Medicine Part II

NAC OSCE
2022

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Topic #7. ABDOMINAL PAIN (ACUTE)

John White, a 45-year-old male, complains of abdominal pain for the past 24 hours. In the next 8
minutes take history. After the 8-minute warning buzzer, the examiner will ask you some questions
related to patient.

Pre-door Prep Name, age, gender duration, possible DD

Intro
Analysis of OsCfD: When / setting: what were you doing? Gradual, colicky, continuous, dull??
CC How?
PQRST: Position: where did it start? Can you point with one finger on it?
— Quality: how does this pain feel like? Sharp, tightness
— Radiation: does it travel anywhere? Umbilicus?
What ↑ or ↓: Eating/Antacids/Defecation/Meds....?

AS Nausea / vomiting

Which started first pain or N/V? Does it relieve the pain? For
vomiting if yes, analyze COCCA +/- B
Screen for Dehydration (Dizziness, Lightheadedness ...)

Bowl Movement
Any blood? Still passing gas?
Did you notice swelling in your ankles? Legs? Calf muscles?

Risk Factors for Intestinal Obstructions

— Previous surgery? Type? When?
— Hx of any gall stones?
— Hx of IBD (Crohn’s, UC) Family Hx? Hx of Hernia?
Constitutional Fever / night sweats / chills
symptoms How about your appetite? Any weight changes?
Any lumps or bumps in your body?
DDx Gastroenteritis:
What did you eat yesterday? Any new place? Diarrhea? Blood in the Stool?
Anyone else who ate with you suffered the same symptoms?

Renal: flank pain? Burning sensation? Going more frequently to the washroom?
Liver: Yellowish discoloration? Itching? dark urine? Pale stool?

ROS
PMH
FH
SH

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Topic #8. DIARRHEA (ACUTE)

Analysis of OsCfD How many times? What about during night?

CC COCA — Yes organic
± B/Mucous — No irritable bowel syndrome (IBS) – day only
↑↓ — How does it affect your sleep?
Consistency: watery / loose / formed / bulky. Any floating fat droplets /
difficult to flush / undigested food
Did you notice blood? When did it start?
— Before you have your bowel move?
— Mixed (higher source of bleeding)?
— On the surface?

AS Pain OCD / PQRST

If pain improves after bowel movement IBS
Vomiting
Alteration with constipation

Impact Acute dehydration: thirsty / dizziness / light headedness / LOC / weak

Red flags Constitutional symptoms – for infection / cancer Flu like symptoms
Anybody around you have the same diarrhea?
Differential Other causes:
diagnosis — Hyperthyroidisms: heat intolerance
— Stress? What do you do for life? Any stress? Does the diarrhea ↑ with stress?
How about your mood?
— Infectious: travel / camping / with whom do you live? Any other person at home
with diarrhea?
— HIV – if risk factors
— Diet: Celiac disease / a lot of dairy products / lactose intolerance / lots of juice /
sugars
— Medications: antibiotics / stool softeners
Rheumatic diseases: red eyes / mouth ulcers / skin changes/ rash / nail changes / hx of
psoriasis / joint pain / swelling / back pain / stiffness (especially in morning) / discharge /
renal stones

PMH
FH
SH

Bloody diarrhea DD:

— GE (gastroenteritis)
— IBD (inflammatory bowel disease)
— Bleeding peptic ulcer

Investigations for clostridium difficile Treatment for clostridium difficile

CBC / differential / lytes and chemistry, stool culture
for parasites
Stool assay for clostridium toxin
Endoscopy
Blood grouping and cross matching
Stop the antibiotic
Metronidazole (500 mg tid x 7 days)
If metronidazole is not effective or severe case
vancomycin (125 mg qid x 14 d)

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Topic #9. DIARRHEA (CHRONIC)

The same as acute diarrhea, except the impact and red flags

Pre door prep

Introduction
CC
Analysis of CC OsCfD How many times? What about during night?
COCA — Yes organic
± B/Mucous — No irritable bowel syndrome (IBS) – day only
↑↓ — How does if affect your sleep?
Consistency: watery / loose / formed / bulky. Any floating fat
droplets / difficult to flush / undigested food
Did you notice blood? When did it start?
— Before you have your bowel move?
— Mixed (higher source of bleeding)?
— On the surface?

AS Pain OCD / PQRST

If pain improves after bowel movement: IBS Vomiting
Alteration with constipation
Impact Acute dehydration: thirsty / dizziness / light headedness / LOC / weak
Chronic weight loss
Red flags Constitutional symptoms – for infection / cancer
For cancer: Age / family hx of Ca colon / change in the calibre of stools / what kind
of diet
Differential Rheumatic diseases: red eyes / mouth ulcers / skin changes/ rash / nail changes /
diagnosis hx of psoriasis / joint pain / swelling / back pain / stiffness (especially in morning) /
discharge / renal stones
Other causes:
— Hyperthyroidisms: heat intolerance
— Stress? What do you do for life? Any stress? Does the diarrhea ↑ with
stress? How about your mood?
— Infectious: travel / camping / with whom do you live? Any other person at
home with diarrhea?
— HIV – if risk factors
— Diet: Celiac disease / a lot of dairy products / lactose intolerance / lots of
juice / sugars
PMH — Medications: antibiotics / stool softeners
FH
SH

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Diarrhea continued …

Cases

Abdominal Pain:
• 48 Male with abdominal pain x 24 hrs
• 74 Male with abdominal pain after meals x 4 weeks (ischemic)

Increased Liver Enzymes:

• 33 male presenting with ALT>>AST
• 58 male presenting with AST >ALT

Diarrhea:
• Chronic Diarrhea x 6 weeks
• Chronic Diarrhea x 6 weeks
• Acute Diarrhea x 3 days

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Topic #10. FATIGUE (TIRED)

Pre door prep

Intro
CC Tell me more about it?

Analysis OsCfD
 Did you measure it? How often? How? What is highest?
 And medications? Did it help?
 Any flu / illness / sickness
 Any diurnal variation? Any special pattern? Is it more every 3rd or 4th day? (malaria)

Impact Are you able to function?

Red flags Constitutional symptoms
Differential CNS: headache / neck pain / stiffness / nausea / vomiting / vision changes / bothered by
diagnosis light / weakness / numbness

Extensive review ENT:

of systems — Ears: pain / discharge
— Nose: runny nose / sinusitis (facial pain)
— Throat: sore throat / teeth pain / difficulty swallowing Cardiac: chest pain / heart racing
(pericarditis)
—
Lung (pneumonia, PE (DVT), TB, cancer): cough / blood / phlegm / wheezes / chest tightness
/ contact with TB pt

GI (except the liver3): abd pain / distension / change in bowel movements /

blood in stools

Urinary: burning / frequency / flank pain / blood in urine Do you have any discharge?
Ulcers? Blisters? Warts?

MSK: joint pain / swelling / ulcers in your body / mouth / skin rash / red eye Autoimmune:
fm hx / dx before with autoimmune dis

LIVER:
— Local: yellow / itching / dark urine / pale stools
— Dx before with liver dis? Screened? Vaccinated?
— Transition to risky behavior
PMH Cancer / Autoimmune disease
FH Cancer / Autoimmune disease
SH Does your partner have any fever? Discharge? Skin rash?

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Fatigue continued …

What investigations do you want to order?

Labs: CBC/D, Electrolytes, Ca2+, Mg2+, BUN, CR

TSH, T4, B12, Iron Studies (Fe, TIBC, Ferritin, Transferin) ALT, AST, ALP, Bilirubin, Total Protein, Albumin
CXR, Sleep Study, EKG,
Mammogram and Colonoscopy if needed

DDX
1. Psych: Depression, Stress, Anxiety
2. Infection: Hepatitis, Mono
3. Endocrinology: Diabetes, Hypothyroidism
4. Sleep: OSA
5. Anemia: ask about period, diet, drinking, meds
6. Malignancy

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Topic #11. PALPITATIONS (HEART RACING)

Jennine Oliver, a 38-year-old female, comes to see because she has been feeling her heart has been
racing for the past 3 weeks. In the next 8 minutes take history. After the 8-minute warning buzzer, the
examiner will ask you some questions related to patient.

Pre door prep

Inro
CC
Analysis of CC Clarification When do you say your heart is racing; what do you mean?
— Do you feel your heart is going fast?
— Or is skipping beats
— Can you tap it for me please? …

OSCfD Is it first time? Or you had it before? When and how were you diagnosed?
PQRST How about treatment?
↑↓ Is it related to activity? How many blocks were you able to walk? And
now?
How about at rest? And at night?
When was the last attack? And what is the duration of the longest attack?
Is it related to caffeine, chocolate, coke, any other type of food?
SAD (Cocaine, Heroin, Marijuana or any other stimulant)

Impact CVA (any weakness / numbness / difficulty finding words / visual problems)
Heart failure (SOB / limitation of activity / swelling in your legs / how many pillows do you
use??
Other cardiac symptoms:
— Chest pain? Nausea/vomiting? Sweating?
— Heart racing / dizziness / LOC? Do you feel tired?
Red flags Constitutional symptoms – for infection / cancer
Risk factors for ischemic heart diseases – IHD
DD Do you take medications on a regular basis? Any new
medication? Any hx of thyroid dx, any sweating / diarrhea?
- Any hx of heart disease / HTN (A Fib) / heart attack / CAD (ischemia) / did you feel your
heart bouncing (arrhythmias)? Any congenital or valvular disease / Chest pain /
tightness / dizziness / light headedness / LOC?
- Any chest / lung disease (wheezes, cough, chest tightness)
- Any kidney disease? Renal failure? Any bleeding? Anemia?

PMH DM / Kidney / Liver diseases

FH Family history of sudden death at a young age? (cardiomyopathy) HTN / heart attacks

SH SAD
Physical Vitals
examination Cardiac exam (looking for mid-diastolic, mitral stenosis, rumbling character)
Thyroid exam
Neurological exam: brief / gross motor and reflexes

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Palpitations continued…

Causes of Atrial Fibrillation Causes of Tachycardia

Hypertension / CHF Exercise
Hyperthyroidism Pregnancy
Medications (e.g. digoxin, some anti- arrhythmic Caffeine/ stimulants/ Anemia
meds – class I)
Electrolyte’s imbalance Hypovolemia
Too much alcohol (holiday heart) Fever
Cardiomyopathy Stress
Valvular heart diseases Smoking
Congenital heart diseases Hyperthyroidism
Myocarditis Pheochromocytoma
COPD / pneumonia
Cardiac surgery
Cocaine
Any condition that leads to tachycardia in a
susceptible person

Atrial fibrillation
Cardiac risk factors: Diabetes, Smoking , HTN, Dyslipidemia, FHx, Hx of A-fib, WPW, arrhythmia,
CAD, CHF, stroke, TIA, Syncope.
Psych Hx: Anxiety, Panic Disorders,
Depression Endocrine: Thyroid,
Diabetes/Hypoglycemia

Episodic pallor, episodic tremor, episodic headache, diaphoresis Pheochromocytoma

Labs: CBC/D, troponin, glucose, lytes, TSH, Bun, Cr, Ca, Mg

- For patients with suspicious cardiac disease, get EKG and echo
- Holter monitor for patients with paroxysmal palpitations, syncope/pre-syncope, suspected mild
ischemia. Urine metanephrines if you are suspecting pheochromocytoma.
- Electro-physiological studies are done if EKG or Holter monitor reveals serious arrhythmias

Treatment:

SVT: carotid sinus massage, Valsalva maneuver, Adenosine IV push, BB if recurrent

VT: Amiodarone, Lidocaine or Procainamide

A-fib:
a. <48 hours: do cardioversion, BB, or non DHPCCB if recurrent
b. > 48 hours anticoagulation for 3 weeks and then attempt cardioversion

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Topic #12. FALLS

76 years old male patient came to clinic because he fell few days ago. He was getting out of bed,
when he fell to the ground

Pre door prep

Intro
HPI: analysis of CC Was this the first time, or did it happen before? Was
it related to Emotions? Coughing? Urination?
Associated During Did you lose conscious? Did you hit your head?
Symptoms Were you alone or with someone? Did your wife describe it to you? Is she
with you? If it is ok with you, after we finish, I would like to speak with her
to get some info.
Were you shaking? Certain part of your body or whole? Were you
For any breathing? Did you turn blue?
Fall, LOC Did you bite your tongue? Roll your eyes? Wet yourself?
or seizure Before Were you able to take few steps or did you fall immediately (orthostatic
hypotension)?

Before you lose consciousness, did you feel:

— Dizzy, lightheaded, nausea, vomiting, any chest pain, heart
racing (cardiac)
— Things are spinning around you (vertigo)
— Weakness, numbness, vision changes (stroke)
— Any flashing light, strange smells (epilepsy)
— Sweaty, shaky, hungry (hypoglycemia)

After How long did it last?

How did you regain consciousness? By yourself or did you need
intervention?
After you regain consciousness; were you able to recognize the
surroundings? Able to talk? Able to move?
Did you feel any weakness, numbness?
Impact Did you hurt yourself? How do you feel now?
Red flags Constitutional symptoms
Risk factor for IHD
Any geriatric Balance
patient; ASK about: Vision
Hearing
Urination
DD Diseases: arrhythmia / CAD, CVA, seizure, hypoglycemia
(already analyzed – before the event)
Environment: is your room well lit? Any chance you tripped? Do
you take any medications? Do you have a list?
— Go through it one by one
— Which one was added / changed recently?
— Each medication: ask about the disease, when started?
— Any OTC? Aspirin? Who prescribed it to you?
Are you getting enough fluids

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Falls continued …

Meds: Any medication for the heart, anti-epileptic, nitrates, supplements, herbals?
PMH: Any Hx of heart disease, HTN, valvular disease, arrhythmias?
FH: Any history of heart disease, Neurologic: Strokes, seizures?
SH: OCCUPATION (School bus drivers, pilot, etc....)

Physical Exam:
VS, O2 saturation, BP sitting and lying down to check for orthostatic hypotension, radial pulse, Glucometer reading
Inspection (look for pallor, cyanosis, edema)
JVP
Heart Exam (complete +Carotid)
Brief Neurologic Exam (CN, DTR, Sensory; Motor)

Labs:
CBC-D, Lytes including Mg2+, Ca2+, Bun, Cr EKG/Echo, continuous EKG / Outpatient Holter monitor EEG
Exercise stress test (R/O exercise induced arrhythmia's)

Radiology:
CT if focal neurological deficits

Dizzy:
ask what do you mean by dizzy?

a. Lightheaded: Syncope (Vaso-vagal, orthostatic hypotension, arrhythmias, etc.)

b. Things spinning Vertigo Is it associated with moving the head?

Yes (Benign paroxysmal positional vertigo (BPPV)

No then ask about hearing loss?

a. Yes: 1. Acoustic Neuroma OR 2. Meniere’s disease
b. No: Vestibular Neuronitis

Seizures:
Bit tongue, post-ictal confusion, loss of urine control

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Topic #13. LOWER EXTREMITIES SWELLING

A. Bilateral Ankle Swelling

Pre door prep

Introduction
CC uni- vs. bi- lateral
Analysis of CC OsCfD What ↑? Walking / standing what ↓ Raising legs?
↑↓ How high does it go?
AS Local symptoms:
— Pain / fullness / heaviness / tightness
— Skin changes (redness / swelling / do you feel your feet warm?)
— Nail changes
Other swellings in your body:
— How about swelling in your face? Eye puffiness? Do you find it
difficult to open your eyes in the morning?
— How about your belly? Did you need to ↑ the size of your belt?
— Hands, did you feel it is tight to wear your ring?
Impact How does this affect your life?
Red flags Constitutional symptoms – for infection / cancer
Differential Differential diagnosis of BILATERAL ankle swelling:
diagnosis • Failure Heart
• Failure Liver
• Failure Kidney: history of kidney disease (changes in urine / bruising /
frequency / burning / frothy urine / clear or no)

Specific cause within this system (e.g. kidney) Hx

or Dx of DM
Any medications (penicellamine, gold, NSAIDs, …)
Recent sore throat
Any skin infection / rash
Hx of autoimmune disease
How about diet? Is it balanced? Any diarrhea?
PMH
FH
SH

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B. Unilateral Ankle Swelling

Introduction
CC uni- vs. bi- lateral
Analysis of CC OsCfD What ↑ / ↓?
↑↓ How high does it go?
If pain PQRST
AS Local symptoms:
— Pain / fullness / heaviness / tightness
— Skin changes (redness / swelling / do you feel your feet warm?)
— Nail changes
Other joints? Toes? Other ankle?
Impact How does this affect your life?
Red flags Constitutional symptoms – for infection / cancer
Differential Differential diagnosis of UNILATERAL ankle swelling:
diagnosis Any trauma, any twist in your ankle?
Gout; previous attacks,
screen kidney for kidney stones
Infection, sepsis, cellulitis; fever, pus, discharge, tenderness
Gonorrhea septic arthritis; Sexual history, penile discharge? Unprotected sex
recently?
Specific
DVT cause within this system (e.g. gout)
Tell me more about your diet? Too much protein?
How about alcohol?
Medications? Pain meds (aspirin) / diuretics (furosemide, thiazides)?
Hx of cancer / chemotherapy (cytotoxic drugs) / radiation?
Family hx of gout / kidney stones?
PMH
FH
SH

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Topic # 14. PERIPHERAL VASCULAR DISEASE

58 year old male presents to the ER with Calf pain / swelling

Introduction
Analysis OsCfD PQRST
of CC P: unilateral or bilateral
R: what about other joints, knees? Thighs? Feet?
What ↑ or ↓: did you notice that your pain ↑ while walking up or down hill?
↑ while walking uphill: peripheral arterial disease
↑ while walking downhill: spinal stenosis

Is it first time? Or you had it before? When and how were you diagnosed?
How about treatment?
Is it related to activity? How many blocks were you able to walk? And now?
How about at rest? And at night?
When was the last attack? And what is the duration of the longest attack?

Impact History of strokes / TIAs / neurological symptoms Chest pain / SOB / heart racing

Pain after eating (intestinal ischemia) Effect of pain on daily activities / work?

Leriche syndrome (aorto-iliac occlusive disease): numbness in buttocks & thighs / absent or
decreased femoral pulses / impotence

Red flags Constitutional symptoms – for infection / cancer

Risk factors for ischemic heart diseases – IHD
Smoking? How much and for how long?
High blood pressure? For how long? Controlled or not?
Diabetes mellitus
Cholesterol measured? When? What was it?

DD Peripheral Arterial Disease versus Spinal Canal Stenosis

Vascular symptoms Neuro symptoms
Cold feet / ulcers Swelling / redness Delayed wound Weakness / numbness / tingling Back trauma /
healing Nail changes / hair loss back pain
Sexual dysfunction / difficulty with erection

PMH Past history of heart disease / stroke / symptoms of stroke / DM / Kidney / Liver diseases
FH Family history of heart disease / HTN / heart attacks
SH SAD

What are the 6 Ps of ischemia?

Pallor / Pain / Parathesia / Paralysis / Pulseless / Polar (cold)

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Peripheral Vascular Disease continued …

Investigations:
CBC/D, Lytes, fasting lipid, glucose, Bun, Cr, (very important because of the contrast) ABI (if ABI <0.9)
then it is abnormal

CTA or MRA is good for large vessels (aortic, iliac, femoral, popliteal) Arteriography Duplex US

Management:
• Risk factor modification (smoking cessation, tx of HTN, Dyslipidemia, DM)
• Exercise program: Improves collateral circulation & oxygen extraction at the muscle
• Foot care especially in DM
• Pharmacotherapy: antiplatelet agents (Aspirin or clopidogrel)
• Surgical options: Stenting, angioplasty, endarterectomy, bypass grafts
• Refer to neurovascular surgeon

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Topic # 15. ANURIA

Pre door Prep

Introduction
Analysis of CC OsCfD PQRST
What ↑ or ↓
Is it first time? Or did it happen before? When and how were you diagnosed? How
about treatment?
Associated Obstructive symptoms
symptoms: Irritative symptoms
Urine analysis (changes): COCA ± Blood
Local symptoms:
Any problems with passing stools? What? When? Any masses in the groin /
pelvic mass / pain?
Abdominal pain? Distension?
Metastasis Back: pain / weakness / numbness Liver: yellow / itchy /
urine / stools Lungs: cough / phlegm / hemoptysis Brain:
headache / nausea / vomiting
Renal failure Generalized swelling / face puffiness / itching
Sexual Sexual dysfunction
Red flags Constitutional symptoms – for infection / cancer

Risk factors for cancer prostate / bladder

Were you ever diagnosed with prostate disease? Screened for prostate
diseases? (DRE or PSA)
Family history of prostate disease / cancer?
Ca bladder (radiation / exposed to chemicals / aniline dye)
Smoking? Alcohol?
DD 1. Renal stones: Have you ever had a renal stone? Any history of colicky pain in
flanks? Have you ever passed a small crystals or stone during voiding? Hx or
repeated UTIs?

2. Medications: glaucoma / anti-psychotic meds / anti- cholinergic drugs; like

those used for incontinence, e.g. Ditropan (Oxybutynin), Detrol (Tolterodine)

3. Neuro: Back problem: trauma – metastasis – cauda equine (spoiled himself

with stools / buttocks numbness), Stroke (diagnosed / weakness / numbness
/ difficulty)

4. Cancer: prostate, bladder (hematuria)

PMH
FH Diabetes, Cancer, etc.
SH SAD

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Anuria continued …

When analyzing the urinary symptoms, check if:

Obstructive:
• Difficulty to initiate urine? Do you need to strain? Any changes in the stream?
• Any dripping?
• After you pass urine, do you feel that you emptied your bladder completely or do you need
to go again?

Irritative:
• How many times do you go to the washroom? How about before? Any change?
• How about during nighttime? How does this affect your sleep? How about your
concentration and mood?
• Do you need to rush to washroom? Are you able to make it all the time? Have you ever lost
control or wet yourself?
• Any burning sensation? Any flank pain?
• Fever / night sweats / other constitutional symptoms

Labs:
• U/A with C&S, voiding diary, post-void residual test, voiding cystourethrograms, Ultra cystoscopy,
US ...

• CBC/D, Lytes, fasting blood glucose, HBA1c, PSA if needed

DDx:
• BPH
• Prostate Cancer
• Bladder Cancer
• UTI
• Renal Failure

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Topic # 16. INCONTINENCE

64 years old female presents with history of urinary incontinence for the year and a half

Pre door prep

Introduction Empathy – how do you feel right now?
Analysis of CC OsCfD
What ↑ or ↓: lifting objects / coughing / straining
Is it first time? Or did it happen before? When and how were you
diagnosed? How about treatment?
Associated symptoms: Obstructive symptoms Irritative symptoms
Urine analysis (changes): COCA ± Blood

Local symptoms:
Any problems with passing stools? What? When? Any masses in the groin /
pelvic mass / pain?
Any perineal skin lesions?
Impact How does it affect your life? Daily activities?
Red flags Constitutional symptoms – for infection / cancer
Risk factors (MGOS):
Menopausal symptoms, and HRT
M
LMP
Gynecological history
G
Previous abdominal or pelvic surgeries
O Obstetric: How many pregnancies? Route of delivery?
S Sexual: Repeated infections / dryness / dyspareunia
DD 1. Urge Incontinence
2. Stress Incontinence
3. Overflow Incontinence
4. UTI
5. Others: Delirium/ Dementia, Infections, stroke

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Topic 17. VISION LOSS

HPI: George White, 65 y.o male presents to the ER with sudden loss of vision in his right eye that
occurred 30 minutes ago. 5 hours ago he experienced similar but transient loss of vision in the same eye
which lasted for 5 minutes.

PMH: HTN, Diabetes Hypercholesterolemia, PVD. MI 6 years ago, Meds: Glyburide, captopril, atenolol,
simvastatin, aspirin

Physical Exam:
BP 146/88, RR: 16 Pulse, 88 Temp 36.7
Fundoscopy shows retinal whitening (pallor of the optic disc, cherry red fovea, and boxer segmentation
of blood in the retinal veins)
Right carotid bruits

DDx:

1. Central Retinal Artery Occlusion

 Transient painless visual loss (mainly monocular but can be both)
 Atherosclerotic emboli from the carotid arteries and cause temporary vision loss as opposed to
the persistent vision loss seen in central retinal vein occlusion (CRVO).
 You will see swelling of the optic desk but NO hemorrhage. If you see hemorrhage, think of CRVO.
 Usually described as black curtain coming down vertically into the field of vision in one eye or
both "Amaurosis fugax".
 Delay in treatment can result in permeant vision loss. Tx --> ocular massage and high flow oxygen.

2. Central Retinal Vein Occlusion (CRVO):

 Presents with acute or subacute persistent painless monocular visual loss.
 Fundoscopic exam shows a "blood and thunder" appearance consisting of optic disk swelling,
retinal hemorrhages, dilated veins and cotton wool spots.

3. Retinal Detachment
 Age 40 – 70
 Painless curtain over part of the field of vision. Mainly monocular but can be both.
 Flashing of flights, floaters (spots in the visual field)
 Usually inciting event occurred months before retinal detachment (i.e cataract surgery, trauma or
myopia…)
 Ophthalmoscopic exam show grey elevated retina
 Treatment - Laser therapy and cryotherapy

4. Angle-Closure Glaucoma
• Age 55-70
• Acute onset of severe pain
• Blurred vision
• Associated N/V
• Ophthalmoscopic exam show red eye, moderately dilated pupil that is not reactive to light

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