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Clinical Pediatric Optometry > MODULE 3: THE PEDIATRIC EXAMINATION > Flashcards

MODULE 3: THE PEDIATRIC EXAMINATION Flashcards

1
Q

Parent’s/Guardian’s consent should always be obtained

TRUE OR FALSE

A

TRUE

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1
Q

Child protection concerns dictate that a child that ages 1-5 years old should be accompanied by a parent or guardian while they are in the consulting room with you

TRUE OR FALSE

A

FALSE

  • Child protection concerns dictate that a child patient, including older children, should be accompanied by a parent or guardian while they are in the consulting room with you
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2
Q

What are the types of vision exam?

A

o Screening
o Comprehensive
o Refraction
o Contact lens

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3
Q

A type of vision exam that has a brief examination with limited elements of testing

A

SCREENING

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4
Q

It assess risk factors and determine presence or absence of potential risk factors

A

SCREENING

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5
Q

It recommends appropriate treatment pathway and timing

A

SCREENING

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6
Q

Usually done by untrained personnel

A

VISION SCRENNING

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7
Q

Done by optometrist or ophthalmologist

A

COMPREHENSIVE

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8
Q

Patient reports with medically related diagnosis

A

COMPREHESIVE

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9
Q

It examine all basic areas of vision including refractive, oculomotor and eye and systemic health

A

COMPREHESIVE

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10
Q

It uses specialized equipment and procedures

A

COMPREHESIVE

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11
Q

It is complete and detailed test

A

COMPREHESIVE

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12
Q

It is a usually limited Testing- VA only

A

VISION SCREENING

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13
Q

Inadequate testing equipment

A

VISION SCREENING

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14
Q

A brief examination devoted only to refractive status

A

REFRACTION

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15
Q

A medical diagnosis unnecessary, often routine care

A

REFRACTION

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16
Q

It examines only refractive status, new or re- evaluate

A

REFRACTION

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17
Q

Medical diagnosis unnecessary, often routine are for fitting, re-fitting or other assessment of contact lens status

A

CONTACT LENS: Basic or complex evaluation and fitting

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18
Q

Examine refractive and eye systemic health status as applied to contact lens wear, new or re-evaluate

A

CONTACT LENS: Basic or complex evaluation and fitting

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19
Q

Infants and Toddlers

A

newborn - 2 y/o

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20
Q

Preschool Children

A

3-5y/o

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21
Q

School-age Children

A

6-18 y/o

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22
Q

An initial and ongoing component of the examination

A

PATIENT HISTORY

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23
Q

Helps identify and assess problems

A

PATIENT HISTORY

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24
Q

Objective is to obtain specific information about the px, and/or parent’s or caregiver’s perception of the child’s eye and vision status, important background information and related medical issues

A

PATIENT HISTORY

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25
Q

Provides an opportunity to become acquainted with the px, parents, caregivers establishing confidence and trust

A

PATIENT HISTORY

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26
Q

If a child is calm/cooperative and does not need the caregiver’s full attention

All questions are directed to the child

TRUE OR FALSE

A

FALSE
* All questions are directed to the caregiver if the child is very young (usually 4 y/o and under)

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27
Q

If a child is calm/cooperative and does not need the caregiver’s full attention

An assistant/clinician can begin objective and noninvasive testing of the child with the parent away from the child and answering question

TRUE OR FALSE

A

FALSE
* An assistant can begin objective and noninvasive testing of the child with the parent near the child and answering question

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28
Q

If a child is young/immature such that parent must hold the child

The caregiver is able to answer lengthy set of questions because the child doesn’t need attention

TRUE OR FALSE

A
  • Caregiver may not be able to answer lengthy set of questions because child need the caregiver’s attention
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29
Q

If a child is young/immature such that parent must hold the child

A clinician should conduct an abbreviated case hx to obtain most vital details and immediately begin the exam to maximize time

TRUE OR FALSE

A

TRUE

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30
Q

If a child is young/immature such that parent must hold the child

Before beginning, the clinician should be positioned highly so he/she is able to begin observation of the child

TRUE OR FALSE

A

FALSE
Before beginning, the clinician should be positioned in a way that eye contact can be made and is able to begin observation of the child

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31
Q

If a child is young/immature such that parent must hold the child

If child can contribute to case hx, clinician should stay at child’s eye level and avoid towering over the child when speaking

TRUE OR FALSE

A

TRUE

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32
Q

What helps establish if a child can contribute to case hx, clinician should stay at child’s eye level and avoid towering over the child when speaking?

A

It helps establish rapport

33
Q

If a child is apprehensive / uncooperative

The child can be held or positioned behind the caregiver during the hx.

TRUE OR FALSE

A

TRUE

34
Q

If a child is apprehensive / uncooperative

The exchange should be friendly and warm so that trust is built as the child observes the interaction.

TRUE OR FALSE

A

TRUE

35
Q

If a child is apprehensive / uncooperative

An assistant can give toys to the child to decrease any apprehension

TRUE OR FALSE

A

TRUE

36
Q

If a child is apprehensive / uncooperative

A mildly cooperative child doesn’t need toys or other distraction to help focus attention

TRUE OR FALSE

A

FALSE
-A mildly cooperative (not just apprehensive) may need some toys or other distractions to help focus attention

37
Q

If a child is apprehensive / uncooperative

Significantly uncooperative child may require a “time out” conversation with caregiver to discuss if some goals for the exam can be achieved or whether it would be best to find another time when child is lessy sleepy, less stressed etc.

TRUE OR FALSE

A

TRUE

38
Q

While taking hx, clinician should only take notes while interviewing the child

TRUE OR FALSE

A

FALSE
* While taking hx, clinician should take mental notes while making observations of the child.

39
Q

What are some signs to intentionally look while observing the child during case hx taking?

A

o Eye turn
o Squinting
o Head tilt
o Type and quality of communication between caregiver and
o Child
o Behavior of the child
o General wellness of the child

40
Q

A clinician should pay attention to?

A

o Caregiver’s reliability as a historian
o Any distractions during case hx taking (other children in room, phone calls and sleeping)
o Quality of the interactions and relationship between the child and caregiver

41
Q

In observation during case hx should include the quality of hx information from caregiver should be assessed

TRUE OR FALSE

A

TRUE

42
Q

What are the elements of case hx?

A
  1. Demographic data
  2. Nature and hx of presenting problem (including chief complaint)
  3. Visual and ocular hx
  4. General health hx
  5. Medication
  6. Family ocular and medical hx
  7. Developmental hx of child
  8. Educational hx / School performance (school-age children)
  9. Time spent outdoors (sports activities) and near work and screen viewing
  10. Names and contact information for the pxs other health care provider
43
Q
  • When was the last full eye exam for the child, or is this the first?
A

VISUAL AND OCULAR HX

44
Q
  • Prenatal, perinatal and postnatal hx
  • Date of most recent medical examination
A

GENERAL HEALTH HX

45
Q
  • Has the child ever worn glasses? How old are the current glasses? How often does the child wear the glasses?
A

VISUAL AND OCULAR HX

46
Q
  • Major medical illnesses (review of systems)
  • Hx of surgeries or inpatient admissions
A

GENERAL HEALTH HX

47
Q
  • Head or ocular trauma hx
  • Vision or ocular tx
A

GENERAL HEALTH HX

48
Q
  • Has the child ever worn CLs? If yes, how does she/he care for the CLs? (e.g. disposal, hygiene, etc)
A

VISUAL AND OCULAR HX

49
Q
  • Any observations of lazy eye or eye turns?
A

VISUAL AND OCULAR HX

50
Q

If a parent has noticed an ocular sign such as eye turn, nystagmus, etc that is not manifesting during the exam, ask to show you a ______, or take a _____ and show it to you at the ff-up visit.

A

Video
VISUAL AND OCULAR HX

51
Q
  • Medication list (Rx and non-Rx drugs, eye drops or ointments)
A

MEDICATION

52
Q
  • Drug, food and environmental allergies
A

MEDICATION

53
Q
  • Family medical hx usually screens for cardiovascular disease or other hereditary conditions affecting the visual system
A

FAMILY MEDICAL AND OCULAR HX

54
Q

What are family ocular hx?

A

⚬ EOR (onset early in life)
⚬ Strabismus
⚬ Amblyopia
⚬ Glaucoma
⚬ CV deficiency
⚬ Blindness

55
Q

Each child develops at different rate.

TRUE OR FALSE

A

FALSE
* Remember that each child develops at different rate.
(DEVELOPMENTAL HX)

56
Q
  • Developmental milestone charts give approximate ages at which skills occur but children may not necessarily follow these timelines to the exact age.
A

DEVELOPMENTAL HX

56
Q

What are age specific questions to infants and toddlers?

A

o Does the infant recognize the caregiver’s faces?
o Does she follow you or preferred toy with their eyes?
o Are they reaching for objects yet?
o Any observation of lazy eye or eye turn?

57
Q

What are age specific questions to preschoolers?

A
  • Questions that focus on typical milestones (motor skills, hand-eye coordination, verbal and social skills)
  • This allows the clinician to make connections to visual development and coordinate with other providers as appropriate
58
Q

School performance is primary point of discussion and learning difficulties

A

ELEMENTARY-AGED CHILDREN

59
Q

What are age specific questions to elementary-aged children?

A
  • Questions regarding visual habit
60
Q
  • May be less responsive to questioning
A

TEENAGERS / ADOLESCENTS

61
Q
  • Ask questions first about themselves and their preferences may help to establish a safe space
A

TEENAGERS / ADOLESCENTS

62
Q
  • May also be interested in cls, and clinician will assess the readiness of the child and parent
A

TEENAGERS / ADOLESCENTS

63
Q
  • What does the child do in her/his spare time? Include time spent outdoors and near work
A

TIME OUTDOORS & SCREEN TIME

64
Q
  • How much total screen time in a 24-hr period (including cell phones, video games, computers, tablets, tv, etc?
A

TIME OUTDOORS & SCREEN TIME

65
Q

In terms of environmental hx, what should you ask?

A

ask about pets at home and type of housing (important with cc of itching, watering, eye rubbing, etc?

66
Q
  • for proper referral and coordination
A

NAMES AND CONTACT INFORMATION FOR THE PXS OTHER HEALTH CARE PROVIDERS

67
Q

What are some basic questions that are important to establish?

A

o Why have you brought your child in to be examined?
o Are you worried about your child’s vision?
o What are you worried specifically about?

68
Q

Underestimate and dismiss a parent’s concerns and observations

TRUE OR FALSE

A

FALSE
(CLINICAL PEARLS)

69
Q
  • Always bear in mind any risk factors that might apply and relevant family hx

TRUE OR FALSE

A

TRUE
(CLINICAL PEARLS)

70
Q

Hx and symptoms will inevitably come from the parents (their own concerns and observations of child’s behavior)

TRUE OR FALSE

A

TRUE

71
Q

If the question is “What kind of toys does your child like to play with?” what answer may be indicators of?

A

developmental milestones / lead to discussion of visual development

72
Q

If the question is “What’s your favorite subject in school? “ what answer may be indicators of?

A

Indicators of school performance or lead to important details about vision

73
Q

If the question is “What’s your favorite thing to do on weekends?” what answer may be indicators of?

A

Details of screen time use and number of hours spent outdoors

74
Q
  • Clinician’s tone should be snob, and doesn’t know to adapt to a need for higher energy or a quieter environment for a sensory-sensitive child

TRUE OR FALSE

A

FALSE
* Clinician’s tone should be friendly and calm, and be able to adapt to a need for higher energy or a quieter environment for a sensory-sensitive child

75
Q

Open-ended questions are not a helpful tool for the clinician especially when asking potentially sensitive questions

TRUE OR FALSE

A

FALSE
* Open-ended questions are a helpful tool for the clinician especially when asking potentially sensitive questions

76
Q
  • Be sure to use affirmative body language and encourage responses to reinforce a beneficial DR-PX relationship.

TRUE OR FALSE

A

TRUE

77
Q
  • Smiling is an essential part of providing care for pediatric pxs. It is important to come across as non-judgmental and reassuring throughout the case hx

TRUE OR FALSE

A

TRUE

78
Q

Effective case hx taking gives the clinician a list of _________ __________ by the end of the case hx

A

differential diagnoses

79
Q
  • An effective clinician will follow the child or caregiver’s leads, ask for their opinions and concerns, practice ________ __________ and open-ended questioning.
A

attentive listening

Clinical Pediatric Optometry (5 decks)

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