BCSC 6. Pediatric Ophthalmology and Strabismus

Question 1

Alignment measurement when paretic or restricted eye is fixating

Answer 1

Secondary deviation

Question 2

Deviation measured when nonparetic eye is fixating

Answer 2

Primary deviation (less than secondary deviation)

Question 3

Deviation in strabismus that is in directino opposite to one that thte patient had originally

Answer 3

Consecutive deviation

Question 4

Strabismus that is the same size in all positions of gaze

Answer 4

Comitant deviation

Question 5

Only extraocular muscle whose origin is on medial orbital wall

Answer 5

Inferior oblique

Question 6

Only extraocular muscle that passes through the trochlea

Answer 6

Superior oblique

Question 7

Primary action of inferior oblique

Answer 7

extorsion

Question 8

Innervates the MR, IR, and IO muscles

Answer 8

inferior division of CN III

Question 9

Primary component of the extraocular muscle pulleys

Answer 9

Elastin (and smooth muscle and collagen)

Question 10

Form of b/l symmetric refractive error at 3.5D would place greatest risk for isoametropic amblyopia

Answer 10

Astigmatism -> isoametropic amblyopia

Question 11

Primary synergistic (yoke) muscles used for gazing up and to the right

Answer 11

Left IO and right SR

Question 12

Term for positions of gaze in which single extraocular muscle is prime mover

Answer 12

Cardinal positions (6)

Question 13

Sensory adaptation to manifest strabismus most commonly seen in patients

Answer 13

Peripheral suppression - eliminates diplopia

Question 14

Best test for measuring amount of strabismus in patient who has amblyopic eye with VA 20/400 and eccentric fixation

Answer 14

Krimsky test - does not depend on sensory or motor response. (Lancaster test depends on subjective localization of targets)

Question 15

What is the most appropriate initial therapy for high accomodative convergence/accomodation (AC/A) esotropia

Answer 15

Bifocals - reduce need for accomodation at near and allow for development of fusion and stereopsis. Overminus increase accomodation

Question 16

Eye motility abnormality commonly associated with infantile esotropia?

Answer 16

Dissociated vertical deviation (DVD).

Question 17

Asymmetric smooth pursuit, better in temporal to nasal direction

Answer 17

Infantile esotropia

Question 18

Exodeviation most commonly seen in general population

Answer 18

intermittent exotropia

Question 19

Exodeviation in which orthoptic exercises are most appropriate initial therapy

Answer 19

Convergence insufficiency

Question 20

Pseudostrabismus in which eyes appear exotropic but visual axes are optically aligned

Answer 20

Positive angle kappa

Question 21

A-pattern exotropia with compensatory head posture

Answer 21

Chin-down

Question 22

Clinical finding that accompanies upward movement of the eye in DVD

Answer 22

Extorsion of globe - (extorsion and exodeviation of elevating eye)

Question 23

DVD is seen in

Answer 23

infantile strabismus

Question 24

Finding most suggestive of bilateral rather than unilateral SO muscle palsy

Answer 24

Large V pattern - extorsion well over 10 degrees in downgaze, esotropic shift in downgaze, head posture chin down to avoid cyclodiplopia in downgaze

Question 25

Finding on exam of esotropic patient that makes type 1 Duane retraction more likely than 6th nerve palsy

Answer 25

Limited adduction of affected eye

Question 26

Most helpful in distinguishing congenital motor nystagmus (infantile nystagmus syndrome) from acquired nystagmus

Answer 26

abnormal head position - (CMN; inflantile nystagmus syndrome) adopt abnormal hed position to take advantage of the better vision possible at null point

Question 27

Exponential decrease in velocity of slow phase and fast-phase direction that reverses with change in fixation

Answer 27

latent nystagmus (fusion maldevelopment nystagmus syndrome)

Question 28

4 weeks after b/l MR muscle recession, patient presents with new exotropia of 15 prism diopters iwth limited adduction of right eye..

Answer 28

Slipped muscle

Question 29

Beneficial effect on visual field can occur as a result of strabismus surgery

Answer 29

Expansion of binocular visual field following surgery for esotropia. (surgery for exotropia constricts binocular visual field)

Question 30

Visual field following surgery for exotropia

Answer 30

constricts binocular visual field

Question 31

Refractive condition true for most infants during first year of life

Answer 31

Hyperopic refractive error that decreases over time

Question 32

Eye movement abnormality can occur in healthy infants in first months of life

Answer 32

intermittent esotropia

Question 33

Congenital ocular disorder most commonly a/w paradoxical pupils

Answer 33

Inherited retinal dystrophy

Question 34

Age infant should be able to maintain fixation and react to facial expression

Answer 34

6-8 weeks

Question 35

Best initial treatment for 11-mo old F with epiblepharon

Answer 35

Observation - often resolves

Question 36

Condition of affected eye a/w pseudoptosis

Answer 36

Hypotropia (upper eyelid "follows" eye in upgaze and downgaze - eyelid moves in same direction)

Question 37

Congenital eyelid malformation that requires early repair

Answer 37

Eyelid coloboma (eyelid cleft, eyelid notch) risk for significant exposure keratopathy and early closure of eyelid defect is often required.

Question 38

Vision threatening periocular hemangiomas

Answer 38

Oral propranolol

Question 39

Orbital cellulitis can be distinguished from preseptal cellulitis by this clinical finding

Answer 39

Chemosis - suggests orbital involvement

Question 40

Most common location of bloackage in congenital NLDO

Answer 40

Valve of hasner

Question 41

Curvilinear tears in Descemet membrane

Answer 41

Primary congenital glaucoma - Haab striae seen b/c of rapid stretching of cornea. (forceps are linear, not curvilinear)

Question 42

Linear tears in descemet membrane

Answer 42

Forceps injury during delivery

Question 43

Congenital iris ectropion is most commonly seen in

Answer 43

Neurofibromatosis 1, Prader-Willi syndrome, or facial hemihypertrophy

Question 44

Most important associated medical condition to exclude in patient with sporadic aniridia

Answer 44

Wilms tumor - renal U/S, repeated until molecular genetic analysis rules out an 11p13 deletion and confirms an intragenic PAX6 mutation

Question 45

Iris abnormality + horner syndrome

Answer 45

neuroblastoma

Question 46

Heterochromia in child

Answer 46

Waardenburg syndrome

Question 47

Treatment for infant with ophthalmia neonatorum 2/2 chlamydia trachomatis

Answer 47

Erythromycin - systemic c trachomatis may cause PNA and otitis media

Question 48

Most severe ocular complication of SJS

Answer 48

Corneal ulcer

Question 49

Finding predisposes child to glaucoma following surgery for congenital cataract

Answer 49

Microcornea - a/w higher incidence of glaucoma

Question 50

Inheritance of primary congenital glaucoma

Answer 50

SPORADIC - but may be inherited as AR

Question 51

Genetic disorder that pupillary block glaucoma is most likely to occur

Answer 51

Weill-Marchesani syndrome a/w microspherophakia

Question 52

Type of uveitis most common in children

Answer 52

Anterior uveitis - 1) idiopathic 2) related to trauma 3) JIA

Question 53

Most significant risk factor for developing ROP

Answer 53

Gestational age and birth weight

Question 54

Preferred imaging for Rb

Answer 54

MRI and U/S - high risk for secondary radiation induced tumors

Question 55

Moyamoya

Answer 55

dx with abnormalities of carotid circulation - Morning glory disc

Question 56

Morning glory disc

Answer 56

A/w basal encephalocele in patients with midfacial anomolies, PHACE syndrome (posterior fossa malformations, hemangiomas, arterial lesions, cardiac and eye anomolies) and carotid circulation (moya moya)

Question 57

Pseudopapilledema a/w

Answer 57

hyperopia - small C:D ratio resembling papilledema

Question 58

African american child with hyphema

Answer 58

Sickle cell testing must be performed.

Question 59

Management of white-eyed blowout fx in child

Answer 59

presents with marked vertical motility restriction in both directions, minimal soft tissue findings requires early surgical repair of fx, (IR muscle and associated nerve may become permanently damaged.)

Question 60

Most common cause of visual impairment in children with head trauma

Answer 60

Cortical or cerebral visual impairment

Question 61

Mode of inheritance in incontinentia pigmenti

Answer 61

X-linked dominant - lethal effect on hemizygous male fetus

Question 62

Most common inheritance of NF1

Answer 62

Autosomal dominant in 50%, 50% with no FHx (high rate of new mutations)