Peds Flashcards
(125 cards)
1
Q
Use 0.2% cyclopentolate on which age group?
A
Pre-term infants
2
Q
Infants under 12 months use % cyclopentolate
A
0.5% cyclo
3
Q
Use 1% cyclo on what age group?
A
Infants older than 1 year
4
Q
At what age should children be able to draw a vertical line?
A
3 years old
5
Q
By age 4-6 a child should be able to draw what shape(s)?
A
Square or triangle
6
Q
When can a child expect to be able to draw a diamond shape?
A
6 or 7 years old
7
Q
Demographic for coats disease
A
Males, around 5 years old
(First decade of life)
* no racial or genetic predilection
8
Q
Etiology & pathophysiology of coats disease
A
Idiopathic retinal telangiectasia
Significant sub retinal and intra-retinal exudation
9
Q
Most common clinical signs of coats disease
A
Leukocoria and strabismus
* iris heterochromia (from iris neo) and nystagmus
10
Q
Pathogenesis of coats disease
A
Abnormal permeability of the retinal vascular endothelium causes breakdown of blood-retinal barrier and leakage of lipid-rich exudates
11
Q
Treatment of coats disease
A
Focal laser photocoagulation
* eradicate abnormal telangiectatic retinal blood vessels
12
Q
End stage of coats disease if left untreated
A
- Total exudative retinal detachment
- Neovascular glaucoma (can lead to blind and painful eye)
- enucleation may be required
13
Q
Babies at most risk for retinopathy of prematurity
A
Birth weight less than 1500 grams
or are born less than 32 weeks (full term is 40 weeks)
14
Q
20/20 VA is achieved at what age for kids? (With preferential looking)
A
By 3-5 years
15
Q
At what ages are kids expected to have 20/20 VA when tested with visual evoked potentials?
A
6-7 months of age
16
Q
Dosage for cycloplegic retinoscopy on infants (full term infant)
A
1 gtts 0.50% cyclopentolate OU, instilled twice, 5 minutes apart
17
Q
According to AOA clinical practice guidelines, what is the recommended comprehensive eye exam schedule for asymptomatic child?
A
- @ 6 months old
- @ 3 years old
- Before 1st grade
- Then every 2 years after
18
Q
Psychosocial stages of development for birth-18 months old
A
Trust vs mistrust
* can I trust the world??
* feeding
* infant basic needs being met by parents
19
Q
What are the psychosocial stages of development?
A
- Trust vs mistrust
- Autonomy vs Shame
- Initiative vs Guilt
- Industry vs Inferiority
- Identity vs Role confusion
20
Q
Ages for identity vs role confusion
A
12-18 years old
21
Q
Industry vs inferiority ages
A
6-11 years old
22
Q
Initiative vs guilt ages
A
Pre-school 3-5 years old
23
Q
Stroking underside of infant foot causes toes to fan out with dorsiflexion of big toe
A
Babinski reflex
* presence of this reflex in patients older than 2 years old may indicated corticospinal damage
24
Q
What is the most commonly encountered form of infantile glaucoma?
A
primary congenital glaucoma
25
In which gender is primary congenital glaucoma observed more frequently?
Males.
26
What percentage of primary congenital glaucoma cases occur bilaterally?
75%.
27
At what age do most cases of primary congenital glaucoma typically present?
Before the child's first birthday.
28
What causes primary congenital glaucoma?
An abnormality of the angle (either a flat iris insertion or a concave iris insertion).
29
Is primary congenital glaucoma linked with any systemic disorders?
Rarely.
30
What are the three characteristic symptoms noted by caregivers in primary congenital glaucoma?
* Photophobia
* Epiphora
* Blepharospasm
31
What may caregivers observe regarding the child's corneas in primary congenital glaucoma?
The corneas may appear cloudy due to corneal edema.
32
What are some clinical findings associated with primary congenital glaucoma? (Name 4)
* Unilaterally or bilaterally enlarged globes and corneas (greater than 12 mm in diameter)
* Tears in Descemet's membrane
* Myopic refractive error
* Elevated IOPs
* Corneal edema
* Hypoplasia of the iris stroma
* Cupping of the optic nerves
33
What is buphthalmos in the context of primary congenital glaucoma?
Stretching of the globe and its associated structures due to consistently elevated IOP.
34
Tx for primary congenital glaucoma
Refer to surgical intervention
* goniotomy: TM is incised while being visualized via gonioscopy
* surgical intervention usually results in smaller cup to disc ration (elasticity of connective tissue in infants)
35
What are the linear corneal striations observed in primary congenital glaucoma?
Haab striae
* high IOP causes corneal edema, horizontal breaks in descemet’s membrane due to stretching of cornea
36
What is the purpose of the APGAR scoring system?
To evaluate a baby's physical status directly after delivery
## Footnote
The APGAR score assesses five signs to determine the overall condition of the newborn.
37
How many signs are evaluated in the APGAR scoring system?
5 signs
Assess at 1 minute and 5 minutes after birth
Max score of 10, score 10 = good health
7 or above at 5 minutes = not at risk
38
What is the scoring range of the APGAR system?
0-10
## Footnote
A score of 10 indicates the best possible condition for the baby.
39
What does a score of 8 or 9 indicate in the APGAR scoring?
Good condition
## Footnote
A score of 4-7 indicates fair condition, while 0-3 indicates poor condition.
40
What is the highest score possible on the APGAR scale?
10
## Footnote
A score of 10 implies that the baby is in the best possible condition.
41
For APGAR, What is the score for a heart rate that is above 100?
2
## Footnote
A score of 1 is given for a slow heart rate (less than 100), and 0 is for no detectable heart rate.
42
What score is given for a baby with absent respiratory effort?
0
## Footnote
A score of 1 is for slow, irregular breathing, and 2 is for good breathing, such as crying.
43
Fill in the blank: A baby with flaccid muscle tone receives a score of _______.
0
## Footnote
A score of 1 is given for some flexion of extremities, and 2 for active motion.
44
What does a reflex irritability score of 1 indicate?
Grimace
## Footnote
A score of 0 indicates no response, while a score of 2 indicates a cry, cough, or sneeze.
45
What does a color score of 2 indicate in the APGAR scoring system?
Completely pink or absence of cyanosis
## Footnote
A score of 1 is for a body that is pink with bluish extremities, while 0 indicates blue or pale color.
46
True or False: Weight and length of the baby are related to the APGAR score.
False
## Footnote
The APGAR score is solely based on the five evaluated signs and does not consider weight or length.
47
APGAR score for color
Is the baby pink all over or hands and feet bluish?
Score 0 if blue
Score 1 if body pink and extremities blueish
Score 2 if completely pink or absence of cyanosis
48
Tetralogy of Fallot
Congenital heart defect
* hole between ventricles of the heart and narrowing of pulmonary valve
* rare
49
RTC for megalopapilla
Annual exam or 6 month follow up for dilated fundus exam
50
What are Haab striae?
Horizontal breaks or ruptures in Descemet's membrane
## Footnote
Haab striae are specifically related to certain eye conditions.
51
What conditions are commonly associated with Haab striae?
Congenital glaucoma and buphthalmos
## Footnote
Buphthalmos refers to an abnormal enlargement of the eyeball.
52
What is the main difference between Haab striae and vertically oriented breaks in Descemet's membrane?
Haab striae are horizontal, while vertically oriented breaks are associated with trauma from forceps delivery
## Footnote
This distinction is crucial for accurate diagnosis.
53
True or False: Haab striae can only occur as single breaks.
False
## Footnote
Haab striae may be single or multiple.
54
At what age should a child be able to lift their head and chest while lying on their stomach?
3 months
55
What should a child be able to do by 4 months?
Recognize familiar faces and start babbling
56
By what age should a child be able to roll over, sit independently, and grasp objects?
6 months old
57
What emotional response should a child show towards strangers by 6 months?
Feel uncomfortable
58
At 9 months, a child should begin to _______.
crawl
59
What key milestones should a child reach by 12 months?
Begin to walk
Experience separation anxiety
Say single words
60
What abilities should a 2-year-old child have?
Run, climb stairs, build a 6 block tower, scribble, eat independently, and be toilet trained
61
At 2 years, a child should have a vocabulary of _______ words.
50
62
By what age should a child be able to hop, manipulate small objects, and throw a ball 10 feet?
3 years old
63
What is the expected vocabulary size for a 3-year-old?
900 words
64
What sentence structure should a 3-year-old be able to produce?
3-5 word sentences
65
What skills should a 5-year-old child possess?
Copy simple shapes and have a mature pencil grip
66
At what age should a child know their right vs left?
6 years old
67
What social skill is expected of a 6-year-old?
Build loyal friendships
68
By age 7, a child should be able to hold _______.
fluid, elaborate conversations
69
Expected ocular milestones for infant
VA 20/400
*child should be able to fixate on a person’s face
70
Expected ocular milestones for 1 month old
VA 20/300
*binocular alignment and pupil response should be swift
71
Expected ocular milestones for 3 month old
Coordinated head-eye movements
72
Expected ocular milestones for 4 month old
VA 20/150
* smooth pursuits, saccades, color vision and accommodation should be adult like
73
Expected ocular milestones for 6 months
VA 20/50
*OKN response becomes symmetric
*NPC to the nose
*stereopsis present
74
For peds, when is VA expected to be 20/20?
3-5 years old
75
What percentage of infants with active retinopathy of prematurity (ROP) will develop cicatricial complications?
Approximately 20%
## Footnote
This statistic highlights the prevalence of severe outcomes in infants suffering from ROP.
76
What is the relationship between the advancement of ROP and cicatricial sequelae?
The more advanced the disease at the time of involution, the more serious the cicatricial sequelae are likely to become.
## Footnote
This indicates that early detection and intervention may mitigate severe outcomes.
77
How many stages are there in cicatricial retinopathy of prematurity (ROP)?
5 stages
## Footnote
Each stage represents a progression of disease severity and associated complications.
78
What characterizes Stage 1 of cicatricial ROP?
Presence of myopia, minimal peripheral retinal pigmentary disturbances, and haze at the vitreous base.
## Footnote
This stage indicates early signs of complications.
79
What is observed in Stage 2 of cicatricial ROP?
Appearance of temporal vitreoretinal fibrosis with dragging of the optic disc and posterior retina.
## Footnote
This stage signifies a progression from Stage 1 with more significant retinal changes.
80
What defines Stage 3 of cicatricial ROP?
More severe peripheral fibrosis with contracture and formation of a falciform retinal fold.
## Footnote
The presence of a falciform fold indicates increased severity.
81
What is the characteristic of Stage 4 cicatricial ROP?
Partial ring of retrolental fibrovascular tissue with a presence of a partial retinal detachment.
## Footnote
This stage highlights significant structural changes within the eye, and increase in stage means more severe and sight threatening
82
What distinguishes Stage 5 of cicatricial ROP?
Complete ring of retrolental fibrovascular tissue with total retinal detachment.
## Footnote
This stage represents the most severe outcome in the progression of cicatricial ROP.
83
Which stage of cicatricial ROP is indicated by the dragging of the optic disc with no observable falciform fold?
Stage 2
## Footnote
The absence of a falciform fold suggests that the disease has not progressed to a more severe stage.
84
What are the two primary risk factors for the development of retinopathy of prematurity (ROP)?
Low birth weight and prematurity
85
What is the weight threshold for newborns to be considered at risk for ROP?
Less than 1500 g
86
What percentage of infants weighing less than 1250 g at birth may exhibit some degree of ROP?
65%
87
Which of the two primary risk factors poses the greatest risk for ROP?
Low birth weight
88
List some other risk factors for retinopathy of prematurity (ROP).
* Intraventricular hemorrhage
* Respiratory distress syndrome
* Sepsis
* Sleep apnea
89
When should a thorough retinal examination begin for newborns at higher risk of ROP?
At 4-7 weeks postnatally
90
What methods should be used for screening newborns for ROP?
Indirect ophthalmoscopy or wide-field retinal imaging
91
How often should the retinal examination be reviewed until the retinal vascularization reaches zone 3 for ROP?
At 1-2 week intervals
92
Fill in the blank: A thorough retinal examination is necessary for all newborns that fall under the category of '_______' of retinopathy.
higher risk
93
True or False: Only infants born at 30 weeks gestation or less are at risk for ROP.
False
94
What are the two primary risk factors for development of ROP?
1. Gestational age less than 31 weeks (infants premature if born 30 weeks or less)
2. Low Birth weight (weight less than 1500g)
95
At what age does the retinal vasculature reach nasal and temporal periphery, respectively?
* 8 months gestation for nasal
* 1 month after birth for temporal
96
What are the three zones used to determine the location of active retinopathy of prematurity?
Zone 1, Zone 2, Zone 3
## Footnote
These zones are centered around the optic disc.
97
Define Zone 1 in the context of active retinopathy of prematurity.
The area encompassed by an imaginary circle in which the radius is twice the distance from the disc to the macula (worse prognosis)
## Footnote
Zone 1 has the worst prognosis for retinopathy of prematurity.
98
What characterizes Zone 2 in retinopathy of prematurity?
Extends from the edge of Zone 1 to the ora serrata nasally, and to an equidistant point temporally
## Footnote
Zone 2 has a better prognosis than Zone 1.
99
Describe Zone 3 in the context of retinopathy of prematurity.
The residual temporal crescent that extends from the edge of Zone 2
## Footnote
Zone 3 indicates the least severe area in terms of prognosis.
100
True or False: Zone 1 has the best prognosis for retinopathy of prematurity.
False
## Footnote
Zone 1 has the worst prognosis.
101
Children with very low birth weight especially treated for ROP, are at higher risk for developing?
- Strabismus
- Myopia
102
What is plus disease characterized by?
Dilation of veins and tortuosity of arterioles in at least 2 quadrants of the posterior fundus, vitreous haze, increased pre-retinal and vitreous hemorrhages, failure of the pupil to dilate with associated iris vasculature engorgement
## Footnote
Plus disease indicates significant changes in the retinal vasculature in the context of retinopathy of prematurity.
103
What happens when plus disease changes are observed?
A plus sign is added to the stage number
## Footnote
This indicates a progression in the severity of the retinopathy.
104
Define pre-plus disease.
Abnormal dilation and tortuosity of the retinal vasculature that is insufficient to be designated as plus disease
## Footnote
Pre-plus disease indicates early signs of vascular changes but not to the extent of plus disease.
105
Describe aggressive posterior (rush disease).
Prominence of plus disease along with ill-defined nature of the retinopathy, most commonly present in zone 1, does not usually progress through the classic stages 1-3
## Footnote
Aggressive posterior disease represents a rapid and severe form of retinopathy, often requiring immediate intervention.
106
Shaken babe syndrome triad
1. Subdural hematoma
2. Cerebral edema (brain swelling)
3. Multilayered retinal hemorrhages
107
What is the most commonly encountered form of infantile glaucoma?
Primary congenital glaucoma
## Footnote
This condition is observed more frequently in males and typically presents before the child's first birthday.
108
What percentage of primary congenital glaucoma cases occur bilaterally?
75%
## Footnote
Most cases are sporadic in origin with no inheritance pattern.
109
What are the characteristic symptoms noted by caregivers in primary congenital glaucoma?
Photophobia, epiphora, and blepharospasm
## Footnote
Occasionally, parents may also notice that the child's corneas appear cloudy due to corneal edema.
110
What clinical findings are associated with primary congenital glaucoma? (Name at least 4)
Enlarged globes and corneas
tears in Descemet's membrane
myopic refractive error
elevated IOPs
corneal edema
hypoplasia of the iris stroma
cupping of the optic nerves
## Footnote
If the condition progresses, it may lead to buphthalmos.
111
What is a common condition in young infants that presents with excessive lacrimation?
Nasolacrimal duct obstruction
## Footnote
This condition may present with mucopurulent discharge and is caused by a membrane covering the valve of Hasner.
112
What percentage of nasolacrimal duct obstructions self-resolve without intervention within the first 12 months of life?
80-90%
## Footnote
Treatment may include massage of the nasolacrimal sac several times a day.
113
What defines megalocornea?
Bilateral condition with corneal diameters measuring 13 mm or greater
## Footnote
The corneas are clear, and lOPs and C/D ratios are normal.
*enlarged optic disc that is not associated with any other morphological anomalies
114
What are congenital hereditary corneal dystrophies typically characterized by?
Bilateral, symmetrical, and early manifestation in life
## Footnote
They are rarely associated with any systemic disease.
115
Fill in the blank: Congenital hereditary corneal dystrophies may have associated corneal haze, but the ______, corneal diameters, and C/D ratios should all be normal.
lOPs
## Footnote
This condition generally presents early in life.
116
What is the average refractive error in children ages 1-4
+3.00 to -0.50
* VA is 20/30 to 20/80
117
What does the American Optometric Association (AOA) recommend regarding early preventative eye care?
Optometrists should educate parents and caregivers about its importance.
118
At what ages should eye examinations be performed according to the AOA?
6 months, 3 years, before entering first grade, and then every 2 years.
119
How often should children who are symptomatic or have risk factors for eye problems be re-evaluated?
On a more frequent basis depending on the condition and professional judgment of the optometrist.
120
Fill in the blank: Examinations should be performed at _______ months old.
6
121
Fill in the blank: Examinations should be performed at _______ years old.
3
122
True or False: The AOA recommends eye examinations only once before entering first grade.
False
Eye exam @ 6 months
Then 3 years
Then before starting school
And every 2 years after
123
Fill in the blank: After the initial examinations, children should have eye exams every _______ years.
2
124
What factors determine the frequency of re-evaluation for children with potential eye and vision problems?
Condition and professional judgment of the optometrist.
125
What chart is this?
Landolt C’s
* most accurate method of determining visual acuity in young children
