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Clinical skills year 2 > History and Symptoms > Flashcards

History and Symptoms Flashcards

1
Q

Why do we need to bother with history and symptoms

A
  • Know nothing about person in room
  • Need to identify and problems
  • Ascertain baseline - decide what is normal for them and if they come back later, we can see what was normal for them and if anything has changed
  • Need to ensure appropriate tests included
  • Establishes a good rapport
  • Must not miss out on any tests - If you do history and symptoms in same order it makes sure you don’t miss out on any tests
  • Need to appear as if you know what you are doing
  • Litigation – record cards clear and complete
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2
Q

What is important when taking history and symptoms

A
  • Keen an open mind
  • Complete thorough history and identify any symptoms px experiencing
  • Don’t just focus on 1st thing they tell you
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3
Q

Open questions

A
  • Open questions has a lot of responses that can be given by px
  • Lot of information about what sort of person your px is
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4
Q

Closed questions

A
  • Yes/no

- Limited choice

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5
Q

What is funnel questioning

A

Start with open question

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6
Q

What is included in history and symptoms

A
  • Reason for Attendance
  • Current ocular and optical status – do they wear glasses and if so how are those glasses
  • Symptoms
  • Previous Ocular History
  • Ocular History (Family)
  • General Medical History (Family) - are there diseases such as diabetes which can affect the eyes
  • General Health
  • Medication
  • Allergies
  • Lifestyle and Occupation - – job and what they do for a living
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7
Q

What are the 3 categories of symptoms

A
  1. What the px sees - .g if look in distance and its blurry
  2. What the px sees in the mirror e.g he looked in the mirror and eye was red
  3. What the px feels e.g eyes dry
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8
Q

What are examples of typical visual complaints

A
  • Visual = not seeing so well
  • Pain, ache
  • Redness, congestion, inflammation
  • Crustiness, flakes on lids
  • Lumps, mass, swelling
  • Eyelid problems
  • Squint, nystagmus
  • Visual defects
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9
Q

What are the symptoms in order of frequency

A
  • Blurred vision at near = presbyopia = = most common reason someone come in to practise
  • Non specific ocular discomfort/fatigue
  • Burning/tearing of eyes
  • Blurred vision at distance
  • No complaint: request for routine check up/ new frame
  • No complaint: Broken/lost glasses
  • Headache (no ocular association)
  • Headache (with ocular association)
  • Conjunctivitis, blepharitis (crusting and flaking)
  • Lid twitching; itchy eyes - Photophobia
  • Ocular pain
  • Loss of vision (uniocular, binocular, and scotomas)
  • Exophthalmos (uniocular or binocular) = thyroid eye disease
  • Diplopia (Double vision)
  • Anisocoria = different sized pupils
  • Photopsia (flashes of light) and halos
  • Strabismus
  • Jumping of words and other difficulties when reading =Meares Irlen Syndrome
  • Chromatopsia (Disturbance of colour vision)
  • Vertigo
  • Foreign body in eye
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10
Q

What is a symptom and examples

A
  • What the px reports and tells you
  • e.g tunnel vision, difficulty going out at night, normal vision, night blindness, difficult reading, difficulty recognising faces
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11
Q

What is sign

A
  • What the optom sees when look back of eye e.g AMD

* Get out opthalmoscope and look at back of eye

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12
Q

What are general rules when taking history and symptoms

A
  • Treat as would like to be treated
  • People older than you call Mrs X
  • Dress appropriately
  • Sharper suit = better
    eye test
  • Harder to sue if like you
  • Setting the stage:
    •Make sure equipment is out, area is clean and tidy
    •Direct px where you want them to sit
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13
Q

What are general observations when taking history and symptoms

A 
- Spectacle wearer
• Head posture
•  Lids – ptosis, asymmetry, lesions
•  Strabismus
•  Facial asymmetry
(iris and/or pupil)
•  General well-being
•Squint 
•Right eye turning in
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14
Q

What are examples of reasons for visit

A
  • Crucial information
  • Perhaps more than one reason
  • Reminder/normal interval
  • Visual problems
  • Dispensing problems
  • Headaches
  • Preventative e.g. for child
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15
Q

Why is looking at last eye test important

A
  • Changes that may have occured
  • Myopia, astigmatism, hyperopia
  • Cataract
  • IOP
  • Presbyopia etc
  • Rx out of date
  • Able to determine if change is normal
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16
Q

What are introductory questions when taking history and symptoms

A
  • Start with open question:
    • Hello. Why have you come to see me today? Are you having any problems?
    • When was your last eye test?
17
Q

What are vision related questions when taking history and symptoms

A

Any problems with:
• DV qualify with or without Rx
• Relate this to normal distance tasks e.g. driving, TV, cinema etc
• Subjective appraisal
• Poor vision in one eye may not have been noticed especially in ‘non-dominant’ eye

Any problems with:
• IV
• Check what Px does at this distance e.g. computer and music
• Dispensing considerations •Bifocals
• Varifocals
• Single vision for DV and NV

 Any problems with: 
•  NV
  •  Distance that they work at
  •  What near tasks are involved?
  •  Relates to hobbies and occupation 
  •  Myopes
  •  Hyperopes
18
Q

History and symptoms - probing questions

A 
Any problems with: 
• Flashes of light
•  Floaters
Why ask about flahses of light or floaters
• Retinal detachment
• Associated with high myopia
Any problems with: 
- Double vision
- Headaches
Why ask about headaches or double vision:
- Binocular vision problems
- Tumour
- Vascualr problems
19
Q

Floaters

A 
- May need to describe to Px
•  Best seen against a bright
background
•  Small numbers normal
•  Looking for a change in shape, size or frequency
20
Q

What routine can be used for follow up questions:

A

FLOADS
F = Frequency = how often
L = Location - which eye, where about
O = Onset = when did it start
A = Association = is it associated with anything
D = Duration = how long does it last for
S = Severity = how servere is it

21
Q

When do you use FLOADS and ask follow up questions

A

If px says yes to probing questions i.e any problems

22
Q

Give example of FLOADS for blurry vision

A
  • FREQUENCY = how often do you get blurry vision?
    = Constant without gls
  • LOCATION = Which eye? What distance? Whole of visual field?
    = Both eyes, distance, whole of visual field
  • ONSET = When did this start? Six months ago
  • ASSOCIATION = Is it associated with anything?
    =Not wearing my glasses
  • DURATION = How long does this blurriness last for?
    = Til I put specs on
    SEVERITY = How severe is this blurry vision?
    =Blind as a bat
23
Q

Follow up questions for diplopia

A
  • Vertical or horizontal?
  • Monocular or binocular?
  • Sudden onset?
  • In any position of gaze or only when look up to right
  • Constant or intermittent (phoria decompensating)?
24
Q

Previous ocular history

A 
Any history of:
•  Squint (strabismus)
•  Lazy eye (amblyopia) 
•  HES = hospital eye service 
•  Ever worn gls/CLs
•  Last A/C = aftercare 
Why ask?
•  Know to expect long standing prob
such as reduced vision
•  Know about previous operations or
tendencies for things such as conjunctivitis
25
Q

Family ocular history

A 
Any history of: 
•  Glaucoma
•  Diabetes
•  Hypertension
•  AMD
•  Any other eye disease

Why ask?
•Certain diseases more likely with family hx
•10 – 50% of POAG ( Primary Open Angle Glaucoma ) patients report a family history
•Sibling with POAG, then 4X more likely
•Parent with POAG, 2x as likely

26
Q

General Health

A
  • Poor general health may be associated with ocular manifestations
  • Ankylosing spondylitis = form of arthritis associated with uveitis

Why ask?
• Known eye problems associated with certain illnesses e.g. HLA B27 = tissue type for ankylosing spondylitis

27
Q

Medication

A
  • All medications have side effects
    • Often Pxs do not know what meds are called so record what used for

Why ask?
• Some of these affect the eye
• Need to know to look for them

28
Q

Allergies

A

• Allergies associated with certain eye conditions

Why ask?
• Allergies associated with certain eye conditions
• E.g hayfever, asthma, eczema associated with keratoconous

29
Q

Driver

A 
- Type of vehicle
•  Do they wear glasses to
drive?
•  Should they wear glasses to drive?
•  A letter 79mm high at a distance of 20m AND VA must be at least 6/12 (0.5) binocularly
(1st May 2012)
30
Q

Occupation

A

Why ask?
Need to know if meet
occupational standards or require safety specs

31
Q

What are requirements for police officer:

A
  • Unaided Vision 6/36 Binocularly
    • Corrected VA
    6/12 in either eye and 6/6 Binocularly
    • Near VA (corrected) N6 at 40cm Binocularly
    • Refractive Surgery
    Yes if the visual standards are met.
    • Colour Vision
    Yes but will need to “be aware of the deficiency and make appropriate adjustments”.
    • Other
    History of Detached Retina or Glaucoma is not acceptable.
32
Q

VDT = visual display terminal

A
  • Hours/day
  • Days/week
  • Viewing distance
Why ask?
Need to know what advice to offer
- Blink rate reduced
•  Eyes tend to get dry
•  Reduced eyelid coverage
•  Employer requires eye check
33
Q

Asthenopia

A
  • Sore eyes
    • Tired eyes
    • Eyes pull
    • Visual discomfort
34
Q

Hobbies

A
  • Sport - CL’s?
  • Painting - intermediate?
  • Music
  • Computing

Why ask?
Need to know what advice to offer - glasses

35
Q

What do you finish with in history and symptoms

A

• Is there anything else I need to know about your eyes?

Why ask?
• To cover you in case of litigation
• If you forget to ask something

36
Q

Litigation

A
  • A good history and symptoms and general record keeping can save you from being banned from practicing.
  • A poor history and symptoms can result in finding another career.1
37
Q

What should the order of history and symptoms be like

A
  • Make sure you have a logical order for your Hx and symptoms
    • Not recorded means not done
    • Do NOT write “No family hx” or “No BP”
    • Recognise that this is a template from which to build
    • Recognise that other areas will require a different approach and set of questions
    • Contact lenses
    • BV
    • Visual impairment

Clinical skills year 2 (3 decks)

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