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Flashcards in Peds Dz Deck (41):
1

Key signs of Kawasaki's?

**1/3 of cases will later develop WHAT type of problem?

Acute conjunctivitis; red tongue, erythema, Palm/sole edema

**CARDIAC problems - coronary artery aneurysm: common cause of ACQUIRED heart dz

2

3 week old presents to you w/ excessive tearing/mucous discharge on lashes/medial canthus.

Dx?

-commonly causes what secondary infx?

-80% resolve by __ months

NLDO (2-6 wks)

-commonly causes recurrent conjunctivitis

-80% self-resolution by 6 months; ABx if 2' conj exists, otherwise, massage. May need puncture if not gone by 9 months

3

T/F: blepharitis is more commonly seen in Down's pts

True! Most common cause: staph

4

What is Riley-Day syndrome

AR condition w/ DECREASED corneal sensation/innervation

--> seriously DRY EYE!

5

You see ptosis in a child. FIRST thing to do? Two types?

Check PUPILS. Need to check for Horners.

Congenital: no lid crease
Acquired: lid crease, look for CAUSE
---birth trauma? Cardiothoracic surgery? Neuroblastoma?

6

Ptosis, telecanthus, horiz narrowing of palpebral fissure, flattened nasal bridge are all signs of what condition?

Tx?

Blepharophimosis - AD in 50% of cases

-surgery for cosmetis OR if deprivation amblyopia/anomalous head posture

7

Marcus gun jaw winking in an abnormal syn kinesics b/w which two muscles?

-inheritance?

-will this resolve on its own?

Levator and lateral pterygoid

Abnml eye = ptotic; elevates when jaw is opened

Congenital, sporadic, unilateral, self-resolving

8

Child is BORN w/ a bluish, distended cyst w/I the lacrimal sac region. (-)inflammation, will spontaneously resolve. Dx?

Dacryocystocele

9

Most common orbital tumor? (General)

DERMOIDS

-egg-shaped mass in assoc w/ orbital bones; may induce astig

10

5Y/O child (4-10) presents w/ proptosis x3 days, quickly worsening. (+)lid erythema, ptosis, restricted EOMs, slightly displaced globe. Dx/Tx?

Rhabdomyosarcoma - MALIGNANT

Tx: radiation, chemo. Good long-term prognosis if caught early.

11

**An infant presents w/ a relatively large cornea, ~12mm. What should you IMMEDIATELY r/o?

What two conditions should come to mind if you see a relatively SMALL cornea (

**Congenital Glaucoma (megalocornea assn)

Peds: megalocornea = >11.5-12mm

micro think 1) PHPV, or 2) congenital cataract

12

You see an epi bulbar dermoid in a child you suspect may have Goldenhar's syndrome. What other key characteristics may you observe?

Facial clefting, microphthalmia, coloboma, strab (Duane's), NLDO

*ear abnormalities, kidney, heart, intellectual disabilities

13

Cystinosis = a _____ storage defect d/t excess deposition of cysteine.

Results in which two key ocular findings?

Corneal crystals, pigmentary retinopathy

-systemic: growth retardation, renal failure, decreased skin/hair pigmentation.

14

Earliest sx of xerophthalmia?

Night blindness (recall: Vit A deficiency)

15

Three key sx of congenital Glc? Tx?

EEE: extreme PHOTOPHOBIA, EYE rubbing, Epiphora

-REFER to pediatric Glc specialist

16

Two key differentials to R/O immediately when leukocoria presents:

1) RB 2)cong cataract. Other: CTRRP, GMRC

17

Most common pediatric ocular neoplasm? Two most common presenting signs?

RETINOBLASTOMA*** (don't miss)

1) leukocoria (56% - majority)
2) strab (20%)

18

Etiology/patho of RB Dx? Likely ____ if unilateral, ____ if bilateral.

Avg age of Dx?

Prognosis for survival? (What % survive)

DELETION of RB gene.

Sporadic if uni; inherited if bilat.

Dx age: 18 months

Prognosis: 85-90% survival

19

3 Y/O presents w/ a highly myopic refractive error, a relatively flat face, hearing loss, joint problems, and intellectual disability. Dx? What is it?

Stickler syndrome - AD CT disorder - at higher risk of subsequent RD.

20

5Y/O male infant pt presents w/ leukocoria. O-scope reveals significant exudation, peripheral telangiectasias. Dx?

Coat's Dz. Mostly males (75%); may lead to serous RD.

Tx w/ cryo, laser, RD Tx.

21

Mom presents w/ 2 month-old child that is visually inattentive, has a mild nystagmus, hyperopic refractive error, poor pupillary light response. Fundus looks relatively nml w/ few white flecks. Dx?

LCA- AR, horrible VA (20/200 BCVA)

Tx: gene therapy

22

Which condition presents w/ reduced night vision, variable vision loss, is non-progressive, inherited (AR, X, or AD), a relatively normal fundus appearance, but a reduced SCOTOPIC response on ERG (Photopic nml). Dx?

CSNB

-AR/X during infancy
-AD later in life

23

three types of achromatopsia (absent/deficient CONE fxn)?

1) Rod mono - AR; worst VA (20/200, complete color blindness), high hyperopia, nystag, photophobia
2) incomplete a - AR (similar to rod mono but better prog (20/80-120)
3) Blue cone mono - XLR; nml blue fxn, no R/G fxn

24

18Y/O pt presents w/ BCVA of 20/40 (slowly deteriorating). Fundus has lost FR (previously noted) and shows subtle pigmented macular atrophy. Dx?

Stargardt's (fundus flavimaculatus)

20/200 by 30 y/o..progressive.

Initially presents @ 8-14Y/O, later lose FR and macula atrophies (lipo slowly accumulates w/I macula)

25

Male presents w/ slowly deteriorating vision over several years. Fundus findings seen bilaterally, but asymmetric. Appearance: spoke-like.

VA initial: 20/70
VA deteriorating to 20/200 @ worst.

Dx?

X-linked retinoschisis - worst VA if foveal retinoschisis. May affect CV

26

S/p fundus, bone spicules, optic atrophy. Dx?

RP. Also (+)vessel attenuation.

Present by 30Y/O. Vit a issue.

27

Tumor that grows quickly like hemangioma, but does NOT self-regress. Lymphoid in nature

Lymphangioma

28

Child presents w/ mild axial proptosis, optic atrophy, unilateral decreased VA, some strab.

Disc swelling noted. (+)NF-1 assn. Dx?

ON glioma

29

Most common solid childhood tumor? Also is most common source of pediatric orbital mets? More common in NF1.

Neuroblastoma.

(+)proptosis, Horners possible, papilledema, mets possible, is MALIGNANT and seen in 10-15% of peds cancers)

30

Two craniosynosis syndromes? Cause? Differences?

-premature closure of cranial sutures resulting in abnml face/cranial vault

Apert: abnml face (mid facial hypoplasia, breathing probs, cleft palate, dev. Delay, proptosis, XT, hypertelorism, optic atrophy, KC, Glc

Crouzon: abnml face (mid facial hypoplasia, anteroposterior SHORTENING of skull w/ steep forehead, SHALLOW orbits that are widely separated/laterally rotated)
-proptosis, V-pattern XT, optic atrophy, Glc, blue sclera

31

___% of type 1 diabetics will develop retinopathy by 15 yrs

__% of type 1 diabetics will develop PROLIFERATIVE ret @ some point

**KEY thing to remember regarding education of DM pts?

80%, 70%

-MUST follow closely thru life & educate pts about potential complications!! ****

32

5 month old pt w/ known Dx of leukemia undergoes bone marrow transplantation. What are three key signs you may observe after this procedure?

1) CWS, 2) Cataract, 3) Dry Eye*** (nerve death d/t exposure to radiation)

33

Typical location of an optic nerve pit?

Inf temp - watch for serous RD (50%) w/ VA loss if macula involved

34

7 month old presents w/ pendular nystag and head nodding/head turn. Dx? Tx?

Spasmus nutans - disappears by 5Y/O, begign, but MUST r/o pathologic causes (same w/ congenital jerk nystaG)

35

Which type of nystagmus manifests more obviously when one eye is covered? Which is more likely d/t poor VA

Latent - cover one eye- use frosted occluder

Sensory - poor VA

If known/suspicious of neuro origin as cause of nystag --> MUST r/o intracranial pathology and have neuroimaging done

36

Which four conditions can lead to an abnormal ERG? What do they each cause? [CALA]

CSNB: no B-wave (bipolar/mueller)
Albinism: EXCESS SCOTOPIC response
LCA: reduced sco and pho topic responses
Achromatopsia: reduced photopic

37

Why should you always measure BINOCULAR acuity first in a child w/ nystagmus?

Many cases of nystag have a latent component; must see what is achievable before b/d w/ frosted occluder

38

Pt presents w/ a "head tilt" - 2 things you should immediately r/o?

1) nystagmus
2) constant strab (A- or V-pattern)

39

**Neonatal conj is seen in what age group?

-3 types?

Infants LESS THAN ONE MONTH old...

-gonorrhea = 2-5d, bilat/purulent
-chlamydia = 5-14d, random disc.
-HSV = w/i 14d, w/ assoc vesicles

40

Two common organisms causing cellulitis (preseptal/orbital, but usually preseptal)?

H. influenza,

Strep pneumoniae

-R/O orbital! EOMs full, VA unaffected, etc.

41

What is the most common cause of a retinal detachment in the pediatric population?

blunt trauma