Question of the day: OSCE revision on the wards- what should be done next?
A medical student is practising for her OSCE exams on the ward…
She examines a 19 year old female patient admitted with asthma on the medical assessment ward for revision purposes.
The patient has a past medical history she has the occasional migraine, and eczema.
The observations are as follows.
BP 128/70
Pulse 98 regular
Fingerprick blood glucose 8.3
Oxygen Sats 97% on Air
She performs a cardiovascular and opthalmological examination.
Cardiovascular examination: Split S2 (second heart sound) on deep inspiration.
Ophthalmology examination: Normal Eye movements. Pupils 6mm and reactive to light. Eye movements normal. Visual fields normal. No scotoma. Fundoscopy examination of one eye is shown below…
Do you get this good a view when performing fundoscopy? Of course not, this is a digital retinal photograph-remember when you are using a hand held opthalmoscope you only get to view a bit of this at a time, which is why its important you should know which eye this is!
Why not have a go at the questions below? We’ll put up the answers in a couple of days…
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eyes are viewed as if you are looking at the patient, therefore looking at this fundoscopy its as if you are facing the patient, which is how you can work out which side it is.
blood pressure too low for hypertensive retinopathy, no need to repeat it.
PS what is the significance of a split S2???
[...] recap the question see below…. or click the link here. Please add any comments or questions! A medical student is practising for her OSCE exams on the [...]
eczema and allergic bronchitis commonly found in the past medical history of patient with asthma….so reassure the patient is enough….
left eye seen by fundoscope….
i think the answer number three ( reassure for the patient_) because some asthmatic patients had history eczema,migraine headache and hay fever
left eye was seen by opthalmoscopy
It seems that she has the right eye is visualized here.What appears to me is blurring of the upper & lower margins of the disc,with the disappearance of the physiological cup&slightly distended veins, which implies the early changes of papilloedema.These changes could be due to the benign idiopathin ICP secondry to Steriods what I think.The split S2 on deep inspiration is insignificant.
What was the pathology seen on fundoscopy?