After this course, you should seek to:

• List and describe key structures accessible via ophthalmoscopy and auscultation
• Outline the principal properties, relations and functional interactions of these structures
• Assess their status via case history, observation and appropriate use of equipment
• Demonstrate key psychomotor skills relevant to your examination of the above
• Apply yourself to a novel theoretical clinical situation (related to the use of ophthalmoscope and / or stethoscope), demonstrating a synthesis of knowledge and skills to test any hypotheses you generate
• Explicitly analyse your diagnostic process, reflecting on its strengths and weaknesses
• Evaluate the bearing of these processes on your subsequent physiotherapeutic care

NB the above may be the subject of formative or summative assessment, in line with prevailing MACP guidelines


References

Visit as many of the references shown below as possible prior to your course. These are drawn from a variety of texts and take a range of forms (pictorial, textual and tabular). Our intention is to provide you with an assortment of information sources that you can choose from - and that you can match to your own learning style.

Detail on practical procedure of ophthalmoscopy: Ref 1 pp 314-318

Examples of clinical manifestation of ‘red eye’: Ref 7 p 712

Examples of examination of fundi: Ref 4 pp 99-122, Ref 8 pp 61-70, Ref 1 p 162

Auscultation: practical procedure: Ref 4 pp 158-168, Ref 7 pp 1753-1763

Bring your own:

Ophthalmoscope and spare batteries
Stethoscope (preferably Littmann type)

Indications: Direct assessment of eye, structural integrity of vascular and neurological anatomy. Visual change: impairment and loss of varying degrees. Sub-clinical context: for example, to assess vascular integrity or that of the central nervous system after trauma.. Enquiry strongly driven by structures’ functional relationships. ‘Reciprocal holism’

OPHTHALMOSCOPY:

• Structures involved: Exterior, chambers of the eye, retina / fundus

• Red reflex: The ‘unwanted flash photo effect’

• Focus: Significance of myopia and hypermetropia

• Fundus: Four quadrants: Colour, degeneration, haemorrhage, exudate, obstruction

• Vessels: Course and bifurcations; obstruction and degeneration; tortuosity, kinking, nipping, atheroma, light reflex, aneurysm, haemorrhage, light reflex (‘silver / copper wiring’). How might various conditions influence the appearance of the optic fundus and disc?

• Disc: Definition and swelling, shape, size, colour, margin, crescents, lamina cribrosa, cup. Ratio between disc and cup (D:C ratio)

• Macula: Degeneration - loss of colour, vessels


AUSCULTATION:

• Structures involved: Cardio-pulmonary, vascular, gastro-intestinal, miscellaneous
hyper-vascular (e.g. thyroid, liver)

• Use of equipment: Bell and diaphragm – differential use and interpretation

• ‘Best practice’ in auscultation: clinical application to above structures and other situations – e.g. the ‘scratch test’ in internal medicine

© Crawford & Cook 2005