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Part2b > DDX PEDI > Flashcards

DDX PEDI Flashcards

1
Q

Retarded Skeletal Maturation

A

Chronic disease
- cyanotic heart, renal, IBD, Rickets, Malnutrition

Endocrine
- hypothyroid, Steroid, hypogonadism, hypopituitarism

Congenital
- chromosomal (21, 18), skeletall dysplasia of the epiphyses

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2
Q

Premature closure of growth plate

A

Local hyperemia - JIA, infection, hemophilia
Trauma - Salter harris
Vascular occlusion - sickle cell, infarcts
Radiotherapy

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3
Q

Hemihypertrophy

A

Vascular

  • Parkes Weber Syndrome (fast flow vascular malfmration, port wine stain, limb overgrowth)
  • Klippel Trenaunay Syndrome (anomalous veins, port wine, limb overgrowth)
  • Capillary malformation

Chronic hyperemia - JIA, hemophilia

Hemihypertrophy - Beckwidth Weiderman

NF1

Macrodysophia lipomatosa - bony and fatty overgrowth of digits

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4
Q

Localized atrophy

A

Paralysis

Radiation treatment

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5
Q

Skeletal dysplasia (metaphyseal)

A

Achondroplasia

Metaphyseal chondrodysplasias

  • Jansen - ricket let changes
  • McKusick - immune defficeincy, hematatological
  • Shwachman Diamond - pancreatic insufficiency
  • Jeune - short rib, irregular costocondral junction
  • Ellis Van Crevald - short ribs, congential heart, polydactyl
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6
Q

Skeletal Dysplasia (epiphyseal)

A

Multiple epiphyseal dysplasias

  • irregular epiphyseal ossification (round, flat)
  • mild short stature
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7
Q

Lethal Neonatal Dysplasia

A

Thanotophoric
- short ribs, severe platyspondylyl, small iliac wings, curved femora and humeri

OI type 2
- numerous fractures

Achondrogenesis
- absent ossification

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8
Q

Dyostosis Multiplex

A

Mucopolysaccharidoses

  • abnormal bone texture
  • large skull vault, calvarial thickening
  • J shaped sella
  • odontoid hypoplasia + AA subluxation
  • anterior beak of upper lumbar vertebrae
  • inferior tapering of iliac bones, steep acetabulua
  • widened idaphyses (oar shaped ribs/clavicle)
  • tilting of distal radius and ulnar towards each other
  • pointy of proximal ends of metacarpals
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9
Q

Generalized increased bone density (pediatrics)

A

DYSPLASIA
Osteopetrosis
- bone in bone, rugger jersey

Pyknodysostosis
- short, hypoplastic lateral clavicle, hypoplastic terminal phalanges

Dysosteosclerosis
- undertubulation of long bones

Camurati-Englemann
- diffuse symetrical cortical thickening of diaphyses of long bones

Melorheostosis

  • undulating periosteal hyperostosis
  • along single limb, along sclerodermal distribution

METABOLIC
Renal osteodystrophy

POISONING

  • Lead - Dense metapyseal bands, erlenmeyer flask
  • Flurosis - thickened cortex, periosteal reaction, ossification of ligaments
  • Hypervitaminosis D - Dense metapyseal bands. Soft tissue calcification
  • Chronic hypervitaminosis A - cortical thickening. Not affect mandible

IDIOPATHIC
- Caffeys

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10
Q

Paediatric Tumour that metastasise to bone

A 
Neuroblastoma
Leukemia
Lymphoma
Renal clear cell sarcoma
Rhabnomyosarcoma
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11
Q

Moth Eaten Bone (pediatrics)

A 
Neuroblastoma met
Leukemia
Long bone sarcoma
Lymphoma
LCH
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12
Q

Periosteal Reaction (child, bilateral, symmetrical)

A

Normal

Juvenile idiopathic arthritis - usually at periarticular

Acute leukemia
- prominent metapyseal bone resorption, calcification at zone of provisional calcification

Rickets
Caffey’s 
Scurvey
Prostaglandin therapy
Congenital Syphilis
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13
Q

Syndromes featuring multiple fractures

A

REDUCED BONE DENSITY
OI
Rickets/hypophosphateasia

NORMAL BONE DENSITY
cleidocranial dysplasia
FD

INCREASED BONE DENSITY
Osteopetrosis
Pyknodysostosis

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14
Q

Pseudoarthrosis (pediatrics)

A

Non-union of fracture
Congenital
NF
OI

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15
Q

Bone within bone (pediatrics)

A

Normal
Growth arrest
Bisophosphonate Therapy
Osteopetrosis

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16
Q

Irregular or Stippled Epiphysis

A

Normal

AVN

Congenital hypothyroidism
- can be granular to fragmented

Morquio
- femoral capital epiphyses

Multiple epiphyseal dysplasia

Meyer Dysplasia
- similar to multiple epiphyseal dysplasia but only to femoral head

Chondrodysplasia Punctata

  • punctate calcification, resolve over time
  • causes - genetic/maternal (connective tissue, vit K def, warfarin)
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17
Q

Solitary Radiolucent Band

A 
Normal 
Severe disease
Metaphyseal fracture 
Healing Rickets
Leukemia/lymphoma/neuroblastoma
Congential infection
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18
Q

Alternative Radiolucent/dense Metaphyseal Bands

A

Growth arrest lines (harris/park)
Bisphosphonate
Rickets
Osteopetrosis

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19
Q

Solitary dense metapyseal band

A

Normal
Lead poisoning (others - bismuth, arsenic, phosphorus, mercury)
Radiation
Congenital hypothyroidisim

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20
Q

Dense Vertical Metaphyseal Lines

A

Congenital Rubella
- celery stalk

Osteopathia striata
- with exostosis

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21
Q

Metaphyseal Fraying

A

Rickets

Hypophosphatasia

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22
Q

Erlenmeyer Flask

A

DYSPLASIA

  • osteopetrosis
  • craniotubular disorders (metaphyseal dysplasia, diaphyseal dysplasia)
  • others (otoplatodigital, Melnick Needls)

HEMAT
- Thalessemia

DEPOSITS

  • Gauchers
  • Neimann Pick

POISON
- lead

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23
Q

Focal Rib lesions (pediatrics)

A

Metastases (neuroblastoma)
Ewing
Benign - osteochondroma/enchondroma
LCH

Healed fracture
FD
Osteomyelitis

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24
Q

Widening of Pubic Symphysis

A

Trauma

Infection

Congenital
- bladder exstrophy

Cleidocranial dysplasia

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25
Q

Sheets Like calcification in Child

A

Fibrodysplasia ossificans progressiva
- short metacarpal and metatarsal

Juvenile dermatomyositis

26
Q

Platyspondyl in Childhood

uniform decrease distance between upper and lower vertebral endplates

A

CONGENITAL

  • thanotophoric - telephone handle
  • metatropic dwarfism - large disease space with preserved heat in infancy
  • OI

LATER CHILDHOOD
- Morquio

ACQUIRED
- Scheuermann
disc space narrowing, irregular enplates and schmorls nodes

  • LCH
    disc space preserved
  • OI
    multiple spinal fractures
  • Sickle Cell
27
Q

Anterior Beaking

A

Mucopolysaccharidoses
- morquio has platyspondyly

Achondroplasia

28
Q

Multifocal Bon Marrow Lesion on MRI

A

MALIGNANCIES
Metastases - neuroblastoma, leukemia/lymphoma, sarcoma
LCH

DYSPLASIA
Hereditary Multiple Osteochondromas
enchondromatosis
Polyostotic Fibrous Dysplasia

INFECTION
Osteomyelitis

TRAUMA
Multiple stress fracture
Multiple infarcts/AVN

29
Q

Soft Tissue Mass (pediatrics)

A 
VASCULAR
infantile hemangioma
AVM
venous malformation (pheboliths)
lymphatic malformation

FAT
Lipoma
Lipoblastoma - only seen in first 3 years of olife

FIBROUS
Rhabdomyosarcoma
Synovial sarcoma
- near the knee, calcification

MIMICS
Post-traumatic - contusion, fat necrosis, FB, cellulitis
Subcutaneous granuloma annulare
- extensor surface of extremeties

30
Q

Acute Upper Airway Obstruction (pediatrics)

A

Croup

  • 6mo to 3yo
  • narrowing of the glottic and subglottia
  • steepling

Acute epiglottis
- swollen supraglottic region

Abscess

Edema

31
Q

Chronic upper airway obstruction (pediatrics

A

NASAL
Choanal atresia
Juvenile nasopharyngeal angiofibroma

SUPRAGLOTTIC
Enlarged tonsils/adenonoids
Larygnomalacia

GLOTTIC
Laryngeal polyps

SUBGLOTTIC
tracheamalacia
- primary - prematurity, chondroid disorder (polychondritis/muco)
- secondary - intbuation, vascular ring, tumour

Vascular ring
- double aortic arch, pulmonary sling, anomalous subclavian

Prolonged inflammation
External compression

32
Q

Neonatal Respiratory Distress

A

NO SHIFT
RDS
- granular pattern, air bronchograms
- small lungs

TTN
- small effusion, resolves in 2-3days

MAS

  • term and post-term
  • hyperinflation
  • pneumothorax and pleural effusion

SHIFT AWAY
Diaphragmatic hernia
- more on the left

Congenital Lobar Overinflation / emphysema
- LUL>RML>RUL

Congenital pulmonary airway malformation (CPAM)
- lucencies of various sizes

Pneumothorax
- sharp heart border, deep lateral sulcus

Pleural fluids
- effusion, chylothorax (noonan, Turner)

SHIFT TOWARDS
Atelectases

OTHERS
Cardiac - congenital heart
Cerebral - hemorrhage, edema

33
Q

Ring Shadows in a Child

A

Diaphragmatic hernia

PIE
- secondary to ventilator

CPAM

  • type 1/4 (at least on cyst >2cm)
  • type 2 (all cysts < 2cm)
  • type 3 (microcystic and is solid)

Bronchopulmonary dysplasia
- bubbly lung appearances

OLDER
Bronchiectases

Pneumatocele

Respiratory Papillomatosis

34
Q

Anterior Mediastinal Mass (pedi)

A

CONGENITAL
Normal thymus

NEOPLASTIC
Lymphoma and leukemia
- Hodgkin in >10yo, NHL in all ages
- NHL - involve lungs, and tracheal compression

GCT
- benign terratoma, yolk sac tumour

Thymic Cyst
- congenital, or in children with LCH, HIV/EBV

Thymolipoma

INFLAMMATORY
Lymph nodes

35
Q

Middle Mediastinal Mass (pedi)

A

Neoplastic - usually from anterior

INFLAMMATORY - lymph nodes

CONGENITAL
Bronchogenic cyst
- can have communication with trachea (infection)
- common at the carina

Esophageal duplication cyst

  • can contain gastric mucosa
  • usually right of midline, and the upper 1/3
  • rarely communicate with esophageal lumen

Neruenteric
- R>L, vertebral body anomalies superior to it

36
Q

Posterior Mediastinal Mass (Pedi)

A

NEOPLASTIC
Ganglion cell tumour
- neuroblastoma, ganglioneuroblastoma, ganglioneuroma

Nerve Sheath Tumour
- schwannoma, neurofibroma, malignant peripheral nerve sheath tumour

CONGENITAL
Bochdalek hernia

Extramedullary hematopoesis

37
Q

Solitary pulmonary mass (pedi)

A

PSEUDOMASS
Round pneumonia - air bronchograms
Encysted pleural effusion

NON-NEOPLASTIC
Sequestration (systemic arteiral supply)
- intralobular - most common, lower lobes (L>R), pulmonary drainage, recurrent infections
- extralobular - own pleural covering, systemic venous drainage

Bronchogenic cysts
CPAM
- types 1/2 = fluid filled at birth, then becomes air filled
- types III = microcystic and is solid

Granuloma
Pulmonary AVM
Bochdalek hernia

NEOPLASTIC
Mets - most common wilms or sarcoma
Neuroendocrine - carcinoids (usually endobronchial)
Pleuropulmonary blastoma

BENIGN
Inflammatory myofibroblastic tumour - similar to inflammatory pseudotumour
Harmatoma

38
Q

Multiple Lung Nodules (pedi)

A 
BENIGN 
Miliary TB
Septic emboli
Wegeners
Respiratory papillomatosis 
Prior varicella 
Multiple AVM

MALIGNANT
Mets - wilm’s and sarcomas
Lymphoma / PTLD

39
Q

Viceral Situs

A

Situs inversus
- complete switched position

Left atrial isomerism
- double left side, bilobed lungs, polysplenia, azygous continuation of IVC

Right atrial isomerism
- double right, triloed lungs, asplenia, double IVC, more severe cardiac/extracardiac malformation

40
Q

Congenital Heart (Plethoria)

A

ACYANOTIC
Shunts
- VSD, ASD, AVSD, APW

Cyanotic

  • dTGA
  • TAPVD
  • Truncus
  • Hypoplastic left
  • Single ventricles
41
Q

Congenital Heart (oligemic or normal)

A 
CYANOTIC
Tetralogy
Ebstein’s 
Triccuspiad atresia
Pulmonary atresia

ACYANOTIC
Aortic stenosis
Coarctation
Pulmonary stenosis

42
Q

ABDOMINAL MASS (pedi)

A

Renal

  • Renal tumous
  • Hydronephrosis
  • Cysts

Non-renal retroperitoneal

  • Neuroblastoma
  • Lymphoma
  • Germ cell tumour

GI

  • appendix
  • hepatoblastoma
  • hemangioma

Genital
- Ovarian cysts/terratoma

43
Q

Abdominal cyst (neonate)

A

Ovarian
Bowel - enteric duplication, mesenteric cysts
Renal - hydronephrosis, multicystic dysplastic kidney, PKD
Liver - choledocal cyst, hydatid cyst, mesenchymal harmatoma

44
Q

IO (pedi)

A

HIGH
duodenal atresia/stenosis/web
- double bubble
- windsock (web)

malrotation and volvulus

  • duodenal loop terminate to right and below the left pedicle at same level of duodenal cap
  • corckscrew jejunum in volvlus

malrotation with obstructing ladd’s band
- ladds band connect cecum to right posterolateral wall

Jejunal atresia

LOW
Meconium Ileus
- soap bubble, peritoneal calcification, microcolon

Hirshsprung

  • reverse rectosigmoid ratio, serrated corckscrew rectum
  • small colon leading to transition to dilated colon on barium

Ileal atresa
Incaerarated inguinal hernia
Small left colon sydnrome

Meconium plug

Inspissated milk
- 3 days to 6 weeks, resolve spontaneously

Colonic atresia

Anorectal malformation
- currarino triad - anorectal malformation, sacral dysgensis and sacrococcyeal terratoma

45
Q

Hepatic mass (children)

A 
MALIGNANT
metastases - neuroblastoma and wilms
hepatoblastoma 
- calcificaiton, hemorrhage, necrosis
- beckwith weiderman, hemihypertrophy, FAP
HCC
- chronic liver disease
BENIGN
infantile hepatic hemangioma
- cardiac failure, hepatomegaly, consuptive coagulopathy
mesenchymal harmatoma 
- cystic or stromal swiss chesse

OTHERS
Cysts
Focal nodular hyperplasia
Abscess

46
Q

Jaundice (infancy)

A 
Neonatal cholestasis
Hemolytic anemia
Biliary atresia
- type 1 CBD
- type 2a CHD
- type 2b CHD, CBD, cystic
- type 3 all extrahepatic ducts
- prominent hepatic artery, gallbladder ghost, triangular cord

Neonatal hepatitis

Choledocal cyst

47
Q

Adrenal mass (childhood)

A

NEOPLASTIC
Medullary
- neuroblastoma/ganglioneuroblastoma/ganglioneuroma
- pheo

Cortical
- adrenocortical

NON-NEOPLASTIC
Hyperplasia
Hemorrhage

48
Q

Primary Renal Neoplasms

A

Wilm’s
- low enhancement, with enhacning “claw” sign of renal parenchyma, necrosis

Nephroblastomatosis
- potential to become Wilms, nonenhancing

Congenital mesoblastic nephroma
- solid renal tumour of the newborn

Multilocular cystic nephroma
- multiple cysts, does not affect whole kidney (unlikel MDK)

AML

Clear cell sarcoma / Rhabdoid tumour
- similar to Wilm’s

49
Q

Hydronephrosis (in a child)

A

PUJ obstruction
- L>R

Primary vesicoureteric reflux without obstruction

VUJ obstruction
- bladder hypertrophy/nerogenic bladder, or obsturctive ureterocele

Primary megaureter
- due to atony

Bladder outflow obstruction
- posterior urethral valves

50
Q

Bladder outflow obstruction

A

Vesical diverticulum

Bladder neck obstruction - ectopic ureterocele

Posterior urethral valve

51
Q

Vesicoureteric Reflux

A

Simple congential reflux

Duplex kidney

Hutch diverticulum - bladder diverticulum

Cystitis

Neurogenic Bbladder

Uretheral obstruction

52
Q

Retinoblastoma (DDX)

A

Persistent Hyperplastic Primary Vitreous
- small eye, at birth

Coats Disease
- 4-8yo, retinal detachment

Retinopathy of prematurity
- small eyes

Toxo
- small eyes

53
Q

Neck Masses in Children

A

Lymphovascular malformation

Cysts

  • thyroglossal
  • branchial cleft
  • Lingual / ranula

lymph nodes

Malignancies - lymphoma, neuroblastoma, rhabdomyosarcoma, LCH

Benign - lipoma, neurofibroma

Fibromatosis Coli

54
Q

Young Stroke

A

Emboli

Arterial Wall

  • Dissection - traumatic/marfan
  • vasculitis - moyamoya, FMD, NF1, Kawasaki, SLE, sarcoid

RCVS - reversible cerebral vasoconstriction syndrome

  • vasospasm, watershed infarcts
  • pregnancy, drugs, migraine

Venous thrombosis

Infection - meningitis

Blood disorders - sickle cell, polycythemia, antiphospholipid

MELAS

55
Q

Widened Sutures

>10 mm at birth, >3mm at 2yo, >2mm at 3yo

A

Increased ICP
Infiltration of sutures - neuroblastoma/leukemia/lymphoma
Metabolic - rickets, lead,
Trauma

56
Q

Multiple wormian bones

A 
PORKCHOPS
pyknodysotosis
OI
Rickets
Kinky hair
Cleidocranial dysplasia
Hypothyroidsm
otopalatodigital syndrome
Pachydermoperiostosis, Progeria
sydnrome of down
57
Q

Craniosynostosis

A 
PRIMARY
Sagital - scaphocephaly
Unilateral coronal - plagiocephaly
Bilateral coronal - barchycephaly
Metopic - trigoncephaly
Cloverleaf - trilobular skull

SYDNROMAL
Acrocephalosyndactylies
- Apert, Carpenter, Pfeiffer
- Crouzon - with no syndactyl

SECONDARY

  • brain damage
  • iatrogenic
  • metabolic - rickets, hyperthryoidism
  • Inborn errors - Hurler/morquio
  • hematological - sickle cell and thalassesmia
58
Q

Cystic lesion on cranial US (pedi)

A

VARIANTS
Coarctation of lateral ventricles
Cavum septum pellucidum

INFRATENTORIAL
Mega cisterna agna
Dandy walker malformation
Arachnoid cyst

SUPRATENTORIAL
Subependymal cyst
- near caudothalamic notch, likely due to germinal matrix hemorrhage

Choroid plexus cyst

Cystic periventricular leukomalacia

  • white matter necrosis in preterm
  • hyperechoic lesions at the dorsal nd lateral aspect of lateral ventricles, becoming cysts

Porencephalic cyst
- cyst due to hemorrhage/infection, communicating with the ventricles

Arachoind cyst

Vein of Galen malformation

59
Q

Disorder of neuronal migration

A

Agyria-pachygyria

  • poorly formed gyri
  • severe = lissencephaly
  • type 1 lissencephaly - small brain, smooth gyri (figure of 8)
  • type 2 lissencephaly - smooth cobblestone cortex, cerebellar hypoplasia, hydrocephalus

Polymicrogyria

  • neurons reach cortext, but abnormally distributed
  • multiple small bumps
  • usually localized
  • underlying white matter increased T2 signal

Schizencephaly

Heterotopic grey matter

Cortical dysplasia
- focal disorganization, similar to focal pachygyria

60
Q

Supratentorial tumours (pedi)

A

Astrocytoma

  • associated with NF1
  • solid + necrosis center OR cystic with mural nodule

Craniopharyngioma
- partially calcified, suprasella

Optic pathway glioma
- NF1, solid enhanceing tumour

Giant cell SEGA
- at the foramen of monroe

Germ cell tumour

61
Q

Infratentorial Tumurs (pedi)

A

Astrocytoma

Medulloblastoma

  • most at vermis
  • restricted diffusion, with drop metastases

Ependymoma

  • floour of rhte fourth
  • calcification, extention through foramen

Brainstem glioma

  • insidious onset
  • subtypes - medullary, pontine, mesencephalic, NF1 associated
  • most common at pons, minimal enhancement

Atypical teratoid/rhabdoid (ATRT)
- less than 3yo

62
Q

Intraventricular mass (pedi)

A

LATERAL
Chroid plexus papilloma/carcinoma

MONROE
subependymal giant cell astrocytoma

THIRD
craniopharyngioma

FOURTH
medulloblastoma
Epednymoma

CYSTIC
Choroid plexus xanthogranuloma
- usually at the trigone

Colloid cyst
- at the third ventricle

Part2b (2 decks)

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