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Flashcards in case histories Deck (27):
1

what does SOAP stand for?

S: subjective, chief complaint (symptoms)

O: objective, all exam observation and findings (signs)

A: assessment, diagnosis

P: plan, treatment and patient insturctions 

2

blur at distance

tenative diagnosis is myopia or astigmatism. test with refraction

3

blur at near

hyperopia, presbyopia. refraction used to test

4

halos

corneal swelling, dirty contacts, cataracts, dry eye. refract but look at cornea, contacts and ocular lens

5

Causes and testing if pt sees shadows around letters

astigmatism or cataracts. refaction with specific health evaluation attention to slit lamp and lenses

6

photopsia describe brief and long and testing

unusual light flashes.

brief flashes (1-3 secs)= retinal etiology

long flashes (1-30 mins)= transient ischemic attack/ migraine

dilate to check peripheral retina and explore migraine/ stroke history

7

floaters - spots in front of eyes. What are two cases?

New onset, changing or associated with flashes make retinal exam a priority

longstanding floaters are less concerning

8

diplopia 

binocular= vergence or neurological problem

monocular= opitcal or retinal problem

check history via FODLARS.

9

accommodative dysfunction

words blur after 10-20 mins of near work and blur at distance.

Patients under 35 with spasm of near focus need Visual Efficiency Evaluation

Patients 35y or older near work/presbyopia eval

10

who requires visual efficiency evaluation?

patients under 35 with accommodation complaints

11

who recquires near work/ presbyopia evaluation? 

patients over 35 years old with accommodative dysfunction

12

List some symptoms of binocular and vergence dysfunction

double vision at night, double vision when reading, discomfrot around eyes, skipping lines or losing place when reading.

 

13

WHat can you check for ocular discomfort (asthenopia)

check tear film quality and  dry eye questionaires

14

What is photophobia?

List 3 possible causes, and 2 tests that can be done

abnormal sensitiviy to light.  Usually due to infection or trauma, can be pathological.  Careful uveitis eval and dry eye eval.

15

headaches

take them seriously. may need to refer/consultation. may require visual field exam and or neuro-exam

16

computer users

about half of users have eyestrain, fatigue, headaches, blur at near

17

What questions do you ask a contact lens wearer

how long have they worn contacts, type of lens, hygiene, duration of wear, past infections and comfort level

18

pediatrics

gaurdian present at all times, the gaurdian will give the history. need written consent to dilate. ask questions regarding childs health and school perfromance. 

19

geriatrics

family member can only give history if the patient allows it. must document the relationship if person giving the history

20

asthenopia

only about 20% of headaches are related. bilateral, achy, dull (non-throbbing), worse at end of day. may be improved by naps

21

tension headaches

stress related. "band-like"

22

sinus headaches

allergies, associated with cough, postnasal drip, sore throat

23

cluster headache

usually male (episodic) chronic knife pain. unilateral pain, associated with unilateral stuffy/ running nose

24

migraine

pulsating throbbing. common in females. certain foods and photophobia trigger them

25

mass effect headache

brain tumor, meningitis, aneurysm, increased intracranial pressure. sub-acute and get worse over the days.

26

when is a mass effect headache a red flag?

if it is worse in the morning

27

worst headache of my life?

aneurysm until proven otherwise