Lecture 1 Flashcards
Exams at pediatrician birth to age 2
Health: Eyelid, orbit, penlight external eval, pupils, red reflex.
acuity: Muscle balance pen light
Exams at pediatrician ages 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.
Only part required from vision screenings
Distance VA
All other optional: Near, alignment, stereo, color
Vision screening limitations
Experience of examiner Size of room/lighting noise/distractions Cognitive Follow up if needed (false positives, true failures)
Photoscreening
Looks for refractive problem and amblyopia
Looks at red reflex and purkinje images
Useful for preverabal or non verbal kids
Recommended eye exam schedule for risk free kids
6 months, 3 years, before 1st grade and every 2 years after
Recommended eye exam schedule for at risk kids (premature, family history of eye disease, high ref error, strabismus, seizures, development delay)
By 6 months, at 3 years, annually or as recommended
Infant
Birth to 12 months. Premature consideration
Toddler
1 to 3 years. Premature consideration
Preschooler
3-6 years
School age
6+
Grade school 6-12 years
Adolescents 12-18 years
Importance of case history
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.
Who is the most reliable and least reliable observer?
Grandma best
Dad worst
During the exam, make sure to __ the chief complaint
Solve
What determines the level of billing (medical vs vision)
CC
Common CC
Routine eye exam/first eye exam/annual eye exam
FLORIDA
Frequency Location Onset Relieved by Intensity/severity/scale Duration Associations
Common medical conditions in peds
ADD, ADHD
Asthma, allergies
What to verify on meds?
What is it, why is it taken, how long and dose
Ocular hx to ask about child
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
Academic history for kids
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?
Development history
Length of pregnancy (full term or premature) Birth weight Exposure to drugs Delivery complications? APGAR score if known
APGAR
Given 1-5 minutes after birth. A: appearance/color P: Pulse G: Grimace/reflex A: Activity/muscle tone R: Respiration.
Normal APGAR score
7 or greater
Critically low APGAR score
Less than 3
Old FDA categories
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
New FDA categories
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.
What 7 main categories to ask about when taking history
- CC. Get HPI
- Medical history ROS
- Meds
- Ocular history
- Family history
- Academic history
- Developmental history
