Livro Erro medico e responsabilidade civil

SIMULATORS, ANATOMICAL MODELS AND CHARTS FOR CLINICAL SKILLS AND TRAINING

AR303/AR303-B

Eye Renopathy Trainer

Instrucon Manual  & Eye Condions

Thank you for purchasing this AR303 Eye Renopathy Trainer. Please read this instrucon manual carefully and retain it for future reference.

Skills • Oers excellent ‘hands-on’ experience and pracce in the examinaon of eyes, and the use of an ophthalmoscope, with the emphasis on Diabec Renopathy • The model is now supplied with a completely new set of images idenfying condions and diseases of the rena. These are shown on a set of 28 interchangeable transparencies

Features • The slides for use in the Renopathy head can be placed in either the le or the right eye and are labelled accordingly

Safety and Precauons During use, the ophthalmoscope light must be switched o to avoid reecon on the slides. The head is open at the back for light to shine through from behind. Do not store the Eye Renopathy Trainer near heat or where it may experience extremes in temperature and humidity. Please treat the Trainer with the same care you would a paent.

Contents Parts and Conguraon

3

During Use

4

List of 28 Slides Showing Condions and Diseases of the Rena

6

2

Parts and Conguraon

b

a

Front

a

Le Eye / Le Eye Slide Holder

b

Right Eye / Right Eye Slide Holder

b

a

Rear

Supplied With SPAR303

Set of 28 Slides

Oponal Extra ARR00002 Ophthalmoscope

If you require any replacement parts or oponal extras please contact our Sales Department, quong codes where applicable.

3

During Use 1

a

b

a

2

4

b

Inserng Slides Ensure the work area is clean and dry. For opmal use, posion the Eye Renopathy Trainer where there is a good light source behind the head.

1

Each of the 28 slides supplied can be used in both the le or right eye and are labelled accordingly. With the Eye Trainer head and numbered condion on the slide facing you: Insert Le Eye slides (Grey Side) into the

a

Le Eye Slide Holder.

Insert Right Eye slides (White Side) into the b Right Eye Slide Holder. When handling the slides, be sure to avoid touching the lm.

Using Ophthalmoscope 2

An ophthalmoscope (not included) may be used to view each slide condion.

During use, the ophthalmoscope light must be switched o to avoid reecon on the slides. The head is open at the back for light to shine through from behind.

5

Slides Showing Condions & Diseases of the Rena Slide 1 The view is of the opc disc and temporal rena The main clinical features are: • Blot haemorrhages in the nasal macular area and superior temporal arcade • Hard exudates along the inferior temporal arcade • Micro-aneurysms at the macula area • Circinate exudates along the inferior temporal arcade The diagnosis is consistent with: BACKGROUND DIABETIC RETINOPATHY AND DIABETIC MACULOPATHY Comment: The macular area, as dened by a circle area centred on the fovea with its radius extending to the edge of the opc disc, has exudates in it. This makes the condion maculopathy. If the visual acuity was normal and there were Micro-aneurysms and haemorrhage only, then this would be Background Diabec Renopathy alone.

Slide 2 The view is of the opc disc and temporal rena (alignment marker is shown) The main clinical features are: • Mulple dot and blot haemorrhages • Coon wool spots (CWS) • Intra-renal micro-vascular abnormalies (IRMA) The diagnosis is consistent with: PRE PROLIFERATIVE DIABETIC RETINOPATHY Comment: Pre-proliferave Diabec Renopathy is characterised by renal ischaemia. CWS represent areas of focal renal ischaemia and IRMA are a pathological aempt at micro-revascularisaon. IRMAs are at and do not grow into the vitreous.

Slide 3 The view is of the central fundus with the opc disc The main clinical features are: • New vessels on the disc • Haemorrhages • Exudates • Pre-renal brosis The diagnosis is consistent with: ADVANCED PROLIFERATIVE RETINOPATHY Comment: On-going ischaemia and increase in vaso-proliferave factors. The new vessels grow into the vitreous and are fragile leading to haemorrhage. As the haemorrhage organises, brous ssue reacon occurs oen resulng in renal tracon and detachment. 6

Slide 4 This view is of the opc disc and temporal rena The main clinical features are: • Mulple hard exudates in the macular area, some are circinate • Haemorrhages and Micro-aneurysms The diagnosis is consistent with: DIABETIC MACULOPATHY Comment: The visual acuity may be reduced depending on the locaon and macular oedema. Circinate hard exudates oen have Micro-aneurysms at their centre. The darker renal appearance is normal in an Asian or Afro-Caribbean paent.

Slide 5 This view is of the opc disc and temporal rena (alignment marker is shown) The main clinical features are: • Mulple laser scars with areas of hyper pigmentaon • Regressed new vessels at the disc with residual gliosis The diagnosis is consistent with: PAN RETINAL LASER PHOTOCOAGULATION Comment: The overall appearance suggests good response to management and stable renopathy. The paent will have reduced peripheral vision and a degree of night-blindness (compare with renis pigmentosa).

Slide 6 This view is of the posterior pole centred on the opc disc The main clinical features are: • Disc area is obscured • Poorly dened vasculature The diagnosis is consistent with: UNGRADABLE RETINOPATHY Comment: The suspicion of brovascular proliferaon at the disc and along the vascular arcade with traconal detachment is very strong. This would be a feature of advanced diabec eye disease. Clearly, urgent referral is indicated.

7 

Slides Showing Condions & Diseases of the Rena

(Connued)

Slide 7 The view is of the opc disc and temporal rena The main clinical features are: • Opc disc with uniform central cup with cup disc rao 5mm, it is worth monitoring for a period. If there is a change in size then further invesgaon is indicated.

11

Slides Showing Condions & Diseases of the Rena

(Connued)

Slide 19 This view is of the opc disc and temporal rena The main clinical features are: • Dense white areas along vessels with vasculis along temporal arcade The diagnosis is consistent with: CYTOMEGALOVIRUS RETINITIS Comment: The spread of vasculis can be relentless from periphery to the disc along renal vessels. Haemorrhages may be present in fulminang cases.

Slide 20 This view is of the opc disc and temporal rena The main clinical features are: • Papilloedema • Totuosity and dilataon of all branches of the central renal vein • Renal haemorrhages: ame shaped, dot and blot in all quadrants • Coon wool spots (CWS) The diagnosis is consistent with: CENTRAL RETINAL VEIN OCCLUSION (CRVO) Comment: The presence of CWS would suggest signicant ischaemic element carrying poor prognosis. Space-occupying lesions in the cerebrum and hyperviscosity have to be excluded. Hypertension alone can cause CRVO.

Slide 21 This view is of the temporal rena and temporal opc disc The main clinical features are: • Aenuaon of arteries and veins • The pale temporal edge of the opc disc is shown • Central ‘cherry red spot’ with surrounding pale rena The diagnosis is consistent with: CENTRAL RETINAL ARTERY OCCLUSION (CRAO) Comment: Poor prognosis due to renal infarcon. Renal cloudiness of pale rena would disappear aer a few weeks. Aenuated vessels would remain and consecuve opc atrophy would be evident. The cherry-red spot is seen because the macular arterial supply from the choroid can remain intact. Oen there is a band of neural ssue that is not rendered ischaemia by the CRAO, this is seen if there is an adequate cilio-renal artery supply.

12

Slide 22 This view is of the opc disc and surrounding rena The main clinical features are: • Yellow orange refracle bodies at an arterial bifurcaon (12 o’clock on the opc disc) The diagnosis is consistent with: RETINAL ARTERY CHOLESTEROL EMBOLI (HOLLENHORST PLAQUE) Comment: Frequently asymptomac as it rarely causes signicant obstrucon of the arteriole unlike calcic emboli. Fibrinoplatelet emboli cause transient renal ischaemic aacks (amaurosis fugax) which may occasionally be complete.

Slide 23 This view is of the mid peripheral rena The main clinical features are: • Mulple bony spicule renal pigmentaon scaered in the periphery of the rena The diagnosis is consistent with: RETINITIS PIGMENTOSA Comment: The associated history of night blindness and family history is oen posive. The opc disc may show waxy pallor with aenuaon of vessels.

Slide 24 This view is of the opc disc and surrounding rena The main clinical features are: • Linear reddish-brown lesions with irregular edges beneath the normal renal vessels. This represents breaks in Bruch’s membrane and visualisaon of the choroidal circulaon • Peripheral focal chorio renal scars may be present The diagnosis is consistent with: ANGIOID STREAKS Comment: Bruch’s membrane is mainly elasn. The condion is associated with connecve ssue disorders. This includes: pseudoxanthoma elascum, Ehlers-Danlos syndrome, Marfan’s syndrome, rarely Paget’s disease, acromegaly and certain haemoglobinopathies.

13

Slides Showing Condions & Diseases of the Rena

(Connued)

Slide 25 This view is of the peripheral rena The main clinical features are: • Elevated dome shaped grey mass The diagnosis is consistent with: MALIGNANT MELANOMA Comment: A secondary renal detachment may be present. Urgent referral indicated.

Slide 26 This view is of the opc disc and surrounding rena The main clinical features are: • Flat pigmented lesion involving inferior aspect of the opc disc The diagnosis is consistent with: BENIGN DISC NAEVUS Comment: Oen dicult to disnguish from malignancy. If in doubt seek a specialist opinion.

Slide 27 This view is of the opc disc and temporal rena The main clinical features are: • Large macular haemorrhage in the pre renal area The diagnosis is consistent with: MACULAR HAEMORRHAGE Comment: Sudden severe intrathoracic or abdominal pressure can lead to this feature. Macular degeneraon and Diabec Renopathy can be considered in presence of addional features. A pre-renal haemorrhage with a uid level can be seen in some paents with subarachnoid haemorrhage. Small areas of haemorrhage adjacent to blood vessels are seen in bacterial endocardis (Roth’s spots).

Slide 28 This view is of the opc disc and temporal rena The main clinical features are: • Pale yellow appearance of vessels in a creamy renal background The diagnosis is consistent with: LIPAEMIA RETINALIS Comment: This is associated with hypertriglyceridaemia and hypercholesterolaemia. This is occasionally encountered in lipid disorders, poorly controlled diabetes and alcoholism. 14

The images of the eye condions supplied are the copyright of Adam,Rouilly Limited. They are for sole use with the AR303 Eye Renopathy Trainer. These images may not be copied, sold, displayed or reproduced in any format without the prior consent of Adam,Rouilly Limited.

15

Adam,Rouilly has over 90 year’s experience in providing quality medical models and simulators. Should you require any further informaon please contact our Sales Department who will be pleased to help with your enquiry. Adam,Rouilly Limited Castle Road Eurolink Business Park Singbourne Kent United Kingdom ME10 3AG

T: +44(0)1795 471378 F: +44(0)1795 479787 E: [email protected] www.adam-rouilly.co.uk

©Copyright 2011

NM1 S0015 MN1