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Peds Flashcards

0
Q

What are racoon eyes a sign of?

A

Neuroblastoma

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1
Q

What cells is neuroblastoma derived from?

A

Precursor cells for the sympathetic pathway. Therefore it excretes catacholamines

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2
Q

Congenital horners should raise suspicion for

A

Neuroblastoma bc it messes w the sympathetic pathway
Check urine catacholamines

Symp dilates
Therefore miosis

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3
Q

What do eyes look like in primary position in browns syndrome?

A

hypotropia of effected eye

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4
Q

Stumped

A 
Sclerocornea
Trauma (foreceps)
Ulcer
Mucopoly
Peters
Endothel dystrophy (ched 2 AR cloudy from birth)
Dermoid
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5
Q

on eom in browns what do you see

A

unable to elevate when adducted improves upon abduction

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6
Q

how do you treat duanes surgically?

A

recess the (tight) medial rectus of effected eye

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7
Q

how do you surgicaly treat upshoots and downshoots in duanes?

A

Y split of lateral rectus of effected muscle

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8
Q

objects that fall on the horopter stimulate what?

A

corresponding retinal points

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9
Q

whats kassebach-merrit syndrome

A

in capillary hemangioma there may be plt sequestration causing thrombocytopenia. so check cbc in kid w cap hemangioma

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10
Q

diplopia in XT is crossed or uncrossed?

A

crossed (stimulates temporal retinas)

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11
Q

diplopia in ET is crossed or uncrossed?

A

uncrossed (stimulates nasal retinas)

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12
Q

is w4d more dissociating w lights on or off?

A

off

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13
Q

if the eye is turned in, on what part of the retina does the image fall?

A

nasal

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14
Q

pts w monofixation will fuse w4d at near or distance?

A

4 lights at near, 2 lights at distance

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15
Q

who gets monofixation syndrome?

A

post-op congenital ET who has small residual ET

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16
Q

whats the most “dissociating test” that you can use to test for arc? (most dissociative means least like an everyday binocular use of eyes

A

afterimage test (tests each eye individually and tags the fovea w vertical line in one eye and horizontal line in the other)

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17
Q

if you give an after image test and you see an X what does that mean

A

you have NRC

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18
Q

order these tests from most dissociative to least

red glass, bagolini, after image, amblyoscope, w4d

A 
afterimage- most
w4d
red glass
amblyoscope
bagolini- least
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19
Q

How many layers are there in the LGN?

A

6

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20
Q

if pt has a strong fixation preference and cannot hold fixation with one of their eyes what does it mean about that eye?

A

it is amblyopic

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21
Q

whats the type of ambly with congenital ptosis?

A

aniso ambly 2/2 astigmatism

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22
Q

how many seconds of stereo is perfect stereo?

A

40 sec

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23
Q

how do you deternine when to operate on someone with X(T)? based on pd?

A

no, its all based on whether they can control the X(T) or not. Not how big it is

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24
Q

why would you give a kid over-minus glasses?

A

if they are XT it will cause them to accommodate more and converge more

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25
Q

whats the normal value of AC:A ratio?

A

5

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26
Q

what surgery do you for X(T)

A

LR recession OU

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27
Q

Whats the surgery for sensory XT?

A

R&R on amblyopic eye

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28
Q

when do you get A and V patterns?

A

in et or xt

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29
Q

what surgery would you do for XT w big V- IO overaction?

A

LR recession OU with IO weakening OR you could move the medials to the apex of the V and laterals the opposite way (MALE)

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30
Q

What chin position would a kid do if they had an A pattern?

A

chin down

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31
Q

how do you treat an XT with mild A pattern (ie SO overaction)

A

SO surgery is fraught with problems.So don’t tough them, instead do MALE surgery

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32
Q

whats the formula to calculate AC:A ratio?

A 
IPD(cm) + N-D/Diopters of accommodation
IPD= interpupillary distance
N= ET in PD at near
D= ET in PD at dist
Diopters = 3
remember to convert IPD from mm to cm
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33
Q

whats the Parks rule for determining if there is high AC:A ratio?

A

if their ET at near is 10PD greater than their ET at distance its accommodative eso

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34
Q

whats the treatment for acomodative eso?

A

glasses! give full plus

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35
Q

when do you give bifocals?

A

straight eyes in distance and big ET at near. So at distance they look thru plano and at near they get plus so it relaxes accomodation

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36
Q

how does plus glasses relax accommodation?

A

it gives you + power, so you don’t have to accommodate to make your own + power

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37
Q

when do you operate on an ET and do you operate for the PD cc or sc?

A

operate for the deviation with glasses on. Only operate if they still have ET even with full spectacle . tell them they will need glasses even after surgery

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38
Q

whats cyclic esotropia and how do you treat?

A

kid who is ET one day and straight the next. Generally has a 24 cycle. Operate for the full ET, do not patch! Will cause the ET to become constant

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39
Q

whats hypermetropia?

A

synonym with hyperopia

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40
Q

how do you treat infantile ET?

A

try full + glasses first

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41
Q

what are the 3 bad complications after treatment of congenital et?

A

1) DVD
2) latent nystagmus
3) IO overaction

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42
Q

what rule does DVD violate?

A

herrings law. its like you take a saw and divide your head. The eyes don’t coordinate

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43
Q

what direction is latent nystagmus?

A

fast phase toward the fixing eye

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44
Q

do kids with congenital ET have any chance for high grade stereopsis?

A

not a chance. At best they can become monofixators (small central suppression/scotoma)

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45
Q

whats smooth pursuit asymmetry?

A

normal kids develop smooth pusuit from temporal to nasal direction first. once they get older they can follow nasal to temporal. Kids with ambly never develop good nasal to temporal pursuit

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46
Q

how often can infantile ET resolve

A

almost never. only 4%

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47
Q

whats the forced generation test?

A

put in proparacaine, grob eye w .12 and tell them to look in each direction and feel if the eye is generating force

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48
Q

how do you treat a vascular or traumatic cn6 palsy?

A

observe 6 months

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49
Q

what surgery can you do for cn6 palsy?

A

1) hummelsheim procedure. split both the SR and IR and transpose part of it to the insertion of the LR
2) Jensen- split the LR and sew the muscle itself to the SR and IR

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51
Q

Whats double elevator palsy?

A

actually a monocular elevation problem
Tight IR (restrictive) vs. paralysis
Causes unable to look up in adduction and abduction (unlike browns has prob w elevation in adduction only)

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51
Q

Whats the main cause of acquired browns sx?

A

Sinusitis

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52
Q

How do you treat double elevator palsy?

A

if restrictive- recess IR

If paralytic- do Knapp procedure. Bring the MR and LR up next to the SR

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53
Q

How do you work up acquired browns?

A

Image the orbit

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54
Q

What does it mean if you have a hyper and the hyper is worse on tilt toward that side?

A

It must be an oblique problem!!!!

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55
Q

If a kid has a left hyper worse on left head tilt, what are the 2 options of which muscle is bad?

A

Left SO

Right IO

56
Q

What will someone w congenital so palsy look like?

A

Will have head tilt and facial asymmetry able to fuse hyper

57
Q

How do you treat congenital so palsy?

A

Weaken ipsilater io

58
Q

Whats a bad complication of anyeriorizing the io to much?

A

Anti elevation syndrome

Bc the io elevates if you weaken too much you fuck it up

59
Q

Why do you do a harada ito procedure?

A

Produces intorsion

60
Q

whats a typical stereoacuity in monofixation syndrome?

A

2000 sec of arc (not good)

61
Q

when would you operate on 1 muscle vs 2 muscles?

A

if the deviation is > 25PD you have to operate in 2 muscles

62
Q

what do you do if a baby doesn’t FF at 5 mo?

A

observe. if still not FF at 1 yr do VEP

63
Q

whats the definition of ophthalmia neonatorum?

A

conjunctivitis in 1st month of life

64
Q

oil droplet cataract associated w?

A

galactosemia

65
Q

what type of cataract in alports syndrome?

A

ant lenticonus

66
Q

what type of cataract in downs?

A

cerulean “blue dot” cataract

67
Q

discaform cataract associated with?

A

lowes syndrome (x-linked recessive, MR, glaucoma)

68
Q

how is lowe’s inherited, whats the synonym, and what type of cataract

A

x-linked
oculocerebrorenal syndrome
discaform (50% will have cat and glaucoma)

69
Q

for any et or xt of 15PD, how far back should your R&R be on the LR AND MR?

A

MR 3mm

LR 4mm

70
Q

you do a goniotomy for a kid- it doesn’t work. Whats the next step?

A

another goniotomy!

71
Q

in what order do these causes of ophthalmia neonatorum present themselves? chlamydia, chemical, gonnorhea, hsv

A

chemical- first 24 hrs
gonorrhea- 2-3 days
chlamydia- 5-7 days
hsv- 2 weeks

72
Q

what’s megalocornea? (besides glaucoma)

A

x-linked condition in boys. random. moms can have enlarged K nerves

73
Q

which antiemetic is totally contraindicated in kids <2

A

promethazine (resp depression- its like meth for kids)

74
Q

which babies get screened for rop?

A

<1500 grams (3.3 lbs)

75
Q

kids with myelinated rnfl are at risk for what type of amblyopia

A

refractive

76
Q

Mass superior to medial canthus worry abt

A

Meningocele!!!!

Superior= coming from brain

77
Q

homocystinurea- inher pattern, how do the kids look, which way does lens dislocate, complication of surgery

A

AR
Tall blonde with MR
inf-nasal dislocation
hypercoaguability

78
Q

upper eyelid coloboma is associated with what syndrome?

A

goldenhaar

79
Q

upper eyelid coloboma is associated with what syndrome?

A

goldenhaar

80
Q

whats another name for posterior lenticonus and is it uni or bilateral?

A

oil droplet cataract

unilateral

81
Q

whats a test beside an MRI that you can use to check for neuroblastoma?

A

urinary catecholamines

82
Q

when do you take out

1) unilateral congenital cat
2) bilateral congenital cats

A

1) before 6 weeks old

2) before 10 weeks old

83
Q

whats the primary, secondary and tertiary fxn of the SR?

A

1) elevation
2) intorstion
3) adduction

84
Q

whats the inher of oculocutaneous albinism?

A

AR

85
Q

Whats the difference between tyrosinase-pos and tyrosinase-neg?

A

tyrosinase negative has worse prognosis bc complete lack of pigment

86
Q

whats the difference between oculocutaneous albinism and ocular albinism

A

ocular albinism occursonly in boys bc its X-linked recessive

87
Q

what chromosome is associated with RB?

A

13

88
Q

What chromosome is associated with alveolar rhabdo

A

cross between chrom 1 and 13 (13 is the rb chrom)

89
Q

what tumor has antoni A and B cells?

A

Schwannoma

90
Q

FGFR gene associated with what syndrome?

A

crouzons

91
Q

how does patau syndrome (trisomy 13) present?

A

Microphthalmos
MR
Polydactyly
dwarfism

92
Q

how are the Y sutures oriented in the lens?

A

upright Y anteriorly

inverted Y posteriorly ((posterior for peace”)

93
Q

what do you have to worry about when you put a pt w weill-marchesani under general anesthesia?

A

thromboembolic events

94
Q

Most common indication for PK in kids?

A

peters

95
Q

what diameter of K should make you suspicious for congenital glaucoma?

A

> 12

96
Q

describe the kestenbaum procedure

A

try to align eyes TOWARD the head turn, so if kid has left head turn, would resess LLR, RMR etc.

97
Q

which has the worst gram + coverage?

A

ceftaz

98
Q

whats the inheritance of ectopia lentis et pupillae?

A

AR (a closed pupil recesses you ability to see)

99
Q

what molecule is defective in marfans?

A

fibrillin

100
Q

in what dz do you give low methionine and high cysteine?

A

homocystinuria (AR, with MR, tall, seizures)

101
Q

inheritance of fabrys

A

x-linked recessive (Fabulous HUNTER- x links the spot)

102
Q

when do you screen rop kids?

A

4-6 weeks post-natal OR

31-32 wks GA

103
Q

if you have a kid straight in dist but has accom ET- how do you treat?

A

give bifocal glasses

no surgery if they are straight in the distance

104
Q

how do you treat infantile ET?

A

Give full +

if still have ET even with glasses then surgery

105
Q

how much ET do you operate for in accommodative ET?

A

Operate on the Dist cc (The augmented way is to operate on the avg value bet the Nsc and Ncc)

106
Q

how do you treat cyclic esotropia?

A

operate on the full deviation on the bad day

107
Q

right hyper, what are the 4 possible effected muscles?

A

RSO
LIO
RIR
LSR

108
Q

what does the harada ito procedure do?

A

strengthens fibers causing intorsion

109
Q

Right hyper WORSE ON LEFT HEAD TILT what are the 2 possibilities?

A

RIR- hyper will be worse with right gaze

LSR- hyper will be worse with left gaze

110
Q

right SO palsy what are parks 3 steps

A

Right hyper
Left gaze worse
Right head tilt worse

111
Q

how does x-linked dominant work?

A

need only 1 X to get the dz so both boys and girls can get it

112
Q

how does x-linked recessive work?

A

mom is the carrier of 1 bad X
boys get the bad X from mom and get dz
girls end up being carriers

113
Q

what are the primary, secondary and tertiary fxns of the SO? (SO-LID)

A

1) intortion
2) depression
3) lateral movement of the eye

114
Q

weill marchesani- inher and cataract type

A

AR
microspherophakia
short
flat head

115
Q

galactosemia- inher, type of cataract

A

AR

oil-droplet (aka post lenticonus)

116
Q

most common manifestation of fabrys in the eye

A

K verticilata (x linked)

117
Q

myelinated rnfl ass with what syndrome

A

basal cell nevus syndrome (they dev bccs)

or ipilateral high myopia

118
Q

how can you differentiate browns from IR restriction

A

there will be restriction with retropulsion in browns

119
Q

CHED1 vs CHED 2- inheritance, how does it present?

A

ched 1- AD presents at 1-2 yo, progresses slowly

ched 2- AR cloudy from birth

120
Q

congenital stroma corneal dystrophy- inher and how does it present?

A

AD

flaky things in stroma, doesn’t get worse

121
Q

what did the beat ROP study show?

A

that IVA was better than laser for stage 3 zone 1 rop

122
Q

what chediak higashi syndrome

A

recurrent pyogenic infections ass with albinism

123
Q

whats hermansky pudalk

A

platlet pooling problem leading to bleeding in Puerto Ricans w albinsim

124
Q

Whats waardenberg sx?

A

Neural crest dz
Iris heterochromia (brilliant blue eye)
White forelock
Deafness

125
Q

What dz ass w pax 6?

A

Peters
Aniridia
Coloboma
Microphthalmia

126
Q

Skew deviation (2/2 bad vestibular input) looks like CN4 palsy in every way except

A

the effected eye will be INCYCLOTORTED! that is not c/w cn4 palsy

127
Q

besides the 3 step test for cn4 palsy, what other deviation can you find w 4th?

A

v pattern eso (worse in downgaze!)

128
Q

can peters be associated with glaucoma?

A

yes!

129
Q

whats peters plus?

A

peters w systemic anomalies- facial cardiac, polydactyly

130
Q

posterior lenticonus present at birth?

A

no
they are unilateral and acquired
ass w galactosemia

131
Q

alports- inheritance, signs and retina finding

A

x-linked dominant
glomerulonephritis
high-tone deafness
“dot and fleck” retinopathy

132
Q

in latent nystagmus when you occlude one eye what happens to the velocity of the nystagmus

A

DECREASE in slow phase velocity

133
Q

in congenital nystagmus what happens to the velocities over time?

A

INCREASE in the slow phase velocity

134
Q

whats the definition of megalocornea?

A

> 13mm in diameter

135
Q

what dz can be associated with megalocornea?

A

marfans

136
Q

kids w forecep injury lose vision from what

A

astigmatic amblyopia (the k edema from the forceps resolves quickly so its not the cause of the ambly)

137
Q

whats the general surgical approach to duanes?

A

RECESS the muscle that’s actually working in the effected eye.

138
Q

2 diseases associated w Christmas tree cataract

A

myotonic dystrophy

hypoparathyroidism (low ca levels)

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