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Radiology oral boards review > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Ddx long bone lesion in 2-year-old

A

Toddler’s fx, osteomyelitis, LCH, fibrous dysplasia, osteoid osteoma

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2
Q

What’s Legg-Calve-Perthes disease?

A

idiopathic AVN of femoral epiphysis
age 4-8 years
10% bilateral
asymmetry then fragmentation of epiphysis

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3
Q

Currarino triad:

A

anorectal malform (imperforate anus)
presacral mass: meningocele, teratoma, lipoma, dermoid, or enteric cyst
partial sacral agenesis

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4
Q

VACTERL =

A 
V : vertebral anomalies :
hemivertebrae
congenital scoliosis
caudal regression
spina bifida
A : anorectal anomalies :
anal atresia
C : cardiac anomalies / cleft lip
T : tracheo-
E : oesophageal fisula + / - oesophageal atresia
R : radial ray anomalies / renal anomalies
L  : limb anomalies
polydactyly
oligodactyly
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5
Q

vessel between trachea and esophagus =

A

pulmonary sling (left PA arises from R PA and courses posterior to the trachea

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6
Q

Age of pyloric stenosis:

Numbers:

A

Age: 2-8 weeks
Male: female 4:1
Muscle thicker than 3mm
Length of pyloric channel >17mm

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7
Q

Ddx for microcolon:

A 
Meconium ileus
distal bowel atresia
Hirshprung's (total colonic)
Microcolon of prematurity
Megacystitis-microcolon hypoperistalsis syndrome
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8
Q

What’s meconium ileus? What’s the difference between meconium ileus and meconium plug?

A

Meconium ileus is abnormally thick, impacted meconium in the ileum, usually related to CF
Meconium plug is a functional colonic obstruction in a newborn due to an obstructing meconium plug. It is usually transient and affects the left colon with meconium plugging the bowel distal to this segment. Small left colon syndrome is a subset of meconium plug syndrome (for most purposes is synonymous)

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9
Q

Enema on newborn shows colon small from splenic flexure distally
what’s it associated with?

A

Small left colon
Functional obstruction due to immaturity of myenteric plexus
Assoc. maternal DM, substance abuse
Ddx: hirschprung’s

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10
Q

ddx Abdominal cyst in a fetus or child

A 
GI duplication cyst
choledochal cyst
ovarian cyst (on pedicle)
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11
Q

Ddx for SBO in a new born: … an infant: …in a child?

A

NB: intestinal atresia, Hirschprung’s disease, small left colon, meconium plug, meconium ileus, midgut volvulus
Infant-2 year old: Incarcerated hernia, Hirshprung’s, malrotation, intussusception
Older child: appendicitis, intussusception, malrotation, adhesions

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12
Q

Neuroblastoma - who gets it?

A 
infants and very young children (mean age of presentation being  ≈ 22 months) with 95% of cases <10 years. Occasionally identified antenatally or at birth
Beckwith-Wiedemann syndrome
DiGeorge syndrome
Hirschsprung disease
NF1
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13
Q

Beckwith-Wiedemann syndrome: what is it? Features?

A

congenital overgrowth disorder characterised by a unique set features which can consist of :
macroglossia (most common clinical finding)
omphalocoele
localised gigantism / macrosomia
hemihypertrophy
organomegalies (nephromegaly, hepatosplenomegaly)
Assoc. with *Neuroblastoma and *Wilm’s, hepatoblastoma

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14
Q

DiGeorge syndrome

A

cleft lip - / + palate
congenital heart disease (particularly conotruncal anomalies): often a major part of this syndrome- tetralogy of Fallot, interrupted aortic arch, truncus arteriosus
charcateristic facies : elongated face

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15
Q

Ddx for nasopharyngeal tumor in teenager

A

JNA
lymphoma
rhabdomyosarcoma
nasopharyngeal carcinoma

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16
Q

Newborn with liver mass

A

Hepatoblastoma or Congenital hemangioma
Hepatoblastoma: fat and osteoid elements, no AV shunting, peak age 18-24 mos. Get chest CT to look for mets
congenital hemangioma (aka Hemangioendothelioma): large endothelial-lined vascular channels (much AV shunting), fetus or neonate

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17
Q

What completes the ring in double aortic arch?

A

Ligamentum arteriosum

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18
Q

Sacrococcygeal teratoma - tell me about it

A

most common congenital tumor
80% in girls
70% benign, rest malignant
classified based on intrapelvic involvement

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19
Q

smooth brain with hourglass configuration

A

Lissencephaly - extreme form of migrational abnormality (do not confuse with normal appearance of preterm brain)
Pts usually present in status epilepticus

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20
Q

features of cleidocranial dysostosis

A

Skull: wormian bones, brachycephaly
Chest: absent/hypoplastic clavicles
Limbs: short / absent fibula, short / absent radius
Widened pubic symphysis

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21
Q

What are the common craniosynostoses? Describe each

A
  • dolichocephaly/scaphocephaly (elongated): sagittal suture (most common)
    -brachycephaly (round, wide): coronal and/or lamboid sutures
    -plagiocephaly (asymmetric): unilateral coronal and lambdoid sutures
    -trigonocephaly (pointy forehead, triangular head): metopic suture
    (many more)
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22
Q

What solution do you use for an enema in an infant?

A

Cysto Conray, 400 mOsm

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23
Q

Congenital heart disease: increased pulmonary blood flow, not cyanotic ddx:

A

Shunts:
ASD (not enlarged)
heart enlarged: VSD, PDA, (ECD) endocardial cushion defect
Peripheral shunt (vein of Galen, congenital hemangioma of liver)

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24
Q

Congenital heart disease: increased pulmonary blood flow, cyanotic ddx:

A 
The "Ts"
Transposition
TAPVR
Truncus arteriosus
Tricuspid Atresia w large VSD
Single ventricle
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25
Q

Congenital heart disease: decreased pulmonary flow (cyanotic)

A 
"right heart problems"
TOF (not enlarged)
Enlarged:
Pulmonary atresia
Tricuspid Atresia w small VSD
Ebstein's anomaly (huge heart)
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26
Q

What’s usually the diagnosis for “snowman heart”

A

supracardiac TAPVR (dilated SVC and left vertical vein)

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27
Q

Pneumomediastinum in a child ddx

A

Foreign body aspiration
asthma
blunt trauma

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28
Q

Most common orbital mass in a child:

A

hemangioma

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29
Q

Ddx for aggressive lesion in retrobulbar space:

A

mets (neuroblastoma), LCH, rhabdomyosarcoma, lymphoma

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30
Q

vascular subcutaneous lesion over the skull that communicates with the dural venous sinuses

A

Sinus pericranei

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31
Q

What is PHACES syndrome?

A 
•P : posterior fossa malformations 
•H : haemangiomas 
•A : arterial anomalies 
•C : coarctation of the aorta and cardiac anomalies 
•E : ocular anomalies 
S: sternal clefting
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32
Q

Ddx for VERY large heart in an infant or child

A

Ebstein’s, pulmonary atresia, cardiomyopathy

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33
Q

Pt with bilateral optic gliomas - what do they probably have?

A

NF1

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34
Q

pneumothorax in a child

A

asthma, pleural blebs, rib fractures, (infant: meconium aspiration)
Always look for tension!

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35
Q

Retropharyngeal abscess - what do you look for?

A

Jugular vein thrombosis, septic emboli (Lemierre syndrome), ICA spasm

36
Q

Ddx for no radius:

A 
TAR (thrombocytopenia with absent radius)
VACTERL
Holt Oram
cleidocranial dysostosis
fanconi anemia (hypoplasia)
Trisomy 18
37
Q

Lucent skull lesion in a child

A

LCH, fibrous dysplasia, osteomyelitis, lymphoma, mets

38
Q

Normal pattern/order of myelination:

A

bottom to top
back to front
central to peripheral
Complete around age 2 or so

39
Q

Chest xray featuers of surfactant deficiency aka hyaline membrane disease

A

Low lung volumes (can be high IF intubated), premature infant, ground glass/granular opacities, air-bronchograms, NO pleural effusion, bilateral and symmetrical

40
Q

complications of treating HMD / surfactant deficiency:

A 
Acute
persistent patent ductus arteriosus (PDA) due to reduced oxygen stimulus
barotrauma (from treatment)
oxygen toxicity (from treatment)
pulmonary hemorrhage (can also included in the differential diagnosis)
Chronic
bronchopulmonary dysplasia
pulmonary interstital emphysema (PIE)
recurrent pulmonary infection
subglottic stenosis (from intubation)
41
Q

Features of meconium aspiration on neonatal chest xray

A 
coarse, asymmetric, patchy densities
full-term or post-term
high lung volumes
\+/- pleural effusions
up to 40% have pneumothorax
42
Q

chest xray features of TTN

A

interstitial edema, small pleural effusions
more common with C-section delivery
always resolves in 1-2 days

43
Q

Hip dysplasia on ultrasound - basic criteria:

A

Alpha angle: acetabulum to ileum - should be at least 60 degrees
Coverage of the femoral head: 50-60% or greater is normal

44
Q

What are the pulmonary manifestations of CF?

A

bronchiectasis
pneumothorax
recurrent bacterial infection
pulmonary arterial hypertension

45
Q

What are the abdominal manifestations of CF?

A 
distal intestinal obstruction syndrome (DIOS) - sort of the meconium ileus of older children/young adults
meconium ileus: 10 - 20%
rectal prolapse
cirrhosis and hepatic steatosis
esophageal dysfunction / GERD
pancreatic insufficiency
fatty replacement of pancreas
46
Q

Head and neck manifestations of CF:

A

chronic sinusitis

nasal polyposis

47
Q

Germinal matrix hemorrhage - grades:

A

1: GM hemorrhage
2. GM hem. + blood in vents
3. GM hem with dilated vents
4. Hemorrhage in brain (+/- GM hem)

48
Q

ddx flared metaphysis

A 
rickets
anemia(s) - sickle, thalassemia
fibrous dysplasia
storage diseases - Gaucher's
chronic lead poisoning
bone dysplasias (eg various dwarfisms) - achondroplasia
49
Q

What syndromes are associated with Wilms?

A

Beckwith-Wiedemann (other overgrowth syndromes are more obscure)

50
Q

What abnormality(ies) are associated with multicystic dysplastic kidney?

A

Contra lateral ureteral reflux or UPJ obstruction

Sometimes is bilateral = incompatible with life

51
Q

thin-walled lung cyst in a child

A

Post-infectious pneumatocele, CPAM

52
Q

enlarged unilateral SCM - called? Treatment?

A

Fibromatosis coli

Rx is physiotherapy (not surgery)

53
Q

Ddx frayed metaphysis

A

Rickets!!

hypophosphatasia, stress eg. gymnast, copper deficiency

54
Q

Features of rickets

A 
lateral bowing of long bones
flared, frayed metaphyses
wormian bones
lucency in zone of provisional calcification
dense metaphyseal bands (healing)
ribs: rachitic rosary
hip deformity (coxa valga and vara)
55
Q

Ddx sclerotic bones in an infant

A 
osteopetrosis (fatal 2/2 anemia, bone-in-bone)
physiologic up to 2 mos old
TORCH inxn
pyknodysostosis
skeletal dysplasia
56
Q

beaking of the medial tibial physis, lateral knee subluxation and varus alignment:

A

Blount’s dz - can be in toddlers or adolescents. Thought maybe related to repatative stress. Toddlers - conservative Rx
Teenagers: may need osteotomy

57
Q

Baby has 11 pairs of ribs, heart disease =

A

Trisomy 21 / Down’s syndrome

58
Q

Radiographic features that differentiate Wilms from Neuroblastoma

A

Wilms: claw sign from kidney, only 10% calcifiy, invades vasculature, mets to IVC, lungs, liver
Neuroblastoma: punctate calcification 90%, encases vessels, mets to bone

59
Q

Hip joint effusion in child - Ddx:

A

infection vs toxic synovitis (self-limited synovitis)

60
Q

Ddx for gibbus deformity of vertebra in a child

A

Trauma, mets/LCH, congenital (segmentation), TB, achondroplasia, mucopolysacharidosis (hunters, hurlers), scheuerman’s (thoracic)

61
Q

Ddx lucent metaphyseal bands

A

rickets, Leukemia /systemic illness/ neuroblastoma, TORCH, malnutrition/scurvy

62
Q

Ddx widened intercondylar notch in a child:

A

hemophilia, JIA (look for widened epiphyses and osteopenia from hyperemia)

63
Q

Ddx expanded bones (child)

A

Mucopolysacharidosis (hunter, hurler, Morquio), sickle cell, thalassemia, gaucher’s

64
Q

Solid, well-circumscribed, highly vascular mass in an infant:

A

Hemangioma

65
Q

How do you differentiate Coat’s dz from PHPV?

A

PHPV - small globe

Coat’s - dense, normal sized globe. Usually in boys under 10 (retinal vascular abnl)

66
Q

What renal tumor is most likely in an infant?

A

Mesoblastic nephroma - a benign hamartomatous lesion - resect.

67
Q

proper course and positioning of an umbilical artery catheter

A

Course: umbilical artery, hypogastric, iliac, aorta
Should terminate tebween T6 and T12
OR low: below the IMA (below L3)

68
Q

Proper course and positioning of an umbilical vein catheter

A

umbilical vein, left portal vein, ductus venosus, middle or left hepatic vein, and into the inferior vena cava
Proper position is at jctn IVC and RA

69
Q

Child neck film: symmetric subglottic stenosis
asymmetric subglottic stenosis
What about a thick “thumb” appearance?

A

-Croup infants (Viral -H. Flu, paraflu) - airway emergency! Look for overdistended hypopharynx
-Membranous Croup - bacterial (staph) inflammation of larynx, trachea and bronchi
asymmetric - hemangioma, papilloma, or granuloma (prior intubation)
Thumb = epiglottitis (3-6y, emergency)

70
Q

Radiologic signs of child abuse:

A

Intracranial bleeds of different ages, DAI, retinal hemorrhage
corner/bucket handle fracture
posterior and lateral rib fx
fx sternum, scapula, spiral fx long bones in non-weight-bearing infant
Retroperitoneal hematoma

71
Q

What is Potter sequence/syndrome?

A

The consequence of oligohydramnios in utero
pulmonary hypoplasia
growth restriction (IUGR)
abnormal facies (Potter facies
Caused by bilateral agenesis, MCDK, UPJ, or ARPCKD

72
Q

Ddx large liver in a neonate

A

hepatoblastoma, neuroblastoma, hepatitis, TAPVR

73
Q

Rasmussen encephalitis:

A

a chronic inflammatory disease of unknown origin, usually affecting one brain hemisphere
Late: cortical atrophy
kids under 10, usually intractable epilepsy

74
Q

What do you do next when you suspect osteosarcoma or Ewings?

A

MRI of whole bone
Bone scan for mets/synchronous
Chest CT for lung mets

75
Q

Ddx for fragmentation of proximal femoral epiphysis

A 
AVN (e.g. Legg-Calve-Perthes)
Meyer dysplasia (normal variant, not painful)
76
Q

Flat, sclerotic navicular bone in foot =

What should you do next?

A

AVN - Kohler disease

Usually self-limited and heals, but may get a cast for a few weeks

77
Q

Posteromedial bowing of the tibia

A

idiopathic (don’t worry)

78
Q

Oar-shaped ribs are seen in:

A

mucopolysaccharidoses

79
Q

Causes of rickets:

A

dietary deficiency, dilantin, breast feeding, liver, renal, GI, Primary hypophosphatemia

80
Q

Ddx cortical thickening in a child

A

Osteoid osteoma, chronic osteomyelitis

81
Q

What problems are associated with a R aortic arch?

A

TGA, TOF, truncus

Rarely isolated

82
Q

Staging of neuroblastoma

A

Stage 1: local, completely excised
Stage 2: local, incompletely excised (2B ipsilateral nodes)
Stage 3: crosses midline or contralateral nodes
Stage 4S: < 1 year of age
localised tumour (stage 1, 2A or 2B)
distant metastases confined to skin, liver and/or bone marrow
Stage 4: Distant mets (and not 4S)

83
Q

Staging of Wilm’s tumor

A

Stage 1: in kidney
Stage 2: kidney + renal vein (can be resected)
Stage 3: nodes or peritoneal spread (can’t be resected)
Stage 4: mets
Stage 5: bilateral (then stage each separately)

84
Q

Fetal or neonatal head ultrasound - bright spots around ventricles

A

Calcification - TORCH, esp CMV or toxo

Prior hemorrahge

85
Q

Coronary aneurysm in a child

A

Kawasaki disease

Radiology oral boards review (10 decks)

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