CTC Paeds

Question 1

Copper beaten skull

Answer 1

Normal Convolutional markings posterior skull only

Seen with raised ICP: craniosynostoses, obstructive hydrocephalus

Question 2

Luckenschadel skull

Answer 2

Lacunar skull
Defective collagen development and ossification
Associated with chiari 2 and NTDs

Question 3

Lch skull

Answer 3

Bevelled edge, button sequestrum

Question 4

Wormian bones

Answer 4

Pork chop

Pyknodysostosis, OI, rickets, kinky hair syndrome, cleidocranial dysostosis, hypothyroid, hypophosphatasia, one too many 21st chromosomes, primary acro-osteolysis (hajdu-cheney)

Question 5

Neonatal scalp haemorrhages

Answer 5

Caput seccundaneum subcutaneous
Subgaleal haematoma can be large and life threatening
Cepahlohaematoma deep to periosteum wont cross suture lines

Question 6

Bessi

Answer 6

Benign enlarged subarachnoid spaces in infancy
Males, macrocephaly, frontal bossing, idiopathic ?immature vili, >5mm, cortical vein sign
Differentials hygroms/subdural - cortical veins adjacent to gyri

Question 7

PVL grading

Answer 7

1 - >7/7 periventicular echogenicity
2- small cysts
3-cysts extend frontal and occipital
4- subcortical

Dorsal and lateral to ventricles
Differenitials: flaring/blush

Question 8

Charge

Answer 8

Choanal atresia (different to pyriform aperture stenosis)
Heart defect
Atresia
Retarded growth
Gu abnormalities
Ear anomalies

Question 9

Paeds nose congenital

Answer 9

Via foramen caecum:
Nasal dermal sinus/dermoid/epidermoid
Nasal encaphalocoele
Nasal glioma

Similar is lacrimal duct obstruction: dacrocystocoele/dacrocystitis

Question 10

Branchial cleft cysts

Answer 10

1. 95%. Between pharyngeal mucosa and skin. Tract passes between eca/Ica, post to smg, anterior to scm, below angle mandible
2. 7%. Parotid or external auditory canal
3. Rare. Posterior to SCM in posterior triangle. Tract passes posterior to carotids between CN 9 and 12
4. Rare. Along course recurrent laryngeal nerve. Adjacent to thyroid

Question 11

Lemierres

Answer 11

Look for pulmonary emboli. Fusobacterium necrophorum

Question 12

Paeds airway infection

Answer 12

Croup - parainfluenza
Epiglottitis - h influenza
Exudative tracheiitis - staph

Differentials:
Subglottic haemangioma - unilateral. 7% phaces (posterior fossa, haemangiomas, arterial anomalies, coarctation aorta, eye abnormalities, sternal cleft/supraumbilical raphe)
Papilloma

Question 13

Paeds mediastinal masses

Answer 13

Anterior: thymus, thymic rebound, gct, hodgkin lymphoma
Middle: nodes, lymphoma, bronchogenic or enteric duplication cyst
Posterior: GG-GN-NB, neurenteric duplication cyst, extramedullar haematopoiesis

Question 14

Vascular oesophageal impressions

Answer 14

Anterior: sling
Posterior: double arch, abberant subclavian (double arch alse anterior tracheal impression)
Anterior tracheal alone - innominate artery compression

Double arch most common symptomatic ring, r arch with alsca most common ring

Question 15

Proximal neonatal bowel obstruction

Answer 15

Duodenal atresia/web/annular pancreas
Malrotation with volvulus
Jejunal atresia
Hypertrophic pyloric stenosis

Question 16

Distal bowel obstruction

Answer 16

Ileal atresia, meconium ileus - microcolon (also total colonic aganglionosis)
Colonic atresia - short microcolon
Calibre change - hirschsprungs, meconium plug
Imperforate anus

Question 17

Older child obstruction

Answer 17

Appendicits, adhesions
Inguinal hernia, intussusception (HSP, meckel, enteric duplication)
Meckels, malrotation - midgut volvulus or ladds bands

Question 18

Pentalogy of cantrell

Answer 18

Oompahlocoele, ectopia cordis, sternal and pericardial defect, diaphragmatic defect, CHD - asd/vsd/tof

Question 19

Choledochal cysts

Answer 19

F4:m1
Associated biliary atresia and hepatic fibrosis

Tondani
T1 90% - extrahepatic
2- extrahepatic diverticulum
3-choledococoele
4-intra and extrahepatic
5-intrahepatic/caroli

Get stones and cholangiocarcinoma

Question 20

Isomerism/heterotaxy

Answer 20

Situs solitus - normal
Situs inversus - mirrored - kartageners
Situs ambiguous:
Right sided isomerism/heterotaxy: cyanotic CHD, bilateral eparterial bronchi and trilobed lungs/minor fissures, revered aorta/ivc, asplenia
Left sided: bilateral bilobed lungs/no minor fissures/hyparterial bronchi, polysplenia, azygos continuation IVC, biliary atresia

Question 21

Vesicoureteric reflux grading

Answer 21

1-reflux into ureter
2-refluc to renal pelvis, no dilatation
3-mild dilatation ureter and calcyces
4-tortuous dilated ureter blunted calyces
5-tortuous severe dilatation, loss of fornices

Question 22

Wilms vs neuroblastoma

Answer 22

Wilms:
Around age 4, <10% calcify, invades vessels, circumscribed, mets to lung

Neuroblastoma:
Age <2, 90% calcify, encases vessels, poor;y marginated, mets to bones

Question 23

Periosteal reaction newborn

Answer 23

Rubella (celery stalk), syphilis (wimberger corner)
Physiologic - 1-6/12, not flat bones, medial tibia
Caffey - <6 months, bearded infant
Prostaglandins
Neuroblastoma
NAI

Older:
LCH
Osteomyelitis

Question 24

Vertebra plana

Answer 24

Infection, mets/myeloma, eg, lymphoma, tb/trauma

Question 25

Posterior vertebral scalloping

Answer 25

Spinal cord tumour
Achondroplasia
Loeys dietz
Marfans, mucopolysaccharoidoses
Oi
Nf1

Question 26

Gorlin goltz

Answer 26

Okc, bcc
Falx calcification
Bifid ribs
Medulloblastoma

Question 27

Oi types

Answer 27

1- mild, blue sclera, normal stature, 1a dentogenesis imperfecta
2-perinatal lethal
3-progressive deforming, multiple fracturesin infancy, short, blue sclera
4-moderate severe somewhere between 1 and 3. Sclera may be white
5-calcification iom

Question 28

Klippel feil

Answer 28

Vertebral fusion, hemivertebrae, sprengel, short neck low hairline

Question 29

Lucent metaphyseal band

Answer 29

Leukaemia, infection, neuroblastoma met, endocrine-rickets, scurvy