MODULE 3: THE PEDIATRIC EXAMINATION Flashcards
Parent’s/Guardian’s consent should always be obtained
TRUE OR FALSE
TRUE
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
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
What are the types of vision exam?
o Screening
o Comprehensive
o Refraction
o Contact lens
A type of vision exam that has a brief examination with limited elements of testing
SCREENING
It assess risk factors and determine presence or absence of potential risk factors
SCREENING
It recommends appropriate treatment pathway and timing
SCREENING
Usually done by untrained personnel
VISION SCRENNING
Done by optometrist or ophthalmologist
COMPREHENSIVE
Patient reports with medically related diagnosis
COMPREHESIVE
It examine all basic areas of vision including refractive, oculomotor and eye and systemic health
COMPREHESIVE
It uses specialized equipment and procedures
COMPREHESIVE
It is complete and detailed test
COMPREHESIVE
It is a usually limited Testing- VA only
VISION SCREENING
Inadequate testing equipment
VISION SCREENING
A brief examination devoted only to refractive status
REFRACTION
A medical diagnosis unnecessary, often routine care
REFRACTION
It examines only refractive status, new or re- evaluate
REFRACTION
Medical diagnosis unnecessary, often routine are for fitting, re-fitting or other assessment of contact lens status
CONTACT LENS: Basic or complex evaluation and fitting
Examine refractive and eye systemic health status as applied to contact lens wear, new or re-evaluate
CONTACT LENS: Basic or complex evaluation and fitting
Infants and Toddlers
newborn - 2 y/o
Preschool Children
3-5y/o
School-age Children
6-18 y/o
An initial and ongoing component of the examination
PATIENT HISTORY
Helps identify and assess problems
PATIENT HISTORY
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
PATIENT HISTORY
Provides an opportunity to become acquainted with the px, parents, caregivers establishing confidence and trust
PATIENT HISTORY
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
FALSE
* All questions are directed to the caregiver if the child is very young (usually 4 y/o and under)
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
FALSE
* An assistant can begin objective and noninvasive testing of the child with the parent near the child and answering question
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
- Caregiver may not be able to answer lengthy set of questions because child need the caregiver’s attention
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
TRUE
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
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
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
TRUE
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?
It helps establish rapport
If a child is apprehensive / uncooperative
The child can be held or positioned behind the caregiver during the hx.
TRUE OR FALSE
TRUE
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
TRUE
If a child is apprehensive / uncooperative
An assistant can give toys to the child to decrease any apprehension
TRUE OR FALSE
TRUE
If a child is apprehensive / uncooperative
A mildly cooperative child doesn’t need toys or other distraction to help focus attention
TRUE OR FALSE
FALSE
-A mildly cooperative (not just apprehensive) may need some toys or other distractions to help focus attention
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
TRUE
While taking hx, clinician should only take notes while interviewing the child
TRUE OR FALSE
FALSE
* While taking hx, clinician should take mental notes while making observations of the child.
What are some signs to intentionally look while observing the child during case hx taking?
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
A clinician should pay attention to?
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
In observation during case hx should include the quality of hx information from caregiver should be assessed
TRUE OR FALSE
TRUE
What are the elements of case hx?
- Demographic data
- Nature and hx of presenting problem (including chief complaint)
- Visual and ocular hx
- General health hx
- Medication
- Family ocular and medical hx
- Developmental hx of child
- Educational hx / School performance (school-age children)
- Time spent outdoors (sports activities) and near work and screen viewing
- Names and contact information for the pxs other health care provider
- When was the last full eye exam for the child, or is this the first?
VISUAL AND OCULAR HX
- Prenatal, perinatal and postnatal hx
- Date of most recent medical examination
GENERAL HEALTH HX
- Has the child ever worn glasses? How old are the current glasses? How often does the child wear the glasses?
VISUAL AND OCULAR HX
- Major medical illnesses (review of systems)
- Hx of surgeries or inpatient admissions
GENERAL HEALTH HX
- Head or ocular trauma hx
- Vision or ocular tx
GENERAL HEALTH HX
- Has the child ever worn CLs? If yes, how does she/he care for the CLs? (e.g. disposal, hygiene, etc)
VISUAL AND OCULAR HX
- Any observations of lazy eye or eye turns?
VISUAL AND OCULAR HX
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.
Video
VISUAL AND OCULAR HX
- Medication list (Rx and non-Rx drugs, eye drops or ointments)
MEDICATION
- Drug, food and environmental allergies
MEDICATION
- Family medical hx usually screens for cardiovascular disease or other hereditary conditions affecting the visual system
FAMILY MEDICAL AND OCULAR HX
What are family ocular hx?
⚬ EOR (onset early in life)
⚬ Strabismus
⚬ Amblyopia
⚬ Glaucoma
⚬ CV deficiency
⚬ Blindness
Each child develops at different rate.
TRUE OR FALSE
FALSE
* Remember that each child develops at different rate.
(DEVELOPMENTAL HX)
- Developmental milestone charts give approximate ages at which skills occur but children may not necessarily follow these timelines to the exact age.
DEVELOPMENTAL HX
What are age specific questions to infants and toddlers?
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?
What are age specific questions to preschoolers?
- 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
School performance is primary point of discussion and learning difficulties
ELEMENTARY-AGED CHILDREN
What are age specific questions to elementary-aged children?
- Questions regarding visual habit
- May be less responsive to questioning
TEENAGERS / ADOLESCENTS
- Ask questions first about themselves and their preferences may help to establish a safe space
TEENAGERS / ADOLESCENTS
- May also be interested in cls, and clinician will assess the readiness of the child and parent
TEENAGERS / ADOLESCENTS
- What does the child do in her/his spare time? Include time spent outdoors and near work
TIME OUTDOORS & SCREEN TIME
- How much total screen time in a 24-hr period (including cell phones, video games, computers, tablets, tv, etc?
TIME OUTDOORS & SCREEN TIME
In terms of environmental hx, what should you ask?
ask about pets at home and type of housing (important with cc of itching, watering, eye rubbing, etc?
- for proper referral and coordination
NAMES AND CONTACT INFORMATION FOR THE PXS OTHER HEALTH CARE PROVIDERS
What are some basic questions that are important to establish?
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?
Underestimate and dismiss a parent’s concerns and observations
TRUE OR FALSE
FALSE
(CLINICAL PEARLS)
- Always bear in mind any risk factors that might apply and relevant family hx
TRUE OR FALSE
TRUE
(CLINICAL PEARLS)
Hx and symptoms will inevitably come from the parents (their own concerns and observations of child’s behavior)
TRUE OR FALSE
TRUE
If the question is “What kind of toys does your child like to play with?” what answer may be indicators of?
developmental milestones / lead to discussion of visual development
If the question is “What’s your favorite subject in school? “ what answer may be indicators of?
Indicators of school performance or lead to important details about vision
If the question is “What’s your favorite thing to do on weekends?” what answer may be indicators of?
Details of screen time use and number of hours spent outdoors
- 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
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
Open-ended questions are not a helpful tool for the clinician especially when asking potentially sensitive questions
TRUE OR FALSE
FALSE
* Open-ended questions are a helpful tool for the clinician especially when asking potentially sensitive questions
- Be sure to use affirmative body language and encourage responses to reinforce a beneficial DR-PX relationship.
TRUE OR FALSE
TRUE
- 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
TRUE
Effective case hx taking gives the clinician a list of _________ __________ by the end of the case hx
differential diagnoses
- An effective clinician will follow the child or caregiver’s leads, ask for their opinions and concerns, practice ________ __________ and open-ended questioning.
attentive listening
