The Doctor Is In


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)

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)

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)

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.

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