Shared Flashcard Set

Details

clinical
final
70
Medical
Professional
04/14/2012

Additional Medical Flashcards

 


 

Cards

Term
what are blooms taxonomies or learning domain?
Definition

1. cognitive domain- knowledge 

2. pyschomotor domain- skill 

3. Affective domain- attitude

Term
Who is allowed in the exam room, during an examination?
Definition

~patient

~intern

~supervisor 

~certain ppl approved by the px(parent etc)

~possibly the clinic director

Term
when px care is being discussed btw practitioners, interns what limitations are there?
Definition

~specific px must not be named or identified in anyway

~causal discussion of px info is inappropriate

Term
what is the intern/extern dress code?
Definition

~Interns must wear an approved clinic coat (some exceptions), clinic coats should be clean and not creased.

~interns must wear a UW intern name tag 

~Men should wear a tie, dress pants and dress shirt 

~Women must wear a dress, or a dress shirt/top (that is not low cut) and a dress pant/skirt

~interns must wear clean dress shoes 

~

Term
In what situations is it permissible to not wear clinic coat?
Definition

~When there is excessive heating in an examination room 

~In paediatric and special needs clinic to ease patient anxiety 

Term
Intern/extern dress code for acessories etc
Definition

~body piercings must not be visible

~Visible piercings must be limited to 3 ear piercings per ear and one small nose stud 

~head dress/coverings are allowed for religious observances ONLY 

~minimum, perfumes, fragrances, colognes and lotions can be worn 

 

**(some px and staff have allergies, also prohibited for the TLC rotation due to laser sensitivity)

Term
what are 3 ways to calculate add determination?
Definition

1. age 

2. monocular cross cyl

3. Sheard's add determination

Term
there are a number of things that can make the ADD determination by age incorrect, list them
Definition

~medication use

~Geographic locations (closer to the equator earlier presbyopia 

~preferred working distance

~systemic disease 

Term
Early presbyopes 
Definition

38-45

~this group can present with blur in the distance due to slow relaxation of accomodation in the distance 

 

~concentrate on prism balance and fog the fellow eye if there are any symptoms of distance blur

Term
Add determination in 38 -45 year olds 
Definition

~X cyl works well in this group (make sure that illumination is reduced or you will get a lower than expected add)

 

~add by amplitude (Sheard's) but can be more difficult

Term
Mid presbyopes 45-59
Definition

~ fogging is NOT required BUT binocular refraction is still needed since there is some accommodation present 

 

~use X cyl, Sheards or age

Term
How large does an add have to be in order to have an intermediate portion to the lenses?
Definition
~add must be +1.75D or larger
Term
True or False Prism balance and fogging are required for an absolute presbyope (+60yrs)
Definition

False- these px have no accommodation left and you should NOT fog or prism balance them

 

~also VA is not usually equal so prism balance would not be done 

 

NOTE:nuclear sclerosis may invalidate R/G balance

Term
In absolute presbyopes what is the best way to conduct add determination?
Definition

Age 

 

~X cyl may not give reliable results(distortions, cataracts)

 

~Sheards may not give reliable results (measuring depth of focus)

Term
When determining ADD what is the first priority ?
Definition
The first priority is the VA then worry about the working distance
Term
To determine the add with bilaterally reduced acuity, use low vision principles
Definition

(Near VA/ Required VA) X WD  = ADD

 

~must educate the px that the working distance must be a specific distance 

 

(0.1/0.5)X2.50= +5.00D 

TF working distance is 20 cm

Term
What screening test is NOT usually done on people older than 40 yrs ?
Definition

~Amplitude of accommodation

push up amplitudes 

~add determination is a sufficient accommodative assessment 

Term
True or False can NPC be conducted on a presbyope?
Definition
Yes, but the end point may be a little more difficult to jugde for the px. 
Term
What is considerd a normal phoria result in presbyopia ?
Definition

Increased Exophoria (no accommodation ie no accommodative convergence)  

6-10 exophoria

 

~ AC/A can not be measured and are NOT useful

~accommodative facility is not measured and is NOT useful 

 

NOTE: also there are NO blur pts on the fusional reserve with an ABSOLUTE PRESBYOPE

Term
What tests are modified in a presbyope?
Definition

1. Cover test

2. Maddox Rod

3. Refraction 

Term
what tests are NOT done in presbyopes ?
Definition

1. AC/A ration 

2. Amplitude of accommodative(push up amplitudes)

Term
A minimum database type exam screens for abnormalities in which systems?
Definition

1. Binocular vision system  

2. Refractive system 

3. Sensory system 

4. Ocular health section 

Term
3 types of reasoning for clinical decision making 
Definition

1. algorithmic 

2. pattern recognition (intuitive)

3. Hypothetico - Deductive reasoning (analytical)

Term
Anterior subcapsular cataracts (what would trigger this dx in your mind)
Definition

~older patient 

~blur vision 

~mild anterior subcapsular opacification (located on the anterior surface of the lens) 

Term
Cortical Cataracts (sxs, location)
Definition

~located in the cortex of the lens, spoke like opacities towards the visual axis 

~Older patient 

~Increased glare

~Gradual decreased VA

~better VA in bright light

Term
Nuclear Cataract (sxs, location etc)
Definition

~found in the nucleus of the lens, delineated yellowed lens. 

~causes myopic shift 

~ older patient 

~near VA better at increased WD

~Gradual loss of VA

~near VA better than distance VA 

Term
Posterior subcapsular cataract (sxs, location)
Definition

~posterior surface of lens, black opacity on retroillumination, 

~pin hole decreases VA

~Younger adults 

~rapid VA loss 

~steroid use, radiation or inflammation 

~RP, myopia or hereditary conditions 

Term
What decision making method is differential diagnosis?
Definition
Hypothetico - Deductive method 
Term
Diagnostic Reasoning 
Definition

1. Problem Identification and clarification 

2.Hypothesis Generation

3. Hypothesis Testing

4. Hypothesis review: dx made?

5. Developing a px management plan  

Term
Differential Dx
Definition

1. Chief complaint 

2. Mentally list diagnostic possibilities 

3. consider px considerations( age- young possible myopia or young possible cataracts)

4. prioritize by order of probablity and revise list 

5. Additional probing questions

6. problem specific testing 

7. Additional probing questions 

8. Database testing 

9. diagnosis and plan 

Term
What are patient characteristics?
Definition

~age

~sex

~race 

~occupation/ environment 

 

~impacts how likely it is for a px to have a certain disease/condition 

Term
Indications when a px should be dilated
Definition

~ when a px experiences floaters and flashes of light 

~onset of change in the number or size of floaters

~when a px has a sudden unexplained vision change or loss, Or experiences metamorphopsia 

~when a px has a systemic condition or is taking a medication that may affect ocular tissues 

~history of ocular trauma or ocular surgery that increased risk to posterior segment

~increased risk of peripheral retinal disease exits 

~Hx of moderate to high axial myopia

~a better appreciation of the nature of a fundus anomaly is required

~ocular fundus is not clearly visible through an undilated pupil 

~the size of a fundus anomaly necessitates the need for an increased view of the view for its interpretation 

~disease of the ciliary body is suspected and or disorders of the vitreous

~

Term
Ontario's Personal Health information Protection Act: An optometrist must keep?
Definition

1.A daily appointment record that sets out the name of each patient that the optometrist examines or treats or to whom the optometrist provides any service.   

2. Financial record for each patient this record must include the optometrists fees for services or any commercial laboratory costs charged to the member

3. A patient health record for each px that must include:

~Name, Address of the patient 

~name of the optometrist that provided the service 

~the date of each visit of the patient 

~ the date of every entry in the record 

~Name and Address of any referring health professional 

~patients oculohealth and vision history 

~clinical procedures used 

~clinical findings obtained

~diagnosis when possible

~every order made by the optometrist for examinations, tests,  consulations, or treaments to be preformed by another person 

~particulars of every referral to and from another health professional 

~information about every delegation of a controlled ACT within the meaning of subsection 27(2) of the Regulated Health Professionals ACT delegated by the optometrist 

~information about a procedure that was commenced by but completed, including reasons for non completion and a copy of every written consent to treatment. 

Term
tests are useful IF they?
Definition

1. Are problem specific and aid in a diagnosis (including grading severity)

2.Provide information useful for monitoring therapy over time

3.Provide information to cross the treatment threshold

4. They help to establish a database of information 

Term
Additional reasons that tests are done
Definition

1. Fee Generation 

2. Medico-legal reasons

Term
What are test measurements that we should consider for each test ?
Definition

~ validity: accuracy

~reliability:reproducibility

~Range: Measurement range within what is needed

Term
Sensitivity 
Definition

The portion of patients with the disease taht have a positive test result

 

When a test with a high sensitivity is negative it effectively rules out the diagnosis of the disease.

Term
Specificity 
Definition

The portion of people with out the disease that have a negative test result

 

~when a test has high specificity a positive result can rule IN the diagnosis 

Term
post test odds = pre test odds X Likelihood ration 
Definition
Term
What is Bayes Theorem
Definition

Post Test Odds= Likelihood Ratio X Pre Test Odds  

 

Pre Test odds = prevalence / (1-prevalence)

Term
What muscle is most likely affected when a px has Grave's ophthalmopathy ?
Definition

~inferior rectus 

(Then the medial rectus)

Term
what is a significant test result?
Definition
~this is when a test being normal is impt 
Term
What is evidence based Medicine?
Definition
It is the integration of the best available evidence with clinical experience and patient values.
Term
What are the steps of EBM ?
Definition

Ask:identify type of question and put it in PICO format 

 

Acquire: Identify the appropriate study design, identify a source for the information then research that source and take the best and most relevant evidence

 

Appraise:look at susceptibility to bias, and look at the results that are impt for the evaluation of impt px outcome 

 

Apply: evaluate the applicability of the study for your px.  Evaluate the issues of applicability with the relational construct

Term
Type of study hierachy
Definition

Meta analysis 

summaries 

Randomized controlled trial 

cohort studies

case control studies

case/series case report studies

Animal Research/ laboratory studies

Term
Expert Opinion 
Definition
A belief not based on absolute certainity or positive knowledge but by what seems valid, true or probable in ones own mind; judgement 
Term
What are the factors contributing to decision making skill?
Definition

~knowledge base (continuing education)

~analytical and diagnostic reasoning skills 

~clinical experience

~professional style (ability to relate to the px)

Term
What are the dft types of thinking ?
Definition

type 1 intuitive: fast pattern recognition, used by experts and takes time to develop

 

Type 2: differential diagnosis. Used for difficult problems and used by novices

Term
What are heuristics ?
Definition

They are general rules or strageties that usually support and assist good decision making. They are "Rules of Thumb"

 

~representative heuristics (miss a dx bc signs ans sxs do not coincide with your knowledge about a condition)

~available heuristics (make a dx bc it is similar to a recent px of yours)

~anchoring heuristics (there is a sign/sxs that anchors and dx in your mind and you do not change the dx even if other tests prove that dx is not the best)

Term
Two main goals of the practitioner for case hx
Definition

1. obtain information from the patient

2. Establish a rapport with the patient  

Term
How is rapport built with a patient ?
Definition

~support 

~empathy 

~reassurance 

Term
How much of the instructions they are given by dr's are remembered by px?
Definition
Less than 60%
Term
what is the typical rate of non adherence?
Definition
~50%
Term

True or false 

REFRACTION= PRESCRIPTION

Definition
FALSE 
Term
How has coverage under the ontario drug benefit (ODB)
Definition

~people over 65 

~people in long term care facilities 

~people in special care facilities 

~people receiving special services under the Home care progam 

~trilium Drug program recipients

~social assistance

Term

If there is no ophthalmologist on call the patients are sent to?

Definition
St. Mary's Hospital 
Term
True or false A referral letter must be finsihed on the same day that you saw the px?
Definition

True

~The referral has to be in the system in the right way or they may fall through the cracks 

Term
Referral procedure in PC
Definition

1. supervisor/patient determines which doctor the referral will go to

2. intern informs the patient on the procedure

3. intern writes the referral/form and saves it to a disc they get from Rose

4. The doctor approves the letter with corrections

5. Rose faxes the letter/form and a records it in a log book

6. when the appointment is received the px is notified by Rose

7. Can take up to 2-3 weeks for non urgent referrals

8. the appointment will likely to months after the notification  

Term
what are the A,B,C's of good letter writing ?
Definition

A-accuracy

B- brevity

C- clarity

Term
The case presenting to the supervising optometrist should include?
Definition

~Name, age, sex, race (if relevant), vocation, avocation of patient 

~chief compliant (all details)

~ Relevant ocular and health history 

~relevant anomalies and abnormalities in the test results

~diagnosis of each identified problem 

~management plan for each problem 

~if should be attempted even if there is uncertainity of the dx or the plan 

Term
supervision has 3 functions
Definition

1. educate

2. Support

3. Administration

Term
What is the most important role of a supervisor
Definition

~1. ensuring the safety of the patient/care

THEN 

2. educating the trainee

3. promoting high Standards  

4. identifying trainee problems 

5. supporting trainee

6. monitoring trainee progress

Term
what lighting should be used for X cyl?
Definition

room lights off over the distance chart and ceiling lights should be set at half maximum

 

~the stand light should be OFF for X cyl test BUT then must be turned on for reading card demonstration of add

Term
what are the codes in clinic ?
Definition

402- partial exam of unisured ages no limits

404- exam for 19 yrs and younger 

406- 65 yrs or older 

408- partial exam for ppl of 409

409- exam for ppl who have other diseases(DM, glaucoma)

410- visual fields for covered px 

Term
what is being billed? cost of exam?
Definition

Privately Billed:

full exam no coverage $80.00

partial (emergency) $55.00

new px partial (emergency) 65.00

other $45

Term
what are the cataract surgery wait times in ontario?
Definition

roughly 2,3,4 months 

 

85 -127 days 

Term
which ophthalmologists in KW DO NOT preform cataract surgery 
Definition
Dr. KIKIS, and WAIND
Term
which dr's are ON CALL 
Definition
Dr. jellie, Mcquaid, wilkinson, pornisch, weinstein  Anderson, Desai, zafar
Term
which dr's are in cambridge?
Definition
Dr. Wilkinson, Desai, Anderson
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