Station 1: Hx, Musc, VF, Pupils Flashcards
Entering the room
Good morning Mr(s). Lee, I’m candidate 392. How are you today?
Today I’m going to examine the health of your eyes
- wash hands 15 seconds
- clean cover paddle and NPC ruler
Histories
Chief complaint
1) “What are you here for today?”
- FOLDARQ
- “Do you have any other issues or concerns that I should address at today’s visit?”
Ocular history
- last eye exam: diagnoses, tx
- previous injuries, sx, infxns: when, tx
- glasses/cls hx
- social hx and whether eyes are involved
Family ocular history
-eye turns, glaucoma, cataracts, or macular degeneration?
Medical history
- last exam, next exam
- conditions: diagnosis, tx
- other meds, drug allergies
- ROS: feeling today
Family medical history
-what, who
Social history
-alcohol, tobacco, recreational
Tentative diagnosis
-“My best tentative diagnosis for the chief complaint is ___”
EOMs and saccades
*remove glasses
Usual EOM spiel
*hold upper lids for downgaze
“EOMs are full with no restrictions OD and OS. The patient reports no pain or double vision”
Saccades spiel
“Saccades are complete and accurate, without over or under-actions”
CVF
CVF spiel - include sitting 1m away and say 1, 2, or if you can’t tell how many
“My hand is equal distance between me and the patient”
“Visual field is full to finger counting OD and OS”
Near CT
CT spiel - including at 40cm, look at letter B (3 down), keep it clear
Unil: “I’m now performing unilateral cover test, looking for a strabismus. To detect this, I am looking for any movement on the uncover stroke of either eye, indicating that the eye was turned in an alternate position when covered by the paddle and fusion was broken. I am also looking for any nystagmus of the non-occluded eye.”
Alt: “I’m now performing alternating cover test to look for a heterophoria. I am looking for any movement of the eye I previously had covered.”
“I see movement ___ward. I will begin to neutralize with B__ prism”
“Mr(s). Lee has a ____PD ___phoria at 40cm
NPC
Now I’m going to perform the near point of convergence test to see how the eyes are working together in a different way. I want you to stare straight at this vertical line. I will bring the target closer to you and I want you to keep it single. Tell me when it first breaks into 2 lines.”
“I am moving the target at 1cm/second and looking to see if there is an eye turn.”
“Is it still single? Can you get it back into one? Let me know when it goes back into one”
“Near point of convergence is __cm with recovery at __cm”
REPEAT NPC and state findings
Pupils
*20/400 letter, moderate room illumination, glasses off
Measure size in bright and dim
“There is no anisocoria present”
Direct and consensual
“I’m observing the direct response… Pupil is round and reactive. Direct response is a 4+”
“I’m observing the consensual response… Pupil constricts and responds briskly. Consensual response is a 4+”
Swinging
“The eyes are not dilating once the light is swung from one side to the other, indicating the direct and consensual are the same and no APD is present in either eye”
Near response
“Pupils display a brisk constriction when viewing a near object OD, OS”
BP
Now I’m going to check your blood pressure. I want you to stay relaxed and continue breathing. Try not to move as much as possible during the test.”
“The arm should be supported horizontally or about at heart level for this test.”
“In the office, I would first adjust the patient’s sleeve, making sure the artery is not compressed. If they have a thick jacket on, I would have them remove the arm from the jacket, otherwise pressure can be taken over loose or thin clothing.”
“I will now place the cuff on the patient’s arm, making sure to align the artery indicator in the proper position. I will now put the stethoscope in my ear and place the diaphragm of the stethoscope on the artery, tucked slightly in the cuff. I am putting pressure on either side of the diaphragm as well”
“I will increase the pressure at a steady rate to 200-220 mmHg and reduce at a steady rate of 2-3 mmHg per second”
“The systolic pressure is ___mmHg and the diastolic pressure is ___mmHg”
“I will now take the cuff off of your arm”
