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Kim's > Paeds > Flashcards

Paeds Flashcards

1
Q

rhizomelic

A

short proximal limb skeletal dysplasia

Achondroplasia
osteogenesis imperfecta

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2
Q

Non rhizomelic dysplasias

A

multiple epiphyseal dysplasia. shortening femur and tibia. metaph flat and square. epiph delayed and fragmentated. double patella.

achondrogenesis. micromelia.

Pyle disease. metaphyseal dysplasia. flaring and ehlmyer flask of long bones.

cleidocranial dysplasia. frontal bossing, wormian bones, absent or dysplastic clavicles extra ribs, hemivert, short or absent fib and radius, short terminal phalages.

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3
Q

multiple fractures

bone density

A

increased. osteopetrosis or pyknodysostosis
normal. fiborous dysplasia
decreased. osteogenesis imperfecta, hypophosphataemia, cushings

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4
Q

Always think of

A

NAI, LCH, Lymphoma/Leukaemia, Infection

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5
Q

Nasal mass

A

Juvenile angio fibroma. 14yo, C+, expansile Antrachoanal polyp. starts max, through osteum to nasal space Rhabdomyosarcoma Venolymphatic malformation or haemangioma Encephalocele

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6
Q

Orophryngeal mass

A

Tonsil or adenoid hyperplasia Ectopic thyroid Lymphadenopathy Rhabdomyosarcoma Venolymphatic malformation or haemangioma

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7
Q

Endobronchial mass

A

FB, Carcinoid, Mucous, papilloma (solitary or Juvenile papillomatosis)

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8
Q

Bubbly lungs

A

PIE, BPD, CF, CPAM, Diaph hernia

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9
Q

Diffuse lung disease newborn - No mediastinal shift

A

Medical!! - Increased lung vol. × TTN. Present at birth. Term baby. looks like apo x Meconium aspiration. Post term. dirty lung. ptx,mtx x Neonatal pn. effusion, consolidation, fever x Pulm oedema x Pulm lymphangectasia - Decreased lung vol. x RDS. Preterm. GG change. Look for PV gas or NEC x beta haem strep pn. x Pulm hypoplasia - Other: Congen heart disease, Pulm haem, abnormal thoracic cage or abdo wall, cerebral cause, metabolic cause

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10
Q

Diffuse lung disease newborn - Mediastinal shift

A
  • Shift towards side abnormal: × Atelectesis × Pulm hypoplasia × Bronchial atresia - Shift away from side abnormal: × CPAM × Diaph hernia × Effusion × Congen lobar emphysema × Ptx
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11
Q

Lucent lesions lung

A

CLE, Diaph hernia, PIE/BPD, cavitation (pn. LCH or wegners), CPAM

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12
Q

Lung Mass child

A

Congenital. Sequestration, bronchopulm cyst, hypoplasia lung, CPAM or CLE fluid filled, AVM, Hamartoma Infection. Round pn. (most common), abscess, loculated effusion Neoplasia. Askin, Met (neuroblastoma, wilms, osteosarc, rhabdomyosarcoma), neuroblastoma, pleuropulmonary blastoma (<5yo)

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13
Q

which side is abnormal lung

A

Increased vascularity is usually the normal side Lucent lung is usually the abnormal side

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14
Q

Increased volume lung child

A

Bilateral. asthma, bronchiolitis Unilateral. FB, Mucous, CF plugging, Carcinoid, papilloma, pn (esp staph), ptx, scimitar, CLE, CPAM, extrinsic compression (LN, mass, Pulm sling) Swyer James. hyperlucent lung is small. >7yo)

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15
Q

Multiple lung nodules

A

Infection. septic emboli, Tb, fungus, viral Inflamm. Wegeners, LCH (cavitate) Neoplasm. Mets rhabdomyosarcoma, neuroblastoma, wilms, osteosarcoma

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16
Q

ca+ lung nodules

A

Granulomatous. Tb, fungus, Mets. Osteosarcoma Hamartoma (look for fat)

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17
Q

Cysts with air in lung

A

Congenital. Bronchogenic cyst with bronchial communication, CPAM, Diaph hernia, PIE/BPD Cavitation. Pn. LCH, Wegeners, Pneumatocele post trauma or surgery

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18
Q

Tubular branching in lung

A

ABPA. Asthma or CF Vascular. PAPVR, AVM, Varix Bronchial atresia Mucocele (from above causes)

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19
Q

Cyanosis heart disease

A

Increased vascularity: - Ts. Tricuspid atresia, Tx great vessels, TAPVR, Truncus, Single ventricle. Normal vascularity. Big heart: Ebstein, Pulmonary atresia Normal vascularity Normal heart size: TOF

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20
Q

Non Cyanosis heart disease

A

Increased Vascularity Normal Heart: ASD Increased Vascularity Big Heart: VSD, AVSD, PDA

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21
Q

big heart

A

Congenital. PDA, Ebstein, AVSD or VSD High output CCF. Head injury, AVM, vein galen malformation Pericardial cyst Pericardial effusion Cardiac tumor. Myxoma, Rhabdomyosarcoma Anaemia. Sickle cell or thalassemia Glycogen storage or metabolic diseases Middle mediastinal mass

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22
Q

Slings

A

Double arch. indents trachea and oesophagus Sling. Goes between trachea and oesophagus Abberrent rt. Posterior to oesophagus

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23
Q

Chest wall mass

A

Askin (ewings), met, neuroblastoma, EG.

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24
Q

Recurrent pn.

A

Immunocompromised. Aspiration. H TOF, GORD, oesophageal Web or obstruction Underlying lung abno. CF, sequestration, cilia dyskinesia, asthma, bronchopulmonary dysplasia

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25
Q

Anterior mediastinal mass

A

Thymoma, thymic hyperplasia, thymolipoma, Thymic carcinoma, thymic cyst Lymphoma Germ cell tumor, teratoma (fat and ca+) LCH. lung cysts also.

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26
Q

Middle mediastinal mass

A

LN, bronchogenic/enteric/neuroenteric cyst, pericardial cyst, vascular lesions (rt arch, double arch, Pulm sling, double svc)

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27
Q

Posterior mediastinal mass

A

Neuroenteric cyst, Discitis/OM, Haematopoiesis (liver/spleen), LN, Haematoma, Meningicele Nn. Neuroblastoma, gangkioblastoma, ganglioneuroma, Schwannoma, paragon glioma, neurofibroma

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28
Q

Cystic abdo mass

A
  • Messentry. Pseudo (mec perfect, pancreatitis), duplication (double wall sign, unilocular ), Messenteric (lymphatic) - Kidneys. MLCN, MCDK, AD/ARPCKD, Syndromes (TS, VHL), Simple cyst, Cystic wilms, PUJ. - Ovarian cyst - Adrenal cyst 2nd haemorrhage - Liver. Choledochal cyst, Biloma, Syndromic, Simple cyst
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29
Q

Intra abdominal calcification

A

Messentry. Mec perforation (peripheral), Duplication cyst (peripheral), teratoma (large chunky, teeth), Tb LN Adrenal. Haemorrhage, neuroblastoma Renal. Wilms, RCC, Cysts (peripheral), Nephrocalcinosis (medullary/cortical), calculus Bowel. Appendicolith, meckels Liver. Hydatid, Granulomatous, Hepatoblastoma, cholelithiasis.

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30
Q

Abdo wall defect

A

oomphalocele (Membrane, aneuploidy) Gastroschesis (no membrane, strictures) Exostrophy of bladder OEIS. Oomphalocele, Exostrophy, Imperforate an us, spinal anomalies (scoliosis, VB anomalies, sacral)

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31
Q

Oesophageal obstruction

A

Vascular sling/ring Oesophageal web Achalasia TOF or atresia Foreign body Duplication cyst Caustic ingestion

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32
Q

Non billous vomiting

A

Pyloric stenosis. >3, >15mm Pylorospasm Hiatus hernia Outlet obstruction from mass. lymphoma, bezoa

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33
Q

Double bubble

A

Duodenal atresia. downs and turners Duodenal stenosis Duodenal Web Mal rotation with volvulus (corkscrew on swallow) Annular pancreas Choledochal cyst Pancreatic pseudo cyst or LN obstructing SMA syndrome

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34
Q

Proximal SBO

A

Ileal or duodenal atresia Midgut volvulus Intussusception Inguinal hernia Perforated appendix Annular pancreas

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35
Q

Distal SBO

A

Hirschprungs Meconium Ileus. CF. all colon small Meconium plug. Small L colon. DM mother Ileal atresia Haematoma. trauma Not a SBO. Pseudo from gastroenteritis. HHAAIIMM Haematoma, Hirschprungs, Adhesions, Appendicitis, Intussusception , Inc. hernia, Malrotation, Meckels, Meconium Ileus and plug

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36
Q

bubbly lucencies gut

A

NEC Pneumatosis. Ischaemic, CF, leukaemia, CVD

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37
Q

GIH

A

Meckels, juvenile polyp, IBD, portal HTN (ADPCKD)

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38
Q

Gass less abdomen

A

Vomiting. Gastroenteritis, Appendicitis Oesophageal atresia Mass Ascities

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39
Q

Hepatic mass

A

by age: - Haemangioendothelioma (<6m) - Hepatoblastoma (<18m) - Hamartoma (cystic, <3yo) - Mets - HCC (6yo) - Sarcoma (10yo) - Adenoma (teen girl) - Haemangioma - Lymphoma - Abscess/fungal

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40
Q

Heterogenous liver

A

Cirrhosis. Tyrosinaemia Mets. neuroblastoma Hepatoblastoma. infiltrating

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41
Q

Cysts in liver

A

Hydatid, simple, Syndromic (VHL, PCKD), Choledochal, Hamartoma, pancreatic pseudocyst

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42
Q

Fatty infiltration liver

A

Cirrhosis, CF, glycogen storage, wilsons, hepatitis, steroids, chemo Protein malnutrition is most common.

43
Q

Cholelithiasis in kids

A

CF, pancreatitis, infections (viral, asc cholangitis), Haemolytic (sickle cell and thalassemia), hyperparathyroidism

44
Q

Pancreatic replacement with fat

A

CF or steroids

45
Q

Pancreatitis in kids

A

CF, congenital (divisium, annular), Choledochal cyst or cholelithiasis, viral infection, steroids, trauma (esp NAI)

46
Q

Pancreatic mass kids

A

Solid/cystic pseudo papillary tumor (tail, teen girl), islet cell, mets (neuroblastoma), pancreatic blastoma, lymphoma Simple cyst, syndrome cyst (VHL, PCKD), pseudocyst, pancreatitis, lymphatic malformation.

47
Q

Cystic renal mass

A

SINGLE. Simple cyst, syndrome (TS, VHL, Meckle gruber, turners), abscess, cystic wilms, cystic rcc, calyceal diverticulum, hydronephrosis, remnant of collecting system duplex. MULTI. MCDK, MLCN, PCKD (AR or AD), syndrome

48
Q

Solid renal mass

A

Nephroblastomatosis (<1yo, increased risk wilms), Cear cell sarcoma, Wilms, RCC, malignant rhabdoid (also have cns mass) Haematoma, mesoblastic nephroma (hamartoma), prominent column bertin, abscess, AML Mets. Lymphoma/Leukaemia (can be bilateral and diffuse), neuroblastoma

49
Q

Adrenal mass

A

Adrenal hyperplasia (keeps shape, bilateral), adrenal haemorrhage (traumatic birth or bleeding abno), Neuroblastoma Uncommon. adenoma, phaeo (men2, VHL), mets, lymphoma, teratoma

50
Q

Duplex kidney

A

Can be complete (2 ureters) or incomplete (Y fused) Upper inserts ectopic (low) with ureterocele Lower inserts orthoptic with reflux (lateral)

51
Q

Hydronephrosis

A

Congenital. - Congenital VUR (normal by 6yo) - PUJ obstruction. most common - Primary mega ureter. no other cause found - Duplex collecting system with reflux into lower pole - Distal ureterocele - Bladder diverticulum (hutch if at VUJ) - Ureteric atresia - Circumcaval ureter on Rt - Posterior urethral valves - Prune belly sx

52
Q

Echogenic kidney

A

ATN, GN, DM, Renal vv thrombus, Leukaemia (only echogenic infiltrating lesion)

53
Q

Big kidneys

A

Renal vv thrombus, Acute hydronephrosis, ARPCKD, Leukaemia/lymphoma.

54
Q

Medullary nephrocalcinosis

A

Hypoparathyroid, Renal tubular acidosis, Medullary sponge, Hypercalcaemia, Oxalosis.

55
Q

Pelvic mass

A

Presacral: Sacrococcygeal teratoma, anterior Meningicele, hind gut duplication cyst, Venolymphatic malformation, neuroblastoma Rhabdomyosarcoma Chordoma Haematometrocolpos Bladder haematoma or rhabdomyosarcoma

56
Q

Cystic Bladder mass

A

Hutch diverticulum - at insertion of ureter Ovarian cyst Ureterocele. can be exophytic. Hydronephrosis or mega ureter Messenteric or omental cyst

57
Q

thick skull

A

Hyperparathyroid (salt and pepper) Anaemia (hair on end) Leukaemia or lymphoma Chronic decreased intracranial pressure. (overshunt) Dilantin Caphalohaematoma Fibrous dysplasia

58
Q

Lytic skull lesion

A

EG (beveled edge), Dermoid, Fibrous dysplasia, Haemangioma, Mets (neuroblastoma, medulloblastoma, leukaemia), arachnoid granulation, OM, growing #, Brown tumour (hyperparathyroid)

59
Q

Intracranial ca+

A

TIC MTV - Tumour. Kids: Craniopharyngioma > Oligodendroglioma > Glioma > other tumour Adults: Meningioma > oligodendroglioma > ependymoma - Infection: TORCH, cysticercosis, tb - Congenital: Atrophy, TS, sturge webber (tramtrack) - Metabolic: Hypercalcaemia, Lead poisoning, hypoparathyroid, farhs (bg) - Trauma - Vascular: AVM, Haematoma, Cavernoma, aneurysm

60
Q

Enlarged sella

A

Tumour. Craniopharyngioma (most common), glioma (hypothalamus or optic chiasm), GCT, meningioma, pituitary adenoma Increased ICP Mucopolysaccharidosis Achondroplasia NF

61
Q

wormian bones

A

PORKCHOPS Pyknodysostosis, OI, Rickets healing, Kinky hair sx, Cleidocranial dysostosis, Hypoparathyroid, Osteopalatal sx, Pachydermoperiostosis, Sx of downs

62
Q

Craniosynostosis

A

Rickets, hyperparathyroid, Achondroplasia, trisomy 21, Sickle cell, thalassemia

63
Q

Button sequestration

A

TOREME Tb, OM, Radiation, EG, Mets, Epidermoid

64
Q

Periventricular Echogenicity

A

Equal to or greater than choroid plexus PVL, Infection (torch), maternal coca in, metabolic disorder

65
Q

Periventricular ca+

A

TORCH. CMV (limited to periventricular) or Toxoplasmosis (throughout brain) TS Bacterial meningitis

66
Q

Posterior fossa tumour

A

Pilocytic astrocytoma (eccentric, cystic with nodule) Medulloblastoma (midline, from vermin, 4th vent, DWI) Ependymoma (midline, 4th vent, mould out of vent, C+, ca+) Brainstem glioma Uncommon: Haemangioma, teratoma, Atrt, Choroid plexus papilloma, dermoid/epidermoid

67
Q

Posterior fossa non neoplastic mass

A

Abscess, haemorrhage, Ischaemic, ADEM, Cavernoma, Fasi of NF, arachnoid cyst

68
Q

Skull base or petrous temporal mass

A

Meningioma, lymphoma, sarcoma, paragon glioma, EG, Mets, chordoma (midline), chondrosarcoma (off centre)

69
Q

Dermoid vs lipoma

A

Dermoid is heterogenous with C+ and lipoma is homogeneous

70
Q

Brainstem mass

A

Glioma, Ischaemic, demyelination (ADEM, ms), NF1 fasi

71
Q

supratentorial mass

A

Astrocytoma (most common). solid or solid/cystic Craniopharyngioma. Cystic/solid with ca+. supra sella Glioma. Assoc NF1, Optic, hypothalamic, solid with c+ Germ cell. Germinoma, teratoma PNET. Large, heterogenous, necrosis with haem, DWI. neonates Ganglioglioma. Peripheral cortical, slow and erodes inner table skull, cystic with nodule Ependymoma. Frontal lobes, large, adj to ventricles Choroid plexus. Cauliflower, c+, atrium lat ventricles DNET. Cortical, temp lobes, bubbly bunch grapes SEGA. Foramen Munroe, cystic. ATRT. Agressive and heterogenous, <3yo

72
Q

supratentorial cystic.

A

subependymal cyst, Choroid plexus cyst, Cystic PVL (loss WM loss), arachnoid cyst, vv galen malformation, neuroglial cyst (smooth round, no C+, no DWI), Porencephalic cyst (2nd to insult. continuous with lat ventricles or subarach space)

73
Q

base of tongue mass

A

lingua thyroid, thyroglossal duct cyst (supra hypodermic midline, infrahyoid mid or paramidline), epidermoid/dermoid, Vascular malfomation

74
Q

midline Nasal mass

A

Nasal glioma. ectopic, T2 iso, t1 low, no c+, clinically blue mass Nadal encephalocele. Dermoid cyst. medial, fat, look for intracranial tract Dermal sinus. dorsum, bifid crystal Gali, fluid signal Epidermoid cyst Haemangioma or lymphangioma. T2 high with diffuse c+ Dacrocystocele. medial.

75
Q

myelination

A

Corpus callosum posterior to anterior. begins 2 months of age, complete 8 months adult myelination pattern reached by 2yrs

76
Q

Absent Corpus callosum

A

trisomy 13 and 18, foetal etoh, gorlin sx, dandy walker, chiari 2, holprosencephaly, lipoma, Mucopolysaccharidosis

77
Q

scoliosis causes

A

Idiopathic, hemivertebrae, cerebral palsy, NF, post op deformity

78
Q

unilateral cerebral atrophy

A

rasmussen encephalitis/chronic focal encephalitis dyke Davidoff sx (thick skull, big sinuses, capillary malformation) unilateral megalencephaly (hamartomatous overgrowth 1 side)

79
Q

unilateral megalencephaly

A

klippel trenaunay (plus vascular malformations), McCune Albright (plus polyostotic fd), NF1, TS, isolated.

80
Q

Big heart older kids

A

cardiomyopathy, VSD, AVSD, asd, PDA, high output heart failure due to avm

81
Q

Gracile bones. nimrod

A

nf, immobilization , muscular dystrophy, JRA, OI, Dysplasia (marfans)

82
Q

BG low T2

A

LINT. Lymphoma, Infarct, Neuro degenerative (Leigh, nf), Toxin/ Co or methanol

83
Q

Overlapping sutures

A

Small brain. dead, IU infection with Microcephaly, overshunting

84
Q

copper beaten skull

A

lukenschadal is specific for chiari 2, Copper beaten. Craniosynostosis, hydrocephalus, hypophosphataemia, intracranial mass

85
Q

VACTERL

A

VB. hemivert, caudal regression, spina bifida Anal atresia Cardiac anomalies or cleft palate TOF Renal anomalies or radial ray Limb. poly or oligodactyly

86
Q

Wormian bones

A

PORCHD. Pyknodysostosis, OI, Rickets, Cleidocranial dysostosis, Hypophosphataemia, Downs

87
Q

Periosteal reaction

A

Normal, Caffè, Rickets, OI, syphilis, Leukaemia, infection, prostaglandin e (PDA rx), JRA

88
Q

Bone mets in kids

A

Neuroblastoma, osteosarcoma, lymphoma

89
Q

Stipple epiphysis. whack

A

Warfarin, Hypothyroid, Alcohol, Chondtodysplasia punctata, Vit K def.

90
Q

Moat common foetal/IU tumors

A

neuroblastoma, teratoma, astrocytoma, lipoma, rhabdomyoma of heart, ST fibrosarcoma, Hamartoma, Hepatoblastoma, haemangioma, Renal rhabdoid or mesoblastic nephroma

91
Q

dandy walker triad

A

vermian agenesis or dysgenesis, communicates with 4th ventricle, we large posterior fossa with upwards displacement tent

92
Q

acute airspace

A

oedema (CCF and non), haemorrhage, infection, lymphoma, inhalation (smoke, drowning) interstitial change. infective, oedema or lch Immunocomp. PCP and LIP

93
Q

chronic airspace

A

recurrent pulm haem, wegeners, eosinophilic pn, LIP, fungal infection, lymphoma

94
Q

abdo pain kids

A

lung base pn, discitis OM, septic arthritis hips, appendicolith

95
Q

bone lesion kids

A

EG, chondroblastoma, OM, ewings, osteosarc, nb mets

96
Q

neuroblastoma stages

A
  1. confined to organ, 2. beyond organ, 3. x midline, 4. mets, 4s. stage 1 or 2 with skin mets in <1yo
97
Q

sclerotic bones

A

osteopetrosis, pyknodysostosis or haematological

98
Q

Lucent bones

A

infection, met, lymphoma, leukaemia

99
Q

vertebral plana

A

e.g., tb, mets

100
Q

bone age

A

greulich and Pyle.

101
Q

bone dysplasia book

A

winters database or tabar. talk to Tom.

102
Q

cystic bone lesions

A

FD, SBC, ABC, EG

103
Q

epiphyseal lesion

A

brodies abscess, chondroblastoma, chondrosarcoma, mets

104
Q

erlenmeyer flask

A

gauchers, multiple enchondromas or osteochondroma, nieman pick, metaph dysplasia, leukaemia and lymphoma

Kim's (6 decks)

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