Lecture 1

Question 1

Exams at pediatrician birth to age 2

Answer 1

Health: Eyelid, orbit, penlight external eval, pupils, red reflex.

acuity: Muscle balance pen light

Question 2

Exams at pediatrician ages 2+

Answer 2

Cover test or ran dot E

Vision testing by appropriate method. If unable, recheck in 3-6 months. If still unable, refer to ophthalmologist.

Question 3

Only part required from vision screenings

Answer 3

Distance VA

All other optional: Near, alignment, stereo, color

Question 4

Vision screening limitations

Answer 4

Experience of examiner
Size of room/lighting
noise/distractions
Cognitive
Follow up if needed (false positives, true failures)

Question 5

Photoscreening

Answer 5

Looks for refractive problem and amblyopia
Looks at red reflex and purkinje images
Useful for preverabal or non verbal kids

Question 6

Recommended eye exam schedule for risk free kids

Answer 6

6 months, 3 years, before 1st grade and every 2 years after

Question 7

Recommended eye exam schedule for at risk kids (premature, family history of eye disease, high ref error, strabismus, seizures, development delay)

Answer 7

By 6 months, at 3 years, annually or as recommended

Question 8

Infant

Answer 8

Birth to 12 months. Premature consideration

Question 9

Toddler

Answer 9

1 to 3 years. Premature consideration

Question 10

Preschooler

Answer 10

3-6 years

Question 11

School age

Answer 11

6+
Grade school 6-12 years
Adolescents 12-18 years

Question 12

Importance of case history

Answer 12

Guides direction of exam- what tests may be needed or possible dx.

Provides insight into: ocular and medical health, family history, socio economic considerations, education, lifestyle, development.

Question 13

Who is the most reliable and least reliable observer?

Answer 13

Grandma best

Dad worst

Question 14

During the exam, make sure to __ the chief complaint

Answer 14

Solve

Question 15

What determines the level of billing (medical vs vision)

Answer 15

CC

Question 16

Common CC

Answer 16

Routine eye exam/first eye exam/annual eye exam

Question 17

FLORIDA

Answer 17

Frequency
Location
Onset
Relieved by 
Intensity/severity/scale
Duration
Associations

Question 18

Common medical conditions in peds

Answer 18

ADD, ADHD

Asthma, allergies

Question 19

What to verify on meds?

Answer 19

What is it, why is it taken, how long and dose

Question 20

Ocular hx to ask about child

Answer 20

Previous eye exam? Where and by who
Previous Rx? For distance, near, full time?
Previous tx? Patching, therapy, drops
Disease? Family or self
Injuries?
Surgeries? Big one in peds: strabismus or laser for premature retina

Question 21

Academic history for kids

Answer 21

Consider are they in an appropriate age for their grade?
Rule of thumb: Age minus 5. Age 7? 2nd grade.

School? Some are for special needs in memphis.

Academic performance: Fav subject? Least fav? Grades in school? IEP/504? (for special needs)

Reading and or learning problems?

Question 22

Development history

Answer 22

Length of pregnancy (full term or premature) 
Birth weight 
Exposure to drugs 
Delivery complications?
APGAR score if known

Question 23

APGAR

Answer 23

Given 1-5 minutes after birth. 
A: appearance/color 
P: Pulse
G: Grimace/reflex
A: Activity/muscle tone
R: Respiration.

Question 24

Normal APGAR score

Answer 24

7 or greater

Question 25

Critically low APGAR score

Answer 25

Less than 3

Question 26

Old FDA categories

Answer 26

A: No risk to fetus demonstrated during well controlled trials. Safe.

B: Animal studies fail to demonstrate risk. No well controlled studies in pregnant women. Safe.

C: No adequate animal or human studies. Animal studies show adverse effect, no controlled tests in humans. Benefit may outweigh risk.

D: Human fetal risk. Don’t give unless absolutely need. Ex: to save life.

X: Human fetal risk. Risk outweighs benefit. Never give

Question 27

New FDA categories

Answer 27

Pregnancy: Dosing and potential risk to fetus.

Lactation: amount of drug in breast milk and how it affects fetus.

Females and male reproductive potential: pregnancy testing, contraception and infertility.

Question 28

What 7 main categories to ask about when taking history

Answer 28

1. CC. Get HPI
2. Medical history ROS
3. Meds
4. Ocular history
5. Family history
6. Academic history
7. Developmental history