Ocular Effects of the Sympathetic Nervous System

Assessment

Question 12

Contrasted with case 6, what was done differently in case 7 that helped ensure that the patient kept his radiology appointment?

Click the appropriate answer.  The two cases are reproduced below, for your reference.

Better pharmacological testing
No difference; the patient was simply more compliant
The patient in case 7 had better insurance than the patient in case 6
The patient education was more complete and thorough in case 7

 

Case Comparison

Case 6

A patient entered the clinic for a routine examination with no complaints.  His history was unremarkable, except for smoking X 20 years. 

During the course of the examination, anisocoria (increasing in dim light) was noted, with the left eye having the smaller pupil.  The IPD was 7mm OD, 5mm OS.  Due to the possibility of Horner’s syndrome, 0.5% apraclonidine was instilled in both eyes, yielding marked pupil dilation OS, and mild pupil dilation OD.  The patient was diagnosed with likely Horner’s syndrome. 

Due to the chance of a life-threatening cause, the patient was referred to radiology for a chest and neck X-ray.  The patient was told that he had Horner’s syndrome and would need an X-ray to see why, and that he should go to the radiologist Monday morning.  The patient confirmed that he would keep the appointment.  However, the patient did not arrive for his scheduled appointment.  Future attempts to contact the patient proved unsuccessful.

Case 7

A patient entered the clinic for a routine examination with no complaints.  His history was unremarkable.

During the course of the examination, anisocoria (increasing in dim light) was noted, with the right eye having the smaller pupil.  The IPD was 7mm OD, 10mm OS.  Due to the possibility of Horner’s syndrome, 0.5% cocaine was instilled in both eyes, yielding marked pupil dilation OS, and mild pupil dilation OD.  The patient was diagnosed with likely Horner’s syndrome. 

Due to the chance of a life-threatening cause, the patient was referred to radiology for a chest and neck X-ray.  The patient was told that he had Horner’s syndrome, which could be evidence of a potentially-life threatening condition, but that was often treatable.  He was told that an X-ray would help determine the cause, which could likely be treated afterward, and that he should go to the radiologist Monday morning.  The patient confirmed that he would keep the appointment, and did.

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