Peds Flashcards
Croup:
- age?
- cause?
6 months - 3 years
- parainfluenza
Epiglottitis
- age?
- cause?
- cause of death?
- 5 years old, also teens
- H. influenzae
- asphyxiation from aryepiglottic flods
exudative tracheitis:
- age?
- cause?
- 6-10 years
- staph A
most common soft tissue mass in trachea
subglottic hemangioma
PHACES syndrome
- Posterior fossa (DWM)
- Hemangiomas
- Arterial anomalies
- Coarctation of aorta/cardiac defects
- Eye abnormalities
- Subglottic hemangiomas
retropharyngeal soft tissues: normal thickness
6 mm at C2
22 mm at C6
Infantile vs. congenital hemangiomas
- infantile are not present at birth; show up around 6 months and nearly always involute
- congenital are present at birth and may or may not involute
neonatal pneumonia -GBS vs. non GBS
- low lung volumes for GBS
- other pneumonias have high lung volumes
- GBS pneumonia less likely to have pleural effusion than non-GBS
PIE
- timeline
- buzzword
- treatment
- warning sign for?
- what is a mimic?
- occurs in 1st week
- linear lucencies
- PIE side down position
- warning sign for impending pneumothorax
- mimic is surfactant replacement therapy
classic appearance for papillomatosis
multiple lung nodules with cavitation
- 2% risk for squamous cell cancer
pleuropulmonary blastoma
- typical location
- calcification?
- rib invasion?
- right sided and pleural based
- no calcification or rib invasion
- 10% have a multilocular cystic nephroma
- cystic type occurs in kids < 1 year old and tend to be more benign
most common mass in masticator space of kid
rhabdomyosarcoma
most common extra-ocular, intra-orbital malignancy in children
rhabdomyosarcoma
most common benign orbital mass in child
dermoid
differential for high lung volumes in neonate
- meconium aspiration
- non GBS neonatal pneumonia
differential for low to normal lung volumes in neonate
- surfactant deficiency
- GBS neonatal pneumonia
Transient tachypnea
- risk factors
- time course
- radiographic appearance
- maternal sedation, C-section, maternal DM
- starts at 6 hrs, peaks at 1 day, resolves by 3 days
- coarse intersitial markings with fluid in fissure
- normal to high lung volumes
risks of surfactant replacement therapy?
- was does it mimic
- pulmonary hemorrhage
- increased risk of PDA
- can cause bleb like lucencies - mimics PIE
Thymic rebound
- FDG avid
- drops out on opposed phase MRI
pulmonary slings
- associations
- tracheal stenosis
- compelte tracheal rings
- imperforate anus
- TE fistula
- horseshoe lung
- hypoplastic lung
Ladd’s procedure
- procedure done to prevent midgut volvulus
- Ladd’s bands are divided
- appendix is removed
- small bowel ends up on the right and large bowel ends up on teh eltq
Pyloric stenosis
- age range
- criteria
- clinical sign
- 2-12 weeks (peaks 3-6 weeks)
- 4 mm single wall; 14 mm length
- paradoxical aciduria
differential for long microcolon
- meconium ileus
- distal ileal atresia - contrast does not reach ileal loops
- total colonic aganglionosis can mimic microcolon
intussusception
- time frame
- size criteria
- classic lead points
- 3 months - 3 years
- > 2.5 cm
- Meckel’s, HSP vasculitis, enteric duplication cysts
air reduction for intussusception
- pressure limit
- contraindications
- success rate
- risk of perforation
- 120 mm Hg
- peritonitis, free air
- 80-90%
- 0.5% risk of perforation
VACTERL
vertebral anomalies anal (imperforate) Cardiac (73%) TE fistula Renal limb (radial ray)
when is physiologic gut herniation seen
6- 8 weeks
omphalocele
- most common associated chromosomal abnormality?
- other associations
- Trisomy 18
- umbilical cord cysts, Turners, Klinefelters, Beckwith Wiedeman, cardiac defects
Schwachman Diamond syndrome
- # 2 cause of pancreatic insufficiency in kdis
- diarrhea, short stature, and eczema
liver tumors age 0-3
- hepatoblastoma
- infantile hepatic hemangioma
- mesenchymal hamartoma
Infantile hepatic hemangioma
- often < 1 yr
- high output CHF
- skin hemangiomas present in 50%
- Endothelial growth factor is elevated
- spontaneously involute without therapy
- prgoressively calcify
- can be associated with Kasabach- Merritt syndrome
Hepatoblastoma
- most common primary liver tumor of childhood (< 5)
- assocaited with hemihypertrophy, Wilms, Beckwith Wiedemann
- prematurity is risk factor
- elevated AFP
- solitary right sided mass
- can extend into PV, HV, and IVC
- calcification present in 50%
- may cause precocious puberty from making beta-HCG
Mesenchymal hamartoma
predominantly cystic mass
- calcification UNCOMMON
- large portal vein branch feeding tumor
- AFP is negative
undifferentiated embryonal sarcoma
- pissed off cousin of mesenchymal hamartoma
- cystic but much more aggressive
- septations and pseudocapsule
pediatric tumors in child > 5 yrs
- HCC
- fibrolamellar HCC - calcifies more often
- undifferentiated embryonal sarcoma
Alagille syndrome
- peripheral pulmonary stenosis
- paucity of intrahepatic ducts
biliary atresia
- absence of extrahepatic ducts with proliferation of intrahepatic ducts
- association with trisomy 18 and polysplenia
- gallbladder may be absent
- Kasai procedure prior to 3 months
- triangle cord sign - near portal vein
- no tracer excretion into bowel at 24 hrs
Right sided heterotaxia
- 2 fissures in left lung
- asplenia
- reversed Aorta/IVC
- more cardiac malformations
left sided heterotaxia
- 1 fissure in right lung
- polysplenia
- azygous continuation of the IVC
less cardiac malformations - biliary atresia in 10%
horseshoe kidney associations
- increased risk of stones and infection
- increased risk of cancer: TCC, renal carcinoid, Wilms
- Turner’s
- smashed against vertebral body in trauma
neonatal renal vein thrombosis
- association?
- apperance
- maternal diabetes
- acute renal enlargement (atrophy when chronic)
what is the cause of neonatal renal artery thrombosis?
How does it present?
umbilical artery catheters; presents with severe hypertension
Prune Belly Syndrome
aka Eagle belly syndrome
- crappy abdominal musculature
- cryptorchidism
- hydroureteronephrosis
Grading for vesicoureteral reflux
grade 1 = reflux 1/2 way up ureter
grade 2 = reflux into nondilated collecting system
grade 3 = reflux + dilated collecting system (blunted calyces)
grade 4: mildly tortuous
grade 5 = very tortuous
urachal anomalies
- most common complication?
- boys vs. girls?
- infection
- boys > girls
bladder exstrophy - increased risk of what?
increased incidence of cancer (adenocarcinoma)
How often do you have to screen kids with nephroblastomatosis?
q 3 months until age 7-8
most common neonatal renal tumor?
mesoblastic nephroma
WAGR
Wilms
Aniridia
Genital
Growth retardation
Drash
Wilms
Pseudohermaphroditism
progressive glomerulonephritis
Beckwith Wiedemann
Wilms, hepatoblastoma, macroglossia, omphalocele, hemihypertrophy, cardiac defects, large organs
Sotos
overgrowth syndrome
- Macrocephaly
- CNS - retardation
- ugly face
- Wilms tumor association
4S stage of neuroblastoma
- less than 1 year old at diagnosis
- distal mets confined to skin, liver, and bone marrow
Paraneoplastic syndrome associated with neuroblastoma
opsomyoclonus - dancing eyes and feet
most common cause of acute scrotal pain in age 7-14
testicular appendage torsion
what is the testicular appendage?
vestigial remnant of the mesonephric duct
Bell Clapper deformity
failure of tunica vaginalis and testis to connect
paratesticular rhabdomyosarcoma
- age
most common extratesticular mass in young men
- bimodal peak (2-4, 15-17)
Testicular teratomas
o Pure testicular teratoma only seen in < 2 years old
o Mixed teratomas seen in 25 year olds
Yolk sac tumor
o Non seminomatous GCT seen in < 2 year olds
o Heterogeneous testicular mass
o AFP is very high
sertoli cell tumors
- usually bilateral
- “burned out” tumors on US - dense echogenic foci that represent calcifeid scars
- subtype associated with Peutz-Jeghers
Testicular lymphoma
mutliple hypoechoic masses in the testicle
Sacrococcygeal teratoma
- most common tumor of fetus or infant
- solid and/or cystic
- abdominal types have highest rate of malignancy
- most (80%) are benign
lateral condyle fracture
- 2nd most common distal humerus fracture in kids
- unstable if fracture passes through capitello-trochlear groove (milch 2)
Little league elbow
medial epicondyle avulsion
Congenital rubella
- bony changes in 50%
- celery stalk apperance- generalized lucency of metaphysis
- occur in 1st few weeks of life
Congenital syphilis
- bony changes in 95%
- changes do not occur until 6- 8 weeks
- metaphyseal lucent bands and periosteal reaction along long bones
- Wimberger sign: destruction of medial portion of proximal metaphysis of the tibia
Caffey disease
self-limiting soft tissue welling, periosteal reaction
- first 6 months of life
- hot mandible on bone scan (mandible is most common location)
Differential for periosteal reaction in new born
- Congenital rubella
- Congenital syphilis
- Caffey disease
- physiologic growth (NOT in newborns; around 3 months and resolves by 6 months)
- prostaglandin therapy
- neuroblastoma metastases
- abuse
physiologic periosteal reaction
- should not be seen before 1 month (NOT in new born)
- usually around 3 months
- should resolve by 6 months
- proximal involvement first (femur), then distal involvement
- ALWAYS involves diaphysis
achondroplasia
- fibroblast growth factor receptor
- rhizomelic dwarfism
- narrowing of interpedicular distance
- tombstone pelvis
- advanced paternal age is risk factor
- trident hands (long 3rd and 4th fingers)
thanatophoric dwarfism
- most common lethal dwarfism
- rhizomelic shortening
- telephone receiver femurs
- short ribs and long thorax
- small iliac bones
- flat vertebral bones (platyspondyly)
- cloverleaf shaped skull
Asphyxiating thoracic dystrophy (Jeune)
- usually fatal
- bell shaped thorax with short ribs
15% have polydactyly - chronic nephritis
- NORMAL vertebral bodies (vs. thanatophoric)
Pyknodysostosis
- osteopetrosis
- dwarf
- wide angled jaw
- acro-osteolysis
Ellis Van Crevald
dwarf with multiple fingers
osteogenesis imperfecta
- lucent skull
- multiple fractures
- wormian bones
- flat or beaked vertebral bodies
- fibula longer than tibia
osteopetrosis
- sclerotic, weak bones
- alternating bands of sclerosis parallel to the growth plate
- bone in bone appearance in the vertebral body or carpals
- picture frame vertebrae
Klippel Feil
- congenital fusion of C spine
- cervical vertebral bodies are tall and skinny
- sprengel deformtiy
- omovertebral bone
mucopolysaccharidoses
- oval shaped vertebral bodies with anteiror peak
- thick clavicles and ribs (canoe paddle)
- iliac wings are tall and flared
- wide metacarpalbones with proximal tapering
Morquio
- mucopolysacchridosis
- dwarf
- mid anterior beaking of vertebral bodies (Hurler’s is inferior)
- most common cause of death is cervical myelopathy at C2
- bony changes progress during first few years of life
Gaucher’s
- H shaped vertebra
- AVN of femoral hedas
- bone ifnarcts
- Erlenmeyer flask shaped femurs
- hepatosplenomegaly
- lysosomal storage disease
Differential for radial dysplasia
- Holt Oram
- Fanconi anemia
- Thrombocytopenia absent radius - will have thumb
- VACTERL
Hand foot syndrome
hand or foot pain/swelling in infant with sickle cell
- radiographs show periostitis 2 weeks after the pain resolves
blounts disease
varus angulation occurring at medial aspect of proximal tibia ( occurs at metaphysis, not the knee)
- seen early (age 2) or late (age 12)
- NOT seen before age 2
- often bilateral
Wormian bones differential
- Pyknodysostosis
- Osteogenesis Imperfecta
- Rickets
- Kinky Hair syndrome
- Cleidocranial dysostosis
- Hadju Cheney syndrome (primary acro-osteolysis)
Club foot
- hindfoot varus
- medial deviation and inversion of fore foot
- elevated plantar arch
- most common surgical complication of repair is over-correction, resulting in a rocker bottom flat foot deformity
- more common in boys
Developmental dysplasia of hip: risk factors
- girls > boys
- breech
- oligohydromnios
Kocher criteria
- fever
- inability to walk
- elevated ESR or CRP
- WBC > 12 k
if 3/4 are positive –> septic arthritis
strongest independent risk factor for septic arthritis
elevated CRP
Rickets
- affects most rapidly growing bones the worst (knees, wrists)
- fraying, cupping, and irregularity along physeal margin
- expansion of anterior rib ends
- NEVER seen in newborn
hypophosphatasia
- alkaline phosphatase deficiency
- frayed metaphyses and bowed long bones
- can be seen in newborn
scurvy
- hemarthrosis
- subperiosteal reaction
- scorbutic rosary - expansion of costochondral junction
- does not occur before 6 months
lead poisoning
wide sclerotic metaphyseal line in area of rapid growth
- will not spare fibula (a normal variant line might)
lucent metaphyseal band ddx
- leukemia
- infection (TORCH)
- Neuroblastoma mets
- endocrine (rickets, scurvy)
Things that calcify in eyeball of child
0-3: retinoblastoma, CMV, colobomatous
> 3: toxoplasmosis, retinal astrocytoma
