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Duke Elder > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Visual acuity in a newborn

A

6/200-6/60

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2
Q

Visual acuity at 3 months

A

6/90-6/60

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3
Q

Visual acuity at 6 months

A

6/36-6/30

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4
Q

Visual acuity at 9 months

A

6/24

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5
Q

Visual acuity at 1 year

A

6/18

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6
Q

Visual acuity at 18 months

A

6/12

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7
Q

Visual acuity at 2 years

A

6/12-6/6

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8
Q

Which tools can be used to measure VA under 1 year?

A

keeler, teller or Cardiff cards - forced preferential looking

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9
Q

What tool is used to measure VA 6m-2y?

A

Cardiff pics

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10
Q

What tool is used to measure VA 2y-3y?

A

Kay pics

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11
Q

What tool is used to measure VA 3y-5y?

A

Sheridan-Gardiner

Crowded Kays

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12
Q

Why is infection more likely to spread to infect the orbit in children under 1y?

A

orbital septum not developed

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13
Q

What is the most common cause of orbital cellulitis in children? Where does the infection originate? (NOT WHAT BUG)

A

Ethmoidal sinus infection

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14
Q

Baby 2 months-1 year. Unilateral asymmetrical raised bright red lesions most commonly in the upper eyelid which may obscure visual axis and cause ambylopia. If deep can cause axial proptosis. Lesions blanches on pressure and enlarges on crying.

A

capillary haemangioma

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15
Q

Gradual painless, monocular decrease in visual acuity with RAPD. Non-axial proptosis. CT head shows fusiform enlargement of optic nerve. Cafe au lait spots, lisch nodules and axillary freckling.

A

Optic nerve glioma

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16
Q

Valve at the junction of nasolacrimal sac and common canaliculus. Prevents reflux of tears.

A

Rosenmuller valve

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17
Q

Valve at the junction of the nasolacrimal duct and inferior nasal meatus. Prevents air entering the nasolacrimal duct during nose blowing.

A

Valve of Hasner

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18
Q

Baby under 1 y. Epiphora and mucopurulent discharge on pressure over the nasolacrimal sac. Not red. May resolve spontaneously.

A

Congenital nasolacrimal obstruction

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19
Q

Hypermetropic boys with reading difficulties due to splitting of the retina at the nerve fibre layer. Bilateral maculopathy, foveal schisis with spoke-like folds resembling CMO. Scotopic ERG.

A

X-linked retinoschisis

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20
Q

AD condition causing defect in type 2 collagen, leading to retinal detachment (50%). High myopia, cataract, ectopia lentis, glaucoma, empty vitreous. Sensorineural hearing loss. Pierre robin or marfanoid features.

A

Stickler syndrome

Tx- 360 degree retinal laser
vitrectomy for RD

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21
Q

AD condition similar to Stickler syndrome but without systemic involvement. Low myopia, cortical cataract, empty vitreous and retinal detachment

A

Wagner syndrome

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22
Q

AD condition in hypermetropic patients. Bilateral macular degeneration, lipofuscin accumulation in the RPE and atrophy of the photoreceptor layer of the retina. Egg yolk lesion at the macula. Abnormal EOG- decreased arden ratio.

A

Best’s Disease

23
Q

AR condition due to mutation in ABCA4 gene on chromosome 1. Most common inherited macular dystrophy. Beaten bronze macula progressing to bullseye pattern. Pisciform yellow/white lesions in RPE. Dark choroid due to reduced choroidal circulation.

A

Stargardt disease

24
Q

AR condition with severe visual loss at birth, nystagmus, roving eye movements and absent pupillary reflexes and oculodigital syndrome. Associated with hypermetropia. Salt and pepper retinopathy

A

Lebers congenital amaurosis

25
Q

Can be AD, AR or XL. Mutation in rhodopsin gene on chromosome 3. Dysfunction of rods then cones and degeneration of retinal tissue. Nyctalopia and tunnel vision. Pale waxy disc, bony spicules and arteriolar attenuation.

A

Retinitis pigmentosa

26
Q

AR. Retinitis pigmentosa, bulls eye maculopathy, polydactyly, learning disability and obesity.

A

Badet-Biedl syndrome

27
Q

AR. Retinitis pigmentosa and hearing loss. Most common inherited cause of deaf-blind.

A

Usher’s syndrome

28
Q

AR. Accumulation of phytanic acid. Retinitis pigmentosa, anosmia, peripheral neuropathy and ichthyosis (scaly skin)

A

Refsum syndrome

29
Q

AR. Abnormal absorption of fat soluble vitamins. Retinitis pigmentosa, spinocerebellar ataxia, acanthocytosis.

A

Bassen Kornzweig syndrome

30
Q

Conditions associated with leukocoria

A 
congenital cataract
retinoblastoma 
persistent fetal vasculature
retinopathy of prematurity
Coat's Disease
toxicarias
31
Q

Most common intraocular malignancy in children arising from embryonal photoreceptor cells. Associated with a mutation in Rb1 gene on chromosome 13. Flexner rosettes and Homer Wright rosettes and fleurettes.

A

retinoblastoma

32
Q

Is Rb1 a tumour suppressor or oncogene?

A

tumour supressor

33
Q

prem baby presents age 7 days with unilateral leukocoria, micro-ophthalmia and cataract

A

persistent foetal vasculature

34
Q

baby born at 30 weeks gestation weighing 800g, required oxygen therapy for respiratory distress

A

retinopathy of prematurity

35
Q

What is the end stage of retinopathy of prematurity?

A

total retinal detachment

36
Q

what additional signs (Plus disease) may be present in ROP that can increase severity of the condition?

A

increased venous dilatation

arteriolar tortuosity of the peripheral retina

37
Q

congenital condition affecting young boys. decreased visual acuity, strabismus and leukocoria. temporal retinal telangectasia and microaneurysms. can result in exudative retinopathy.

A

Coat’s disease

38
Q

Increase in innervation of a muscle is accompanies by a decrease in innervation of its antagonist. i.e. when lateral rectus contracts, medial rectus relaxes

A

Sherrington’s law

39
Q

what are yolk muscles?

A

muscles pulling the eyes in the same direction e.g. right LR and left MR

40
Q

Yolk muscles have equal and simultaneous flow and innervation

A

Hering’s law

41
Q

developmental defect of spatial visual processing that can occur in the central visual pathway during the early years of life, leading to diminished vision. Causes include: stabismus, anisometropia and stimulus deprivation

A

Amblyopia

42
Q

What pharmacological intervention can be used in amblyopia?

A

penalisation of good eye using atropine

43
Q

In turning squint associated with hypermetropia. normal AC/A ratio

A

accommodative esotropia

correct hypermetropia

44
Q

in turning squint for near vision only. high AC/A ratio

A

convergence excess esotropia

treat with bifocals or bilateral medial rectus recession

45
Q

Non-accommodative in turning squint in child at 6 months. Large angle deviation and alternating fixation. Latent horizontal nystagmus.

A

infantile esotropia

46
Q

out .turning squint associated with myopia. most common type

A

intermittent exotropia

correct myopia

47
Q

constant large angle out turning squint in baby at 6 months. associated with neurological abnormalities

A

constant exotropia

48
Q

What nervous anomaly is seen in Duane retraction syndrome?

A

lateral rectus supplied by CN III

49
Q

Deaf patient with globe retraction on adduction. Esotropia with limited abduction.

A

Duane retraction syndrome

50
Q

Superior oblique restricted at trochlea. Globe sitting down and in. Limited elevation in adduction or on upgaze with associated click sensation.

A

Brown syndrome

51
Q

resection vs recession

A 
resection = shortening muscle to strengthen 
recession = loosening muscle to weaken
52
Q

is strabismus concomitant?

A

yes, looks the same regardless of where you are looking

53
Q

is CN III palsy concomitant?

A

no

Duke Elder (8 decks)

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