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148 Cards in this Set
- Front
- Back
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Put these visual skills in order from earliest to latest to reach adult levels:
a. VF b. Color vision c. Ocular Motilities d. 20/20 acuity e. Refractive error |
C
B D A E |
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What % of ped population has significant refractive error (> 4D)?
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5-10%
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___- ___% of pediatric population have nonstrabismic binocular and accomodative disorders
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10-20%
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Congenital esotropia is what % of ped pop?
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1-2%
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Esotropia is what % of ped pop?
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3%
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Exotropia is what % of ped pop?
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1.5%
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Amblyopia is present in ____% of ped pop?
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1-3%
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8% of males and .5% of females in ped pop have this kind of anomaly
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color vision
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What is the most prevalent general ped population problems?
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nontrab. binocular and aomodative anomalies
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Put the following in order from most prevalent to least prevalent in general ped population:
a. Amblyopia b. Congenital glaucoma c. Strabismus d. Sig. Refractive Error e. Nonstrab bincoular and accommodative anomalies |
E
D C A B |
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When does the AOA first recommend a comprehensive eye exam?
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6 months
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After a 6 month eye exam, when does AOA recommend the child get reexamined (note: notoriously difficult to examine at this age)
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1-2 yrs
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At what age do we frequently see onset of visual disroders such as meidional amblyopia, accomodative esotropia, etc?
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3 yrs, during 2nd comprehensive eye exam
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A child's third comprehensive vision exam occurs at this age and child can begin to participate in subjective testing
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5 yrs
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The american academy of ophthalmology and pediatrics recommends a child's first eye exam when=
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a problem is suspective
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A 3 yr old has 20/50 VA, whaich of the following could this indicate?
a. ocular pathology b. normal exam c. reduced due to amblyopia d. see px in 2 yrs e. will most likely have significant RE before age 10 f. child is slightly myopic and will need glasses for school |
Answer=B
small children have reduced VA mainly due to distractions |
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at 6 months and under it is easiest to exam patient when
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patient is held by parent.
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Infants begin to crawl at _____ months
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7 months
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T/F when testing a child age 2 and under, its okay to use an occluder
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FALSE
patch |
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________ acuity is the gold standard measurement of visual acuity
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recognition acuity
(Snellen) |
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For kids under 2 we use _____ acuity tests for VA
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resolution
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T/F a child that is nonveral can be tested using resolution acuity to get their VAs
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T
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Forced choice preferential looking is a type of _____ acuity
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resolution
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_____________ are the clinical test of choice for testing acuity in babies
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Teller acuity cards (FPL test)
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FPL is measure in cycles per degree, so to conver this to snellen you
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divide 600 by CPD
so if pt sees 30 cycles per degree card their VA is 600/30= 20 |
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FPL estimate for a 1-2 month old is
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20/800
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FPL estimate for a 6 month old is
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20/100
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at 12 months a patient's FPL acuity should be
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20/50
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a patient should have 20/20 when doing FPL at this age
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3
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When baby is premature and their VA is normal with FPL testing, their Snellen acuity should be normal by age
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5
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T/F FPL can predict the actual snellen VA at age 5 in premature babies
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FALSE
it can nonly predict if it will be normal or not |
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Teller acuity cards are based on this type of acuity and use _______ to determin VA
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resolution
spatial frequency |
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T/F Cardiff cards are recongition acuity testing
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FALSE
resolution acuity old test q |
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FPL is measured in cycles per degree so if patient sees 30 cycles per degree what is their VA?
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divide 600 by CPD to get VA
20/20 |
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The clinical choice for babies/non-verbal to test VA is
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resolution acuity
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_______-acuity is used when resolution and recognition acuity cannot be done
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Detection
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The target for a child with a signifcant refraction error will appear optically blurred, making the object bigger and easier to detect. This is why ______ acuity is not an accurate method)
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detection
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Preferred test of ophthalmologist VA used
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Fix and Follow
assesses the presence of pattern vision, but hard to follow child's progress |
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When a child does not respond to object use ______ to test VA
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light and form perception
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To measure involuntary visual responses use
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OKN drum
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To confirm amblyopia use these tests:
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1. Alternative Fixation
2. 10 prism dipter vertical prism 3. bruckner test for amblyopia |
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Rather than use an occluderwhen doing cover tet for kids under 2, use
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a thumb
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If strabismus is suspected on a child perform
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1. measure centration point with esotropia
2. test 9 positions for commitancy consider prolonged occlusion |
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NPC should be normal by age
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3-4 months
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To confirm presence of strabismus use
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Hirschberg test
1 mm equal 22 pd |
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To test stereo on infants use
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stereo smile test
done at 55 cm target is a happy face consisting of three levels |
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normal pursuits should occur by
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6-8 weeks
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saccades are accurate by
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6-8 weeks
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When performing confrontations on child, use lights for target
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False
it is difficult to determine if child is seeing target or its glow first ALWAYS record size of target used |
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Child should know colors by age
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3
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Test of choice for VAs for kids older than 2
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Snellen
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For a 3.5 yr old chidl, list the order of preference for VA testing:
a.allen b. VER c. OKN d. LEA e. Broken wheel |
E
D A B C |
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Broken wheel test is a _____ test
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forced choice test
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T/F Broken wheel test takes into account crowding effect
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T
wroks off of Landolt C |
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T/F Lea symbols full chart takes crowding into account
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FALSE
does not, which is why Broken wheel is much better |
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What distance should the broken wheel test be tested?
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10 feet
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LEA symbols are tested at
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10 feet
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How many symbols do you need to get right for Lea Linear Crowded Symbol Cards
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2 out of 4 for each level
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T/F HOTV test has symbols
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F
letters |
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This test is a near vision only test
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Allen Pictures
it does NOT have a 20/0 line |
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T/F Tumbling E is a first choice for testing VA
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false
some kids do not know left adn right |
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T/F For a 3-5 year old any random dot test is okay to use
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T
3-5 year old should have 120 sec of arc |
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The advantage of using Lang stereotest is
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that we do it without glasses and can identify pictures
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Stereofly is not a good stereo test beccause
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pt can use monocular cues
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When doing near retinoscopy, the corection factor for children over age of 2 is
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1.25 D
under 2 its .75D |
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For _____ you must occlude the other eye when you perform ret so that you are scoping on axis
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strabismics
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In the 3-Figure flashlight test, the three targets are a green elephant, a red girl, and a white ball.
1.How many targets will a child see if they are supressing? 2. What will they see if they suppress OD? 3. Supress OS? |
1. 2 targets
2. Elephant and green ball 3. Red girl and red ball |
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If pt has diplopia, how many dots will they see on a Worth 4-dot test?
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5
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When doing near retinoscopy, the correction factor is _____ for children over 2
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1.25 D
.75D for less than 2 |
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This test is used for color tests
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F2
A card woth green square on purple background and a card with a blue square and a purple background 4 out 5 is correct |
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If a child tilts his head when he is reading it is probably because:
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they are seeing double
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What additional test should a 3-5 yr old patient be given that was not performed when they were an infant?
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colr test
Children should know colors by age 3 |
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what test is preferred over LEA symbols for a 3-5 year old?
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Broken wheel!!
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At what distance is the Broken Wheel test performed?
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10 ft
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A child will name or trace shapes during this color vision test
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Wagonner
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To administer drops in a 2-5 yr old pt it is best to have the patient
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lay down with eyes closed
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When using ophthalmic drugs in newborns, multiple drug instillations and drug dosages that we use in older children and adult are contraindicated because:
a. Infants have thicker skin and absorb drugs better b. Infants have more plasma protein in their bloodstream c. Infants have mor extracullar fluid and therefore absorb hydrophic drugs better d. The infant GI tract is a good barrier to drugs e. Newborns have an incomplete blood-brain barrier d. |
E!!
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T/F Children have thnner, more porous skin than adults
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T
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T/F Children up to age 6 absorb drugs topically BETTER than adults and therefore hay have more systemic toxicity
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T
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T/F When applying topical drugs thru conjunctival and nasal mucous membranes, it undergoes first pass metabolism thru the liver
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F
It absorbs directly into systemic circulation |
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T/F In neornate, hastic acid secretions and peristalsis is REDUCED which can change the absorption rate of some drugs
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T
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T/F I tracts in neonates have a GREAT barrier to drug absoprtion
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FALSE
poor barrier to dru absorption so that the drug hangs around longer, leading to toxicity. Once dru is absorbed it can be metabolized |
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When does a child's GI tract function as an adults would?
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10-12 yrs
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T/F Newborns and infants my need HIGHER doses of hydrophillic drugs
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T, they have a higher % of water in their body. HOWEVER , it is not HIGHER than adult doses!!!
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Since newborns have an incomplete blood-brain barrier, it can predispose them to _______- effecs of drugs
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CNS
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T/F children younger than 6 months have decreased amount of plasma protein available for drugs to bind to, thus leading to increased drug toxcity
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T
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Metabolism of childrne reach adult levesl by ______ years
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3-4
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T/F NEonates have DECREASED drug elimination through kidney
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T
Dosing adjustments mst be made for renal function until 1-2 yrs of age |
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What should you dilate a 2 year old child with?
a. 1% cyclo OU: 2 gtt separated by 5 min b. .5% atropine OU c. 1% cylopentolate 1 gtt: OU with punctal oclusion. 1% tropicamide OU and 2.5% phenylephrine OU, spearated by a few minuts with punctal occlusion. d. .5% tropicamide OU, 1 gtt and 3.5% phenylephrine OU, 1gg separated by a few minutes |
C
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If a 5 yr old child comes into your office and has Hyperacute bacterial conjunctivitis, the best treatment option is:
a. Refer to ophthalmologist b. Tobrabex gtt q2h c. Tetracycline d. Tobramycin tt q2h e. Refer to pediatrician |
E!
Must rule out possible systmic involvment via preseptal cellulitis or meningitis Tobramycin is poor against strep. Management nicludes: MANDATORY gram strain and a broad specturm topical antibiotic --> Vigamox |
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Drug of Choice for Hyperacute bacterial conjunctivitis
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Vigamox
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How do you treat an Acute bacterial conjunctivitis?
a. Sulfacetamide QID x 7-10 days b. Chloroptic QID x 7-10 days c. Polytrim gtts q3 OU d. Tobramycin tt q2h OU e. Doxcycline po f. Refer to pediatricin |
C!
DRUG OF CHOICE for ACUTE bacterial conjunctivities because its broad specturm. |
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Drug of choice for ACUTE acterial conjunctivitis
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Polytrim
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What type of bacterial conjunctivitis is:
bilateral, rapidly progressive, causes lid emema, hemes in ulbar conj, mixed follicular/pap response, copious mucprulence and preauricular lymphadenopathy? |
Hyperacute
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Conjunctivitis in children is most commonly due to
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Infection, and mostly bacterial (80%)
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__% of visits to primary care doctors are for conjunctivitis
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2
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According to the American acadamy of Pediatrics, a child can return to school after having a bacterial conjunctivitis once _________
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therapy has begun!
Polytrim is bacteriostatic and not bacteriocidal so child will still be contagous in 24 hours |
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T/F Polytrim, which is used in ACUTE bacterial conjunctivitis, is bbacteriocidal
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FALSE
bacteriostatic, so child will be contangious for 24 hrs |
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Most common bacteria in pediatric conjunctivitis
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Haemophilus influenzae
followed by strep pneumonia |
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Peak incidience of peiatric acue conjunctivitis is between
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12-36 months
it is also concurent with acute otitis media |
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Number one cause of bacterial keratitis in children under 3 years of age:
a. Psuedomonas aeruginosa b. Alpha streptoccal species c. Streptoccus pnuemonia |
A
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Bacterial keratitis in older children age 3-5 is mostly caused by:
a. Strep pneumoniae b. Staph aureus c. Pseudomonas aeruginosa |
A
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2 Antibiotics effective against H. Influenzae and Strep pneumoniae
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Cirpofloxacin
Ofloxacin |
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Azithroymicin is a macrolide used or 1 yr and older children and is good against
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Gram + and chlamydia
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What drug is a LAST RESORT ins pediatric use?
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Sulfacetamide
drops sting and can cause serious alleric reactions and many staph and pseudomonas strains are rsistant |
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T/F Amingoycosides works well on strep.
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FALSE
active for H. influenza and Pseudomonas |
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T/F Tetracycline should not be given to kids
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T
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This drug is NOT USED due to risk of death due to aplastic anemia
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Cloramphenicol
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Ocuflox should be given to ages
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1 year and old.
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Ciloxan should be used on ages
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1 yr and older fro drop
2 yrs and older for ointment (Ung) |
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Quixin and Zymar dosage
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Dayy 1-2 q2h up to 8x/day
Days 3-7 QID |
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dosage for Vigamox
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3 drops a day for 7 days
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______ has a higher ceoncentraion than Cipro, ocuflox or Zymar
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Vigamox
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With acute bacterial conjunctivitis drug of choice that is an ointment is
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Ciloxan TID for 2 days then bid
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For treatment of bacterial keratitis in infants to school age use
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Ciloxan ung
Vigamox Polsporin |
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7 yr old with blepharo-kerato-conjunctivitis. Tx?
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lid hygiene, warm compress, Bacitracin. Oral Erthromycin if needed
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20 DAY old infant with red eye and mild mucous discharge.
Do you a. assume its gonoccoccal and prescribe Bacitracin b. Assme its Herpes simplex 2 and prescribe Va-A? c. Assme its chlamdia and prescribe erythromycin d. Perofm conjunctival scraping and culture and prscribe Erythrmycin e. Prescribe Erythromycin ung and do not du any further testing |
E!
In kids under 2 months of age Chlamydia is involved in 2% of cases. So see if it goes away without culturing first |
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Conjunctivitis occurs in ________ % of neonate population
POSSIBLE TEST QUESTION |
1.6-12%
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Onset of conjuctivitis due to chemical reaction occurs _____ in neonates
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in the first 24 hours from birth
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Onset of conjuctivitis due to Bacterial reaction occurs _____ in neonates
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after the first 24 hours from birth
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Onset of conjuctivitis due to gonoccocal reaction occurs _____ in neonates
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2-4 DAYS until 6 days (from birth)
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Onset of conjuctivitis due to Chlamydial reaction occurs _____ in neonates
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2 weeks after birth
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_________ is one of the few bacteria that can penetrate intact corneal epithelium and cause a corneal ulcer. It appears _______ days after birth
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Gonococcal
2-4 days |
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Chylamdial Treatment involves
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Erythromycin syrup 50 mgs/kg/day x 2-3 weeks
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______- can be associated with devastting systemic disease. Discharge is watery
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Neonatal Herpes Simplex Type II
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____ conjunctivitis is a "red light" for systemic involvement
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Chlaymdial
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_______ bacterial conjunctivitis can lead to widspread systemic disease
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H. influenzae
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At Birth, the average Rx is
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+2 D
99$ of children at birth are between -6 to +10D |
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99$ of children at birth are between
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-6 to +10D
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When do we wait until to prescribe glasses?
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usually when they are school age
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Percentage of children that have anisometropia at birth __________
percentage in school _______- |
11-22%
1% |
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Percentage of children that have astigmatism at birth __________
percentage in school _______ |
20-60%
10% |
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Percentage of children that have Hyperopia at birth __________
percentage in school _______ |
30%
30% |
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Percentage of children that have Myopia at birth __________
percentage in school _______ |
25%
1-2%--> 12%--> 25% |
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RATE OF CHANGE FOR MYOPES
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.25-.50D per year
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Rate of change for Hyperopes:
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.25-.50D per SIX years
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If a 5 year old is +2D, what will their Rx be like when they are 17?
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+1.50 to +1.00 D
decreases .25-.50D per SIX years |
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A 10 yr ol dwith a +1 D Rx will have what Rx at age 16?
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+.50 to +.75D
decreases .25-.50D per SIX years |
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A 15 yr old with +.25 D will have what Rx at age 18?
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+.12 to plano
decreases .25-.50D per SIX years |
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A 5 yr with -2 D will be what Rx at age 17?
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-5 D to - 8D
.25-.50D per YEAR |
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A 10 yr old with -1 D will have what Rx at age 16?
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-2.50 D to -4 D
.25-.50D per YEAR |
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If you are 15 and your Rx is -.50D what will it be like at age 18?
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-1.25 to - 2.00D
.25-.50D per YEAR |
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If an 8 month old has VA of 20/50 and an RE of -1.00 OU hat do your Rx?
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NOTHING
pt may still undergo a decrese in myopia as they age |
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A 13 month olf has VA of 20/40. Cover test= 3XP. Refractive erros is
+2.75-.50x 170 +3.00-1.00 x 10 Do you Rx? |
Do not Rx because VA is normal and RE will probaly chane, check at age 2-3 yrs.
Be concerned if cyl is over -1.25D... then you might Rx |
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9 month VA 20/100 OU
RE= plano -2.00 x90 OU Do you Rx? |
Monitor and see pt back in 1.5 yrs.
While that is alot of cyl, at this age, the risk of amblyopia is low. ATR astigmastism is comomon when first born, and tends to drop with age |
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3 yr old VA is 20/50 OD and 20/25 OS
RE= plano-2.50x180 OD plano-.75x 180 Do you Rx and how much? |
Must Rx to make sure amblopia does not occur.
Give full Rx |
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5 yr old with VA
20/20 OD 20/100 OS NO stereo Refractive error: OD +1.00 OS +4.00-2.00 x 180 Do your Rx? |
YES
full Rx. Give all the sill, at most cut off -.25 You can also just make OD plano and OS +3.00-2.00x180 so both eyes ate +1.00 Hyoperic |
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4 yr pt who squints ha VA
20/400 OD 20/100 OS NO stereo RE= +8.50-.50x90 OD +7.75-.50x90 OS What should you be concerned with? |
Accomodation would be effected i given the whole Rx because then pt would not accomodate to get clearn near vsion. This could lar to a tropia so Rx almost all of the Rx without the cyl since that is stll normal for age.
Rx +8 OD +7.50D OS See pt one monh later |
