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CLI PEDIA M2 > M3 > Flashcards

M3 Flashcards

1
Q

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

A

Child protection

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2
Q

should always be obtained

A

Parent’s/Guardian’s consent

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3
Q

TYPES OF VISION EXAM

A
  • Screening
  • Comprehensive
  • Refraction
  • Contact lens
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4
Q

Brief examination with limited elements of testing

A

Screening

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5
Q

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

A

Screening

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6
Q

recommend appropriate treatment pathway and timing

A

Screening

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7
Q

patient reports with medically related diagnosis

A

Comprehensive

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8
Q

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

A

Comprehensive

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9
Q

brief examination devoted only to refractive status

A

Refraction

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10
Q

medical diagnosis unnecessary , often routine care

A

Refraction

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11
Q

examine only refractive status, new or re- evaluate

A

Refraction

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12
Q

⚬medical diagnosis unnecessary, often routine are for fitting, re-fitting or other assessment of contact lens status
⚬examinerefractiveandeyesystemichealthstatusas applied to contact lens wear, new or re-evaluate

A

Contact lens * Basic or complex evaluation and fitting

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13
Q

⚬medical diagnosis uncessarry, often routine care to check CL status
⚬examine refractive and eye and systemic health status as applied to contact lens wear, new or re-evaluatE

A

Contact lens * Check

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14
Q

Limited Testing - VA only

A

Vision Screening

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15
Q

Untrained personnel

A

Vision Screening

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16
Q

Inadequate testing equipment

A

Vision Screening

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17
Q

Complete and detailed test

A

Comprehensive

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18
Q

Optometrists/ Ophthalmologists

A

Comprehensive

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19
Q

Specialized equipment and procedures

A

Comprehensive

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20
Q
  • evaluate the functional status of the eyes and visual system, taking into account each child’s level of development and special vision demand and needs
  • assess ocular health and related systemic health conditions
  • establish a diagnosis (or diagnoses)
  • formulate a treatment and management plan
  • counsel and educate parents/caregivers regarding their child’s visual, ocular and releated health care status, including recommendations for prevention, treatment, management, and future care
A

Objectives of a compre pedia test (AOA)

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21
Q

newborn - 2 y/o

A

Infants and Toddlers

22
Q

3-5y/o

A

Preschool Children

23
Q

6-18 y/o

A

School-age Children

24
Q
  • Patient History
  • Visual Acuity
  • Refraction
  • Accommodation
  • Binocular Vision
    ⚬ OcularMotility
    ⚬ Stereopis
    ⚬ ColorVision
  • Ocular Health Assessment
A

Examination Procedures

25
Q

an initial and ongoing component of the examination

A

Patient History

26
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

27
Q

helps identify and assess problems

A

Patient History

28
Q

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

A

Patient History

29
Q
  • Electronic health record or paper charting system
  • Chair/stool to enable sitting at child’s height or enough space to squat at child’s level for initial conversation
  • Toys to maintain child’s attention as appropriate
  • 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 child can contribute to case hx, clinician should stay at child’s eye level and avoid towering over the child when speaking —> helps establish rapport
  • when initial questioning is focused on the caregiver, three strategies can be used depending on the disposition of the child at the time:
A

Case hx intake (Equipment)

30
Q
  • All questions are directed to the caregiver if the child is very young (usually 4 y/o and under)
A

Child is calm/cooperative and does not need the caregiver’s full attention

31
Q
  • An assistant can begin objective and noninvasive testing of the child with the parent near the child and answering question
A

Child is calm/cooperative and does not need the caregiver’s full attention

32
Q
  • The child can be held or positioned behind the caregiver during the hx. The exchange should be friendly and warm so that trust is built as the child observes the interaction.
A

Child is apprehensive / uncooperative

33
Q
  • An assistant can give toys to the child to decrease any apprehension.
  • A mildly cooperative (not just apprehensive) may need some toys or other distractions to help focus attention
  • 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.
A

Child is apprehensive / uncooperative

34
Q
  • Caregiver may not be able to answer lengthy set of questions because child need the caregiver’s attention.
A

Child is young/immature such that parent must hold the child

35
Q
  • clinician should conduct an abbreviated case hx to obtain most vital details and immediately begin the exam to maximize time
A

Child is young/immature such that parent must hold the child

36
Q

Observation during Case Hx

A

⚬ eye turn
⚬ squinting
⚬ head tilt
⚬ type and quality of communication between caregiver and child
⚬ behavior of the child
⚬ general wellness of the child

37
Q
  • Name
  • Age
  • Gender
  • Address
  • Contact nos
  • Occupation/Course/Grade Level
  • Hobbies/Avocation
A

Demographic Data

38
Q
  • Open-ended question: “What brings you in today?”
  • What are the associated factors affecting the chief complaint?
A

Chief complaint/Hx of Present Illness

39
Q
  • When was the last full eye exam for the child, or is this the first?
  • Has the child ever worn glasses? How old are the current glasses? How often does the child wear the glasses?
  • Has the child ever worn CLs? If yes, how does she/he care for the CLs? (e.g. disposal, hygiene, etc)
  • Any observations of lazy eye or eye turns?
A

Visual and Ocular Hx

40
Q
  • Prenatal, perinatal and postnatal hx
  • Date of most recent medical examination
  • major medical illnesses (review of systems)
  • Hx of surgeries or inpatient admissions
  • Head or ocular trauma hx
  • vision or ocular tx
A

General Health hx

41
Q
  • medication list (Rx and non-Rx drugs, eye drops or ointments)
  • drug, food and environmental allergies
A

Medication

42
Q
  • Family medical hx usually screens for cardiovascular disease or other hereditary conditions affecting the visual system
  • Family ocular hx:
    ⚬ EOR (onset early in life)
    ⚬ Strabismus
    ⚬ Amblyopia
    ⚬ Glaucoma
    ⚬ CV deficiency
    ⚬ Blindess
A

Family Medical and Ocular Hx

43
Q

*Remember that each child develops at different rate.
*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

44
Q
  • Does the infant recognizes the caregiver’s faces?
  • Does she follow you or preferred toy with their eyes?
  • Are they reaching for objects yet?
  • Any observation of lazy eye or eye turn?
A

Infants and Toddlers ask specific questions like

45
Q

*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

A

Preschoolers ask specific questions like

46
Q
  • school performance is primary point of discussion and learning difficulties
  • questions regarding visual habits
A

Elementary-aged children ask specific questions like

47
Q
  • may be less responsive to questioning
  • ask questions first about themselves and their preferences may help to establish a safe space
  • may also be interested in CLs, and clinician will assess the readiness of the child and parent
A

Teenagers/ Adolescents ask specific questions like

48
Q
  • Are there any learning-related visual symptoms?
  • How is the child doing in school?
  • Is the child in the age-approrpiate grade? Has she/he ever repeated a grade level? If yes, why?
  • Is the child in a special education setting (individualized education plan or adjusted learning plan)?
A

Educational Hx

49
Q
  • What does the child do in her/his spare time? Include time spent outdoors and near work
  • How much total screen time in a 24-hr period (including cell phones, video games, computers, tablets, tv, etc?
  • Environmental hx: ask about pets at home and type of housing (important with cc of itching, watering, eye rubbing, etc)
A

Time outdoors & screen time

50
Q
  • for proper referral and coordination
A

Names and contact information for the pxs other health care providers

CLI PEDIA M2 (4 decks)

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