Peds Trivia Flashcards
before what exam is Cimetidine given
Meckels scan
Dose of phenobarbital before HIDA for biliary atresia
5 mg/kg/d for 3-5 days before the test
Hepatic calcification in young kid
get US, could be mass
Hepatoblastoma
usually < 5 yo
heterogeneous solid mass that can calcify
Hepatoblastoma is assoc with what syndrome
Beckwith-Wiedemann Syndrome
Fatty infiltration of the pancreas in a kid
CF
Echogenic bowel seen on fetal US suggests what
CF (70%)
Hydropic GB with strawberry tongue, etc.
Kawasaki syndrome
Umbilical artery line
high position = T6-T10
Or low postion = L3-L5 (avoids mesenteric branches)
Umbilical vein line
should be at the inferior cavoatrial jcn
Multicystic dysplastic kidney
multiple noncommunicating cysts throughout the right kidney without dilated renal pelvis
- assoc with contralateral UPJ obstruction 7-27%
ARPKD
first decade of life
can have macrocysts, but most are 1-2 mm
congenital hepatic fibrosis
ADPKD
after first decade of life
macrocysts
berry aneurysms
Wilms tumor
heterogeneous mass arising from kidney (look for claw sign of renal paryenchyma)
Get CT of the chest for lung mets
Look for liver mets
commonly invades renal veins and IVC
Sickle trait and renal tumor
Medullary carcinoma
Bilateral pelvicaliectasis and thick, trabeculated bladder in the male
poster urethral valves - VCUG
What medication should be discontinued prior to MIBG study
TC antidepressants (imipramine)
Amphetamines
Insulin
reserpine
Neuroblastoma IV-S
skin, liver, and bone marrow mets (no cortical bone mets)
Good prognosis
< 3 months with heterogeneous solid mass in the kidney that involves the renal sinus
congenital mesoblastic nephroma
girl with spinning top proximal urethra on VCUG
unstable bladder contractions that are resisted by the distal voluntary sphincter = dysfunctional voiding
septated, T2 bright cystic mass in the vagina of the 2-6 yo or 14-18 yo girl
embyonal rhabodomyosarcoma (botryoides variant)
which ped renal tumor is most likely to go to bone
clear cell renal sarcoma
Medullary nephrocalcinosis in a kid
usually assoc with hypercalciuria (distal renal tubular acidosis and prolonged immobilization)
kidneys in kids should be within what size of each other
1 cm
MCL for osteomyelitis in kids
metaphysis
MCL for osteomyelitis in infacnts
epiphysis
lateral condylar fractures occur most often at what ages
5-10 yo and are usually Salter Harris Type IV
Blounts disease
inward bowing of the tibia (varus) with hypertrophy of the medial meniscus
unilateral spntaneous hip or knee pain with worsening joint stiffness with normal X ray and T2 bright confined to the middle third of the subchondral femoral head
idipathic chondrolysis
Chronic recurrent multifocal osteomyelitis
often lytic followed by sclerosis in chronic course with bone marrow edema and periositis (usually in metaphysis of long bones)
may involve clavicle
assoc with Wegener granulomatosis
Lipomatosis of a nerve with macrodactyly
macrodystrophia lipomatosa
thanatophoric dysplasia
telephone receiver femurs
shortened ribs
flattened vertebral bodies
megalencephaly
Capitellar osteochondritis dissecans (elbow)
MC in kids with radial head subluxation
MCL of relapse of osteosarcoma
lung (90%)
structural scoliotic curve
vertebral morphologic changes like wedging and rotation (not correctable with ipsilateral bending)
what Cobb angle is bracing and surgery recommended
bracing - 20-45 degrees
Surgery - > 45 degrees
proximal focal femoral deficiency disorder
failure of development of the proximal femur
assoc with abscent cruciate ligaments
Osteochondrosis of the inferior pole of the patella (10-14 yo)
Sindin-Larsen-Johansson syndrome (like osggod-schlatter of the patella)
Congenital lobar overinflation
LUL > RML > RUL > lower lobes (rare)
hyperexpansion of one or more pulmonary lobes
Round pneumonia
90% < 12 yo
usually Strep pneumo
CF in lungs
central/perihilar distribution
upper lobe predominant
apical segments of the lower lobes
large cystic lung mass with multiple septations with a hx of cystic nephroma and DICER-1 mutation
pleuropulmonary blastoma
DDX of chest wall masses
rhabdomyosarcoma osteosarcoma chest wall and pleural mets lymphoma solitary fibrous tumor of the pleura
Lymph nodes in primary TB
usually right hilar
low density centers with enhancing rim on CT
primary TB doesn’t cavitate
Haller index that is significant
> 3.25
MC type of TE fistula
proximal esophageal atresia with distal fistula
Fractures highly specific for kid abuse
bucket handle or corner posterior ribs scapula spine sternum
Assoc with schizencephaly
septo-optic dysplasia
Gray matter heterotopia
absent septum pellucidum
most common suprasellar mass in kids
Craniopharyngioma
Craniopharyngioma
CT - hypodense mass with possible calcs
MRI - T1-T2 hyperintense, cystic with peripheral enhancement
Nonenhancing mass in the tuber cinereum with percocious puberty, isointense to gray matter on T1
hypothalamic hamartoma
- gelastic seizures
Juv. Pilocystic astrocytoma
round, T2 hyperintense tumor with internal mural nodules and peripheral contrast enhancement
- arise in midline and can extend into the cerebellar hemispheres
- 30% optic nerve/chiasm
Medulloblastoma
arise from (velum) of the 4th ventricle CT - hyperdense
MRI - hypo T1, vary T2, avid enhancement, ** diffusion restriction **
- scan the whole spine for drop mets
Joubert Syndrome
Hypoplastic cerebellar vermis and hypoplastic superior cerebellar peduncle = molar tooth sign (midbrain)
- enlarged 4th vent
- superior cerebellar peduncles are vertically oriented and elongated in AP direction
- separation of cerebellar hemispheres
Ependymoma
arise from floor of 4th vent
- plastic tumor
- intramural cysts and hemorrhage in 66%
- heterogeneous and enhancing mass
subependymoma
inferior 4th vent
middle-age or older
T2 hyper lobular mass
No or mild enhancement
Choroid plexus papilloma
40% in 4th vent, CPA and foramina of Luschka
Lateral vent more common in kids
Lobular and greatly enhances
Scaphocephaly
Sagittal suture
Plagiocephaly
single coronal or lamboid suture
Vein of Galen malformation
embolization
ADEM (acute disseminated encephalomyelitis)
MCL = subcortical WM (can involve GM)
- multiple T2 bright foci
- CSF analysis
Chordoma
- MCL = sacrum followed by around clivus
- CT - calcified matrix common
- MRI = hypo T1, Hyper T2 and most enhance
MC feeding artery for juvenile nasopharyngeal angiofibroma
internal maxillary artery
JNA
bony changes on CT
ST mass centered on sphenopalatine foramen (often wide) and bowing of the posterior wall of the maxillary antrum anteriorly
- marked contrast enhancement
Mildly enhancing, mineralized T2 hypo masses in the orbits of kids
Retinoblastoma
Scheuermann Disease (juvenile kyphosis)
kyphosis of the thoracic or thoracolumbar spine
at least 3 sdj vertebrae have wedging
assoc with schmorl nodes, limbus vertebrae, scoliosis, spondylolisthesis
Caudal regression syndrome
- lumbosacral vertebral body dysgenesis
- usually below L1 and often limited to sacrum
- truncated, blunt spinal cord terminating above the expected level
- severe canal narrowing rostral to last intact vertebrae
Pulmonary sling
impression on posterior trachea and anterior esophagus
- left pulmonary artery arises from posterior right pulmonary artery
Types of pulmonary artery sling
Type 1 - position of carina NORMAL (T4-T5)
Type 2 - LOW carina (T6)
Types of fibromuscular hyperplasia
medial (MCC), perimedial, and intimal
- medial and perimedial cause stenosis and aneurysms
- intimal = smooth narrowing
collateral path for lower extremities in abdominal aortoiliac stenosis
SMA -> IMA -> hemorrhoidal arteries -> external iliac arteries
Cicumflex aortic arch
aorta passes to the left of the trachea but then becomes the descending aorta (assoc with anomalous right subclavian artery)
- always forms a vascular ring
Le compte maneuver
transposition of the great vessels
- MC complication is coronary artery occlusion
Management of Ebstein abn
tricuspid valvoplasty
Common anomaly assoc with PAPVR
- congenital heart
- sinus venosus ASD
- bronchogenic cysts
- accessory diaphragms
- hernias
- horseshoe lung
Next test in PAPVR
Echo -> CTA or MRA
Cardiac fibroma
- intramyocardial
- septum or free wall
- T1 vary
- T2 vary
- No first pass perfusion
- Delayed enhancement
Cardiac Rhabodmyoma
- Intramycocardial or intravacitary
- T1 vary
- T2 vary
- No first pass perfusion
- NEGATIVE delayed enhancement
Cardiac Myxoma
- MCL left atrium
- T1 vary
- T2 bright
- No first pass perfusion
- Variable delayed enhancement
Cardiac Hemangioma
- location vary
- T1 Dark
- T2 bright
- Bright first pass perfusion
- Vary delayed enhancement
Cardiac Malignancy
all vary
High origin of the coronary artery
> 1 cm above the sinotubular junction
Most common coronary artery anomaly assoc with TOF
right coronary from the LAD
Increased lung markings with cyanotic heart disease
- truncus
- transposition
- hypoplastic left heart
- TOF in decreased
Stages of Norwood for hypoplastic left heart
- Blalock-Taussig shunt
- Glenn
- Fontan
Beckwith-Wiedemann
congenital overgrowth disorder
- omphalocele
- macroglossia
- neonatal hypoglycemia
- hemihypertrophy
- hepatosplenomegaly
- nephromegaly
- cardiac abn
- adrenal cytomegaly
- pancreatic islet cell hyperplasia
- facial nevus flammus
- ear lobe creases
- increased Wilms
Nuchal translucency should be done when
11-13 weeks
Inheritance of Ehlers-Danlos
Autosomal dominant
MCA cardiac abn with Di-Geroge syndrome
TOF
Klippel-Trenaunay Syndrome
Triad
- capillary malformation
- venous malformation
- limb overgrowth (with or without lymphatic malformation)
Post transplant lymphoproliferative disorders usually due to what organism
EBV
