Peds Flashcards
Most common form of craniosynostosis?
Scaphocephaly; sagittal suture subtype. Normal IQ. No hydrocephalus. Seen in Marfan.
Which scalp hematoma is limited by sutures?
Cephalohematoma. Located under the periosteum. Can calcify.
In which layer subgaleal hematoma is located?
Deep to aponeurosis. Between the aponeurosis and periosteum.
Most commonly involved suture in diastatic fracture?
Lambdoid
What’s the outcome in ping pong skull fracture in kids?
Favorable
Sinus pericranii
- Skull defect + LOW FLOW vascular malformation.
- communication between dural sinus and extra cranial vein eg emissary vein.
Most common cause of macrocephaly in kids?
BESSI; Benign enlargement of subarachnoid stance in infancy. Have increased risk for subdurals.
Congenital pirifom aperture stenosis
- abnormal development of medial nasal eminence.
- associated with central maxillary mega incisor.
- can have midline brain defects.( should image brain).
- associated with hypothalamic pituitary adrenal axis dysfunction.
Location of the branchial cleft cyst?
Lateral to Carotid space. Lateral and posterior to submandibular gland. Anterior to SCM muscle.
What’s the most common direction of radial head dislocation in Monteaggia?
ANTERIOR (Bado class I).
Hydrocephalus in achondroplasia is caused by?
Narrow foramen magnum.
Side effects of surfactant replacement therapy?
- Risk of Pulmonary Hemorrhage.
- Risk of PDA.
Right CDH is is associated with which infection?
GBS pneumonia.
Pleuropulmonary blastoma
- Big mass in the RIGHT chest.
- No bone erosion.
- No calcification.
- 10% might have multilocular cystic nephroma.
What’s the course of a UVC?
umbilical vein –> Left portal vein –> ductus venosus –> hepatic vein –> IVC.
Which condition is a contraindication for placing a UAC?
Omphalocele.
Where should the tip of the arterial ECMO cannula be placed?
should lie at the origin of the common carotid artery to maximize deliv- ery of oxygenated blood. Position is confirmed by an echo.
Extra gonadal germ cell tumor?
Klinefelter syndrome (47 XXY).
Meconium plug (small left colon)
- Infants of DM mothers.
- Mother received Mg sulfate for pre-eclampsia.
- NOT associated with CF.
What’s the most common cause of bowel obstruction in >4 years old?
Acute appendicitis.
What’s the most common cause for bowel obstruction in 1 month - 1 year old?
Inguinal hernia.
Enteric duplication cysts are associated with what other anomalies?
Vertebral anomalies (30%).
MC chromosomal anomaly associated with omphalocele?
Trisomy 18. الملك مكيّس
Umbilical cord cysts are seen with what?
Omphalocele.
Pancreatoblastoma
- Age around 1. - High AFP. - Associated with Beckwith-Weidemann Syndrome
Fibrosing colonopathy
Thick walled right colon seen with enzyme replacement therapy in CF patients.
Dorsal pancreatic agenesis
- High risk for DM (beta cells are mostly in the tail). - Associated with polysplenia
Alagille syndrome
- Paucity of Intrahepatic bile ducts. - Peripheral pulmonary stenosis. - Differentiated by biliary atresia (paucity of extra hepatic duct) through liver biopsy
Neonatal renal vein thrombosis is associated with what condition?
Maternal DM. Presents with renal enlargement.
Neonatal renal artery thrombosis is associated with what condition?
UAC. Presents with severe HTN.
Hutch diverticulum
- Congenital muscular defet.
- Occurs just above the UVJ.
- Better seen on VCUG during VOIDING phase.
- Resected surgically if there’s reflux.
What cancer can occur in bladder exstrophy?
Adenocarcinoma.
Better prognosis in neuroblastoma seen in:
- Age less than 1. - Thoracic primary. - Stage 4S. (mets to liver, skin and bone marrow).
Which testicular tumor is associated with Peurtz-Jegher syndrome?
Sertoli cell tumors.
Multiple hypo-echoic masses in the testcile?
Lymphoma.
How sacrococcygeal teratoma is treated?
Surgical with complete resection of the coccyx.
Which type of sacrococcygeal teratoma has the highest rate of malignancy?
The intra-abdominal type.
“Celery stalk” metaphysis?
Seen in congenital Rubella.
Wimberger Sign
Destruction of the medial metaphysis of proximal tibia; seen in Syphilis.
What’s Caffey disease?
aka (Infantile cortical hyperostosis); self-limited periosteal reaction, ST swelling seen in first 6 months of life. MANDIBLE is classically affected (seen as hot in bone scan).
Most common site of EG?
Skull (beveled edges).
What’s Kocher criteria?
Used for suspected septic arthritis;
- Fever.
- Inability to walk.
- High ESR or CRP.
- High WBCs
3/4 positive = septic arthritis.
Newborn with metaphyseal cupping and fraying
Hypophospatasia; due to alkaline phosphatase deficiency. Rickets NEVER occurs in Newborns! Maternal vit D is still working.
Lucent metaphyseal bands ddx:
LINE; - Leukemia - Infection (TORCH) - Neuroblastoma mets. - Endocrine (rickets, scurvy).
Currarino Triad:
- Anterior sacral meningocele (pre-sacral mass).
- Anorectal malformations.
- Sacrococcygeal defect (simitar sacrum).
In meckles diverticulum, pre-treating the patient with which medication increases the sensitivity of the scan?
Histamine H2 blockers (cimetidine, ranitidine, famotidine) inhibit acid secretion by the parietal cells, thus limiting release of Tc-99m pertechnetate by the mucosal cells and improving the sensitivity of the Meckel scan.
Osteoarticular osteomyelitis in young children (<4 years of age) involving the epiphyseal cartilage is suggestive of which causative organism?
Kingella kingae.
Which conditions are associated with chronic recurrent multifocal osteomyelitis (CRMO)?
psoriasis and pyoderma gangrenosum, autoinflammatory disorders such as Takayasu arteritis and Wegener granulomatosis, gastrointestinal syndromes such as inflammatory bowel disease, and genetic syndromes such as Majeed syndrome. CRMO is also associated with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis)
Which nerve is most commonly affected in macrodystrophia lipomatosa?
Median nerve. Radiographs of this disorder demonstrate both soft tissue and bony overgrowth in the distribution of a sclerotome.
What’s the main difference between thanatophoric dysplasia vs Jeune syndrome?
The vertebral bodies in thanatophoric dysplasia are FLAT and in Jeune are Normal.
What’s the physical exam findings in radial dysplasia?
RADIAL Deviation of the hand due to the unopposed flexor carpi ulnaris.
Where is the most common site of relapse of Osteosarcoma?
Lung
What Cobb angle differentiates structural from nonstructural scoliotic curvature?
25 degrees or more on ipsilateral side-bending.
How different Cobb angles are managed?
- observation is recommended for a Cobb angle <20 degrees.
- bracing is recommended when the Cobb angle is between 20 and 45 degrees.
- surgery is recommended when the Cobb angle is >45 degrees.
How bisphosphobate therapy appears on the spine?
Bone within bone.
How bisphosphobate therapy appears on the metaphysis?
DENSE metaphyseal lines. Each line corresponds to the administration of IV bisphosphonate.
What’s Haller index?
(maximal transverse diameter/narrowest AP length of chest). A normal Haller index is 2.5. Significant pectus excavatum has an index >3.25, representing the standard for determining candidacy for repair.
What’s the most common congenital venous anomaly in the chest?
persistent left-sided SVC.
What complication in meconium aspiration leads to higher morbidity and mortality?
severe parenchymal pulmonary disease and pulmonary hypertension is as high as 20%.
What kind of shunt does Vein of Galen aneurysmal malformation present?
Left-to-right shunt.
Most common location for EG?
Skull.
What’s the feeding artery for Juvenile nasopharyngeal angiofibroma?
internal maxillary artery.
What’s the most common location of the thyroglossal duct?
Infra-hyoid.
MC location for Ewing Sarcoma?
Pelvis.
What’s The most common risk factor for pulmonary embolism in both neonates and older children?
central venous catheter.
Hydrops of the gallbladder seen in?
Kawasaki disease
What’s LeCompte maneuver?
placing the ascending aorta posterior to the bifurcation of the main pulmonary artery. (PA drapes over aorta).
What’s the most common cause of morbidity and mortality following an arterial switch operation?
An obstructed coronary artery leading to myocardial ischemia
When should nuchal translucency scan be performed for aneuploidy?
11 to 13 weeks.
Which of the following cardiothoracic abnormalities is seen in DiGeorge syndrome?
TOF
Klippel-Trenaunay syndrome
- capillary malformation (skin nevi).
- Venous malformation. (dilated vein of Servelle).
- Focal limb overgrowth.
When should transcranial Doppler US screening begin for sicklers?
at 3 years of age.
Which receptor is associated with tendency to regression in Infantile hepatic hemangioma?
GLUT 1; if +ve —> Regress.
Ruptured Wilms associated with?
Worse prognosis
How hepatoblastoma does to adjacent structures?
Displace them.
What’s the most sensitive sign of pancreatic Trauma?
Fluid seen between splenic vein and the pancreas.
Juvenile Tillaux fracture
Salter Harris 3 and occurs through lateral tibial epiphysis after closure of medial tibial epiphysis.
Which part of bone osteosarcoma arises from?
Medullary cavity.
Lucent lesions in metaphysis of long bones, with flame shape appearance and perpendicular to the physis
classical for Enchondromatosis (Ollier disease)
What’s the most common endobronchial tumor in children?
Carcinoid.
Choroid plexus cyst is associated with which trisomy?
Trisomy 18 (Edward’s)
Right arch with increased pulmonary flow?
TRUNCUS ATRERIOSUS
Right arch with DECREASED pulmonary flow
TET OF FALLOT.
Pramaturity increases risk of hepatoblastoma.
Pramaturity increases risk of hepatoblastoma.
Chondroblastoma is treated by
curettage and bone grafting.
Scimitar syndrome is associated with which lung anomaly?
Horseshoe lung.
Hypothyroidism is associated with slipped capital femoral epiphysis.
Hypothyroidism is associated with slipped capital femoral epiphysis.
VSD primarily causes dilation of the
left heart.
What’s the earliest sign of tuberous sclerosis that can be diagnosed in utero?
Cardiac Rhabdomyoma
What’s the most common delayed complication of NEC?
Bowel strictures; enema should be done after kid recovers.
Duodenal atresia with distal bowel gas?
Could be froma bifid CBD. bowel gas can travel through the ampulla of Vater and enter the distal bowel. Bifid CBD with limbs proximal and distal to the atresia –> bypassing it.
how Post-partum ovarian vein thrombosis Is treated ?
ABX and heparin.
What’s apophysis ?
is a growth plate that does not contribute to longitudinal growth.
Legg–Calvé–Perthes in bone scan?
there’s decreased uptake on bone scan.
Fetal bowel is considered echogenic when
it is at least as echogenic as bone. The iliac wing is the usual standard for comparison.
In normal pregnancies, S/D (peak systolic/end diastolic) ratio in the umbilical artery decreases throughout the second and third trimesters indicating decreasing placental resistance and increasing diastolic flow.
In normal pregnancies, S/D (peak systolic/end diastolic) ratio in the umbilical artery decreases throughout the second and third trimesters indicating decreasing placental resistance and increasing diastolic flow.
What’s the diagnosis?
Wolman disease.
marked bilateral adrenal calcification. Kills before 1 year of age.
