Term
All of these might be appropriate to say after you have given bad news to a patient, EXCEPT:
a. I can see that you are upset.
b. This must be very difficult for you.
c. I'm sorry.
d. Are there any questions you have that I can answer? |
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Definition
| Answer C. Don't say that you're sorry without qualifying it (I'm sorry for your loss, I'm sorry to have to give you this information, I'm sorry that Dan Thomas is your doctor, etc). |
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Term
Which term from the 'Griev_ing' mneumonic is incorrectly paired with its meaning?
a. G - Gather appropriate family members together
b. R - Respect the family and their wishes for the deceased
c. I - Identify yourself and be sure that you have the correct family (use the deceased's name)
d. N - Nuts and Bolts: discuss things like organ donation, funeral arrangements, etc |
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Definition
| B is incorrect. The R stands for Resources - things like hospital chaplains, interpreter services, private physicians that may be of use to you or the family during the grieving process |
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Term
| During which stage of breaking bad news, using the Griev_ing model, do you actually tell the family that their loved one has died? |
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Definition
| Verify! During this stage, you tell the family that their loved one has died, being sure not to use a euphemism (passed on, walked towards the light, chillin' with jesus, etc) |
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Term
Which of the following may be obstacles to the smooth and professional delivery of bad news in an emergency setting?
a. The physician's own emotions
b. Guilt
c. Lack of time
d. Cumulative family pathology
e. More than one of the above
f. None of the above |
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Definition
| E - All of the above are potential obstacles. Physicians may be upset, the family and physician may feel guilty about the situation (family may feel the death was their fault - so might the physician), there may be little time to devote to delivering the bad news in a busy ED, and having the whole family in one room may bring up issues unknown to the physician. |
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Term
| True or False: Giving bad news as a physician will always be at odds with your sense of personal and professional satisfaction. |
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Definition
False. "Done well, giving bad news adds to personal and professional satisfaction" - Dr. Johnson's lecture
If you do a good job, you can help the family begin the grieving process in a healthy and appropriate way. |
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Term
When might you use the "shit sandwich" method of bad news delivery?
a. Telling someone their imaging studies are abnormal
b. Telling someone their labs are normal.
c. Telling someone their spouse has died in a car accident.
d. all of the above
e. A and B |
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Definition
| E - A and B are correct. Use the Griev_ing method for death notifications. |
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Term
| Pupillary dilation is normally a symathetic or parasympathetic process? |
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Definition
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Term
Pupillary dilations allows:
a. The examiner to see a brighter image with the ophthalmoscope
b. The patient to have a better field of view.
c. Maximizes the amount of light that is reflected by the cornea and iris.
d. All of the above. |
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Definition
A - by making the pupil bigger, you allow more light to enter, so the view from the ophthalmoscope is brighter.
b - The examiner has a better field of fiew. The patient can't see shit.
c - Dilation MINIMIZES the amount of light reflected. |
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Term
| The first thing you should look for with the ophthalmoscope is the... |
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Definition
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Term
| Following the eye vasculature should lead you to the... |
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Definition
| Optic Disc. The vessel branch points are like arrows points you towards it. |
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Term
| True or False: people will poor vision may have different pigmentation around their optic disc. |
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Definition
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Term
Visual acuity is greatest in the:
a. optic disc
b. optic cup
c. macula
d. central fovea |
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Definition
| D. The central fovea is the site of greatest visual acuity. |
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Term
The fundus is composed of:
a. vitreous humor
b. retina
c. blood vessels
d. optic nerve
e. All of the above.
f. A, B and C only. |
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Definition
| E - all of the above. See slide 3 of ophthalmology lecture. |
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Term
Primary care physicians typically use:
a. direct ophthalmoscopy
b. indirect ophthalmoscopy
c. neither. |
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Definition
| A - direct ophthalmoscopy is what we did in class - looking in eyes with the fundoscope. Indirect ophthalmoscopy is fancy and is only for ophthalmologists (uses a condensing lens, a wider field of view, and inverted and reversed images). |
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Term
| The fancy word for pupillary constriction is... |
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Definition
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Term
| The fancy word for pupillary dilation is... |
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Definition
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Term
To find the macula, you should move:
A. Superiorly and laterally
B. Centrally
C. Temporally and inferiorly
D. You can's see the macula in a normal fundoscopic exam. |
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Definition
| C - you should move temporally and slightly inferiorly (see slide 10 of ophthalmology notes) |
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Term
Routine ophthalmoscopy can help in diagnosing:
A. Glaucoma
B. Diabetic retinopathy
C. Hollenhorst plaques
D. Vascular occlusions
E. All of the Above |
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Definition
| E - All of the above! It can also help diagnose elevated intracranial pressure. |
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Term
| True or False: Closed angle glaucoma has an insidious onset, and begins with a loss of peripheral vision that probably won't be noticable to the patient. |
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Definition
| FALSE. This is the description of OPEN angle glaucoma. Closed angle glaucoma typically presents in an emergency setting and is not diagnosed with fundoscopy. Open angle will usually be asymptomatic until the end stages. |
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Term
| What is the mechanism of visual loss in glaucoma? |
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Definition
| Elevated intracranial pressure causes optic nerve compression, leading to axonal loss. |
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Term
Which are characteristic findings of glaucoma?
A. Cupping
B. Pallor
C. Neuro-retinal rim loss
D. Disc hemorrhages
E. All of the above |
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Definition
E. All of the above.
Cupping is best appreciated with binocularity. Neuroretinal rim loss/thinning can be seen with nasalization of vessels. |
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Term
Risk factors for the development of diabetic retinopathy include:
a. Duration of diagnosis
b. Glycemic control
c. Age
d. Sex
e. All of the above
f. A and B only |
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Definition
| F - duration of diabetes diagnosis and glycemic control are risk factors for diabetic retinopathy (one of the leading causes of blindness in America!) |
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Term
Characteristic findings in diabetic retinopathy include:
A. Elevated intraocular pressure
B. Cotton wool spots and venous beading
C. Neuroretinal rim loss and hard exudates
D. All of the above |
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Definition
B - cotton wool spots and venous beading are indicative of diabetic retinopathy.
A - Elevated IOP is seen in glaucoma
C - Hard exudates are seen in diabetic retinopathy, but neuroretinal rim loss is characteristic of glaucoma |
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Term
| True or False: The macula has the highest density of photoreceptors, especially cones. |
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Definition
True. The macula (which includes the fovea, site of greatest visual acuity) is where good vision comes from! It is located in the center of the fundus.
See slide 27 of ophthalmology lecture |
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Term
Findings related to wet age-related macular degeneration would be:
a. choroidal neovascularization
b. drusen
c. pigment mottling and clumping
d. all of the above |
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Definition
| A - choroidal neovascularization. B and C are characteristic of dry ARMD. Wet ARMD also has subretinal swelling and hemorrhage, exudates, and fibrosis. Both wet and dry ARMD show atrophy of the retinal pigment epithelium. |
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Term
| True or false: papilledema is typically unilateral. |
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Definition
| False. Papilledema is the result of elevated intracranial pressure, and is thus almost always bilateral. It can be due to a tumor, hyrocephalus, infection, inflammation, thrombosis, etc. |
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Term
A patient comes in with a headache. Fundoscopy is perfomed, and the physician finds blurred optic disc margins, venous engorgement and loss of spontaneous venous pulsations. The most likely diagnosis is:
A. Glaucoma
B. ARMD
C. Carotid plaques
D. Papilledema |
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Definition
| D - these findings are characteristic of papilledema. Others may include elevated optic disc and heme on/around the disc. |
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Term
| True or False: A "cherry red spot" will be seen with retinal vein occlusion. |
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Definition
| False - see this is with retinal ARTERY occlusion. RAO has a poor prognosis without immediate intervention to break up the clot and prevent ischemia. |
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Term
Which of the following is true of Hollenhorst plaques:
A. By definition, they must be associated with arterial occlusion.
B. They are often associated with amaurosis fugax.
C. They can be associated with cardiac thrombi.
D. The color of the plaque has no diagnostic significance. |
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Definition
C is true - though typically associated with carotid plaques, they may be caused by cardiac thrombi.
A - they are not necessarily associated with arterial occlusion
B - They are more likely to be asymptomatic than associated with amaurosis fugax
D - the color of the plaque can help differentiate plaque origin (white = heart, yellow = carotid) |
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Term
| True or false: Retinal detachment usually cannot be seen with direct ophthalmoscopy. |
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Definition
| True! Unless the damage is severe enough to cause drastic visual loss, direct ophthalmoscopy usually can't detect it. |
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