Pediatrics Case Hx Flashcards
What is the importance of a case history?
guides the direction of examination
The case history is…
never finished
What insight does a case history provide?
ocular and medical health, family Hx, socio-economic considerations, education, lifestyle, development
What is one additional goal of a case history?
build rapport with the patient and parent
Who is the most reliable observer?
grandmother– hyperaware
During the chief complaint what is the goal of your questions?
determine parent and child reliability, determine billing level of examination, make sure to solve the chief complaint with the exam
What are vision codes and what are medical codes?
vision 92000 for routine eye exams, medical 99000 ex: flashes of light, headaches
List the common chief complaints in peds
routine eye exam/1st eye exam/annual eye exam, failed vision screening, problems seeing the board or seeing up close, perceived eye turn, rubs/blinks eye excessively, FOHx, problems reading, pink eye, headaches
List the HPIs
frequency, location, onset, relief, intensity/severity, duration, associated signs and symptoms
What are the main ROS complaints for a peds exam?
attention deficit disorder/hyperactivity, asthma, allergies
What are additional ROS complaints for a peds exam?
autism, down syndrome, cerebral palsy, diabetes, hypertension, marfan’s, neurofibromatosis, juvenile idiopathic arthritis, sickle cell anemia
What do you need to make sure to include in PMHx?
current treatments, prior surgeries
What questions need to be asked about medications?
what is taken? why? how long? dose?
POHX questions?
LEE, previous Rx, previous Tx, disease, injuries, surgeries
FMHx questions?
conditions, ocular hx: refractive error, strabismus, amblyopia, color vision defects, congenital glaucoma/cataracts
What does lazy eye mean?
it depends, need parent to elaborate, could be strabismus or amblyopia
How do you determine if a child is an appropriate age for their grade?
age-5
What should you ask about academics?
favorite and least favorite subject, grades, IEP/504 plan
What is included in a developmental history?
length of pregnancy, birth weight, exposure to drugs, delivery, apgar, milestones
What is meant by exposure to drugs (legal and illegal)?
often comes up during exam not Hx, Fetal alcohol spectrum, neonatal abstinence syndrome (heroine)
What are delivery complications?
unplanned c-section, loss of oxygen (increases risk of CP)
What are developmental interventions?
physical therapy, occupational therapy, speech therapy, vision therapy
What does physical therapy work on?
gross motor movement
What does occupational therapy work on?
fine motor movement and activities of daily living
What does speech therapy work on?
autism, speech delay, reading
What does vision therapy work on?
binocularity, perception, amblyopia, concussion
What does apgar stand for?
appearance, pulse, grimace, activity, respiration
When is apgar assessed?
at 1 and 5 minutes after birth
What is appearance?
color, 0-pale/blue, 1-pink body and blue extremities, 2- pink body and extremities
What is pulse?
0-absent, 1- less than 100 bpm, 2- greater than 100 bpm
What is grimace?
reflex, 0-absent, 1- grimace or facial movement, 2- cough, sneeze or pull away
What is activity?
muscle tone, 0-absent, 1- some flexion of extremities, 2- active and spontaneous movement of limbs
What is respiration?
0- absent, 1- slow and irregular, 2-good breathing with crying
What is a normal apgar score?
7+
What is a critically low apgar score?
< 3
What are the extremes of apgar?
0=nonviable, 10=maximum score
How are prescription and OTC drugs involved in pregnancy?
FDA established pregnancy categories outlining potential risk to fetus, majority of women use prescription or OTC meds at some point during pregnancy
What is the effect of illicit drugs during pregnancy?
should be discontinued during pregnancy and breastfeeding, may result in birth defects, miscarriage, premature birth
What are the old FDA pregnancy categories?
A, B, C, D, X
What is category A?
adequate well controlled studies failed to demonstrate risk to the fetus in the first or additional trimesters
What is category B?
animal studies failed to demonstrate a risk to fetus, no adequate well controlled studies in pregnant women
What is category C?
no adequate human or animal studies OR animal studies show adverse effect but there are no studies in pregnant women —– benefit may warrant use despite potential risk
What is category D?
evidence of human fetal risk based on adverse reaction data —- potential benefits may warrant use despite potential risk
What is category X?
avoid! human or animal studies have demonstrated risk to human fetus, risk to fetus outweighs potential benefits
What are the new 2015 FDA pregnancy categories?
pregnancy, lactation, and females and males of reproductive potential
What is the pregnancy category?
dosing and potential risks to the developing fetus, will require information about whether there is a registry that collects and maintains data on how pregnant women are affected when they use the drug
What is the lactation category?
the amount of drug in breast milk and potential effect on the child
What is the females and males of reproductive potential category?
pregnancy testing, contraception, and infertility
What is different about the new FDA categories?
they are in summary form
