Ophthalmology

Question 1

When does optic nerve myelination complete?

Answer 1

2 years old

Question 2

When does eye development begin?

Answer 2

5th week of gestation

Question 3

At 30 weeks what can the eye do?

Answer 3

Response to light, pupils reactive (some may not be reactive until 32 weeks)

Question 4

When does conjugate horizontal gaze develop? Conjugate vertical gaze?

Answer 4

Horizontal - at birth for full term

Vertical - 2 months of age

Question 5

What causes leukocoria?

Answer 5

Leukocoria = white reflex

1. Most common cause: cataracts
2. Less common: retinoblastoma, coloboma, ROP, retinal detachment, vitreous hemorrhage, intraocular inflammation

Question 6

What causes ptosis?

Answer 6

Dysfunction of levator palpebral muscle (cranial nerve III)

Question 7

What is the most common area involved in ROP?

Answer 7

Zone 3

Question 8

What does threshold ROP mean?

Answer 8

50% progression to stage 5 (retinal detachment)

ROP zone I or II with at least 5 contiguous clock hours (or 8 total), with plus disease

Question 9

What babies get ROP screening?

Answer 9

All < or = to 32w0d OR bw < or = 1500g

Some over 32w0d with resp instabiliy

Question 10

When does ROP screening occur?

Answer 10

4-6 weeks of age or 31-32 weeks cga, whichever is later

Question 11

What treatment does threshold disease require?

Answer 11

Laser or cryotherapy within 2-3 days

Question 12

What is a coloboma?

Answer 12

Defect in iris of the eye (pupil abnormally shaped)

Associated with trisomy 13 and deletion 13q

Question 13

What trisomy has hypotelorism? Hypertelorism?

Answer 13

Hypotelorism: trisomy 13 (also small eyes and coloboma), meckel gruber, williams
Hypertelorism: trisomy 8, apert, deletion 13q, digeorge, noonan

Question 14

What is most common cause of conjuctivitis in 1st month of life?

Answer 14

Chlamydia (treat with oral erythromycin)

Occurs in 1/2 of colonized mothers

Question 15

When does gonorrhea conjunctivitis occur?

Answer 15

2-5 days of age, prevented with erythromycin at birth. Copious, purulent drainage. Treat with cephalosporin

Question 16

What congenital infection has highest incidence of chorioretinitis?

Answer 16

Toxo - 80-90% of infants will have b/l chorioretinitis

CMV - second (20%)

Question 17

What syndromes are associated with glaucoma?

Answer 17

Sturge Weber and Stickler

Question 18

When does visual evoked potential reach adult level?

Answer 18

6 months

Question 19

What congenital infection is most likely to give cataracts?

Answer 19

Rubella (50% of infants will have bilateral catarcts)

Also seen in HSV, varicella, and toxo

Question 20

What is inheritance pattern of isolated congenital cataract?

Answer 20

Autosomal dominant (accounts for 25% of infants with cataracts)

Question 21

What is the most common cause of neonatal seizures? Second most common?

Answer 21

1. Global cerebral hypoxic ischemia (40%)

2. Focal cerebral hypoxic ischemia (17-18%)

Question 22

What is the mortality rate and neurodevelopmental outcome for neonatal seizures?

Answer 22

Mortality: 10%
Disability: 54%