Clinical Skills 1 - A - Opthamology History taking

Question 1

What are the top 3 complaints of people presenting with eye pathology?

Answer 1

Visual loss Pain Red eye

Question 2

When asking questions regarding visual loss, what can you ask?

Answer 2

How long the vision has been lost for, is it only one eye, central or peripheral vision

Question 3

If there is a visual loss in the central vision, what do these make you think? (what is the usual cause of central vision loss)

Answer 3

Visual loss in central vision means there is a defect with the macula - most likely due to age related macular degeneration

Question 4

What is the form of inherited retinal degeneration which causes the loss of rods leading to loss of peripheral vision causing tunnel vision?

Answer 4

This is called retinitis pigmentosa

Question 5

Retinitis pigmentosa causes loss of temporal vision, what time of day does retinitis pigmentosa affect?

Answer 5

Causes night blindness due to the loss of rods which are used for vision in dim light

Question 6

What is another cause of tunnel vision due to loss of vision in both temporal vision fields?

Answer 6

A bitemporal hemianopia due to a pituitary tumour compressing the optic chiasm

Question 7

Older person comes to you with a visual loss, headache and sore scalp when combing hair What do you suspect?

Answer 7

Suspect a giant cell arteritis

Question 8

What are other signs of giant cell artertis? What condition is this associated with?

Answer 8

Associated with jaw claudication - it is also known as temporal arteritis Associated with polymalgia rheumatica

Question 9

What is the treatment of polymalgia rheumatica? What about when it is seen with giant cell arteritis?

Answer 9

Polymalgia rheumatica - treat with steroids up dose with giant cell arteritis

Question 10

When a patient presents with red eye, what conditions can you think?

Answer 10

Conjunctivits keratitis Subconjunctival haemorrhage

Question 11

How is keratitis diagnosed?

Answer 11

Diagnosis made through usuing a slit lamp - bascially doctor uses a microscope to see which layer of the eye is inflamed

Question 12

What do you think of when a patient has a red eye and a watery discharge? What about when it is a purulent discharge?

Answer 12

When a patient has a red eye and watery discharge, makes you think allergic conjunctivits Purulent discharge makes one thing bacterial conjunctivitis

Question 13

What type of questions should you ask someone with a red eye?

Answer 13

Ask if itchy, sexual history (could be chlamydial conjunctivitis Ask if any pain or visual loss

Question 14

If patient is young and has red eye, make sure to ask about sexual history How is chlamydial conjunctivitis treated?

Answer 14

Treated using topical oxytetracycline

Question 15

After taking swab and waiting for results, what is the best treatment plan for the conjunctivitis?

Answer 15

Give patient chloramphenicol as it treats most bacteria

Question 16

What is the anterior uveitis known as? Can present as red eye, painful and loss of vision but no discharge

Answer 16

This is iritis

Question 17

the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve. What is this?

Answer 17

This is open angle glaucoma

Question 18

WHat are the symptoms of pen angle glaucoma?

Answer 18

Peripheral visual feild loss followed by central visual field Red eye Intense eye pain Headache

Question 19

When questioning a patient about pain in the eye What does pain on moving the eye make you think?

Answer 19

Pain on eye movement is classical of optic neuritis

Question 20

In eye history, make sure to ask about previous eye operations, diabetes or HBP What can proptosis make you think? What can stereoids cause?

Answer 20

Proptosis of eye makes you think hyperthyroid Steroids can cause cataracts Can also cause gluacoma by increasing the intra-ocular pressure

Question 21

If somebody has flashes and floaters in the eye and complains of a shadow coming across their vision, what does this make you think?

Answer 21

Retinal detachment

Question 22

What are the symptoms of acute glaucoma?

Answer 22

Headache, vision loss, severe eye pain, nausea and vomiting

Question 23

A patient presents with a sudden onset of unilateral eye pain and blurred vision. You should suspect:

Answer 23

acute angle-closure glaucoma.

Question 24

Is this person short or long sighted? What is the diagnosis?

Answer 24

Patient is long sighted Diagnosis of acute glaucoma

Question 25

What are the differentials in this patient?

Answer 25

Virall conjunctivitis - possibly HSV Bacterial conjunctivits Keratitis - associated with the lens

Question 26

What should be done as management of this patient?

Answer 26

Swabs - for bacterial, viral or chlamydial due to age Give chloramphenical +/- oflaxacin to cover most organisms See back in 2-3 days

Question 27

What type of discharge presents with conjunctivtis?

Answer 27

Allergic conjunctivits - watery discharge Bacterial conjunctivitis - pus discharge

Question 28

What are the red flags in an opthamology history taking?

Answer 28

Sudden change in vision Eye pain Visual field defect

Question 29

After taking a history, usually an examintion can be carried out like an opthalmoscopy or slit lamp What are the four ways to assess the optic nerve function?

Answer 29

Visual acuity (sharpness of vision) Pupillary reflex Visual fields examination Colour vision (we dont get taught this at our level)