Episode Details

Episode 28: Anisocoria

The sun rises over the San Joaquin Valley, California, today is September 18, 2020.

Welcome to our “student-only” episode. Out of all the social determinants of health, the USPSTF recommends screening for intimate partner violence and for child maltreatment[1]. Today, we would like to dedicate a few minutes to intimate partner violence (IPV) in women. 

Screening for IPV is a USPSTF grade B recommendation, which means you should offer this service to your patients. Women of reproductive age should be screened for IPV and receive ongoing support services, if screening is positive. There are several tools you can use to screen. For example, HARK (Humiliation, Afraid, Rape, Kick); HITS (Hurt, Insult, Threaten, Scream); and WAST (Woman Abuse Screening Tool)[2].

Briefly, the WAST has two questions, which can be followed by 6 additional questions (just like when you do PHQ2 and PHQ9). The first two questions are:

1. In general, how would you describe your relationship? (No tension, Some tension, A lot of tension)

2. Do you and your partner work out arguments with... (No difficulty, Some difficulty, Great difficulty?). 

It is POSITIVE if patient answers "a lot of tension" and "great difficulty", then you can continue with the rest of the questions which is part 2, until completing 8 questions in total. The screen is positive based on your clinical judgement, no positive score threshold is established. 

In California, health practitioners are required to report to law enforcement if they provide medical services to a patient with a physical injury due to firearm, or assaultive/abusive conduct within two working days[3]. Make sure you review your local regulations about mandatory reporting in your area.  

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This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program, from Bakersfield, California. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care since 1971. 

“The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.” ― William Arthur Ward.

Did you know the word doctor comes from the Latin root docere which means teacher? I was very surprised by that etymology. So, as doctors, we are teachers. What kind of teacher do you want to be as a doctor? A teacher who tells, explains, or demonstrates? It takes a lot of practice and effort, I bet, but your patients will thank you if you become a teacher who inspires them. Today, you will listen to our medical students. This is the first episode that is 100% made by medical students. Today our doctor students become our teachers. First, let’s listen to Li Liang, then Hugh and Meredith. 

Anisocoria: Unequal Pupils

As a continuation on the theme of anisocoria, we will wrap up. Hopefully with something wise, but more than anything the point of this is just to stir your mind and say, “Yeah…the cobwebs are lifting.” Yes, Halloween is coming. Is it the eye? Or is it the brain? Or is it in the blood vessel? 

It has been said by multiple somebodies some time ago, “the eyes are the windows into the soul” or rather into the hidden chambers of what’s inside the big watermelon we have atop of our gravity defying bodies.

I learn best by stories and people, so if you’ll indulge me. Think of a musician, a rather famous rock star who The Rolling Stones called “The Greatest Rock Star ever.” Maybe this clip might help. https://youtu.be/J-_30HA7rec.

That was just David Bowie. I never knew this but conveniently he will highlight our topic for both anisocoria and heterochromia. As a quick reminder, heterochromia is asymmetric iris coloration, whe