PEDS Final - Anterior And Posterior Segment
Dr. Chen and Dr. Patel
- 1.
Nasolacrimal Duct Obstruction
- A.
Is often caused by Neisseria gonorrhoeae or Chlyamydia trachomatis and can be treated with erythromycin ointment
- B.
Spontaneously resolves in 65% of cases and can be conservatively treated by ODs with antibiotics, cleaning and digital massage
- C.
Often presents unilaterally, with no history of fever. Mucopurulent discharge, conjunctival papillae and conjunctival chemosis are also common
- D.
Can be caused by gram positive organisms Streptococcus pneumoniae and staphylococcal species as well as gram negative organism haemophilus influenzae and moraxella catarrhalis
Correct Answer
B. Spontaneously resolves in 65% of cases and can be conservatively treated by ODs with antibiotics, cleaning and digital massageExplanation
For babies that don’t have the condition spontaneously resolve by 1yo then what you can do is refer the patient for probingRate this question:
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- 2.
Your 2 month old asian female infant with a gram positive bacterial infection. Which of the following medications would you be LEAST likely to use?
- A.
Polysporin
- B.
Polytrim
- C.
Gentamicin
Correct Answer
C. GentamicinExplanation
- Polytrim which has Polymycin B covers Gram negative and trimethoprim covers Gram positive so together you have a medication that covers gram negative and positive. Approved for kids 2mo and older. Side effects are rare. Here you can see the dosage for mild infection and moderate to severe infection
- Polysporin: Bacitracin and Polymycin B, because Polymycin B covers Gram (-) bacteria. Combined, this is a pretty good medication that goes against bacterial infection. Dosage is about 3-4 times per day. These medications have ↓cost, little hypersensitivity, and little resistance and low toxicity so it’s pretty good for kids.
- Gentamicin (Aminoglycoside) : safety in neonates not yet established, more toxic questionable for gram positive bacteriaRate this question:
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- 3.
4th generation fluoroquinolones Vigamox and Zymar are both approved for use in childen 1yo and older, they both provide gram + coverage and some gram - coverage. Which of the following is not a benefit of using Vigamox over Zymar?
- A.
Preservative free
- B.
It requires a loading dose and therefore more frequent administration initially
- C.
It is closer to physiological pH and there for stings less on application
- D.
It has greater ocular penetration
Correct Answer
B. It requires a loading dose and therefore more frequent administration initiallyExplanation
the dosage Vigamox is TID for 7days and Zymar is Q2H for 2 days and then QID for 5 days. So there’s a loading dosage for Zymar. So for kids you can see that Vigamox is less problematic because you don’t have to put in the drops as frequently as Zymar. Both medications have good Gram positive and negative coverage so that’s a good thing for kids. Vigamox, unlike Zymar, is preservative free and closer to physiological pH and dosage is a little bit less.Rate this question:
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- 4.
What is the main benefit of using Moxeza over Vigamox?
- A.
Moxeza is a higher concentration of moxifloxacin
- B.
Moxeza is approved for use in children 4months and younger.
- C.
Moxeza has a short treatment duration
- D.
Moxeza is a 0.6% bexifloxacin suspension and more effective for the treatment of bacterial conjunctivitis
Correct Answer
B. Moxeza is approved for use in children 4months and younger.Explanation
The brother of Vigamox is Moxeza, the benefit is that it’s approved for kids as young as 4mo compared to Vigamox. The concentration is the same but the carrier for Moxeza allows for the drop to stay in the eye for a longer period of time, that’s why the dosaging is only 2x per day compared to 3x per day for Vigamox.Rate this question:
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- 5.
Which of the following is NOT something you would do to increase compliance and effectiveness when prescribing antibiotics to children?
- A.
Clear the eye of mucus prior to instillation of antibiotic
- B.
Educate the parents on the use of punctal occlusion
- C.
Tell parents to taper the antibiotics once they begin to see improvement in children
- D.
Prescribe ointments when possible to decrease the chances of it washing out when the child cries.
Correct Answer
C. Tell parents to taper the antibiotics once they begin to see improvement in childrenExplanation
Tapering antibiotics once improvement is seen is not a recommended practice because it can lead to incomplete treatment and potential antibiotic resistance. It is important to complete the full course of antibiotics as prescribed by the healthcare provider to ensure effective treatment and prevent the development of antibiotic-resistant bacteria.Rate this question:
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- 6.
Anti-Allergy treatment often includes combination drops such as Pataday and Patanol. If your patients redness and discharge has abated but the itching continues what would the best next step in treatment?
- A.
Have the parent wash the child's hair every night and wash their bedding and clothing frequently.
- B.
Prescribe an additional mast cell stabilizer such as Alamast and Alocril
- C.
Consider using a mild steroid on top of the Patanol or Pataday.For the severe condition you want to use a stronger steroid, PredForte on a frequent basis and for that patient you want to follow up with them again at the end of the day or the next day
- D.
Suggest an OTC Ophthalmic Antihistamine and vasoconstrictor such as Vasocon-A or OcuHist
Correct Answer
C. Consider using a mild steroid on top of the Patanol or Pataday.For the severe condition you want to use a stronger steroid, PredForte on a frequent basis and for that patient you want to follow up with them again at the end of the day or the next dayExplanation
If the patient's redness and discharge have improved but the itching persists, the best next step in treatment would be to consider using a mild steroid in addition to the combination drops (Patanol or Pataday). If the condition is severe, a stronger steroid like PredForte can be used on a frequent basis. It is important to follow up with the patient later in the day or the next day to monitor their progress.Rate this question:
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- 7.
A concerned parent brings in their child because they are concerned about a strawberry lesion that appeared near the childs eye 3 weeks after birth. The parent is concerned because it looks darker when the child cries. You zone out when the staff doctors names the condition but tune back in as he tells the parent that the lesion will most likely grow rapidly for now then reach it's maximum stage when the child is about 1-1.5 years of age after which there is a 95% change it will begin to involute. What condition does the child most likely have?
- A.
Leukocoria
- B.
Coat's Disease
- C.
Rhabdomyosarcoma
- D.
Capillary Hemangioma
- E.
Best Disease
Correct Answer
D. Capillary HemangiomaExplanation
Capillary hemangioma is the most likely condition that the child has. Capillary hemangioma is a benign tumor made up of small blood vessels. It commonly appears in infancy and grows rapidly in the first year of life. It is often red or purple in color and can darken when the child cries due to increased blood flow. Capillary hemangiomas typically reach their maximum size by 1-1.5 years of age and then begin to involute, or shrink, with time. The information provided in the question aligns with the characteristics and progression of capillary hemangioma.Rate this question:
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- 8.
What type of congential cataract is most associated with aniridia?
- A.
Anterior Polar cataract
- B.
Posterior Polar cataract
- C.
Nuclear cataract
- D.
Posterior Subcapsular Cataract
Correct Answer
B. Posterior Polar cataractExplanation
Aniridia is a genetic disorder characterized by the absence of the iris in the eye. It is commonly associated with the development of posterior polar cataracts. These cataracts form at the back of the lens and are often located in the central area. The presence of aniridia increases the likelihood of developing posterior polar cataracts, making it the most associated type of congenital cataract in individuals with this condition.Rate this question:
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- 9.
The Infant Aphakia treatment Study
- A.
Determined that visual deprivation present at birth can lead to a poor prognosis if surgery is not done by 1yo.
- B.
Showed that there was no statistically significant difference in VA at age 1yr between children who received IOLs or CLs for their aphakia
- C.
Showed that overly aggressive patching can result in reverse amblyopia
Correct Answer
B. Showed that there was no statistically significant difference in VA at age 1yr between children who received IOLs or CLs for their aphakiaExplanation
The Infant Aphakia Treatment Study found that there was no significant difference in visual acuity (VA) at the age of 1 year between children who received intraocular lenses (IOLs) or contact lenses (CLs) for their aphakia. This suggests that both treatment options are equally effective in improving visual outcomes in infants with aphakia.Rate this question:
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- 10.
Which of the following is a new topical treatment being researched for capillary hemangiomas discussed in class which ODs may possibly be involved in?
- A.
Propanolol
- B.
Timolol
- C.
NSAIDs
- D.
Steroids
Correct Answer
B. TimololExplanation
Propanolol - was an oral treatment and we can't prescribe this
There’s a lot of treatment options that are available in order to medically manage these patients. Steroids used to used frequently in the past and they can be administered orally if the tumor is very
large in size. They can be administer intralesionally, so if it’s a smaller tumer then via injection, the steroid can be administered. There were a few doctors that tried topical administration of steroids to see if that would help regression of the tumor and it actually was found not to be very successful. So it’s usually giving via injection or orally. With steroids there are complications, so weight gain, behavior changes, GI upset, as well as a lot of other things that are items to worry about with a steroid administration. Laser or an excision type of a procedure has also been done in the past. So more recently Oral propanolol and Topical Timolol has been in the research as a method of treatment for capillary hemangiomas.Rate this question:
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- 11.
Which of the following is NOT a differential diagnosis for Leukocoria?
- A.
Coloboma
- B.
Persistent hyperplastic primary vitreous (PHPV)
- C.
Coat's Disease
- D.
Neurofibromatosis
- E.
Retinopathy of Prematurity (ROP)
Correct Answer
D. NeurofibromatosisExplanation
Neurofibromatosis is not a differential diagnosis for Leukocoria because it is a genetic disorder that causes tumors to grow on nerves, while Leukocoria is a symptom characterized by a white reflection in the eye. The other options listed, such as Coloboma, Persistent hyperplastic primary vitreous (PHPV), Coat's Disease, and Retinopathy of Prematurity (ROP), are all potential causes of Leukocoria.Rate this question:
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- 12.
Which statement is NOT true regarding retinoblastoma (RB)?
- A.
28mons is the latest age children with a positive family Hx of RB will develop the first tumor
- B.
Unilateral cases of RB will be caught normally at 7mons while bilateral cases are normally caught at 24mons
- C.
18mons is the average age of diagnosis for RB
- D.
44 mons is the latest age a child w/unilateral RB will develop a tumor in their fellow eye
Correct Answer
B. Unilateral cases of RB will be caught normally at 7mons while bilateral cases are normally caught at 24monsExplanation
Unilateral cases of RB are not normally caught at 7 months, while bilateral cases are not normally caught at 24 months. The statement is false because the age at which RB is caught can vary and is not specific to unilateral or bilateral cases.Rate this question:
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- 13.
Coat's Disease
- A.
Is treated with laser photocoaulation regardless of stage of the disease
- B.
Shows as a mass with a high reflectivity that blocks sound on a B-scan
- C.
Typically present b/t the ages of 6-8 years, 90% of cases are unilateral. This disease also has a strong male predominance.
- D.
Typically has excellent visual prognosis because it develops after the critical period.
Correct Answer
C. Typically present b/t the ages of 6-8 years, 90% of cases are unilateral. This disease also has a strong male predominance.Explanation
Option 4 - Lamellar cataract
Option 2: RB
Coats - Tx dependent on stage , refer at stage 2Rate this question:
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- 14.
What type of congential cataract is most associated with Anisometropia?
- A.
Anterior Polar cataract
- B.
Posterior Polar cataract
- C.
Nuclear cataract
- D.
Posterior Subcapsular Cataract
Correct Answer
A. Anterior Polar cataractExplanation
Anisometropia refers to a condition where there is a significant difference in the refractive power between the two eyes. Anterior Polar cataract is most associated with Anisometropia because it occurs in the front portion of the lens, causing a significant difference in the refractive power between the affected eye and the unaffected eye. This difference in refractive power can lead to anisometropia, resulting in unequal focusing abilities between the two eyes.Rate this question:
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- 15.
CT scans are no longer done in children with retinoblastoma because it forces them to be at a higher risk to develop a secondary cancer later on in life. So CT scans are excellent at detecting calcium but we have another tool here at the clinic, the B-Scan which is also great at detecting calcium as well.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
CT scans are no longer done in children with retinoblastoma because they increase the risk of developing a secondary cancer later in life. This is because CT scans use ionizing radiation, which can damage DNA and potentially lead to the development of cancer. Instead of CT scans, the clinic uses a B-Scan, which is also effective at detecting calcium.Rate this question:
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- 16.
Coat’s disease is the most common misdiagnosis of retinoblastoma, but there are a few things that are different.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The onset of symptoms is much later in life vs. with retinoblastoma we said that shows up between 7 or 8 months of age up to about 2 years of age when that condition typically presents.Rate this question:
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- 17.
You are taking a care history of a 9 year old female. The patient's mother tells you that when the child was younger there was a blue lesion that appeared on her eye that spread to her forehead. After the patient turned 1 the lesion went away. Which of the following should you look for in the patient's ocular health given that history?
- A.
Nystagmus
- B.
Induced astigmatism and anisometropic refractive error
- C.
Microphthalmia/Microcornea
- D.
Iris neovascularization and corneal edema
- E.
Lipids/proteins in the aqueous chamber
Correct Answer
B. Induced astigmatism and anisometropic refractive errorExplanation
Microphthalmia/Microcornea - in nuclear cataract and persistend hyperplastic primary vitreous
Iris neovascularization and corneal edema, Lipids/proteins in the aqueous chamber - Coat's diseaseRate this question:
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- 18.
Unilateral presentation of congenital cataracts is more common than the bilateral presentation and often has a hereditary component.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement contradicts the commonly known fact that bilateral presentation of congenital cataracts is more common than the unilateral presentation. Additionally, while congenital cataracts can have a hereditary component, it is not always the case. Therefore, the correct answer is false.Rate this question:
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- 19.
Which of the following is NOT a factor to consider for surgical intervention?
- A.
If it is located near posterior nodal point
- B.
Family Hx of glaucoma
- C.
Appearance of strabismus in a unilateral cataract
- D.
Appearance of nystagmus in a bilateral cataract
- E.
Density of the cataract
Correct Answer
B. Family Hx of glaucomaExplanation
The family history of glaucoma is not a factor to consider for surgical intervention. Factors to consider for surgical intervention typically include the location of the condition, the appearance of strabismus or nystagmus, and the density of the cataract. However, a family history of glaucoma does not directly impact the decision for surgical intervention.Rate this question:
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- 20.
Which of the following is not a characteristic of Rhabdomyosarcoma
- A.
It may initially present as a hordeolum or a chalazion but the big difference is that this is a RAPID progression
- B.
It has a predilection for the superior nasal quadrant of the orbit, and typically shows up in first decade of life. Mean age of dx is 6-8 yo
- C.
Characterized as rapid onset of bilateral propstosis
- D.
If this condition manifests in children it’s usually in the head or neck area. Whereas with adults, it’s usually the trunk or extremities. It shows up in males and females, but more so in males
Correct Answer
C. Characterized as rapid onset of bilateral propstosisExplanation
The given answer is not a characteristic of Rhabdomyosarcoma because it does not present with a rapid onset of bilateral proptosis. Rhabdomyosarcoma is a type of cancer that commonly occurs in children and is characterized by the rapid growth of malignant cells in the soft tissues, such as muscles. It typically presents as a mass or swelling in the head or neck area, but can also occur in other parts of the body. While it can cause proptosis or bulging of the eyes, it does not usually manifest as a rapid onset of bilateral proptosis.Rate this question:
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- 21.
Retinopathy of Prematurity
- A.
Is typically associated with the CHARGE Syndrome - coloboma, heart defect, atresia, growth delays, genital hypoplasia, and ear abnormalities
- B.
Risk factors include being born before 31 wks, birth weight less than 1500g and being exposed to postnatal O2.
- C.
Is typically associated with other conditions including Marfan's syndrome,aniridia, rubella, PHPV, Neurofibromatosis and anterior chamber syndromes
- D.
Presents with a characteristic yellow, round subretinal lesion likened to an egg yolk
Correct Answer
B. Risk factors include being born before 31 wks, birth weight less than 1500g and being exposed to postnatal O2.Explanation
This retina is avascular because it hasn’t had a chance to develop. Now they are placed in an incubator (O2 rich), the retina undergoes vasoconstriction. Then when it returns to normal room temperature, then that’s going to trigger a vasoproliferation, and that can lead to neovascularization due to change in O2 environment. That neo can further lead to RDs and fibrosis
Option 4 - Best Disease
Option 3 - refers to Infantile GLC
Option 1 - refers to colobomasRate this question:
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- 22.
Select the statement that best applies to ROP and the progression of the disease.
- A.
Stage 3 is the final stage of ROP and results in complete Retinal detachment (RD)
- B.
There are 3 zones where ROP can manifest, manifesting in zone 1 is the most problematic because this area includes the ON.
- C.
Children may have a decrease in VAs before retinal changes appear and complain of black spots in central vision and difficulty going from dark to bright conditions.
- D.
Once they hit 20/40 there’s a rapid decrease in their VA to 20/400. They’ll have nonspecific macular mottling. They’ll have macular lesions of a beaten bronze color, often referred to as snail slime appearance. The yellow/white flakes appear in posterior pole. Once these macular lesions increase, their visual acuity decreases. Central scotoma and color vision defect show up in the end stages
Correct Answer
B. There are 3 zones where ROP can manifest, manifesting in zone 1 is the most problematic because this area includes the ON.Explanation
Stage I- flat demarcation line that separates vascular and avascular retina. Stage II- Demarcation line is more distinct and now forms an elevated ridge. Stage III- demarcation has neovascularization. Stage IV- partial RD. Stage 5- Complete RD. Plus dz is when there are tortuous and engorged vessels in the posterior pole area. If pt has tortuous vessels it might be noted Stage III with a plus sign next to it
meaning they have plus dz as well.
Option 3 and 4 - Stargardt's DiseaseRate this question:
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- 23.
Surgery is the definitive treatment for infantile glaucoma. Drops are given until the surgery can be done, but not as a permanent treatment
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Surgery is considered the definitive treatment for infantile glaucoma, meaning it is the most effective and reliable method to address the condition. While eye drops may be used temporarily to manage symptoms until the surgery can be performed, they are not intended to be a permanent solution. Therefore, the statement that surgery is the definitive treatment for infantile glaucoma and drops are not a permanent treatment is true.Rate this question:
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- 24.
Fluorescein Angiography helps differentiate Best Disease and Stargardt's disease.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
EOGs and ERGs help differentiate Stargardt’s from Best Dz.
In Stargardt’s pts EOGs are normal, and EOGs are abnormal in Best's DiseaseRate this question:
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- 25.
Optic Nerve Hypoplasia
- A.
May have lesions which degenerate and lead to macular hemorrhaging and scarring. In the end stages this dz in indistinguishable from age related mac degen.
- B.
Children may have excess tearing, photophobia, red eye due to rubbing, patient may also have a myopic shift
- C.
Is due to an interruption in fetal development and may present with a double ring sign
- D.
Usually appear inferior or inferior-nasal in the retinal area
Correct Answer
C. Is due to an interruption in fetal development and may present with a double ring signExplanation
Option1 - Best Disease
Option 2 - Infantile GLC
Option 4 - Retinal colobomaRate this question:
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Mar 20, 2023Quiz Edited by
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