The Doctor Is In
Overview
You use your senses every day to understand the world around you. Look. What do you see? Touch. What do you feel? Listen. What do you hear?
Doctors use their senses to determine their patients’ health. Often they rely on tools that help enhance their senses. The ophthalmoscope (Of-thal-mah-scope ) is an instrument with a special mirror that allows doctors to examine the interior of the eye. The otoscope (oh-toe-skope) is a flashlight with a magnifying lens that helps doctors to examine the inside of the ear. The stethoscope (steh-thuh-skope) enhances the sounds inside of the body so that the doctor can listen in.
Looking and Listening
Ophthalmoscope (of-thal-mah-scope)
- Pupil
The pupil (pyoo-pul) is the dark opening in the middle of your eye that lets light in. - Iris
The iris (eye-riss) is the colored ring around your pupil. Muscles expand or shrink the iris to control the amount of light entering the pupil. - Lens
The lens is a clear disk that focuses light on the back of the eye. - Retina
The retina (reh-tin-ah) is a thin wall in the back of your eye. It changes the images that appear on it into signals for the brain. - Optic nerve
The optic nerve sends signals from the retina to the brain, so that you can make “sense” of what you see.
Normal
Using the ophthalmoscope (of-thal-mah-scope), the doctor examines the thin,
back wall of the eye, or the retina. The thin red lines that you see in this
healthy retina are the blood vessels that provide the eye with nutrients
while taking away waste products. The light area on the left is where the
optic nerve connects to the retina.
Condition 1
See how many more blood vessels are in this eye than in the normal eye? This
patient has proliferative retinopathy (pro-liff-er-uh-tiv reh-ton-ah-pa-thee).
Her blood vessels are damaged and are releasing a chemical that makes unhealthy
new blood vessels grow. These new vessels leak blood very easily and can
harm the eye. Regular eye exams can identify this problem before the unhealthy
blood vessels start to leak.
Condition 2
See the orange areas? Fat and fluids have leaked out of weakened blood vessels.
This patient has diabetic macular edema (die-uh-beh-tick mack•you•lar
eh-dee-muh). The buildup of fluid in his eyes makes his vision blurry. Eye
surgery can help fix this condition.
Condition 3
See the red and yellow blotches? This retina has been infected with a virus
and appears swollen and irritated. The red areas are blood and the yellowish-white
areas are where fluid has pooled. This patient has cytomegalovirus (site-uh-meg-uh-low-vi-rus)
and her immune system is too damaged to fight it off. She needs immediate
treatment to save her vision.
Otoscope (oh-toe-skope)
- Ear canal
The ear canal is a passageway that funnels sounds to the middle ear inside of your head. - Eardrum
The eardrum is a thin membrane that caps the ear canal. It is stretched tight like a drum and vibrates when sound waves hit it. - Ossicles
The ossicles (ah-sih-kulz) are the three tiniest bones in your body. They work together to carry vibrations from the eardrum to the inner ear. - Eustachian tube
The eustachian (yoo-stay-shun) tube lets air from the nose into the middle ear. It balances air pressure within the middle ear. - Cochlea
The cochlea (co-klee-uh) is a coiled, liquid-filled tube lined with special cells that change sound vibrations into nerve signals for the brain.
Normal
Using the otoscope (oh-toe-skope) the doctor examines the eardrum. Healthy
eardrums are semi-transparent and the doctor can see the shapes of the ossicles
on the other side.
Condition 1
See the dark orangey yellow color towards the bottom of this left eardrum?
This patient has otitis media (oh-tite-uhs mee-dee-uh), an inflammation of
the inner ear. The color indicates that fluid is collecting in the inner
ear. The bright white material is plaque (plack) buildup from previous infections.
The middle of the eardrum is sucked in because of pressure within the inner
ear. This patient has a painful earache and needs antibiotics (an-tie-by-ah-tics)
to clear it up.
Condition 2
See how this right eardrum is sucked in to the point where you can really see
the structures behind it? This patient has an advanced case of otitis media
(oh-tite-uhs mee-dee-uh), or inflammation of the inner ear. The Eustachian
(yoo-stay-shun) tube, which opens to balance air pressure within the middle
ear, has been blocked because of infection. Liquid is building up in the
middle ear and can't drain out.
Condition 3
See how this left eardrum has a mark on the lower left side? It is actually
a tear. This patient received a blow to the head. Most eardrum tears, or
perforations, (perf-or-a-shuns) will heal on their own. Sometimes surgery
is required to repair a large perforation. This condition is not painful
if it doesn’t get infected, but it can limit hearing.
Stethoscope (steh-thuh-skope)
- Right atrium,Left atrium
The right atrium (ay-tree-um) receives blood that needs to go to the lungs while the left atrium receives blood ready to go out to the body. Together, these pumps are called the atria (ay-tree-uh). - Valves
When these valves open, blood is pumped from the two atria to the ventricles below. - Right ventricle,
Left ventricle
The right ventricle (ven-trick-ul) pumps oxygen-poor blood to the lungs. At the same time, the left ventricle pumps oxygen-rich blood out to the body. - Valves
These valves open to let the ventricles pump blood out to the lungs and body.
Normal
Using the stethoscope (steh-thuh-skope) the doctor listens to the heart. Hear
the soft sound followed by the loud sound? The soft sound is made when the
valves letting blood into the heart’s two atria (ay-tree-uh) close.
The loud sound is made when the valves controlling blood flow from the ventricles
(ven-trick-ulz) out to the body close. Doctors describe this healthy sound
as a “lub dub.”
Condition 1
Can you hear an extra sound after the “lub dub?” This patient has
dilated cardiomyopathy (dye-uh-late-ed card-ee-oh-my-op-ah-thee). Her heart
is not doing a good job pumping blood and is filling up with extra blood to
try to make up for it. The extra sounds come from the additional blood rushing
into the heart.
Condition 2
Can you hear the “vroom?” This patient has a hole in his heart.
Blood from the left side of the heart is flowing through the hole into the
right side of the heart. If the hole is really small, it might not cause too
much of a problem, and may even close up on its own.
Condition 3
Can you hear the “lub dub?” It’s hard to, because there is
so much other noise. This patient has aortic stenosis (ay-or-tic sten-oh-sis).
One of her heart valves has become damaged and is too narrow. The extra sounds
come from blood trying to flow through this narrowed valve.
Pick Up Your Tools
You use your senses every day to understand the world around you. Look. What do you see? Touch. What do you feel? Listen. What do you hear?
Tool 1
What is the right tool for the job?
Click on the part of the body that is examined with an ophthalmoscope (of-thal-mah-scope).
Tool 2
What is the right tool for the job?
Click on the part of the body that is examined with an otoscope (oh-toe-skope).
Tool 3
What is the right tool for the job?
Click on the part of the body that is examined with a stethoscope (steh-thuh-skope).
A Doctor Making a Difference
Dr. Virginia Apgar used her powers of observation to help newborn babies. In 1953 she developed a special scoring system that helps a doctor to decide whether a baby needs extra medical help. The doctors examine a baby one minute after birth. During the exam, they make five different observations and “score” the baby’s condition. They repeat the exam four minutes later. A high score means that the baby is healthy. A low score means that the baby will need medical help. This system is called the “Apgar score” and is used by doctors around the world.
Ten years after Dr. Apgar published her scoring system, another doctor came up with this chart to help medical students remember the five scoring categories.
A Appearance (skin color)
0 points: Blue-grey, pale all over. 1 point: Normal, except for extremities.
2 points: Normal over entire body.
P Pulse
0 points: Absent. 1 point: Below 100 beats per minute. 2 points: Above 100
beats per minute.
G Grimace (reflex irritability)
0 points: No response. 1 point: Grimace. 2 points: Sneeze, cough, pulls away.
A Activity (muscle tone)
0 points: Absent. 1 point: Arms and legs flexed. 2 points: Active movement.
R Respiration
0 points: Absent. 1 point: Slow, irregular. 2 points: Good, crying.
