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Neontal boards J > ophtha and ent > Flashcards

ophtha and ent Flashcards

1
Q

Which vitamin can lower chances of cleft lip

A

Folate (Vitamin B9)

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2
Q

A neonate presents with respiratory distress with inability to pass NG through the anterior nasal vestibule
CT scan: bony narrowing of the anterior most aspect of the nasal airway

What’s the diagnosis?

A

Pyriform Apeture Stenosis
* Associated with single central megaincisor
* Dx: nasopharyngoscopy and CT scan
* Tx: widening of bone via sublabial approach, may need nasal stent after to prevent impact of edema

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3
Q
  • Presents with nose smaller than average internal diameter
  • Normal neonatal rhinits and mucosal edema causes airway obstruction

What’s the diagnosis?

A

Midvault stenosis
* Tx: nasal decongesant, steroid drops
* After several weeks- airway will grow

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4
Q
  • It is the most common anatomic cause of nasal obstruction
  • Results from incomplete rupture of buccopharyngeal membrane or abnormal palatal dev’t
  • Pe: resp distress when quiet or feeding, resolves on crying, unable to pass NG

What’s the diagnosis?

A

Choanal atresia
* Dx: CT scan (aspirate secretions prior to procedure for optimal visualization)
* Associated with CHARGE- needs to be eval
* Tx: endoscopic visualization and removal of tissue vs removal of bony plate
- avoid damage to skull base

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5
Q
  • Baby presents with respiratory distress and feeding difficulty
  • PE: grey mass under the head of the inferior turbinate

What’s the diagnosis?

A

Nasolacrimal duct cyst
* Tx: endoscopic marsupialization

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6
Q

Congenital nasal mass that may have a connection to the CNS

What’s the differential diagnosis?

A

Dermoid cyst- most common nasal masses
*Buzz word: external pit on the nasal dorsum with pus
*may be connected to the CNS via fonticulus frontalis

Glioma- neural element, continue to grow after birth

Encephalocele
* Buzz: cyst that increases in size with crying or compression of the jugular veins (Fursternberg’s sign)

Dx: MRI
Tx: Consult ENT- resection if no connection with CNS otherwise ENT and neuro surg to include close of skull base

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7
Q

It is a mesenchymal tumor of the alveolar ridge (hard palate)

A

Epulis
Tx: excision

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8
Q

Its is mucocele of the sublignual or submandibular glands (floor of the mouth musculature)

A

Ranula
* Can cause anterior cervical compression
* Can cause airway obstruction
* STAT mgt: needle aspiration
* Definite mgt: surgical resection

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9
Q

Relationship of ROP and gestational age

A

Inverse
- 22-24 wks 90%

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10
Q

What is the relationship of severe ROP and long term neuro developmental outcome

A

Severe ROP is a predictor of functional disability (lower longitudinal IQ)

also includes: strabismus, myopia

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11
Q

Risk with laser therapy for ROP

A
  1. loss of peripheral vision
  2. myopia
  3. cataract
  4. pthisis bulbi (shruken nonfunctional eye)
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12
Q

What is timing of retinal vasculogenesis and angiogenesis

vasculogenesis- de novo synthesis of bld vessels
angiogenesis- formation of bld vessels from preexisting

A
  1. Vasculogenesis- 12-22 wks
  2. angiogenesis- 17- (36-40) wks GA
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13
Q

What is needed for retinal vasculogenesis

A

VEGF

Retinal vessels grow following hypoxia (inc VEGF) due to inc O2 demand by retinal vessels

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14
Q

What is pathogenesis of ROP

A

Phase 1- O2 sats 85-89% (most important)- until 31 wks
Phase 2 O2 sats 85-92% until 34 wks, > 94% at >34 wks
- Fluctuating O2 sat have increased risk for severe ROP

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15
Q

What increase phase I ROP (reduced physiologic retinal vascular dev’t)

A

Retinal hyperoxia

preterm birth leads to inc O2 tension

Leads of dec retinal VEGF, EPO, dec amt growth factors (IGF-1 and Omega 3 FA)

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16
Q

What factors increases risk for phase 2 ROP

A
  1. elevated VEGF
  2. increased levels of retinal EPO
17
Q

Until when is
a. exotropia
b. esotropia
c. strabismus or abnormal eye movement
considered normal

A

a. 4 months
b. 2 months
c. 3 months

18
Q

Conditions associated with eyelid coloboma

A

a. Goldenhar syndrome- upper eyelid
b. Treacher Collins- lower lid

Need close monitoring - can lead to corneal scarring and vision loss

19
Q

Newborn presents with persistent tearing and intermittent mucoid discharge
Whats the dx?

A

Nasolacrimal duct obstruction
Mgt: observation and lacrimal sac massage

resolves spontaneously by 12 mos

Differential: congenital glaucoma, infection, corneal injury

20
Q

Differential for conjunctivitis

A
21
Q

classification of ROP: What are the Zone

A
  • zone I optic disk initially
  • zone II- complete on the nasal
  • zone III reach the ora serrata as they complete crossing on the temporal side
22
Q

Newborn presents with photophobia, tearing, blepharospasm
What’s the dx?

involuntary tight closure of the eyelids.

A

Congenital glaucoma

Complication: optic nerve damage, bupthalmos
Mgt: urgent ophtha referral (surgical intervention, lower intraoccular pressure)

23
Q

Classification of ROP
What are the stages

A
  • Stage 1: a distinct line (usually white or yellowish) demarcating the vascularized to avascular retina
  • Stage 2: line develops thickness in height and width, it is called a ridge
  • Stage 3: When vessels break through the retina into the vitreous space, they become extraretinal neovascularization
  • Stage 4- retina begins to detach
  • Stage 5- detachment becomes complete
24
Q

Classification of ROP
Definition of plus disease, pre-plus disease, aggressive posterior ROP

A
  • Plus: severe form of ROP followed by rapid progression to retinal detachment. Characterized- dilation and tortuosity of the retinal arterioles and venule
  • Pre-plus: dilation and tortuosity of the retinal arterioles and venule that are insufficent plus disease
  • Aggressive posterior ROP: more serious variant; subtle retinal finding, posterior location, rapid progression
25
Q

Classification of ROP
Definition of threshold, prethreshold, Type I ROP

A
  • Threshold: 5 contiguous clock hours or eight total clock hrs of stage 3 and plus disease in zone I or II
  • Prethreshold: ROP less than threhold in zone I; S2 plus in zone II, S3 with plus in ZII but fewer clock hr
  • Type I ROP
    * Any stage ROP with plus disease in zone I
    * Stage 3 ROP without plus disease in zone I
    * Stage 2 or 3 ROP with plus disease in zone II
26
Q

When to treat ROP

A
  • Type I ROP
    * Any stage ROP with plus disease in zone I
    * Stage 3 ROP without plus disease in zone I
    * Stage 2 or 3 ROP with plus disease in zone II
27
Q

When is pupillary light response

A

31 weeks

28
Q

When does optic myelination conclude

A

2 years

29
Q

Treatment goals for retinoblastoma

A
  1. Overall survival remains the top priority over globe salvage
  2. Requires multidisciplinary team
  3. Treatment: enucleation, chemotherapy is globe saving therapy and also target metz
  4. Best treatment approach: consider individual disease characteristics, family’s needs from an economic and psychological standpoint
30
Q

A baby was born via forceps assisted delivery. On exam, there was unilateral corneal clouding with vertical tears in Descemet membrane (posterior corneal layer).
a. What is the cause
b. Management

A
  • A. Trauma
  • B. 1. Reassure parents 2. Followed by ophtha

Resolves in a few months
can cause ambylopia & astigmatism- ophtha ref

31
Q

Factoids on retinoblastoma

A
  1. Majority (60%) are nonheritable
  2. Involves the RB1 gene
  3. All Bilateral or unilateral but multifocal RB are heritable
  4. Heritable presents: younger, assoc nonmetastatic pineal tumors, nonoccular tumors, higher chance to pass to future generation (45%)
32
Q

Screen for retinoblastoma

A
  • screening at-risk patients from birth until 7 years of age.
  • After 7 years, if there is no clinical evidence of Rb and does not have RB1 mutation, no further ophthalmologic follow-up is needed.
  • If there is an existing RB1 mutation, ophthalmologic screening should be done every year and indefinitely.

Neontal boards J (19 decks)

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