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Pediatrics > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is leukocoria and what is indicative of?

A

Leukocoria is abscence of red reflex “becoming white”

Indicative of tumor (retinoblastoma)

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2
Q

What is the most common intraocular malginancy in children under the age 4

A

Retinoblastoma

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3
Q

What is the clinical presentation of retinoblastoma

A
  • leukocoria
  • strabismus
  • poor vision
  • red painful eye
  • proptosis
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4
Q

What is the finding in the imaging for retinoblastoma?

A

Calcifications within tumor

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5
Q

What is the imaging modality of choice for retinoblastoma?

A

MRI brain and orbit

“Never CT”

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6
Q

What are the goals of RB therapy?

A

Preservation of
1- Life
2- Globe
3- sight

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7
Q

What is the treatment of choice in RB?

A
  • Enucleation (large - optic nerve affected)
  • laser (stop vasculature)
  • cryotherapy (freeze) +- chemotherapy (ocular\intra arterial)
  • external beam radiotherapy
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8
Q

What is the follow up plan for retinoblastoma?

A
  • Every 4-6w for EUA
  • for RB1 genetic type
  • systemic follow up for metastasis
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9
Q

In RB familial type, we should find

A

RB1 gene

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10
Q

Are the patients with sporadic RB have any genetic mutation

A

No

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11
Q

What is cataract

A

Opacification of lens

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12
Q

What is the most common inheretence of cataract in KSA

A

AR

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13
Q

What are the associated systemic disease in cataract?

A

1- galactosemia
2- hypoocalcemia
3- wilson
4- diabetes

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14
Q

What are the chromosomal abnormalities associated in Catarct

A
  • down

- patau

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15
Q

What will you do if you see bilateral cataract

A

Intensive workup

  • TORCH screening
  • Syphilis (VDRL)
  • Calcium levels
  • Phosphorus
  • glactokinase
  • glucose
  • urine for reducing substance
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16
Q

What will you see if you see unilateral cataract?

A

Bring them to OR immidiatly

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17
Q

What does the management of cataract depen on?

A

The size - laterality

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18
Q

How to treat cataract ( in general)

A
  • lensoctomy

- optical correction

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19
Q

In small cataract what would you like to do next?

A

cover and Observe

However if i cover for long time i risk the development of ampylopia

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20
Q

If the child is more than 1 year, what will we do in case of catarct?

A

Lens aspiration + IOL

“If less we don’t do IOL”

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21
Q

If the child was less than 1 year of age, and we did not introdue IOL. what will we do

A

Provide a high power glassess

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22
Q

To avoid formation of posterior membranes, what surgical intervention should we do in cataract

A

Posterior capsulotomy and anterior viterctomy

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23
Q

What do you expect to see in glucoma?

A
  • megalocornea
  • Haabs striae
  • opacity and haze
  • corneal edema\scar
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24
Q

What is the clinical presentation of primary congenital glucoma?

A
  • Epiphorea (tearing)
  • Blephrospasm (blinking)
  • Photophobia
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25
Q

What is the IOP in glucoma?

A

> 21mmhg increased

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26
Q

What causes opacity of the cornea?

A

Increased IOP will cause edema and it will go in the corena

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27
Q

What is the poor outcome of glucoma if IOP was not corrected in early childhood

A

Optic nerve damage leading to loss of sigth

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28
Q

What will you find in glucoma in fundoscopy examination

A

Cupping

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29
Q

When can we do surgery in glucoma

A

After 4-6 weeks of life, usually we do multiple

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30
Q

When is retinopathy of prematurity?

A

<31 weeks of gestation

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31
Q

What is the pathophysiology of ROP?

A

Cessation of vasculogensis after birth > VEGF release causing either

  • resuming normal process
  • abnormal proliferation leading to retinal detachment
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32
Q

What are the risk factors for ROP?

A
  • LBW <1500
  • <30 wks
  • Supplemental O2
  • Coexisting illness rds-sepsis
  • Caucation
  • multiples
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33
Q

What;s the severist type of ROP

A

1 and 2 due to the closeness of optic nerve

34
Q

Whats the treatment for ROP

A

1- observe
2- laser and cryotherapy
3- anti-VEGF
4- surgery if retinal detachment

35
Q

Allergic conjunctivitis, bilateral or unilateral?

A

Bi-lateral because immune reaction

36
Q

How does allergic conjunctivits present

A

Watery, itchy, puffy, history of atopy §

37
Q

How to treat allergic conjunctivitis

A
  • lubricant
  • cold compressor
  • Antihistamine
  • mast cell inhibitor
38
Q

What reaction is seen with allrgic conjunctivits vs viral conjunctivits

A

Papillary reaction in allergic

Follicular in viral

39
Q

How does viral conjunctivitis commonly present?

A
  • History of contact
  • watery, itchy, puffy eyes “uni unless he scratch the other eye”
  • URTI hx
40
Q

How should you treat viral conjunctivits?

A

Cold compressor and lubricant

Isolate from school for at least 7d

41
Q

When to refer allergic and viral conjunctivits to optha

A

Allergic: one week
Viral: 2 weeks

42
Q

What are the risks for bacterial conjunctivitis

A
  • Hygiene: Poor contact lens hygiene, contaminated cosmetics, elementary school, military
  • Ocular: dry eye, blepharitis, foreign body
  • Iatrogenic: recent surgery, chronic use of topical medication, immunocompromised
43
Q

What diff bacterial conjunctivitis from viral and allergic

A

Mucopurulent discharge

44
Q

Which age group is more common to develop bacterial conjunctivits?

A

Neonates from birth canal

45
Q

How to approach newnate with bacterial conjunctivits

A

Scrape the discharge and put under gram stain, if gram negative diplococci > immidiatly treat w\IV AB

46
Q

Is bacterial conjunctivtis uni or bilateral

A

Unilateral

47
Q

Define opthalmia neonatorum

A

Neonatal conjunctivitis occuring within 30 days of life

Caused by

  • chemical
  • nisseria
  • chlamydia
  • viral
48
Q

Chemical opthalmia neonatorum starts at

A

24 hours of life

49
Q

Nisseria opthalmia neonatroum starts at

A

3-5 days

50
Q

Chlamydia opthlamia neonatrum starts at

A

5-14 fays

51
Q

Viral opthalmia neonatorum starts at

A

After 2nd week

52
Q

What chemical causes opthalmia neonatorum?

A

Silver nitrate

53
Q

Differentiate between discharge in chlamydia and gonorrhea

A

Chlamedia minimal discharge

Gonorrhea copious diacharge

54
Q

How to do prophylaxis of neonatorum opthalmia?

A

Erythromycin

Tetracyclin and iodine

55
Q

How to treat opthalmia nenonatorum

A

Systemic AB

56
Q

What aer the complications of opthalmia neonatorum

A

Sepsis
Meningitis
Pneumonia
Blindness

57
Q

What is the typical presentation of conginital nasolacrimal duct obstruction

A

1- tearing

2- recurrent conjunctivitis

58
Q

What should one rule out regarding tearing in congenital nasolacrimal duct obstruction?

A

Glcuoma

59
Q

What is the pathophysiology of conginital nasolacrimal duct?

A

Obstruction at the valve of haner

60
Q

How to treat congintial nasolacrimal duct obstruction?

A
  • Spontanous (most common)
  • massage
  • topical AB in conjunctvitis
  • surgery in 1 year or older
61
Q

What is the name of surgery in nasolacrimal duct obstruction?

A

Probing (metallic insstrument)

62
Q

What are the types of cellulitis?

A

Pre-septal

Orbital

63
Q

To differentiate treatment in cellulitis vs viral and allergic conjunctivitis

A

Cellulitis: hot compress
Allergic: cold

64
Q

What are the causes of preseptal cellulitis?

A
  • Trauma “Staph”
  • URTI “ Strep, staph, Hib”
  • conjunctivits “impetigo, HSV”
65
Q

How to treat preseptal?

A

Topical\systemic AB - self limited

66
Q

Which type of cellulitis is more severe?and why

A

Orbital

It may cause blindness and meningitis

67
Q

Orbital organism in

<9yr:
>9yr:
Neonate:
Old:

A
  • single aerobic
  • complex aerobe + anaerobe
  • S.aureus & gram negative
  • s. Aureus, strep & anerobe
68
Q

Treatment in orbital cellulitis differ from preseptal in that:

A

It requires admission, IV abx, imaging, neuro\ENT\ optha

69
Q

What are the complications of orbital cellulitis

A
  • Cavernous sinus thrombosis
  • Abscess
  • Endopthalmitis
  • Meningitis
  • Blindness
70
Q

What are the things that you should preform to cautiously identify any red flag in orbital cellulitis

A
  • Vitals & mental state: spread of infection
  • pupil reaction: infectious spreaded posteriorly
  • visual acuity: affected optic nerve
  • eye movement: affected muscle
71
Q

What is the most important sign in orbital cellulitis?

A

Proptosis

72
Q

How to differentiate orbital from preseptal cellulitis clinically

A

By the bulging of eye (proptosis) which is found in orbital cellulitis

73
Q

What is a red flag in ptosis

A

3rd nerve palsy

74
Q

What neurological disease may be associated with ptosis in newborn

A

Mysthenia gravis

75
Q

Diurnal variation of ptosis and after exercise are associated with

A

MG

76
Q

Pupils assymetry + proptosis could give you a clue of

A

Horner’s syndrome

77
Q

How to treat mild ptosis ?

A

Observation

78
Q

If isolated ptosis is not corrected what could develop over the years

A
  • astigmatism
  • occlusion amblyopia
  • head tilt “Chin up to see:
79
Q

What do we call the ptosis found in marcus gunn jaw winking syndrom

A

Synkinetic ptosis

80
Q

In marcus gunn jaw winking syndrome, what is the connection that causes the synketic ptosis?

A

Trigeminal V3 (external ptrygoid)

+ occlumotor (Superior vision)

+ levator palperbral superiorsis

81
Q

The winking syndrome is commonly noticed during

A

breastfeeding or bottle feeding

Pediatrics (41 decks)

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