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Clinical Skills Year 2 > History & Symptoms - CSA > Flashcards

History & Symptoms - CSA Flashcards

1
Q

Why do we bother taking history and symptoms?

A

First off we don’t know anything about the patient

Need to identify any problems

Ascertain a baseline - find out what is normal for them.

Need to ensure proper tests are included - (if you do the tests in order of history and symptoms you won’t miss any tests out)!

Establishes a good rapport

Makes you appear as if you know what your doing

For the sake of litigation

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2
Q

What is an open question?

A

A question where the answer cannot simple be yes or no. There is no limited choice on response.

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3
Q

What is a closed question?

A

A question where the answer can only be yes, no or limited responses.

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4
Q

What is funnel questioning?

A

Where you start with an open question.
Response
Then narrow question done.
Then get your response.

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5
Q

What information are you looking to record for history and symptoms of a patient?

A 
Reason for attendance 
Last eye examination
Current optical and optical status
Symptoms
Previous ocular history
Ocular history (family)
General medical history (family) e.g. Diabetes
General Health 
Medication 
Allergies 
Lifestyle and Occupation
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6
Q

What are the three categories of symptoms?

A

What the patient sees or doesn’t see
What the patient sees when they look in the mirror
What the patient feels

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7
Q

What are typical patient complains?

A 
Visual complaints 
Pain, Ache 
Redness, Congestion , Inflammation
Crustiness, flakes on lids
Lumps, mass, swelling
Eyelid problems
Squint, nystagmus
Visual defects
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8
Q

What are the most common reasons patients will come to see you in practice?

A

In order of most common:

Blurred vision at near
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
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9
Q

What are the most common symptoms in order of frequency?

A 
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)
Diplopia (Double vision)
Anisocoria
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
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10
Q

What is the difference between a symPtom and sign?

A

symPtom —> what the Patient sees

sign—> what the optometrist sees

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11
Q

What are general rules for when you see patients?

A 
-Treat as would like to
be treated
• People older than you
call Mrs X
• Dress appropriately
• From a patients POV: Sharper suit = better eye test
• Harder to sue if like you
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12
Q

What should you do when you enter the treating room?

A

Make sure room is tidy.

Equipment is all out and turned on.

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13
Q

When a patient comes in what must you do?

A

Guide the patient to where you want them to sit.
“Take a seat in the big black chair”.

Observe the patient when they walk in.

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14
Q

What general observations should you make of the patient upon first meeting?

A
  • Whether they are a Spectacle wearer
  • Head posture - are they tilting their head to guide themselves towards the chair when they walk in
  • Lids – ptosis, asymmetry, lesions
  • Strabismus
  • Facial asymmetry (iris and/or pupil e.g. anisocoria )
  • General well-being
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15
Q

What is anisocoria?

A

Unequal pupil sizes

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16
Q

What can we work out from the general observation of a right eye that turns in?

A

Right eye has strabismus.
Would expect poorer vision in the right eye.
Right eye is amblyopic (unable to focus as well - lazy eye)
No tests that involve binocularity are needed.

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17
Q

How can a stroke affect vision?

A

It could leads to double vision or even hemianopsia.

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18
Q

What may be reasons for visit?

A 
Perhaps more than one reason
Reason for visit
Crucial information
Reminder/normal interval
Visual problems
Dispensing problems - they can't see out of the pair of glasses they were prescribed.
Headaches
Preventative e.g. for child
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19
Q

Why is it important recall when the last eye examination was?

A

So you can record any changes that have occurred e.g:

Myopia, astigmatism, hyperopia
Cataract
IOP
Presbyopia etc
Rx out of date

This allows you to determine whether that change from last eye appointment is normal

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20
Q

What kind of questions do you start talking to a patient with?

A

Introductory questions e.g:

• Hello. Why have you
come to see me today?
Are you having any
problems?
• When was your last eye test?
- Are you having an problems?
21
Q

After asking introductory questions what type of questions do you want to ask next and make note of?

A

Vision related questions in order:

• Ask if they have any problems with:
• Distance Vision with or without Rx
• Relate this to normal distance tasks
e.g. driving, TV, cinema etc

• Ask if they have any problems with:
• Intermediate Vision
• Check what Px does at this distance
e.g. computer and music

• Ask if they have any problems with:
• Near Vision
• What distance that they work at?
• What near tasks are involved?
•

Ask what their hobbies and occupation are and relate this to their vision.

22
Q

What is important to remember when asking vision related questions to patients?

A

Their answers are subjective (a.k.a subjective appraisal) thus they may have poor vision in one eye but may not have noticed because its in their ‘non dominant’ eye.

23
Q

If a patient had a problem with intermediate vision by asking what they do at this distance what can you determine?

A

You can determine how to prescribe them according to what would best suit what they do at this vision and how regularly (e.g. lifestyle and ocupation).

Depending on this you would either prescribe
Bifocals
Varifocals
Or two separate glasses - one for near vision and one for distance vision.

24
Q

After asking introductory questions and vision related questions, what questions will you ask next?

A

Probing questions- a question where you are asking about a particular thing e.g:

• Any problems with:
• Flashes of light
• Floaters
• Why ask?
• Retinal detachment
• Associated with high
myopia
25
Q

Why ask probing questions such as whether they see flashes of light or floaters?

A

You are looking to see if they have any conditions wrong with their eye.

For example flashes of light and floaters may be indications of retinal detachment - (which is associated with high myopes).

26
Q

When asking about things such as floaters you may need to explain to your patient what these are- how would you describe this?

A

Dark small shadowy shapes that cloud your vision (best seen against a bright background.

27
Q

What are you looking for in regards to floaters?

A

Small number of floaters is normal.

You are looking to record if there is any change in size, shape or frequency of floaters.

28
Q

If a patient answers yes to any question regarding visual problems then how do we follow up?

A

FLOADS.

We ask (and note) the following:

F-Frequency (e.g. how often does this occur? )
L- Location (e.g. which eye? what distance?)
O- Onset - (e.g. when did it start?)
A- Association - ( Does it happen when wearing glasses or without?)
D- Duration ( How long does it last?)
S-Severity (e.g. how severe is it?)

29
Q

Why ask probing questions to do with headaches and double vision?

A

To prompt checking for:

Binocular Vision problems
Tumour
Vascular problems

30
Q

If you have confirmed double vision what should be the next line of questioning in regards to this diplopia ( after FLOADS has already been done)?

A 
Is it Vertical or horizontal?
• Monocular or binocular?
Sudden onset?
• Associated with any position of gaze?
• Constant or intermittent
(phoria decompensating)?
31
Q

What examples of questions to we ask in regards to ocular history?

A

Whether there is any history of:
• Squint (strabismus)
• Lazy eye (amblyopia)
• Ever had treatment at the hospital eye service
• Ever worn glasses/CLs
• If they have worn contact lenses you need to check when their last after care was - ( should be six months)

32
Q

Why do we ask ocular history questions?

A

We want to know whether we should be expecting any problems due to ocular history.

You also want to ask so you can know about any previous tendencies for things such as conjunctivitis.

33
Q

What examples of questions should you be asking in regards to family history?

A
  • Whether there is any history of:
  • Glaucoma
  • Diabetes
  • Hypertension
  • AMD
  • Any other eye disease
34
Q

Why do we ask about family history?

A

• Certain diseases more likely with certain family
histories e.g:

• 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

35
Q

Why ask about general health?

A

Poor general health may be
associated with ocular
manifestations

36
Q

What is an example of a health condition that is associated with an eye condition?

A 
E.g. 
Ankylosing spondylitis ( a type of arthritis) is associated with uveitis.
37
Q

Why do we ask about medication?

A

All medication has side effects - some of them affect the eye.

38
Q

What do you do if a patient doesn’t know the name of a drug?

A

Ask them what it is for

39
Q

Why ask about allergies?

A

Some allergies are associated with certain eye
conditions
• E.g hayfever, asthma, eczema are
associated with Keratoconus (KC)

40
Q

What is an important lifestyle question to ask adults?

A

Whether they are a driver and whether they wear glasses to drive.

41
Q

What are the driving standards for vision?

A

The patient must be able to read a letter 79mm high at a distance of 20m AND have a VA of at least 6/12
(0.5) binocularly!

42
Q

What lifestyle and occupational questions may we ask and why?

A

What the patients occupation is- this lets us know if perhaps the patient needs to be prescribed safety specs. Some jobs have visual standards that must be met.

Hobbies

Whether a patient is using a Visual Display Terminal (VDT) basically a screen of any type.

43
Q

In regards to a Visual display terminal (VDT) what must you follow up and ask?

A

How many :

  • Hours per day it is used
  • How many Days per week it is used

At what Viewing distance is it used?

44
Q

What advice do we offer to people that use VDTs a lot?

A

Remind them to always keep blinking as VDTs reduce blink rate- as a result eyes get dry. This makes eyes feel sore and dry.

The fact that when something is straight on you have reduced eyelid coverage. When you read ur eyelid covers more of your eye leading to less dryness.

Remind them that the employee is entitled to free eye tests from the employer if they would like them.

45
Q

What is asthenopia?

A

A broad term that covers the following terms:

  • sore eyes
  • tired eyes
  • eyes pulling
  • visual discomfort
  • (essentially eye fatigue symptoms)
46
Q

Why do we ask about VDTs?

A

To know what advice to offer

47
Q

What question should you always finish history and symptoms with and why?

A

‘Is there anything else I should know about your eyes?’

We ask this question to cover ourselves in litigation and in case you forgot to ask something.

48
Q

If you don’t record a response what is assumed?

A

That you didn’t ask the question- so always record responses!

49
Q

What are the consequences of poor litigation?

A

Can result in you being banned from practising.

Clinical Skills Year 2 (20 decks)

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