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Crack the Core > Peds > Flashcards

Peds Flashcards

1
Q

Croup:

  • age?
  • cause?
A

6 months - 3 years

- parainfluenza

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2
Q

Epiglottitis

  • age?
  • cause?
  • cause of death?
A
  1. 5 years old, also teens
    - H. influenzae
    - asphyxiation from aryepiglottic flods
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3
Q

exudative tracheitis:

  • age?
  • cause?
A
  • 6-10 years

- staph A

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4
Q

most common soft tissue mass in trachea

A

subglottic hemangioma

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5
Q

PHACES syndrome

A
  • Posterior fossa (DWM)
  • Hemangiomas
  • Arterial anomalies
  • Coarctation of aorta/cardiac defects
  • Eye abnormalities
  • Subglottic hemangiomas
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6
Q

retropharyngeal soft tissues: normal thickness

A

6 mm at C2

22 mm at C6

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7
Q

Infantile vs. congenital hemangiomas

A
  • 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
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8
Q

neonatal pneumonia -GBS vs. non GBS

A
  • low lung volumes for GBS
  • other pneumonias have high lung volumes
  • GBS pneumonia less likely to have pleural effusion than non-GBS
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9
Q

PIE

  • timeline
  • buzzword
  • treatment
  • warning sign for?
  • what is a mimic?
A
  • occurs in 1st week
  • linear lucencies
  • PIE side down position
  • warning sign for impending pneumothorax
  • mimic is surfactant replacement therapy
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10
Q

classic appearance for papillomatosis

A

multiple lung nodules with cavitation

- 2% risk for squamous cell cancer

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11
Q

pleuropulmonary blastoma

  • typical location
  • calcification?
  • rib invasion?
A
  • 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
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12
Q

most common mass in masticator space of kid

A

rhabdomyosarcoma

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13
Q

most common extra-ocular, intra-orbital malignancy in children

A

rhabdomyosarcoma

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14
Q

most common benign orbital mass in child

A

dermoid

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15
Q

differential for high lung volumes in neonate

A
  • meconium aspiration

- non GBS neonatal pneumonia

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16
Q

differential for low to normal lung volumes in neonate

A
  • surfactant deficiency

- GBS neonatal pneumonia

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17
Q

Transient tachypnea

  • risk factors
  • time course
  • radiographic appearance
A
  • 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
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18
Q

risks of surfactant replacement therapy?

- was does it mimic

A
  • pulmonary hemorrhage
  • increased risk of PDA
  • can cause bleb like lucencies - mimics PIE
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19
Q

Thymic rebound

A
  • FDG avid

- drops out on opposed phase MRI

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20
Q

pulmonary slings

- associations

A
  • tracheal stenosis
  • compelte tracheal rings
  • imperforate anus
  • TE fistula
  • horseshoe lung
  • hypoplastic lung
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21
Q

Ladd’s procedure

A
  • 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
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22
Q

Pyloric stenosis

  • age range
  • criteria
  • clinical sign
A
  • 2-12 weeks (peaks 3-6 weeks)
  • 4 mm single wall; 14 mm length
  • paradoxical aciduria
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23
Q

differential for long microcolon

A
  • meconium ileus
  • distal ileal atresia - contrast does not reach ileal loops
  • total colonic aganglionosis can mimic microcolon
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24
Q

intussusception

  • time frame
  • size criteria
  • classic lead points
A
  • 3 months - 3 years
  • > 2.5 cm
  • Meckel’s, HSP vasculitis, enteric duplication cysts
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25
Q

air reduction for intussusception

  • pressure limit
  • contraindications
  • success rate
  • risk of perforation
A
  • 120 mm Hg
  • peritonitis, free air
  • 80-90%
  • 0.5% risk of perforation
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26
Q

VACTERL

A 
vertebral anomalies
anal (imperforate)
Cardiac (73%)
TE fistula
Renal
limb (radial ray)
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27
Q

when is physiologic gut herniation seen

A

6- 8 weeks

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28
Q

omphalocele

  • most common associated chromosomal abnormality?
  • other associations
A
  • Trisomy 18

- umbilical cord cysts, Turners, Klinefelters, Beckwith Wiedeman, cardiac defects

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29
Q

Schwachman Diamond syndrome

A
  • # 2 cause of pancreatic insufficiency in kdis

- diarrhea, short stature, and eczema

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30
Q

liver tumors age 0-3

A
  • hepatoblastoma
  • infantile hepatic hemangioma
  • mesenchymal hamartoma
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31
Q

Infantile hepatic hemangioma

A
  • 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
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32
Q

Hepatoblastoma

A
  • 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
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33
Q

Mesenchymal hamartoma

A

predominantly cystic mass

  • calcification UNCOMMON
  • large portal vein branch feeding tumor
  • AFP is negative
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34
Q

undifferentiated embryonal sarcoma

A
  • pissed off cousin of mesenchymal hamartoma
  • cystic but much more aggressive
  • septations and pseudocapsule
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35
Q

pediatric tumors in child > 5 yrs

A
  • HCC
  • fibrolamellar HCC - calcifies more often
  • undifferentiated embryonal sarcoma
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36
Q

Alagille syndrome

A
  • peripheral pulmonary stenosis

- paucity of intrahepatic ducts

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37
Q

biliary atresia

A
  • 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
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38
Q

Right sided heterotaxia

A
  • 2 fissures in left lung
  • asplenia
  • reversed Aorta/IVC
  • more cardiac malformations
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39
Q

left sided heterotaxia

A
  • 1 fissure in right lung
  • polysplenia
  • azygous continuation of the IVC
    less cardiac malformations
  • biliary atresia in 10%
40
Q

horseshoe kidney associations

A
  • increased risk of stones and infection
  • increased risk of cancer: TCC, renal carcinoid, Wilms
  • Turner’s
  • smashed against vertebral body in trauma
41
Q

neonatal renal vein thrombosis

  • association?
  • apperance
A
  • maternal diabetes

- acute renal enlargement (atrophy when chronic)

42
Q

what is the cause of neonatal renal artery thrombosis?

How does it present?

A

umbilical artery catheters; presents with severe hypertension

43
Q

Prune Belly Syndrome

A

aka Eagle belly syndrome

  • crappy abdominal musculature
  • cryptorchidism
  • hydroureteronephrosis
44
Q

Grading for vesicoureteral reflux

A

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

45
Q

urachal anomalies

  • most common complication?
  • boys vs. girls?
A
  • infection

- boys > girls

46
Q

bladder exstrophy - increased risk of what?

A

increased incidence of cancer (adenocarcinoma)

47
Q

How often do you have to screen kids with nephroblastomatosis?

A

q 3 months until age 7-8

48
Q

most common neonatal renal tumor?

A

mesoblastic nephroma

49
Q

WAGR

A

Wilms
Aniridia
Genital
Growth retardation

50
Q

Drash

A

Wilms
Pseudohermaphroditism
progressive glomerulonephritis

51
Q

Beckwith Wiedemann

A

Wilms, hepatoblastoma, macroglossia, omphalocele, hemihypertrophy, cardiac defects, large organs

52
Q

Sotos

A

overgrowth syndrome

  • Macrocephaly
  • CNS - retardation
  • ugly face
  • Wilms tumor association
53
Q

4S stage of neuroblastoma

A
  • less than 1 year old at diagnosis

- distal mets confined to skin, liver, and bone marrow

54
Q

Paraneoplastic syndrome associated with neuroblastoma

A

opsomyoclonus - dancing eyes and feet

55
Q

most common cause of acute scrotal pain in age 7-14

A

testicular appendage torsion

56
Q

what is the testicular appendage?

A

vestigial remnant of the mesonephric duct

57
Q

Bell Clapper deformity

A

failure of tunica vaginalis and testis to connect

58
Q

paratesticular rhabdomyosarcoma

- age

A

most common extratesticular mass in young men

- bimodal peak (2-4, 15-17)

59
Q

Testicular teratomas

A

o Pure testicular teratoma only seen in < 2 years old

o Mixed teratomas seen in 25 year olds

60
Q

Yolk sac tumor

A

o Non seminomatous GCT seen in < 2 year olds
o Heterogeneous testicular mass
o AFP is very high

61
Q

sertoli cell tumors

A
  • usually bilateral
  • “burned out” tumors on US - dense echogenic foci that represent calcifeid scars
  • subtype associated with Peutz-Jeghers
62
Q

Testicular lymphoma

A

mutliple hypoechoic masses in the testicle

63
Q

Sacrococcygeal teratoma

A
  • most common tumor of fetus or infant
  • solid and/or cystic
  • abdominal types have highest rate of malignancy
  • most (80%) are benign
64
Q

lateral condyle fracture

A
  • 2nd most common distal humerus fracture in kids

- unstable if fracture passes through capitello-trochlear groove (milch 2)

65
Q

Little league elbow

A

medial epicondyle avulsion

66
Q

Congenital rubella

A
  • bony changes in 50%
  • celery stalk apperance- generalized lucency of metaphysis
  • occur in 1st few weeks of life
67
Q

Congenital syphilis

A
  • 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
68
Q

Caffey disease

A

self-limiting soft tissue welling, periosteal reaction

  • first 6 months of life
  • hot mandible on bone scan (mandible is most common location)
69
Q

Differential for periosteal reaction in new born

A
  • Congenital rubella
  • Congenital syphilis
  • Caffey disease
  • physiologic growth (NOT in newborns; around 3 months and resolves by 6 months)
  • prostaglandin therapy
  • neuroblastoma metastases
  • abuse
70
Q

physiologic periosteal reaction

A
  • 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
71
Q

achondroplasia

A
  • 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)
72
Q

thanatophoric dwarfism

A
  • most common lethal dwarfism
  • rhizomelic shortening
  • telephone receiver femurs
  • short ribs and long thorax
  • small iliac bones
  • flat vertebral bones (platyspondyly)
  • cloverleaf shaped skull
73
Q

Asphyxiating thoracic dystrophy (Jeune)

A
  • usually fatal
  • bell shaped thorax with short ribs
    15% have polydactyly
  • chronic nephritis
  • NORMAL vertebral bodies (vs. thanatophoric)
74
Q

Pyknodysostosis

A
  • osteopetrosis
  • dwarf
  • wide angled jaw
  • acro-osteolysis
75
Q

Ellis Van Crevald

A

dwarf with multiple fingers

76
Q

osteogenesis imperfecta

A
  • lucent skull
  • multiple fractures
  • wormian bones
  • flat or beaked vertebral bodies
  • fibula longer than tibia
77
Q

osteopetrosis

A
  • 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
78
Q

Klippel Feil

A
  • congenital fusion of C spine
  • cervical vertebral bodies are tall and skinny
  • sprengel deformtiy
  • omovertebral bone
79
Q

mucopolysaccharidoses

A
  • oval shaped vertebral bodies with anteiror peak
  • thick clavicles and ribs (canoe paddle)
  • iliac wings are tall and flared
  • wide metacarpalbones with proximal tapering
80
Q

Morquio

A
  • 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
81
Q

Gaucher’s

A
  • H shaped vertebra
  • AVN of femoral hedas
  • bone ifnarcts
  • Erlenmeyer flask shaped femurs
  • hepatosplenomegaly
  • lysosomal storage disease
82
Q

Differential for radial dysplasia

A
  • Holt Oram
  • Fanconi anemia
  • Thrombocytopenia absent radius - will have thumb
  • VACTERL
83
Q

Hand foot syndrome

A

hand or foot pain/swelling in infant with sickle cell

- radiographs show periostitis 2 weeks after the pain resolves

84
Q

blounts disease

A

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
85
Q

Wormian bones differential

A
  • Pyknodysostosis
  • Osteogenesis Imperfecta
  • Rickets
  • Kinky Hair syndrome
  • Cleidocranial dysostosis
  • Hadju Cheney syndrome (primary acro-osteolysis)
86
Q

Club foot

A
  • 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
87
Q

Developmental dysplasia of hip: risk factors

A
  • girls > boys
  • breech
  • oligohydromnios
88
Q

Kocher criteria

A
  • fever
  • inability to walk
  • elevated ESR or CRP
  • WBC > 12 k
    if 3/4 are positive –> septic arthritis
89
Q

strongest independent risk factor for septic arthritis

A

elevated CRP

90
Q

Rickets

A
  • 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
91
Q

hypophosphatasia

A
  • alkaline phosphatase deficiency
  • frayed metaphyses and bowed long bones
  • can be seen in newborn
92
Q

scurvy

A
  • hemarthrosis
  • subperiosteal reaction
  • scorbutic rosary - expansion of costochondral junction
  • does not occur before 6 months
93
Q

lead poisoning

A

wide sclerotic metaphyseal line in area of rapid growth

- will not spare fibula (a normal variant line might)

94
Q

lucent metaphyseal band ddx

A
  • leukemia
  • infection (TORCH)
  • Neuroblastoma mets
  • endocrine (rickets, scurvy)
95
Q

Things that calcify in eyeball of child

A

0-3: retinoblastoma, CMV, colobomatous

> 3: toxoplasmosis, retinal astrocytoma

Crack the Core (12 decks)

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