CMN 568 QUESTIONS AND VERIFIED
ANSWERS
Anticipatory guidance - Answers - Patient/family counseling which includes information,
advice, and suggestions about expected health-related life occurrences, health
maintenance, and preventive plans.
Where should pediatric history information be obtained from? - Answers - both patient
and parent; obtain as much as possible from patient to give child a degree of control
over a potentially threatening situation
Order of pediatric physical examination - Answers - 1. Inspection first, from afar;
examine skin color and work of breathing before beginning exam; establish trust; allow
child to sit in parents lap; defer otoscopic exam until last
When should eyes and ears be examined? - Answers - during every health visit
3 components of vision assessment - Answers - - visual inspection of eyes/eyelids
- alignment of eyes
- visual acuity
Birth to age 3 ophthalmic exam includes: - Answers - - eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
- ocular mobility
- red reflex check
Age 3 and up ophthalmic exam includes: - Answers - - eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
- ocular mobility
- red reflex check
Visual acuity test with eye chart; classes should be worn if prescribed and record data
as "corrected"
Assessing newborn visual acuity - Answers - should be able to briefly track mother's
face or brightly colored object within an hour after birth (fixation reflex not developed for
several weeks); dont talk while assessing vision, baby may look toward sound rather
than visual stimulus
,When patient presents with eye condition (infection, injury, etc), what do you check
first? - Answers - visual acuity; UNLESS there is chemical injury to eye, then you should
irrigate first and refer to ophthalmologist; when there is decreased acuity, also refer to
ophthalmologist
What is the visual acuity of a newborn? - Answers - 20/200-20/400; acuity reaches adult
level of 20/20 by age 5
When to refer child to ophthalmologist - Answers - - 3-5yr: if acuity is less than 20/40 in
either eye, or if theres a difference in two lines in acuity between eyes
- 6yr and older: if acuity is less than 20/30 or if theres a difference in two lines in acuity
between eyes
When to assess red reflex - Answers - birth until the child can read eye chart
When should you start to assess fixation and following? - Answers - 2 months; refer out
if fixation and following are poor by 3 months
When to test corneal light reflex (hirschsbergs test)? - Answers - 3 months- 5 years;
refer out for asymmetry in light reflex
When to start cover testing for strabismus - Answers - 6 months- 5 years
When to start a fundoscopic exam - Answers - 3 years
When to start preliterate eye chart testing - Answers - 3-4 years
Minimal visual acuity at age 3-5 - Answers - 20/40
Minimal visual acuity greater than 6 years old - Answers - 20/30
Downs syndrome children have increased risk of what eye disorders? - Answers -
refractive error, strabismus, cataracts
Hearing screening after age 4 - Answers - conventional screening audiometry (raise
your hand if you can hear the noise); each ear tested and referred for discrepancy
greater than 20 db; hearing screening should be part of attention problem workup
What percentage dose acute care visits account for in a primary care office? - Answers
- 30%
Clinician documentation of acute care visit - Answers - document events related to
presenting problem (describe them in medical record), including supporting physical
data/ diagnostics; treatment, follow up instructions (when to return to work or school);
immunization status screening; anticipatory guidance
, Sports physicals are also known as what? - Answers - preparticipation physical
examination (PPE)
Goal of PPE - Answers - identify medical conditions that may make sports unsafe;
screen for underlying illness through history and physical; recognize preexisting injuries
or medical problems that affected previous sports seasons
Specifics to document in PPE - Answers - - sport being played
- previous cardiac, respiratory, musculoskeletal, or neuro problems associated with
activity
- CONCUSSIONS, any suspicion of cardiac syncope, asthma, or unilateral organs
- anabolic steroid or nutritional supplements
- relevant family history of cardiac death less than 50 yr old
Goal of chronic disease management - Answers - optimize quality of life while
minimizing the side effects of treatment interventions
Medical home - Answers - children and their families have an identified, easily
accessible primary care provider or group of pcps within an office; crucial for children
with special healthcare needs or those with one or more chronic health conditions
expected to last more than 1 year
AAP 7 characteristics of a medical home - Answers - 1. Must be accessible
2. Family-centered
3. Continuous
4. Comprehensive
5. Coordinated
6. Compassionate
7. Culturally effective
Healthy steps for young children program - Answers - trains pediatric providers to
deliver enhanced developmental services in the primary care setting
Most important aspect of telehealth call - Answers - deciding which patients need to be
seen and how urgently
Fever - Answers - rectal temp of 38C or 100.4F
Fever in infants less than 1 month old - Answers - infant should be managed in an
inpatient setting
Lumbar puncture is recommended for... - Answers - infants less than 30 days old with
fever, or infants 1-3 months old who are ill-appearing, or children 3-36 months old if
neurological/ meningeal signs are present
What temperature is harmful? - Answers - 41.7C
ANSWERS
Anticipatory guidance - Answers - Patient/family counseling which includes information,
advice, and suggestions about expected health-related life occurrences, health
maintenance, and preventive plans.
Where should pediatric history information be obtained from? - Answers - both patient
and parent; obtain as much as possible from patient to give child a degree of control
over a potentially threatening situation
Order of pediatric physical examination - Answers - 1. Inspection first, from afar;
examine skin color and work of breathing before beginning exam; establish trust; allow
child to sit in parents lap; defer otoscopic exam until last
When should eyes and ears be examined? - Answers - during every health visit
3 components of vision assessment - Answers - - visual inspection of eyes/eyelids
- alignment of eyes
- visual acuity
Birth to age 3 ophthalmic exam includes: - Answers - - eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
- ocular mobility
- red reflex check
Age 3 and up ophthalmic exam includes: - Answers - - eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
- ocular mobility
- red reflex check
Visual acuity test with eye chart; classes should be worn if prescribed and record data
as "corrected"
Assessing newborn visual acuity - Answers - should be able to briefly track mother's
face or brightly colored object within an hour after birth (fixation reflex not developed for
several weeks); dont talk while assessing vision, baby may look toward sound rather
than visual stimulus
,When patient presents with eye condition (infection, injury, etc), what do you check
first? - Answers - visual acuity; UNLESS there is chemical injury to eye, then you should
irrigate first and refer to ophthalmologist; when there is decreased acuity, also refer to
ophthalmologist
What is the visual acuity of a newborn? - Answers - 20/200-20/400; acuity reaches adult
level of 20/20 by age 5
When to refer child to ophthalmologist - Answers - - 3-5yr: if acuity is less than 20/40 in
either eye, or if theres a difference in two lines in acuity between eyes
- 6yr and older: if acuity is less than 20/30 or if theres a difference in two lines in acuity
between eyes
When to assess red reflex - Answers - birth until the child can read eye chart
When should you start to assess fixation and following? - Answers - 2 months; refer out
if fixation and following are poor by 3 months
When to test corneal light reflex (hirschsbergs test)? - Answers - 3 months- 5 years;
refer out for asymmetry in light reflex
When to start cover testing for strabismus - Answers - 6 months- 5 years
When to start a fundoscopic exam - Answers - 3 years
When to start preliterate eye chart testing - Answers - 3-4 years
Minimal visual acuity at age 3-5 - Answers - 20/40
Minimal visual acuity greater than 6 years old - Answers - 20/30
Downs syndrome children have increased risk of what eye disorders? - Answers -
refractive error, strabismus, cataracts
Hearing screening after age 4 - Answers - conventional screening audiometry (raise
your hand if you can hear the noise); each ear tested and referred for discrepancy
greater than 20 db; hearing screening should be part of attention problem workup
What percentage dose acute care visits account for in a primary care office? - Answers
- 30%
Clinician documentation of acute care visit - Answers - document events related to
presenting problem (describe them in medical record), including supporting physical
data/ diagnostics; treatment, follow up instructions (when to return to work or school);
immunization status screening; anticipatory guidance
, Sports physicals are also known as what? - Answers - preparticipation physical
examination (PPE)
Goal of PPE - Answers - identify medical conditions that may make sports unsafe;
screen for underlying illness through history and physical; recognize preexisting injuries
or medical problems that affected previous sports seasons
Specifics to document in PPE - Answers - - sport being played
- previous cardiac, respiratory, musculoskeletal, or neuro problems associated with
activity
- CONCUSSIONS, any suspicion of cardiac syncope, asthma, or unilateral organs
- anabolic steroid or nutritional supplements
- relevant family history of cardiac death less than 50 yr old
Goal of chronic disease management - Answers - optimize quality of life while
minimizing the side effects of treatment interventions
Medical home - Answers - children and their families have an identified, easily
accessible primary care provider or group of pcps within an office; crucial for children
with special healthcare needs or those with one or more chronic health conditions
expected to last more than 1 year
AAP 7 characteristics of a medical home - Answers - 1. Must be accessible
2. Family-centered
3. Continuous
4. Comprehensive
5. Coordinated
6. Compassionate
7. Culturally effective
Healthy steps for young children program - Answers - trains pediatric providers to
deliver enhanced developmental services in the primary care setting
Most important aspect of telehealth call - Answers - deciding which patients need to be
seen and how urgently
Fever - Answers - rectal temp of 38C or 100.4F
Fever in infants less than 1 month old - Answers - infant should be managed in an
inpatient setting
Lumbar puncture is recommended for... - Answers - infants less than 30 days old with
fever, or infants 1-3 months old who are ill-appearing, or children 3-36 months old if
neurological/ meningeal signs are present
What temperature is harmful? - Answers - 41.7C
