Question Bank – Pediatric Ocular

How far behind the globe of the eye is the optic nerve sheath measured?

Which of the following statements regarding ocular ultrasound literature is FALSE?

Measuring the optic nerve sheath at an angle (rather than parallel to) the ultrasound beams will most likely:

Which of the following is an advantage of optic nerve sheath diameter over optic disc elevation?

What is the purpose of setting the ultrasound transducer to the lowest mechanical and thermal index on the ultrasound “ocular setting”?

Which of the following is NOT a pearl for optimizing ultrasound of the optic nerve and optic disc?

Which of the following optic disc findings is more often a finding in pseudopapilledema rather than true optic disc elevation?

Which of the following findings are NOT associated  with increased probability of elevated intracranial pressure?

You attempt to assess the optic disc and optic nerve sheath with ocular ultrasound of a toddler who cries when held still and doesn’t follow instructions to look forwards reliably. Which of the following techniques can you use to obtain the measurements you need?

An asymptomatic 10 year old boy with no history of medical problems agrees to allow you to ultrasound his eyes during ultrasound teaching session. Ocular POCUS shows elevation of the optic disc that is sharp/pointy in appearance and fleeting when the probe is rotated or fanned. The optic nerve sheath is 6.0mm in diameter. Neurological exam is normal. Which of the following is the next best step in management for this patient?

A 5 year old boy presents for daily emesis in the morning for the past 2 weeks. He has endorsed new onset headache to his parents in the mornings. Neurologic exam is limited by cooperation, as he does not seem to understand the instructions which his mom says is unusual for him. There is no family history of migraines. Fundoscopic exam is unsuccessful. Ocular ultrasound shows a flat optic disc and optic nerve sheath diameter is 5.7mm.

A patient with a VP shunt and history of frequent admissions for VP shunt malfunction presents to the emergency department for vomiting, diarrhea, and one day of subjective fever. His mother endorses that she had similar symptoms the week prior. Temperature and vitals signs in the emergency department are normal. His mother notes that he is tired and seems sad, but otherwise his exam is at baseline. Fundoscopic exam is unsuccessful, ocular ultrasound shows optic disc elevation that measures 0.4mm and optic nerve sheath that is 5.9mm in diameter. Because he has presented frequently for concern for elevated ICP before you consult his chart and you see that the optic nerve sheath is typically 4.3mm when measured between episodes of ICP elevation. Which of the following is the next best step in management?

What structure is indicated by the arrow?

What structure is indicated by the arrow?

What structure is indicated by the arrow?

Where is the optic nerve sheath measured?

Which of the measurements depicted in the image is the correct way to measure the optic nerve sheath diameter?

Which of the following statements is true?

When performing ocular ultrasound on a child in your pediatric outpatient clinic presenting for headaches, you note that the optic disc looks a little bulgy. Which if the following is MOST suggestive of true papilledema (as opposed to pseudopapilledema)?

Which of the following ocular ultrasound findings is more sensitive for elevated intracranial pressure?

Which of the following ocular ultrasound findings is more specific for elevated intracranial pressure?

Which of the following is a cause for false overestimation of the optic nerve sheath diameter?

An image from ocular ultrasound is shown below:

Which of the following findings is shown in the image?

An obese teenage girl taking isotretinoin presents with daily headaches for 2 weeks that have been progressively worsening and are now severe. She states that the headaches feel like they originate behind her eyes and she complains of a rushing or whooshing sound when trying to fall asleep at night.

What findings are shown in the image?

An obese teenage girl taking isotretinoin presents with daily headaches for 2 weeks that have been progressively worsening and are now severe. She states that the headaches feel like they originate behind her eyes and she complains of a rushing or whooshing sound when trying to fall asleep at night. Ocular ultrasound shows the findings below:

What finding is shown in the image?

An obese teenage girl taking isotretinoin presents with daily headaches for 2 weeks that have been progressively worsening and are now severe. She states that the headaches feel like they originate behind her eyes and she complains of a rushing or whooshing sound when trying to fall asleep at night. Ocular ultrasound shows the findings below:

What findings are shown in the image?

An obese teenage girl taking isotretinoin presents with daily headaches for 2 weeks that have been progressively worsening and are now severe. She states that the headaches feel like they originate behind her eyes and she complains of a rushing or whooshing sound when trying to fall asleep at night. Ocular ultrasound shows the findings below:

What findings are shown in the image?

An 8 year old with no past medical history presents for evaluation of headaches. Headaches are frontal and usually occur at the end of the school day, occur about 4-6 times per week, and are less frequent on weekends or holidays.  Review of systems and neurological exam is otherwise normal. Ocular POCUS shows the following finding.

A 4yo boy presents with new-onset focal seizures. History is significant for daily headaches and daily emesis for the past 2 weeks.

Which of the following is the most likely etiology of his presentation and findings?

A 3 year old child with a VP shunt presents for acute onset of vomiting. He has multiple sick contacts in his family with similar symptoms. On exam, he appears tired and his neuro exam is non focal. Review of his chart shows that in the past his only symptoms of VP shunt malfunction were vomiting and fatigue. Ocular POCUS shows the following:

What is the most likely cause of his vomiting?

 A 3 year old child with a VP shunt presents for acute onset of vomiting. He has multiple sick contacts in his family with similar symptoms. On exam, he appears tired and his neuro exam is non focal. Review of his chart shows that he has presented with similar symptoms for VP shunt malfunction in the past. Ocular POCUS shows the following: