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Clinical Skills H > History and symptoms and record keeping > Flashcards

History and symptoms and record keeping Flashcards

1
Q

Why would you carry out history & symptoms on a patient (list 8 main points)

A
  • know nothing about the person in your room
  • need to identify any problems
  • ascertain baseline
  • need to ensure appropriate tests included
  • establishes a good rapport
  • must not miss out any tests
  • need to appear as if you know what you are doing
  • litigation
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2
Q

Give an example on an open question

A

How are you today?

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3
Q

why would you ask open questions

A

you can learn a lot about a px with the variable answers they can give

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4
Q

give an example of a closed question and possible answers

A

is your name rose bush? yes/no limited choices

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5
Q

what are the three steps to funnel questioning

A
  • start with an open question
  • narrow question down
  • response
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6
Q

list the 10 topics needed to be completed in history and symptoms

A
  • reason for attendance
  • current ocular and optical status
  • symptoms
  • previous ocular history
  • family ocular history
  • general family medical history
  • general health
  • medication
  • allergies
  • lifestyle and occupation
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7
Q

list the 3 categories of symptoms

A
  • what the px sees
  • what the px sees in the mirror
  • what the px feels
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8
Q

list the 8 different types of typical patient complaints

A
  • visual
  • pain, ache
  • redness, congestion, inflammation
  • crustiness, flakes on lids
  • lumps, mass, swelling
  • eyelid problems
  • squint, nystagmus
  • visual defects
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9
Q

list the 22 most frequent symptoms in order of frequency, stated by Borish 1970

A
  • blurred vision at near (presbyopia)
  • non-specific ocular discomfort/fatique
  • 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, belpharitis (crusting and flaking)
  • lid twitching: itchy eyes
  • photophobia
  • ocular pain
  • loss of vision - uniocular, binocular and scotomas
  • exophthalmos/swollen eye - uniocular or binocular
  • diplopia/double vision
  • anisocoria - different size pupils
  • photopsia/flashes of light & haloes
  • strabismus
  • jumping of words and other difficulties when reading - placing colour light can improve or worsen the movement
  • chromotopsia - disturbance of colour vision
  • vertigo
  • foreign body in eye
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10
Q

what is a symptom

A

what the patient reports

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11
Q

what is a sign

A

what the optom sees e.g. fund photo, what px can’t see

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12
Q

list 5 general rules which should be considered as an optom

A
  • treat as you would like to be treated
  • people older than you call Mrs X
  • dress appropriately
  • sharper suit = better eye test
  • harder to sue if you like
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13
Q

what 6 general observations on a px should you carry out as an optom

A
  • spectacle wearer
  • head posture
  • lids - ptosis, asymmetry, lesions
  • strabismus
  • facial asymmetry - iris and/or pupil
  • general well-being
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14
Q

what 4 things can you work out from a general observation such as a px’s ‘right eye turning in’

A
  • right eye has a strabismus
  • would expect poorer vision in that eye
  • RE = amblyopic
  • no tests that involve binocularity needed
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15
Q

from general observations from a px that has these clues, what can you work out:

  • wheelchair
  • left leg larger than right
  • left arm in spasm
  • right arm appears to be working
  • left leg does not appear to be working
A
  • px restricted to wheelchair
  • left hand non functioning
  • left leg larger than right leg so…prosthesis?
  • left paralysis
  • stroke
  • vision = left sided hemianopia
    (can only see one side)
  • concentration..poor?
  • communication difficulties - left side paralysis so speech should be fine?
  • need to order tests
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16
Q

what can you tell by a px with these general observations:

  • normal head posture
  • eyes straight
  • looks healthy
A
  • not expecting to find anything wrong

- full set of tests needed

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17
Q

give 6 examples of outcomes you can get from asking a px their reason for visit

A
  • crucial information
  • perhaps more than one reason
  • reminder/normal interval
  • visual problems
  • dispensing problems
  • headaches
  • preventative e.g. for child, if other child has e.g. a squint etc
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18
Q

give 7 benefits/pieces of information that can be obtained from knowing when a px had their last eye examination

A
  • changes that may have occurred
  • myopia, astigmatism, hyperopia
  • cataract
  • IOP
  • presbyopia etc
  • rx out of date
  • able to determine if change is normal
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19
Q

what points should be considered when asking a px if they have any problems with DV

A
  • 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
20
Q

what points should be considered when asking a px if they have any problems with IV

A
  • check what px does at this distance e.g. computer and music
  • dispensing considerations - bifocals, varifocals, single vision for DV and NV
21
Q

what points should be considered when asking a px if they have any problems with NV

A
  • distance that they work at
  • what near tasks are involved
  • relates to hobbies and occupation
    myopes
    hyperopes
22
Q

give 2 examples of probing questions in history and symptoms, and state why you would ask these in particular

A

any problems with…

  • flashes of light
  • floaters

ask because…

  • retinal detachment
  • associated with myopia
23
Q

what things need to be thought about when dealing with flashes

A
  • may need to describe to px
  • best seen against a bright background
  • small numbers normal
  • looking for changes in shape, size or frequency
24
Q

list the meaning of FLOADS

A
  • frequency
  • location
  • onset
  • association
  • duration
  • severity
25
Q

give 4 examples of probing questions in history and symptoms, and state why you would ask these in particular

A

any problems with…

  • flashes of light
  • floaters
  • double vision
  • headaches

for flashes of light & floaters ask because…

  • retinal detachment
  • associated with myopia

for double vision and headaches ask because…

  • BV probs
  • tumour
  • vascular probs
26
Q

which further questions should you ask, when a px reports that they get diplopia

A
  • vertical or horizontal
  • monocular or binocular
  • sudden onset
  • in any position of gaze
  • constant or intermittent (phoria decompensating?)
27
Q

what 5 points need to be covered when asking about previous ocular history and state why you would ask

A
  • squint
  • lazy eye
  • HES
  • ever worn glasses/CLs
  • last A/C

asked because…

  • know to expect long standing prob such as reduced vision
  • know about previous operations or tendencies for things such as conjunctivitis
28
Q

what 5 points need to be covered when asking about family ocular history and state why you would ask

A
  • glaucoma
  • diabetes
  • hypertension
  • AMD
    = closed questions
  • any other eye diseases = open question

asked because…

  • certain diseases more likely with family history
  • 10-15% of POAG patients report a family history
  • sibling with POAG, then 4x more likely
  • parent with POAG, then 2x more likely
29
Q

why ask about general health

A

poor general health may be associated with ocular manifestations e.g. ankylosing spondylitis

30
Q

what points need to be considered when asking about medication and state why you would ask if they’re on medication

A
  • all medicines have side effects
  • often pxs do not know what meds are called so record what used for

asked because…

  • some of these affect the eye
  • need to know to look for them
31
Q

why do we need to ask if a px has any allergies

A

allergies are associated with certain eye conditions e.g. hay fever, asthma, eczema associated with KC

32
Q

what points need to be considered for a px who is a 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 atlas 6/12 (0.5) binocularly
33
Q

why do you need to ask a px of their occupation

A

need to know if meet occupational standards or require safety specs

34
Q

what is the unaided vision standards for the police

A

6/36 binocularly

35
Q

what is the corrected visual acuity standards for the police

A

6/12 in either eye and 6/6 binocularly

36
Q

what is the corrected near visual acuity standards for the police

A

N6 at 40cm binocularly

37
Q

what is the refractive surgery standards for the police

A

yes if the visual standards are met

38
Q

what is the colour vision standards for the police

A

yes can have colour vision anomalies, but will need to be aware of the deficiency and make appropriate adjustments

39
Q

what other standards for the police should be known

A

history of detached retina or glaucoma is not acceptable

40
Q

what 3 things should be asked about VDU

A
  • hours/day
  • days/week
  • viewing distance
41
Q

why should you ask things about VDU

A

need to know what advice to offer

42
Q

why is it important for a px who uses the VDU to get their eyes checked

A
  • blink rate reduced
  • eyes tend to get dry
  • reduced eyelid coverage
  • employer requires eye check
43
Q

what symptoms are described with asthenopia

A
  • sore eyes
  • tired eyes
  • eyes pull
  • visual discomfort
44
Q

why would you ask a px of their hobbies

A

need to know what advice to offer

45
Q

what question should you always finish with once completed history and symptoms and why

A

is there anything else i need to know about your eyes?

because. ..
- to cover you in case of litigation
- if you forget to ask something

Clinical Skills H (18 decks)

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