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Pediatric > Pediatrics 2 > Flashcards

Pediatrics 2 Flashcards

1
Q

What is a ddx for leukocoria in a child?

A

RetinoblastomaCongenital cataractsToxocariasisPersistent hyperplastic primary vitreousCoats diseaseRetinal astrocytomaROPRetinal detachment (from ROP)

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2
Q

What is the CSM method when testing visual acuity?

A

CSM (central, steady, maintained) 1. Central: foveal fixation with a centrally located corneal light reflex2. Steady means good smoth movements without nystagmus, etc3. Maintains means keeps fixation with both eyes uncoveredAbnormal is uncentral, unsteady, and unmaintained

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3
Q

What are two methods to test visual acuity in proverbal children?

A
  1. Teller acuity charts (stripes on one side of card)2. Visually evoked potential (VEP): electrodes on occipital while striped stimuli are presented
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4
Q

Orthotropia

A

Straight alignment under binocular conditions with the affects of any fusional capacity. Orthophoria is commonly used interchangeably although these terms technically are different

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5
Q

What does the term consecutive mean in consecutive exotropia?

A

Exotropia that occurs following correction of an esotropia

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6
Q

What is the terms preferred to inferior oblique overaction and superior oblique overaction respectively?

A

Over elevation in adduction Over depression in adduction

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7
Q

Does the SO pass under or over the SR?

A

Under

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8
Q

What is the most common cause of infectious uveitis in children? The most common identified cause overall?

A

ToxoplasmosisJIA

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9
Q

What percentage of kids with oligoarthritis variant of JIA have chronic uveitis?

A

10-30%

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10
Q

What are the typical lab results of ANA and RF in oligoarthritis subset of JIA?

A

ANA positive, RF negative

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11
Q

How often should a screening eye exam be performed in kids with high risk JIA?

A

Every 3 months

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12
Q

What is the most common cause of posterior uveitis in kids?

A

Toxoplasmosis

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13
Q

What are the three causes of amblyopia?

A
  1. Strabismus2. Refractive3. Visual deprivation
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14
Q

What category of amblyopia is most profound?

A

Deprivational

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15
Q

What is the neutral density filter effect?

A

When a neutral density filter is place over an eye with amblyopia the vision declines less sharply compared to an eye with organic disease.

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16
Q

What amount of anisometropia is thought to lead to anisometropic amblyopia?

A
  1. Anisohyperopia of greater than 1.5 D2. Anisoastigmatism of greater,than 2.0 D3. Anisomyopia of greater than 3.0 D
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17
Q

What degree of refractive error should cause concern for isoametropic amblyopia?

A

4-5D of hyperopia, 5-6 D of myopia, and 2-3 D of astigmatism

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18
Q

Is central vision affected in amblyopia?

A

Yes, peripheral vision is not

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19
Q

How soon should an unilateral congenital cataract be removed to avoid permenent amblyopia? Bilateral?

A

ASAP, best within 4-6 weeks from birth; within 10 weeks

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20
Q

Approximately what percentage of amblyopia recurs after completion of initial treatment?

A

1/3rd

21
Q

Reverse amblyopia

A

Amblyopia that occurs in the non amblyopic eye as a result of amblyopia treatment

22
Q

When should penalization/patching be used after refractive correction does not correct refractive amblyopia?

A

After 6-12 weeks

23
Q

How long should an eye be patched in amblyopia?

A

2-6 hours while awake depending on severity. Follow up 1wk/year of child (e.g. 3 weeks for a 3 year old)

24
Q

What does the term gaze mean?

A

Version movements as opposed to ductions

25
Q

What is the gene defect in marfans?

A

Fibrillin defect found on chromosome 15

26
Q

What does the simultaneous prism and cover test demonstrate? What eye is covered and which eye gets the prism?

A

Heterotropia alone (vs heterotropia + heterophoria as demonstrated in alternate cover testing); the fixating eye is covered while the non fixating has a prism placed before it

27
Q

What is the approximate deviations in prism diopters that are elicited by hirschberg testing at the pupil margin, mid iris, and limbus

A

30, 60, 90

28
Q

How do you test for NPC (near point of convergence)? What is the normal NPC?

A

Have patient look at thumb at approx 40 cm and then slowly bring closer until one eye turns out. Normally 8-10cm or less

29
Q

What is the 3 step test?

A

Used to determine which of the 8 cyclovertical muscles is implicated in a deviation1. Determine which eye is hypertropic, eliminating 4/8 muscles.2. Determine if deviation is greater in right or left gaze, eliminating 2/4 remaining muscles3. Bielschowsky head tilt test: determine if there is greater deviation in head tilt to right or left eliminating the remaining muscle and isolating the implicated muscle

30
Q

Abnormal head position (AHP), aka torticollis, can be due to rotation about any of the three axises. What are the three abnormal head positions called?

A
  1. Head turn2. Head tilt3. Chin up or chin down
31
Q

When do you usually place an iol in a aphakic infant?

A

Usually after the age of 2

32
Q

What is an important consideration to think about when choosing an iol for a young child?

A

A myopic shift that will occur as the child grows

33
Q

Which EOM manipulation is most likely to cause oculocardiac reflex?

A

MR

34
Q

Superior segmental optic nerve hypoplasia

A

Dense inferior defects in children from optic nerve hypoplasia. CRA appears to arise from the superior discAssociated with mothers having diabetes

35
Q

Marfans

A

-Fibrillin mutation on chromosome 15-AD-75% will have superior subluxated lens-spontaneous RD’s

36
Q

At what age do you expect a child to begin to fixate and follow

A

2 months +- a couple of weeks

37
Q

What is the definition of ophthalmia neonatorum and what are the common causes at different time periods after birth?

A

Conjunctivitis after birth and before 1 month-24 hours: chemical from silver nitrate-3-7 days: n. Gonorrhea-7 days: chlamydia

38
Q

What percentage of CN VI palsies in children are the result of intracranial tumor?

A

1/3rd

39
Q

How can intermittent XT be measured after normal alternate cover measurements?

A

Monocular (after 60 min occlusion) or with plus 3 lenses. This negated tenacious proximal fusion

40
Q

How many degrees in prism diopter difference between up and down gaze must there be for an A pattern strabismus that is clinically significant? A V pattern strabismus?

A

10 PD; 15 PD

41
Q

What causes a Y pattern deviation?

A

Aberrant innervation of the lateral rectus in upgaze

42
Q

How much does an inferior oblique recession/myectomy correct in V pattern deviations,

A

15-20 PD

43
Q

How much does superior oblique weakening correct for in A pattern deviations

A

20 PD

44
Q

A hyperdeviation with comitant horizontal deviation is suggestive of what type of muscle disorder? Incomitant?

A

Vertical muscle; horizontal

45
Q

What is secondary inferior oblique overaction?

A

Palsy of superior oblique causing overaction of inferior oblique

46
Q

Periodic alternating nystagmus

A

Jerk nystagmus in 1 direction for 60-90 seconds followed by 10-20 seconds of no nystagmus followed by nystagmus in the opposite direction-congenital or acquired-associated with Arnold chiari malformation-some children adopt alternating head positions

47
Q

What is the treatment of convergence insufficiency?

A

Orthoptic exercises including pencil push ups, base out prisms, stereograms, etc

48
Q

The eye can be moved about 50 degrees in every direction from primary position (by forced ductions) but under normal physiologic conditions, how far can it normally move?

A

15-20 degrees from primary position

49
Q

What is the approximate length of the rectus muscles (excluding their tendons)?

A

40mm

Pediatric (4 decks)

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