Paediatrics Flashcards
Lymphoma staging:
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
What is VACTERL?
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%)
Li Fraumeni syndrome - associated cancers
SCAB
Sarcomas - Osteosarcoma, Rhabdos
CNS tumours - glioma
Adrenal cortical tumours
Breast cancer
What are the diagnostic measurements for pyloric stenosis?
Pyloric length - >15mm
Transverse diameter - >12mm
Pyloric thickness - >3mm
What are the signs for congenial biliary atresia on USS?
Triangular cord sign - echogenic fibrous tissue adjacent to the portal vein
Absent gall bladder
What does double bubble sign suggest?
Duodenal dilatation.
Causes include: duodenal web, atresia, stenosis, annular pancreas
What is a leptomeningeal cyst?
Leptomeninges herniate through a skull fracture.
The fracture grows overtime as the CSF pulsates within the meninges
What is the most common cause of macrocephaly?
BESSI
Benign enlargement of the subarachnoid space in infancy
What is periventricular leukomalacia?
Ischaemia secondary to birthing.
Early - periventricular necrosis
Late - periventricular cyst formation
What is the grading for germinal matrix haemorrhage?
- Blood in caudo thalamic groove
- Blood in ventricles no dilatation.
- Blood in ventricles with dilation.
- Blood in brain parenchyma
What is pyriform aperture stenosis associated with?
Midline developmental problems.
Holoprocencephaly
Pituitary dysfunction
Central mega incisor.
Classic imaging appearances of a branchial cleft cyst?
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
How do you treat infantile haemangiomas?
Beta blockers
Classic imaging features of a cystic hygroma and what are its associations?
Lymphatic malformations
Cystic mass in the posterior triangle of the neck
Associated with Turners disease and Downs
Classic imaging features of Fibromatosis coli?
Torticollis
Enlarged sternocleidomastoid.
Average age for Croup and what infection causes it?
6mnths to 1 year
Parainfluenza virus
(Epiglottitis is 3-6 year, H. influenza)
Average age for epiglottitis and what infection causes it?
3-6 years old.
H. influenza.
(Croup is 6-12 months and parainfluenza virus).
Classic imaging appearance of meconium aspiration?
Asymmetric “ropy” lung densities.
Hyperinflation.
Pneumothorax
Classic imaging appearance of TTN?
Classic history of C-section, maternal diabetes.
Course interstitial markings
Fluid in the fissures
Findings peak at day one, and disappear by day 3.
Classic imaging appearance of RDS?
Pre term
Reduced lung volume
Bilateral diffuse ground glass (granular) opacities.
What is neonatal pneumonia classically caused by?
Group b Strep
What is pulmonary interstitial emphysema?
Ventilator pressure associated.
Cystic / linear radio lucencies with hyperinflation.
Sign of impending pneumothorax.
Classic imaging appearance of CPAM?
Multicystic lesion
Can communicate with the airway and can be filled with air
How can you differentiate between CPAM and sequestration?
Sequestration has a systemic feeding artery.
Sequestration typically left lower lobe.
What is the most common primary lung malignancy in children?
Pleuro pulmonary blastoma.
Correct positions for UVC and UAC?
UVC - atriocaval junction
UAC - initially travels inferiorly, then turns superiorly, with tip ending at T7
What is Swyer James syndrome?
Unilateral small hyperlucent lung due to air trapping, from post infective obliterative bronchiolitis.
Bronchiectasis of the affected lung.
What conditions are Kleinfelter disease associated with?
BCOG
Breast cancer
Choroid plexus cysts
Omphalocele
Germ cell tumours
How can you differentiate Ewing’s sarcoma from Pleuropulmonary blastoma?
Both present as massive thoracic masses.
Ewing’s destroys ribs.
What are the 5 types of tracheosophageal fistula?
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
What are the different diagnosis for short microcolon vs long microcolon?
Short microcolon - colonic atresia
Long microcolon - meconium ileus (CF patients), ileal atresia
Classic imaging appearance for hirshsprungs disease?
Small calibre rectum when compared with sigmoid.
Can have sawtooth appearance (spasm)
Difference between Gastroschisis and Omphalocele?
Omphalocele surrounded by membrane
Gastroschisis is on the right of midline
Omphalocele can contain other organs
Which isomerism is polysplenia associated with?
Left isomerism
Where do the upper and lower pole ureters insert with duplex kidney?
Upper pole inserts lower
Lower pole inserts higher
Upper pole obstructs (upstructs)
Lower pole refluxes
What are the five grades for vesico ureteric reflux?
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
What is Beckwith Wiedermann associated with?
WHO?
Wilms
Hepatoblastoma
Omphalocele
Classic imaging appearance of multilocular cystic nephroma?
Fluid filled locules that protrude into the renal pelvis
How do you differentiate neuroblastoma Vs Wilms?
Neuroblastoma - Encases vessels, calcifies, mets to bone
Wilms - displaces/invades vessels, rarely calcifies, mets to lung
Classic imaging appearance of Torsion of the testicular appendage?
Blue dot sign
What is the normal alpha angle used for?
DDH
>60⁰
How do you define recurrent UTI?
3 or more episodes of lower UTI
1 episode lower UTI + 1 pyelonephritis
2 episodes of pyelonephritis
When should children have an USS scan for UTI?
- Younger than 6 months
- Recurrent UTI
- Atypical UTI
When should children have a DSMA scan for UTI?
Younger than 3 with recurrent or atypical UTI
Older than 3 with recurrent UTI
Perform the DSMA scan 4-6 months post UTI
When should a MCUG be performed for UTI?
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
What is a skeletal survey comprised of?
AP chest and abdomen
Ribs view (obliques)
Lateral spine
Upper and lower limbs
When is a CT head added to the skeletal survey?
All children under 1 year
All children with neurology
What is McCune Albright syndrome?
Polyostotic fibrous dysplasia
Cafe au lait spots
Precocious puberty
What paediatric tumours commonly metastasise to the lungs?
Ewing’s sarcoma
Osteosarcoma
Rhabdomyosarcoma
Wilms
What age group is intralobar Vs extralobar sequestration seen in?
Intralobar seen in older kids with recurrent infections
Extralobar seen in younger kids with comorbidities
How to differentiate Multicystic dysplastic kidney from AR-PKD?
AR-PKD is bilateral
Multicystic dysplastic kidney is unilateral, associated with VUR
What is a hepatic mesenchymal hamartoma and how do you differentiate it from hepatoblastoma?
Large benign septate cystic mass in the liver.
Hepatoblastoma raises AFP.
Most common solid renal tumor of INFANCY?
Mesoblastic nephroma
Wilms is more common in childhood
What is interrupted aortic arch syndrome?
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
How does Kawasaki’s disease present?
Medium vessel vasculitis.
Strawberry tongue
Erythema and lip cracking
Bilateral conjunctivitis
Cervical lymphadenopathy
Rash
Most concerning morbidity with Kawasaki’s disease?
Coronary artery aneurysm
Most common heart disease in Patau syndrome?
Hypoplastic left heart syndrome
+
VSD
What is scimitar syndrome?
Partial anomalous pulmonary venous return
+
Pulmonary hypoplasia
How to differentiate toxoplasmosis Vs cytomegalovirus in utero infection on cranial USS
Calcification
Toxoplasmosis - randomly distributed
Cytomegalovirus - periventricular distribution
How does osteogenesis imperfecta present clinically?
Blue sclera
Hearing impairment
Osteoporosis
How is SUFE assessed?
Ap and frog leg plain films
Radiographic features of SUFE
AP and frog leg views
AP view - line of Klein does not intersect the epiphysis
Frogs leg - epiphysis slipped posterior-medially
How does Klinefelter syndrome typically present?
Post pubertal bilateral small volume testes.
Sub fertility
Gynaecomastia
Increased risk of:
- Breast cancer
- Choroid plexus cyst
- Omphalocele
- Germ cell tumour
X-ray sign of Croup
Wine bottle sign - Narrowing of the subglottic airway
Most specific injuries for NAI
Skull, spine, scapular, limbs
- Non parietal skull fractures
- Posterior rib fractures
- Scapula fractures
- Corner fractures of metaphysis
Most common congenital cardiac abnormality?
VSD
Most common type of tracheoesophageal fistula?
Type 3.
Proximal atresia with distal fistula.
Imaging features of Gaucher’s disease?
Massive splenomegaly
Hepatomegaly
Bone infarcts
Pathological #s
Erlenmeyer flask deformity
What side is Bochdalek hernia on?
Left
BochdaLek - Left
MoRgagni - Right
Annular pancreas associations?
Oesophageal / duodenal atresia
Tracheoesophageal fistula
Downs syndrome
Classic appearance of Klippel Feil syndrome?
Short neck, low hairline.
Scoliosis
Sprengle deformity
Vertebral fusion
What is a torus fracture?
Buckle fracture
I.e. from compressive forces
What is a greenstick fracture?
Cortical disruption on one side of the bone, from bending forces
Most common cause for failure to pass meconium?
Meconium plug syndrome
Most common association with right sided aortic arch?
Tetralogy of Fallot
What is bronchopulmonary dysplasia?
Chronic lung disease of the newborn
Typically ventilator associated, causing hyperinflation and reticular opacities.
What is a toddler’s fracture?
Spiral fracture of the tibia
What is Ebstein anomaly associated with?
Turner’s
Downs
ASD
What is associated with CPAM?
Renal agenesis
Pleuropulmonary blastoma
Mucinous adenocarcinoma
