OSCE 1 Flashcards
OSCE GAT explanation:
- Hi, my name is Dyllan
- This test will assess your intraocular pressures using a Goldmann Applanation Tonometer
- It works via the Imbert-Flick law, essentially reading your eyes internal pressure by pushing against the front part of your eye
- This measurement helps me gauge that your eye is healthy and circulating fluid properly
- This probe has been disinfected
- Cleaned with a mild surfactant
- Rinsed with saline
- Soaked in sodium hypochlorite 5000ppm for 10 minutes (1:10 bleach)
- Rinsed with saline
- Air dried
- Do you consent to this test being performed?
- Are you pregnant, or know of any allergies you may have to medication
GAT rubric
- instruct purpose of test
- Hand hygiene and disinfection
- assess cornea for staining
- instill anaesthetic and fluorescein
* Record drops and time - position tono and biomicroscope for measuring iop
- obtain clear mires
- adjust mires to obtain IOP
- asses post. corneal staining
- resord in correct terminology
- no significant damage
GAT procedure
- NaFl stained examination
- Assess healthy cornea
- Place tono probe on mount
- set doubling at horizontal meridian
- Wide slit (max luminance)
- 45-60(deg) from probe temporally
- 16x mag
- Move probe into visual axis
- Set measuring drum to 10mmHg
- Instill anesthetic
- 0.5% alcaine
- Px not to rub eyes for 15mins
- Follow with another NaFl stain
- Note Alcaine 0.5%, one drop, at time
1. “Place head in rest, focus straight ahead and slightly upwards” - Motion probe forward until contact is made
- Limbus will illuminate blue
- change measuring drum to have rings barely intersecting
- Increasing forward motion until size of rings doesn’t change
- note final measure
- re-examine cornea for complications
- clean and disinfect prisms after use
SIO procedure:
- Set up
- Illumination in-line with scope
- Parallelepiped 2mm, height equal to pupil
- low intensity
- low mag (10x)
- Focus on the iris, beam centre of pupil
- place lens 4mm parallel to cornea
- Pull lamp back until retina focuses
- increase mag / illumination as needed
- mitigate reflections by tilting illumination system
- Evaluate ON
- Size / Shape / Colour / Depth
- CDR
- NRR > ISNT rule
- Abnormalities
- Assess arcades
- Tilt lens with lamp motion
- Colour / Tortuosity of BVs
- AV ratio
- Pull back slightly > assess pos. vitreous
- Assess 8 gazes of periphery
SIO dialogue:
- I’m assessing the health of your eye with a microscope and lens held near your eye
- The lamp will be bright, lmk if you’d like a break
- Please look at my ear, if it helps to close your other eye just look forward
- I’ll need to rest my hand on your cheek, is that okay
- Blink normally, just try to hold your eyes open wide
- Lmk if the lens touches your lids
- Please look (8 directions)
- While looking down, ill pull your lid up a bit, blink as much as you need, lmk if im pushing too hard
SIO recording:
- Vitreous > NAD (no abnormalities detected)
- ONH
- Disc margins distinct
- Average size
- No PPA
- NRR uniform, ISNT obeyd
- CDR 0.4H, 0.4V
- No abnormalities
- Clear NFL
- ILM sheen noted
- BV normal
- AV ratio of vessels near disc 2:3
- Posterior pole NAD
- Macula NAD
BIO OSCE rubric:
- Instruct purpose, Px orders, obtain consent
- Adjust BIO for optimal viewing
- Maintain appropriate lens vertex distance in all gazes
- Maintain appropriate lens tile in all quadrants
- Maintain level/position while scanning
- Troubleshoot poor view
- Systematic view of peripheral, mid-periphery, central retina
- Obtain stable/clear view in all regions
- Comprehensively scan the retina in all regions
- view anatomical landmarks
- Vortex veins
- Short/Long ciliary nerves
- Record retinal lesion described by examiner on recording sheet
BIO explanation:
- This test will examine the health of the inside of your eye using a light from my head-band and a lens
- do you consent to this test
- I’ll lower and recline your chair and position you as if you were at the dentist
- Please look at the ceiling (straight ahead)
- Let me know if the light is too bright
- Blink as you need, just try to keep your eyes wide
- Change your gaze, i’ll hold your eyelid when you look down
- up-right
- up
- up-left
- left
- down-left
- down
- down-right
- right
- Change your gaze
- Up
- Left
- Down
- Right
- Please look at my ear
- the ear in-line with the eye not being observed
BIO set up:
- Wash hands
- Eye pieces perpendicular to eyes
- Directed at arms length thumb
- Adjust PDs to center thumb
- Adjust tilt to situate light in upper VF
- Adjust illumination to medium intensity
- Largest spot size
- Dim room lights
- Lower Px
- Hold lens between thumb/index
- middle finger can hold/pivot sup. lid
- Direct light on pupil
- BIO at arms length from Px
- Introduce lens 4cm from eye
- external eye is seen
- center pupil in lens
- observe red reflex
- move lens away from px until red reflex fills lens
BIO scanning procedure:
While Px looking in gaze
- Full lens focus shows mid-periphery
- Direct beam towards gaze and tilt lens in opposite direction
- partial view of peripheral fundus
- sweep and change Px gaze
Mid periphery requires gaze in 4 quadrants
- full lens focus should show most of mid periphery
Posterior pole
- Sweep in snake motion to observe structures
BIO troubleshooting:
Losing view:
- move lens towards eye until pupil is noted > centre pupil and pull back
Reflections on lens:
- tile lens slightly
BIO recording sheet description:
- Outer circle is posterior edge of ciliary processes
- Middle circle is ora serrata
- Inner circle in equator
BIO standard recording:
Record flipped and inverted
- BV
- Long ciliary nerves
- thin band at 3’ and 9’
- Short ciliary nerves (hard to note)
- Thin ovals crossing equator at 1’/5’/7’/11’
- Vortex veins
- Pineapple shape
- Ora seratta
- Traced middle circle
- leave some holes like a tent
BIO abnormality recording:
Retinal pigmentation: Black dots
Laser photocoagulation scars: Black crosses
- CWS
Lattice degeneration: Black stitching inside black oval
Retinal detachment: blue border with shading over detached area
White without pressure: blue circle
Macula edema: yellow patch
Hard exudate: yellow dots
Recording position and size of lesion on retina
As # of disc diameters in a given direction (temporal) from ON
And as # disc diameters in size
Also record time and drops used
BIO narration:
- ONH
- Disc margins distinct
- Average size
- No PPA
- NRR uniform, ISNT obeyed
- CDR 0.4H, 0.4V
- No abnormalities
- Clear NFL
- ILM sheen noted
- BV normal
- AV ratio of vessels near disc 2:3
- Posterior pole NAD
- Macula NAD
Narrate anything of note as DD size and distance from OD
