OPHTHALMOLOGY

Quirino Memorial Medical Center

EDIT History:
1. Created - _____, 2017 - LEC 09
2. Edited - Oct 9-15, 2017 - LEC 10
3. Edited - Nov 6-19, 2018 - LEC 20

I. General Information
A background on the hospital

A. Directions (from ASMPH)

1. By car
a) C5
2. How to commute
a) Take a jeep/FX/bus to Galleria or Megamall (P8/P15/P12 respectively)→ Ride a bus
along EDSA with the signboard Cubao Ibabaw (P12 with aircon, P10 without aircon) →
Go down at Farmer’s Market →
(1) Walk to LRT 2 (P13/ride)
(a) Alight at ANONAS STATION → Go out through South Exit → Walk to
the trike terminal beside Hi-Top → Take a trike to Labor/QMMC (P17)
(b) Alight at KATIPUNAN STATION → Go out through North Exit (same
side as St. Bridget) → Look for FXs with P. Tuazon as part of their route
(P12) → Alight at the first stoplight (P. Tuazon corner J.P. Rizal) or when
the driver announces “Labor”
(2) Walk to Jeepney Terminal near Farmer’s Garden (which is across Farmer’s
Market)
(a) Take a Project 4 jeep (P8), you can choose to go down on
(i) Daily Supermarket (especially if traffic) → Take FX or trike to
Labor/QMMC (P10/P17 respectively)
(ii) Labor/QMMC (J.P.Rizal side)
3. Usual Peak Times of Traffic
a) Rush hours
B. Where to park
C. Where to eat
1. Realitea: ​Oh my god this place is lyf. ​They offer excellent yet affordable Chinese comfort food.
Dumplings, pork chops, wanton noodles, milk tea are my top picks. Plus, the place is
air-conditioned! Budget: PHP 90 (​busog​) - 150 (nirvana). When it’s full, the orders take a while,
but still worth it!
2. Everybuddies: Their pares is quite good, ​pero bitin and ang mahal. ​Budget:​ ​PHP 120-150
3. (The place that sells shakes): Mango graham! Avocado! They make typical Filipino ​carinderia
dishes. Budget: PHP 60-100
4. Banapple: Self-explanatory. Budget: PHP 200-300
5. Mario’s: It’s apparently the favorite of some of the residents. Good Italian place. Budget: PHP
300-500
6. Maximo: Try the carbonara!

II. General Rules

A. Uniform: Standard until after 5 PM-ish when removing our coats and changing into scrub tops ​may ​be
allowed.
B. Where to sleep: We sleep at the LRU. May available doon na foldable mattress that we can use. The
residents have their own quarters, so by 12 AM-ish (or earlier), they leave us at the LRU to sleep/study.
You can also sleep in the treatment room beside the LRU on the couches.
C. Bathroom: We have our own comfort room outside the ophtha examination room. We can also use the
CRs located at the nurse’s station at the 2nd and 4th floors.
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 D. There are 2 sets of keys: a) Keys to treatment room and CR; b) Keys to LRU
1. DON’T LOSE THEM!

III. What to do/Expectations

A. Pre-duty
1. Schedule: 7 AM (8 AM if no activity/endorsements) - 5 PM (ask before MGH)
2. Things to Bring (to stay alive):
a) PENLIGHT.
b) Jaeger chart and Pediatric near vision chart
c) Ophthalmoscope (two per group to not kink the waiting line)
d) No need for anything else (steth, BP, etc) - there was this one time we used our steth for a
3. Special Tasks during this Status: Mostly just OPD. OR only if from people have been decked, or
when the patient is in your charge.
a) Major OR: Done in the OR Suite.
b) Minor OR: Done in the Eye Center. Sometimes 2 are allowed to observe.
c) Make sure ALL ORs are decked, even minor ones.
4. How Do Departmental Endorsements go/happen? The residents will assign you patients, acting
as their clerks in charge (CICs). Make sure you know everything about your patient, each
procedure, test they undergo, etc. You attend their OR. You may very well get to know them and
their family. Then it’s best to prepare an endorsement script as soon as you can, complete with a
thorough history and a focused ophthalmologic PE. Such is essential as the senior residents may
require you to endorse your patient’s case any time of the day. Know the terms you plan on using.
Know your anatomy. Prepare well!
B. Duty
1. Schedule: 7 AM (8 AM if no activity/endorsements) to 7 AM the next day
2. Things to Bring (to stay alive): Bring your own sleeping bag, pillow (though may available din sa
LRU, pero isa lang), blanket (It gets really cold in the early morning, strong ang aircon!). Some
residents like to ask clerks for movies, since some of them like watching movies in the LRU during
downtime.
3. Medical Equipment to Bring: Penlight, Ophthalmoscope, Jaeger chart (they have it available sa
OPD, pero it helps if you have your own), Bandage scissors, Micropore/Transpore tapei
4. Special Tasks during this Status: OPD in the morning, ward rounds (only 10 beds for Ophtha),
then on call for any ER primary, ER referrals, Ward referrals at night, decked for ORs also if any
a) We are in charge of the Emergency Department Record Book for Ophtha

b)
c) Record as:

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(1) ER Primary: Keep the ER blotter form, record. These are patients na ER Ophtha

(2) ER Referrals: Referrals from other ER departments, also need to keep

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 (3) Ward Referrals: Referrals from other departments. Keep these in the ER logbook.
d) There are respective forms for each, and you’ll easily know which is which. Record sa
logbook accordingly. Fill out 3 copies of the ER census (long bond paper), daily census
summary, record only those under ER Primary.
(1) For the daily census summary, just leave “prepared by” blank

e) In the morning, bring the logbook, ER Blotters, ER Census 3x (Long) and ER Daily
Census Summary (Lengthwise) to the ER. Submit the census and blotters to the nurse
and have him or her sign the logbook. One of the long ER Census will go to you as a
receiving copy.

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 5. How Do Departmental Endorsements go/happen?
a) Take endorsements seriously. Know how to report properly and completely.
C. From
1. Schedule: 7 AM to 5 PM (8 AM if no activity/endorsements in the morning)
2. Things to Bring (to stay alive): Bring scrubs and OR shoes
3. Medical Equipment to Bring
4. Special Tasks during this Status: OPD mostly, but will decked to major ORs (unless yung patient
na ioOR is assigned to another clerk)
5. How Do Departmental Endorsements go/happen? Same as above. But again, prepare very, very
well. This is probably the only responsibility we have that can be considered toxic, so do prepare!

IV. Must Knows / Must See

A. Are there prescribed must knows, must dos for this rotation? If yes, what are these?
1. Vaughan & Asbury. Read up on anatomy. They usually ask the different layers/parts of the eye.
2. Kanski. Occasionally recommended for certain conditions. Good for overviews/differentials
B. What other cases do you think are deemed must-knows despite it not being prescribed?
1. Ophthalmologic Trauma! Including common differentials and sequelae.
2. Ophthalmologic Pharmacology! Review your antibiotics (i.e., penicillins, cephalosporins,
fluoroquinolones), sympathomimetics (i.e., alpha- and beta-agonists), anticholinergics (e.g.,
atropine). Know the MOA.

V. History Taking
A. What are the important history questions for this rotation?
1. Chief complaint: Record this in the words of the patient
2. Ocular history
3. Ocular Medications - note the frequency, number of drops, and which eye/s
B. Are there any often (most common) overlooked history taking questions?
1. Ocular history
2. Allergies
3. Ocular medications (frequency, number of drops, and eye/s)

VI. Physical Exam

A. What are the most important PE skills needed for this rotation?
1. VAGETF. Take the gross exam seriously; it has to be in proper order
a) Sample: symmetric eyebrows, no periorbital swelling, eyelids without lesions, no matting
on eyelashes, no discharge, non-hyperemic conjunctiva, white sclera, distinct limbus,
clear cornea, iris without discoloration or deformity, pupils 2-3mm EBRTL, no RAPD
2. Slit lamp examination of the periorbital area, ocular surface, and anterior chamber
B. Are there any important PE skills that are often overlooked?
1. Know when NOT to perform PE on the eye/s
a) Do not do tonometry on eye trauma cases
C. What tools are need to have/nice to have during this rotation?
1. Need: Penlight, Near vision charts
2. Nice: Ophthalmoscope (but the group needs to have at least one)

VII. Skills
A. What are the important/required skills needed for this rotation?
1. Taking a patient’s 12-lead ECG. Know how to use the equipment, that is, where the leads are
placed on the chest, extremities.
2. Blood extraction
3. IV insertion
4. Change of dressing/bandaging
5. Suturing, application of local anesthetic (for eyebrow laceration cases)

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VIII. Requirements (e.g. professional skills form, SGDs)
A. What are the expected outputs for this rotation? Please make a summary checklist of the requirements
1. SGD/Reporting with Dr. Cloma - Preventive Ophthalmology
a) He likes the slides to be pictures mainly. He’s really chill and mabilis lang pagrereporting,
then life lessons/open questions afterwards. Base your ppt on Vaughan and Asbury (17th
ed chapter 21; or Chapter 20.2 if you have 18th ed) and supplement with pictures from
the internet, though you may add additional research if you want/can.
(1) The residents recommend you only use text for the slide title. Other than that,
your slides should be pictures
b) Prefers Vaughan, but you may add info from Kanski
c) Presentation should be ≤ 20 mins.
2. SGD/Reporting with Dr. Fortuna - Ocular Trauma
a) Treat this like our SGDs with Dr. Alfonso during surgery. The reporters must know the
topic on trauma really well. No gadgets, sleeping, eating or drinking during this SGD.
Non-reporters must listen well to the reporters. Basta, we must act and look like
professionals during this specific SGD. He likes it when everyone participates, so make
the SGD slightly interactive. He also asks questions that anyone can answer.
b) Make sure to clean the conference table (remove papers and clutter), and arrange the
chairs and bags
c) Prefers Vaughan, but you may add info from Kanski
d) Keep it short. Presentation should be ≤ 30 mins
3. To clarify, there are 4 topics to report on. 2 in TMC and 2 in QMMC. If, for example, you already
reported in QMMC on your first week, you’re done with SGD for the rotation, meaning you won’t
need to do SGD in TMC next week. Here’s the breakdown w/ TMC.
a) Ocular Trauma - Dr Fortuna, QMMC (≤ 30 mins reporting)
(1) 1 clerk or 2 clerks (if you are a group of 7)
b) Preventive Ophthalmology - Dr Cloma, QMMC (≤ 20 mins reporting)
(1) 1 clerk
c) Red Eye - Dr Timothy Tan, TMC (~ 2 hours reporting)
(1) 2 clerks
d) Ocular manifestations of Systemic Diseases - Dr Timothy Tan, TMC (~ 2 hours reporting)
(1) 2 clerks
B. How many write-ups, conferences, case presentations, etc are expected of each clerk/clerkship group (i.e.
number of grading sheets accomplished by the residents?, number of inpatient progress notes/outpatient
notes? Any print-outs necessary during case presentations or grand rounds?, etc.)
1. Case presentation during AdCon = 1
2. Write-ups = 0
3. Progress notes = 0 (as far as we were told)
4. Print-outs = just your endorsement script as devices are not allowed during meetings, SGDs, etc.
C. How many grading sheets are needed for each clerk for each of the summaries by the end of the rotation?
1. 2 Professionalism forms
2. 2 Skills forms
3. Case log (check out page 72-74 of our booklet. Just the must-see cases. You only need the patient
number, age, and have it signed by a resident)

IX. Safety Concerns

A. Are there any safety threats in the hospital or nearby areas? ​Parang wala naman​, standard prec, I guess.
B. Are there any storage areas in the hospital for things?
1. We usually leave our things sa LRU, or pagdapat malinis yung LRU sa Ophtha exam room beside
the LRU
C. Have there been any case of theft in the hospitals rotated?

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 1. The residents just always advise us to store our things in the back end of the OPD, or at the LRU,
never anywhere else.
2. Basag bintana ng LRU. Ingat-ingat na lang sa gamit

X. Special Notes on Being a Clerk in the Rotation

A. Indicate any particular departmental event that happens which clerks must be or can be part of.
1. AdCon (scheduled)
a) There is a template in the references folder (2012 AdCon Template)
2. Endorsements (may be extemporaneous)
3. Department meetings (announced)
B. Be friendly with the QMMC PGIs ͱ
C. Bring MOVIES. Some residents like watching movies in the LRU during downtime
1. You may work on something else, but you have to stay in the LRU, so might as well watch if you
are easily distracted

XI. Residents to Take Note of

A. Indicate any notable resident and the characteristics which make them distinct
1. R1: Marlo Cancio
a) The resident clerk monitor. Doc is very nice and approachable, so the best thing we can
do is make him proud by preparing well for each requirement and by being worthy of
good feedback from other residents and consultants. He asks basic but essential questions
at the OPD.
b) For questions, kindly ask ​Sarah Baguio​.
2. R1: NJ Mamaclay
a) Also very, very nice. He gives us a lot of tips. He also teaches.
b) For questions, kindly ask ​Celine Felizardo​.
3. R2: Raph Guballa
a) Very nice. Asks and teaches during rounds. Doesnt mind if you look up the answer to the
question immediately.
b) For questions, kindly ask ​Jerson Taguibao
4. R2: Pat Chu
a) Quiet but very nice. Also asks practical questions, especially on anatomy. You can
approach him if you have any questions, especially on diagnostics.
5. R3: BJ Velecina
a) He asks a lot of questions which may seem difficult but are actually very practical and
must-knows.
6. R3: Nina Garcia
a) Make sure you refer systematically, especially for the PE
b) She’s a foodie! If you’re on duty with her, she’ll bring you to yummy places
c) For questions, kindly ask ​Rainier Villanueva​.
7. R4: Adriano
a) For questions, kindly ask ​Kamille Enriquez​.
b) He likes to teach us clerks. Very nice and approachable.
8. R4: Sobrio
a) The chief resident. She does not really engage us in any way though.
B. What are the expectations of these residents?
1. Anatomy
2. Pharmacology
3. Good history taking and PE
C. List residents who ask a lot of questions
1. DR. ADRIANO
2. Dr. Cancio
3. Dr. Velecina

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 D. List residents who love to teach
1. Lahat naman sila pero most sina:
2. Dr. Adriano
3. Dr. Mamaclay
4. Dr. Garcia
5. Dr. Cancio
6. Dr. Guballa
7. Dr. Chu
E. List residents who allow you to do skills
1. Dr. Cancio
2. Dr. Guballa
3. Dr. Garcia
4. Dr. Chu

XII. Consultants to Take Note of

A. Indicate any notable consultant and the characteristics which make them distinct
1. Dr. Cruz - loves to teach, and gives everyone a chance to look at the slit lamp findings
B. What are the expectations of these consultants?
1. When consultants are in the OPD, the residents usually want us to listen to the consultants, which
means we drop what we are doing at the moment and listen
C. List consultants who ask a lot of questions
1. Dr. Cruz
D. List consultants who love to teach
1. Dr. Cruz
E. List consultants who allow you to do skills

XIII. Special notes on Allied Medical Professionals

A. General idea on the role delineation between you and allied health professionals
B. Notes on how to deal with other professionals during this rotation?
1. The nurses in the Ophtha ward and eye center are very nice and approachable!
2. The interns are also very nice (well, depending on the intern)
C. What are the expectations of other professionals towards clerks?
D. List notable nurses or other professionals who can grade skills

XIV. Other information

A. Are there any other notable things that were not previously mentioned or laid out in the outline?
1. Use this opportunity to maximize use of the slit lamp!
2. The residents are very nice and they teach a lot! They do take endorsements very seriously so
prepare well and know your patient’s history and PE.
3. If you still have the jaeger chart from YL5 (the one AMGD gave), consider laminating it most of
the residents liked it since it’s complete