Pediatrics Case Hx

Question 1

What is the importance of a case history?

Answer 1

guides the direction of examination

Question 2

The case history is…

Answer 2

never finished

Question 3

What insight does a case history provide?

Answer 3

ocular and medical health, family Hx, socio-economic considerations, education, lifestyle, development

Question 4

What is one additional goal of a case history?

Answer 4

build rapport with the patient and parent

Question 5

Who is the most reliable observer?

Answer 5

grandmother– hyperaware

Question 6

During the chief complaint what is the goal of your questions?

Answer 6

determine parent and child reliability, determine billing level of examination, make sure to solve the chief complaint with the exam

Question 7

What are vision codes and what are medical codes?

Answer 7

vision 92000 for routine eye exams, medical 99000 ex: flashes of light, headaches

Question 8

List the common chief complaints in peds

Answer 8

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

Question 9

List the HPIs

Answer 9

frequency, location, onset, relief, intensity/severity, duration, associated signs and symptoms

Question 10

What are the main ROS complaints for a peds exam?

Answer 10

attention deficit disorder/hyperactivity, asthma, allergies

Question 11

What are additional ROS complaints for a peds exam?

Answer 11

autism, down syndrome, cerebral palsy, diabetes, hypertension, marfan’s, neurofibromatosis, juvenile idiopathic arthritis, sickle cell anemia

Question 12

What do you need to make sure to include in PMHx?

Answer 12

current treatments, prior surgeries

Question 13

What questions need to be asked about medications?

Answer 13

what is taken? why? how long? dose?

Question 14

POHX questions?

Answer 14

LEE, previous Rx, previous Tx, disease, injuries, surgeries

Question 15

FMHx questions?

Answer 15

conditions, ocular hx: refractive error, strabismus, amblyopia, color vision defects, congenital glaucoma/cataracts

Question 16

What does lazy eye mean?

Answer 16

it depends, need parent to elaborate, could be strabismus or amblyopia

Question 17

How do you determine if a child is an appropriate age for their grade?

Answer 17

age-5

Question 18

What should you ask about academics?

Answer 18

favorite and least favorite subject, grades, IEP/504 plan

Question 19

What is included in a developmental history?

Answer 19

length of pregnancy, birth weight, exposure to drugs, delivery, apgar, milestones

Question 20

What is meant by exposure to drugs (legal and illegal)?

Answer 20

often comes up during exam not Hx, Fetal alcohol spectrum, neonatal abstinence syndrome (heroine)

Question 21

What are delivery complications?

Answer 21

unplanned c-section, loss of oxygen (increases risk of CP)

Question 22

What are developmental interventions?

Answer 22

physical therapy, occupational therapy, speech therapy, vision therapy

Question 23

What does physical therapy work on?

Answer 23

gross motor movement

Question 24

What does occupational therapy work on?

Answer 24

fine motor movement and activities of daily living

Question 25

What does speech therapy work on?

Answer 25

autism, speech delay, reading

Question 26

What does vision therapy work on?

Answer 26

binocularity, perception, amblyopia, concussion

Question 27

What does apgar stand for?

Answer 27

appearance, pulse, grimace, activity, respiration

Question 28

When is apgar assessed?

Answer 28

at 1 and 5 minutes after birth

Question 29

What is appearance?

Answer 29

color, 0-pale/blue, 1-pink body and blue extremities, 2- pink body and extremities

Question 30

What is pulse?

Answer 30

0-absent, 1- less than 100 bpm, 2- greater than 100 bpm

Question 31

What is grimace?

Answer 31

reflex, 0-absent, 1- grimace or facial movement, 2- cough, sneeze or pull away

Question 32

What is activity?

Answer 32

muscle tone, 0-absent, 1- some flexion of extremities, 2- active and spontaneous movement of limbs

Question 33

What is respiration?

Answer 33

0- absent, 1- slow and irregular, 2-good breathing with crying

Question 34

What is a normal apgar score?

Answer 34

7+

Question 35

What is a critically low apgar score?

Answer 35

< 3

Question 36

What are the extremes of apgar?

Answer 36

0=nonviable, 10=maximum score

Question 37

How are prescription and OTC drugs involved in pregnancy?

Answer 37

FDA established pregnancy categories outlining potential risk to fetus, majority of women use prescription or OTC meds at some point during pregnancy

Question 38

What is the effect of illicit drugs during pregnancy?

Answer 38

should be discontinued during pregnancy and breastfeeding, may result in birth defects, miscarriage, premature birth

Question 39

What are the old FDA pregnancy categories?

Answer 39

A, B, C, D, X

Question 40

What is category A?

Answer 40

adequate well controlled studies failed to demonstrate risk to the fetus in the first or additional trimesters

Question 41

What is category B?

Answer 41

animal studies failed to demonstrate a risk to fetus, no adequate well controlled studies in pregnant women

Question 42

What is category C?

Answer 42

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

Question 43

What is category D?

Answer 43

evidence of human fetal risk based on adverse reaction data ---- potential benefits may warrant use despite potential risk

Question 44

What is category X?

Answer 44

avoid! human or animal studies have demonstrated risk to human fetus, risk to fetus outweighs potential benefits

Question 45

What are the new 2015 FDA pregnancy categories?

Answer 45

pregnancy, lactation, and females and males of reproductive potential

Question 46

What is the pregnancy category?

Answer 46

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

Question 47

What is the lactation category?

Answer 47

the amount of drug in breast milk and potential effect on the child

Question 48

What is the females and males of reproductive potential category?

Answer 48

pregnancy testing, contraception, and infertility

Question 49

What is different about the new FDA categories?

Answer 49

they are in summary form