OTM Midterm

what are the three main styles of an eye exam

database examination

systems approach

problem oriented approach

what is database examination

-using same set of clinical procedures for every exam

-done for annual/complete eye exams

-used by students to practice various clinical techniques to gain technical experience

-not useful for experienced practitioners

what is the systems approach

-exam defined by systems that are assessed

-non comprehensive exams

what is the problem oriented approach

-choosing tests based on patients complaints

-exam involved SOAP (subjective, objective, assessment, and plan)

what are the nine components of a comprehensive case history

1. chief complaint

2. history of present illness (HPI)- FOLDARQ

3. review of systems

4. past medical history

5. past ocular history

6. medications/allergies to meds

7. family medical and ocular history

8. social history

9. summary/history wrap-up

what does A&O x 3 mean

alert and oriented to person, place, and time

why does sex at birth, gender identity, age, and ethnicity matter

it plays a role in the differential diagnosis of certain ocular problems

what is the chief complaint

a concise statement that describes symptom, problem, condition, diagnosis, or reason for the patient encounter

what is history of present illness

a chronological description of the development of patients present CC from the first sign/symptom or from the previous encounter to the present

what does the F in FOLDARQ stand for

frequency- constant or comes and goes

what does the O in FOLDARQ stand for

onset- when did the problem start

what does the L in FOLDARQ stand for

location- where the problem is (OD, OS, OU, behind the eye, etc.)

what does the D in FOLDARQ stand for

duration- how long do the symptoms last

what does the A in FOLDARQ stand for

associated factors- any other symptoms associated with this problem

what does the R in FOLDARQ stand for

relief- what can the patient do to relieve the pain

what does the Q in FOLDARQ stand for

quality- on a scale on 1-10, how bad is the pain? mild, moderate, severe

what is review of systems

an inventory of the bodies systems to identify signs and/or symptoms that the patient may be experiencing or has experienced

what are the eye related symptoms included in the review of symptoms

flashes, floaters, double vision, headaches, eye pain, burning, itching, redness, tearing

what are the three questions to any "yes" in the review of symptoms

onset

PCP aware

management

what is past/present medical history

questions asked to determine the risk of systemic or neurological diseases

what does past medical history include (systemic diseases)

LME (when, where, who)

DM, HTN, high cholesterol, CAD, cancer, thyroid

if a patient answers yes to any systemic diseases, what must you ask

when was it diagnosed?

is it controlled? with what?

any pertinent information

what is past/present ocular history

questions to determine risk of ocular disease or prognosis

what does past ocular history include (ocular diseases)

LEE (when, who, where)

glasses, contact lenses, trauma, surgery, VT, amblyopia, blindness, glaucoma, ARMD, retinal disease, strabismus

what should you ask about glasses and/or contact lenses

how long? distance or near? how do you feel they are working? are they the last Rx you were given or older?

**specific to contact lens: name? replacement schedule?

what should you ask if a patient says "yes" to any common ocular diseases

when/how long?

controlled?

any pertinent information

what do you need to ask about for medication

name of medication

dosage

adherence (ex. "last does last night")

what should you ask about allergies

type of allergy

reaction that occurs

what does family medical history include

DM, HTN, high cholesterol, CAD, cancer, thyroid

-know any pertinent info about disease, any visual complications, are they deceases from disease

what does family ocular history include

amblyopia, blindness, glaucoma, ARMD, retinal disease, strabismus

-know any pertinent info about disease, how it is/was treated, are they blind from disease

what is social history

includes an age appropriate review of past and current activities

what does social history include

-tobacco usage: current/former/new, how much, tried to quit

-alcohol: type, how often, how much

-drug use: type, how often, how much

-work: visual demands, computer usage

-driving

-hobbies: visual demands

what does the summary of case history include

-brief summary back to patient what they have told you

-ask if there is anything you may have missed or if there is anything the patient would like to add

what specific things should you ask if you're examining a child

ask parent:

-birth history: premature/any complications

-developmental milestones

-how are they doing in school

-family history of dyslexia

what is the overall goal of the case history

to have a list of differential diagnoses

how does HTN usually present in terms of symptoms

asymptomatic

What in a case history would make you take blood pressure

history of HTN, cardiovascular disease, renal conditions, obesity, physical inactivity, heavy alcohol intake, smoking.

family history of: HTN or cardiovascular disease

What is systollic pressure?

max blood pressure, measures heart pumping efficiency and elasticity of arterial walls

what is diastolic pressure

pressure when heart ventricles are relaxed, peripheral vascular pressure

how does high blood pressure harm the body

increases workload of heart and blood vessels, leads to build up of LDLs in tiny tears (atherosclerosis)

what is primary hypertension

90-95%, no identifiable cause, but tends to be related to genetics and environmental factors

what is secondary hypertension

caused by another factor (ex. pregnancy)

what is the blood pressure of acute ER cases

\>180/120mmHg

what are symptoms of acute ER cases

confusion, headaches, visual disturbances, nausea and vomiting

when in a review of systems should you take BP

- HTN

- CAD

- Carotid artery disease

- heart attack

- stroke

- heart failure

- renal failure

- DM

- hyperlipidemia

what ocular conditions can HTN lead to

- hypertensive retinopathy

- choroidopathy

- optic neuropathy

where is the brachial artery

the antecubital space

where do you line up the artery marker on the cuff

with the brachial artery

what pulse do you use when inflating the sphygmomanometer

radial pulse

how far past the last feeling of pulse should you inflate the cuff

30 mmHg past