Peds Flashcards
Use 0.2% cyclopentolate on which age group?
Pre-term infants
Infants under 12 months use % cyclopentolate
0.5% cyclo
Use 1% cyclo on what age group?
Infants older than 1 year
At what age should children be able to draw a vertical line?
3 years old
By age 4-6 a child should be able to draw what shape(s)?
Square or triangle
When can a child expect to be able to draw a diamond shape?
6 or 7 years old
Demographic for coats disease
Males, around 5 years old
(First decade of life)
* no racial or genetic predilection
Characteristics of coats disease
Idiopathic retinal telangiectasia
Significant sub retinal and intra-retinal exudation
Most common clinical signs of coats disease
Leukocoria and strabismus
* iris heterochromia (from iris neo) and nystagmus
Pathogenesis of coats disease
Abnormal permeability of the retinal vascular endothelium causes breakdown of blood-retinal barrier and leakage of lipid-rich exudates
Treatment of coats disease
Focal laser photocoagulation
* eradicate abnormal telangiectatic retinal blood vessels
End stage of coats disease if left untreated
- Total exudative retinal detachment
- Neovascular glaucoma (can lead to blind and painful eye)
- enucleation may be required
Babies at most risk for retinopathy of prematurity
Birth weight less than 1500 grams
or are born less than 32 weeks (full term is 40 weeks)
20/20 VA is achieved at what age for kids? (With preferential looking)
By 3-5 years
At what ages are kids expected to have 20/20 VA when tested with visual evoked potentials?
6-7 months of age
Dosage for cycloplegic retinoscopy on infants (full term infant)
1 gtts 0.50% cyclopentolate OU, instilled twice, 5 minutes apart
According to AOA clinical practice guidelines, what is the recommended comprehensive eye exam schedule for asymptomatic child?
- @ 6 months old
- @ 3 years old
- Before 1st grade
- Then every 2 years after
Psychosocial stages of development for birth-18 months old
Trust vs mistrust
* can I trust the world??
* feeding
* infant basic needs being met by parents
What are the psychosocial stages of development?
- Trust vs mistrust
- Autonomy vs Shame
- Initiative vs Guilt
- Industry vs Inferiority
- Identity vs Role confusion
Ages for identity vs role confusion
12-18 years old
Industry vs inferiority ages
6-11 years old
Initiative vs guilt ages
Pre-school 3-5 years old
Stroking underside of infant foot causes toes to fan out with dorsiflexion of big toe
Babinski reflex
* presence of this reflex in patients older than 2 years old may indicated corticospinal damage
What is the most commonly encountered form of infantile glaucoma?
primary congenital glaucoma
In which gender is primary congenital glaucoma observed more frequently?
Males.
What percentage of primary congenital glaucoma cases occur bilaterally?
75%.
At what age do most cases of primary congenital glaucoma typically present?
Before the child’s first birthday.
What causes primary congenital glaucoma?
An abnormality of the angle (either a flat iris insertion or a concave iris insertion).
Is primary congenital glaucoma linked with any systemic disorders?
Rarely.
What are the three characteristic symptoms noted by caregivers in primary congenital glaucoma?
- Photophobia
- Epiphora
- Blepharospasm
What may caregivers observe regarding the child’s corneas in primary congenital glaucoma?
The corneas may appear cloudy due to corneal edema.
What are some clinical findings associated with primary congenital glaucoma?
- Unilaterally or bilaterally enlarged globes and corneas (greater than 12 mm in diameter)
- Tears in Descemet’s membrane
- Myopic refractive error
- Elevated IOPs
- Corneal edema
- Hypoplasia of the iris stroma
- Cupping of the optic nerves
What is buphthalmos in the context of primary congenital glaucoma?
Stretching of the globe and its associated structures due to consistently elevated IOP.
Tx for primary congenital glaucoma
Refer to surgical intervention
* goniotomy: TM is incised while being visualized via gonioscopy
* surgical intervention usually results in smaller cup to disc ration (elasticity of connective tissue in infants)
What are the linear corneal striations observed in primary congenital glaucoma?
Haab striae
* high IOP causes corneal edema, horizontal breaks in descemet’s membrane due to stretching of cornea
What is the purpose of the APGAR scoring system?
To evaluate a baby’s physical status directly after delivery
The APGAR score assesses five signs to determine the overall condition of the newborn.
How many signs are evaluated in the APGAR scoring system?
5 signs
The five signs are heart rate, respiratory effort, muscle tone, reflex irritability, and color.
What is the scoring range of the APGAR system?
0-10
A score of 10 indicates the best possible condition for the baby.
What does a score of 8 or 9 indicate in the APGAR scoring?
Good condition
A score of 4-7 indicates fair condition, while 0-3 indicates poor condition.
What is the highest score possible on the APGAR scale?
10
A score of 10 implies that the baby is in the best possible condition.
For APGAR, What is the score for a heart rate that is above 100?
2
A score of 1 is given for a slow heart rate (less than 100), and 0 is for no detectable heart rate.
What score is given for a baby with absent respiratory effort?
0
A score of 1 is for slow, irregular breathing, and 2 is for good breathing, such as crying.
Fill in the blank: A baby with flaccid muscle tone receives a score of _______.
0
A score of 1 is given for some flexion of extremities, and 2 for active motion.
What does a reflex irritability score of 1 indicate?
Grimace
A score of 0 indicates no response, while a score of 2 indicates a cry, cough, or sneeze.
What does a color score of 2 indicate in the APGAR scoring system?
Completely pink or absence of cyanosis
A score of 1 is for a body that is pink with bluish extremities, while 0 indicates blue or pale color.
True or False: Weight and length of the baby are related to the APGAR score.
False
The APGAR score is solely based on the five evaluated signs and does not consider weight or length.
APGAR score for color
Is the baby pink all over or hands and feet bluish?
Score 0 if blue
Score 1 if body pink and extremities blueish
Score 2 if completely pink or absence of cyanosis
Tetralogy of Fallot
Congenital heart defect
* hold between ventricles of the heart and narrowing of pulmonary valve
* rare
RTC for megalopapilla
Annual exam or 6 month follow up for dilated fundus exam
What are Haab striae?
Horizontal breaks or ruptures in Descemet’s membrane
Haab striae are specifically related to certain eye conditions.
What conditions are commonly associated with Haab striae?
Congenital glaucoma and buphthalmos
Buphthalmos refers to an abnormal enlargement of the eyeball.
What is the main difference between Haab striae and vertically oriented breaks in Descemet’s membrane?
Haab striae are horizontal, while vertically oriented breaks are associated with trauma from forceps delivery
This distinction is crucial for accurate diagnosis.
True or False: Haab striae can only occur as single breaks.
False
Haab striae may be single or multiple.
At what age should a child be able to lift their head and chest while lying on their stomach?
3 months
What should a child be able to do by 4 months?
Recognize familiar faces and start babbling
By 6 months, a child should be able to _______.
roll over, sit independently, and grasp objects
What emotional response should a child show towards strangers by 6 months?
Feel uncomfortable
At 9 months, a child should begin to _______.
crawl
What key milestones should a child reach by 12 months?
Begin to walk, experience separation anxiety, and say single words
By 15 months, a child should be able to build a _______.
two block tower
At 18 months, a child should know a few _______.
words
What abilities should a 2-year-old child have?
Run, climb stairs, build a 6 block tower, scribble, eat independently, and be toilet trained
At 2 years, a child should have a vocabulary of _______ words.
50
By age 3, a child should be able to _______.
hop, manipulate small objects, and throw a ball 10 feet
What is the expected vocabulary size for a 3-year-old?
900 words
What sentence structure should a 3-year-old be able to produce?
3-5 word sentences
What skills should a 5-year-old child possess?
Copy simple shapes and have a mature pencil grip
At 6 years, a child should know their _______.
right from left
What social skill is expected of a 6-year-old?
Build loyal friendships
By age 7, a child should be able to hold _______.
fluid, elaborate conversations
Expected ocular milestones for infant
VA 20/400
*child should be able to fixate on a person’s face
Expected ocular milestones for 1 month old
VA 20/300
*binocular alignment and pupil response should be swift
Expected ocular milestones for 3 month old
Coordinated head-eye movements
Expected ocular milestones for 4 month old
VA 20/150
* smooth pursuits, saccades, color vision and accommodation should be adult like
Expected ocular milestones for 6 months
VA 20/50
*OKN response becomes symmetric
*NPC to the nose
*stereopsis present
For peds, when is VA expected to be 20/20?
3-5 years old
What percentage of infants with active retinopathy of prematurity (ROP) will develop cicatricial complications?
Approximately 20%
This statistic highlights the prevalence of severe outcomes in infants suffering from ROP.
What is the relationship between the advancement of ROP and cicatricial sequelae?
The more advanced the disease at the time of involution, the more serious the cicatricial sequelae are likely to become.
This indicates that early detection and intervention may mitigate severe outcomes.
How many stages are there in cicatricial retinopathy of prematurity (ROP)?
5 stages
Each stage represents a progression of disease severity and associated complications.
What characterizes Stage 1 of cicatricial ROP?
Presence of myopia, minimal peripheral retinal pigmentary disturbances, and haze at the vitreous base.
This stage indicates early signs of complications.
What is observed in Stage 2 of cicatricial ROP?
Appearance of temporal vitreoretinal fibrosis with dragging of the optic disc and posterior retina.
This stage signifies a progression from Stage 1 with more significant retinal changes.
What defines Stage 3 of cicatricial ROP?
More severe peripheral fibrosis with contracture and formation of a falciform retinal fold.
The presence of a falciform fold indicates increased severity.
What is the characteristic of Stage 4 cicatricial ROP?
Partial ring of retrolental fibrovascular tissue with a presence of a partial retinal detachment.
This stage highlights significant structural changes within the eye.
What distinguishes Stage 5 of cicatricial ROP?
Complete ring of retrolental fibrovascular tissue with total retinal detachment.
This stage represents the most severe outcome in the progression of cicatricial ROP.
In the example provided, which stage of cicatricial ROP is indicated by the dragging of the optic disc with no observable falciform fold?
Stage 2
The absence of a falciform fold suggests that the disease has not progressed to a more severe stage.
What are the two primary risk factors for the development of retinopathy of prematurity (ROP)?
Low birth weight and prematurity
What is the weight threshold for newborns to be considered at risk for ROP?
Less than 1500 g
What percentage of infants weighing less than 1500 g at birth may exhibit some degree of ROP?
25-30%
What percentage of infants weighing less than 1250 g at birth may exhibit some degree of ROP?
65%
Which of the two primary risk factors poses the greatest risk for ROP?
Low birth weight
List some other risk factors for retinopathy of prematurity (ROP).
- Intraventricular hemorrhage
- Respiratory distress syndrome
- Sepsis
- Sleep apnea
When should a thorough retinal examination begin for newborns at higher risk of ROP?
At 4-7 weeks postnatally
What methods should be used for screening newborns for ROP?
Indirect ophthalmoscopy or wide-field retinal imaging
How often should the retinal examination be reviewed until the retinal vascularization reaches zone 3?
At 1-2 week intervals
Fill in the blank: A thorough retinal examination is necessary for all newborns that fall under the category of ‘_______’ of retinopathy.
higher risk
True or False: Only infants born at 30 weeks gestation or less are at risk for ROP.
False
What are the two primary risk factors for development of ROP?
- Gestational age less than 31 weeks (infants premature if born 30 weeks or less)
- Low Birth weight (weight less than 1500g)
At what age does the retinal vasculature reach nasal and temporal periphery, respectively?
8 months gestation for nasal
1 month after birth for temporal
What are the three zones used to determine the location of active retinopathy of prematurity?
Zone 1, Zone 2, Zone 3
These zones are centered around the optic disc.
Define Zone 1 in the context of active retinopathy of prematurity.
The area encompassed by an imaginary circle in which the radius is twice the distance from the disc to the macula (worse prognosis)
Zone 1 has the worst prognosis for retinopathy of prematurity.
What characterizes Zone 2 in retinopathy of prematurity?
Extends from the edge of Zone 1 to the ora serrata nasally, and to an equidistant point temporally
Zone 2 has a better prognosis than Zone 1.
Describe Zone 3 in the context of retinopathy of prematurity.
The residual temporal crescent that extends from the edge of Zone 2
Zone 3 indicates the least severe area in terms of prognosis.
True or False: Zone 1 has the best prognosis for retinopathy of prematurity.
False
Zone 1 has the worst prognosis.
Children with very low birth weight especially treated for ROP, are at higher risk for developing?
- Strabismus
- Myopia
What is plus disease characterized by?
Dilation of veins and tortuosity of arterioles in at least 2 quadrants of the posterior fundus, vitreous haze, increased pre-retinal and vitreous hemorrhages, failure of the pupil to dilate with associated iris vasculature engorgement
Plus disease indicates significant changes in the retinal vasculature in the context of retinopathy of prematurity.
What happens when plus disease changes are observed?
A plus sign is added to the stage number
This indicates a progression in the severity of the retinopathy.
Define pre-plus disease.
Abnormal dilation and tortuosity of the retinal vasculature that is insufficient to be designated as plus disease
Pre-plus disease indicates early signs of vascular changes but not to the extent of plus disease.
What is threshold disease in the context of retinopathy?
Five contiguous clock hours or eight cumulative clock hours of extraretinal neovascularization in zone 1 or 2 in association with plus disease
Threshold disease is considered stage 3 disease and indicates a critical level of retinal damage.
Describe aggressive posterior (rush disease).
Prominence of plus disease along with ill-defined nature of the retinopathy, most commonly present in zone 1, does not usually progress through the classic stages 1-3
Aggressive posterior disease represents a rapid and severe form of retinopathy, often requiring immediate intervention.
Shaken babe syndrome triad
- Subdural hematoma
- Cerebral edema (brain swelling)
- Multilayered retinal hemorrhages
