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Peds > Optho > Flashcards

Optho Flashcards

1
Q

When do infants begin to develop the ability to fixate?

A

At 6 weeks of age

*Fix at Six

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2
Q

When does color perception develop?

A

2 months of age

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3
Q

When does binocular vision with convergence ability develop?

A

3 months of age

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4
Q

When does preference for patterns, including faces develop?

A

4 months of age

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5
Q

What is the visual acuity of a newborn?

A

20/200

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6
Q

By one year of age, what is visual acuity?

A

20/30

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7
Q

What refers to the ability to see a moving target, follow it, and then return to the original gaze?

A

Optokinetic Nystagmus

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8
Q

What is one of the earliest reflexes that infant develop in the first few months of life?

A

Optokinetic Nystagmus

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9
Q

What is pendular nystagmus?

A

Equal velocity movements in both directions (to and fro)

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10
Q

What is pendular nystagmus often a sign of?

A

Underlying disorder like MS or spinocerebellar disease

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11
Q

What is jerk nystagmus characterized by?

A

Slow phase back to central position with a quick gaze laterally

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12
Q

When is jerk nystagmus normal?

A

When a child gazes far upwardly or laterally

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13
Q

What is a benign, transient disorder without known cause that is characterized by pendular nystagmus, intermittent head tilt, and nodding or head bobbing?

A

Spasmus nutans

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14
Q

What can spasmus nutans be mistaken for?

A

Muscular torticollis

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15
Q

True or False: Spasmus nutans is self-resolving

A

True

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16
Q

What is the loss of visual acuity due to active cortical suppression of the vision of one eye?

A

Amblyopia

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17
Q

What can cause amblyopia?

A

Result of deprivation due to:

  1. Ptosis
  2. Dense congenital cataract
  3. Persistent strabismus
  4. Extended eye closure
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18
Q

What is an inward turning eye called (a form of strabismus)?

A

Esotropia

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19
Q

What is an outward turning eye called (a form of strabismus)?

A

Exotropia

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20
Q

What is mild farsightedness where parallel rays are focused behind the retina- distant objects are seen more distinctly than near ones?

A

Hyperopia

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21
Q

True or False: Most children normally have mild hyperopia

A

True

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22
Q

What is the refractive state most likely to be seen in a 3 year old?

A

`Hyperopia

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23
Q

What should you think if a child resists you covering an eye during the cover test?

A

That’s his good eye- If one eye is abnormal and you attempt to cover the good eye, he will resist you

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24
Q

What is deviation of the alignment of one eye in relation to the other?

A

Strabismus

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25
Q

When is eye alignment more difficulty?

A

When significant focusing effort is required (as with significant hyperopia)

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26
Q

When can strabismus become more significant?

A

When significant focusing effort is required

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27
Q

What test is used for strabismus?

A

Corneal light reflex test (Hirschberg test)

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28
Q

How is the corneal light reflex test performed?

A

Shine a penlight on both eyes and expect a symmetrical light reflex

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29
Q

Why is screening for strabismus crucial?

A

Untreated strabismus results in amblyopia if not detected by age 6

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30
Q

What is the loss of use of the nondominant eye and permanent loss of binocular vision?

A

Amblyopia

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31
Q

What are infants born with Sturge Weber at risk for?

A

Glaucoma

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32
Q

Child born with a port wine stain… what needs to be addressed?

A

Glaucoma

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33
Q

What is violaceous discoloration describing?

A

Port wine stain

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34
Q

What is seen in a child with strabismus during the “cover test”?

A
  • Child looks at one particular spot

- Eye with strabismus deviates instead of fixating on object

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35
Q

What happens during the cover test with accommodative esotropia?

A

When one eye is covered, the uncovered eye moves outward to fix on spot

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36
Q

What happens during the cover test with accommodative exotropia?

A

When one eye is covered, the uncovered eye moves inward to fix on spot

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37
Q

What is pseudostrabismus?

A

When eyes appear to deviate, but actually due to other factors

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38
Q

What are some things that can cause pseudostrabismus?

A

Extra skin covering inner corner of eye, broad/flat nose, eyes set unusually close together or far apart

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39
Q

What is done for strawberry hemangiomas of the eye?

A

May resolve without any intervention unless on or near eyelid and interfering with vision (then they may need to be dealt with early on)

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40
Q

How does congenital glaucoma present?

A

Tearing, photophobia, blepharospasm, corneal clouding, redness, edema, progressive enlargement of the eye

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41
Q

Why does concern for glaucoma require prompt referral to an ophthalmologist?

A

Need to measure intraocular pressure and may need surgery

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42
Q

What are 3 important associations to know with congenital cataracts?

A
  1. Rubella
  2. CMV
  3. Galactosemia
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43
Q

Besides rubella, CMV, and galactosemia what are other things you can see congenital cataracts with?

A
  1. Hereditary
  2. Other infections (TORCH)
  3. Metabolic/genetic syndromes (parathyroidism, Smith-Lemli-Opitz)
  4. Other ocular malformations
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44
Q

What should you consider with a clumsy child who runs into objects or spills liquids more often than the average child?

A

Faulty depth perception- Child with a cataract

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45
Q

What are external hordeolums also called?

A

Styes

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46
Q

What causes Styes?

A

Inflammation and infection (usually staph) of sebaceous glands in the eyelid)

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47
Q

What are the mainstays of treatment for Styes?

A

Warm compresses and possibly topical antibiotics

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48
Q

What are styes due to?

A

Inflammation and possible infection of the follicles and/or sebaceous glands

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49
Q

What might be needed for a stye if warm compresses and topical antibiotics don’t work?

A

I&D

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50
Q

When are oral antibiotics required for a stye?

A

Never

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51
Q

What is the first step in the evaluation of an infant with congenital cataracts?

A

Evaluation of the parents for cataracts (50% inherited as an autosomal dominant condition

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52
Q

What % of cataracts are inherited as an autosomal dominant condition?

A

50%

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53
Q

What is a chalazion?

A

Lipogranuloma

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54
Q

What causes a chalazion?

A

Chronic inflammation of one of the small oil-producing glands secondary to retention of secretions

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55
Q

What are chalazions due to?

A

Chronic inflammation (not bacterial infection)

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56
Q

True or False: Chalazions are typically painless?

A

True

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57
Q

Patient with a 4 month history of a painless nodule on her upper eyelid…treatment?

A

Referral to ophthalmology for surgical excision (this is a chalazion)

58
Q

What is the difference between a Stye and Chalazion?

A

Styes: Red, angry, painful (like a pimple)
Chalazion: Cool, painless, chronic

59
Q

What is the initial treatment for a nasolacrimal duct obstruction?

A

Massage the duct 2-3 times per day

60
Q

What should be done if there is evidence of infection in nasolacrimal duct obstruction?

A

Topical antibiotic treatment

61
Q

When are oral antibiotics needed for a blocked nasolacrimal duct in an infant?

A

Never

62
Q

If a blocked tear duct isn’t resolved by 12 months of age, what should be done?

A

Ophthalmological consultation

63
Q

2 month old with excessive tearing of left eye and mucoid discharge. Tears pool on left eyelid and cheek. Child has nasal congestion and coughs occasionally. Pregnancy/delivery were unremarkable. Appropriate Management?

A

Conservative measures for a blocked nasolacrimal duct (massage and warm compress)

  • Topical antibiotics only if there was erythema and other signs of infection
  • Chlamydia pneumonia needs more persistent staccato cough or CXR findings and eye discharge would need to be bilateral.
64
Q

What two things both present with edema and redness around the eye?

A

Preorbital and orbital cellulitis

65
Q

Which is more serious… Preorbital or orbital cellulitis?

A

Orbital (since it is an infection invading the eye itself

66
Q

What are some buzz words that would tip you off to orbital cellulitis?

A
  1. Compromised vision
  2. Proptosis
  3. Decreased extraocular movement
  4. Pain exacerbated by eye movement
67
Q

What can cause orbital cellulitis?

A
  1. Spread of skin infections (insect bites)
  2. Sinusitis
  3. URI
  4. Dental infection
68
Q

What is the most common bug in orbital cellulitis when the infection is caused by initial skin infection?

A

S. Aureus

69
Q

What are 4 bacteria to think of with orbital cellulitis that spread from the respiratory tract or sinuses (besides S. Aureus)?

A
  1. Strep pyogenes
  2. Peptostreptococcus
  3. Bacteroides
  4. Non-typeable H. Flu
70
Q

Why is it important to note if someone with orbital cellulitis is immunized?

A

Because Hib can cause this (if patient immigrated from a developing country, assume they are unimmunized)

71
Q

What may be needed to differentiate between orbital and periorbital cellulitis and is indicated to document the extent of involvement in orbital cellulitis?

A

CT scan

72
Q

What needs to be done for kids with orbital cellulitis?

A

Admit them to the hospital for IV antibiotics and consult ophthalmology

73
Q

What can periorbital (or preseptal) cellulitis be treated with?

A

Oral antibiotics that cover typical skin and respiratory flora

74
Q

True or False: Periorbital cellulitis can spread to become orbital celluilitis

A

True

75
Q

If there is decreased EOM or proptosis, what type of cellulitis are you likely dealing with?

A

Orbital

76
Q

Red, swollen, periorbital area which is itchy/pruritic (rather than painful)…?

A

Insect bite or allergic reaction (rather than an infection)

77
Q

What are some findings seen with a corneal abrasion?

A
  1. Photophobia
  2. Tearing
  3. Intermittent sharp pain
  4. Irregular red reflex
  5. Dulled corneal light reflex
78
Q

What test/finding is a slam dunk for a corneal abrasion?

A

Fluorescein staining of cornea

79
Q

What eye problem should you consider with an irritable infant?

A

Corneal abrasion

80
Q

Once a corneal abrasion is confirmed with fluorescein, what should be done?

A

Topical antibiotic treatment

81
Q

True or False: A semi pressure patch for 24 hours is routine for treatment of a corneal abrasion?

A

False… no longer considered to be routine treatment

82
Q

Patient with symptoms of corneal abrasion following mild trauma… what is the first thing to do?

A

Fluorescein stain the eye (not prescribe topical antibiotic)

83
Q

What is seen on funduscopic view in retinitis pigmentosa?

A
  1. Optic disc with “waxy pallor”
  2. Narrow arterioles
  3. Retinal pigment deposition
84
Q

Funduscopic exam with pallor in the center of the optic disc, narrow arterioles coming off the optic disc, retinal pigment deposition on the periphery…?

A

Retinitis pigmentosa

85
Q

What syndrome can retinitis pigmentosa be seen with?

A

Usher Syndrome

86
Q

What is seen on funduscopic exam with retinal hemorrhages?

A

Flame-shaped hemorrhage

87
Q

What clinical scenario are retinal hemorrhages often seen in?

A

Child abuse (NAT)

88
Q

Which two groups should be screened for ROP?

A
  1. Birthweight less than 1500g or GA less than 32 weeks

2. Birthweight 1500-2000g with unstable clinical course, judged to be at risk

89
Q

When do you screen for ROP?

A

31-34 weeks post-conception or 4-6 weeks after birth (whichever is later)

90
Q

What is the greatest risk factor for developing ROP?

A

Prematurity (with gestation less than 28 weeks)

91
Q

What is the risk for developing ROP in an infant greater than 37 weeks gestation on oxygen?

A

Very low (retinal vascularization is almost complete at this gestational age)

92
Q

Most likely risk factor for ROP?

A

Very low birthweight or prematuriy

*Exposure to O2 or maintenance of sats >95% doesn’t influence progression of ROP

93
Q

What is ROP inversely proportional to?

A

Birthweight and gestational age

94
Q

What is opthalmia neonatorum?

A

Conjunctivitis in the first 4 weeks after birth

95
Q

What are 4 most frequent causes of opthalmia neonatorum?

A
  1. S. Aureus
  2. S. Epidemidis
  3. S. Pneumoniae
  4. M. Catarrhalis

*Can also be seen with Chlamydia, Neisseria, and HSV

96
Q

What type of conjunctivitis typically develops 5-14 days after delivery and has a watery discharge that progresses to a mucopurulent discharge?

A

Chlamydial conjunctivitis

97
Q

What is done to prevent chlamydial conjunctivitis?

A

Erythromycin ointment at birth (prophylaxis)

98
Q

What % of infants with chlamydial conjunctivitis have coinfection at other sites?

A

50%

99
Q

What could chlamydial conjunctivitis progress to?

A

Pneumonitis (co-infection)

100
Q

How is chlamydial conjunctivitis treated?

A

Oral eryhtromycin x14 days

101
Q

What 2 things does topical erythromycin applied to the eyes after birth prevent?

A
  1. Chlamydial conjunctivitis

2. Neisseria conjunctivitis

102
Q

Which is more severe, chlamydial or neisseria conjunctivitis?

A

Neisseria

103
Q

How does neisseria conjunctivitis present?

A

Hyperacute, hyperpurulent conjunctivitis 24-48 hours after birth

104
Q

How is neisseria conjunctivitis treated?

A

IV ceftriaxone (+frequent saline lavage)

105
Q

If you have an infant with neisseria conjunctivitis, what else do you need to look for?

A

Disseminated GC disease

106
Q

What time-frame does neonatal HSV conjunctivitis present?

A

1-2 weeks after birth

107
Q

True or False: Skin vesicles are often absent in HSV conjunctivitis?

A

True

108
Q

What is treatment for HSV conjunctivits?

A

IV acyclovir (hospital admit + optho consult)

109
Q

How does conjunctivitis present?

A
  • Erythema of conjuntiva (pink or red eye)
  • Discharge (clear to purulent)
  • Eye matting
110
Q

Name 4 symptoms of conjunctivitis

A
  1. Foreign body sensation
  2. Itching
  3. Burning
  4. Photophobia
111
Q

Child with a red eye who wears contact lenses… what do you do?

A

Referral to optho for definitive care

112
Q

18 year old, red and irritated right eye, took out contacts ~10 hours ago, no improvement. Conjunctiva is irritate, can’t keep eye open, fundoscopic exam normal, PERRL, no discharge. Diffuse uptake of fluorescein. Next step?

A

Refer to optho- Could be gram - infection or ulceration of corneal epithelium

*Simple corneal abrasion is focal uptake of stain

113
Q

Name 5 bugs that can cause bacterial conjunctivitis

A
  1. S. Aureus
  2. S. Epidermidis
  3. S. Pneumoniae
  4. M. Catarrhalis
  5. Pseudomonas
114
Q

In a child who is unimmunized, what specific bug must you remember for bacterial conjunctivitis?

A

H. Flu type B

115
Q

What is treatment for acute bacterial nongonococcal conjunctivitis?

A

None- Benign and self-limited

-Can do topical antibiotics to quicken resolution and limit spread

116
Q

What should you think for a child with a hyperacute presentation of conjunctivitis with severe extremely purulent discharge and pseudomembrane formation?

A

N. Gonorrheae or N. Meningitidis

117
Q

What should you do if you suspect Neisseria conjunctivitis?

A

Urgent optho referral, admission, IV abx

118
Q

What is the most common cause of viral conjunctivitis?

A

Adenovirus

119
Q

What can you recommend for symptom relief in viral conjunctivitis?

A
  1. Artificial tears

2. Cool compresses

120
Q

True or False: Topical antibiotics and steroids can be given for severe viral conjunctivitis?

A

False- Abx not recommended and steroid drops contraindicated

121
Q

When do you refer to optho for viral conjunctivitis?

A

If no symptom improvement in 2 weeks

122
Q

What is important to remember to counsel patients on with viral conjunctivitis?

A

HIGHLY CONTAGIOUS

-Avoid touching eyes, shaking hands, sharing towels, wash hands frequently

123
Q

What are the symptoms of allergic conjunctivitis?

A
  1. Eye itching

2. Watery or mucoid discharge

124
Q

What helps to distinguish allergic conjunctivitis from bacterial conjunctivitis?

A

Intense itching

125
Q

What helps to distinguish allergic conjunctivitis from viral conjunctivitis?

A
  • Presence of other atopic conditions (allergic rhinitis and atopic dermatitis)
  • Viral more likely to start in one eye, allergic starts in both eyes simultaneously upon exposure to allergic trigger
126
Q

Name 3 systemic conditions that present with conjunctivitis

A
  1. Kawasaki
  2. Measles
  3. JIA
127
Q

How does conjunctivitis present with Kawasaki disease?

A
  • Non-purulent
  • Bilateral
  • Peri-limbal sparing
128
Q

How does conjunctivitis with measles present?

A

Exudative conjunctivitis

129
Q

What can happen in JIA that might be confused with conjunctiovitis?

A

Uveitis

130
Q

When should you prescribe topical eye steroids?

A

NEVER… only optho should be doing this

131
Q

What words in a question stem involving eye trauma should prompt referral to optho?

A
  1. Pupil irregularity
  2. Significantly reduced visual acuity
  3. Orbital fracture
  4. Decreased extra-ocular eye movements
132
Q

What is a collection of blood between the cornea and iris (usually following eye trauma)?

A

Hyphema

133
Q

What is treatment for a hyphema?

A
  1. Immediate referral to optho
  2. Admit
  3. Bed rest with head at 30 degree angle (decrease IOP)
134
Q

True or False: A patch is needed for treatment of hyphema?

A

False: Need a shield

135
Q

Where is the fracture in a blowout fracture?

A

Orbital wall or floor

136
Q

Blunt trauma to eye, double vision when looking to one side, dysconjugate gaze to one side, pupillary reflexes intact?

A

Blowout fracture

137
Q

Severe eye pain and tearing, no diplopia, no dysconjugate gaze

A

Corneal abrasion

138
Q

Blood in the anterior chamber, possible visual impairment, no diplopia

A

Hyphema

139
Q

Eye pain and severe photophobia without diplopia

A

Traumatic iritis

140
Q

Visual deficit in peripheral field (curtain like), no dysconjugate gaze

A

Detached retina

Peds (35 decks)

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