Visit 2 Flashcards
8i
what does migraines present as
- FH
- Unilateral
- Pulsating Pain
- Lasts few hours – days
- Photophobia
- Phonophobia
- Fatigue
- Neck Stiffness
- Blurred Vision
- May have associated aura:
o Zigzaged lines
o Flashing Lights/Spots/Lines
o Loss of Vision
o Scotoma
o Pins and Needles - Numbness
- may have trigger
what do tension HAs present as
- Bilateral
- Pressing/Tightening
- Mild-Moderate Intensity
- Most common HA
- Constant ache that affects both sides of the head – may also feel the neck muscle tighten and a feeling of pressure behind the eyes
- Not normally severe enough to prevent you doing everyday activities
- Can develop at any age – more common in teenagers and adults (women more than men)
- Chronic tension-type headache
o >15x a month for at least 3/12 in a row
what do cluster HAs present as
- Short Lasting: 15-3hrs
- Severe Pain
- Unilateral
- Neuralgiform Headache
- Conjunctival Injection, Lacrimation or nasal congestion
- Sweating
- Miosis
- Ptosis
- Lid Oedema
- Typically affects men in 30s or 40s
GCA classic presentation
New severe headache (maybe worse on standing up)
* Temporal artery - prominent, inflamed, non-pulsatile
* Loss of vision in one/both eyes
* scalp tenderness
* pain on jaw claudication (discomfort chewing),
* proximal myalgia (muscle pain)
* weight loss
* Malaise
* Eye pain/orbital pain (rarer symptom)
amaurosis fugax
It is a TIA
Medical Emergency!
Amaurosis fugax is a harbinger of an imminent stroke
One cause is when a blood clot or a piece of plaque blocks an artery in the eye.
raised Intracranial pressure presentation
- Headache (diffuse, constant, aggravated by coughing/straining/bending/lying
down, worse in morning) - Blurred vision - induced hyperopia
- Transient visual obscuration of vision (postural)
- Photopsia (perceived flashes of light)
- Transient/persistent diplopia
- Bilateral swelling of optic nerve head
- Nausea and vomiting
- Pulsatile tinnitus
questions to ask about diplopia
- Do you have double vision such that you see two of everything?
- Is It at distance or at near?
- Does the double vision stop when one eye is covered? (Mono/Bino)
- Are the double images side by side, one on top of the other or both?
- Is the double vision always present or does it come and go?
- Is the double vision more noticeable when looking in a certain direction?
- Is the double vision worse when you’re tired?
aacg present as
severe temporal HA with associated pain around affected eye
nausea
vomiting
red eye
flashes vs migraine symptoms
if lights last longer than 20mins then we think possible RD
real flashes:
o Photopsia caused by vitreous traction on the peripheral retina
o Generally vertical, peripheral, more obvious in dim light, monocular
optic neuritis HA
o Fatigue, vision problems, numbness/tingling etc
o Uhthoff phenomenon: transient worsening of symptoms i.e. when core body temperature increases i.e. after exercise/hot bath
** check and add to this
Giant Cell Arteritis (A&E)
- New severe headache (maybe worse on standing up)
- Temporal artery - prominent, inflamed, non-pulsatile
- Loss of vision in one/both eyes
- scalp tenderness
- pain on jaw claudication (discomfort chewing),
- proximal myalgia (muscle pain)
- weight loss
- Malaise
- Eye pain/orbital pain (rarer symptom)
- Amaurosis fugax (transient blurred vision),
- Transient diplopia
- Cranial nerve palsies
Carotid Artery Dissection (A&E) presentation
Split in vessel wall -occlusion of lumen - stroke
Presentation
* Headache
* Gradual
* Deteriorates in severity
* Scalp tenderness
o pain in area around arm and neck.
o Ipsilateral horner’s syndrome
* characterised by:
o miosis (constriction of the pupil),
o ptosis (drooping of the upper eyelid),
o anhidrosis (absence of sweating of the face)
* Neurological signs (i.e. limb weakness, speech disturbances, visual field loss)
* Possible visual field loss (from ischaemic optic neuropathy, retinal artery
occlusion)
* Possible diplopia
Subarachnoid Haemorrhage (A&E) presentation
Presentation:
* Thunder-clap headache
o Onset = split second
o Described as: ‘worst ever headache’ the patient has experienced
Location: occipital (back of head)
Other associated symptoms:
* neck stiffness
* loss of consciousness
* agitation
* nausea
* vomiting
* Resembles acute attack of meningitis
Ocular manifestations:
* optic nerve head swelling,
* 6th nerve palsy
* Terson’s Syndrome (Haemorrhage (pre-retinal, vitreous) with a subarachnoid
haemorrhage)
Trigeminal Neuralgia
Idiopathic/secondary to compression by tumour/aneurysm/secondary to MS
* Persistent/recurrent/unilateral/periocular
* Electric shock-like quality or unpleasant ‘pins and needles’/ants crawling under
skin sensation
* Decreased corneal or facial sensation
* Anisocoria
health and saftey
o Make sure bins are not overflowing, counter tops and sink are clean – have enough tissues, paper towels and soap
o Cotton buds should be in a drawer with the lid closed over it – do not want it to be contaminated (same for NaFl strips)
o Make sure have tonometer heads and equipment in the room on the day of the assessment, looks organised and saves time
o Have a spare CL case as well for the px
o Ensure POM drops are placed in the correct bin
o Do not leave out any water bottles in the room, should be stored in a cupboard
- clean room, no hazards
when should MPS be discarded
3/12 after opening
for expiry dates, is it the beginning or the end of the month
the end of the month of jul 2024
- cannot use after july 31st
Fire exists in the store
o Front door and back door in the break room – there is also a floor layout in the break room showing the fire exits
o Certificates of the fire responders of the shop in the break room too e.g. DO and Mark
o Fire assembly point = outside M&S
o Fire extinguishers = one at the front of the shop next to the front desk and second one at the back of the shop before the staff room
first aid in store
o First aid kit in the break room
o First aiders in the shop are the directors and DO
* Would report to directors if there were any safety risks in the shop e.g. exits blocked, loose wires, tripping hazards etc.
* Hazardous substances include:
o Cleaning agents, fumes, dust, gases, bacteria and viruses
clinical waste
- Environment Protection Act 1990 states it’s unlawful to deposit, recover or dispose of controlled waste without a waste management license and it’s the responsibility of producer of the waste to properly dispose of waste
- Most waste produced in optometric practice is not considered clinical as it is not hazardous (known as ‘special waste’ in Scotland)
o This means that waste such as soiled tissues and small quantities of used contact lenses can be disposed of in general domestic waste stream
oshould have a contract with a registered waste disposal contractor, who will come to your practice to remove non-hazardous and hazardous waste when required - Practices should keep all waste transfer or consignment notes, and the length of time practices are required to keep these will vary depending on the type of waste
- How should sharps e.g. for FB removal be disposed of?
in a sharps box
o Sharp boxes are colour coded according to whether they are infectious or not
Reusable probes (e.g. tonometer, pachymeter) should be decontaminated IMMEDIATELY by:
- Rinse with saline
- Wash with liquid soap
- Soak in sodium hypochlorite 1% for 10 minutes
- Rinse with saline for 10 mins
- Dry
- Alcohol wipes alone do not remove prion proteins from contact devices.
adaptative period for rx - for child
18 weeks
what is mohindras technique?
done in complete darkness
use hand held lenses - WD 50cm 2D
infants <2y/o subtract 0.75 from result. Allows for 1.25D accommodation
px’s >2 y/o. Subtract 1.00D from result. Allows for 1.00D of accommodation
no cyclo needed