Paediatrics

Question 1

Visual acuity in a newborn

Answer 1

6/200-6/60

Question 2

Visual acuity at 3 months

Answer 2

6/90-6/60

Question 3

Visual acuity at 6 months

Answer 3

6/36-6/30

Question 4

Visual acuity at 9 months

Answer 4

6/24

Question 5

Visual acuity at 1 year

Answer 5

6/18

Question 6

Visual acuity at 18 months

Answer 6

6/12

Question 7

Visual acuity at 2 years

Answer 7

6/12-6/6

Question 8

Which tools can be used to measure VA under 1 year?

Answer 8

keeler, teller or Cardiff cards - forced preferential looking

Question 9

What tool is used to measure VA 6m-2y?

Answer 9

Cardiff pics

Question 10

What tool is used to measure VA 2y-3y?

Answer 10

Kay pics

Question 11

What tool is used to measure VA 3y-5y?

Answer 11

Sheridan-Gardiner

Crowded Kays

Question 12

Why is infection more likely to spread to infect the orbit in children under 1y?

Answer 12

orbital septum not developed

Question 13

What is the most common cause of orbital cellulitis in children? Where does the infection originate? (NOT WHAT BUG)

Answer 13

Ethmoidal sinus infection

Question 14

Baby 2 months-1 year. Unilateral asymmetrical raised bright red lesions most commonly in the upper eyelid which may obscure visual axis and cause ambylopia. If deep can cause axial proptosis. Lesions blanches on pressure and enlarges on crying.

Answer 14

capillary haemangioma

Question 15

Gradual painless, monocular decrease in visual acuity with RAPD. Non-axial proptosis. CT head shows fusiform enlargement of optic nerve. Cafe au lait spots, lisch nodules and axillary freckling.

Answer 15

Optic nerve glioma

Question 16

Valve at the junction of nasolacrimal sac and common canaliculus. Prevents reflux of tears.

Answer 16

Rosenmuller valve

Question 17

Valve at the junction of the nasolacrimal duct and inferior nasal meatus. Prevents air entering the nasolacrimal duct during nose blowing.

Answer 17

Valve of Hasner

Question 18

Baby under 1 y. Epiphora and mucopurulent discharge on pressure over the nasolacrimal sac. Not red. May resolve spontaneously.

Answer 18

Congenital nasolacrimal obstruction

Question 19

Hypermetropic boys with reading difficulties due to splitting of the retina at the nerve fibre layer. Bilateral maculopathy, foveal schisis with spoke-like folds resembling CMO. Scotopic ERG.

Answer 19

X-linked retinoschisis

Question 20

AD condition causing defect in type 2 collagen, leading to retinal detachment (50%). High myopia, cataract, ectopia lentis, glaucoma, empty vitreous. Sensorineural hearing loss. Pierre robin or marfanoid features.

Answer 20

Stickler syndrome

Tx- 360 degree retinal laser
vitrectomy for RD

Question 21

AD condition similar to Stickler syndrome but without systemic involvement. Low myopia, cortical cataract, empty vitreous and retinal detachment

Answer 21

Wagner syndrome

Question 22

AD condition in hypermetropic patients. Bilateral macular degeneration, lipofuscin accumulation in the RPE and atrophy of the photoreceptor layer of the retina. Egg yolk lesion at the macula. Abnormal EOG- decreased arden ratio.

Answer 22

Best’s Disease

Question 23

AR condition due to mutation in ABCA4 gene on chromosome 1. Most common inherited macular dystrophy. Beaten bronze macula progressing to bullseye pattern. Pisciform yellow/white lesions in RPE. Dark choroid due to reduced choroidal circulation.

Answer 23

Stargardt disease

Question 24

AR condition with severe visual loss at birth, nystagmus, roving eye movements and absent pupillary reflexes and oculodigital syndrome. Associated with hypermetropia. Salt and pepper retinopathy

Answer 24

Lebers congenital amaurosis

Question 25

Can be AD, AR or XL. Mutation in rhodopsin gene on chromosome 3. Dysfunction of rods then cones and degeneration of retinal tissue. Nyctalopia and tunnel vision. Pale waxy disc, bony spicules and arteriolar attenuation.

Answer 25

Retinitis pigmentosa

Question 26

AR. Retinitis pigmentosa, bulls eye maculopathy, polydactyly, learning disability and obesity.

Answer 26

Badet-Biedl syndrome

Question 27

AR. Retinitis pigmentosa and hearing loss. Most common inherited cause of deaf-blind.

Answer 27

Usher's syndrome

Question 28

AR. Accumulation of phytanic acid. Retinitis pigmentosa, anosmia, peripheral neuropathy and ichthyosis (scaly skin)

Answer 28

Refsum syndrome

Question 29

AR. Abnormal absorption of fat soluble vitamins. Retinitis pigmentosa, spinocerebellar ataxia, acanthocytosis.

Answer 29

Bassen Kornzweig syndrome

Question 30

Conditions associated with leukocoria

Answer 30

``` congenital cataract retinoblastoma persistent fetal vasculature retinopathy of prematurity Coat's Disease toxicarias ```

Question 31

Most common intraocular malignancy in children arising from embryonal photoreceptor cells. Associated with a mutation in Rb1 gene on chromosome 13. Flexner rosettes and Homer Wright rosettes and fleurettes.

Answer 31

retinoblastoma

Question 32

Is Rb1 a tumour suppressor or oncogene?

Answer 32

tumour supressor

Question 33

prem baby presents age 7 days with unilateral leukocoria, micro-ophthalmia and cataract

Answer 33

persistent foetal vasculature

Question 34

baby born at 30 weeks gestation weighing 800g, required oxygen therapy for respiratory distress

Answer 34

retinopathy of prematurity

Question 35

What is the end stage of retinopathy of prematurity?

Answer 35

total retinal detachment

Question 36

what additional signs (Plus disease) may be present in ROP that can increase severity of the condition?

Answer 36

increased venous dilatation | arteriolar tortuosity of the peripheral retina

Question 37

congenital condition affecting young boys. decreased visual acuity, strabismus and leukocoria. temporal retinal telangectasia and microaneurysms. can result in exudative retinopathy.

Answer 37

Coat's disease

Question 38

Increase in innervation of a muscle is accompanies by a decrease in innervation of its antagonist. i.e. when lateral rectus contracts, medial rectus relaxes

Answer 38

Sherrington's law

Question 39

what are yolk muscles?

Answer 39

muscles pulling the eyes in the same direction e.g. right LR and left MR

Question 40

Yolk muscles have equal and simultaneous flow and innervation

Answer 40

Hering's law

Question 41

developmental defect of spatial visual processing that can occur in the central visual pathway during the early years of life, leading to diminished vision. Causes include: stabismus, anisometropia and stimulus deprivation

Answer 41

Amblyopia

Question 42

What pharmacological intervention can be used in amblyopia?

Answer 42

penalisation of good eye using atropine

Question 43

In turning squint associated with hypermetropia. normal AC/A ratio

Answer 43

accommodative esotropia correct hypermetropia

Question 44

in turning squint for near vision only. high AC/A ratio

Answer 44

convergence excess esotropia treat with bifocals or bilateral medial rectus recession

Question 45

Non-accommodative in turning squint in child at 6 months. Large angle deviation and alternating fixation. Latent horizontal nystagmus.

Answer 45

infantile esotropia

Question 46

out .turning squint associated with myopia. most common type

Answer 46

intermittent exotropia correct myopia

Question 47

constant large angle out turning squint in baby at 6 months. associated with neurological abnormalities

Answer 47

constant exotropia

Question 48

What nervous anomaly is seen in Duane retraction syndrome?

Answer 48

lateral rectus supplied by CN III

Question 49

Deaf patient with globe retraction on adduction. Esotropia with limited abduction.

Answer 49

Duane retraction syndrome

Question 50

Superior oblique restricted at trochlea. Globe sitting down and in. Limited elevation in adduction or on upgaze with associated click sensation.

Answer 50

Brown syndrome

Question 51

resection vs recession

Answer 51

``` resection = shortening muscle to strengthen recession = loosening muscle to weaken ```

Question 52

is strabismus concomitant?

Answer 52

yes, looks the same regardless of where you are looking

Question 53

is CN III palsy concomitant?

Answer 53

no