Category: Head, Eyes, Ears, Nose, and Throat (HEENT)

Eye Complaints

Common Complaints

  • Red Eye
  • Decreased Vision
  • Trauma to the Eye

Approach to a Vision Complaint

  • Step 1: Assess visual acuity
    • Visual acuity is the “vital sign of the eye”
    • Snellen eye chart is best
    • If patient unable to see chart…
      • Count fingers?
      • Able to see light?
  • Step 2: Examine the conjunctiva/cornea with fluorescein
    • How to apply fluorescein
      • Recline patient 45 degrees
      • Pull down on lower eyelid to create pocket
      • Place anesthetic eye drops in pocket (ex. tetracaine)
      • Wet the fluorescein strip with eye drops and apply to pocket
      • Have the patient blink to distribute the dye
    • Look under woods lamp for bright “uptake” areas that don’t move with blinking
      • These represent abrasions, ulcers, etc
    • This step is also a good opportunity to evert the eyelids and examine for foreign bodies if appropriate
  • Step 3: Examine the anterior chamber with slit lamp
    • “Cell and flare” (example HERE)
    • Representative of iritis, uveitis
    • This is also a good opportunity to examine any other abnormal areas of the eye under magnification!!!
  • Step 4: Check intraocular pressure
    • Pressure >20mmHg (especially when unequal) is concerning for acute angle closure glaucoma
    • Multiple tools to measure pressure on market, ask somebody to show you how to use
  • Step 5: If appropriate, use ultrasound to evaluate posterior eye
    • Multiple things can be diagnosed with ultrasound of the eye
      • Retinal detachment
      • Optic neuritis
      • Papilledema
      • Foreign bodies

Additional Reading

Sore Throat

During my clerkship, every time a patient came in with a sore throat, my attending would ask me, “Zack, what are the 4 life threatening causes of sore throat!?”  I could never remember the answer, but after the episode today you will. Also, extra special thanks to Dr. O’Connell and Elsevier for allowing us to use the book USMLE Step 2 Secrets during this episode. We will be incorporating these questions into future shows as well. I hope you find it useful.

Dental Pain

Get excited the next time you have a patient with dental pain! Because this is one of those chief complaints that will give you tons of points on your SLOE as long as you can articulate your way through it. This is also one of those rare opportunities where you get to demonstrate procedural skills by doing an inferior alveolar nerve block. So never roll your eyes at these patients, because they are an opportunity for you to stand out from the pack and earn high clinical scores!

Epistaxis

If you listened to the introduction episode, you heard my story about the patient with a bleeding nose. I had NO IDEA what to do. It was embarrassing. And that specific situation is what inspired the creation of this episode. Nosebleeds can be scary! You will probably have a patient with this during your clerkship, and the approach requires a completely different mindset than when we just articulate the differential diagnosis for a Core 4 medical complaint. Epistaxis requires a plan with a series of interventions as opposed to labs and imaging, and it WILL throw you off balance if you aren’t prepared.

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