case histories

Question 1

what does SOAP stand for?

Answer 1

S: subjective, chief complaint (symptoms)

O: objective, all exam observation and findings (signs)

A: assessment, diagnosis

P: plan, treatment and patient insturctions

Question 2

blur at distance

Answer 2

tenative diagnosis is myopia or astigmatism. test with refraction

Question 3

blur at near

Answer 3

hyperopia, presbyopia. refraction used to test

Question 4

halos

Answer 4

corneal swelling, dirty contacts, cataracts, dry eye. refract but look at cornea, contacts and ocular lens

Question 5

Causes and testing if pt sees shadows around letters

Answer 5

astigmatism or cataracts. refaction with specific health evaluation attention to slit lamp and lenses

Question 6

photopsia describe brief and long and testing

Answer 6

unusual light flashes.

brief flashes (1-3 secs)= retinal etiology

long flashes (1-30 mins)= transient ischemic attack/ migraine

dilate to check peripheral retina and explore migraine/ stroke history

Question 7

floaters - spots in front of eyes. What are two cases?

Answer 7

New onset, changing or associated with flashes make retinal exam a priority

longstanding floaters are less concerning

Question 8

diplopia

Answer 8

binocular= vergence or neurological problem

monocular= opitcal or retinal problem

check history via FODLARS.

Question 9

accommodative dysfunction

Answer 9

words blur after 10-20 mins of near work and blur at distance.

Patients under 35 with spasm of near focus need Visual Efficiency Evaluation

Patients 35y or older near work/presbyopia eval

Question 10

who requires visual efficiency evaluation?

Answer 10

patients under 35 with accommodation complaints

Question 11

who recquires near work/ presbyopia evaluation?

Answer 11

patients over 35 years old with accommodative dysfunction

Question 12

List some symptoms of binocular and vergence dysfunction

Answer 12

double vision at night, double vision when reading, discomfrot around eyes, skipping lines or losing place when reading.

Question 13

WHat can you check for ocular discomfort (asthenopia)

Answer 13

check tear film quality and dry eye questionaires

Question 14

What is photophobia?

List 3 possible causes, and 2 tests that can be done

Answer 14

abnormal sensitiviy to light. Usually due to infection or trauma, can be pathological. Careful uveitis eval and dry eye eval.

Question 15

headaches

Answer 15

take them seriously. may need to refer/consultation. may require visual field exam and or neuro-exam

Question 16

computer users

Answer 16

about half of users have eyestrain, fatigue, headaches, blur at near

Question 17

What questions do you ask a contact lens wearer

Answer 17

how long have they worn contacts, type of lens, hygiene, duration of wear, past infections and comfort level

Question 18

pediatrics

Answer 18

gaurdian present at all times, the gaurdian will give the history. need written consent to dilate. ask questions regarding childs health and school perfromance.

Question 19

geriatrics

Answer 19

family member can only give history if the patient allows it. must document the relationship if person giving the history

Question 20

asthenopia

Answer 20

only about 20% of headaches are related. bilateral, achy, dull (non-throbbing), worse at end of day. may be improved by naps

Question 21

tension headaches

Answer 21

stress related. “band-like”

Question 22

sinus headaches

Answer 22

allergies, associated with cough, postnasal drip, sore throat

Question 23

cluster headache

Answer 23

usually male (episodic) chronic knife pain. unilateral pain, associated with unilateral stuffy/ running nose

Question 24

migraine

Answer 24

pulsating throbbing. common in females. certain foods and photophobia trigger them

Question 25

mass effect headache

Answer 25

brain tumor, meningitis, aneurysm, increased intracranial pressure. sub-acute and get worse over the days.

Question 26

when is a mass effect headache a red flag?

Answer 26

if it is worse in the morning

Question 27

worst headache of my life?

Answer 27

aneurysm until proven otherwise