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Peds Flashcards

1
Q

When should phenobarbital be given to a neonate when evaluating for biliary atresia?

A

3-5 days prior to imaging

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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

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3
Q

grade 4 interventricular hemorrhage –> MOA?

A

occlusion of the ependymal veins –> periventricular venous hemorrhagic infarction –> interventricular hemorrhage

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4
Q

grade 1-3 interventricular hemorrhage –> MOA?

A

germinal matrix hemorrhage –> extend into ventricle

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5
Q

Endotracheal tube –> ideal position?

  • relative to clavicles
  • distance from carina
A
  • inferior border of clavicles

- 2cm above carina

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6
Q

PICC –> ideal position?

  • UE
  • LE
A
  • UE –> SVC

- LE –> IVC within 1cm of diaphragm

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7
Q

How differentiate umbilical arterial catheter vs umbilical venous catheter?

A
  • UAC –> initially course downward into internal iliac A

- UVC –> course immediately superiorly

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8
Q

Ideal position?

  • umbilical arterial catheter
  • umbilical venous catheter
A
  • UAC –> below L2

- UVC –> IVC within 1 cm of diaphragm

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9
Q

Supine CXR –> PTX findings (2)

A
  • unusually sharp heart border

- hyperlucent costophrenic angle (deep sulcus sign)

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10
Q

neonate –> respiratory distress –> causes (medical)? (4)

A
  • transient tachypnea of the newborn
  • meconium aspiration
  • neonatal pneumonia
  • respiratory distress synd (surfactant def)
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11
Q

neonate –> respiratory distress –> causes (surgical)? (4)

A
  • congenital diaphragmatic hernia
  • congenital cystic adenomatoid malformation
  • congential lobar emphysema
  • sequestration
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12
Q

transient tachypnea of the newborn –> pathophys?

A

delayed clearance of intrauterine pulmonary fluid

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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

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14
Q

transient tachypnea of the newborn –> findings during 1st day of life?

A

fluid overload:

  • vascular congestion
  • small pleural effusions
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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

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16
Q

neonate –> CXR –> hyperaeration, patchy asymmetric infiltrate –> ddx?

A
  • meconium aspiration

- neonatal pneumonia

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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
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18
Q

respiratory distress synd –> CXR findings?

A
  • diffuse symm reticulogranular opacities
  • prominent central air bronchograms
  • generalized hypoventilation
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19
Q

intubation –> airway pressure too high –> barotrauma –> CXR findings?

A
  • PTX

- pulmonary interstitial emphysema

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20
Q

pulmonary interstitial emphysema –> pathophys?

A

barotrauma –> alveoli rupture –> air accumulate w/in peribronchial & perivascular spaces

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21
Q

pulmonary interstitial emphysema –> CXR findings

A
  • linear lucencies radiating from hilum

- cystic

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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

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23
Q

patent ductus arteriosus –> CXR findings

A
  • increased heart size

- increased pulm vascularity

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24
Q

bronchopulmonary dysplasia –> definition

A

continued oxygen needs & CXR abnormalities beyond 28days of life

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25
Q

bronchopulmonary dysplasia –> pathophys

A

respiratory distress synd –> intubate –> oxygen toxicity & positive pressure –> pulm inflamm –> pulm fibrosis

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26
Q

bronchopulmonary dysplasia –> CXR findings

A
  • hyperinflation
  • diffuse interstitial thickening
  • severe –> cystic changes
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27
Q

diaphragmatic hernia –> types? which is MC? where do they occur?

A
  • MC: Bochdalek –> post lat

- Morgagni –> ant med

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28
Q

congenital cystic adenomatoid malformation –> what is it?

A

hamartoma of the lung

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29
Q

congenital cystic adenomatoid malformation –> type 1 –> findings

A

MC

> 2cm dominant cyst –> surrounded by multiple smaller cysts

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30
Q

congenital cystic adenomatoid malformation –> type 2 –> findings

A

<2cm uniform smaller cysts

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31
Q

congenital cystic adenomatoid malformation –> type 3 –> findings

A

microscopic cysts not grossly visible –> appears solid on imaging

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32
Q

congenital lobar emphysema –> what is it?

A

overexpansion of 1 or more lobes

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33
Q

congenital lobar emphysema –> predilection for which lobes?

A

upper lobes, middle

lower very uncommon

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34
Q

congenital lobar emphysema –> CXR findings

A
  • initial: delayed clearance of pulm fluid –> appears as solid mass
  • subsequent: hyperlucent lobe
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35
Q

pulmonary sequestration –> what is it?

A

lung tissue that is not connected to tracheobronchial tree

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36
Q

pulmonary sequestration –> diagnostic imaging finding

A

has systemic arterial supply (not pulmonary artery supply)

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37
Q

pulmonary sequestration –> types (2)

A
  • intralobar

- extralobar

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38
Q

pulmonary sequestration –> MC location

A

medial LLL

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39
Q

intralobar sequestration –> when does it present? clinical presentation?

A

20-30s yo –> recurrent infection

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40
Q

extralobar sequestration –> when does it present? clinical presentation?

A

neonate –> respiratory distress from mass effect

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41
Q

tracheomalacia –> what is it?

A

collapse of trachea w expiration

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42
Q

viral respiratory infection (bronchitis) –> CXR findings

A
  • hyperinflation
  • peribronchial cuffing
  • dirty hilum
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43
Q

CXR:

  • hyperinflation
  • peribronchial cuffing
  • dirty hilum

ddx?

A
  • viral infection

- reactive airway dz

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44
Q

lobar PNA –> pt is improving –> 1wk fu CXR –> round cyst w thin walls –> dx?

A

pneumatocele

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45
Q

lobar PNA –> pt is improving –> 1wk fu CXR –> round cyst w thin walls –> dx: pneumatocele –> why not an abscess?

A

abscess:
- thick irreg wall
- air-fluid level
- pt is very ill

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46
Q

Bordatella pertussis pneumonia (whooping cough) –> classic CXR findings

A

“shaggy heart”

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47
Q

primary TB –> CXR findings

A
  • focal lobar consolidation
  • hilar adenopathy
  • pleural eff
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48
Q

cystic fibrosis –> CXR findings

A
  • hyperinflation

- bronchiectasis

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49
Q

neonate –> CXR –> NG tube looped in upper esophagus –> dx?

A

esophageal atresia

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50
Q

neonate –> CXR –> NG tube looped in upper esophagus –> what does air in stomach indicate?

A

esophageal atresia w associated tracheoesophageal fistula

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51
Q

congenital duodenal obstruction –> MC cause?

A

duodenal atresia

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52
Q

duodenal atresia –> findings?

A
  • “double bubble” –> stomach & duodenal bulb

- no gas in small/lrg bowel

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53
Q

meconium ileus –> findings?

A
  • dilated small bowel loops –> SBO
  • “frothy”/”soap bubble” pattern bowel gas (meconium mixed w air) in RLQ
  • microcolon (unused colon)
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54
Q

what is meconium plug synd?

A

meconium obstruction of colon

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55
Q

meconium plug synd –> findings on LGI?

A
  • meconium cast filling defect in colon

- normal caliber colon

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56
Q

what are Ladd bands? What pathology can they cause?

A

dense peritoneal band –> from malpositioned cecum to liver –> crossing the duodenum –> may cause partial obstruction

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57
Q

suspect malrotation –> best study? –> diagnostic finding?

A

UGI –> abnormal position of ligament of Treitz (R of the spine)

58
Q

midgut volvulus –> UGI findings?

A
  • findings of malrotation

- spiral course of midgut loops

59
Q

intussusception –> key US finding?

A

“pseudo-kidney” sign –> alternating rings of hyper & hypo-echogenicity (telescoped bowel)

60
Q

what is biliary atresia?

A

congenital obstruction of biliary system –>

  • focal/total absence of extrahepatic ducts
  • prolif of intrahep ducts
61
Q

biliary atresia –> US findings

A
  • absence of GB
  • normal intrahep bile ducts
  • normal liver
62
Q

choledochal cyst –> types (4)?

A
  • 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
Q

autosomal recessive polycystic kidney disease –> US findings

A
  • enlarged kidney
  • increased renal echogenicity
  • no macroscopic cysts
64
Q

primary megaureter –> pathophys?

A

distal segment of ureter –> aperistaltic –> functional obstruction

65
Q

Multicystic dysplastic kidney –> complication of what?

A

severe ureteropelvic jx obstruction

66
Q

Multicystic dysplastic kidney –> key finding?

A

kidney –> large noncommunicating cysts

67
Q

neonate –> MC solid renal mass

A

mesoblastic nephroma

68
Q

mesoblastic nephroma –> what is it?

A

benign hamartoma of mesenchymal connective tissue

69
Q

mesoblastic nephroma –> US finding

A

large mixed echogenic intrarenal mass

70
Q

Wilms tumor –> what is it?

A

malignant embryonal neoplasm arising from metanephric blastema

71
Q

pseudohermaphroditism + glomerulonephritis + Wilms tumor –> what synd?

A

Drash synd

72
Q

macroglossia + omphalocele + visceromegaly –> what synd?

A

Beckwith-Wiedemann synd

73
Q

Wilms tumor –> important to look at what other structures?

A

invasion of:

  • renal V
  • IVC
  • R atrium
74
Q

2nd MC solid childhood neoplasm

A

neuroblastoma

75
Q

neuroblastoma –> MC arises from what organ?

A

adrenal gland

76
Q

what is torus (buckle) fx?

A

buckling of one cortex

77
Q

what is greenstick fx?

A

incomplete transverse fx w fx & periosteal rupture on convex side

78
Q

Salter-Harris fx classification

A
  • type I: physis
  • type II: metaphysis + physis
  • type III: epiphysis + physis
  • type IV: metaphysis + physis + epiphysis
  • type V: crush injury of physis
79
Q

elbow –> anterior humeral line –> normal position?

A

mid 1/3 capitellum

80
Q

elbow ossification –> order & ages

A
  • capitellum (1yo)
  • radial head (5)
  • medial epicondyle (7)
  • trochlea (10)
  • olecranon (10)
  • lateral epicondyle (11)
81
Q

what is developmental dysplasia of the hip?

A

congenital hip dislocation

recurrent subluxation/dislocation d/t:

  • acetabular dysplasia
  • abnormal ligamentous laxity
  • both
82
Q

why is early diagnosis of developmental dysplasia of the hip important?

A

chronic dislocation –> growth deformity of acetabular fossa

83
Q

developmental dysplasia of the hip –> US is the study of choice for which age range?

A

2wk-6mo

84
Q

developmental dysplasia of the hip –> plain film –> at what age? why?

A

> 12mo

at <12mo –> lack of skeletal ossification

85
Q

developmental dysplasia of the hip –> normal alpha angle?

A

> 60 degrees

55 deg in newborns

86
Q

what “lines” are used to evaluate DDH on plain film? (4)

A
  • 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
Q

what is proximal femoral focal deficiency?

A

congenital disorder –> hypoplasia/absence of proximal portion of femur

88
Q

proximal femoral focal deficiency –> assoc w what other conditions? (2)

A
  • ipsilat fibular hemimelia (absent fibula)

- foot deformity

89
Q

what is Legg-Calve-Perthes dz?

A

idiopathic avascular necrosis of the femoral head

90
Q

Legg-Calve-Perthes dz –> occurs in what age range?

A

5-8 yo

91
Q

Legg-Calve-Perthes dz –> early radiographic findings? (2)

A
  • widened jt space

- crescent sign: subchondral fx thru necrotic bone

92
Q

Legg-Calve-Perthes dz –> chronic findings? (5)

A
  • 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
Q

slipped capital femoral epiphysis –> which way is the femoral head displaced?

A

posteromed

94
Q

slipped capital femoral epiphysis –> findings on AP view? (2)

A
  • asymm physeal widening

- indistinct metaphyseal border at the physis

95
Q

slipped capital femoral epiphysis –> definitive finding on frogleg view?

A

draw line tangential to lat cortex of metaphysis:

  • normal: the line goes thru the ossified epiphysis
  • SCFE: the epiphysis is medial to line
96
Q

slipped capital femoral epiphysis –> complications (2)

A
  • avascular necrosis

- chondrolysis

97
Q

what is Osgood-Schlatter dz?

A

patellar tendon avulsion –> tibial tuberosity attachment –> painful tibial tuberosity

98
Q

clubfoot –> 4 main components

A
  • hindfoot varus –> calcaneus too medial
  • equinus heel –> fixed plantarflexed heel
  • metatarsus adductus –> adduction of metatarsals, forefoot varus
  • talonavicular subluxation
99
Q

clubfoot –> hindfoot varus –> radiographic finding?

A

decreased talocalcaneal angle <20

100
Q

clubfoot –> equinus heel –> radiographic finding? (2)

A
  • decreased lateral talocalcaneal angle <35

- increased lat tibiocalcaneal angle >90

101
Q

clubfoot –> metatarsus adductus –> radiographic finding

A

medial displacement of 1st metatarsal relative to long axis of talus

102
Q

clubfoot –> talonavicular subluxation –> radiographic finding

A

medial subluxation of navicular compared to talus

103
Q

what is tarsal coalition?

A

congenital fusion of 2 tarsal bones

104
Q

tarsal coalition –> MC form?

A

calcaneonavicular

105
Q

tarsal coalition –> 2nd MC form?

A

talocalcaneal

106
Q

tarsal coalition –> what kind of matrix? (2)

A
  • bony

- cartilaginous/fibrous

107
Q

distal femoral metaphyseal irregularity –> aka?

A

cortical desmoid

108
Q

distal femoral metaphyseal irregularity –> what is it?

A

avulsion off medial supracondylar ridge of distal femur

109
Q

distal femoral metaphyseal irregularity –> radiographic findings (3)

A
  • distal femoral metaphysis –> posteromed cortex –> cortical irreg
  • assoc lucency on AP view
  • periosteal rxn
110
Q

distal femoral metaphyseal irregularity –> unilat or bilat?

A

often bilat

111
Q

distal femoral metaphyseal irregularity –> benign or malig?

A

benign

112
Q

benign cortical defect –> seen in which part of bone?

A

cortex of long bone metaphysis

113
Q

benign cortical defect –> MC bone?

A

distal femur

114
Q

benign cortical defect –> radiographic finding

A
  • <2cm
  • well-defined round/oval
  • lucent
  • eccentric
  • thin sclerotic border
  • no periosteal rxn
115
Q

what is non-ossifying fibroma?

A

> 2cm benign cortical defect

116
Q

benign cortical defect –> what happens to them over time?

A

spontaneous regress

117
Q

benign cortical defect –> MC age range?

A

4-6 yo

118
Q

which branchial arch –> portions of pulm A?

A

6th

119
Q

young child –> h/o chronic hoarseness & stridor –> imaging shows mult irreg cavities in bilat lungs –> most likely dx?

A

HPV

rationale: peripartum –> HPV transmission from mother –> tracheolaryngeal papillomatosis –> stridor –> nodular material into distal bronchial tree –> cavitary lesions

120
Q

what is scimitar synd?

A
  • pulm hypoplasia

- partial anomalous pulmonary venous return

121
Q

craniosynostosis –> MC involved suture?

A

sagittal

122
Q

4yo –> circle of willis –> occlusion –> dx?

A

moyamoya dz

123
Q

moyamoya dz –> classic angiographic contrast appearance? what causes this appearance?

A

numerous irregular collaterals of lenticulostriate vessels –> “puff of smoke”

124
Q

microcolon –> ddx? (2)

A
  • meconium ileus

- ileal atresia

125
Q

Tc-99m MAA perfusion lung scan –> uptake in left lung only –> dx?

A

R pulm A agenesis

126
Q

what is swyer-james synd? classic imaging finding?

A

postinfectious obliterative bronchiolitis –> unilat small lung w hyperlucency

127
Q

Salter-Harris classification

A 
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
Q

chiari 2 malformation –> classic characteristics? (2)

A
  • myelomeningocele

- small post fossa

129
Q

adolescents w closing growth plates –> MC ankle fx (2)?

A
  • Tillaux fx

- triplane fx

130
Q

Tillaux fx vs triplane fx

A

distal tibia:

  • Tillaux –> Salter Harris III
  • triplane –> Salter Harris IV
131
Q

pediatric –> vertebra plana –> MC cause?

A

Langerhans cell histiocytosis

132
Q

What is the earliest age at which radiographic findings of dietary rickets are identifiable in term
infants?

A

9mo

133
Q

shwachman – Diamond Syndrome –> sync? (3)

A
  • exocrine pancreatic insuff
  • hematologic abnormalities with abnormal hematopoiesis typically neutropenia
  • neoplastic predisposition to development of leukemia
134
Q

Concerning the conversion of hematopoietic bone marrow to fatty bone marrow, which portion of the femur is the last to convert?

A

prox metaphysis

135
Q

holoprosencephaly –> the fornix and septum pellucidum are absent in all forms –> T/F?

A

T

136
Q

Tetralogy of Fallot –> 4 features?

A
  • VSD
  • overriding aorta
  • hypoplastic RVOT –> right ventricular hypertrophy
137
Q

most common primary bone malignancy in childhood? 2nd MC?

A
  • # 1 osteosarcoma

- #2 Ewing sarcoma

138
Q

Ewing sarcoma of bone –> histology –> identical to what other condition?

A

primitive neuroectodermal tumor (PNET)

139
Q

Ewing sarcoma of bone –> epidemiology –> MC decade?

A

20s

140
Q

fibromatosis colli –> chin points toward ipsilat or contralat side?

A

contralat

141
Q

Glenn shunt –> anastomosis of what 2 struct?

A

anastomosis of the superior vena cava to the pulmonary artery

142
Q

Blalock-Taussig shunt –> anastomosis of what 2 struct? purpose?

A

anastomosis of the subclavian A to pulmonary artery

increase pulmonary arterial blood flow in patients with right ventricular outflow tract obstruction

R1 (15 decks)

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