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OD3 S1 > Paeds: Competency Exam Deck > Flashcards

Paeds: Competency Exam Deck Flashcards

1
Q

According to Susan Leat’s criteria for refractive error management: When should you correct hyperopia in a:
- 1-4 yo
- 4-5 yo
- 5+ yo

and by how much should you correct them?

A

> +3.50. Correct to 1 Diopter less.
+2.50. 1D less.
+1.50. Full Rx.

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2
Q

According to Susan Leat’s criteria, when should you correct myopia in a 5+yo and by how much?

A

Any myopia. Full, near add if eso.

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3
Q

According to Susan Leat’s criteria, when should you correct anisometropia in a 3.5+yo and by how much?

A

> 1.00 anisometropia. Full correction.

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4
Q

When should you correct for astigmatism in a 2+ yo patient?

A

> /=1.50. Full correction.

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5
Q

When should you correct myopia in a 3-4+ yo and by how much?

A

> =-2.50. Full correction.

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6
Q

When should you correct for a hyperopia with esoT in a 3-4yo and by how much?

A

> =+1.50 (i.e. if patient has hyperopia + esoT, start correcting for it at smaller powers cf hyperopia alone)

NB: Give full correction that can be tolerated.

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7
Q

At what age is visual acuity expected to be fully developed (not necessarily 6/6 vision)?

A

around 3 years of age

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8
Q

When is 6/6 vision typically achieved?

A

5-6 years of age

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9
Q

Children with what kind of spherical equivalent and astigmatism in infancy are more likely to develop myopia by school-age?

A

Negative spherical equivalent and Against-the-Rule (x180) astigmatism

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10
Q

At what age does binocular interaction in the visual cortex appear?

A

4mo

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11
Q

At what age does convergence and accommodation reach close to adult levels?

A

6mo

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12
Q

By what age do eye movement abilities develop to adult levels?

A

By 1 year of age.

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13
Q

What is the axial length of the typical:
- neonatal/newborn eye
- adult eye

A

neonatal: 16.5mm
adult: 23.5mm

(most of the increase in axial length happens fairly early on, from what I’ve seen online children as young as 5yo can have axial lengths of like 22mm)

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14
Q

Name 3 red flags for poor vision upon observing 0-3yo patients

A

If no eye contact from a child > 6 months old
If large slow moving nystagmus
If slow eye movements

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15
Q

How do you perform Mohindra (near) retinoscopy?

A

50cm in a darkened room monocularly.
Neutralise the reflex then add:
- -0.75D for infants
- -1.25D for children over 2 years

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16
Q

When do you consider Mohindra retinoscopy?

A

when cycloplegia is contraindicated and as a supplementary refraction method (do not rely on this in isolation)

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17
Q

When should you only instill 0.5% cyclopentolate instead of the usual 1% (4)

A

Pale iris
Albinism
Down syndrome
Anybody under 6 months of age

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18
Q

When should you add tropicamide or phenylephrine to your 1% cyclopentolate drop? (1)

A

For very dark irises

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19
Q

How do you perform a blur function? (5 steps)

A

Step 1: Add +1.00-+1.50 over ret binocularly (monoc if asymmetrical VA)
Step 2: warn child of blur
Step 3: read letters + reduce size of letters while making it clearer (lowering plus)
Step 4: Reduce plus once errors are made
Step 5: Keep going until plateau or max plus to 6/6

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20
Q

What are the normal values for:
- Phoria D + N
- NPC
- NPA

A

Phoria: 3xp +/- 3 N + 1xp +/-1 D
NPC: 8/10 break/recovery (<5cm break in children)
NPA: 18-1/3 age +/-2 (avg) and 15-1/4 age (min)

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21
Q

What are the normal values for:
- PRA/NRA
- Acc facility with 2D flipper
- Verg facility with 3BI/12BO flipper
- ACA ratio

A

PRA/NRA: +/- 2.50D
Acc facility: 8cpm
Verg facility: 15cpm
ACA ratio: 4pd +/- 2pd

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22
Q

What are the normal values for PRC/NRC at
- near
- distance

A

near: BI >/= 10/16/10, BO >/= 10/16/10
distance: BI >/= -/6/4, BO >/= 10/10/10

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23
Q

What is:
- Sheard’s criterion
- Percival criterion

A

Sheards: reserve >/= 2 x phoria
Percival: Phoria = 1/3 reserve

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24
Q

List the major characteristics of:
- Convergence insufficiency
- Accommodative excess
- Divergence excess
- Accommodative spasm

A

C.I: n exo>D, reduced PRC and BO facility, remote NPC
AE: variable VA, no lag or lead, fail +ve facility
DE: D exo>N, reduced PRC@D, intermittent esoT
AS: reduced VA, lead, fail +ve facility

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25
Q

List the 4 management options for divergence excess

A

VT in office/home
Minus lens distance add (if too young/unwilling to do VT)
BI prism (compensatory)
Surgery for strab

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26
Q

What unique management option exists for accommodative spasm?

A

administering cyclo

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27
Q

List the 4 management options for divergence insufficiency

A

Identify etiology (refer MRI if recent onset/acquired)
Yoked prism
Vision therapy
BO prism (compensatory)

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28
Q

What are the 4 main concepts to remember regarding VIP skills?

A

Significant hyperopia (>+1.75) can add to a VIP delay
VIP (and other developmental) delays are better early reading predictors than IQ
VIP testing should be considered for prep to grade 3
VIP skills can be trained

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29
Q

When should you correct the hyperopia of any child with reading difficulties?

A

When hyperopia is >+1.75

30
Q

How do you conduct the Rosner TVAS?

A

Tests prep-grade 3. Numbered plates with dots and increasingly complicated shapes that the child has to copy.

31
Q

What results should we expect on the Rosner TVAS from a child who is:
- in grade 1
- in grade 2

A

grade 1: reach plate 7
grade 2: reach plate 9-10.

32
Q

What percentile on the Rosner TVAS is considered highly at risk?

A

Bottom 16th percentile

(some consider bottom 30th percentile to be a fail too)

33
Q

When should you stop the Rosner TVAS test? How do you score it?

A

When there is 2 consecutive fails. Then score it as the last correct plate.

34
Q

In the WISC-C intelligence test:
- what scores fit within the normal range?
- under what score do children often experience issues at school?
- under what score is early reading impacted?
- for what score is assistance offered at school?

A

Normal: 100 +/- 15
Issues: <90
Early reading impacted: < 80
Assistance offered: = 70

35
Q

How do you conduct the Beery VMI?

A

Child copies a range of geometric shapes (e.g X, \, triangle) and the accuracy of drawings are rated with a score provided.

NB: there are different test plates for different age groups

36
Q

What does the Rosner TAAS assess?

A

assesses how children can manipulate sounds - breaking up words into phonemes

37
Q

What does NSUCO test?

A

saccades and pursuits with wolff wands

38
Q

What 3 criteria is used for a SCCO rating? What do the ratings mean? [what is considered normal/abnormal]

A

Fixation, pursuit, and saccadic ability. Rating of 4+ is normal whereas 1+ is abnormal.

39
Q

What does a 1+ score SCCO result look like in terms of fixation, pursuit, saccades?

A

Fixation: > 2 fixation losses
Pursuit: > 2 fixation losses or uncontrolled head movement
Saccades: inability to do task or any uncontrolled head movement

40
Q

What does a 2+ score SCCO result look like in terms of fixation, pursuits, saccades?

A

Fixation: 2 fixation losses
Pursuit: 2 fixation losses
Saccades: Gross undershooting + overshooting or increased latency

41
Q

What is King Devick used for?

A

reading specific eye movements. Is a saccadic fixation test.

42
Q

What is the main disadvantage of King Devick? [important. Apparently this is a likely exam question]

A

It does NOT take into account the child’s rapid automatic naming skills

43
Q

What is the advantage of DEM over King Devick?

A

DEM only looks at reading eye movements so it doesn’t worry about naming/naming skills

44
Q

How is DEM typically used?

A

as a screening tool to identify poor reading skills in school aged children

45
Q

Does DEM performance correlate with saccadic eye movement skills or symptamotology?

A

NO!

46
Q

What does DEM performance correlate with?

A

reading performance

47
Q

What 5 management strategies are children with reading difficulties likely to benefit from?

A

Full correction of Rx (esp hyperopia)
VIP and Oc. motility testing
VT for oculomotor dysfunction/VIP
Referral to speech and audiology specialists
Referral occupational therapists

48
Q

List the 4 amblyogenic factors

A

STRAB
Anisometropia
High bilateral refractive error
Media opacity or ptosis

49
Q

What 5 steps can we go through to determine the prognosis of a patient’s amblyopia?

A

Find the cause/amblyogenic factor
Length of time the amblyogenic factor has been present
Px age (critical period?)
Is px using eccentric fixation
High refractive error and large anisometropia

50
Q

What does amblyopia typically respond best to?

A

Full plus worn full time

51
Q

What are the 3 steps of amblyopia treatment?

A

Prescribe refractive correction (must give full plus if esoT)
Occlusion or Penalisation
Review patient in same number of weeks as their age

52
Q

How should we patch amblypia patients?

A

2 hours/day until VA 6/12 then 6 hours/day

53
Q

What level of visual acuity does penalization with 1% atropine require to be effective?

A

VA of 6/30 or better

54
Q

What level of visual acuity does penalization with fogging require to be effective?

A

VA of 6/12 or better

55
Q

What was the main finding of ATS2A?

A

6hrs patching for severe amblyopia is equivalent to full time patching (over 17 weeks)

56
Q

What was the main finding of ATS2B?

A

2hrs of occlusion is just as efficient (end result or rate of improvement) as 6 hours of occlusion for moderate amblyopia for tx of 4 months. After 4 months it doesn’t work.

57
Q

What was the main finding of ATS15?

A

After 2hrs a day for 4m and stable acuity is reached then increase to 6hrs patch for 12 weeks

58
Q

What was the main finding of ATS2C?

A

Treatment stopped - recurrence during 1 yr follow up: 24% recurrence

59
Q

What was the main finding of ATS1?

A

Daily atropine vs 6hr patch a day in VA of 6/12-6/30, children 3-7yrs. Patch has a faster response @6mths, but atropine is subjectively easier.

Same improvement @ 2 years

60
Q

What was the main finding of ATS4?

A

Daily vs weekend atropine. VA 6/12-6/24. Same response, daily is easier.

61
Q

What was the main finding of ATS10?

A

6hrs daily patching vs BF at 24 weeks. Moderate amblyopia, children 3-10 yrs old. Patching improved VA by 2.3 line and BF improvement of 1.9 lines. BF was more acceptable.

62
Q

What are the 5 steps of treating any esoT?

A

Give full + (cyclo ret) [confirm plus at each review]
Treat any amblyopia
Plus for amblyopic eye is for vision
Plus for the fixing eye is for EsoT (relax accom)
Consider referral for realignment sx for any residual EsoT after best amblyopia result and plus has ben rechecked

63
Q

In what 3 scenarios will you prescribe spectacles in patients with EsoT?

A

Hyperopia over +2.00DS
EsoT responds to plus lenses (via RAAB +3 test)
Hyperopia is less than +2.00DS but high AC/A ratio (indicateing convergence excess)

64
Q

What is the gold standard for determining the amount of plus in a patient?

A

cycloplegia

65
Q

What is Streff Syndrome characterised by? (4)

A

Reduced VA (D/N)
Reduced stereo
Emmetropia to low hyperopic refraction
No change in D VA with corrective lenses

66
Q

What is the most efficacious treatment for a patient with streff syndrome? (2)

A

Low plus lenses, combined with vision training

(NB: however there’s no evidence right now to know if it’s a placebo or not)

67
Q

What should you be wary of with charge syndrome patients?

A

Often will present with retinal colobomas

68
Q

What percentage of amblyopia treatment fails due to compliance?

A

10%

69
Q

What percentage of amblyopia treatment fails due to unknown reasons?

A

4%

70
Q

What percentage of amblyopia treatment fails due to eccentric fixation?

A

1%

OD3 S1 (25 decks)

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