Peds Flashcards
(142 cards)
1
Q
When should phenobarbital be given to a neonate when evaluating for biliary atresia?
A
3-5 days prior to imaging
2
Q
Why is phenobarbital given to a neonate when evaluating for biliary atresia?
A
to enhance the biliary excretion of the radiotracer and increase the specificity of the test
3
Q
grade 4 interventricular hemorrhage –> MOA?
A
occlusion of the ependymal veins –> periventricular venous hemorrhagic infarction –> interventricular hemorrhage
4
Q
grade 1-3 interventricular hemorrhage –> MOA?
A
germinal matrix hemorrhage –> extend into ventricle
5
Q
Endotracheal tube –> ideal position?
- relative to clavicles
- distance from carina
A
- inferior border of clavicles
- 2cm above carina
6
Q
PICC –> ideal position?
- UE
- LE
A
- UE –> SVC
- LE –> IVC within 1cm of diaphragm
7
Q
How differentiate umbilical arterial catheter vs umbilical venous catheter?
A
- UAC –> initially course downward into internal iliac A
- UVC –> course immediately superiorly
8
Q
Ideal position?
- umbilical arterial catheter
- umbilical venous catheter
A
- UAC –> below L2
- UVC –> IVC within 1 cm of diaphragm
9
Q
Supine CXR –> PTX findings (2)
A
- unusually sharp heart border
- hyperlucent costophrenic angle (deep sulcus sign)
10
Q
neonate –> respiratory distress –> causes (medical)? (4)
A
- transient tachypnea of the newborn
- meconium aspiration
- neonatal pneumonia
- respiratory distress synd (surfactant def)
11
Q
neonate –> respiratory distress –> causes (surgical)? (4)
A
- congenital diaphragmatic hernia
- congenital cystic adenomatoid malformation
- congential lobar emphysema
- sequestration
12
Q
transient tachypnea of the newborn –> pathophys?
A
delayed clearance of intrauterine pulmonary fluid
13
Q
transient tachypnea of the newborn:
- when does it peak?
- by when does it resolve?
A
- peak at 24 hr
- recovery by 48-72 hr
14
Q
transient tachypnea of the newborn –> findings during 1st day of life?
A
fluid overload:
- vascular congestion
- small pleural effusions
15
Q
neonate –> CXR –> diffuse reticulonodular densities –> ddx?
What if there was pleural effusion?
A
- respiratory distress sydn
- neonatal pneumonia
If pleural effusion –> more likely pneumonia
16
Q
neonate –> CXR –> hyperaeration, patchy asymmetric infiltrate –> ddx?
A
- meconium aspiration
- neonatal pneumonia
17
Q
meconium aspiration –> CXR findings? why?
A
aspirated meconium obstructs bronchi:
- atelectasis –> patchy asymmetric airspace dz
- compensatory hyperinflation of remaining patent airways –> hyperinflated lungs
18
Q
respiratory distress synd –> CXR findings?
A
- diffuse symm reticulogranular opacities
- prominent central air bronchograms
- generalized hypoventilation
19
Q
intubation –> airway pressure too high –> barotrauma –> CXR findings?
A
- PTX
- pulmonary interstitial emphysema
20
Q
pulmonary interstitial emphysema –> pathophys?
A
barotrauma –> alveoli rupture –> air accumulate w/in peribronchial & perivascular spaces
21
Q
pulmonary interstitial emphysema –> CXR findings
A
- linear lucencies radiating from hilum
- cystic
22
Q
patent ductus arteriosus –> pathophys
A
pulmonary resistance remains high –> ductus remains open w R to L shunt –> ventilatory therapy decreases pulm resistance –> switch to L to R shunt –> increased pulmn blood flow
23
Q
patent ductus arteriosus –> CXR findings
A
- increased heart size
- increased pulm vascularity
24
Q
bronchopulmonary dysplasia –> definition
A
continued oxygen needs & CXR abnormalities beyond 28days of life
25
bronchopulmonary dysplasia --> pathophys
respiratory distress synd --> intubate --> oxygen toxicity & positive pressure --> pulm inflamm --> pulm fibrosis
26
bronchopulmonary dysplasia --> CXR findings
- hyperinflation
- diffuse interstitial thickening
- severe --> cystic changes
27
diaphragmatic hernia --> types? which is MC? where do they occur?
- MC: Bochdalek --> post lat
| - Morgagni --> ant med
28
congenital cystic adenomatoid malformation --> what is it?
hamartoma of the lung
29
congenital cystic adenomatoid malformation --> type 1 --> findings
MC
>2cm dominant cyst --> surrounded by multiple smaller cysts
30
congenital cystic adenomatoid malformation --> type 2 --> findings
<2cm uniform smaller cysts
31
congenital cystic adenomatoid malformation --> type 3 --> findings
microscopic cysts not grossly visible --> appears solid on imaging
32
congenital lobar emphysema --> what is it?
overexpansion of 1 or more lobes
33
congenital lobar emphysema --> predilection for which lobes?
upper lobes, middle
lower very uncommon
34
congenital lobar emphysema --> CXR findings
- initial: delayed clearance of pulm fluid --> appears as solid mass
- subsequent: hyperlucent lobe
35
pulmonary sequestration --> what is it?
lung tissue that is not connected to tracheobronchial tree
36
pulmonary sequestration --> diagnostic imaging finding
has systemic arterial supply (not pulmonary artery supply)
37
pulmonary sequestration --> types (2)
- intralobar
| - extralobar
38
pulmonary sequestration --> MC location
medial LLL
39
intralobar sequestration --> when does it present? clinical presentation?
20-30s yo --> recurrent infection
40
extralobar sequestration --> when does it present? clinical presentation?
neonate --> respiratory distress from mass effect
41
tracheomalacia --> what is it?
collapse of trachea w expiration
42
viral respiratory infection (bronchitis) --> CXR findings
- hyperinflation
- peribronchial cuffing
- dirty hilum
43
CXR:
- hyperinflation
- peribronchial cuffing
- dirty hilum
ddx?
- viral infection
| - reactive airway dz
44
lobar PNA --> pt is improving --> 1wk fu CXR --> round cyst w thin walls --> dx?
pneumatocele
45
lobar PNA --> pt is improving --> 1wk fu CXR --> round cyst w thin walls --> dx: pneumatocele --> why not an abscess?
abscess:
- thick irreg wall
- air-fluid level
- pt is very ill
46
Bordatella pertussis pneumonia (whooping cough) --> classic CXR findings
"shaggy heart"
47
primary TB --> CXR findings
- focal lobar consolidation
- hilar adenopathy
- pleural eff
48
cystic fibrosis --> CXR findings
- hyperinflation
| - bronchiectasis
49
neonate --> CXR --> NG tube looped in upper esophagus --> dx?
esophageal atresia
50
neonate --> CXR --> NG tube looped in upper esophagus --> what does air in stomach indicate?
esophageal atresia w associated tracheoesophageal fistula
51
congenital duodenal obstruction --> MC cause?
duodenal atresia
52
duodenal atresia --> findings?
- "double bubble" --> stomach & duodenal bulb
| - no gas in small/lrg bowel
53
meconium ileus --> findings?
- dilated small bowel loops --> SBO
- "frothy"/"soap bubble" pattern bowel gas (meconium mixed w air) in RLQ
- microcolon (unused colon)
54
what is meconium plug synd?
meconium obstruction of colon
55
meconium plug synd --> findings on LGI?
- meconium cast filling defect in colon
| - normal caliber colon
56
what are Ladd bands? What pathology can they cause?
dense peritoneal band --> from malpositioned cecum to liver --> crossing the duodenum --> may cause partial obstruction
57
suspect malrotation --> best study? --> diagnostic finding?
UGI --> abnormal position of ligament of Treitz (R of the spine)
58
midgut volvulus --> UGI findings?
- findings of malrotation
| - spiral course of midgut loops
59
intussusception --> key US finding?
"pseudo-kidney" sign --> alternating rings of hyper & hypo-echogenicity (telescoped bowel)
60
what is biliary atresia?
congenital obstruction of biliary system -->
- focal/total absence of extrahepatic ducts
- prolif of intrahep ducts
61
biliary atresia --> US findings
- absence of GB
- normal intrahep bile ducts
- normal liver
62
choledochal cyst --> types (4)?
- type I: dilate extrahep duct
- type II: eccentric diverticulum
- type III: choledochocele --> focal dilation near sphincter that extends into duodenal wall
- type IV: multiple dilations
63
autosomal recessive polycystic kidney disease --> US findings
- enlarged kidney
- increased renal echogenicity
- no macroscopic cysts
64
primary megaureter --> pathophys?
distal segment of ureter --> aperistaltic --> functional obstruction
65
Multicystic dysplastic kidney --> complication of what?
severe ureteropelvic jx obstruction
66
Multicystic dysplastic kidney --> key finding?
kidney --> large noncommunicating cysts
67
neonate --> MC solid renal mass
mesoblastic nephroma
68
mesoblastic nephroma --> what is it?
benign hamartoma of mesenchymal connective tissue
69
mesoblastic nephroma --> US finding
large mixed echogenic intrarenal mass
70
Wilms tumor --> what is it?
malignant embryonal neoplasm arising from metanephric blastema
71
pseudohermaphroditism + glomerulonephritis + Wilms tumor --> what synd?
Drash synd
72
macroglossia + omphalocele + visceromegaly --> what synd?
Beckwith-Wiedemann synd
73
Wilms tumor --> important to look at what other structures?
invasion of:
- renal V
- IVC
- R atrium
74
2nd MC solid childhood neoplasm
neuroblastoma
75
neuroblastoma --> MC arises from what organ?
adrenal gland
76
what is torus (buckle) fx?
buckling of one cortex
77
what is greenstick fx?
incomplete transverse fx w fx & periosteal rupture on convex side
78
Salter-Harris fx classification
- type I: physis
- type II: metaphysis + physis
- type III: epiphysis + physis
- type IV: metaphysis + physis + epiphysis
- type V: crush injury of physis
79
elbow --> anterior humeral line --> normal position?
mid 1/3 capitellum
80
elbow ossification --> order & ages
- capitellum (1yo)
- radial head (5)
- medial epicondyle (7)
- trochlea (10)
- olecranon (10)
- lateral epicondyle (11)
81
what is developmental dysplasia of the hip?
congenital hip dislocation
recurrent subluxation/dislocation d/t:
- acetabular dysplasia
- abnormal ligamentous laxity
- both
82
why is early diagnosis of developmental dysplasia of the hip important?
chronic dislocation --> growth deformity of acetabular fossa
83
developmental dysplasia of the hip --> US is the study of choice for which age range?
2wk-6mo
84
developmental dysplasia of the hip --> plain film --> at what age? why?
>12mo
at <12mo --> lack of skeletal ossification
85
developmental dysplasia of the hip --> normal alpha angle?
>60 degrees
55 deg in newborns
86
what "lines" are used to evaluate DDH on plain film? (4)
- Shenton's curve:medial border of femoral metaphysis to sup border of obturator foramen
- Hilgenreiner's line: horizontal line thru triradiate cartilage of actebuli
- Perkin's line: vertical line --> lateral margin of ossified acetabular roof to lateral margin of ossification center of femoral head
- acetabular angle: angle of actebular line w Hilgenreiner's line
87
what is proximal femoral focal deficiency?
congenital disorder --> hypoplasia/absence of proximal portion of femur
88
proximal femoral focal deficiency --> assoc w what other conditions? (2)
- ipsilat fibular hemimelia (absent fibula)
| - foot deformity
89
what is Legg-Calve-Perthes dz?
idiopathic avascular necrosis of the femoral head
90
Legg-Calve-Perthes dz --> occurs in what age range?
5-8 yo
91
Legg-Calve-Perthes dz --> early radiographic findings? (2)
- widened jt space
| - crescent sign: subchondral fx thru necrotic bone
92
Legg-Calve-Perthes dz --> chronic findings? (5)
- femoral epiphysis --> fragment/collapse, areas of sclerosis/lucency
- coxa magna (broad overgrown femoral head)
- coxa plana (flat femoral head)
- short femoral neck
- arrest of physeal growth
93
slipped capital femoral epiphysis --> which way is the femoral head displaced?
posteromed
94
slipped capital femoral epiphysis --> findings on AP view? (2)
- asymm physeal widening
| - indistinct metaphyseal border at the physis
95
slipped capital femoral epiphysis --> definitive finding on frogleg view?
draw line tangential to lat cortex of metaphysis:
- normal: the line goes thru the ossified epiphysis
- SCFE: the epiphysis is medial to line
96
slipped capital femoral epiphysis --> complications (2)
- avascular necrosis
| - chondrolysis
97
what is Osgood-Schlatter dz?
patellar tendon avulsion --> tibial tuberosity attachment --> painful tibial tuberosity
98
clubfoot --> 4 main components
- hindfoot varus --> calcaneus too medial
- equinus heel --> fixed plantarflexed heel
- metatarsus adductus --> adduction of metatarsals, forefoot varus
- talonavicular subluxation
99
clubfoot --> hindfoot varus --> radiographic finding?
decreased talocalcaneal angle <20
100
clubfoot --> equinus heel --> radiographic finding? (2)
- decreased lateral talocalcaneal angle <35
| - increased lat tibiocalcaneal angle >90
101
clubfoot --> metatarsus adductus --> radiographic finding
medial displacement of 1st metatarsal relative to long axis of talus
102
clubfoot --> talonavicular subluxation --> radiographic finding
medial subluxation of navicular compared to talus
103
what is tarsal coalition?
congenital fusion of 2 tarsal bones
104
tarsal coalition --> MC form?
calcaneonavicular
105
tarsal coalition --> 2nd MC form?
talocalcaneal
106
tarsal coalition --> what kind of matrix? (2)
- bony
| - cartilaginous/fibrous
107
distal femoral metaphyseal irregularity --> aka?
cortical desmoid
108
distal femoral metaphyseal irregularity --> what is it?
avulsion off medial supracondylar ridge of distal femur
109
distal femoral metaphyseal irregularity --> radiographic findings (3)
- distal femoral metaphysis --> posteromed cortex --> cortical irreg
- assoc lucency on AP view
- periosteal rxn
110
distal femoral metaphyseal irregularity --> unilat or bilat?
often bilat
111
distal femoral metaphyseal irregularity --> benign or malig?
benign
112
benign cortical defect --> seen in which part of bone?
cortex of long bone metaphysis
113
benign cortical defect --> MC bone?
distal femur
114
benign cortical defect --> radiographic finding
- <2cm
- well-defined round/oval
- lucent
- eccentric
- thin sclerotic border
- no periosteal rxn
115
what is non-ossifying fibroma?
>2cm benign cortical defect
116
benign cortical defect --> what happens to them over time?
spontaneous regress
117
benign cortical defect --> MC age range?
4-6 yo
118
which branchial arch --> portions of pulm A?
6th
119
young child --> h/o chronic hoarseness & stridor --> imaging shows mult irreg cavities in bilat lungs --> most likely dx?
HPV
rationale: peripartum --> HPV transmission from mother --> tracheolaryngeal papillomatosis --> stridor --> nodular material into distal bronchial tree --> cavitary lesions
120
what is scimitar synd?
- pulm hypoplasia
| - partial anomalous pulmonary venous return
121
craniosynostosis --> MC involved suture?
sagittal
122
4yo --> circle of willis --> occlusion --> dx?
moyamoya dz
123
moyamoya dz --> classic angiographic contrast appearance? what causes this appearance?
numerous irregular collaterals of lenticulostriate vessels --> "puff of smoke"
124
microcolon --> ddx? (2)
- meconium ileus
| - ileal atresia
125
Tc-99m MAA perfusion lung scan --> uptake in left lung only --> dx?
R pulm A agenesis
126
what is swyer-james synd? classic imaging finding?
postinfectious obliterative bronchiolitis --> unilat small lung w hyperlucency
127
Salter-Harris classification
```
I: S(lipped) - physis
II: A(bove) - metaphyis & physis
III: L(ower) - physis & epiphysis
IV: T(hru) - meta, physis, epi
V: R(ammed) - compressed physis
```
128
chiari 2 malformation --> classic characteristics? (2)
- myelomeningocele
| - small post fossa
129
adolescents w closing growth plates --> MC ankle fx (2)?
- Tillaux fx
| - triplane fx
130
Tillaux fx vs triplane fx
distal tibia:
- Tillaux --> Salter Harris III
- triplane --> Salter Harris IV
131
pediatric --> vertebra plana --> MC cause?
Langerhans cell histiocytosis
132
What is the earliest age at which radiographic findings of dietary rickets are identifiable in term
infants?
9mo
133
shwachman – Diamond Syndrome --> sync? (3)
- exocrine pancreatic insuff
- hematologic abnormalities with abnormal hematopoiesis typically neutropenia
- neoplastic predisposition to development of leukemia
134
Concerning the conversion of hematopoietic bone marrow to fatty bone marrow, which portion of the femur is the last to convert?
prox metaphysis
135
holoprosencephaly --> the fornix and septum pellucidum are absent in all forms --> T/F?
T
136
Tetralogy of Fallot --> 4 features?
- VSD
- overriding aorta
- hypoplastic RVOT --> right ventricular hypertrophy
137
most common primary bone malignancy in childhood? 2nd MC?
- #1 osteosarcoma
| - #2 Ewing sarcoma
138
Ewing sarcoma of bone --> histology --> identical to what other condition?
primitive neuroectodermal tumor (PNET)
139
Ewing sarcoma of bone --> epidemiology --> MC decade?
20s
140
fibromatosis colli --> chin points toward ipsilat or contralat side?
contralat
141
Glenn shunt --> anastomosis of what 2 struct?
anastomosis of the superior vena cava to the pulmonary artery
142
Blalock-Taussig shunt --> anastomosis of what 2 struct? purpose?
anastomosis of the subclavian A to pulmonary artery
increase pulmonary arterial blood flow in patients with right ventricular outflow tract obstruction
