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BV revision > lecture 23-26 paediatric pathology > Flashcards

lecture 23-26 paediatric pathology Flashcards

1
Q

What does neonatal eye examination consist of?

A

-redness
-size and symmetry of globe, corneas, pupils
-clarity of cornea and lens
-FH (inherited disorders)

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2
Q
  1. What is the epicanthus?
    2.What is the telecanthus?
    3.What is hypertelorism?
A
  1. vertical fold of skin over inner canthus
  2. increased distance between inner canthi
  3. increased inner and outer canthal distances (orbits wider apart)
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3
Q

How can you classify a potsis?

A

-congenital
-neurogenic (3rd CNP, Horners, Marcus Gunn)
-myogenic (myasthenia, progressive external -opthalmoplegia)
-mechanical (meiobomian bump)

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4
Q

What is the aetiology of congenital ptosis?
what are the features of congenital ptosis?

A

-dystrophy/dysgenisis of levator palpebrae superioris

-unilateral or bilateral
-absence of skin crease
-lid lag on down gaze
-SR weakness

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5
Q

What are the consequences of ptosis?

A

vision
can induce astigmatism
amblyopia
AHP
cosmesis

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6
Q

What happens in Marcus Gunn ptosis?

A

if child moves jaw, eyelid can shoot up
-known as jaw winking
-happens due to abnormal synkinesis between levator and lateral pterygoid muscle (3rd and 5th cn)

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7
Q

What are the features of Horner’s syndrome?

A

-ptosis (less than 2mm)
-heterochromia
-enophthalmos
-anhidrosis
-lower IOP

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8
Q

What is the management of ptosis?

A

-refer if pathology found
-correct refractive error and treat amblyopia
-urgent surgery if complete ptosis in baby as high risk of amblyopia
-surgery at 4-5 years old has better results

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9
Q

What eyelid bumps can children get?

A

-inflammatory (meibomian cyst, hordeolum, molluscum contagiosum)
-stasis
-tumour (benign or malignant)
-hamartoma
-hemangioma

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10
Q

What is a haemangioma?

A

benign vascular tumour
diffuclt to treat
resolves over 5-7 years
can use propranolol

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11
Q

How can you treat a meibomian cyst in children?

How can you treat a hordeolum?

How can you treat molluscum contagiosum?

A

-resolve over few weeks to many motnhs
can incsie and curette but this requires general anesthetic

-antibiotics

-best left alone. can be curretted.

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12
Q

What is a coloboma?

A

-tissue is misplaced during development

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13
Q

What causes epiphora in infancy?
what are the features?
what is the treatment?

A

-blocked nasolacrimal systems

-epiphora
-stickiness
-no redness

-resolve spontaneously by 12 months
-massage lacrimal sac
-if doesn’t resolve, consider syringe and probe under general anesthetic

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14
Q

When is the onset of ophthalmia neonatorum?
what can cause it

A

after 4 weeks of birth

Chlamydia trachomatis
– 7-28 days - peak in week 2
– Unilateral & bilateral
– Pseudomembranous (also strep)

  • Neisseria gonorrhoea
    – 4-7 days
    -green pus spurts out when you open eyelid
    – Massive bloodstained conjunctivitis – Corneal penetration - blindness
  • Herpes simplex
    – As part of a generalised infection – Bilateral
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15
Q

What are the symptoms of conjunctivitis?
what is the aetiology?

A

Symptoms
* Bilateral, although one eye commences first
* Conjunctival redness & discharge
* Itchiness - not severe pain
* Vision unaffected

Aetiology
* Infection
– Bacterial or Viral (often involves cornea also) – Allergic (eg vernal)
– Trauma

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16
Q

What are the causes of red eye in infancy?

A

-infantile glaucoma
-conjunctivitis
-tumour of eyelid

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17
Q

What is phlyctenular conjunctivitis?

A

-few symptoms
-has staph lid disease
-allergic response

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18
Q

Who is vernal disease more common in?
what are the signs?
what is the treatment?

A

-boys
-atopic

-cobblestone appearance (papillae)
-looks like bacterial conjunctivitis

-igE and igG in tears
lodoxamide

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19
Q

What are limbal dermoids?

A

abnormal growths of abnormally located tissue
tissue was destined for skin

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20
Q

What are phthisical eyes (small) at a risk of developing?

A

Blind phthisical eyes are at risk of developing Band shaped keratopathy

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21
Q

What cellulitis issues can you get?
what is the treatment?

A

Preseptal cellulitis
– Associated eyelid infection or trauma
– Respiratory infection

  • Orbital cellulitis
    – Mostly >5 years
    – 90% secondary to sinusitis (usually ethmoid)
    – Sinus development
  • Maxillary @ birth; Sphenoid @ 2; Ethmoid & Frontal @ 7
  • Subperiosteal abscess
    – 10% orbital cellulitis
  • Treatment
    – Admission for urgent systemic antibiotics
    – Danger infection can spread back to the brain
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22
Q

What anterior segment developmental anomalies can you get?

A

-coloboma
-albinism
-anridia
-glaucoma
-anterior seg dysgenesis

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23
Q

What are some of the types of anterior segment dysgenesis disorders?

A

-posterior embryotoxon
-axenfield-reiger syndrome
-sclerocornea (opaque sclera encroaches onto cornea)
-peters anomaly (corneal opacity with or without adherent iris strands)

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24
Q

What is a coloboma?

A

failure of fetal fissure to close around 4-5 weeks fetal life
can present with microphthalmos

25
Q

What is reiger’s anomaly?

what are the signs?

what are these children at risk of?

A

-defect of neural crest

-facial formation , iris abnormalities

-risk of glaucoma

26
Q

What is aniridia?

A

-no iris
-sporadic
-associated with wilm’s tumour kidney
-glaucoma develops in 50%
-ectopia lentis can occur (displacement of lens)
-keratopathy later in life

27
Q

What are the consequences of anterior segment developmental anomalies?

A

vision
glaucoma
cataract
strabismus
nystagmus

28
Q

How can albinism effect eyes?

A

-neuroectodermal defect
-foveal hypoplasia
-strab
-nystagmus

29
Q

What can cause a child to be photosensitive?

A

-albinism

anterior segment disorders:
-corneal problems
-uvieitis, aniridia
-glaucoma
-cataract

retinal conditions:
-achromatopsia (no colour vision)
-retinitis pigmentosa

CNS
-meningitis
-migraine

30
Q

What can cause glaucoma in children?

what is a sign of congenital glaucoma?

A

primary: infantile, congenital, juvenile

secondary: anterior segment dysgenesis, aphakia, uveitis, downs syndrome

buphthalmos, breaks in descements membrane

31
Q

What are the symptoms of infantile primary glaucoma?

what are the signs?

What is the management?

A

-photophobia

-red eye
-enlarged cornea
-corneal clouding

-surgery, amblyopia therapy, refraction (expected to be large)

32
Q

What are the associations of cataract?

A

-intrauterine infections (rubella, toxoplasmosis)
-metabolic (diabetes)
-atopy
-steroids
-downs
-low birthweight
-CNS and hearing

33
Q

What is the management of cataract?

A

unilateral: surgery before 9 years old
bilateral: surgery when vision compromised

34
Q

What are the associations of ectopia lentis?

A

systemic:
-marfan’s syndrome

ocular:
-unstable refraction
-iridiodenisis (iris wobbles)
-stretched zonules

35
Q

What are the associations of anterior uveitis?

A

-juvenile idiopathic arthirtis
-sarcoidosis
-TB
-Behcets disease

36
Q

What is leukocoria?
what is it associated with?

A

white pupil

-cataract
-ROP
-coats disease
-trauma
vitreous hemorrhage
-coloboma

37
Q

What electrophysiology tests are there?

A

ERG-
EOG- not possible for young children as child has to look left to right repeatedly
VEP-tells you if visual pathway is intact

38
Q

How can a preterm birth effect the visual pathway?

A

exposure of immature tissues to light
some areas of retina will be avascular

39
Q

Where does ROP develop on retina?

A

at junction of vascualrised and non-vascualrised retina

40
Q

What are the stages of ROP?

A

stage 1-white line in retina
stage 2- white line becomes a ridge
stage 3-ridge with extraretinal fibrovascualr proliferation
stage 4+5- partial/total retinal detachement

41
Q

What is the treatment of severe acute ROP?

A

-cryotheraphy
-laser
-antiVEFG

42
Q

What is the ocular outcome of premature birth?

A

-no, mild or severe ROP
-strab
-higher incidence of refractive error

43
Q

What can cause a dragged disc?

A

-ROP
-exudative vitreopathies
-norrie’s disease
-congenital folds

44
Q

what can shaking babies cause?

A

subconjunctival/retinal haemorraghes

45
Q

What does von hippie Linda syndrome cause?

A

-vascular tumours of retina and CNS
-inherited
-can be bilateral

46
Q

what is sickle cell retinopathy?

A

-asymptomatic
-African or Mediterranean origin
-looks like pre retinal haemorraghe and white fuzz, ischaemic retina

47
Q

What infections can you get that effect the retina?

A

-toxoplasmosis
-cytomegalovirus
-TB
rubella- lack of pigmentation in retina
-toxocara

48
Q

what is one of the first signs of pigmentary retinopathy?

A

arteriolar attenuation

49
Q

what inherited macular disorders are there?

A

stargardts
x-linked retinoschisis
bests disease
pattern dystrophy

50
Q

What is retinoblastoma?
what are the signs?
whats the treatment?

A

-malignant ocular tumour

-leucocoria
-strabismus
-glaucoma

-chemo
-enucleation

51
Q

what can cause proptosis?

A

sinus disease
tumours
TED

52
Q

What does speed of nystagmus movement tells us about vision?

what causes sensory nystagmus?

A

the faster the movement, the better the vision

poor vision due to lesions In anterior visual pathway

53
Q

What can cause asymmetrical nystagmus?

A

ocualr motor apraxia
monocular blindess
spasmus nutans

54
Q

what nerve is the most vulnerable to damage?

A

6th nerve
-enters cavernous sinus at a right angle

55
Q

what is light-near dissociation?

A

pupils don’t react to light but react to accommodation

56
Q

what does macular sparring mean in terms of VF defect?

A

defect lies in occipital cortex

57
Q

What can cause a swollen optic disc?

A

papilloedema
ischaemic optic neuropathy
optic neuritis
pseudopapilloedema

58
Q

what is morning glory syndrome?

A

a coloboma

59
Q

What is optic nerve hypoplasia?

what are the associations?

A

Early fetal damage to the visual system

  • Associated with:
    – Young maternal age
    – First born
    – Fertility & antidepressant drugs – Cocaine et al - rare
    – Maternal diabetes
  • Structural abnormalities
    – Absent septum pellucidum
  • Neuroendocrine associations
    – Some children have growth – & other hormonal problems

BV revision (18 decks)

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