fundoscopy

[chand7]

Hello everyone,
I will be joining as pgy1 in Int Med .As a MED STUDENT I did fundoscopic Exams ,I never could make out anything,But of course when the residents explained the findings,(kinda),i could understand them(sort of),I still dont know if I can make out Any diabetic,hypertensive changes on my own.Dont know if I can make out s/o increased ICT!!!.I have been out of clinical medicine for around a year.(will be joining this year),so right now it is difficult for me to go to hospital and ask for volunteer to let me examine their fundus 😳 .I AM REALLY NERVOUS ,Is this really basic to know this,is this such a basic thing that I have to be embaressed to have asked that q here.I am genuinely confused and am not asking this q to waste anybodys time or make fun of anybody(It is just that, July 1 is fast approaching and I am seriously beginning to doubt my skills and knowledge !!.and these doubts just pop up in my mind when I am watching tv,going for a walk etc.Oh!!How I hate that feeling.)
Any input is appreciated ,Thanx in advance 🙂

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[glorytaker]

Don't stress over this. I hardly saw any doctors use the opthalmascope. The only time I actually used one was when I did a 2 week optho rotation. I never used it in the ER or Family practice rotations. Heck, some offices don't even have them. But one word of advice, DO NOT buy a panoptic. It's very impractical to carry one around, even if someone tells you you'll get a better view.

 

[APACHE3]

Unless you dilate the eyes, you are never going to get a good view for a fundoscopic exam. I'm sure the patient will be relieved you will not hold a light to his eye for 10 minutes trying to find your landmarlks!! I'm sure I'll give it a go every now and then if the patient history makes me suspicious, but I wont bother with it. If thats your only worry, you're in good shape.

 

[Mumpu]

Same as everything else, it's practice. If a fundoscope is available (e.g. ER rooms) I do an exam as part of my routine admission physical. I think it's ******ed that many wards don't have fundo/otoscopes. True, you cannot see much with an undilated pupil but you can see the optic disk and many diabetic and hypertensive changes can be seen in that conglomeration of vessels.

 

[ASDIC]

I am an entering med student and they require us to buy the opthalamascope....i guess I will be saving some money over here

 

[Mumpu]

They made us buy them too. Whatever, $350 is no biggie. Don't buy the Ophthalmopanopticon or whatever that giant tube is called -- you need to learn fundoscopy with a conventional device since that's what's available in ERs and offices.

Also you'll be $300 richer. And yes, the sellers prey on the unfounded fear of fundoscopy and advertise the Tube to let you see more. In reality, you will either take a glance at the fundus or call optho consult, there's no gray area.

 

[dukeblue01]

Medical Trivia:

Funduscopy is scoping out the fundus. It is commonly mispelled even on the internet. 😀

 

[Mumpu]

Which fundus are we talking about? They are sort of diametrically opposed. 😛

 

[vtrain]

This is a tough procedure to do but will give you good diagnostic info if you can get it right. The bottom line, is that it just takes practice! The younger the patient, the easier it is to do it on, therefore, try to get the pupil as wide a possible - ie turn off the lights if it's reasonable to do so. Also welch-allen's are more difficult to get a view. If you can get your hands on a keeler oscope, go with that one. The panoptic is just OK. It easy to get a view and good for a quick screen, but the view lacks detail which can cause you to miss some very potentially important findings. Other helpful hints are to turn the the light (you don't need it a max to get a view - usually 50% is good enough) and make sure the light is on the smallest apperature - this improves the view by reducing glare. Good luck.

 

[Mumpu]

Yup, Vtrain just gave away the biggest secret. Turn down the brightness from "nuclear flash" to normal. I use about 30-40% -- play around with your friends/relatives/S.O. to see how much light you need to see. Lower light also helps to reduce the glare.

And practice practice practice. Make it a part of your routine physical exam, a quick look takes about 30 seconds total.