Peds Flashcards
When should phenobarbital be given to a neonate when evaluating for biliary atresia?
3-5 days prior to imaging
Why is phenobarbital given to a neonate when evaluating for biliary atresia?
to enhance the biliary excretion of the radiotracer and increase the specificity of the test
grade 4 interventricular hemorrhage –> MOA?
occlusion of the ependymal veins –> periventricular venous hemorrhagic infarction –> interventricular hemorrhage
grade 1-3 interventricular hemorrhage –> MOA?
germinal matrix hemorrhage –> extend into ventricle
Endotracheal tube –> ideal position?
- relative to clavicles
- distance from carina
- inferior border of clavicles
- 2cm above carina
PICC –> ideal position?
- UE
- LE
- UE –> SVC
- LE –> IVC within 1cm of diaphragm
How differentiate umbilical arterial catheter vs umbilical venous catheter?
- UAC –> initially course downward into internal iliac A
- UVC –> course immediately superiorly
Ideal position?
- umbilical arterial catheter
- umbilical venous catheter
- UAC –> below L2
- UVC –> IVC within 1 cm of diaphragm
Supine CXR –> PTX findings (2)
- unusually sharp heart border
- hyperlucent costophrenic angle (deep sulcus sign)
neonate –> respiratory distress –> causes (medical)? (4)
- transient tachypnea of the newborn
- meconium aspiration
- neonatal pneumonia
- respiratory distress synd (surfactant def)
neonate –> respiratory distress –> causes (surgical)? (4)
- congenital diaphragmatic hernia
- congenital cystic adenomatoid malformation
- congential lobar emphysema
- sequestration
transient tachypnea of the newborn –> pathophys?
delayed clearance of intrauterine pulmonary fluid
transient tachypnea of the newborn:
- when does it peak?
- by when does it resolve?
- peak at 24 hr
- recovery by 48-72 hr
transient tachypnea of the newborn –> findings during 1st day of life?
fluid overload:
- vascular congestion
- small pleural effusions
neonate –> CXR –> diffuse reticulonodular densities –> ddx?
What if there was pleural effusion?
- respiratory distress sydn
- neonatal pneumonia
If pleural effusion –> more likely pneumonia
neonate –> CXR –> hyperaeration, patchy asymmetric infiltrate –> ddx?
- meconium aspiration
- neonatal pneumonia
meconium aspiration –> CXR findings? why?
aspirated meconium obstructs bronchi:
- atelectasis –> patchy asymmetric airspace dz
- compensatory hyperinflation of remaining patent airways –> hyperinflated lungs
respiratory distress synd –> CXR findings?
- diffuse symm reticulogranular opacities
- prominent central air bronchograms
- generalized hypoventilation
intubation –> airway pressure too high –> barotrauma –> CXR findings?
- PTX
- pulmonary interstitial emphysema
pulmonary interstitial emphysema –> pathophys?
barotrauma –> alveoli rupture –> air accumulate w/in peribronchial & perivascular spaces
pulmonary interstitial emphysema –> CXR findings
- linear lucencies radiating from hilum
- cystic
patent ductus arteriosus –> pathophys
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
patent ductus arteriosus –> CXR findings
- increased heart size
- increased pulm vascularity
bronchopulmonary dysplasia –> definition
continued oxygen needs & CXR abnormalities beyond 28days of life
bronchopulmonary dysplasia –> pathophys
respiratory distress synd –> intubate –> oxygen toxicity & positive pressure –> pulm inflamm –> pulm fibrosis
bronchopulmonary dysplasia –> CXR findings
- hyperinflation
- diffuse interstitial thickening
- severe –> cystic changes
diaphragmatic hernia –> types? which is MC? where do they occur?
- MC: Bochdalek –> post lat
- Morgagni –> ant med
congenital cystic adenomatoid malformation –> what is it?
hamartoma of the lung
congenital cystic adenomatoid malformation –> type 1 –> findings
MC
> 2cm dominant cyst –> surrounded by multiple smaller cysts
congenital cystic adenomatoid malformation –> type 2 –> findings
<2cm uniform smaller cysts
congenital cystic adenomatoid malformation –> type 3 –> findings
microscopic cysts not grossly visible –> appears solid on imaging
congenital lobar emphysema –> what is it?
overexpansion of 1 or more lobes
congenital lobar emphysema –> predilection for which lobes?
upper lobes, middle
lower very uncommon
congenital lobar emphysema –> CXR findings
- initial: delayed clearance of pulm fluid –> appears as solid mass
- subsequent: hyperlucent lobe
pulmonary sequestration –> what is it?
lung tissue that is not connected to tracheobronchial tree
pulmonary sequestration –> diagnostic imaging finding
has systemic arterial supply (not pulmonary artery supply)
pulmonary sequestration –> types (2)
- intralobar
- extralobar
pulmonary sequestration –> MC location
medial LLL
intralobar sequestration –> when does it present? clinical presentation?
20-30s yo –> recurrent infection
extralobar sequestration –> when does it present? clinical presentation?
neonate –> respiratory distress from mass effect
tracheomalacia –> what is it?
collapse of trachea w expiration
viral respiratory infection (bronchitis) –> CXR findings
- hyperinflation
- peribronchial cuffing
- dirty hilum
CXR:
- hyperinflation
- peribronchial cuffing
- dirty hilum
ddx?
- viral infection
- reactive airway dz
lobar PNA –> pt is improving –> 1wk fu CXR –> round cyst w thin walls –> dx?
pneumatocele
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
Bordatella pertussis pneumonia (whooping cough) –> classic CXR findings
“shaggy heart”
primary TB –> CXR findings
- focal lobar consolidation
- hilar adenopathy
- pleural eff
cystic fibrosis –> CXR findings
- hyperinflation
- bronchiectasis
neonate –> CXR –> NG tube looped in upper esophagus –> dx?
esophageal atresia
neonate –> CXR –> NG tube looped in upper esophagus –> what does air in stomach indicate?
esophageal atresia w associated tracheoesophageal fistula
congenital duodenal obstruction –> MC cause?
duodenal atresia
duodenal atresia –> findings?
- “double bubble” –> stomach & duodenal bulb
- no gas in small/lrg bowel
meconium ileus –> findings?
- dilated small bowel loops –> SBO
- “frothy”/”soap bubble” pattern bowel gas (meconium mixed w air) in RLQ
- microcolon (unused colon)
what is meconium plug synd?
meconium obstruction of colon
meconium plug synd –> findings on LGI?
- meconium cast filling defect in colon
- normal caliber colon
what are Ladd bands? What pathology can they cause?
dense peritoneal band –> from malpositioned cecum to liver –> crossing the duodenum –> may cause partial obstruction
suspect malrotation –> best study? –> diagnostic finding?
UGI –> abnormal position of ligament of Treitz (R of the spine)
midgut volvulus –> UGI findings?
- findings of malrotation
- spiral course of midgut loops
intussusception –> key US finding?
“pseudo-kidney” sign –> alternating rings of hyper & hypo-echogenicity (telescoped bowel)
what is biliary atresia?
congenital obstruction of biliary system –>
- focal/total absence of extrahepatic ducts
- prolif of intrahep ducts
biliary atresia –> US findings
- absence of GB
- normal intrahep bile ducts
- normal liver
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
autosomal recessive polycystic kidney disease –> US findings
- enlarged kidney
- increased renal echogenicity
- no macroscopic cysts
primary megaureter –> pathophys?
distal segment of ureter –> aperistaltic –> functional obstruction
Multicystic dysplastic kidney –> complication of what?
severe ureteropelvic jx obstruction
Multicystic dysplastic kidney –> key finding?
kidney –> large noncommunicating cysts
neonate –> MC solid renal mass
mesoblastic nephroma
mesoblastic nephroma –> what is it?
benign hamartoma of mesenchymal connective tissue
mesoblastic nephroma –> US finding
large mixed echogenic intrarenal mass
Wilms tumor –> what is it?
malignant embryonal neoplasm arising from metanephric blastema
pseudohermaphroditism + glomerulonephritis + Wilms tumor –> what synd?
Drash synd
macroglossia + omphalocele + visceromegaly –> what synd?
Beckwith-Wiedemann synd
Wilms tumor –> important to look at what other structures?
invasion of:
- renal V
- IVC
- R atrium
2nd MC solid childhood neoplasm
neuroblastoma
neuroblastoma –> MC arises from what organ?
adrenal gland
what is torus (buckle) fx?
buckling of one cortex
what is greenstick fx?
incomplete transverse fx w fx & periosteal rupture on convex side
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
elbow –> anterior humeral line –> normal position?
mid 1/3 capitellum
elbow ossification –> order & ages
- capitellum (1yo)
- radial head (5)
- medial epicondyle (7)
- trochlea (10)
- olecranon (10)
- lateral epicondyle (11)
what is developmental dysplasia of the hip?
congenital hip dislocation
recurrent subluxation/dislocation d/t:
- acetabular dysplasia
- abnormal ligamentous laxity
- both
why is early diagnosis of developmental dysplasia of the hip important?
chronic dislocation –> growth deformity of acetabular fossa
developmental dysplasia of the hip –> US is the study of choice for which age range?
2wk-6mo
developmental dysplasia of the hip –> plain film –> at what age? why?
> 12mo
at <12mo –> lack of skeletal ossification
developmental dysplasia of the hip –> normal alpha angle?
> 60 degrees
55 deg in newborns
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
what is proximal femoral focal deficiency?
congenital disorder –> hypoplasia/absence of proximal portion of femur
proximal femoral focal deficiency –> assoc w what other conditions? (2)
- ipsilat fibular hemimelia (absent fibula)
- foot deformity
what is Legg-Calve-Perthes dz?
idiopathic avascular necrosis of the femoral head
Legg-Calve-Perthes dz –> occurs in what age range?
5-8 yo
Legg-Calve-Perthes dz –> early radiographic findings? (2)
- widened jt space
- crescent sign: subchondral fx thru necrotic bone
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
slipped capital femoral epiphysis –> which way is the femoral head displaced?
posteromed
slipped capital femoral epiphysis –> findings on AP view? (2)
- asymm physeal widening
- indistinct metaphyseal border at the physis
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
slipped capital femoral epiphysis –> complications (2)
- avascular necrosis
- chondrolysis
what is Osgood-Schlatter dz?
patellar tendon avulsion –> tibial tuberosity attachment –> painful tibial tuberosity
clubfoot –> 4 main components
- hindfoot varus –> calcaneus too medial
- equinus heel –> fixed plantarflexed heel
- metatarsus adductus –> adduction of metatarsals, forefoot varus
- talonavicular subluxation
clubfoot –> hindfoot varus –> radiographic finding?
decreased talocalcaneal angle <20
clubfoot –> equinus heel –> radiographic finding? (2)
- decreased lateral talocalcaneal angle <35
- increased lat tibiocalcaneal angle >90
clubfoot –> metatarsus adductus –> radiographic finding
medial displacement of 1st metatarsal relative to long axis of talus
clubfoot –> talonavicular subluxation –> radiographic finding
medial subluxation of navicular compared to talus
what is tarsal coalition?
congenital fusion of 2 tarsal bones
tarsal coalition –> MC form?
calcaneonavicular
tarsal coalition –> 2nd MC form?
talocalcaneal
tarsal coalition –> what kind of matrix? (2)
- bony
- cartilaginous/fibrous
distal femoral metaphyseal irregularity –> aka?
cortical desmoid
distal femoral metaphyseal irregularity –> what is it?
avulsion off medial supracondylar ridge of distal femur
distal femoral metaphyseal irregularity –> radiographic findings (3)
- distal femoral metaphysis –> posteromed cortex –> cortical irreg
- assoc lucency on AP view
- periosteal rxn
distal femoral metaphyseal irregularity –> unilat or bilat?
often bilat
distal femoral metaphyseal irregularity –> benign or malig?
benign
benign cortical defect –> seen in which part of bone?
cortex of long bone metaphysis
benign cortical defect –> MC bone?
distal femur
benign cortical defect –> radiographic finding
- <2cm
- well-defined round/oval
- lucent
- eccentric
- thin sclerotic border
- no periosteal rxn
what is non-ossifying fibroma?
> 2cm benign cortical defect
benign cortical defect –> what happens to them over time?
spontaneous regress
benign cortical defect –> MC age range?
4-6 yo
which branchial arch –> portions of pulm A?
6th
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
what is scimitar synd?
- pulm hypoplasia
- partial anomalous pulmonary venous return
craniosynostosis –> MC involved suture?
sagittal
4yo –> circle of willis –> occlusion –> dx?
moyamoya dz
moyamoya dz –> classic angiographic contrast appearance? what causes this appearance?
numerous irregular collaterals of lenticulostriate vessels –> “puff of smoke”
microcolon –> ddx? (2)
- meconium ileus
- ileal atresia
Tc-99m MAA perfusion lung scan –> uptake in left lung only –> dx?
R pulm A agenesis
what is swyer-james synd? classic imaging finding?
postinfectious obliterative bronchiolitis –> unilat small lung w hyperlucency
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
chiari 2 malformation –> classic characteristics? (2)
- myelomeningocele
- small post fossa
adolescents w closing growth plates –> MC ankle fx (2)?
- Tillaux fx
- triplane fx
Tillaux fx vs triplane fx
distal tibia:
- Tillaux –> Salter Harris III
- triplane –> Salter Harris IV
pediatric –> vertebra plana –> MC cause?
Langerhans cell histiocytosis
What is the earliest age at which radiographic findings of dietary rickets are identifiable in term
infants?
9mo
shwachman – Diamond Syndrome –> sync? (3)
- exocrine pancreatic insuff
- hematologic abnormalities with abnormal hematopoiesis typically neutropenia
- neoplastic predisposition to development of leukemia
Concerning the conversion of hematopoietic bone marrow to fatty bone marrow, which portion of the femur is the last to convert?
prox metaphysis
holoprosencephaly –> the fornix and septum pellucidum are absent in all forms –> T/F?
T
Tetralogy of Fallot –> 4 features?
- VSD
- overriding aorta
- hypoplastic RVOT –> right ventricular hypertrophy
most common primary bone malignancy in childhood? 2nd MC?
- # 1 osteosarcoma
- #2 Ewing sarcoma
Ewing sarcoma of bone –> histology –> identical to what other condition?
primitive neuroectodermal tumor (PNET)
Ewing sarcoma of bone –> epidemiology –> MC decade?
20s
fibromatosis colli –> chin points toward ipsilat or contralat side?
contralat
Glenn shunt –> anastomosis of what 2 struct?
anastomosis of the superior vena cava to the pulmonary artery
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
