History Flashcards
Generic
HPI: Vision, Irritation, Photophobia, Epiphora, Redness, Diplopia, Trauma
POHx:
PMHx:
FmHx:
Meds:
Allergies:
Glaucoma History
- HPI: Vision change, Irritation/Pain , Photophobia, Epiphora, Redness. Family history, older age, descent, myopia/hyperopia.
- POHx: Steroid, Trauma, Surgery, previous increased IOP, refractive surgery
- PMHx: Lung problems, CHF, heart block, Migraine, DM, HTN/hypotension
- FmHx: Glaucoma
- Meds:
- Allergies:
Cornea History
HPI: Vision change, Irritation/Pain , Photophobia, Epiphora, Redness.
POHx: Trauma, Previous Surgery, CL wear, refractive surgery, chronic steroid or drop use.
PMHx: arthritis? dry mouth? oral ulcers?
FmHx: Glaucoma
Meds:
Allergies:
Neuro History:
Target Key diagnoses with questions depending on presumed diagnosis (ON, GCA, Cav Sinus, Pit Apoplexy, Amaurosis)
HPI: VIPERDT + Proptosis, Pain with EOM, Tinnitus, Headache, Jaw Claudication, Photopsia, Any focal neuro defecits.
POHx: Any previous episodes of TVO, LHermittes, Utoffs
PMHx: Recent Infections? B-Symptoms, CV risk factors
Smoking Hx.
FmHx:
Meds: Depends on History (IIH vs Myesthenia for ex. )
Allergies:
Peds History
HPI: Vision, Irritation, Photophobia, Epiphora, Redness, Diplopia, Trauma **NAI
Pregnancy: (illness, mom’s vaccines)
Birth: (gestational age, NICU stay)
Development: General and Visual
Childs POHx:
Childs PMHx:
FmHx:
Meds:
Allergies:
***CONSIDER RED FLAGS FOR NAI***
Trauma History
Always State ABC’s first! Rule out life threatening injuries and involve necessary teams.
AMPLE:
Allergies, Meds (anti-coags, insulin), Previous Med Conditions, Last meal/Last tetanus, Events around injury.
For Events around injury: Metal? Chemical? Eye protection? Immediate loss of vision?
**All other history POHx, Fam. Hx, Social Hx should be included if time allows **
Trauma Exam
Begin with periorbital trauma: Lids, facial bones, proptosis, swelling and eccymosis
Vision, pressure, pupils, EOM, Conf. Field.
SLE: C/S/K/I/L/AC
DFE: Vit, Disc, Macula, Vessels, Periphery
In perforating trauma: CT, CBC, lytes, Cr, HIV/hepatitis, INR, sickle cell, drug/ethanol level
Signs suggestive of penetrating ocular injury
vs. Diagnostic
Suggestive:
- Full thickness lid lac
- Conj lac
- 360 sub conj hmg and chemosis
- focal iris corneal adhesion
- shallow AC
- iris defect
- hypotony
- lens capsule defect
- acute lens opacity
- VH
- RD
DIAGNOSTIC
- Seidel +
- exposed uvea
- Visible IOFB
- Imaging confirmed IOFB
Examination under Aneasthesia in Peds Patients:
IOP measurement first acounting for decline with prolonged sedation:
Pupils (then dilate with cyclopentolate)
Forced ductions
Measurements: White-to-White/ Pachymetry / NLD
Anterior Segment: (LL/C/S/K/I/L/AC)
Gonio
DFE: (Vitreous/Disc Macula/Vessels/Periphery)
Cycloplegic refraction
Other potential examinations: OCT, B-Scan, A-Scan.
Physical Exam Generic:
For every Patient you MUST SAY….
Vision, Pressure, Pupils, Extra-Ocular Movements and Confrontational fields in everyone!
Then SLE, and DFE.
Peds Physical:
- General Observation and behaviour of child and head tilts or postures.
- Stereo Acuity,
- Vision,
- Pressure,
- Pupils
- Extra-Ocular Movements: Ductions + Versions
- Characterize and Nystagmus
- Cover Testing
- Confrontational fields
- Anterior Segment (LL/C/S/K/I/L/AC)
- Dilated Fundus (Vit/D/M/V/P)
- CYCLOPLEGIC REFRACTION.
Special Circumstances: In infants with nystagmus or query low vision, consider response to light like paradoxical pupils.
Glaucoma Physical
Vision,
Pressure,
Pupils
Pachymetry
Gonioscopy
Confrontational fields
Anterior Segment State: Looking for K spindle, TID’s, PXF. (LL/C/S/K/I/L/AC)
Dilated Fundus (Vit/D/M/V/P)
What are you looking for on your optic nerve exam?
RNFL, PPA, Neuro retinal rim colour and contour (notches or heme), Vasculature calibre, distribution and tortusosity, size of nerve, size of cup, note pallor.
INVESTIGATIONS in all glaucoma cases: Stereo Disc Photos, Visual Field and OCT - optic nerve head.
Cornea Physical
- Vision
- Pressure
- Pupils
- Extra-Ocular Movements
- Confrontational fields
- Pachymetry
Anterior Segment:
- Careful assessment of Lids and Lashes,
- Palpebral and Bulbar Conjunctiva
- Episceral and Sclera
- Corneal Epithelium
- Corneal sensation
- Fluorescein and vital dye staining
- Stroma and Endothelial exam
- Gonioscopy
- Iris
- Lens
Dilated Fundus (Vit/D/M/V/P)
Neuro
General Observation of gait, appearance and language.
Vision,
Pressure,
Pupils - Anisocoria, light/dark, APD
Colour vision/Red Desat.
Extra-Ocular Movements: Pursuit, Saccades, VOR.
Characterize Nystagmus
Cover Testing
Confrontational fields
Anterior Segment (LL/C/S/K/I/L/AC)
Dilated Fundus (Vit/D/M/V/P)
SCREENING NEUROLOGIC EXAM: CN’s, Strength/Sensation/Reflexes and cerebellum.
Uveitis /Retina History
HPI: Vision, Irritation, Redness, Diplopia, Trauma, Floaters / Photopsia, Metamorphopsia, Nyctalopia,
POHx: surgery
PMHx: Hearing loss, In uveitis consider Rheum Review of Systems.
FmHx: AMD, RD
Meds: Chloroquine/ Hydroxychloroquine
Social: IVDU, Smoking, Travel, High risk sexual activity
Allergies:
