Pratique du Shadowing: Retinal Vascular Disorders - CRASH! Medical Review Series - Apprendre l'anglais à l'oral avec la vidéo
Choisissez un mode d'entraînement
Chaque mode ouvre une salle d'entraînement en plein écran.
234 phrases
Si les phrases sont trop courtes ou trop longues, cliquez sur Edit pour les ajuster.
1
Retinovascular disorders is going to be the topic of this lecture
2
and by retinovascular disorders I'm referring to the central retinal artery occlusion
3
and the central retinal vein occlusion
4
so you have a central retinal artery the retinal artery is
5
is the first artery off of the internal carotid artery in most people
6
and that's going to branch into several branches smaller branches
7
that then go off to different parts of the retina now
8
if the entire retinal artery is blocked before it gives off tributaries branches then it's considered a central retinal artery occlusion.
9
If it's just a branch that's blocked, that can cause symptoms, but that would be considered just a branch retinal artery occlusion.
10
And it works the same way with the veins.
11
If the main vein that's leaving the eye is blocked, then it's a central retinal vein occlusion.
12
If it's just a tributary of that vein, then it's a branch retinal vein occlusion.
13
So hopefully that makes sense.
14
Okay, so the central retinal artery occlusion is an occlusion of the retinal artery, is mentioned.
15
It's the first artery coming off of the internal carotid
16
and it presents as a sudden profound monocular loss of vision without pain or redness.
17
So this is just like having a stroke to the eye.
18
And about one to two percent of patients will present with bilateral CRAO, but that's pretty unusual.
19
The incidence is one in 10 ,000 and the average age of onset is in the 60s.
20
So this is a disease of the elderly.
21
However, if you do see this in somebody who's in their 30s or 40s, you should be highly suspicious of something like a thrombophilia.
22
In many cases, the patient will have a history of giant cell arteritis, whether that's diagnosed or not diagnosed.
23
That's also called temporal arteritis.
24
And this is a big risk factor for central retinal artery occlusion
25
so that branch retinal artery occlusion as was mentioned I'm not going to spend a whole slide talking about it
26
but this is just a similar process due to similar causes
27
but it's a smaller clot and it affects a downstream vessel
28
and so it doesn't affect as much of the retina as a central retinal artery occlusion
29
so this is much further downstream and
30
so it affects a smaller part of the retina
31
and the symptoms will be similar
32
but it will only affect the part of the visual field that that obstructive segment supplied
33
okay so what are the risk factors hypercholesterolemia of course that's a risk factor for clotting obesity
34
Obesity, advanced age, diabetes mellitus, and all of these three things,
35
maybe not hypercholesterolemia, but obesity and advanced age, those certainly play into diabetes mellitus.
36
But just having diabetes mellitus by itself, even if you're not obese and you're not advanced age, that is a risk factor too
37
and then temporal arteritis is a big risk factor for artery occlusion
38
and so what is temporal arteritis again I address this in a different lecture in the medical section
39
but temporal arteritis happens to people 55 years of age
40
or older it involves a headache scalp tenderness and thickening
41
or tenderness of the superficial temporal artery you should be able to feel pulse over
42
that artery and it's right over the temple
43
if you feel your own superficial temporal artery you feel your temple you should be able to palpate
44
that artery patients with temporal arteritis they usually have this this inflamed firm cord
45
and you can't feel the pulse because the artery is
46
so inflamed so what does this lead to especially the hypercholesterolemia the obesity the diabetes
47
and the fact of being old those all can lead to
48
or increase your risk of carotid artery stenosis and of atrial fibrillation
49
because of small undetected heart attacks and those things carotid artery stenosis
50
because you're gathering plaque and atrial fibrillation because you can develop a clot
51
because of a lack of a lack of appropriate contraction both of those things you can develop a clot
52
or release a clot or release a plaque and
53
that can be the embolus that's needed that can go in to the into the retinal artery
54
and so this is how central retinal artery occlusion and
55
if it's a smaller plaque
56
or a smaller clot that's how a branch retinal artery occlusion can happen other risk factors include
57
congenital or acquired thrombophilia you can acquire thrombophilia by taking birth control pills
58
and so those would be something you would look for in younger patients who don't have these risk factors.
59
And there's other risk factors in addition to these, but these are some of the most common that you'll see.
60
So as mentioned, this is painless, sudden, and often this is a profound loss of vision.
61
98 to 99 % are monocular.
62
The symptoms are sudden loss of vision.
63
Acuity is typically worse than 2200, which is the cutoff point for being legally blind
64
and a lot of times they won't even be able to tell you how many fingers
65
you're putting up in front of their face even
66
if you get really close there may be some preservation in the temporal field I'm assuming that's
67
because there may be some additional there may be some additional circulation coming from somewhere else
68
but I'm not exactly sure but the literature does say
69
that there may be some preservation in temporal fields and
70
that is certainly the case
71
so some of the things you're going to want to know from the patient
72
or at least know on the question
73
that's going to help you with the diagnosis is how long have the symptoms been present usually
74
when somebody loses their vision they're going to get to the er as quickly as possible
75
you also want to know
76
if they have any past medical history of ocular problems you'll want to know if the patient has a high cholesterol,
77
if you ask the patient that or if you look in their charts, do they have a history of diabetes?
78
Certainly both of those would increase the risk of this being a central retinal artery occlusion.
79
And do they have any history of stroke or TIA?
80
That would lead you to believe that perhaps there's a carotid artery stenosis
81
and that's a big contributor to retinal artery occlusion
82
now I just want to right now differentiate central retinal artery occlusion from something else
83
which is called amaurosis fugax and with amaurosis fugax you get a temporary loss of vision
84
that usually lasts a few minutes
85
and then your vision comes back with central retinal artery occlusion you have a loss of vision
86
and it stays at least until you get treated on On physical examination,
87
you want to document their visual fields and then get their visual acuity, even though it's probably going to be 2200 or worse,
88
just to compare it to baseline and document it on the records.
89
Look for signs of temporal arteritis, especially in older patients, because that contributes, that strengthens your diagnosis.
90
You should also check their pupils for an afferent pupillary defect or the Marcus Gunn pupil.
91
Ocultate for a carotid brui, and then ocultate the heart for murmurs, and especially an irregular beat, which can be consistent with atrial fibrillation.
92
For diagnosis, you'll want to get routine labs,
93
and that's great, but all patients with acute loss of vision should be referred to ophthalmology for a formal ophthalmoscopy,
94
highlighting the fact here that CRAO, as in a lot of cases of vision loss,
95
cannot be diagnosed with a simple handheld ophthalmoscope.
96
You'll need to do a dilated exam and have the optometrist use their equipment.
97
So findings consistent on indirect ophthalmoscopy, consistent with CRAO, includes retinal pallor, which makes sense because it's not getting enough blood,
98
a prominent cherry red macula, and that is actually because the fovea,
99
the macula, gets its vascularization elsewhere from the choriocapularis.
100
And then attenuated arteries may be present, as well as a boxcar appearance of veins.
101
But what you're really going to notice is the retinal pallor and the prominent cherry red macula.
102
So here's a normal posterior pole.
103
Here's your optic disc and in the center here is your macula.
104
Now the macula is red but it's a lot different in comparison than when we see the retinal artery occlusion.
105
So here's an example of a central retinal artery occlusion and as you can see there's pallor here.
106
This is much more pale.
107
Now, every ophthalmoscope uses slightly different lighting,
108
but you can see that there's a much more contrast between the macula and the rest of the retina,
109
whereas here, the macula and the retina weren't as contrasted.
110
You also see that you don't have a whole lot of vasculature around the macula,
111
whereas on a normal visualization, you do have vasculature around the macula.
112
So here's another one, again the macula is much more prominent, that cherry red macula.
113
See the same here too.
114
So this is a branch retinal artery occlusion.
115
So you can see that it's normal on the top here, but it's abnormal on the bottom.
116
If the rest of the retina was like this on the bottom, then you'd have a central retinal artery occlusion you'd be able
117
to see this macula very distinguished from the rest of the retina
118
but it's only distinguished from this retina here on the bottom
119
which is the diseased retina that's not getting enough blood
120
and then here's another one here above the above the macula
121
so the treatment the patient is going to need admission through
122
ophthalmology the treatment is going to be under the guidance of an ophthalmologist.
123
So I don't expect ever you'll be required to know how to do this
124
or exactly how to treat them in the ER or as an internist or even as a surgeon.
125
But you do need to know that they need to be admitted and it's worth knowing some of the things that
126
ophthalmologists use.
127
So presently there's controversy in the exact management for patients with CRAO, but most ophthalmologists agree with some basic principles.
128
So high concentration inhaled 100 % oxygen, that's something you can start in the ER.
129
So that's something you should know.
130
IV acetazolamide, IV corticosteroids, those are done,
131
the IV corticosteroids are done to reduce the inflammation and
132
that is expected to help with with maintaining vision reducing the inflammation
133
and then treatment of the underlying cause as the internist this is going to be your concern finding
134
and treating the underlying cause right some ophthalmologists use intra arterial thrombolytics
135
and they inject those thrombolytics into the retinal artery system that's not universal
136
but this has been shown to be effective by the EGLE study
137
so you can look look up more on that if you want
138
but high high concentration inhaled oxygen acetazolamide corticosteroids
139
and treatment of the underlying cause
140
so upon diagnosis it's going to be your responsibility to work
141
the patient up for underlying causes these don't just happen on their own
142
so the patient will have something wrong with them
143
that put them at predisposition all patients regardless of their age should get a carotid artery duplex ultrasound
144
they should get an echocardiogram to look for atrial fibrillation
145
or any other kind of abnormality valvular abnormalities that can gather clots
146
and then and then release them they should get an EKG routine labs that's usually done anyway
147
when you're first investigating the patient an ESR is useful
148
and that's kind of to look more towards the temporal arteritis
149
that would be elevated a fasting blood glucose is useful to work them up for diabetes
150
if they haven't been diagnosed with diabetes and then coagulation studies younger patients
151
or older patients who have normal results after this workup should get a workup for any kind of congenital
152
or acquired thrombophilia so factor V Leiden antithrombin 3 deficiency protein C deficiency protein S deficiency
153
and so forth oh and then elevated homocysteine
154
that was another one I wanted to add to and that's another congenital thing older
155
Older patients should follow up regularly, patients with CRAO have a 56 % mortality rate within 9 years
156
and that's compared to 27 % in aged match patients who have never had CRAO.
157
So that's a big deal when you think about it.
158
Somebody who's older and has the same,
159
let's say you've got two twins and one twin develops a CRAO and the other twin doesn't,
160
That twin that developed the CRAO is two times more likely to die within the next nine years.
161
And that shows that it's likely due to the fact that there's some level of increased thrombosis.
162
The plaque is not stabilized but it's important to remember that patients who have CRAO,
163
really what this was, was a stroke that just happened to go the right way.
164
Rather than go up to the brain, it went to the retinal artery.
165
And so rather than having a debilitating or deadly stroke, you just got your eye taken out.
166
And I mean, neither of those are good, but this is the same pathologic process that causes a stroke.
167
So it's important that patients are aware that they are at imminent risk of stroke and that you take interventions as necessary,
168
as if the patient had had a stroke.
169
Okay, so central retinal vein occlusion is occlusion of the retinal vein.
170
And this presents a little bit differently.
171
So initially, the patient will present with sudden monocular loss of vision without pain or redness,
172
but it's usually not as severe as the central retinal artery occlusion.
173
But this is a more progressive disease, and the vision will worsen with time.
174
And eventually, pain erythema and watering can develop.
175
So this is less severe usually when it presents, but with time, when it's diagnosed with time, if it's not treated, it gets worse.
176
The symptoms have a tendency to be noticed on wakening.
177
I'm not sure why.
178
The lifetime incidence is 2 to 5 per 1000
179
and 90 % of cases are seen over the age of 50
180
so again this has a preponderance in the elderly and there's a slight male preponderance.
181
The equivalent branch retinal vein occlusion is a similar process
182
but it affects a downstream vein and
183
so it does not affect as much of the retina
184
and the ophthalmoscopic findings will be localized so
185
when we look at what the ophthalmoscopic findings of central retinal
186
vein occlusion are you're only going to find them in one part of the retina with the BRVOs.
187
BRVOs are thought to be most commonly caused by a mechanical compression on the branch vein by an artery
188
but there are other possible causes systemic hypertension is considered the most significant major risk factor in BRVOs.
189
So back on the CRVOs they're very similar as far as risk factors go
190
but other risk factors with CRVO can include primary glaucoma probably because of the elevated pressure,
191
alcohol consumption, head trauma, and excessive physical activity.
192
Symptoms include as mentioned progressive visual impairment.
193
The natural progression includes worsening of vision to the point of blindness, pain, photophobia, redness, and eye watering.
194
All suspected cases of loss of vision, as mentioned, should be referred to an ophthalmologist for formal indirect ophthalmoscopy.
195
And the findings on ophthalmoscopy depend on how progressed the CRVO is.
196
So typically with CRVO, we see a certain degree of optic disc swelling there's going to be a certain amount of hemorrhages
197
and you may see some tortuous veins
198
but as it progresses you're going to see a more swelled optic disc you're going to see more
199
and more and larger hemorrhages
200
and a lot of times the hemorrhages get in the way to where you can't see the veins even
201
if they are tortuous so i'll show you some examples
202
further tests to evaluate the CRVO include fluorescein angiography
203
when to do this test is at the discretion of the ophthalmologist
204
so here is a case of what would be considered early CRVO
205
so the you can see there's some hemorrhaging here on these early veins
206
and then you also have this tortuosity this would be probably a little bit later
207
so you've got more hemorrhages here and this is much later too
208
because the hemorrhages are much further out okay
209
so this is a branch retinal vein occlusion so you can see here
210
that the veins and arteries are normal but here you have this localized area of hemorrhage
211
So this was found to be a branch retinal vein occlusion.
212
Here's another one.
213
Now just looking at the results of an ophthalmoscope, it isn't going to tell you what the disease is.
214
You always have to include it in the clinical picture of the patient.
215
Any radiologist would tell you that.
216
But with a patient with consistent symptoms, this is certainly a branch retinal vein occlusion, as is this.
217
So patients with central retinal vein occlusions should be worked up for diabetes, hyperlipidemia.
218
So both of those are easy.
219
You can get them in the morning, get a fasting blood glucose level, get a lipid panel.
220
They should also be worked up for thrombophilia markers such as factor V Leiden, protein C, etc. and then be worked up for an elevated homocysteine.
221
For treatment, unfortunately there is no available effective medical treatment for CRVO.
222
Various treatment modalities are under investigation, however, and they may be performed by the ophthalmologist.
223
Some patients can get enrolled in studies, but you won't be responsible for knowing any of this on the USMLE
224
but some of those modalities include intravitreal administration of anti -VEGF inhibitors
225
so remember that VEGF is a protein that stimulates angiogenesis and
226
so this will reduce the development of more arteries
227
which is the classic response
228
when there's ischemia there's also intravitreal administration of corticosteroids to reduce some of the inflammation
229
that invariably happens with this the use of locally injected tpa and then plasmapheresis
230
complications include neovascular glaucoma panretinal photocoagulation can be performed either prophylactically in crvo
231
or as soon as there's signs of neovascularization
232
and macular edema is another complication for that laser photocoagulation can be effective but only if it's due from BRVO.
233
It has not been shown to be effective in CRVO.
234
So if you have any questions, feel free to leave a message below.
Télécharger l'application
Tout pour parler couramment
Prononciation IAChaque phrase notée
Phonétique (IPA)Maîtrisez chaque son
VocabulaireEnrichissez votre lexique
Jeu de vocabulaireApprenez en jouant
Même chaîne
FOR YOU
Vidéo recommandée
C11
287 phrases
Lecture 12: Retina, Part 2: Retinal vascular occlusions
Daily ConversationUniversity Students
C11
124 phrases
Ischemic Stroke - causes, symptoms, diagnosis, treatment, pathology
Daily ConversationUniversity Students
C11
77 phrases
Retinal Artery Occlusion vs. Retinal Vein Occlusion
Daily ConversationUniversity Students
C11
127 phrases
Doctor explains DIABETIC RETINOPATHY (eye disease) - STAGES, SYMPTOMS, PREVENTION AND TREATMENT
Daily ConversationUniversity StudentsWorking Adults
C11
214 phrases
2026 ESC Guidelines for the Management of Cardiovascular Disease and Chronic Kidney Disease
Daily ConversationUniversity Students
C12
39 phrases
Immunology of the rheumatoid joint
Daily ConversationUniversity Students
C156 phrases
ST Elevation and Depression on an EKG Rhythm Strip
Daily ConversationUniversity Students
C11
406 phrases
Scoliosis: How to medically classify scoliosis (the Lenke System for AIS)
Daily ConversationUniversity Students
C11
380 phrases
A man hiked in the woods. Every brain cell got cooked.
Daily ConversationUniversity StudentsWorking Adults
C12
56 phrases
Intracranial Angioplasty | Dr. Sukalyan Purkayastha | Brain Mechanic
Daily ConversationUniversity StudentsWorking Adults
C13
41 phrases
SVINutes: Pulsatile Tinnitus
Daily ConversationUniversity StudentsWorking Adults
Vocabulaire et conseils d’expression pour cette leçon
Cette leçon d’expression orale s’appuie sur la vidéo « Retinal Vascular Disorders - CRASH! Medical Review Series ». Les mots qui reviennent le plus souvent : artery, retinal, occlusion, patient, vein. Cette vidéo contient 234 phrases et 3050 mots à répéter en shadowing. La partie parlée dure 22:30. Le locuteur parle à un rythme régulier d’environ 136 mots par minute, confortable pour le shadowing. Seuls 75 % des mots font partie des 3 000 mots les plus courants en anglais, le vocabulaire est donc exigeant.
Vocabulaire clé de cette vidéo
15 mots de la vidéo à retenir, avec leur prononciation et leur sens :
| Mot | Prononciation | Sens |
|---|---|---|
| artery nom | /ˈɑɹ.təɹ.i/ | artère |
| vein nom | /veɪn/ | veine |
| temporal adjectif | /ˈtɛm.pə.ɹəl/ | temporel |
| diabetes nom | /ˌdaɪəˈbiːtiːz/ | diabète |
| symptom nom | /ˈsɪm(p)təm/ | symptôme |
| consistent adjectif | /kənˈsɪs.tənt/ | constant |
| sudden adjectif | /ˈsʌd.ən/ | soudain, subit |
| twin nom | /twɪn/ | jumeau, jumelle |
| diagnosis nom | /daɪəɡˈnəʊsɪs/ | diagnostic, diagnose |
| underlying adjectif | sous-jacent | |
| obesity nom | /ə(ʊ)ˈbiːsɪti/ | obésité |
| plaque nom | /plæk/ | plaque |
| prominent adjectif | /ˈpɹɑmɪnənt/ | protubérant, saillant |
| cherry nom | /ˈt͡ʃɛɹi/ | cerise, griotte |
| acquire verbe | /əˈkwaɪɚ/ | acquérir |
Les verbes à particule que vous entendrez
| Mot | Prononciation | Sens |
|---|---|---|
| give off verbe | /ɡɪv ɒf/ | émettre |
| take out verbe | supprimer, sortir |
La grammaire de cette vidéo
Les structures que le locuteur utilise le plus, avec les mots exacts de la vidéo :
| Structure | Dans la vidéo |
|---|---|
| Voix passive be + participe passé — l’accent est mis sur ce qui arrive, pas sur qui le fait | is blocked · would be considered · is mentioned |
| Present perfect have/has + participe passé — une action passée qui compte encore maintenant | has been shown · haven't been diagnosed · have never had |
| Propositions relatives who / which + proposition — une précision sur une personne ou une chose | beat, which can · pallor, which makes |
Prononciation à surveiller
Le locuteur utilise 40 contractions et formes réduites, comme you're, I'm, you'll. Prononcez-les sous leur forme courte, telles que vous les entendez.
- Les sons « th »: gather /ˈɡæðɚ/, ophthalmologist /ˌɔf.θə(l)ˈmɑ.lə.d͡ʒɪst/, ophthalmology /ˌɒfθə(l)ˈmɒləd͡ʒi/, antithrombin /ˌæntɪˈθɹɒmbɪn/
- Les sons « sh » et « zh »: inflammation /ɪnfləˈmeɪ̯ʃən/, deficiency /dɪˈfɪʃənsi/, concentration /ˌkɑn.sənˈtɹeɪ.ʃən/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, preservation /ˌpɹɛz.əˈveɪ.ʃən/
- Mots longs — placez bien l’accent: obesity /ə(ʊ)ˈbiːsɪti/, inflammation /ɪnfləˈmeɪ̯ʃən/, deficiency /dɪˈfɪʃənsi/, concentration /ˌkɑn.sənˈtɹeɪ.ʃən/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/
Les sons difficiles pour les francophones :
- /h/ — il se souffle, il n’est pas muet: whereas /(h)wɛɹˈæz/, highlight /ˈhaɪˌlaɪt/, headache /ˈhɛdeɪk/, hemorrhage /ˈhɛm(ə)ɹɪd͡ʒ/, inhale /ɪnˈheɪl/
- /tʃ/ et /dʒ/ — à ne pas adoucir en « ch » et « j »: cherry /ˈt͡ʃɛɹi/, oxygen /ˈɑksɪd͡ʒən/, lecture /ˈlɛk.t͡ʃə/, chart /t͡ʃɑɹt/, surgeon /ˈsɝd͡ʒən/
- /r/ anglais — langue recourbée, sans frotter la gorge: artery /ˈɑɹ.təɹ.i/, temporal /ˈtɛm.pə.ɹəl/, prominent /ˈpɹɑmɪnənt/, cherry /ˈt͡ʃɛɹi/, downstream /ˌdaʊnˈstɹiːm/
Comment s’entraîner avec cette vidéo
- Écoutez la vidéo en entier une fois sans parler et notez les mots que vous ne connaissez pas.
- Répétez phrase par phrase à vitesse normale, en reprenant chacune jusqu’à ce que votre rythme corresponde à celui du locuteur.
- Enregistrez-vous et comparez avec l’original, en faisant attention à des mots comme artery, vein, temporal.
Qu'est-ce que la technique du Shadowing ?
Le Shadowing est une technique d'apprentissage des langues fondée sur la science, développée à l'origine pour la formation des interprètes professionnels. Le principe est simple mais puissant : vous écoutez de l'anglais natif et le répétez immédiatement à voix haute — comme une ombre suivant le locuteur avec un décalage de 1 à 2 secondes. Les recherches montrent une amélioration significative de la précision de la prononciation, de l'intonation, du rythme, des liaisons, de la compréhension orale et de la fluidité.