TOPIC 2: Hx Taking Flashcards
what are 4 things you should do during Hx taking?
- ask open ended qns, allows for px to elaborate on their situation
- take and record negative hx (not written=not asked)
- ask qns aimed at excluding conditions, helps narrow down diagnosis
- good communication and manners, determines ox willingness to open up and share necessary info
what is the info required from caregivers in hx taking for PAEDS? how is it sometimes obtained?
At times, history taking can be in form of a questionnaire.
first consult:
1. personal details (name, age, gender)
2. occupational and vocational visual environment and demands
3. general health hx and existing medical problems
4. family general health and ocular hx
PAEDS:
5. ROV/presenting complaint
6. other visual or ocular hx (e.h predisposing conditions e.g prematurity and medical conditions)
7. family hx of rx error and strabismsus
4 things to note during observation? what do they each indicate?
Start observing patient the moment we see them -It might be as soon as we call them from the waiting area. and continues throughout the examination
- posture, any head tilt or face turn which made indicate BV anomalies.
- eye centration for any strabismus.
- Check if they blink normally or conscious hard blinking which is indicative of dry eyes.
- child tends to rub their eyes or squint which may indicate underlying condition such as refractive error.
what are the common chief complaints? what use does chief complaint give us?
-Difficulty seeing whiteboard/TV
- Complains of headaches/eyestrain
- Failed a vision screening
-Appears to have an eye turn
-Holds book close to eyes
-Learning difficulty
-Routine eye check/2nd opinion
hold some clues as what we should focus on and look out for during the eye examination.
For example, “failing a vision screening” or “difficulties seeing what teacher is writing”, indicates possibility of a refractive error.
what should we doif px complain of (+) symptom?
Follow up qn using “DR FALOPPE”
*Chief complaint and positive sign(s) should be explored further.
Suggest to refer “DR FALOPPE” or “LOFTSEA”
Follow-up Qs for DR FALOPPE includes:
Duration: how long it lasted?
Relief: anything to relief?
Frequency: how often?
Association: does it come with other symptoms?
Location: which eye? Which part of the eye?
Onset: since when?
Pain: any pain? Grade of pain
Prescription: with or without rx?
Exacerbating factor: anything make it worst?
what should we ask in birth hx? when should we ask about birth hx?
mother’s age, health and the delivery method.
Pre-natal (during pregnancy, before birth)
Peri-natal (period immediate before and after birth)
Post-natal (after birth)
More for infants and very young children
(≤2 years old)
why should we ask about mother’s age?
Young mother, associated with poor vision, possibly as a result of low birth weight.
Older mother associated with strabismus, high refractive error, nystagmus and Down syndrome.
how and why should we ask about mother’s health?
“how are you during your pregnancy?” or “Did you keep well yourself during your pregnancy?”
Something to specifically ask and take note are the following:
- Rh factor, also called Rhesus factor, is a type of protein found on the outside of red blood cells. The protein is genetically inherited. If you have the protein, you are R h positive. If you did not inherit the protein, you are R h negative.
- If the mother has any viral infection, gestational diabetes, rubella, mumps, measles or other fever producing diseases during the duration of her pregnancy.
- Toxaemia, aka pre-eclampsia, refers to the presence of toxins in blood, resulting in high blood pressure during pregnancy and protein in urine. It is a one of a complication of pregnancy.
- Any high intake of smoking, alcohol, excessive coffee. This action may results in “small for dates” babies.
what is a small for date baby? what are they at risk for?
baby with low birth weight. Or babies who are smaller than the usual amount for the number of weeks of pregnancy.
have birthweights below the 10th percentile for babies of the same gestational age.
Increased risk of strabismus and/or amblyopia
how and why should we ask about delivery?
If the delivery of the baby or child is with the aid of forceps, it may cause:
-Swelling in area of lateral recti
-Increased risk of strabismus: 10x
-Possibility of mental or physical retardation if baby was distressed
“is the child premature (37 – 38 weeks) or full term baby?”
“was the delivery natural? Any use of forceps?”
Normal birth size and weight?
Apgar score >=7?
what is considered a premature baby? what are they at risk of?
Babies born earlier than 37 weeks of gestation are considered premature:
higher incidences of myopia and astigmatism at birth, with an increased risk of strabismus as well.
They are also susceptible to brain damage, infections, breathing problems, hypoglyaemica and jaundice.
how and why should we ask about developmental hx?
In developmental history, we need to find if the child’s growth is norm.
Any possibility of cerebral damage or palsy need to be noted.
Examples:
Cerebral damage/ Cerebral palsy
Hearing problem
Motor milestone achieved:
Did he follow his mother’s face shortly after birth and follow objects by 2 to 3 months of age?
Cognitive milestone achieved:
Did the child sit, walk and talk at the usual time?
how and why should we ask about medical hx?
It is important to check and note if there is any medical history of recent infection and/or medication that the child is taking.
Points to note:
-Recent infection
-Recent medication
how and why should we ask about family hx?
There is a strong association between squint in a parent or close relative and squint in child.
Ingram, 1977: 58% of children with strabismus or amblyopia have a family history of squint or amblyopia.
Kramar, 1973 : Children with a significant refractive error and with more than one close relative with a squint, the incidence is 86%.
A child has higher risk of developing myopia if both parents have high myopia.
Some other examples of inherited eye conditions are ptosis, droopy eye lids; nystagmus, a vision condition in which the eyes make repetitive, uncontrolled movements; aniridia, absence of iris; and congenital cataract.
Points to note:
-Squint / Strabismus
-Amblyopia
-Refractive errors: High Myopia, Astigmatism (parents vs siblings)
-Inherited conditions: Ptosis, Nystagmus, Aniridia, Congenital Cataract etc.
how should we ask about school hx?
Points to note:
-Academic performance
-Enjoy school?
