CORE - Peds Flashcards
1
Q
Telephone receiver femurs
A
thanatophoric dysplasia
2
Q
Cloverleaf skull
A
thanatophoric dysplasia, severe Apert syndrome, severe Crouzon syndrome
3
Q
Platyspondyly
A
thanatophoric dysplasia
4
Q
Anterior beaking of mid vertebral body
A
Morquio’s
5
Q
Anterior beaking of inferior vertebral body
A
Hurler’s
6
Q
Banana sign
A
Chiari II - appearance of the cerebellum
7
Q
Lemon sign
A
Chiari II - appearance of the skull shape
8
Q
Luckenschadel skull
A
associated with Chiari II - dysplasia of the skull with multiple rounded lytic defects; affects inner table
9
Q
Hair-on-end skull
A
thalassemia, sickle cell disease
10
Q
Most common cause of cyanosis in newborn
A
Transposition of the great arteries
11
Q
Wimberger sign
A
Congenital syphilis
12
Q
Celery stalk metaphyses
A
Congenital rubella
13
Q
Floating tooth in the mandible
A
Eosinophilic granuloma
14
Q
Wide angled mandible and dwarfism
A
pycnodysostosis
15
Q
Osteonecrosis of the mandible (peds)
A
OI on bisphosphonates
16
Q
Wimberger ring sign
A
Circular calcification surrounding the osteoporotic epiphyseal center of ossificatoin in scurvy - may result from bleeding
17
Q
Subperiosteal hemorrhage
A
Scurvy
18
Q
Gingival bleeding
A
Scurvy
19
Q
Intralobar sequestration, most common location
A
LLL
20
Q
Congenital lobar emphysema, most common location
A
LUL
21
Q
Bronchial atresia, most common location
A
LUL
22
Q
Elevated endothelial growth factor (EGF)
A
Hemangioendothelioma; follows peripheral nodular discontinuous enhancement pattern
23
Q
Elevated AFP DDx
A
Hepatoblastoma, HCC, gastroschisis, yolk sac tumor (testes), pancreatoblastoma, anencephaly
24
Q
Subglottic hemangioma
A
assoc. with PHACES syndrome (P = Dandy-Walker), cutaneous hemangiomas; most commonly left-sided
25
Cutaneous hemangioma
assoc. with PHACES syndrome (P = Dandy-Walker)
26
Ropy opacities
Meconium aspiration
27
Pneumothorax (neonate)
Meconium aspiration
28
Fluid in the fissures (neonate)
TTN
29
Granular opacities, premature, low lung volumes
RDS
30
Granular opacities, normal/increased lung volumes
PNA
31
Granular opacities, low lung volumes, pleural effusion
B-hemolytic strep PNA
32
Band-like opacites (neonate)
CLD/BPD
33
Non-bilious vomiting (3 weeks to 3 months) + NEXT STEP
Hypertrophic pyloric stenosis; next step is ultrasound
34
Paradoxical aciduria
Hypertrophic pyloric stenosis
35
Thickness and length hypertrophic pyloric stenosis
4 mm and 14 mm
36
Posterior mediastinal mass <2 y/o
Neuroblastoma
37
Absent or hypoplastic GB
Biliary atresia
38
Triangle cord sign
Biliary atresia - triangular or tubular echogenic cord of fibrous tissue seen in the porta hepatis at ultrasonography
39
Asplenia
Congenital heart disease
40
Splenic infarct
SCD
41
Gallstones
SCD
42
Fishmouth or H-shaped vertebrae
SCD, Gaucher's
43
Hand or foot pain/swelling (infant)
Hand-foot syndrome (dactylitis in SCD)
44
Short microcolon
Mid to distal colonic atresia, Hirschsprung's (dependent on length of involvement)
45
Long microcolon
Meconium ileus, ileal/proximal colonic atresia, total colonic Hirschsprung's
46
Calcified abdominal mass in newborn
Meconium peritonitis
47
Meconium ileus equivalent
DIOS
48
Abrupt caliber change of aorta below celiac origin
Hepatic hemangioendothelioma (shunt)
49
Cystic mass in liver of newborn
Mesenchymal hamartoma
50
Unilateral renal agenesis
Unicornuate uterus (females); absent vas deferens/epididymis, seminal vesicle cysts (males)
51
Neonatal renal vein thrombosis
Maternal diabetes
52
Neonatal renal artery thrombosis
Misplaced umbilical artery catheter (should be at T8-10 or L3-5)
53
Hydronephrosis on fetal MRI
Posterior urethral valve
54
Urachal anomaly assoc. malignancy
Adenocarcinoma
55
Solid renal tumor in <3 month old
Mesoblastic nephroma
56
Solid renal tumor of childhood
Wilms
57
Midline pelvic mass in female
Hydrometrocolpos
58
Blue dot sign
Torsion of testicular appendage (>5 mm)
59
Extratesticular scrotal mass
Rhabdomyosarcoma
60
Narrowing of interpedicular distance
Achondroplasia
61
Tombstone iliacs
Achondroplasia
62
Champagne glass pelvic inlet
Achondroplasia
63
Trident hands
Achondroplasia; short fingers with a separation between the 3rd and 4th digits
64
Posterior vertebral scalloping
Achondroplasia, NF1, Marfan's, Ehlers-Danlos, intraspinal mass, mucopolysaccharidoses
65
Idiopathic scrotal edema
Henoch-Schonlein purpura
66
Acute scrotal pain age 7-14
Torsion of testicular appendage (most common), testicular torsion, epididymitis
67
Physiologic periostitis of the newborn
1-4 months; femur before tibia, always diaphyseal
68
Acetabular angle should be
<30
69
Alpha angle should be
>60
70
Klein's line
along lateral femoral neck; for SCFE
71
Hilgenreiner line
drawn through triradiate cartilage; 'H' for horizontal
72
Perkins line
drawn through lateral acetabulum; 'P' for perpendicular to Hilgenreiner line
73
Most common symptomatic vascular ring
Double aortic arch
74
Neonatal infection with frontal lobe atrophy
HIV
75
Dolicocephaly
Sagittal suture fusion
76
Brachycephaly
Bilateral coronal or lambdoid suture fusion
77
Plagiocephaly
Unilateral coronal or lambdoid suture fusion
78
Trigonocephaly
Metopic suture fusion
79
Turricephaly
Sagittal, coronal, and lambdoid suture fusion
80
Right-sided heterotaxia
bilateral major/minor fissures, asplenia, more cardiac malformations, aorta on the right side of the spine
81
Left-sided heterotaxia
bilateral single fissures, polysplenia, fewer cardiac malformations, azygous continuation
82
Congenital CMV (CNS)
periventricular calcifications, pachygyria-lissencephaly, hydrocephalus
83
Congenital toxoplasmosis (CNS)
basal ganglia calcifications, hydrocephalus
84
Congenital HSV (CNS)
hermorrhagic infarction => bad encephalomalacia
85
Congenital HIV (CNS)
frontal lobe atrophy
86
Caffey disease
<6 m/o, self-limited; periosteal reaction, soft-tissue swelling, irritability; affects mandible, ulna, and clavicle; hot on bone scan
87
Wormian bones DDx
Pycnodysostosis, OI, Rickets, Kinky hair syndrome, Cleidocranial dysostosis, Hajdu-Cheney, Syndrome of Downs
88
Differential for high output cardiac failure in pediatric patient
Hepatic hemagnioendothelioma, vein of Galen malformation, sacrococcygeal teratoma
89
Grade 1 VUR
reflux into ureter only
90
Grade 2 VUR
reflux into renal pelvis, no dilation
91
Grade 3 VUR
mild dilation of ureter and pelvicalyceal system
92
Grade 4 VUR
tortuous ureter with moderate dilation, pelvicalyceal blunting with preserved papillary impressions
93
Grade 5 VUR
tortuous ureter with severe dilation of the ureter and pelvicalyceal system, loss of fornices and papillary impressions
94
VUR treatment
grades 1-3 with antibiotics only, grades 4-5 with antibiotics +/- reimplantation
95
Rhizomelic
Proximal limb shortening
96
Mesomelic
Mid limb shortening
97
Acromelic
Distal limb shortening
98
Most common congenital heart disease
Bicuspid aortic valve or VSD (depends on wording)
99
Aortic coarctation associations
assoc. with Turners, bicuspid aortic valve
100
Extra-cardiac shunts
hepatic hemangioendothelioma, vein of galen malformation, sacrococcygeal teratoma
101
type 1 TAPVR
Supracardiac (50%) - snowman sign
102
type 2 TAPVR
Cardiac (30%)
103
type 3 TAPVR
Infracardiac (20%) - veins drain below the diaphragm (hepatic or IVC); often causes pulmonary edema in newborns
104
Double aortic arch
right arch is classically higher and larger compared to the left arch
105
Risk factors for germinal matrix hemorrhage
prematurity, multiple gestations, birth trauma, prolonged labor
106
Pectus excavatum
Haller index = transverse diameter / AP diameter; >3.25 => surgical correction
107
Causes of pulmonary hypoplasia
CDH, Potter sequence, decreased vascular supply
108
CCAM types
1 = cystic; 2 = mixed; 3 = solid; treatment is resection
109
Congenital diaphragmatic hernia
Bochdalek hernia most commonly; almost all are malrotated; when right-sided assoc. with GBS pneumonia
110
Bronchiolitis obliterans
air trapping, mosaic attenuation, bronchiectasis, bronchial wall thickening
111
Pleuropulmonary blastoma
1-2 y/o, usually right-sided, mixed cystic and solid, no calcifications or rib invasion
112
UVC position
cavoatrial junction
113
UAC position
high position (T8-10) or low position (L3-5)
114
SMA on ultrasound
echogenic halo of fat
115
Malrotation associations
heterotaxy, omphalocele, CDH
116
Small left colon syndrome associations
pre-term delivery, diabetic mothers, mag sulfate
117
High obstruction in a neonate - NEXT STEP
Upper GI series to exclude midgut volvulus (emergency)
118
Low obstruction in a neonate - NEXT STEP
Contrast enema to exclude surgical causes (Hirschsprung's, colonic/ileal atresia) from non-surgical causes (small left colon syndrome, meconium ileus)
119
Imperforate anus associations
VACTERL, caudal regression syndrome; may need to assess for GU fistula
120
Contraindications to air/contrast enema for intussusception
peritoneal signs or free air (should go straight to surgery)
121
Increased risk of NEC
pre-term delivery, low birth weight, congenital heart disease, Hirschsprung's, hyperosmolar feeds
122
Omphalocele associations
trisomy 18, allantoic cysts, cardiac anomalies, Beckwith-Wiedemann, caudal regression syndrome, malrotation
123
Dorsal pancreatic agenesis
increased risk of diabetes; associated with polysplenia
124
Biliary atresia associations
polysplenia, trisomy 18, Alagille syndrome
125
Retrocaval ureter
fishhook or J-shaped
126
Allantois
becomes urachus (which is between the bladder and umbilicus)
127
Omphalomesenteric duct
a.k.a. vitelline duct; fetal connection between umbilical cord and midgut; persistence is a Meckel's
128
Bladder exstrophy associated malignancy
increased risk of adenocarcinoma
129
Wilms tumor associations
Beckwith-Wiedemann, WAGR, horseshoe kidney, trisomy 18, Denys-Drash
130
Neuroblastoma - stage 4S
<1 y/o, confined to skin, liver, and bone marrow; excellent prognosis
131
Hydrometrocolpos association
didelphyc uterus
132
Hydrocele with septations
hematocele or pyocele
133
Isolated orchitis
mumps
134
Paratesticular mass
rhabdomyosarcoma or hematoma (with h/o trauma)
135
Pediatric elbow fracture prevalence
supracondylar fracture > lateral condylar fracture > medial epicondylar fracture/avulsion
136
Little league elbow
medial epicondylar fracture/avulsion
137
Neonatal periosteal reaction
physiologic, prostaglandins, rubella, syphilis, neuroblastoma mets, Caffey disease
138
Fracture(s) with hyperplastic callus
osteogenesis imperfecta
139
"Bone-in-bone" appearance of carpals or vertebral bodies
osteopetrosis
140
Small, skinny vertebral bodies
Klippel-Feil syndrome; with cervical fusion anomalies
141
Hindfoot valgus
flat foot, a.k.a. pes planus; talocalcaneal angle >40 degrees
142
Hindfoot varus
club foot, a.k.a. talipes equino varus; talocalcaneal angle <25 degrees
143
Increased risk of DDH
girls, breech birth, oligohydramnios, first born, family history
144
Rickets in a newborn
hypophosphatasia (deficient alkaline phosphatase)
145
Stippled epiphyses DDx
chondrodysplasia punctata, maternal coumadin use, hypothyroidism, Fairbank disease
146
Tethered cord associations
caudal regression syndrome, VACTERL, most open or closed spinal dysraphisms
147
Absent thumb and radius DDx
VACTERL, Holt-Oram, Fanconi anemia
148
Surfactant replacement therapy
increased risk of pulmonary hemorrhage and PDA; can mimic PIE
149
Recurrent pneumonia in same location
intralobar sequestration
150
Absent vas deferens
unilateral renal agenesis or cystic fibrosis
151
Spinnaker sail sign
pneumomediastinum
152
Mediastinal mass with calcification DDx (peds)
neuroblastoma, treated lymphoma, teratoma
153
Increased risk of extra-gonadal germ cell tumors
Klinefelter's syndrome (specifically NSGCT)
154
Increased risk of male breast cancer
Klinefelter's syndrome
155
Most common type of TEF
N-type (blind-ending esophagus with TE fistula to distal esophagus)
156
Criteria for VACTERL diagnosis
3 or more anomalies
157
Duodenal atresia associations
prematurity, Down syndrome, polyhydramnios
158
"Double bubble" with distal bowel gas
midgut volvulus, duodenal stenosis, duodenal web, annular pancreas
159
Ladds bands
cause obstruction in the setting of malrotation
160
Organoaxial gastric volvulus
old ladies with paraesophageal hernias
161
Mesenteroaxial gastric volvulus
peds, may cause ischemia and/or obstruction
162
Annular pancreas (peds)
duodenal obstruction
163
Annular pancreas (adults)
pancreatitis
164
Treatment for meconium ileus and small left colon syndrome
enema
165
Cutoff for small vs. large bowel intussusception
2.5 cm
166
Lead points for intussusception
lymph nodes, HSP, Meckel's, enteric duplication cysts
167
Most common cause of pancreatitis (peds)
trauma
168
Kasabach-Merritt syndrome
assoc. with hemangioendothelioma
169
Hepatoblastoma associations
Wilms, Beckwith-Wiedemann, hemi-hypertrophy
170
Caroli's disease associations
polycystic kidney disease (AR > AD), medullary sponge kidney
171
Diffuse liver metastases (infant or toddler)
neuroblastoma or Wilms; if <6 m/o => neuroblastoma
172
High imperforate anus fistula
vesicorectal (males) or vaginorectal (females)
173
Low imperforate anus fistula
perineal fistula
174
"Pancake adrenal gland"
congenitally absent kidney
175
Most common congenital GU anomaly
UPJ obstruction
176
Whitaker test
to differentiate UPJ from an extra-renal pelvis; urodynamics + antegrade pyelogram
177
No urine in bladder in utero
bilateral renal agenesis, ARPKD
178
Causes of primary megaureter
idiopathic, distal adynamic segment, reflux at UVJ
179
Obstructive causes of hydronephrosis in male neonates
UPJ obstruction, PUV, ureteral ectopia (obstructs)
180
Non-obstructive causes of hydronephrosis in male neonates
VUR, primary megaureter, prune belly syndrome
181
Most common complication of a urachal remnant
infection
182
Screening for Wilms in nephroblastomatosis
q3 months until age 7
183
Renal scintigraphy with no excretory function (neonate)
renal agenesis, MCDK
184
Beckwith-Wiedemann (3 associations)
Wilms, hepatoblastoma, omphalocele
185
WAGR syndrome
Wilms, Aniridia, Genital anomalies, Retardation of growth
186
Wilms-like tumor + bone mets
clear cell sarcoma; regular Wilms most commonly mets to lungs
187
"Bunch of grapes" in the pelvis
Botryoid rhabdomyosarcoma; this variant occurs in the bladder and vagina most commonly
188
Neuroblastoma associations
NF-1, Hirschsprung's, DiGeorge syndrome, Beckwith-Wiedemann
189
Scrotal hemorrhage (neonate)
assoc. with adrenal hemorrhage
190
"Cerebriform" adrenal gland
adrenal hyperplasia
191
Ovarian torsion
swollen ovary, peripheral follicles, no flow
192
Most common cause of painless scrotal swelling
hydrocele
193
Large or coarse testicular calfications
NSGCT
194
Most common testicular tumors in 1st decade
yolk sac tumor, teratoma
195
Sertoli cell tumor associations
Peutz-Jeghers, Klinefelter's
196
5+ y/o elbow
"Where is the medial epicondylar ossification center?"
197
Lucent skull lesions (peds)
EG, neuroblastoma mets, Luckenshadel skull (Chiari II)
198
Fibula longer than tibia
osteogenesis imperfecta
199
Wormian bones, acroosteolysis, osteosclerosis
pycnodysostosis
200
Sprengel deformity (high-riding scapula)
Klippel-Feil syndrome; assoc. with an omovertebral bone
201
Caudal regression syndrome associations
VACTERL, Currarino triad
202
Currarino triad
anorectal malformation, sacrococcygeal osseous defect, presacral mass (meningocele, teratoma, hamartoma)
203
Presacral mass DDx
sacrococcygeal teratoma, meningocele, rectal duplication cyst
204
Absent radius DDx
VACTERL, Holt-Oram, Fanconi anemia, thrombocytopenia absent radius (TAR)
205
Medial subluxation of the navicular
club foot (talipes equinovarus)
206
Hip pain with with widened joint space - NEXT STEP
septic arthritis must be excluded
207
Kocher criteria
fever, inability to bear weight, elevated ESR/CRP, WBC >12; 3 or more is positive for septic arthritis
208
Duodenal hematoma (infant)
NAT
209
Pancreatitis (infant)
NAT
210
Piriform aperture stenosis associations + NEXT STEP
central mega-incisor, agenesis of the corpus callosum, holoprosencephaly; next step is image the brain
211
Dimple screening
high dimples (above gluteal crease) are screened; low dimples are not
212
Excessive expiratory airway collapse (>50%)
tracheobronchomalacia
213
Massive perinatal pericardial effusion
pericardial teratoma
214
Soap bubble luciences in RLQ (x-ray)
meconium ileus
215
Simple renal cyst(s) associations
tuberous sclerosis, VHL
216
Abnormal anterior humeral line
supracondylar fracture
217
Abnormal radiocapitellar line
elbow dislocation
218
Salter-Harris type of an avulsion injury
Salter-Harris type 1
219
Skeletal survey
frontal view of all long bones, rib views with obliques, skull, pelvis, hands/feet, entire spine
220
J-shaped sella
mucopolysaccharidoses, achondroplasia, NF1
221
Madelung deformity associations
prior trauma, Turner syndrome, Hurler's, achondroplasia, multiple hereditary exostoses
222
Oncogenic rickets
seen with hemangiopericytoma or non-ossifying fibroma
223
Alagille syndrome
intrahepatic biliary atresia, peripheral pulmonary artery stenosis
224
Salter-Harris type for a lateral condylar fracture
Salter-Harris type 4
225
Cyst with trilaminar wall
enteric duplication cyst
226
Hemolytic uremic syndrome
renal failure, hemolytic anemia, thrombocytopenia; enlarged echogenic kidneys; due to E. coli most commonly
227
Echogenic chest mass (neonate)
CLE, CDH, sequestration, CCAM
228
Congenital venolobar syndrome
a.k.a. scimitar syndrome (RLL PAPVR + pulmonary hypoplasia)
229
Work-up for pediatric bone tumor (any)
MRI of affected limb, CT chest, whole body surveillance (skeletal survey, bone scan, or MIBG)
230
Small thorax with a distended abdomen
consider renal issues (Potter sequence)
231
Age for ganglioneuroma
>10 y/o
232
Echogenic pulvinar
seen in DDH; femoral heads will be displaced
233
Pediatric ovarian neoplasms
GCTs are most common regardless of age (also most common amongst malignant ovarian tumors)
234
Infant with UTI by urinalysis - NEXT STEP
renal ultrasound to evaluate for pyelo or structural anomalies
235
Indication for VCUG in an infant
recurrent UTI or abnormal renal ultrasound
236
% SCFE is bilateral
25%; Tx for SCFE is surgical pinning
237
Complications of SCFE
FAI, chondrolysis, avascular necrosis
238
Renal mass with a subcapsular fluid collection
rhabdoid tumor of the kidney
239
Anterior mediastinal mass DDx (peds)
lymphoma, leukemia, GCT (teratoma, seminoma, NSGCT), thymic rebound, normal thymus
240
Most common extra-ocular orbital malignancy (peds)
rhabdomyosarcoma
241
Lytic lesion of bony pelvis DDx (peds)
Ewing's, osteosarcoma, EG, neuroblastoma met, lymphoma/leukemia, osteomyelitis
242
Diffusely sclerotic bones DDx
osteopetrosis, pycnodysostosis, hypervitaminosis A, renal osteodystrophy, fluorosis
243
Age when DDH screening shifts from US to x-ray
6 months (when femoral heads ossify)
244
Situs solitus
normal position of chest and abdominal organs
245
Copper-beaten skull
hydrocephalus
246
ARPKD types
infantile = worse renal disease, less hepatic fibrosis; juvenile = less renal disease, more hepatic fibrosis
247
Short femurs
skeletal dysplasia (especially achondroplasia)
248
Criteria for BPD
abnormal CXR + persistent need for oxygen at 36 post-conceptual weeks or at 28 days of life
249
Most common benign liver tumor (peds)
infantile hepatic hemangioma
250
Bony findings in achondroplasia
bullet-shaped VBs, posterior VB scalloping, decreasing interpedicular distance, horizontal acetabular roofs, tombstone iliac bones, exaggerated lumbar lordosis
251
Diabetic mother associations
TGA, TTN, small left colon, renal vein thrombosis, caudal regression syndrome
252
Intussusception reduction procedure
surgeon present, large bore needle available, large enema tip, up to 120 mmHg; up to 3 attempts up to 3 minutes each
253
High vs. low imperforate anus landmark
puborectalis sling
254
Physiologic jaundice of the newborn
unconjugated hyperbilirubinemia; note that conjugated hyperbilirubinemia is never normal
