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FRCR 2a Flashcards > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Lymphoma staging:

A

Lugano classification:

Stage I - One node/group of node.
Stage 1e - One extra-lymphatic site only (i.e. hepatic lymphoma, small bowel lymphoma WITHOUT nodal disease)

Stage II - two nodal groups on SAME side of diaphragm
Stage IIe - extralymphatic spread from a node

Stage III - nodes both sides of the diaphragm

Stage IV - nodal and separate extra nodal disease/ multiple extra nodal disease

A - absence of symptoms
B - presence of symptoms

Bulky - Single nodal mass >10cm, or 1/3 of thoracic diameter

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2
Q

What is VACTERL?

A

Conditions that are commonly seen together

V - Vertebreal anaomalies
A - Anal (imperforate anus 63%)
C - Cardiac
TE - Tracheoesophageal fistula
R - Renal
L - Limb (radial ray 58%)

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3
Q

Li Fraumeni syndrome - associated cancers

A

SCAB

Sarcomas - Osteosarcoma, Rhabdos
CNS tumours - glioma
Adrenal cortical tumours
Breast cancer

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4
Q

What are the diagnostic measurements for pyloric stenosis?

A

Pyloric length - >15mm
Transverse diameter - >12mm
Pyloric thickness - >3mm

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5
Q

What are the signs for congenial biliary atresia on USS?

A

Triangular cord sign - echogenic fibrous tissue adjacent to the portal vein

Absent gall bladder

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6
Q

What does double bubble sign suggest?

A

Duodenal dilatation.
Causes include: duodenal web, atresia, stenosis, annular pancreas

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7
Q

What is a leptomeningeal cyst?

A

Leptomeninges herniate through a skull fracture.
The fracture grows overtime as the CSF pulsates within the meninges

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8
Q

What is the most common cause of macrocephaly?

A

BESSI
Benign enlargement of the subarachnoid space in infancy

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9
Q

What is periventricular leukomalacia?

A

Ischaemia secondary to birthing.

Early - periventricular necrosis
Late - periventricular cyst formation

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10
Q

What is the grading for germinal matrix haemorrhage?

A
  1. Blood in caudo thalamic groove
  2. Blood in ventricles no dilatation.
  3. Blood in ventricles with dilation.
  4. Blood in brain parenchyma
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11
Q

What is pyriform aperture stenosis associated with?

A

Midline developmental problems.

Holoprocencephaly
Pituitary dysfunction
Central mega incisor.

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12
Q

Classic imaging appearances of a branchial cleft cyst?

A

Second arch cyst is most common

Cyst at level of angle of mandible
Lateral to the submandibular gland
Between the internal and external carotid arteries

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13
Q

How do you treat infantile haemangiomas?

A

Beta blockers

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14
Q

Classic imaging features of a cystic hygroma and what are its associations?

A

Lymphatic malformations
Cystic mass in the posterior triangle of the neck
Associated with Turners disease and Downs

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15
Q

Classic imaging features of Fibromatosis coli?

A

Torticollis
Enlarged sternocleidomastoid.

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16
Q

Average age for Croup and what infection causes it?

A

6mnths to 1 year
Parainfluenza virus

(Epiglottitis is 3-6 year, H. influenza)

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17
Q

Average age for epiglottitis and what infection causes it?

A

3-6 years old.
H. influenza.

(Croup is 6-12 months and parainfluenza virus).

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18
Q

Classic imaging appearance of meconium aspiration?

A

Asymmetric “ropy” lung densities.
Hyperinflation.
Pneumothorax

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19
Q

Classic imaging appearance of TTN?

A

Classic history of C-section, maternal diabetes.

Course interstitial markings
Fluid in the fissures

Findings peak at day one, and disappear by day 3.

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20
Q

Classic imaging appearance of RDS?

A

Pre term
Reduced lung volume
Bilateral diffuse ground glass (granular) opacities.

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21
Q

What is neonatal pneumonia classically caused by?

A

Group b Strep

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22
Q

What is pulmonary interstitial emphysema?

A

Ventilator pressure associated.
Cystic / linear radio lucencies with hyperinflation.
Sign of impending pneumothorax.

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23
Q

Classic imaging appearance of CPAM?

A

Multicystic lesion
Can communicate with the airway and can be filled with air

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24
Q

How can you differentiate between CPAM and sequestration?

A

Sequestration has a systemic feeding artery.
Sequestration typically left lower lobe.

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25
Q

What is the most common primary lung malignancy in children?

A

Pleuro pulmonary blastoma.

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26
Q

Correct positions for UVC and UAC?

A

UVC - atriocaval junction
UAC - initially travels inferiorly, then turns superiorly, with tip ending at T7

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27
Q

What is Swyer James syndrome?

A

Unilateral small hyperlucent lung due to air trapping, from post infective obliterative bronchiolitis.
Bronchiectasis of the affected lung.

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28
Q

What conditions are Kleinfelter disease associated with?

A

BCOG

Breast cancer
Choroid plexus cysts
Omphalocele
Germ cell tumours

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29
Q

How can you differentiate Ewing’s sarcoma from Pleuropulmonary blastoma?

A

Both present as massive thoracic masses.

Ewing’s destroys ribs.

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30
Q

What are the 5 types of tracheosophageal fistula?

A

A - isolated esophageal atresia
B - proximal fistula with distal atresia
C - distal fistula with proximal atresia
D - proximal and distal fistula
E - H type, isolated fistula

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31
Q

What are the different diagnosis for short microcolon vs long microcolon?

A

Short microcolon - colonic atresia
Long microcolon - meconium ileus (CF patients), ileal atresia

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32
Q

Classic imaging appearance for hirshsprungs disease?

A

Small calibre rectum when compared with sigmoid.
Can have sawtooth appearance (spasm)

33
Q

Difference between Gastroschisis and Omphalocele?

A

Omphalocele surrounded by membrane
Gastroschisis is on the right of midline
Omphalocele can contain other organs

34
Q

Which isomerism is polysplenia associated with?

A

Left isomerism

35
Q

Where do the upper and lower pole ureters insert with duplex kidney?

A

Upper pole inserts lower
Lower pole inserts higher

Upper pole obstructs (upstructs)
Lower pole refluxes

36
Q

What are the five grades for vesico ureteric reflux?

A

1- halfway up the ureter
2 - reflex into non-dilated collecting system
3 - reflex into dilated collecting system
4 - mildly tortuous ureter
5 - very tortuous ureter

37
Q

What is Beckwith Wiedermann associated with?

A

WHO?

Wilms
Hepatoblastoma
Omphalocele

38
Q

Classic imaging appearance of multilocular cystic nephroma?

A

Fluid filled locules that protrude into the renal pelvis

39
Q

How do you differentiate neuroblastoma Vs Wilms?

A

Neuroblastoma - Encases vessels, calcifies, mets to bone
Wilms - displaces/invades vessels, rarely calcifies, mets to lung

40
Q

Classic imaging appearance of Torsion of the testicular appendage?

A

Blue dot sign

41
Q

What is the normal alpha angle used for?

A

DDH
>60⁰

42
Q

How do you define recurrent UTI?

A

3 or more episodes of lower UTI
1 episode lower UTI + 1 pyelonephritis
2 episodes of pyelonephritis

43
Q

When should children have an USS scan for UTI?

A
  • Younger than 6 months
  • Recurrent UTI
  • Atypical UTI
44
Q

When should children have a DSMA scan for UTI?

A

Younger than 3 with recurrent or atypical UTI
Older than 3 with recurrent UTI

Perform the DSMA scan 4-6 months post UTI

45
Q

When should a MCUG be performed for UTI?

A

Younger than 6 months with atypical or recurrent UTI
Between 6 months and 3 years if hydronephrosis on USS, NON Ecoli infection, reduced urine flow

46
Q

What is a skeletal survey comprised of?

A

AP chest and abdomen
Ribs view (obliques)
Lateral spine
Upper and lower limbs

47
Q

When is a CT head added to the skeletal survey?

A

All children under 1 year
All children with neurology

48
Q

What is McCune Albright syndrome?

A

Polyostotic fibrous dysplasia
Cafe au lait spots
Precocious puberty

49
Q

What paediatric tumours commonly metastasise to the lungs?

A

Ewing’s sarcoma
Osteosarcoma
Rhabdomyosarcoma
Wilms

50
Q

What age group is intralobar Vs extralobar sequestration seen in?

A

Intralobar seen in older kids with recurrent infections

Extralobar seen in younger kids with comorbidities

51
Q

How to differentiate Multicystic dysplastic kidney from AR-PKD?

A

AR-PKD is bilateral
Multicystic dysplastic kidney is unilateral, associated with VUR

52
Q

What is a hepatic mesenchymal hamartoma and how do you differentiate it from hepatoblastoma?

A

Large benign septate cystic mass in the liver.

Hepatoblastoma raises AFP.

53
Q

Most common solid renal tumor of INFANCY?

A

Mesoblastic nephroma

Wilms is more common in childhood

54
Q

What is interrupted aortic arch syndrome?

A

Separation between the ascending and descending thoracic aorta.

Requires for survival:
- Large VSD
- Patent ductus arteriosus.

Different types depending on where the separation occurs.
Most common is type B, between left common carotid and left subclavian

55
Q

How does Kawasaki’s disease present?

A

Medium vessel vasculitis.

Strawberry tongue
Erythema and lip cracking
Bilateral conjunctivitis
Cervical lymphadenopathy
Rash

56
Q

Most concerning morbidity with Kawasaki’s disease?

A

Coronary artery aneurysm

57
Q

Most common heart disease in Patau syndrome?

A

Hypoplastic left heart syndrome
+
VSD

58
Q

What is scimitar syndrome?

A

Partial anomalous pulmonary venous return
+
Pulmonary hypoplasia

59
Q

How to differentiate toxoplasmosis Vs cytomegalovirus in utero infection on cranial USS

A

Calcification

Toxoplasmosis - randomly distributed
Cytomegalovirus - periventricular distribution

60
Q

How does osteogenesis imperfecta present clinically?

A

Blue sclera
Hearing impairment
Osteoporosis

61
Q

How is SUFE assessed?

A

Ap and frog leg plain films

62
Q

Radiographic features of SUFE

A

AP and frog leg views

AP view - line of Klein does not intersect the epiphysis

Frogs leg - epiphysis slipped posterior-medially

63
Q

How does Klinefelter syndrome typically present?

A

Post pubertal bilateral small volume testes.
Sub fertility
Gynaecomastia

Increased risk of:
- Breast cancer
- Choroid plexus cyst
- Omphalocele
- Germ cell tumour

64
Q

X-ray sign of Croup

A

Wine bottle sign - Narrowing of the subglottic airway

65
Q

Most specific injuries for NAI

A

Skull, spine, scapular, limbs

  • Non parietal skull fractures
  • Posterior rib fractures
  • Scapula fractures
  • Corner fractures of metaphysis
66
Q

Most common congenital cardiac abnormality?

A

VSD

67
Q

Most common type of tracheoesophageal fistula?

A

Type 3.

Proximal atresia with distal fistula.

68
Q

Imaging features of Gaucher’s disease?

A

Massive splenomegaly
Hepatomegaly

Bone infarcts
Pathological #s
Erlenmeyer flask deformity

69
Q

What side is Bochdalek hernia on?

A

Left

BochdaLek - Left
MoRgagni - Right

70
Q

Annular pancreas associations?

A

Oesophageal / duodenal atresia
Tracheoesophageal fistula
Downs syndrome

71
Q

Classic appearance of Klippel Feil syndrome?

A

Short neck, low hairline.
Scoliosis
Sprengle deformity
Vertebral fusion

72
Q

What is a torus fracture?

A

Buckle fracture
I.e. from compressive forces

73
Q

What is a greenstick fracture?

A

Cortical disruption on one side of the bone, from bending forces

74
Q

Most common cause for failure to pass meconium?

A

Meconium plug syndrome

75
Q

Most common association with right sided aortic arch?

A

Tetralogy of Fallot

76
Q

What is bronchopulmonary dysplasia?

A

Chronic lung disease of the newborn

Typically ventilator associated, causing hyperinflation and reticular opacities.

77
Q

What is a toddler’s fracture?

A

Spiral fracture of the tibia

78
Q

What is Ebstein anomaly associated with?

A

Turner’s
Downs
ASD

79
Q

What is associated with CPAM?

A

Renal agenesis
Pleuropulmonary blastoma
Mucinous adenocarcinoma

FRCR 2a Flashcards (11 decks)

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