history and symptoms CSA

Question 1

why do we take history and symptoms?

Answer 1

1. need to identify any problems
2. ascertain baseline- see what is normal for px - so when they come back later we can see if there are any changes
3. need to ensure appropriate test included
4. establishes good rapport between you and px
5. not miss out any tests if you do history and symptoms in same order all the time
6. need to appear as if you know what you are doing
7. litigation

Question 2

what is open question?

Answer 2

question which there is a lot of answers to it

e.g. How are you?

Question 3

what is closed question?

Answer 3

yes/no or limited choices

e.g. do you wear glasses

Question 4

what is funnel questionning?

Answer 4

you start with an open question and narrow down till you get appropriate response

Question 5

what questions to ask when taking history and symptoms?

Answer 5

. reason for attendance
. current ocular and optical status ( are they wearing glasses , how are the glasses)
. symptoms
. previous ocular history ( family)
. general medical history ( family)
. general health
. medication
. allergies
. lifestyle and occupation

Question 6

what are the 3 categories of symptoms?

Answer 6

. what the Px sees
. what the Px sees in the mirror ( e.g. red eye)
. what the px feels ( e.g. eye is dry )

Question 7

what are typical patient complaints?

Answer 7

. visual 
. pain, ache
. redness, congestion, inflammation
. crustiness, flakes on lids
. lumps, mass, swelling
. eyelid problems
. squint, nystagmus
. visual defects

Question 8

what are the most common symptoms?

Answer 8

. blurred vision at near
. non specific ocular discomfort/fatigue
. burning/tearing of eyes
. blurred vision at distance
. no complaint; 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- sensitive to light
. ocular pain
. loss of vision ( uniocular, binocular and scotomas which patch of vision that is lost in visual field )
. exophthalmos such as thyroid disease ( uniocular or binocular )
. diplopia ( double vision)
. anisocoria - different size pupils
. photopsia ( flashes of light ) and halos
. strabismus
. jumping of words and other difficulties when reading
. chromatopsia - disturbance of colour vision
. vertigo
. foreign body in eye

Question 9

what is a symptom?

Answer 9

symptoms is what the px reports

Question 10

what is sign?

Answer 10

what the optom sees when looking at the back of eye

Question 11

what to do before seeing a px?

Answer 11

.make sure room is tidy and equipment is out

. tell the px where to sit

Question 12

what are general observations to look out for?

Answer 12

. if px is spectacle wearer
. head posture
. lids- ptosis, asymmetry, lesions
. strabismus
. facial asymmetry ( iris and/ or pupil)
. general well-being

Question 13

what can we work out from general observation ( e.g. right eye turning in )?

Answer 13

. right eye has a strabismus
. expect poorer vision in that eye
. RE=amblyopic
. no tests that involve binocularity needed

Question 14

what questions to ask px upon arrival?

Answer 14

1. introductory questions
   . reason for visit
   . last eye examination
2. vision related questions
   . are you having problems with DV with or without RX
   . relate this to normal distance tasks e.g driving

. are you having problems with IV
. check what px does at this distance
e.g. computer

. are you having problems with NV

• check distance they work at
• what tasks are involved
• relates to hobbies and occupation

Question 15

why is it important to recall when last eye examination was?

Answer 15

. to note any changes that may have occured
. e.g. maybe they have become more myopic or hyperopic or astigmatism may have increased
. IOP could’ve increased
. RX could be out of date
. this allows you to determine if changes is normal

Question 16

what is a probing question ?

Answer 16

• question when you are asking about particular things
  e.g. any problems with
  . flashes of light and floaters
  ask this to see if they may have retinal detachment which is associated with high myopia

Question 17

what to do when asking px about floaters ?

Answer 17

. may need to describe to px
. best seen against a bright background
. looking for changes in shape, size or frequency

Question 18

what are FLOADS?

Answer 18

F- frequency 
L- location 
O- onset 
A- association
D- duration 
S- severity

Question 19

how to use floads when asking about blurry vision?

Answer 19

F- how often do you get blurry vision?
L- which eye? what distance? whole of VF?
O- when did this start?
A- is it associated with anything?
D- how long does this blurriness last for ?
S- how severe is this blurry vision?

Question 20

example of probing question ?

Answer 20

.any problems with double vision or headache

. you ask this incase BV probs or tumour

Question 21

what to ask if px has diplopia?

Answer 21

. vertical or horizontal
. monocular or binocular
. sudden onset
. in any position of gaze
. constant or intermittent

Question 22

what question to ask about previous ocular history?

Answer 22

. squint ( strabismus )
. lazy eye ( amblyopia)
. HES- hospital eye service 
. ever worn gls/CLs
. last A/C

• you ask this to know to expect long standing problems such as reduced vision

Question 23

what questions to ask about family ocular history?

Answer 23

. any history of 
. glaucoma
. diabetes
. hypertension
. AMD

• you ask this because certain diseases are more likely with family history
  e.g 10-50% of POAG report a family history
  . siblings with POAG, then 4X more likely
  . parent with POAG, then 2X more likely

Question 24

why to ask about px general health?

Answer 24

• poor general health may be associated with ocular manifestations
• known eye problems associated with certain illnesses
  e. g. Ankylosing spondylitis which is associated with uveitis

Question 25

why to ask px about medication?

Answer 25

• all medication have side effects
• often px do not know what meds are called so recored what they are used for
• some medications affect the eye so need to know to look for them

Question 26

why to ask px about allergies ?

Answer 26

• allergies associated with certain eye conditions

e. g. hayfever, asthma, eczema associated with KC

Question 27

what to ask if px is a driver ?

Answer 27

• type of vehicle
• do they wear glasses to drive?
• should they wear glasses to drive

Question 28

what is driving standard ?

Answer 28

. a letter 79mm high at a distance of 20m and VA must be at least 6/12 (0.5) binocularly

Question 29

why to ask px about occupation ?

Answer 29

. need to know if meet occupational standards or require safety specs

Question 30

what to ask about VDT ( visual display terminal )

Answer 30

. hours /day
. days/week
. viewing distance

Question 31

what are complaints associated with VDT?

Answer 31

. blink rate reduced
. eyes tend to get dry
. reduced eyelid coverage

Question 32

what is asthenopia ?

Answer 32

covers wide range of symptoms such as 
. sore eyes
. tired eyes
. eyes pull
. visual discomfort

Question 33

why to ask about hobbies ?

Answer 33

need to know what advice to offer

Question 34

what to always finish history and symptoms?

Answer 34

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

Question 35

how to avoid litigation ?

Answer 35

. a good history and symptoms and general record keeping can save you from being banned from practicing

Question 36

why do we carry out history ?

Answer 36

. any problems that need addressing
. anything you need to look out for
. any test that you should do