Question 1

Infant Exam, APEA, includes

Accepted Answer

- General Appearance, growth and development. - Hearing - Vision, including red reflex - Muscle tone, including symmetrical movement, hip dysplasia. - Diaper area: tests, patent vagina, rash - Abnormal findings that might indicate a congenital syndrome. - Adequate care.

Question 2

Eye Evaluation

Accepted Answer

- Newborn - 3 months: red reflex, inspection, check for hypertelorism. - 3 - 6 months: fix and follow, red reflex, inspection. - 6 - 12 months: fix and follow with each eye, corneal light reflex, cover/uncover test, red reflex, inspection - Over 3 years: visual acuity, corneal light reflex, cover/uncover, red reflex, inspection, attempt ophthalmology.

Question 3

Red reflex

Accepted Answer

The most effective way to detect ocular pathology in this population is the red reflex test, which can identify cataracts, retinal detachments and anisometropia (a condition in which the refractive power of the eyes is unequal). The red reflex confirms that light enters and exits the eye confirming retina attachment and ruling out cataracts. Red reflex should be bright and equal in both eyes, no black spots or opacities.

Question 4

Hypertelorism

Accepted Answer

Abnormal (increased) distance between two paired organs especially the eyes. This is an indication of some congenital defects, refer.

Question 5

Corneal Light Reflex

Accepted Answer

AKA Hirshberg The Corneal Light Reflex test is used to check for milder forms of constant strabismus. Ages: 2 months through 8 years. Description: By noting the position of light being reflected in the pupils, the observer is able to check for a less obvious constant strabismus. Equipment: A penlight is required for this test as well as a small target object that should be used to keep the child’s vision fixed in a forward gaze. Small toys of cartoon characters are especially useful for this activity. It is very important that a proper light source is used. Procedure: Position the child so that the penlight, target object, and the examiner's line of vision are at the same level as the child's eyes. The distance between the target object, penlight and the child’s eyes should be about 14-16 inches. Use the object/toy to attract the child’s attention. If they are old enough, tell them to concentrate their sight on one specific part of target object. With the penlight directly above or resting on the target object, shine the penlight at the center of the child's forehead directly above the child's eyes. Look to make sure the child is still focused on the target. The screener then observes the reflected light in each pupil. Pass: The reflection of the light appears to be symmetrical in the pupil of each eye. If not, refer.

Question 6

Strabismus, Taber's

Accepted Answer

A disorder of the eye in which optic axes cannot be directed to the same object. This disorder is present in 4% of children.

Question 7

Question: A one week old infant does not have a red reflex in his right eye. What might this indicate? 1. Glioblastoma 2. Strabismus 3. Congenital cataracts 4. Congenital glaucoma

Accepted Answer

3. Refer this child. Cataracts are the most common cause but retinobalstoma may be the cause. Retinoblastoma is an eye cancer that begins in the retina — the sensitive lining on the inside of your eye. Retinoblastoma most commonly affects young children, but can rarely occur in adults. A rare form of eye cancer, retinoblastoma is the most common form of cancer affecting the eye in children. Retinoblastoma may occur in one or both eyes.

Question 8

Glioblastoma, Taber's

Accepted Answer

A neuroglial cell tumor. Glioblastomas (GBM) are tumors that arise from astrocytes—the star-shaped cells that make up the “glue-like,” or supportive tissue of the brain. These tumors are usually highly malignant (cancerous) because the cells reproduce quickly and they are supported by a large network of blood vessels. Symptoms Because glioblastomas can grow rapidly, the most common symptoms are usually caused by increased pressure in the brain. These symptoms can include headache, nausea, vomiting, and drowsiness. Depending on the location of the tumor, patients can develop a variety of other symptoms such as weakness on one side of the body, memory and/or speech difficulties, and visual changes.

Question 9

Question: at what age should eye alignment occur? 1. Within 2 months of age. 2. 2 - 4 months of age. 3. By 6 months of age. 4. Before 12 months of age.

Accepted Answer

2. By 2 - 4 months of age, the two eyes should be able to track and follow and focus on the same object at the same time.

Question 10

Vision Screening for Children less than 5 years of age, screen for:

Accepted Answer

- Amblyopia - loss of vision - When the two eyes don't focus on the same object, the brain ignores information from one of the eyes. If this is not corrected, it can result in loss of vision, amblyopia. This is the most common cause of vision problems in children.

Question 11

Amblyopia, Taber's

Accepted Answer

Unilateral or bilateral decrease of best corrected vision in an otherwise healthy eye, commonly d/t asymmetric refractive error or strabismus.

Question 12

Question: the corneal light reflex and the cover/uncover tests are used to assess: 1. Visual tracking. 2. Strabismus. 3. Red reflexes. 4. Vision.

Accepted Answer

2. Cover/uncover test. Do from 6 months to 3 years of age. In the cover/uncover test, an eye is covered and then the infant is shown an object to focus on. Uncover the covered eye, if the eye has to move to focus on the object, that is a red flag. Cover and Cover/Uncover Tests: assist in determining the binocular relationship of the eyes. The cover test is one of the most important tests in detecting strabismus. When performing the cover test, ask the child to fixate on a distinct object (detailed picture, toy etc.) while covering one eye and observing the movement of the uncovered eye. In a normal child, no movement in the uncoverd eye will be observed. Manifest strabismus is present if the uncovered eye moves to refixate on the target. The Cover/Uncover test is performed to detect latent strabismus and does not need to be done if the cover test has already revealed manifest strabismus. Again the child is asked to visually fixate on an object, near or far. One eye is covered for a few seconds and then rapidly removed. This time, the movement of the eye that was under the cover is observed. If the previously covered eye shifts back into position to refixate as it deviated while covered, the patient is said to have latent strabismus.

Question 13

Vision Screening

Accepted Answer

``` Use Snellen Chart. Start at age 3 - 4 years. At 3 YO: 20/50 At 4 YO: 20/40 At 5 YO: 20/30 ``` 6 and up: 20/20 Per APEA, no need to memorize this. At three years of age, the child may not be able to cooperate. If that is the case, not to worry, just continue to follow-up, either annually or every 6 months.

Question 14

Vision screening, AAP recommendations:

Accepted Answer

Vision screening should be done at: 5, 6, 8, 10, 12, 15, and 18 years of age. Again, per APEA, no need to memorize. Assess periodically because growth spurts can impact vision.

Question 15

Tests for strabismus are:

Accepted Answer

Cover and cover/uncover tests Corneal light reflex

Question 16

Ear Evaluation

Accepted Answer

- Hearing evaluation is part of the newborn assessment, should be done at the hospital. - Newborn - 3 months: Moro or startle reflex. - 3 - 6 months - stops and listens to new sound; stops crying with hearing parent's voice. - 6 - 12 months: responds to own name. - 12 - 18 months: follows directions without cues - 18 - 24 months: 50% of speech intelligible to strangers.

Question 17

Question: Pediatric hearing loss is associated with what abnormality? 1. Poor hand-eye coordination 2. Renal agenesis 3. Speech delay 4. Poor socialization

Accepted Answer

3.

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Disc 19 - Growth and Development, Newborn Assessment by Body System, Overview, eyes, ears, speech, heart, GI, jaundice, 6 - end Flashcards

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