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A DDx > Paeds DDx > Flashcards

Paeds DDx Flashcards

1
Q

Hepatic Mass in child < 5yrs:

A 
Hepatoblastoma (Raised AFP)
Congenital Haemangioma
Infantile Haemangioma
Hepatic Mets (neuroblastoma / Wilms)
Mesenchymal Hamartoma
Abscess
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2
Q

Hepatic Mass in Child > 5yrs:

A 
Infantile haemangioma
Focal nodular Hyperplasia
Mets (neuroblastoma, Wilms, lymphoma)
HCC (Raised AFP).
Hepatic adenoma
Abscess
Undifferentiated sarcoma
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3
Q

Multiple liver lesions:

A 
Infantile haemangiomas
Focal Nodular Hyperplasia
Mets (Neuroblastoma, Wilms, Lymphoma)
Abscesses
Cat scratch disease
Lymphopriliferative disease
Hepatic adenomas secondary to Fanconi anaemia or Gaucher disease.
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4
Q

Retroperitoneal Mass:

A

Most solid retroperitoneal masses are malignant.

Lymphoma:
- > 5yrs, hyper dense nodes.

Neuroblastoma:

  • < 5yrs.
  • Along SNS chain, commonly contain Ca++.
  • large masses cross midline.
  • MIBG uptake.

Abscess

Lymphatic malformation.

Metastases:

Haematoma

Plexiform neurofibroma.

Ganglioneuroma

Paraganlgioma

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5
Q

Causes of bronchiectasis:

A 
CF
Allergic Bronchopulmonary aspergillosis
Post infectious
Tracheobronchomegaly (Mounier Kuhn)
Aspiration
INtra lobar sequestration.
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6
Q

Unilateral hyper lucent lung DDX:

A

Endo bronchial FB:
- acute SOB, persistent expansion of dependent lung on decubitus view.

Pneumothorax:
- Acute SOB, pleural edge

Swyer James Syndrome:
- Previous constrictive bronchiolitis.

Congenital Lobar emphysema:
- Primary middle or upper lobes

CPAM with large cyst:
- History of recurrent infections.

Poland Syndrome:
- abnormal chest wall, arm / hand abnormalities.

Pulmonary hypoplasia.

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7
Q

DDX diffuse pulmonary disease new born: High lung volumes, streaky peri hilarious densities:

A

Meconium Aspiration
TTN
Neonatal pneumonia

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8
Q

DDX diffuse pulmonary disease new born: low lung volumes, granular opacities:

A

Surfactant deficiency syndrome (no effusion)

Group B Strep Infection (effusion)

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9
Q

Causes of acute diffuse pulmonary consolidation in neonate:

A 
Oedema: patent ductus arteriosus
Haemorrhage
Diffuse micro atelectasis
Worsening surfactant deficiency
Pneumonia.
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10
Q

Focal lung lesion in neonate: Lucent lesion:

A 
Congenital Lobar emphysema 
CPAM
PIE
Congenital diaphragmatic hernia
Necrotising pneumonia
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11
Q

Focal lung lesion in neonate: solid lesion:

A

Sequestration

Bronchogenic Cyst.

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12
Q

DDX anterior mediastinal mass child:

A 
Normal thymus: usually < 10yrs, homogenous.
 - Thymic rebound
Lymphoma: usually teenager
Germ Cell tumour:
 - Teratoma.
 - Seminoma
 - Non Semenomatous germ cell tumour.
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13
Q

DDX middle mediastinal mass child:

A

Lymphadenopathy:

  • Inflammatory
  • Neoplastic

Duplication cysts:

  • Bronchogenic
  • Enteric
  • Neuroenteric (Usually associated vertebral anomaly)
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14
Q

DDX posterior mediastinal mass child:

A

Neurogenic tumours:

  • Neuroblastoma: < 10yrs
  • Ganglioneuroblastoma
  • Ganglioneuroma > 10yrs

Neurofibroma
Lateral meningocele
Ewing sarcoma / Askin Tumour (posterior chest wall)

Discitis
Haematoma
Extra Medullary haematopoiesis - check liver/spleen.
Neuroenteric cyst - vertebral anomalies / scoliosis.

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15
Q

Aggressive chest wall mass in child DDX:

A

Ewing Sarcoma / Askin Tumour

Mesenchymal harmatoma:
- wild / aggressive, dysplastic before becoming agressive.

Metastatic neuroblastoma
Metastatic lymphoma
Metastatic leukaemia

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16
Q

Umbilical Lines Ideal position:

A

High position UAC: Tip T8 - T10
Low position UAC: tip below L3
Never positioned between T10 - L3

UVC: tip at IVC - RA junction at hemidiaphragm level.

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17
Q

Acyanotic Heart Disease DDx:

A

Pulmonary oedema:

  • Hypoplastic left heart
  • Extra cardiac shunt: Vein of Galen, hepatic haemangioendothelioma.
  • Coarctation.

Shunt vascularity:

  • ASD
  • VSD
  • PDA
  • AVSD (T21)
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18
Q

Cyanotic Heart Disease:

A

Reduced Pulmonary Vasculature:

  • Massive cardiomegaly:
    - > Ebstein anomaly
    - > Pulmonary atresia with intact septum.
  • No cardiomegaly:
    - > TOF: boot shaped heart.

Increased Pulmonary vasculature: (4 T’S)

    - > TGA: egg on string
    - > Tricuspid atresia
    - > Truncus arteriosus
    - > TAPVR: snowman
    - > Single ventricle.
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19
Q

Surfactant Deficiency Disease CXR features:

A 
Pre term
Low lung volumes
Granular hazy opacities
\+/- air bronchograms
No pleural effusion
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20
Q

Pulmonary Interstitial emphysema CXR features:

A

Barotrauma, 1st week of life
Bubble like / linear non branching lucencies, focal or diffuse.
Static lung volumes.

Progression to Bronchopulmonary dysplasia:

  • Oxygen dependence > 28 days, usually born early 32 weeks.
  • Hazy opacity progressing to course markings and bubble like lucencies.
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21
Q

Transient tachypnea New Born CXR features:

A

C section / maternal diabetes
Interstitial oedema, indistinct vasculature
Pleural fluid
Normal / increased lung volumes.

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22
Q

Meconium aspiration CXR features:

A

Increased lung volumes
Asymmetric patchy opacities, ropey, peri hilar appearance.
Alternating hyperinflation / atelectasis.
Pneumothorax 20-40%

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23
Q

Neonatal pneumonia CXR features:

A

PROM
Increased lung volumes
Patchy asymmetric peri hilar opacities
+/- pleural fluid

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24
Q

Group B strep CXR features:

A

Low lung volumes
Bilteral granular opacities
Pleural fluid.

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25
Q

PHACES Syndrome

A 
P: Posterior fossa - Dandy Walker
H: Haemangioma
A: Arterial anomalies
C: Coarctation / cardiac defects
E: eye anomalies
S: Sub glottic haemangiomas.
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26
Q

Bowel Obstruction DDX: AIMS:

A

A: appendicitis, Adhesions
I: Internal hernia, Intussecption
M: Meckels, Malrotation

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27
Q

Causes of micro colon:

A

Meconium Ileus:

  • Filling defects in bowel -> CF
  • Scrotal / peritoneal Ca++

Ileal or colon atresia:
- abrupt cut off

Total colonic Hirschsprungs

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28
Q

High Neonatal bowel Obstruction DDx:

A 
Mid gut volvulus and malrotation
Duodendal atresia and stenosis
Duodendal web
Annular pancreas
jejunal atresia
29
Q

Low neonatal bowel obstruction DDX:

A 
Hirschsprung disease
Meconium plug syndrome
 - Transition point splenic flexure.
Ileal atresia
Meconium ileus (CF)
Anal atresia / ano rectal malformations.
30
Q

Low neonatal Bowel obstruction -> assess with contrast enema:

A

No Micro colon:

  • Normal
  • Meconium plug syndrome
  • Hirschsprung

Microcolon:

  • Ileal atresia
  • meconium ileus (CF)
  • Total colonic Hirschsprung
31
Q

Bubble approach on AXR:

A

Single bubble = antral / pyloric atresia

Double Bubble = duodendal atresia (T21, polyhydramnios)

Tripple Bubble = jejunal atresia (vascular insult)

Single bubble with gas = normal, or with bilious vomiting concerning for volvulus
-> upper GI study.

Double bubble with distal gas - excludes atresia: duodendal web, duodendal stenosis, mid gut volvulus
-> upper GI study.

Multiple diffusely dilated loops = low obstruction
-> contrast enema.
If normal -> upper GI study to exclude volvulus.

32
Q

Pancreatic Mass:

A

Pancreaticoblastoma - age 1
Adenocarcinoma - age 6
Solid papillary epithelial neoplasm (SPEN) - age 15.

33
Q

Solid Renal Mass:

A

Neonate:

  • Nephroblastomatosis
  • Mesoblastic nephroma

Child 4yrs:

  • Wilms
  • Wilms variants
  • Lymphoma
  • Multilocular cystic nephroma

Teenager:

  • RCC
  • Lymphoma.
34
Q

Horse shoe kidney:

A 
Increased risk of trauma
Increased risk of stones
Increased risk of infection
Increased risk of cancer:
 - Wilms
 - TCC
 - Renal carcinoid
Association with Turners.
35
Q

Prune Belly Syndrome:

A

Deficiency anterior abdominal wall muscles
Hydro-uretero-nephrosis
Cryptochordism

Associations:

  • T18, T 13
  • Congenital heart disease
  • Intestinal malrotation
  • Imperforate anus
  • Polydactyly / syndactyly

Other renal tract anomalies:

  • Enlarged bladder
  • Vesico-uretral reflux
  • Dilated posterior urethra without obsturction.
36
Q

Duplex System - Weigert Meyer Rule:

A

Upper renal moiety:

  • Ectopic insertion inferior and medial
  • Ends in ureterocele -> obstruction

Lower renal moiety:

  • Normal insertion
  • Refluxes.
37
Q

Bowel Wall thickening immunocompromised DDX:

A

Pseudomembranous colitis
Neutropenic colitis
Graft vs Host disease
Post transplant lymphoproliferative disorder

38
Q

Double Bubble DDX:

A

Duodendal atresia / stenosis
Malrotation with volvulus
Annular pancreas
Duodendal web

39
Q

Vascular causes of oesophageal / tracheal compressions:

A

Aberrant right subclavian artery:
- Posterior oesohageal compression.

Double aortic arch
- May cause anterior tracheal and posterior oesphageal compression.

Right aortic arch with aberrant left subclavian

Pulmonary sling
- only malformation posterior compression on trachea and anterior compression on oesophagus.

Innominate artery syndrome.
- Higher compression anterior trachea.

40
Q

Endobronchial lesion:

A 
Foreign body
Papilloma
Carcinoid tumour
Inflammatory polyp
Salivary gland neoplasm.
41
Q

Permeative Bone Lesion < 5yrs:

A

Osteomyelitis
LCH / Eosinophilic granuloma
Neuroblastoma Mets

42
Q

Permeative bone lesion > 5yrs:

A

Osteomyelitis
Ewing Sarcoma
Lymphoma / Leukaemia
LCH / Eosinophilic granuloma.

43
Q

Focal scelerotic lesions:

A

Osteoid osteoma
Chronic osteomyelitis
Stress Fracture
Osteosarcoma

44
Q

Multifocal bone lesions:

A

Multifocal osteomyelitis

LCH

Mets

Multiple hereditary exostoses

Enchondromatosis:

  • Ollier disease
  • Maffucci syndrome.

Polyostotic fibrous dysplasia
- McCune Albright syndrome

Neurofibromatosis

45
Q

Dysaplsia:

A

Rhizomelic:

  • Proximal shortening
  • Achondroplasia
  • Thantophoric dwarfism

Mesomelic:
- Middle shortening

Acromelic:

  • Distal shortening
  • Asphyxiating thoracic dystrophy / Jeune syndrome
  • Chondroectodermal dysplasia.
46
Q

Wormian Bones: “PORK CHOP”

A 
P: Pyknodysostosis
O: Osteogenesis Imperfecta
R: Rickets
K: Kinky hair syndrome
C: Cleidocrainal dysostosis
H: Hypothyroidism / Hypophosphatasia
O: one too many chromosomes: T21
P: Primary acro osteolysis.
47
Q

Elbow ossification CRITOE:

A 
C: Capitellum - 1 year
R: Radial head: 3 year
I: Internal medial epicondle: 5 year
T: Trochlea: 7 year
O: Olecranon: 9 year
E: External lateral epicondyle: 11 year
48
Q

Lucent metaphyseal Bands: “LINE”

A

L: Leukaemia / lymphoma
I: Infection - TORCH
N: Neuroblastoma Met
E: Endocrine: Rickets / Scurvy.

49
Q

Posterior Vertebral Scalloping:

A

Dural ectasia:

  • Marfans
  • NF 1: assess for lateral meningocele.
  • Schwannoma

Mucopolysaccharidosis

Achondroplasia

Osteogenesis Imperfecta

Spinal cord Tumour: Ependymoma.

50
Q

Pre Sacral Mass DDX:

A 
Saccrococcygeal Teratoma
Anterior meningocele
Rectal Duplication Cyst
Lymphoma
Germ Cell tumour
Adnexal Mass
51
Q

Long Bone aggressive lesion:

A 
Osteosarcoma
Ewing Sarcoma
Osteomyelitis
LCH
Mets
52
Q

Erlenmeyer FLask Deformity:

A 
Osteopetrosis
Gaucher disease
Haemoglobinopathies:
 - Thalaesaemia
 - Sickle Cell
Fibrous dysplasia
Multiple hereditary Exostoses
Craniometaphyseal dysplasia
Niemann Pick disease
53
Q

Lytic lesion in skull:

A 
LCH
Epidermoid cyst
Neoplasm:
 - Leukaemia
 - Ewing
 - Metastatic neruoblastoma
Infection
Leptomeningeal cyst
54
Q

Femoral Head avascular Necrosis:

A 
Perthes Disease
Trauma
Sickle Cell disease
Corticosteroids
Gaucher disease
Meyer Dysplasia
55
Q

features of infantile Haemangioma:

A

Absent at birth, rapid growth, regression.
Elongated lobulated well defined vascular soft tissue mass.
High vessel density, multiple arterial tracing with low resistance index, no arterilised veins.

Associated with PHACES syndrome

56
Q

Venous Malformation features:

A

Low Flow vascular malformation

Klippel-Trénaunay-Weber syndrome (KTWS) is a syndrome combination of capillary malformations, soft-tissue or bone hypertrophy, and varicose veins or venous malformations. It is considered an angio-osteo-hypertrophic syndrome.

KTS classically comprises a triad of:

  • port wine nevi
  • bony or soft tissue hypertrophy of an extremity (localized gigantism)
  • varicose veins or venous malformations of unusual distribution

Maffucci syndrome
congenital nonhereditary mesodermal dysplasia characterized by multiple enchondromas with soft-tissue venous malformations (hemangiomas).

On imaging, it is usually portrayed by a short limb with metaphyseal distortions due to multiple enchondromas, which may appear grotesque, and soft tissue masses with phleboliths depicting hemangiomas.

57
Q

Abdominal Ca++

A 
Meconium peritonitis
Neoplasm:
 - Neuroblastoma
 - Teratoma
 - Hepatoblastoma
Adrenal Haemorrhage

RUQ:

  • Gall stones
  • Hapatoblastoma
  • Hepatic TORCH infection: CMV and toxoplasmosis.
58
Q

Stippled epiphyses DDX:

A

Chondrodysplasia puncta
- short limb dwarfism (rhizomelic)

Multiple epiphyseal dysplasia (Fairbank disease):

Hypothyroidism

Complications post maternal warfarin use in a newborn

59
Q

Grades of germinal matrix haemorrhage:

A

Grade 1: haemorrhage confined to germinal matrix at caudothalamic groove.

Grade 2: haemorrhage extends into ventricles without ventriculomegaly

Grade 3: Haemorrhage extends into ventricles with ventriculomegaly.

Grade 4: Haemorrhage extends out ventricles into the parenchyma.

60
Q

Neonatal CMV vs Toxo vs other CNS TORCH:

A

CMV:

  • Most common TORCH
  • Likes germinal matrix, periVentricular tissue necrosis
  • PeriVentricular Ca++
  • Highest association with polymicrogyria

Toxo:

  • Random Ca++, commonly basal ganglia
  • Associated hydrocephalus.

Rubella:
- Vasculopathy / ischaemia, high T2 signal less Ca++

HSV:
- Haemorrhage Infarct, hydranencephaly.

HIV:
- brain atrophy frontal lobes

61
Q

DDx for endo bronchial lesion:

A

Leiomyoma
Harmatoma
mucoepidermoid carcinoma
carcinoid tumour

62
Q

DDx for thickened / enhancing pituitary stalk

A 
Sella Germinoma (presenting with Diabetes insipidus)
LCH
Lymphocytic hypophysitis
Lymphoma
Leukaemia
Neurosarcoidosis
Pituicytoma
63
Q

DDx for acute coalescent otomastoiditis:

A

Infective otitis media
LCH
Rhabdomyosarcoma
Cholesteatoma

64
Q

CHARGE syndrome

A 
Colobloma
Heart defect
Atresia of choanal
Retarded growth
Genito-urinary abnormalities
Ear abnormalities.
65
Q

PHACES syndrome:

A 
Posterior Fossa - Dandy Walker
Haemangiomas
Arterial anomalies
Coarctation of aorta / cardiac defects
Eye abnormalities
Subglottic haemangiomas.
66
Q

BFM in chest of Kid:

A 
Askin tumour - rib destruction (>10yrs)
Pleuropulmonary blastoma (<2yrs).
67
Q

Neonatal chest xray volumes:

A

Anterior ribs:
3-4 = expiratory
5-6 = inspiratory
7 or more = hyperexpanded.

Posterior ribs:
9-10 = adequate.

Other hyperinflation signs: flattened diaphragms, horizontal ribs, increased lucency under heart.

68
Q

VACTERAL

A 
Vertebral anomalies (37%)
Anal / imperforate anus (63%)
Cardiac (77%)
TracheoEosphageal fistula / Esophageal atresia (40%)
Renal (72%)
Limb / radial ray (58%)
69
Q

Radial dysplasia:

A

VACTERL
Holt oram
Fanconi anaemia
Thrombocytopenia Absent Radius (thumb present)

A DDx (14 decks)

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