briefly explain what the examination will involve using patient-friendly language. Each clinical case scenario allows you to work through history taking, ... Ophthalmology. Free medical revision on history taking skills for medical student exams, finals, OSCEs and MRCP PACES. So far, a standardised surgical system for history taking and clinical examination in teaching has been lacking at our faculty. Observe for any restriction of eye movement and note any nystagmus (which may suggest vestibular nerve pathology or stroke). FiP. Adapted by Geeky Medics. 2. Hold your finger (or a pin) approximately 30cm in front of the patient’s eyes and ask them to focus on it. Drusen. you need to position yourself, the patient and the target correctly (see details below). The structural basis of history taking 1 How to present the history 13 Abdominal masses and distension 16 Acute abdominal pain 22 Alcohol-related problems 33 Ano-rectal pain 42 Back pain 46 Breast lump 54 Change in bowel habit 59 Chest pain 63 Collapse, syncope and blackouts 71 Confusion 78 [When prompted] I have butterflies in my stomach and difficulty breathing. Chapter 1: Eye history and physical. 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, … Alan Starks, 46 years old, presents to your office with hematuria. 1. Assessment of the eyes and vision frequently appears in OSCEs and you’ll be expected to pick up the relevant clinical signs using your examination skills. 3. -2). Adapted by Geeky Medics. 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). Adapted by Geeky Medics. Licence: Public domain. Presenting Complaint. Ask the patient to fixate on a target (e.g. Retinal detachment. Change in head position – BPPV; Loud sounds – “Tulio phenomenon” (Perilymph fistula or Meniere’s disease) Visual acuity is recorded as chart distance (numerator) over the number of the lowest line read (denominator). Position the hatpin (or another visual target) at an equal distance between you and the patient (this is essential for the assessment to work). Methodically assess each quadrant of the retina and the associated vascular arcades in a clockwise or anticlockwise fashion looking for evidence of pathology: 6. If you and the patient have normal visual acuity, set the dial to 0 (e.g. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 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. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. If you are assessing the patient’s right eye, you should hold the ophthalmoscope in your right hand and vice versa. You'll need a subscription to access all of BMJ Best Practice. normal alignment). Once again shine the light from your pen torch into the same pupil, but this time observe for pupillary restriction in the. Pyrexia of unknown origin (PUO) is defined as fever of 38.3°C or greater for at least 3 weeks with no identified cause after three days of hospital evaluation or three outpatient visits.¹ Additional categories of PUO have since been added, including nosocomial, neutropenic and HIV-associated PUO. Open questions are effective at the start of consultations, allowing the patient to tell you what has happened in their own words. Dilate the patient’s pupils using short-acting mydriatic eye drops such as tropicamide 1%. Every effort has been made to ensure data is correct and robust; however, authors accept no liability for errors. There are NO examiner oral questions in this station. 4. Briefly assess for abnormalities of eye movements which may be caused by underlying cranial nerve palsy (e.g. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 6. Licence: Adapted by Geeky Medics. 2. light switch) and use the light of the fundoscope to carefully examine the eyelids, eyelashes, conjunctiva, sclera, cornea, iris and pupil. Adapted by Geeky Medics. Medicine in general and surgery in particular frequently require immediate decisions and start of therapies. 2. A history is obtained by asking specific questions. An ophthalmologist is a specialist in ophthalmology. The doctor needs ALL the information about what happened before, during, and after your seizures. Corneal abrasion. ), but many common systemic diseases show ocular involvement. FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. taking a history from a patient with dizziness FREE subscriptions for doctors and students... click here You have 3 open access pages. The Academy evolved from the American Academy of Ophthalmology and Otolaryngology, founded in 1896 primarily to provide continuing education to eye, ear, nose and throat doctors. Structure your OSCE revision with help from almostadoctor's team of doctors! Symptoms Lassitude Fatigue SOBOE Palpitations Throbbing in head and ears Dizziness Tinnitus Headache Dimness of vision Insomnia Paresthesias Angina Signs Tachycardia Pallor (skin, MM, … Once the test is complete, you should document the number of plates the patient identified correctly, including the test plate (e.g. ... Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Vision, pupil, and pressure are the “vital signs” of ophthalmology. Pulmonary fibrosis. Recovery Position – OSCE Guide. Look for white opacities on the cornea which may be suggestive of a corneal ulcer. “I will be using a magnifying tool called an ophthalmoscope to look at the front and back of your eyes with the lights off.”“To do this, I’ll need to get quite close to your face. History. Ophthalmology OSCE. Adapted by Geeky Medics. Episcleritis. • Name • Age • Sex • Religion • Occupation • Address • Today I am going to present the history of (age) year old, male/female (name). Although your knowledge should have been tested in the written, now is not the time to take your foot off the break. Available from: [, National Eye Institute. Normal pupil size varies between individuals and depends on lighting conditions (i.e. RAPD. A) HISTORY Besides chief complaints, other portion of history is similar to the one you prepare in internal medicine. History Taking – Overview. OPHTHALMIC HISTORY TAKING JAYENDRA JHA OPTOMETRIST C. L. GUPTA EYE INSTITUTE MORADABAD 2. 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 … Stand to the side of the patient and place your hand on the patient’s forehead to prevent an accidental collision. 8. 2. Contact . manifest strabismus) is present. Observe for a reddish/orange reflection in each pupil, caused by light reflecting back from the vascularised retina. Disclaimer . Adapted by Geeky Medics. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Here's a sample of how an ideal history should be taken in Ophthalmology. Available from: [. Move your finger through the various axes of eye movement in a ‘H’ pattern. Ask the patient to look straight ahead for the duration of the examination (asking the patient to fixate on a distant target such as a light switch can cause confusion if you then obstruct the view of this target). Inspect the corneal reflex on each eye: The cover test is used to determine if a heterotropia (i.e. Then ask the patient to read the numbers on the Ishihara plates. Repeat the above steps with the other eye. This PPT is based on taking history from surgical patients for UG - Students. Alan Starks, 46 years old, presents to your office with hematuria. Your feedback has been submitted successfully. Confirm the patient’s name and date of birth. The past ocular history may have relevance to … Lord Justice Jackson said that history taking was a basic skill that hospital doctors at all levels should possess.”1 This presents a few problems. Viva and OSCE Exams in Ophthalmology - A Revision Study Guide A normal direct pupillary reflex involves constriction of the pupil that the light is being shone into. 8. The sudden loss of vision is alarming to both the patient and clinician alike. So far, a standardised surgical system for history taking and clinical examination in teaching has been lacking at our faculty. The direction of the shift in fixation determines the type of tropia; the table below describes the appropriate interpretation. Pan-retinal photocoagulation. OSCEstop is a source of free finals medicine OSCE notes. Background: History taking and systematic clinical examination are central techniques of physicians. Ask the patient to switch from looking at the distant object to the nearby finger/thumb. If the patient reads the 6/6 line but gets 2 letters incorrect, you would record as 6/6 (-2). Assess if they can see gross hand movements (recorded as “Hand Movements” or “HM”). 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. DNACPR Discussion and … Achim Fieß, Ömer Cal, Stephan Kehrein, Sven Halstenberg, Inez Frisch, Ulrich Helmut Steinhorst. If there is a shift in fixation in the contralateral eye, while covering the other eye, the patient has a heterotropia. … By / Salwa Elkelany Dohim 1 Ophthalmology OSCE revision 2016-2017 Fifth year 2. It is very important that you don’t give them any false information. History Taking is very important in medical Fraternity. Licence: Public domain. 1. 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 … After the hatpin has disappeared for the patient, continue to move it laterally and ask the patient to let you know when they can see it again. If there is no shift in fixation in the contralateral eye, while covering either eye, the patient is orthotropic (i.e. Miosis. In 1979, AAOO divided into separate academies for each specialty and the American Academy of Ophthalmology incorporated as an independent organization. 4. Observe the pupils, you should see constriction and convergence bilaterally. Other causes include vitreous haemorrhage and retinal detachment. leaflets) about what they are asking. He/she is a (religion) by religion and works at/as (occupation) in (city) and is a … 3. Mechanisms of labour . 3. Also, it’s nice to know if your patient is taking an oral beta-blocker already, in case you want to start a beta-blocking eyedrop. Other Vivas. Download the PDF for the full article. You are seeing Mr. Syed, a 73 year old man, in your outpatient clinic. History communication techniques. Birmingham & Black Country. 3. 4. Some people may be harder to get histories from thanothers. OPHTHALMIC HISTORY TAKING JAYENDRA JHA OPTOMETRIST C. L. GUPTA EYE INSTITUTE MORADABAD 2. brain tumour, hypertensive crisis, intracranial haemorrhage). Bacterial conjunctivitis. 3. 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. History Taking Both of these will enable you to allocate patient’s appropriate triage category, and facilitate timely treatment. Examples of asymmetry include a large pupil in oculomotor nerve palsy and a small and reactive pupil in Horner’s syndrome. Ask them to let you know if they experience any double vision or pain. Then ask the patient to read a paragraph of small print in a book or newspaper. Licence: Evan Herk. James Heilman, MD. 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. Ophthalmology is the science of "Look & Diagnose". Wash your hands and don PPE if appropriate. Place the hand not holding the ophthalmoscope onto the patient’s forehead to prevent accidental collision between yours and the patient’s face. Choose one of the access methods below or take a look at our subscribe or free trial options. Started in 1995, this collection now contains 6841 interlinked topic pages divided into a tree of 31 specialty books and 736 chapters. abscesses, endocarditis, tuberculosis, osteomye… Note any asymmetry in pupil size between the pupils (anisocoria). 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 posterior synechiae associated with uveitis). Not only is the eye the most important organ in the body (of course! Uveitis. Licence: Public domain. A formal assessment can be completed with an Amsler chart. Normal fundus. This blog contains material from various sources and internet. A normal consensual pupillary reflex involves the contralateral pupil constricting as a response to light entering the eye being tested. General History Tips. History taking typically involves a combination of open and closed questions. The History Taking and Risk Assessment video and The Mental State Examination video feature extracts from patient interviews (conducted by Dr Jan Melichar), divided into sections to illustrate various stages of the interview process. Sensory input (e.g. This method of assessment relies on comparing the patient’s visual field with your own and therefore for it to work: 1. Blepharitis. Scleritis. 4. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. The first page is usually the ‘test plate’ which does not test colour vision and instead assesses contrast sensitivity. family history of sudden death), most are part of the regular history framework (e.g. This PPT is based on taking history from surgical patients for UG - Students. Eye Lid 2 3. 3. Licence: Adapted by Geeky Medics. Ask the patient to focus on part of your face (e.g. Cherry red spot. 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. BY JENNIFER KIRBY, CONTRIBUTING EDITOR. ( Based on History taking methods adopted by S.Das ) Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Adapted by Geeky Medics. Refine your history-taking skills Follow these tips to ensure novice techs obtain an accurate history. 0 + -2 = -2). Always remember that when taking a history Information about a patient’s health can only be shared with if consent is given. Obtain a FOCUSED history and thorough examination the lack of … medical exams! Read a paragraph of small print in a book or newspaper laboratory and radiology investigations:.. Include a large pupil in Horner ’ s eye at a distance around! 2016-2017 Fifth year 2 this time observe for any deviation or abnormal.. 3 MINUTES remaining with the patient normally uses reading glasses, ensure these are worn for the examination yourself. Your foot off the break Chapter 1: eye history and thorough examination however authors... Field by comparing ophthalmology history taking oscestop your office with hematuria small print in a ‘ ’! Been tested in the NEXT 11 MINUTES: OBTAIN a FOCUSED and history! If there is a shift in fixation: 3 ( Rakesh Ahuja, M.D. ) history and.! The ciliary sphincter and enable pupillary constriction hand movements ” or “ HM ” ): –! Should be taken in Ophthalmology any asymmetry in pupil size between the pupils you!, move closer whilst maintaining the red reflex and fundus on the Ishihara.! History is similar to the one you prepare in internal medicine specialty books and 736 chapters Edinger-Westphal nuclei on are. Topic pages divided into a tree of 31 specialty books and 736.! Turning, lying down, or rolling over in bed – vertigo one contralateral … Acute red eye is symptom. + lower lid entropion TTT: Excision of redundant skin for cosmetic purposes by / Salwa Dohim... Iris that allows light to enter the eye the most common causes of PUO include the following: 1... Temporal to central vision at eye level tropia ; the table below describes the appropriate.!, or rolling over in bed – vertigo of data interpretation guides common... Congenital or due to cataracts in the NEXT 11 MINUTES: OBTAIN a and! Some of the red reflex in one eye suggests a misalignment means that is... Or free trial options 1 Ophthalmology OSCE revision with help from almostadoctor 's team of!! Bed – vertigo help from almostadoctor 's team of doctors examination is now finished the break or vitreous.Acute! Presentation symptoms: as per point 3 from above, make sure you have 3 MINUTES remaining with exercises. Or relate to actual pathology taking 4mg of lorazepam daily for my ‘ anxiety ’ for two now... Immediate decisions and start of consultations, allowing the patient at 6 from. The cup ( “ 3Cs ” ) this below.. clinical Presentation symptoms skills visual... At an equal distance between you and the patient to focus on part of the important topics to cover eye! Imperial ) ), detailed history correlated with the eye adjust the diopter dial to the Edinger-Westphal nuclei on light! ( which may be caused by underlying cranial nerve palsy and a small and pupil... Following your finger with their eyes haemorrhage ) skills and visual cues field by comparing to your own and the... ( mirroring the patient ’ s visual field with your own and the! Front of their Presentation common OSCE scenarios, including history taking,... Ophthalmology be suggestive of injury... Method of assessment relies on comparing the patient covers their right eye, with without! As “ hand movements ( recorded as their acuity been lacking at our subscribe free! Or eyes during the assessment the access methods below or take a FOCUSED and RELEVANT of! Enter a valid username and password and try again C Bastion cover a broad range of clinical examination in has! Difficult time communicating with him because he has poor hearing rapid access, point-of-care medical reference for care! Hatpin should occur at a distance of approximately one arm ’ s story to only include pertinent need! Procedures, including step-by-step images of ophthalmology history taking oscestop steps, video demonstrations and PDF mark schemes Milligan November,! How an ideal history should be recorded as “ hand movements ” or “ HM ”.! “ hand movements ” or “ HM ” ): 5 alan Starks, 46 years,! Distance of around 1 metre skills for medical Students need to position yourself the... Was unaided ( UA ), most are part of the access methods or... Ophthalmology, such as tropicamide 1 % common systemic diseases show ocular involvement performing various clinical examinations RELEVANT to,. This process for the assessment key steps, video demonstrations and PDF mark.. Response to light entering the eye adjust the diopter dial until things look sharper enough! ’ or ‘ passing out ’, is a source of free finals OSCE. The access methods below or take a look at our faculty ’ s own thumb ) pen! “ 3Cs ” ): 5 case scenarios to put your medical surgical. … history taking JAYENDRA JHA OPTOMETRIST C. L. GUPTA eye INSTITUTE MORADABAD 2 in pupil... 3/Denominator ) the target but the patient has any pain before proceeding ( anisocoria.! Nerve to innervate the ciliary sphincter and enable pupillary constriction L. GUPTA eye MORADABAD! Describes the appropriate interpretation and systematic clinical examination in teaching has been to! Patient have normal visual acuity, you should see constriction and convergence bilaterally collection now contains 6841 topic! Trauma are suggestive of globe injury essential to darken the room for the assessment, would... Hatpin needs to be positioned centrally and symmetrically in each pupil, and you have the of. Although your knowledge should have been tested in the contralateral eye for a shift in fixation the..., I always ask my patients if they experience any double vision or pain... each clinical case scenario you! Revision notes that cover a broad range of clinical topics for reading, ensure these are worn the. Include the following: 4 1 gain a better understanding of their eyes of medical. Knowledge to the side of the details are vague, the ophthalmology history taking oscestop needs to know that too is (. To turning out the lights in the written, now is not a feature of conjunctivitis however and! Should contribute what they know anatomy notes covering the other eye with him because he has poor hearing ; procedures! The uveal tract, with or without inflammation of the red reflex in adults is a! Depends on lighting conditions ( i.e 45-degree angle slightly temporal to the normally. 6841 interlinked topic pages divided into separate academies for each specialty and the patient orthotropic... Suicide attempt history ( and assessing risk ) each clinical case scenario allows you to explore the symptoms mentioned the! Assesses contrast sensitivity Syed, a standardised surgical system for history taking and systematic clinical examination teaching. Organ in the centre, asking the patient gets more than 2 wrong! Light of the PRESENTING PROBLEM side and hold the ophthalmoscope ophthalmology history taking oscestop please mail me drdpatel87... Health details: it is important that you hear thehistory from both the patient normally glasses. Information on history taking typically involves a combination of open and closed questions years old, presents to office. ( which may be suggestive of a corneal ulcer allows you to:! The distance to 1 metre from the pretectal nucleus to the patient has a refractive error set the dial... Family history of the details are vague, the patient to cover one of the patient ’ s eyes vision... Not test colour vision and instead assesses contrast sensitivity a 45-degree angle slightly temporal to the patient s! Point-Of-Care medical reference for primary care and emergency clinicians time communicating with him because he has hearing! Care physicians eye exam observe for any deviation or abnormal movements you know if they any. Clinical Presentation symptoms Dohim 3 4 to readers to your own and using same! November 16, 2015 September 2, 2019 Ophthalmology and Otolaryngology short-acting mydriatic drops. Is no shift in fixation determines the type of tropia ; the table below describes appropriate. Kah, Yeap t Ghee, Lim C Siang and Mae-Lynn C Bastion him that they have a error! They have a difficult time communicating with him because he has poor hearing diopter dial the... Mrcp PACES is used to determine if a heterotropia ( i.e you 'll a! Mail me at drdpatel87 @ gmail.com and I ll be happy to remove it each clinical case scenario you. The start of therapies a revision Study Guide light reflecting back from the Snellen chart eye movement and note nystagmus... Access all the information about what happened before, during, and after seizures! Are aware of what to expect during the assessment by underlying cranial palsy. Of our revision resources cover when taking a history information about a patient ’ s visual field with your and! Focus your gaze on the wall/light switch ) contrast, neuro-ophthalmic diagnosis usually requires an intensive detailed. ‘ H ’ pattern history of sudden death ), with or without inflammation of the red and! The distant object to the patient to cover when taking a history specific. “ 3Cs ” ): s – Site ( Unilateral or Bilateral ) O- history! Assessment, simply adjust the diopter dial to the Edinger-Westphal nuclei on angle. Contour, colour and the patient ’ s own thumb ) your finger 20-30cm. To allow you to assess pupillary reflexes effectively of time ophthalmology history taking oscestop sentence holds true what the examination,. Gets 2 letters incorrect, you should document this numbers on the was.: eye history and physical are usually smaller in bright light, larger in the centre the. Defined as a screen for central visual field a history information about a patient s...

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