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Optometry > History & Symptoms > Flashcards

History & Symptoms Flashcards

1
Q

What are the Advantages of Electronic Patient Records?

A

1) Avoid problem of illegal record cards.
2) Information from previous test can be uploaded then amended with information from current examination.
3) Record can be linked to digital ocular photography and other equipment.
4) Referral letters easier to produce and print.
5) Reduce the likelihood of lost records which are common with paper records.
6) Alleviates bad handwriting

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2
Q

What are the Disadvantages of Electronic Patient Records?

A

1) Inability to sketch features if desired like a lesion, cataract, fluorescein staining patterns for example.
2) Different types of system require adaptation which can be difficult for locums.
3) Time consuming to scan in old record cards.
4) Fragmented nature of information means it can be difficult to highlight key details,

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3
Q

Case History

A

The first and most important element of an eye examination.

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4
Q

What elements should the Case History include?

A

1) General information
2) Last eye examination and Where
3) Reason for Visit (RFV)
4) Symptoms (Sxs)
5) Ocular history (OH)
6) General health (GH)
7) Family Ocular History (FOH)
8) Family Medical History (FMH/FGH)
9) Occupation, hobbies & Driving

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5
Q

GENERAL INFORMATION

A
  • Date of Eye Examination
  • Title – Mr/Mrs/Miss/Ms/Dr/Prof
  • Surname
  • Forenames
  • Date of Birth – to calculate Age
  • Address – including postcode
  • Telephone No – home, work, mobile
  • GP name & Address
  • Previous Optometrist
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6
Q

General Observation of Px:

  1. Thin, ‘twitchy’
  2. Overweight, ruddy-faced
  3. Abnormal head position
  4. Facial Asymmetry
  5. Eyelids
  6. Eyes
A
  1. Overactive Thyroid = Hyperthyroidism
  2. Hypertension
  3. Binocular Visual Defect
  4. Congenital Anomalies
  5. Lesions, Ptosis, Epiphora
  6. Nystagmus, Strabismus
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7
Q

What other things should you pay attention to?

A
  • Overall physical appearance
  • Mobility
  • Speech, intelligence and Emotional state.
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8
Q

What 3 factors can influence the prevalence of some ocular disorders?

A
  1. Age
  2. Gender
  3. Race
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9
Q

RFV

A

Establishes the Chief Complaint - CC

The examination should attend to this CC as a priority plus any secondary complaints that are mentioned.

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10
Q

What comprehensive approach is best to adopt when conducting H&S?

A

Problem-oriented Approach

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11
Q

Problem-oriented Approach allows you to _______

A
  1. Consider a list of Tentative Diagnoses
  2. Ask more questions and Probe at Differential Diagnosis
  3. Start by asking an Open-ended Question like:
    “Do you have any problems with your vision or your eyes?
  4. Obtain a full description of the CC using LOFTSEA.
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12
Q

What does
LOFTSEA
stand for?

A 
L - Location | Laterality
O - Onset
F - Frequency and Occurrence
T - Type and Severity
S - Self-treatment and its Effectiveness
E - Effect on you
A - Associated and Secondary Sxs
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13
Q

Location | Laterality

If CC is Headache (H/A), Ask ______

If CC is Blurred Vision, Ask _______

If CC is Diplopia, Ask ________

A

“Where does it hurt?”

“Are both eyes affected?”

“Does this happen when you are looking in any particular direction?”

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14
Q

Onset

Ask __________

Ask __________

A

“When did this start happening?”

“Did it occur suddenly or gradually?”

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15
Q

Sudden Onset may indicate _______

A

Serious pathology

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16
Q

Long duration may indicate ________

A

Problem is not having a significant effect on patient due to lack of severity.

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17
Q

Frequency and Occurrence

Ask ___________

Ask ___________

A

“How often does this happen?”

“How long does this last?”

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18
Q

If the problem is of Visual Origin, then they tend to occur….

A
  • When using eyes i.e. reading, watching TV, driving
  • During weekdays more than weekends
  • Starts in the middle of the day and gradually get worse
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19
Q

Type and Severity

If CC is H/A, Ask _________

If CC is Blurred Vision, Ask __________

If CC is Diplopia, Ask ___________

A

“Is it a throbbing/sharp or dull H/A?”

“Is the blur constant or intermittent?”
“Was the vision loss partial or total?”

“If the Double Vision one on top of the other or side by side?”
“Does the Double Vision disappear when one eye is closed?”

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20
Q

Self-treatment and its Effectiveness

Ask __________

Ask __________

A

“Does anything make it go away?”

“How well does this work?”

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21
Q

Medication

A

Note down:

Dosage
How frequently they took it

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22
Q

Effect on Patient

Ask __________

Ask __________

Ask __________

A

“Does this affect how well you can do certain things?”

“Have you been to see your GP about this?”

“Has this restricted your ability to drive?”

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23
Q

The responses to the “Effect on Px” section may….

A

dictate Patient management

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24
Q

Associated or Secondary Symptoms

Ask ___________

A

“Are you having any other difficulties?”

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25
Q

Symptoms

Some Sxs may already have emerged in the RFV.

However, ALL Patients should be Asked:

A
  1. DV and NV
  2. Asthenopia
  3. Headaches
  4. Pain or Burning
  5. Diplopia
  6. Flashes
  7. Floaters
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26
Q

What does Constant DV Blur

indicate?

A

Myopia

Nuclear Sclerosis

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27
Q

What does Intermittent DV Blur

indicate?

A

Young Diabetics

Pseudomyopes

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28
Q

What does Intermittent NV Blur

indicate?

A

Presbyopia

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29
Q

What does DV and NV Blur

indicate?

A

Astigmatism

Pathology

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30
Q

Asthenopia has 2 causes….

A
  1. Visual causes

2. Pathological causes

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31
Q

What are the Visual Causes for Asthenopia?

A
  • Ametropia
  • Accommodative Dysfunction
  • Presbyopia
  • Binocular Anomaly
  • Poor illumination
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32
Q

What are the Pathological Causes for Asthenopia?

A
  • Ocular inflammation

- Retinal Disease

33
Q

When asking about Headaches, what should you follow up with?

A

Are the H/As related to Vision?

34
Q

Vision-related H/As tend to be:

A
  1. Associated with the use of eyes
  2. Mild/moderate, dull, non-throbbing nature.
  3. Located Occipital or Temporal
35
Q

Pain or Burning can commonly be a symptom of _____

A

Dry Eye

36
Q

Ocular Discomfort can also be related to:

A
  • Tear Anomalies
  • Side effect of Medication for Hypertension
  • Associated with Arthritis
  • Ocular Inflammatory Conditions
37
Q

What should you ensure when asking about Diplopia?

A

Patient is aware of the difference between Double Vision and Blurred Vision.

38
Q

How can you confirm this?

A

“Do you see two of everything or does everything seem blurred?”

39
Q

If Diplopia, Ask _________

A

“Does the double vision disappear when one eye is closed?”

40
Q

If yes ______-

A

then Binocular Diplopia

41
Q

Pathological / Traumatic Diplopia is most often

A

Vertical

42
Q

What are Floaters?

A

Normal age-related change that occurs when the Vitreous liquefies and shrinks, creating visible microscopic fibres.

43
Q

Flashes or also called _______-

A

Photopsia

44
Q

OH

Comprised of:

A
  • Present refractive correction
  • Spectacles
  • Contact lenses
  • Lower Visual Aids (LVA) e.g. magnifying glass
  • Previous eye treatment
  • Injuries, infections, surgery, treatment like patching, squint surgery
  • Last eye examination (LEE)
45
Q

What are 2 important questions to ask in Ocular History?

A

“Have you ever had any eye injuries, infections, surgery or any other treatment?”

“Have you ever had vision training or eye patching?”

46
Q

GH

Comprised of:

A
  1. Medical History
  2. Medication
  3. Allergies & Hypersensitivities
47
Q

For Medical History what are the 2 most important conditions that need to be asked about?

A
  1. Diabetes

2. Hypertension

48
Q

Clinical relevance in Medical History

A

Systemic Diseases such as:

Diabetes (IDDM & NIDDM)

Hypertension (↑BP)

Arthritis

Thyroid disorders have Ocular Manifestations.

49
Q

Medication

Key Question, Ask ______

A

“Are you taking any medicines, eyedrops or pills?”

  • Px may NOT consider that drops that whiten the eyes, hay fever pills or birth control pills are medication.
50
Q

Clinical relevance in Medication

A

Many systemic medications can have ocular side effects or may interact with the topical diagnostic drugs Optometrists use.

51
Q

Give examples of how Systemic Drugs may affect the eyes:

A

Beta-blocker prescribed for Systemic Hypertension can cause Dry eyes which will have implications for successful CLW.

Oral Corticosteroids can cause Posterior Subcapsular Cataracts.

Topical eye drops for Hayfever will have implications for CLW and should be instilled at least 20 minutes before lens insertion.

52
Q

What is the key relationship when it comes to Medication?

A

 Typically, the higher the dosage of the drug and the longer the patient has been taking it, the more likely there are adverse ocular effects.

53
Q

What 2 Questions should you ask in Allergies?

A

“Do you suffer from any allergies?”

“Have you ever had a bad reaction to medicine or eye drops?”

54
Q

Clinical relevance in Allergies & Dry Hypersensitivity

A

Allergies can cause eye irritation and influence tolerance to CLs.

Drug Hypersensitivity may occur with topical diagnostic drugs used by Optometrists.

55
Q

What 3 things should you be aware of in Drug Hypersensitivity?

A
  • Dilation drops
  • Diagnostic dyes
  • Local Anaesthetics
56
Q

FOH

A

“Has anybody in your family had any eye problems such as lazy eye or Glaucoma?”

57
Q

Clinical Relevance in Family Ocular History

A

Some eye abnormalities are inherited:

The prevalence of Strabismus:

  • Increases if one parent has strabismus
  • Increases again if both parents have strabismus
  • TRIPLES
  • The prevalence of Primary Open Angle Glaucoma (POAG): increases if a parent or sibling has POAG
58
Q

FMH

A

“Has anybody in your family had any medical problems such as high blood pressure or Diabetes?”

59
Q

Clinical Relevance in Family Medical

History

A

Some systemic diseases that show ocular manifestations are hereditary.

The prevalence of Hypertension:

  • Increases if one parent has hypertension
  • Increases again if both parents have hypertension
  • TRIPLES

The prevalence of NIDDM:

  • Increases if one parent has NIDDM
  • Increases again if both parents have NIDDM
  • Increases if a sibling has NIDDM
60
Q

IDDM

A

Insulin Dependent Diabetes Mellitus

61
Q

NIDDM

A

Non-Insulin Dependent Diabetes Mellitus

62
Q

Type 1 Diabetes =

A

IDDM

63
Q

Type 2 Diabetes =

A

NIDDM

64
Q

Other

Ask _______

A
  • “What is your Occupation?”
  • “Do you have any Hobbies?”
  • “Do you play sports regularly?”
  • “Do you drive?”
  • “Do you smoke?”
  • “Do you use the VDU?”
65
Q

Clinical Relevance for Other

A

Need to establish patients Visual demands like:

Do they need:

  • Safety eyewear
  • CLs
  • Separate Spex
66
Q

Smoking is the strongest environmental risk factor for ____

A

ARMD

67
Q

 Record positive and negative Px responses:

A

From legal viewpoint, no recorded response means question not asked.

68
Q

If the cause of the CC is not determined, then present your negative findings in a positive manner.

A

For example, non-ocular headaches:

“I do not believe your headaches are due to a problem with your eyes or vision, Mr Wiggins.
Your eyesight is excellent and there is no need for glasses/change in glasses, your eye muscles and focusing muscles are all working normally and are working well together and there is no sign of eye disease from any of the tests that I have performed.”

69
Q

Myodesopsia

A

Perception of Floaters

70
Q

Reduced Vision

A

Transient loss of vision

71
Q

What would you associate with Visual Migraine?

A
  1. Lasts 10-30minutes
  2. Dark spot in vision which moves and grows
  3. Zigzagging lines
  4. Binocular
72
Q

Which Peripheral Degeneration is pre-disposing for Retinal Detachment?

A

Lattice Degeneration

73
Q

What advice should you give a patient with a recent-onset PVD?

A
  • PVD is a normal occurence with Aging
  • It is caused by Vitreous Syneresis
  • This causes the Vitreous to pull away from its attachment creating a new floater.
  • In very rare cases, the vitreous can cause a retinal tear when it pulls away.
  • You are at higher risk of this for 6 weeks following a PVD.
  • The warning signs of a RD are continually increasing floaters.
  • Increasing flashing lights in your vision
  • And a curtain or vein coming over your vision.
  • If you experience these Sxs you need to ensure you seek medical attention so its investigated within 48hrs.
74
Q

How can glare reduce Visual Acuity?

A
  • Reduction of brightness of the rest of the scene by constriction of the pupils.
  • Reduction in contrast of the rest of the scene by scattering of the bright light within the eye.
  • Reduction in contrast caused by scattering light in particles in the air.
  • Reduction in contrast by reflection of bright areas on the surface of a transparent medium e.g. glass, plastic, water = Veiling glare
  • Bloom surrounding objects in front of glare.
75
Q

Transient Visual Obscurations (TVOs)

A

These are often described as momentary grey spots, or a dimming or blackout of vision that occur in one or both eyes, especially after a change in position (such as standing up from a seated position).

76
Q

Postural Hypotension / Hypertension:

A

A condition in which a person’s blood pressure drops/increases abnormally when they stand up after sitting or lying down.

77
Q

General health:

Ideal Answer

A 
Fit and well. 
No diagnosed systemic conditions. 
No cardiovascular or metabolic disorders (i.e. no diabetes). 
No allergies. 
No medication.
78
Q

In general, vision loss can be caused by the following:

A
  1. Refractive error.
  2. Binocular vision anomalies (strabismic and non-strabismic).
  3. Opacities of the ocular media.
  4. Central retina disorders.
  5. Optic nerve disorders.
  6. Intracranial disorders that impact on the visual pathway.
79
Q

Temporal Artiertitis Sxs:

A
  1. Jaw Claudication
  2. Malaise
  3. Scalp tenderness
  4. Polymyalgia Rheumatica
  5. Temporal Headaches - Persistent
  6. Vision loss or Diplopia

Optometry (41 decks)

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