CMN 568 QUESTIONS AND WELL EXPLAINED ANSWERS
anticipatory guidance
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?
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
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?
during every health visit
3 components of vision assessment
- visual inspection of eyes/eyelids
- alignment of eyes
- visual acuity
birth to age 3 ophthalmic exam includes:
- eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
- ocular mobility
- red reflex check
age 3 and up ophthalmic exam includes:
- 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
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); don’t 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?
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?
20/200-20/400; acuity reaches adult level of 20/20 by age 5
when to refer child to ophthalmologist
- 3-5yr: if acuity is less than 20/40 in either eye, or if there’s a difference in two
lines in acuity between eyes
- 6yr and older: if acuity is less than 20/30 or if there’s a difference in two lines in
acuity between eyes
when to assess red reflex
birth until the child can read eye chart
when should you start to assess fixation and following?
2 months; refer out if fixation and following are poor by 3 months
when to test corneal light reflex (Hirschberg’s test)?
3 months- 5 years; refer out for asymmetry in light reflex
,when to start cover testing for strabismus
6 months- 5 years
when to start a fundoscopic exam
3 years
when to start preliterate eye chart testing
3-4 years
minimal visual acuity at age 3-5
20/40
minimal visual acuity greater than 6 years old
20/30
downs syndrome children have increased risk of what eye disorders?
refractive error, strabismus, cataracts
hearing screening after age 4
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?
30%
clinician documentation of acute care visit
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?
preparticipation physical examination (PPE)
goal of PPE
, 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
- 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
optimize quality of life while minimizing the side effects of treatment
interventions
medical home
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
1. must be accessible
2. family-centered
3. continuous
4. comprehensive
5. coordinated
6. compassionate
7. culturally effective
healthy steps for young children program
trains pediatric providers to deliver enhanced developmental services in the
primary care setting
most important aspect of telehealth call
anticipatory guidance
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?
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
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?
during every health visit
3 components of vision assessment
- visual inspection of eyes/eyelids
- alignment of eyes
- visual acuity
birth to age 3 ophthalmic exam includes:
- eye history
- vision assessment
- inspection of eyelids and eyes
- pupil examination
- ocular mobility
- red reflex check
age 3 and up ophthalmic exam includes:
- 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
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); don’t 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?
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?
20/200-20/400; acuity reaches adult level of 20/20 by age 5
when to refer child to ophthalmologist
- 3-5yr: if acuity is less than 20/40 in either eye, or if there’s a difference in two
lines in acuity between eyes
- 6yr and older: if acuity is less than 20/30 or if there’s a difference in two lines in
acuity between eyes
when to assess red reflex
birth until the child can read eye chart
when should you start to assess fixation and following?
2 months; refer out if fixation and following are poor by 3 months
when to test corneal light reflex (Hirschberg’s test)?
3 months- 5 years; refer out for asymmetry in light reflex
,when to start cover testing for strabismus
6 months- 5 years
when to start a fundoscopic exam
3 years
when to start preliterate eye chart testing
3-4 years
minimal visual acuity at age 3-5
20/40
minimal visual acuity greater than 6 years old
20/30
downs syndrome children have increased risk of what eye disorders?
refractive error, strabismus, cataracts
hearing screening after age 4
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?
30%
clinician documentation of acute care visit
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?
preparticipation physical examination (PPE)
goal of PPE
, 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
- 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
optimize quality of life while minimizing the side effects of treatment
interventions
medical home
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
1. must be accessible
2. family-centered
3. continuous
4. comprehensive
5. coordinated
6. compassionate
7. culturally effective
healthy steps for young children program
trains pediatric providers to deliver enhanced developmental services in the
primary care setting
most important aspect of telehealth call
