Clinical Skills 1 - A - Opthamology History taking Flashcards
What are the top 3 complaints of people presenting with eye pathology?
Visual loss Pain Red eye
When asking questions regarding visual loss, what can you ask?
How long the vision has been lost for, is it only one eye, central or peripheral vision
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)
Visual loss in central vision means there is a defect with the macula - most likely due to age related macular degeneration
What is the form of inherited retinal degeneration which causes the loss of rods leading to loss of peripheral vision causing tunnel vision?
This is called retinitis pigmentosa
Retinitis pigmentosa causes loss of temporal vision, what time of day does retinitis pigmentosa affect?
Causes night blindness due to the loss of rods which are used for vision in dim light
What is another cause of tunnel vision due to loss of vision in both temporal vision fields?
A bitemporal hemianopia due to a pituitary tumour compressing the optic chiasm
Older person comes to you with a visual loss, headache and sore scalp when combing hair What do you suspect?
Suspect a giant cell arteritis
What are other signs of giant cell artertis? What condition is this associated with?
Associated with jaw claudication - it is also known as temporal arteritis Associated with polymalgia rheumatica
What is the treatment of polymalgia rheumatica? What about when it is seen with giant cell arteritis?
Polymalgia rheumatica - treat with steroids up dose with giant cell arteritis
When a patient presents with red eye, what conditions can you think?
Conjunctivits keratitis Subconjunctival haemorrhage
How is keratitis diagnosed?
Diagnosis made through usuing a slit lamp - bascially doctor uses a microscope to see which layer of the eye is inflamed
What do you think of when a patient has a red eye and a watery discharge? What about when it is a purulent discharge?
When a patient has a red eye and watery discharge, makes you think allergic conjunctivits Purulent discharge makes one thing bacterial conjunctivitis
What type of questions should you ask someone with a red eye?
Ask if itchy, sexual history (could be chlamydial conjunctivitis Ask if any pain or visual loss
If patient is young and has red eye, make sure to ask about sexual history How is chlamydial conjunctivitis treated?
Treated using topical oxytetracycline
After taking swab and waiting for results, what is the best treatment plan for the conjunctivitis?
Give patient chloramphenicol as it treats most bacteria
What is the anterior uveitis known as? Can present as red eye, painful and loss of vision but no discharge
This is iritis
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?
This is open angle glaucoma
WHat are the symptoms of pen angle glaucoma?
Peripheral visual feild loss followed by central visual field Red eye Intense eye pain Headache
When questioning a patient about pain in the eye What does pain on moving the eye make you think?
Pain on eye movement is classical of optic neuritis
In eye history, make sure to ask about previous eye operations, diabetes or HBP What can proptosis make you think? What can stereoids cause?
Proptosis of eye makes you think hyperthyroid Steroids can cause cataracts Can also cause gluacoma by increasing the intra-ocular pressure
If somebody has flashes and floaters in the eye and complains of a shadow coming across their vision, what does this make you think?
Retinal detachment
What are the symptoms of acute glaucoma?
Headache, vision loss, severe eye pain, nausea and vomiting
A patient presents with a sudden onset of unilateral eye pain and blurred vision. You should suspect:
acute angle-closure glaucoma.
Is this person short or long sighted? What is the diagnosis?
Patient is long sighted Diagnosis of acute glaucoma
What are the differentials in this patient?
Virall conjunctivitis - possibly HSV Bacterial conjunctivits Keratitis - associated with the lens
What should be done as management of this patient?
Swabs - for bacterial, viral or chlamydial due to age Give chloramphenical +/- oflaxacin to cover most organisms See back in 2-3 days
What type of discharge presents with conjunctivtis?
Allergic conjunctivits - watery discharge Bacterial conjunctivitis - pus discharge
What are the red flags in an opthamology history taking?
Sudden change in vision Eye pain Visual field defect
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?
Visual acuity (sharpness of vision) Pupillary reflex Visual fields examination Colour vision (we dont get taught this at our level)
