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Pediatric Optometry Final Exam > Children With Special Needs and Co-Management of Pediatric Patients > Flashcards

Children With Special Needs and Co-Management of Pediatric Patients Flashcards

1
Q

What is the life expectancy for a child with Down syndrome?

A

47 years old

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2
Q

There are ________ copies of chromosome 21 in 95% of Down syndrome cases

A

three

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3
Q

57-80% of people with Down syndrome have what type of refractive error?

A

Hyperopia

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4
Q

Accumulating oblique eyelid pressure and the mechanical force of the eyelid are thought to be responsible for what type of refractive error?

A

Astigmatism

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5
Q

One hypothesis for refractive error in children with Down syndrome is the failure to ________________

A

emmetropization

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6
Q

What has been linked to myopia progression in more than half of children with Down syndrome?

A

large lag of accommodation

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7
Q

Cognitive ability, mental deficiency and post-retinal reduction in acuity are thought to be linked to the lack of growth in what structure in the visual cortex?

A

Dendritic Tree Structure

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8
Q

55% of children with DS have a (lead/lag) of accommodation >1.00D

A

lag

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9
Q

What type of glasses helped improve reading grade levels in children with Down syndrome?

A

bifocals

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10
Q

What is the overall prevalence of strabismus in children with DS?

A

19-34%

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11
Q

What laterality is most common in esotropia?

A

alternating (70%)

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12
Q

Why must we use caution when prescribing atropine amblyopia therapy for children with DS?

A

Atropine may increase heart rate

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13
Q

What type of cataracts make up 71% of cataracts diagnosed after age 12 in children with DS?

A

Cerulean Cataracts

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14
Q

What are focal areas of iris stromal connective tissue hyperplasia surrounded by relative hypoplasia?

A

Brushfield Spots (found in 52% of children with DS)

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15
Q

What is thought to play a role in the development of keratoconus in children with Down syndrome?

A

itchiness of blepharitis leads to eye rubbing

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16
Q

What percent of patients with autism have an ocular manifestation?

A

40%

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17
Q

Do children with autism tend to have normal or reduced stereo?

A

reduced

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18
Q

41% of children with autism had some form of ____________

A

strabismus

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19
Q

What percent of children with autism required strabismus surgery?

A

11%

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20
Q

Strabismus, amblyopia and anisometropia are (more/ less) commonly found in children with autism than children without autism

A

more

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21
Q

What structural and functional abnormalities contribute to poor oculomotor control in children with autism?

A

abnormalities in cerebellar vermis lobules VI-VII, fastigial nucleus, and brainstem; atypical activation of prefrontal cortex during oculomotor tasks

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22
Q

What may be an early marker for ASD?

A

oculomotor function

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23
Q

fear of escalators, impaired eye-hand coordination (catching a ball), difficulty learning to drive occur as a result of reduced top-down control of which type of ocular motility pattern?

A

Pursuits

shown in fMRI as diminished activation in V5, and higher order projections of V5

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24
Q

Which gender experiences milder symptoms related to fragile X syndrome?

A

females

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25
Q

What condition consists of autistic-like behaviors, sensory integration and mild to severe intellectual disabilities

A

Fragile X Syndrome

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26
Q

What are ocular manifestations of Fragile X?

A

strabismus, amblyopia, refractive errors, nystagmus, ptosis, convergence insufficiency

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27
Q

What is the cause of cerebral palsy?

A

non progressive disturbances that occur in the developing fetal or immature brain

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28
Q

What are the 4 types of Cerebral Palsy?

A

Spastic diplegia, spastic hemiplegia, spastic quadriplegia, extrapyramidal

29
Q

Vision problems are prevalent in which type of cerebral palsy?

A

spastic cp

30
Q

Which types of vision problems are prevalent in more than 50% of children with cerebral palsy?

A

Strabismus (70.5%), significant refractive error (53.3%)

31
Q

What is the typical range of reduced VA’s in children with cerebral palsy?

A

20/25-20/63

32
Q

Which type of optic nerve abnormalities are found in children with cerebral palsy?

A

optic nerve cupping, optic atrophy and optic nerve hypoplasia

33
Q

Pallor is commonly seen in children with q___________ or n___-__________ cerebral palsy

A

quadriplegic, non-ambulatory

34
Q

What disorder comprises visual malfunction due to retro-chiasma visual and visual association pathway pathology?

A

Cerebral Visual Impairment

35
Q

CVI is common in children with __________ ________ and ________________

A

cerebral palsy, hydrocephalus

36
Q

CVI is secondary to to pathologies affecting what pathways?

A

visual pathways, pathways serving higher visual functions

37
Q

what can CVI interfere with?

A
  • Visual guidance of eye, head, and body movement;
  • visual search and attention;
  • visual acuity, fields, contrast perception;
  • face, object, route recognition
38
Q

Where does image data under go basic processing

A

occipital visual cortex

39
Q

What area of the brain creates a visual representation of the surroundings?

A

posterior parietal lobes that are connected to visual cortex by the dorsal stream

40
Q

What does the ventral stream do?

A

matches incoming information with prior visual memories

Ventral stream: What

41
Q

Damage or malfunction of the visual association territories of the brain and their pathways causes what?

A

Visual perception dysfunction

42
Q

What kind of changes happen in the brain in response to ocular blindness?

A

structural and functional changes

43
Q

What are the 3 groups of patients with CVI?

A
  1. Profound visual impairment
  2. impaired but functionally useful vision with cognitive and often motor challenges
  3. impaired but functionally useful vision and work at or near expected academic level for their age
44
Q

What are the causes of CVI?

A
  1. Hypoxic-ischemic encephalopathy
  2. TBI
  3. Infections of CNS
  4. Neonatal hypoglycemia
  5. Metabolic Disorders
  6. Seizure disorder
  7. Maternal intake of drugs
  8. Acquired causes of CVI (respiratory arrest, head injury, cardiac arrest, focal infection, cerebrovascular accident, encephalitis)
  9. Cerebral Palsy
  10. Hydrocephalus
  11. Williams Syndrome
  12. Autism
45
Q

Children with CVI often have preference for a specific color; in general, ____________ is better

A

brighter

46
Q

What does visual latency look like in a child with CVI?

A

may take time for a child with CVI to look at an object

47
Q

What are some ways to help a child with CVI that has difficulty with visual complexity?

A

provide simpler colored objects (single colored stuffed animals); use solid color backgrounds

48
Q

What does light gazing and non-purposeful gazing look like in a child with CVI?

A

staring at lights, gazing out windows, looking at things not there

49
Q

What does visual field preferences look like in a child with CVI?

A

child will prefer to look at objects in particular direction

50
Q

what does it look like when a child with CVI has impaired visually guided reach?

A

often look away from object, then reach for it

51
Q

What are ocular manifestations of spina bifida?

A

strabismus, amblyopia, nystagmus, coloboma, optic nerve abnormalities

52
Q

When considering global developmental delays

What are the developmental domains?

A

gross or fine motor; speech/language; cognitive; social/ personal; ADL

GDD: significant delay in 2 or more domains

GDD is the term used for children under 5; ID is used for older children (IQ testing reliable)

53
Q

GDD can predict future ID, but milder delays may be ___________

A

transient

kids may catch up

54
Q

What 3 questions are we most concerned with when examining a patient with special needs?

A

Can the child see? Are the eyes aligned? Are the eyes healthy?

55
Q

Congenital exotropia is a large angle divergent strabismus that presents at what age?

A

within 1st year of life

56
Q

What other abnormalities is congenital exotropia associated with?

A

neurological abnormalities or craniofacial syndromes

57
Q

What type of surgery is typically used for congenital exotropia?

congenital XT > 35 PD

A

bilateral LR recessions or monocular MR resection with LR recession

58
Q

What are 3 types of exotropia?

A

sensory, consecutive, convergence insufficiency

59
Q

When do we refer for congenital esotropia?

A

constant alternating esotropia before 6 months

60
Q

What are characteristics of congenital esotropia?

A

associated latent nystagmus, IOOA, DVD; typically > 30 pd

61
Q

What is the goal of surgery for congenital esotropia?

A

align to within 8pd of ortho

62
Q

what type of surgeries are used for congenital esotropia?

A

bilateral MR recessions, bilateral LR resections, uniocular MR recession or LR resection

63
Q

Are cranial nerve palsies comitant or noncomitant deviations?

A

noncomitant

64
Q

What condition is a congenital hypoplasia or absence of CN6 nerve or nuclear that results in abnormal innervation of LR by CN III?

A

Duane Syndrome

65
Q

Globe ____________ and palpebral fissure __________ are seen in Duane syndrome

A

retraction, narrowing

66
Q

What causes deprivation amblyopia?

A

structural abnormalities (ptosis or other asymmetric lid abnormalities, corneal opacities, hyphema, cataract, vitreous hemorrhage)

67
Q

What visual findings are associated with learning problems?

A

hyperopia, anisometropia, exophora, low vergence ranges, reduced or asymmetric near VA; accommodative infacility and poor oculomotor control

68
Q

What are categories of an IEP that optometrists might be involved in?

A

specific learning disability, visual impairment; deaf-blindness; traumatic brain injury

Pediatric Optometry Final Exam (3 decks)

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