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Pediatrics > MT 1 > Flashcards

MT 1 Flashcards

1
Q

Germinal periods times

A

Day 1-21

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2
Q

Embryonic period

A

4-8 weeks

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3
Q

Fetal period

A

9 weeks to birth

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4
Q

what happens during the germinal period

A

Fertilization to zygote. Rapid cell division begins differentiation. Inner=ectoderm, endoderm, mesoderm. Outer forms with implantation and create placenta

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5
Q

Day 10

A

Implantation occurs in the uterus (42% survival rate here)

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6
Q

Day 21

A

neural tube forms

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7
Q

Ectoderm form what in the eye

A

RPE, Retina, Optic nerve, lens

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8
Q

Mesoderm forms what in the eye

A

Uveal tract, sclera, cornea

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9
Q

What is the most critical period of prenatal development

A

embryonic

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10
Q

what happens during the embryonic period

A

differentiation of all major internal and external body structure and vital organs. Growth occurs in a cephalon to caudal and proximal to distal way. Chromosomal abnormalities cause spontaneous abortion in 20%.

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11
Q

What happens during Fetal period

A

Growth stage: sexual differentiation by week 12. Further differentiation and refinement of ocular structures. Myelination of CNS begins. Brain waive pattern shifts to active cycles at 28 weeks

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12
Q

What is the age of viability

A

24-28 weeks

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13
Q

What is a normal term

A

38 weeks

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14
Q

4 types of congenital disorders

A

Genetic in origin (any stage), genetically determined by enviormenteally induced, purely environmental, sporadic (unknown)

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15
Q

Greatest risk for chromosomal abberations

A

maternal age.

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16
Q

Chromosomal abberation viable births

A

all share a syndrome

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17
Q

Cause of chromosomal abberations

A

90% environmental and 10% genetic

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18
Q

Retinoblastoma

A

Germaine deletion or translocation of the long arm of 13. Results in loss of function of RB1 gene.

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19
Q

Retinoblastoma inheritance

A

Typically AD

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20
Q

Cri-Du-Chat

A

5p syndrome. Short arm of 5 gone. High pitched cry like a kitten. Hypertelorism. microcephaly, optic atrophy, severe mental retardation.

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21
Q

Single gene mutations that are autosomal dominant

A

each offspring has 50% chance. Vertical pattern seen in families.

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22
Q

Autosomal recessive single gene mutations

A

Need 2 defective genes to express. Appears sporadically with a horizontal pattern in family tree.

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23
Q

Single gene defects are ____

A

rare. Most humans traits are determined by multiple genes and factors.

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24
Q

Multifactorial genetics

A

Specific genes in specific cells turn on and off in response to trauma, pathogens, neurochemicals, oncogenesis.

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25
Q

Teratogens

A

Range of substances and conditions that increase risk of prenatal anomalies. Effects of exposure vary according to timing. Each structure has its own critical period where it is most susceptible. Also varies effect due to threshold. Also has an interaction effect (i.e. smoking and alcohol) and genetic vulnerability.

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26
Q

When is the eye most susceptible to tetragens

A

4th week but anomalies can arise at any time.

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27
Q

Specific Tegragens

A

infectious agents, medicinal drugs, hyperthermia, psychoactive drugs, maternal age and health

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28
Q

Infectious Agents

A

Mother’s immune system must necessarily be suppressed to accept the fetus. Infectious agents can be transmitted prenatal, perinatal (during birth) or postnatal.

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29
Q

Infectious agents that can be passed to child.

A

TORCH dz. Toxo, other (syphillis, hep b, coxsackie, epstein bar, varicella), Rubella, cytomegalovirus, herpes simplex virus.

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30
Q

Toxo

A

30% affected mothers will transmit to chid. Children will have chorioretinitis. Most affected babies are asymptomatic at birth. Hydrocephalus, cerebral calcification, microcephaly, deafness, seizures.

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31
Q

Rubella

A

Transmitted during first trimmest (7 weeks). Includes cataracts, salt and pepper retinopathy, a heart defects.

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32
Q

Cytomegalovirus

A

Most asymptomatic at birth but go to develop cerebral calcifications, atrophy, sensorineural hearing loss, seizures, and chorioretinitis.

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33
Q

HIV

A

Transmitted to baby during birth. Risk is higher if mother is exposed during 3rd trimester.

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34
Q

Visual consequences of TORCH dz

A

Severe encephalopathy often leads to permanent damage to visual processing areas and leads to cortical vision impairment. Optic atrophy is also common.

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35
Q

Drugs and pregnancy

A

Ocular diagnostic drugs have a risk so discuss with patient.

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36
Q

Hyperthermia

A

Maternal fever at critical period can cause microphthalmost, CNS and facial defects.

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37
Q

psychoactive drugs

A

Due to the interaction of tetragens, poor or nonexistent prenatal care, poor nutrition, high stress levels, poor lifestyle after birth. unknown.

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38
Q

Cigarette smoking and pregnancy

A

Associated with higher incidence of low birth rate. Also arterial damage.

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39
Q

Fetal alcohol syndrome

A

Skin fold at corner of the eye, low nasal bridge, short nose, small head circumference, small eye opening, small mid face, thin upper lip. Basically small features of head.

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40
Q

Mothers 16 or younger

A

higher risk of eclampsia and preeclampsia and for delivery of low birth weight or nutritionally deficient infants.

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41
Q

Mothers 35 or older

A

At a greater risk for gestational diabetes or hypertension and for chromosomal aberration.

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42
Q

Chiari malformation

A

common cause of hydrocephalus. Herniation of cerebral tonsils blocks outflow of CSF. Cause papilledema.

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43
Q

WHAT IS A LOW BIRTH WEIGHT

A

less than 5.5 lbs.

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44
Q

Factors of infant survival

A

respiratory distress syndrome, low body fat, vulnerability to infections

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45
Q

Extreme low birth weigh

A

Less than 1,000 g

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46
Q

APGAR score

A

check of body functioning at birth. o, 1, or 2 assigned to heart rate, respiratory effort, muscle tone, skin color, and reflex irritability. measure at 1 and 5 minutes.

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47
Q

What does the APGAR score mean

A

Best is 10. A score below 7 means child needs help establishing breathing. below 4 is critical.

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48
Q

Body weight in infant

A

double it by 4 months, triple it by 1st year, and 1/5th adult weight by 24 months

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49
Q

Growth in infants

A

mostly in the limbs. Infantas grow 1 inch longer each month and at 24 months 1/2 adult height.

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50
Q

SIDS

A

leading cause of death in infants after congenital anomalies. Risk with poverty, young mothers, smoker, male babies, bottle fed, sleeping on stomach.

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51
Q

4 physiological states in the infants life

A

Quiet deep sleep, active sleep, alert, crying.

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52
Q

Infant’s daily cycles

A

develop during the first year

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53
Q

at birth the human brain is ____ of its adult weight

A

25%

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54
Q

When does myelination occur

A

rapid up to 4 years but continues after

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55
Q

Critical period

A

The first two years. There is a rapid increase in dendrite growth and sympases

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56
Q

Transient exuberance

A

The increase in connection in the brain

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57
Q

When does synaptic dentisty reach its maximum

A

2 years

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58
Q

When does synaptic pruning occur

A

at age 7

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59
Q

What determines the density of the cortical synpases

A

environmental encounters.

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60
Q

WHAT IS THE CRITICAL AGE

A

BIRTH TO 2 YEARS

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61
Q

Peak critical age

A

3-6 months

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62
Q

Plastic period

A

2 to 7-10 years

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63
Q

Visual maturity

A

10-15 years

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64
Q

what is the least developed sense at birth

A

vision

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65
Q

Hearing development

A

infants can distinguish there mothers voice almost immediately. They can discriminate similar sounds at 1 month. Hearing acuity develops for higher frequencies but poor localization.

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66
Q

Taste and smell development

A

fairly well developed at birth and reach peak at 1 year

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67
Q

Intermodal perception

A

The ability to associate one stimulus with t he input of another. Good by 3 months. i.e. know what objects create what sound.

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68
Q

Cross modal perception

A

Present at 1 month. The ability to use information from one sensory modality to imagine input from another.

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69
Q

Infant reflexes for survival

A

Breathing, cold, sucking, rooting

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70
Q

Babinksy reflex

A

toes go out and back when put fingers on bottom of foot

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71
Q

Moro

A

Startle reflex.

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72
Q

Palmar grasping

A

will hold onto finger

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73
Q

Stepping and swimming

A

when hold up will walk. when hold stomach will swim.

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74
Q

Age lifts head on stomach

A

3

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75
Q

Rolls over

A

5

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76
Q

Sits without support

A

8

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77
Q

Crawls

A

9

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78
Q

Stands holding on

A

10

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79
Q

Walks holding on

A

13

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80
Q

Walks well

A

14

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81
Q

walks backward

A

21

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82
Q

Walks up steps with help

A

22

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83
Q

Kicks ball

A

24

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84
Q

Can touch objects

A

3

85
Q

grasps objects

A

5

86
Q

grasps objects and put in mouth

A

8

87
Q

Use thus and finger to pick up

A

9

88
Q

what limits oculomotor control in infnats

A

sensory (afferent) defects in motor reflex arc (retina is not mature)

89
Q

how long should you breast fed

A

recomended for 6 months but suggested for 2 years

90
Q

Marasmus

A

sever malnutrition during first year that stops development and growth.

91
Q

when is cognitive development rapid

A

during first year.

92
Q

Piaget’s Model

A

Sensorimotor intelligence occurs from birth to 2 years. All stages are based on affordance of opportunities to learn.

93
Q

Piaget substage 1

A

Intelligence functions in terms of senses and motor skills

94
Q

piaget stubstage 2

A

More cognitive in terms of cause and effect thinking (6-9).

95
Q

piaget substage 3

A

repeats actions to get desired results

96
Q

piaget substage 4

A

goal directed behavior where results are anticipated despite any distraction

97
Q

Piaget substage 5

A

Little scientist

98
Q

piaget substage 6

A

more contemplative and reflective. pretend stage.

99
Q

Object contancy

A

during first 2 years. Perceive boundaries and learn that an object stays the same size despite change in appearance when closer or further.

100
Q

Object permanence

A

objects and people still exist even when they cannot be seen.

101
Q

Categorizontal

A

infants greater than 6 months can categorize objects, speech.

102
Q

Memory

A

Better than though. Good at non-language.

103
Q

language development

A

born ready to learn language.

104
Q

Parantese

A

high pitched baby talk. Helps with language acquisition

105
Q

Language acquisition steps

A

receptive language, expressive language, reading acquisition, written.

106
Q

Underextension

A

Toddlers use a word to refer to a narrow category. i.e. dog is there dog only

107
Q

overextension

A

Overgeneralization of word to similar characteristic. All 4 legged animals are dogs.

108
Q

Holophase

A

A single word to describe a complete though. I.e. pee pee

109
Q

First words

A

13 months

110
Q

growth spurt of words

A

18 months

111
Q

First 2 word senstence

A

21 months

112
Q

Multiword sentence

A

24 months

113
Q

when do social smiles start

A

2 months

114
Q

Stranger wariness

A

First noticeable by 6 months

115
Q

Seperatetion anxiety

A

8-9 months and peaks at 14 months.

116
Q

Social referencing

A

appears at 12 months where they will look at trusted individual for cues

117
Q

Self awareness

A

2nd year. become more self conscious.

118
Q

Secure attachment

A

an infant who desires to be close to caregiver but who is not afraid to explore

119
Q

insecure attachment

A

very mixed. sign of neglect or abuse

120
Q

Freud stages

A

Oral stage (birth-1year), anal stage (1-2).

121
Q

Erikson stages

A

Trust vs. mistress (with to 1 year), autonomy vs. shame.

122
Q

Pacific Acuity Cards

A

Must look at shape or compare the two. Testability of two figure forced choice good for children up to 18 months and up. Younger children better for single.

123
Q

Acuity with PAT vs. cardiff

A

PAT is one line worse

124
Q

What patient is PAT good for?

A

reduced vision (amblyopia). Fine on teller but awful on lea. This is in-between.

125
Q

Teller card and amblyopia

A

Good to test difference in RE before patient knows lea symbols.

126
Q

At what age should you use PAT

A

18 months or older

127
Q

What to test those below 18 months

A

single vanishing optoype (cardiff).

128
Q

What is PAT good for

A

Yields acuity measures closer to standard optotype tests than most commonly used refractive tests for preverbal children. Good for detecting and monitoring amblyopia at a younger age and assessment of vision in children with impairment.

129
Q

VEP

A

The ultimate way to determine resolution capability at the level of the visual cortex in nonverbal patients. Demonstrate that infant acuity is much greater than we can observe.

130
Q

When does VEP show 20/20 vision

A

around 6 months

131
Q

Cons of VEP

A

must have the child’s attention.

132
Q

Recognition acuity

A

By 2.5-3 years children can usually use lea symbols.

133
Q

What to expect for 3 year olds w/out RE with lea

A

20/30

134
Q

When 20/20 with lea

A

4-5 years

135
Q

Contrast sensitivity in young

A

Most useful for kids with visual impairment.

136
Q

When is the stimulus response curve and accuracy adult like?

A

3-4 months

137
Q

Response to ____ lens is poor in infants

A

minus lenses

138
Q

When are the motor pathways for eye movements and accommodation present?

A

At birth but they are dependent upon maturation of the sensory system for development.

139
Q

What systems develop together

A

Sensory and motor

140
Q

Accuracy of fixation at birth

A

Limited by foveal immaturity

141
Q

What do infants use for vision

A

rough central fixation during the first 3 months of life.

142
Q

What are the most mature eye movements at birth

A

saccades

143
Q

what type of saccades do 1-2 month year olds use

A

they can only make small saccades

144
Q

What type of saccades do 6-8 month olds use

A

One large single saccade.

145
Q

Scanning in infants

A

Use same scan pattern as adults but they make smaller saccades and show longer fixation times

146
Q

When does the cortical aspect of saccades develop

A

improves rapidly in the first few months of life and then continues on a slower trajectory.

147
Q

Pursuit eye movement development

A

More affected by foveal development than saccades.

148
Q

When can you see pursuits

A

1-4 weeks. At first pursuit velocity lags behind stimulus velocity and there is a large latency before initiation. The infant uses saccades to catch up to the stimulus.

149
Q

Head movement in young

A

Will use head movement to supplement both saccades and pursuits. Early head control is poor so the oculomotor systems must do most of the work in very young infants

150
Q

Accurate pursuit of moving object at 6 months is accomplished by

A

equal head and eye movements.

151
Q

Pupillary reflex

A

response to light and accommodation are present at birth in full term and pre term infants.

152
Q

Is anisocoria normal in infants?

A

Yes less than 1.5mm. Reduces overtime.

153
Q

Pupil diameter in infants

A

highly variable

154
Q

VOR in children

A

Infants show a much greater VOR than adults

155
Q

OKN in infancy

A

Have a much weaker in nasal to temporal direction. Has asymmetry of monocular response. This should be gone by 6 month.

156
Q

Who is persistent asymmetry of OKN seen in?

A

Children with unilateral deprivation of strabismus. It is not dx as some children with normal binocular visual input retain this asymmetry.

157
Q

Newborns accommodation

A

Exhibit inaccurate accommodative response to varying stimulus demands. Can find some over accommodation and pseudo myopia.

158
Q

Infants with hyperopia over 3-4D

A

show less likely to emmetropize.

159
Q

Critical period for BV

A

First 12 month. Especially 3-9 months

160
Q

Most neonates enter the worth with rough ___tropia

A

orthotropic and yoked eye movements

161
Q

The development of normal binocular vision including accurate mergence eye movements depend on

A

foveal and cortical development

162
Q

At birth the _____ of retinal cells is stable but the ____ of the retina will

A

number and type, area. Thus the primary retina changes post natal is the redistribution of retinal elements. Retinal periphery expands most rapidly.

163
Q

Neonate Fovea

A

Foveal depression is immature at birth. By 1 week after birth there is a shallow foveal depression but the thick cones still lack outer segments and are only 1 cell deep in the fovea.

164
Q

When does the fovea reach maturity

A

Between 15 and 45 months of age.

165
Q

When can you see the FLR

A

6 months

166
Q

Difference in neonates foveas

A

Cone density is lower. Photoreceptors are diferent

167
Q

When is visual pathway myelinated

A

24 months

168
Q

Neonate visual cortex has reduced ____ & ____

A

Disparity tuning, contrast sensitivity

169
Q

What is the limiting factor for binocular function?

A

foveal and cortical immaturity

170
Q

When are appropriate convergence and divergence responses present for binocular vision

A

Prest at 1 month and consistent at 2 months

171
Q

Hirschberg test at birth

A

1 mm nasal.

172
Q

At what age are the eyes aligned 100%

A

3-4 months

173
Q

When is convergence to 10-15 cm seen?

A

3-4 months

174
Q

When is convergence to adult (6-10) seen

A

6 months

175
Q

When does true fusion occur

A

10-14 weeks

176
Q

When can you see stereopsis in clinical settings

A

9-12 months

177
Q

When will you see normal adult stereopsis

A

7-8 years. Adult level (20 arc seconds). Think it is normal at 5.

178
Q

Critical period for susceptiblity

A

Time frame in which deprivation or abnormal experience can permanently alter the function of the neurological system.

179
Q

Critical period for acuity

A

First year is most critical but periods as late as 7-9 can still change.

180
Q

Critical period for steropsis

A

3-9 months but deprivation even after maturity can affect

181
Q

_____ during critical period leads to very poor outcomes

A

constant strabismus

182
Q

Most sever amblyopia

A

deprivational

183
Q

Brain growth and Optometry

A

Brain growth at 2 years for language development. Visual spatial development in right at 4-5. No rolling E’s.

184
Q

Fine motor during preschool

A

Do not develop as much as gross. Due to incomplete myelination and lack of full muscle control.

185
Q

When do children connect numbers and counting

A

2 years

186
Q

Giving a 3 year old vs. 5 year old directions

A

3 year old: needs specific instructions

5 year old: planning and goals.

187
Q

building memory

A

ask specific questions and supplement the questions with additional information

188
Q

when is right and left established

A

6 or 7

189
Q

laterality on external object

A

7-12

190
Q

Centration

A

Tendency to focus their analysis on one aspect of a situation or object to the exclusion of all other. EX: lions are not cats.

191
Q

conservation

A

The inability to understand that an amount or quantity is unaffected by changes in its shape or placement

192
Q

Irreversibility

A

inability to recognize that reversing a transformation brings about the same conditions that existed prior to the transformation.

193
Q

Piaget’s preoperative thoughts

A

Concentration, conservation, irreversibility

194
Q

When are preoperative thoughts understood

A

By 3 years but fragile

195
Q

guided participation

A

A process in which the child turns through social interaction with a tutor.

196
Q

Zone of proximal development

A

Difference between individuals development and what could be attained with a tutor.

197
Q

Scaffold

A

To structure a child’s participation so they learn.

198
Q

Fast Mapping

A

Process used to group essential meaning of new words by quickly connecting them to words and categories that are understood.

199
Q

When does prevalence of myopia increase

A

About age 7.

200
Q

Identity

A

The logic that a given substance remains the same no matter what change occurs. Concrete.

201
Q

Reversability

A

The logic that something that has been changed can return to its original state

202
Q

Reciprocity

A

A change in one dimension of an object can be compensated for a change in another.

203
Q

Class inclusion

A

The idea that a particular object or person may belong to more than one class.

204
Q

Evaluating cognitive growth in school

A

Achievement, aptitude, IQ

205
Q

Acheivement

A

how much a person knowns in an area. I.e. midterm

206
Q

aptitude test

A

potential rather than accomplishment

207
Q

IQ

A

Mental age.

208
Q

When are 2nd languages most easily learned

A

before age 10

Pediatrics (1 decks)

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