Eyes & ENT · History + examination

Severe eye pain with vomiting overnight - Emergency Department

HardYear 5 · Curtin style · 15 min + 2 min reading · 5 tasks

2 min reading · 15 min station · reminders at 2 min

Station - Instructions for candidate

You are an intern working in the Emergency Department of a tertiary hospital in Perth.

Li Hua Wong, a 66-year-old retired landscaper, has been brought in by her daughter at 6 am with severe pain in her left eye and a headache since last night, blurred vision and repeated vomiting. She is in a cubicle with a vomit bag, and the nurse has recorded her observations. A Snellen chart, pen torch, fluorescein and a Tono-Pen (handheld tonometer) are available, and the on-call ophthalmology registrar can be contacted by phone.

Your tasks are to:

  1. Take a focused history.
  2. Perform a focused examination.
  3. Request any relevant investigations and interpret the results provided.
  4. Summarise your findings to the examiner with your most likely diagnosis and differential diagnoses.
  5. Outline your immediate management plan to the examiner.
  • Please verbalise your examination to the examiner; findings will be provided on request.

This is a 15-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you would examine or request, the way you would in the station. Nothing is named until you ask for it.

Whatever the examiner recognises is revealed below. Or pick a numbered item to reveal it blind.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.

After treatment

Once you have acted, ask how the patient has responded.