Return to Scenario ListShow Learning Points most relevant to Phase 1:

Annual eye screen for patient with diabetes

Clinical Discipline(s)/Organ System(s)
Endocrinology, General Practice, Ophthalmology
Progress Test Topic(s)
Eyes, Homeostasis
A NZ European man with diabetes of 15 years duration presents for an eye screen. He is blind in one eye following unsuccessful surgery for diabetic eye disease and now presents with pre-proliferative retinopathy in his remaining eye.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the blood supply to the eye, with particular focus on the retinal circulation
   - Effects of ischaemia and vaso-proliferative cytokines on tissue
   - Pathophysiology of pre-proliferative diabetic retinopathy; include consideration of retinal ischaemia, compounded by hypertension, renal impairment, poor diabetic control, smoking
Clinical and Communication Skills 
   - History from a patient with diabetes, that is relevant to maintaining vision; consider duration of diabetes, diabetic control,treatment adherence, blood pressure control, smoking, diet, weight
   - Measure and document distance and near vision, plus visual fields to confrontation
   - Direct ophthalmoscopy to clearly identify features of diabetic retinopathy
   - Document fundoscopy findings with a diagram; quantify the severity of the signs
   - Describe signs associated with pre-proliferative diabetic retinopathy (retinal haemorrhages, cotton wool spots, irregular vein and arteriole caliber)
   - Management of diabetic retinopathy; actions required to decrease the risk of blindness
Personal and Professional Skills 
   - Communicate with health care professionals involved in this patient's care: dietitian, physician, GP, diabetic educator, members of the diabetic retinopathy screening team
   - Understand the legal requirements for retaining a New Zealand driver's licence
Hauora Māori 
   - Understanding of inequities in eye related conditions and their outcomes for Māori compared with non Māori (e.g. higher rates of diabetes-related eye complications), and application of this to clinical decision making and management
Population Health 
   - Impact of low socio-economic status on attendance at follow-up clinics and adherence to therapeutic regimens
   - Community based programmes that can help diabetics to manage their disease
Conditions to be considered relating to this scenario
diabetic retinopathy, hypertensive retinopathy