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Peds Fall 2020 > Test 1 things I can't remember > Flashcards

Test 1 things I can't remember Flashcards

1
Q

4 types of acuity

A

Detection/minimum visible
Resolution/minimum seperable
Vernier
Recognition

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2
Q

Visual acuity testing limits

A

Cognitive
Boredom
Cortical immaturities
Foveal cone immaturities- short, stubby, spread out. (Full development at 4 years)
Foveal pit immaturities (development at 17 mos)

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3
Q

Examples of resolution VA testing

A

TAC, Lea paddles. Subjective. Must pay attention to where child looks.

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4
Q

TAC ranges

A

20/400 to 20/10 (but not really equal to snellen)

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5
Q

Visual acuity FPL norms of development

  • Steady increase from when to when?
  • Adult levels by what age?
A

Steady increase from 4 weeks to 1 year. Adult levels by 3-3-5 years.

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6
Q 
FLP VA 
1-2 months 
4 months
6 months
9 months
A

1-2 months 20/400
4 months 20/200
6 months 20/150
9 months 20/50

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7
Q

Lea gratings distance

TAC distance

A

Lea: 57cm
TAC: 55

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8
Q

OKN Is induced by

A

Speed of motion of the visual field. Holds image stable on retina with head/world movement

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9
Q

Is OKN foveal/affected by blur?

A

Not foveal, not affected by blur. Can get positive response with high refractive error.

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10
Q

No OKN response could indicate

A

Lesions in OKN cortex, cerebellum, brain stem
Dysmorphia
Cortical blindness

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11
Q

5 methods to test VA in an infant/non-verbal child

A 
CSM
F&F
TAC
Lea paddles
OKN
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12
Q

What does the VEP look at?

A

Wiring from the central retina to the primary visual cortex.
Looks at macular function and makes sure the visual system is in tact.

Unlike FPL, cannot determine perception of what the child sees, just that they can see at all.

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13
Q

3 types of VEP displays

A
  1. Pattern reverse- detects minor pathway abnormalities.
  2. Sweep- clinician can see where good response drops off.
  3. Flash
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14
Q

VEP and binocular summation

A

Should be at least 10% more than either OD or OS.

If it is lower than the dominant eye then interference may be going on. need to get tx for baby.

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15
Q

cardiff cards test disc

A

1 meter or 50 cm

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16
Q

What kind of acuity tests are preferred for pre school acuity?

A

Letter tests. Should be able to ID letters by age of kindergarten. ( age 5)

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17
Q

What VA test does not go down to 20/20?

A

Allen. pictures do not blur equally, may over estimate VA

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18
Q

Tumbling E horizontal responses are not consistent until

A

Age 8

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19
Q 
Average VA test for age: 
Infant/non verbal
Toddler
Preschooler 
School age
A

Infant/non verbal: CSM, F&F, TAC, Lea paddles, OKN
Toddler: Cardiff
Preschooler: HOTV, lea symbols, cardiff
School age: Snellen

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20
Q

4 types of binocular vision tests

A

Alignment
Motility
Sensory fusion- stereo
Motor fusion- everything else

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21
Q

At what age should you expect alignment, convergence, and stereo to improve? Expect eyes to be straight

A

12 weeks/3 month

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22
Q

Angle kappa results

A

+ kappa = nasal reflex = temporal fovea
- kappa = temporal reflex = nasal fovea

Between visual axis (FNF) and pupillary axis (tangential to cornea, through the ent pupil)

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23
Q

Hirschberg results

A

Nasal + exo

Temporal - eso

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24
Q

Krimsky

A

Hirschberg + prism

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25
Bruckner
Use DO 1 meter away from patient. | Look at hirschberg and size/color/brightness of pupils.
26
Convergence development
1 months can converge consistent at 2 months without delay at 3 months
27
Stereo development emerges when?
3-4 months | By age 6, all infants appreciate stereo.
28
Flashlight tests are used to determine
Binocularity, 2nd degree fusion. | Do this test if pt cannot appreciate stereo.
29
Why do you do flashlight test in dark and bright illumination?
Tests for deepness of suppression. Bright suppress? Easier to fix. Bright and dim suppress. More embedded
30
4 dot procedure. Pt is diplopic. What do they see?
``` 5 dots 3 green 2 red Red on right? Eso. uncrossed. Red on left? Exo. Corssed ```
31
``` Motor fusion tests Infant/non verbal: Toddler: Preschool: School age: ```
Infant/non verbal: Hirschberg, krimsky, Bruckner, NPC Toddler: Hirschberg, krimsky, Bruckner, NPC Preschool: NPC, Step vergences, CT School age: smooth vergences, CT, phoria
32
``` Sensory fusion tests (stereo) Infant/non verbal: Toddler: Preschool: School age: ```
Infant/non verbal: Bernell (KBB), smile (PASS), lang Toddler: Bernell (KBB), smile (PASS), lang Preschool: Lang, Ran dot E, flashlight worth 4 dot School age: Randot, flashlight worth 4 dot
33
Infants and pursuits
Infants have the ability to make pursuits, but not very well or consistently.
34
Development of saccades Trends Adult like when?
Infants tend to: make saccades initially in the wrong direction, make multiple mini saccades, and have a longer latency. Adult like by 13 months
35
NSUCO
Standardized way to measure ocular motor skills. Ability, accuracy, head movement, body movement Do not say anything about holding head steady or not moving head.
36
NSUCO scoring
level 1: poor Level 5: excellent Trend: Girls better than boys
37
How to calculate Z score
Patient time- average / standard deviation
38
DEM adjusted horizontal time
Patient time x 80/ 80-omission+ additions
39
DEM ratio
horizontal adjusted/vertical
40
DEM results type 1 - type 4
Type 1: Normal 2: OMD 3: RAN 4. OMD and RAN
41
Mohindra near ret
A near ret technique for assessment of distance ref error. Static even tho not fixating in distance. Good correlation with cyclo results. Infant fixate at 50 on ret (only light in room) Take out 1.25D for working distance
42
Average ref error for full term newborns.
+2.00 +/- 2.75
43
Evidence for active emmetropization
Media opacities, ROP? Animal studies Excessive near work= myopia
44
3 categories for passive emmetropization
Physical- movement towards plano Genetic Other- lens thinning and corneal changing powers
45
BIBS results
Emmetropization (between -2.00 and +2.00) was complete by 9 months. Bidirectional movement towards plano. Best predicted by cyclo.
46
Common cyl in kids under 3 and over 3
ATR under 3 | WTR over 3
47
When is astigmatism levels high? Adult levels when?
Highest in first 2 years, adult levels by age 4-5
48
MEPEDS
Looked at astigmatism in children. Found that hispanic/latino children are most likely to have astigmatism. Astigmatism is the most common refractive error in preschoolers.
49
When is accommodation accurate?
3 months Infants under 3 tend to over accommodate. (large depth of field/small pupils, low sympathetic innervation) Babis are more accurate when accommodating to closer targets.
50
Tests of accommodation Infants/toddlers/preschool School age
Infants/toddlers/preschool: Near ret | School age: Amp (push up, pull away, minus), FCC, Near ret, NRA/PRA. Subjective with correction.
51
Hofstetters norms
Normal amp: 18.5- (1/3)(Age) | Min amp: 15- (1/4)(Age) - 2
52
3 categories of accommodation tests
Amplitude: Push up, pull away, minus lenses Response: FCC, MEM Ability: NRA/PRA, facility
53
MEM. Should see what motion? What do you do
Should see with. Dip plus lenses in
54
Bell ret What do you do? Results?
Start at 50cm. Move bell target in when you see with, away when you see against. Results: 1. Fraction of the range of neutrality. with to against/ against to with 15/17 2. Compare neutral point to where ret is. take diff to find lag
55
Nott | What do you do?
Pt corrected in phoropter with target at 40 cm. Move ret based on reflex. With motion? Move further back, pt has lag. Take distance between target and ret to find lag.
56
Non linear relationship between
Accommodative stimulus (X) and accommodative response (Y)
57
Stress point. What are you looking for?
Change in reflex brightness, not motion.
58
Waggoner
Color vision testing for kids
59
How to examine infant pupils
Use direct | Pupils are mitotic and sluggish
60
VF testing Infants/toddlers: Preschool: School age:
Infants/toddlers: Bring target in from periphery Preschool: Count fingers School age: Add fingers automatic VF at 8+
61
Cyclo has what side effects
Drowsy | Seizures
62
How is phenylephrine different from atropine, cyclo, tropicamide?
Not a mydriatic. Will not stop accommodation, only dilates pupils.
63
Highest prevalence of disorders in patients 6 months- 6 years
``` Most Hyperopia Astigmatism Myopia Strab - most common was constant eso ```
64
Highest prevalence of disorders in patients 6 years- 18 years
``` Most Hyperiopia Astigmatism Myopia Non strabismic binocular disorders- convergence excess (eso) Strab ```
65
Most common non-strabismic binocular disorder in patients 6 years to 18 years
Convergence excess- eso at near. (8.2%)
66
Most common strab type in patients 6 months- 6 years
constant eso (7.5%)
67
Most common ocular diseases in 6 months- 6 years and 6 years to 18 years?
young- ptosis | Older- peripheral retinal probs
68
What 4 biosocial consequences of poverty can be related to visual development and school achievement?
1. Malnutrition- less alert, may affect school achievement. 2. Low birth weight. (increase incidence of strab, amblyopia and high ref errors) 3. Teenage pregnancy - more likely to be poor and single. 4. Maternal consequences of pregnancy (complications later in the term affect cognition and fine motor activity) Ex: loss of blood, oxygen to baby.
69
are younger or older kids more likely to have strab?
Younger 21% compared to older 10% | Older kids 16% more likely to have non-strab binocular disorder- usually convergence excess.

Peds Fall 2020 (15 decks)

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