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Peds > Peds Dz > Flashcards

Peds Dz Flashcards

1
Q

Key signs of Kawasaki’s?

**1/3 of cases will later develop WHAT type of problem?

A

Acute conjunctivitis; red tongue, erythema, Palm/sole edema

**CARDIAC problems - coronary artery aneurysm: common cause of ACQUIRED heart dz

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2
Q

3 week old presents to you w/ excessive tearing/mucous discharge on lashes/medial canthus.

Dx?

  • commonly causes what secondary infx?
  • 80% resolve by __ months
A

NLDO (2-6 wks)

  • commonly causes recurrent conjunctivitis
  • 80% self-resolution by 6 months; ABx if 2’ conj exists, otherwise, massage. May need puncture if not gone by 9 months
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3
Q

T/F: blepharitis is more commonly seen in Down’s pts

A

True! Most common cause: staph

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4
Q

What is Riley-Day syndrome

A

AR condition w/ DECREASED corneal sensation/innervation

–> seriously DRY EYE!

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5
Q

You see ptosis in a child. FIRST thing to do? Two types?

A

Check PUPILS. Need to check for Horners.

Congenital: no lid crease
Acquired: lid crease, look for CAUSE
—birth trauma? Cardiothoracic surgery? Neuroblastoma?

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6
Q

Ptosis, telecanthus, horiz narrowing of palpebral fissure, flattened nasal bridge are all signs of what condition?

Tx?

A

Blepharophimosis - AD in 50% of cases

-surgery for cosmetis OR if deprivation amblyopia/anomalous head posture

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7
Q

Marcus gun jaw winking in an abnormal syn kinesics b/w which two muscles?

  • inheritance?
  • will this resolve on its own?
A

Levator and lateral pterygoid

Abnml eye = ptotic; elevates when jaw is opened

Congenital, sporadic, unilateral, self-resolving

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8
Q

Child is BORN w/ a bluish, distended cyst w/I the lacrimal sac region. (-)inflammation, will spontaneously resolve. Dx?

A

Dacryocystocele

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9
Q

Most common orbital tumor? (General)

A

DERMOIDS

-egg-shaped mass in assoc w/ orbital bones; may induce astig

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10
Q

5Y/O child (4-10) presents w/ proptosis x3 days, quickly worsening. (+)lid erythema, ptosis, restricted EOMs, slightly displaced globe. Dx/Tx?

A

Rhabdomyosarcoma - MALIGNANT

Tx: radiation, chemo. Good long-term prognosis if caught early.

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11
Q

**An infant presents w/ a relatively large cornea, ~12mm. What should you IMMEDIATELY r/o?

What two conditions should come to mind if you see a relatively SMALL cornea (

A

**Congenital Glaucoma (megalocornea assn)

Peds: megalocornea = >11.5-12mm

micro think 1) PHPV, or 2) congenital cataract

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12
Q

You see an epi bulbar dermoid in a child you suspect may have Goldenhar’s syndrome. What other key characteristics may you observe?

A

Facial clefting, microphthalmia, coloboma, strab (Duane’s), NLDO

*ear abnormalities, kidney, heart, intellectual disabilities

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13
Q

Cystinosis = a _____ storage defect d/t excess deposition of cysteine.

Results in which two key ocular findings?

A

Corneal crystals, pigmentary retinopathy

-systemic: growth retardation, renal failure, decreased skin/hair pigmentation.

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14
Q

Earliest sx of xerophthalmia?

A

Night blindness (recall: Vit A deficiency)

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15
Q

Three key sx of congenital Glc? Tx?

A

EEE: extreme PHOTOPHOBIA, EYE rubbing, Epiphora

-REFER to pediatric Glc specialist

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16
Q

Two key differentials to R/O immediately when leukocoria presents:

A

1) RB 2)cong cataract. Other: CTRRP, GMRC

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17
Q

Most common pediatric ocular neoplasm? Two most common presenting signs?

A

RETINOBLASTOMA*** (don’t miss)

1) leukocoria (56% - majority)
2) strab (20%)

18
Q

Etiology/patho of RB Dx? Likely ____ if unilateral, ____ if bilateral.

Avg age of Dx?

Prognosis for survival? (What % survive)

A

DELETION of RB gene.

Sporadic if uni; inherited if bilat.

Dx age: 18 months

Prognosis: 85-90% survival

19
Q

3 Y/O presents w/ a highly myopic refractive error, a relatively flat face, hearing loss, joint problems, and intellectual disability. Dx? What is it?

A

Stickler syndrome - AD CT disorder - at higher risk of subsequent RD.

20
Q

5Y/O male infant pt presents w/ leukocoria. O-scope reveals significant exudation, peripheral telangiectasias. Dx?

A

Coat’s Dz. Mostly males (75%); may lead to serous RD.

Tx w/ cryo, laser, RD Tx.

21
Q

Mom presents w/ 2 month-old child that is visually inattentive, has a mild nystagmus, hyperopic refractive error, poor pupillary light response. Fundus looks relatively nml w/ few white flecks. Dx?

A

LCA- AR, horrible VA (20/200 BCVA)

Tx: gene therapy

22
Q

Which condition presents w/ reduced night vision, variable vision loss, is non-progressive, inherited (AR, X, or AD), a relatively normal fundus appearance, but a reduced SCOTOPIC response on ERG (Photopic nml). Dx?

A

CSNB

  • AR/X during infancy
  • AD later in life
23
Q

three types of achromatopsia (absent/deficient CONE fxn)?

A

1) Rod mono - AR; worst VA (20/200, complete color blindness), high hyperopia, nystag, photophobia
2) incomplete a - AR (similar to rod mono but better prog (20/80-120)
3) Blue cone mono - XLR; nml blue fxn, no R/G fxn

24
Q

18Y/O pt presents w/ BCVA of 20/40 (slowly deteriorating). Fundus has lost FR (previously noted) and shows subtle pigmented macular atrophy. Dx?

A

Stargardt’s (fundus flavimaculatus)

20/200 by 30 y/o..progressive.

Initially presents @ 8-14Y/O, later lose FR and macula atrophies (lipo slowly accumulates w/I macula)

25
Q

Male presents w/ slowly deteriorating vision over several years. Fundus findings seen bilaterally, but asymmetric. Appearance: spoke-like.

VA initial: 20/70
VA deteriorating to 20/200 @ worst.

Dx?

A

X-linked retinoschisis - worst VA if foveal retinoschisis. May affect CV

26
Q

S/p fundus, bone spicules, optic atrophy. Dx?

A

RP. Also (+)vessel attenuation.

Present by 30Y/O. Vit a issue.

27
Q

Tumor that grows quickly like hemangioma, but does NOT self-regress. Lymphoid in nature

A

Lymphangioma

28
Q

Child presents w/ mild axial proptosis, optic atrophy, unilateral decreased VA, some strab.

Disc swelling noted. (+)NF-1 assn. Dx?

A

ON glioma

29
Q

Most common solid childhood tumor? Also is most common source of pediatric orbital mets? More common in NF1.

A

Neuroblastoma.

+)proptosis, Horners possible, papilledema, mets possible, is MALIGNANT and seen in 10-15% of peds cancers

30
Q

Two craniosynosis syndromes? Cause? Differences?

A

-premature closure of cranial sutures resulting in abnml face/cranial vault

Apert: abnml face (mid facial hypoplasia, breathing probs, cleft palate, dev. Delay, proptosis, XT, hypertelorism, optic atrophy, KC, Glc

Crouzon: abnml face (mid facial hypoplasia, anteroposterior SHORTENING of skull w/ steep forehead, SHALLOW orbits that are widely separated/laterally rotated)
-proptosis, V-pattern XT, optic atrophy, Glc, blue sclera

31
Q

___% of type 1 diabetics will develop retinopathy by 15 yrs

__% of type 1 diabetics will develop PROLIFERATIVE ret @ some point

**KEY thing to remember regarding education of DM pts?

A

80%, 70%

-MUST follow closely thru life & educate pts about potential complications!! **

32
Q

5 month old pt w/ known Dx of leukemia undergoes bone marrow transplantation. What are three key signs you may observe after this procedure?

A

1) CWS, 2) Cataract, 3) Dry Eye*** (nerve death d/t exposure to radiation)

33
Q

Typical location of an optic nerve pit?

A

Inf temp - watch for serous RD (50%) w/ VA loss if macula involved

34
Q

7 month old presents w/ pendular nystag and head nodding/head turn. Dx? Tx?

A

Spasmus nutans - disappears by 5Y/O, begign, but MUST r/o pathologic causes (same w/ congenital jerk nystaG)

35
Q

Which type of nystagmus manifests more obviously when one eye is covered? Which is more likely d/t poor VA

A

Latent - cover one eye- use frosted occluder

Sensory - poor VA

If known/suspicious of neuro origin as cause of nystag –> MUST r/o intracranial pathology and have neuroimaging done

36
Q

Which four conditions can lead to an abnormal ERG? What do they each cause? [CALA]

A

CSNB: no B-wave (bipolar/mueller)
Albinism: EXCESS SCOTOPIC response
LCA: reduced sco and pho topic responses
Achromatopsia: reduced photopic

37
Q

Why should you always measure BINOCULAR acuity first in a child w/ nystagmus?

A

Many cases of nystag have a latent component; must see what is achievable before b/d w/ frosted occluder

38
Q

Pt presents w/ a “head tilt” - 2 things you should immediately r/o?

A

1) nystagmus

2) constant strab (A- or V-pattern)

39
Q

**Neonatal conj is seen in what age group?

-3 types?

A

Infants LESS THAN ONE MONTH old…

  • gonorrhea = 2-5d, bilat/purulent
  • chlamydia = 5-14d, random disc.
  • HSV = w/i 14d, w/ assoc vesicles
40
Q

Two common organisms causing cellulitis (preseptal/orbital, but usually preseptal)?

A

H. influenza,

Strep pneumoniae

-R/O orbital! EOMs full, VA unaffected, etc.

41
Q

What is the most common cause of a retinal detachment in the pediatric population?

A

blunt trauma

Peds (12 decks)

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