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Neonatology Boards > Optho/ENT > Flashcards

Optho/ENT Flashcards

1
Q

Name the derivation for each part of the eye below:
1. Retina
2. Vascular and sclerocorneal layers
3. Lens

A
  1. Neuroectoderm of the forebrain
  2. Mesoderm
  3. Surface ectoderm

Development of the eye begins in the 5th week of gestation

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2
Q

When does the pupil become reactive to light?

A

30 weeks but may not respond until 32 weeks, well developed by 1 month of age

eyelid closes in response to light at 30 weeks

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3
Q

When is optic nerve myelination complete?

A

2 years old

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4
Q

How does innervation control the pupillary reaction?

A

parasympathetic innervation –> constriction
sympathetic innervation –> dilation

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5
Q

What does the pupillary respons to light test for?

A

intact afferent and efferent pathways of cranial nerve III

suggests visual function of subcortex

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6
Q

What does a nonreactive UNILATERAL pupil with increased size suggest?

A

subdural hematoma or other unilateral mass

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7
Q

What does nonreactive BILATERAL pupils with increased size suggest?

A

Late signs of HIE, IVH, infantile botulism

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8
Q

What does the red reflex detect?

A

Retinal blood vessels
Demonstrates lack of obstruction between external corneal surface and retina

<28 weeks may not have red reflex- unclear corneas and vitreos

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9
Q

What is leukocoria and what does it suggest?

A

White reflex
Most commonly caused by cataracts
Other: retinoblastoma, coloboma, ROP, retinal detachment

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10
Q

What is hypotelorism associated with?

A

HIGHLY assoc with holoprosencephaly
Others: Meckel-Gruber, T13, Williams

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11
Q

What is hypertelorism associated with?

A

Apert, Cruzon, cat-eye, CHARGE, Cri du chat, DiGeorge, Holt-Oram, Noonan, Trisomy 8
Teratogentic effects of hydantoin, isoretinoin

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12
Q

Describe Ptosis

A

upper eyelid cannot rise to normal level
Usually caused by dysfunction of the levator palpebral muscle (CN III)
AD
Cranial nerve palsy in Horner’s syndrome

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13
Q

5 stages of ROP

A
  1. Distinct demarcation line separatin transition of vascularized posterior retina and avascular anterior retina
  2. Demarcation line is thickened and elevated
  3. Ridge with extraretinal neovascularization and retinal vessels enter vitreos space
  4. Partial retinal detachment
  5. Complete retinal detachment- severest from

Plus disease: dilated, tortuous vessels that demonstrate advanced vascular disease, always evident before retinal detachment

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14
Q

s

Threshold for treatment in ROP

A

stage 3 with plus disease in zone I and II + 5 contiguous clock hours or 8 total clock hours

50% progress to stage 5 ROP

Risk of retinal detachment decreased to 25% with treatment

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15
Q

Type I prethreshold ROP

A

Zone I: any ROP with plus disease; or stage 3+/- plus disease
Zone 2: stage 2 or 3 with plus disease

Treat

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16
Q

Type 2 prethreshold ROP

A

Zone 1: stage 1 or 2 without plus disease
Zone 2: stage 3 without plus disease

Close observation
15% progress to type I

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17
Q

Prognosis in ROP- infants are at risk for?

A

AMBLYOPIA, REFRACTIVE ERRORS (mostly MYOPIA with severe ROP), STRABISUMUS
If ROP as neonate, increased risk of retinal detachment during adulthood

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18
Q

Infectious causes of cataracts

A

Rubella, toxoplasmosis, HSV, varicella

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19
Q

**In utero radiation exposure can cause _____

A

Cataracts

20
Q

Etiology of primary glaucoma

A

AR
Males>females
presents at birth

caused by structural abnormality

21
Q

Epidemiology of hearing loss

A

~2% of all infants screened will refer
~15-20% of those will have confirmed hearing loss

22
Q

Most common genetic cause of hearing loss

A

Mutation in the connexin 26 (Cx26) gene
Causes ~20-30% of congenital hearing loss

23
Q

Etiology of hearing loss

A

50% genetic (Cx26 gene most common)
25% acquired (develops secondary to injury to the developing auditory system in intrapartum or perinatal period)
25% unknown

24
Q

What is the most common cause of nonhereditary sensorineural hearing loss?

A

CMV!
10-15% of babies with congenital CMV are symptomatic
60% will have sensorineural hearing loss
5-10% of asymptomatic babies develop sensorineural hearing loss

25
Q

In utero infections associated with hearing loss

A

CMV
Zika
Herpes
Rubella
Syphilis
Toxoplasmosis

26
Q

Epidemiology of choanal atresia

A

1:8,000 births
2:1 females:males
More often unilateral (2/3) R>L

27
Q

Differences between nasal encephalocele, glioma and meningocele

A

Encephalocele:
contiguous with CSF
lesion may be pulsatile, expand with crying or compression of jugular vein

Glioma:
connective tissue mass of CNS- NO CONNECTION WITH CNS
firm, noncompressible lesions

Meningocele:
contiguous with CNS, CONTAINS BRAIN TISSUE
lesion may be pulsatile, expand with crying or compression of jugular vein

28
Q

Nasolacrimal duct obstruction

A

MC lacrimal abnormality in infants
incomplete canalization of nasal lacrimal duct system- nasal end at level of Hasner’s valve
Majority mild and resolve spontaneously

29
Q

Distinguishing test to dx pyriform aperture stenosis

A

inability to pass #6 french catheter anteriorly through nares

manifestation of bony overgrowth of the nasal process of the anterior maxilla–> anterior narrowing of nasal airway

30
Q

Describe a lingual thyroid

A

MC congenital mass
Posterior aspect of tongue
F>M (4:1)
mass of ectopic thyroid tissue- failure of normal thyroid tissue to descend to its usual cervical position
when present, only functioning thyroid tissuein 70%
Majority asymptomatic
Confirm by radionuclide scanning

31
Q

Differences in mucoceles and ranulas

A

Mucoceles: develop from minor salivary glands, painless asymptomatic, acute smooth swelling, fluctuate in size, rupture spontaneously

Ranula: develop from major salivary glands, nontender, mobile, glistening, broad-based englargement with intact overlying mucosa, BLUISH HUE

32
Q

Effects of edema on the neonatal airway

A

more profound effects because neonatal airway is small
1mm of local edema reduces the glottis to 35% of it’s initial size, reduces subglottic airway to 25% of initial size

with age, airway shape changes from conical to cylindrical

33
Q

Which side is vocal cord paralysis more common?

A

LEFT- recurrent laryngeal nervs has longer/winding course, more susceptibel to trauma

2nd MC congenital laryngeal anomaly
Unilateral more common

34
Q

Type of stridor in vocal cord paralysis

A

Inspiratory
may be biphasic

35
Q

Type of stridor in laryngomalacia

A

INSPIRATORY

improves with prone positioning
worse with agitation

36
Q

Type of stridor in tracheomalacia

A

EXPIRATORY

37
Q

Disease associated with laryngomalacia

A

GE reflux

38
Q

DD for preauricular lesions

A

Hemangioma
Venous malformation

39
Q

DD for postauricular lesions

A

Branchial cleft cyst (I)

40
Q

DD for submandibular lesions

A

Hemangioma
Ranula

41
Q

DD for submental and midline neck lesions

A

Thyroglossal duct cyst
Dermoid cyst
Venous malformation

42
Q

DD for anterior border of SCM muscle lesions

A

Branchial clef cyst (I, II, III)
Hemangioma
Laryngocele

43
Q

DD for supraclavicular/paratracheal lesions

A

Thyroid mass
Parathyroid mass
Esophageal diverticulum
Lipoma
Dermoid cyst

44
Q

DD for supraclavicular lesions

A

Lipoma

45
Q

Bilateral leukocoria and hearing loss
Diagnosis?

A

Rubella!
CMV and toxo have hearing impairment but chorioretinitis not cataracts

46
Q

when is retinal vascularization complete?

A

nasal side: 36 weeks
temporal side: 40 weeks

Neonatology Boards (19 decks)

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