Exam (elaborations)
CMN 568: Module 1 (HEENT PEDIATRIC) – Qs And As
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CMN 568: Module 1 (HEENT PEDIATRIC) – Qs And As
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CMN 568: Module 1 (HEENT PEDIATRIC) – Qs And AsEye assessment in infant less than age 5 Right Ans - 1. Clarity of Cornea
2. Red Reflex
3. Eyelid dropping
Red Reflex Right Ans - the red glow filling the person's pupil which is
caused by the reflection of your ophthalmoscope light iff the inner retina.
Does NOT assess visual acuity
If red reflex is absent on ophthalmic exam? Right Ans - Retinoblastoma or
cataracts
REFER!
How long do you assess red reflex Right Ans - from birth til pt can read eye
chart
Clarity of Cornea Right Ans - if opacy detected: could be a sign of congenital
glaucoma
what if congenital glaucoma is suspected Right Ans - refer!
Eyelid drooping Right Ans - could result in perm blindness-- REFER!
Eye drainage days after birth upon assessment Right Ans - ophthalmia
neonatorum
prevention: erythromycin ointment post birth
**ask mother if erythromycin ointment done post birth?
Eye drainage few weeks old upon assessment Right Ans - Lacrimal duct
Obstruction
Vision screen of newborn Right Ans - tracking moms face
3 months old vision screen Right Ans - Corneal light reflex
Corneal Light Reflex (Hirschberg Test) Right Ans - Assess the parallel
alignment of the eye axes by shining a light toward the person's eyes.
,Normal Hirschberg test Right Ans - light reflection symmetric in both eyes
abnormal hirschberg test results Right Ans - **Esotropia
Exotropia
Hypertropia
Hypotropia**
**Esotropia Right Ans - inward turning of the eye
-if detected after 5- CNS disease
**Exotropia Right Ans - outward turning of the eye, away from the nose,
nasally displaced
**Hypertropia (strabismus) Right Ans - upward deviation of one eye
**Hypotropia (strabismus) Right Ans - downward deviation of one eye
How long do you continue corneal light reflex (Hirschberg) and Cover Test ?
Right Ans - til age 5
What is very common in infancy?
If beyond __ months, Refer! Right Ans - Intermittent Strabismus!
if beyond 4 MONTHS-- REFER!
6 Month vision assessment Right Ans - assess for strabismus or malignancy
**COVER TEST**
Cover test Right Ans - a test that detects a small degree of deviated
alignment by interrupting the fusion reflex that normally keeps the two eyes
parallel. ask the person to stare straight ahead at your nose, place a card in
front of one eye and note the uncovered eye. A normal response is a steady
fixed gaze.. if the uncovered eye jumps to reestablish fixation, eye muscle
weakness exists
What age does formal testing of visual acuity begin? Right Ans - Age 3
What age does adult level of 20/20 vision reached? Right Ans - Age 3-5 y.o.
, when do you give credit for that line during vision exam Right Ans - greater
than 50% correct
What visual screening result findings require the NP to refer the to Opthal?
3-5 years old Right Ans - Visual acuity less than 20/40 in either eye!
What visual screening result findings require the NP to refer the to Opthal?
6 years-Older Right Ans - Less than 20/30 in either eye
What visual screening result findings require the NP to refer the to Opthal?
Right Ans - **Difference of 2 or More lines between eyes-- even with passing
range in any pt 3 years or older-- REFER!
Hearing Screen when? Right Ans - examine at every visit.
@ Birth
then 4 years old...5, 6, 8, 10 yrs
When does convention screening audiometry start? Right Ans - 4 years old
Sports Physical exam Right Ans - ** Concussions, any sus. of cardiac
syncope, asthma symp, past concussions, hx of unilateral organs
(kidney/testicles)**
V/S: BP
Resp/Cardiac: note any exercise induced bronchospasm or anatomic heart
failure (obtain EKG or pul fx tests)
Skin: cont. (impetigo/molluscum)
Musculoskeletal: muscle groups, ROM, neck back shoulders, hips knees ankles,
safety coun.
Pediatric Fever Right Ans - **rectal temp greater than 38 C or 100.4 F
(most acc in pt less than 1 y.o.)
fever less than one refer to hosp.
Pediatric fever eval: Right Ans - Less than 1 mon: think GBS (tx?)
1-3 Mon: Strp pneumoniae and Meningitis (Most common)
**Non toxic presentation of fever Right Ans - Strong cry
Consolable*
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