osce 2 Flashcards
(22 cards)
BVS procedure:
VA
Retinoscopy, darken light
VA, brighten light
Occlude eye
Add plus/minus until reversal and go back, magnitude depends on VA
Add plus 1, expect 4 lines, if not step down until no change
JCC
BVS step magnitude based on VA
6/120 = 3.00D steps 6/60 = 2.00D steps 6/30 = 1.00D steps 6/12 = 0.25D steps
Imperial to metric conversion for room 2
Times 3 then divide by 10
Conversion is on wall and remote
Eg. 20/25 = 6/7.5
JCC procedure:
Block other eye Dots on screen Flipper on "axis" at where ret was taken Determine axis Flipper on "power" Red=more minus, add until reversal and go back one Every .50 cyl add .25 sphere Return to "axis" Refine axis
BVS script:
focus on green while I shine light
read the first letter of each line
I’m blocking your other eye
Focus on the line above what you read to
Tell me if this new lens is clearer, worse, or just smaller?
I’m making it blurry, which line can you read to?
Can you see the dots? Now same as before
JCC script:
Can you see the dots?
Which lens makes them clearer/rounder/darker, or the same
Recording sheet:
Vision: “retinoscopy R:6/6”
Refraction: R: -4.50/-1.75 X 180 (6/4.8)
Van Herrick angle: 0.5
R: (ticks in 5 spaces)
VA rules
Record last line read
(-/+) for each letter missed on the line/got on next line
Eg. 6/6-2
Slit lamp: order of examination
Set up Diffuse illumination Parallelepiped Optic section Van Herrick
Slit lamp: set up rules
Explain purpose of test, GAIN CONSENT
Focus slit lamp on rod
Clean slit lamp and hands
Instruct head placement and eye focus on wall behind
Slit lamp: set up script
This test will let me examine your eye
I will have to shine a light into your eye and touch your eyelids for a bit, do I have your permission to do so
Place your chin in the rest, and rest forehead on band
Focus your other eye on the wall
Slit lamp: diffuse what to examine
Superior lids/lashes/palpebral conjunctiva Inferior lids/lashes/palpebral conjunctiva Superior bulbar conjunctiva Inferior bulbar conjunctiva Temporal conjunctiva Nasal conjunctiva Inferior nasal punctum and caruncle Iris
Slit lamp: parallelepiped what to examine
Tear film
cornea
Slit lamp: diffuse order of exam
Low mag X6, light 45 degrees temporal Sup. lids, Px looks down Sup. Conj, hold lid up Inf. Lids, Px looks up Inf. Lid/conj, hold lid down in 3 spaces while scanning
Slit lamp diffuse script lids:
With the diffuser on, 6X zoom, beam width of 5mm, light angle of 45, medium illumination level I”m going to look at the ocular adnexa
Px look down
Scanning sup. Lash follicles, expecting no crusting/scuff/build-up/missing lashes/lesions/inflammation
Px I’m holding your upper eyelid
Scanning sup. Bulbar Conj, some hyperemia not uncommon, no discoloration/lesions
Px look up
Scanning inf. Lash follicles, expecting no crusting/scuff/build-up/missing lashes/lesions/inflammation
Px I’m holding your lower eyelid
Scanning inf. Bulbar Conj/lids, Meibomian glands normal, some hyperemia, no discoloration
Holding nasal inf. Lids, punctum and caruncle look normal
Scanning across temporal and nasal bulbar conjunctiva, slight hyperemia, otherwise normal, iris is normal
Slit lamp: parallelepiped: order of exam
Medium mag >16X, light 45 degrees, low light intensity, 2mm beam
Assess tear film
Scan cornea
Verbalize motion while moving slit lamp
Move light nasally once at midpoint of cornea
Slit lamp: parallelepiped script
Removing the diffuser, magnification at 16, light at 45 degrees, low light intensity, and a 2mm beam I’m going to assess the tear film meniscus and cornea
Px look at wall
Looking at the tear film
Px blink please, assessing the tear film, noting small ammount of tear debris, otherwise normal
Now scanning across the cornea, starting from the temporal side with the conjunctiva and iris in focus
As I move to the nose, I’m pulling the scope towards myself, to follow the radius of the cornea
This is as the cornea is curved, I need to keep the distance from the scope the same to keep it focused
I am judging the ammount of motion by the clarity of the tear film and corneal nerves
Cornea is clear, no opacity or lesions, noticing reflection of lashes and small nerves
Now at the middle of the cornea, I move the lamp nasally 90 degrees to follow the curvature of the cornea
Slit lamp: optic section what to assess
Cornea layers
Lens layers
Van Herrick’s
Slit lamp optic section: order of exam
Max light intensity, minimum beam thickness, 25 mag, 45 degrees for cornea / 15 degrees for lens / 60 degrees for van Herrick’s
Assess central cornea, focused STATIONARY view of layers
Push in from cornea through anterior chamber
Assess lens layers, each layer noted as presented
Assess van Herrick’s on both sides, expect 0.5 of the corneal beam
Slit lamp: optic section cornea script
Now with max light intensity, magnification at 25, smallest beam width and light at 45 degree I will assess the layers of the cornea
This time ill have a stationary point at the central cornea, but ill start from the conjunctiva as it is easier to focus from there and will not be bright for the patient while I focus
Now on central cornea, aligning the brightest reflection, the filament, with the light beam I see the cornea
The 3 cornea layers are visible, brightest line is the epithelium, next to that is the stroma, and next to that is the endothelium.
It is clear, no lesions or thinning present in any layers
Now changing the light angle, magnification, and moving scope inwards, passing the focus through the anterior chamber to the crystalline lens
Slit lamp: optic section crystalline lens script
Moving light 10 degrees from optic axis, and lowering the magnification, I will assess the crystalline lens
Focusing slightly past the iris onto the crystalline lens
The first thin line is the anterior lens capsule, and the thick line after is the anterior lens cortex.
Now moving forward to focus on the lens nucleus, seen as the darker section following
Moving further forward the posterior lens is visible, with the posterior lens capsule behind it.
Moving further to show the posterior chamber
Noting the whole lens is clear, no opacities or obstructions
Moving back onto the iris
Slit lamp: optic section van Herrick’s script
Keeping the beam thin, lowering magnification to 6x, and moving light 60 degrees from optic axis, I will assess the van Herrick measurement
Focusing between the iris and the cornea I note the darker section to be half the width of the corneal beam
So a ratio of 0.5
The dark section represents the anterior chamber angle, and is completely normal
And it is the same
