VIQ - Paediatrics - Warm Up

Question 1

@# 3. Paediatric intussusception:
a) Accounts for over 75% of paediatric intestinal obstruction
b) Typically occurs between 4-8 years of age
c) Plain films are typically abnormal
d) A lead point is identified in over 50% of cases
e) Pneumoperitoneum is a contraindication to air reduction

Answer 1

3.
a) True
b) False - highest incidence between 3 months and 4 years of age
c) False - plain films may be normal in up to 50%
d) False - in children, 95% are idiopathic, with no lead point
e) True - as are peritonitis and hypotension

Question 2

@# 4. Childhood rhabdomyosarcoma:
a) Is the most common soft tissue sarcoma in children
b) Is the most common pelvic malignant neoplasm in children
c) Genitourinary tumours account for 25% of cases
d) Orbital tumours are highly malignant
e) T2 weighted MRI is ideal for assessing tumours of prostatic origin

Answer 2

4.
a) True
b) True
c) True
d) False - non-invasive, with a good prognosis
e) False - tumours are hyperintense on T2 sequences, and may be obscured by adjacent high
signal urine

Question 3

@# 6. Prune belly syndrome:
a) The bladder is hypoplastic
b) Is associated with abdominal wall deficiency
c) Is accompanied by cryptorchidism in males
d) Ureters are of normal calibre on IVU
e) Pulmonary hypoplasia is a complication

Answer 3

6.
a) False - large, distended bladder
b) True - with cryptorchidism, distended bladder and dilated ureters
c) True
d) False
e) True

Question 4

@# 7. Medullary calcification of the kidneys occurs in:
a) Hyperparathyroidism
b) Renal tubular acidosis
c) Pseudohyperparathyroidism
d) Medullary sponge kidney
e) Chronic glomerulonephritis

Answer 4

7.
a) True
b) True
c) False
d) True
e) False - cortical nephrocalcinosis

Question 5

@# 9. Slipped upper femoral epiphysis:
a) Is seen typically between 4-8 years of age
b) is bilateral in one third of cases
c) The Line of Klein should intersect the normal femoral head
d) The epiphysis slips posteromedially
e) Subchondral lucency is an early sign

Answer 5

a) False - typically 8-17 years of age
b) True
c) True
d) True
e) False - an early sign of Perthes’ disease

Question 6

@# 10. The radiological features of pyknodysostosis include:
a) Limb overgrowth
b) Multiple wormian bones
c) Reduced bone density
d) Resorption of the lateral end of the clavicle
e) Tapered distal phalanges

Answer 6

10.
a) False - short limbs
b) True
c) False - increased bone density
d) True
e) True

Question 7

@# 11. Regarding normal skeletal variants:
a) Bipartite patella typically involves the upper outer quadrant
b) The medial humeral epicondyle ossification centre appears after the lateral epicondyle
c) A prominent anterior fat pad indicates intra-articular injury
d) The scaphoid bone is the first carpal bone to ossify
e) Os radiale externum is the commonest supernumary bone around the wrist

Answer 7

11.
a) True
b) False - medial at 5 years, lateral at 13 years
c) False - a normal variant in up to 15%
d) False - capitate and hamate ossify in the 1st year; scaphoid in the 6th year
e) True

Question 8

@# 12. Multiple wormian bones are a feature of:
a) Rickets
b) Osteogenesis imperfecta
c) Down’s syndrome
d) Hypothyroidism
e) Chondrodysplasia punctata

Answer 8

12.
a) True
b) True
c) True
d) True - also in pyknodysostosis, kinky hair syndrome, cleidocranial dysostosis,
hypophosphatasia
e) False

Question 9

@# 14. Retinoblastoma:
a) Is the most common intra-ocular malignancy in childhood
b) Ultrasound demonstrates a hypoechoic mass in the posterior globe
c) CT shows calcification in 90%
d) Is associated with pineoblastoma
e) Is bilateral in 66%

Answer 9

14.
a) True
b) False - hyperechoic mass within the globe
c) True
d) True - the trilateral retinoblastoma
e) True

Question 10

@# 17. Regarding pancreatic development:
a) The tail, body and neck of the pancreas develop in the dorsal mesogastrium
b) The ventral pancreatic bud forms the uncinate process
C) The accessory pancreatic duct drains into the duodenum distal to the Ampulla of Vater
D) Annular pancreas is associated with Turner’s syndrome
E) Pancreas divisum predisposes to chronic pancreatitis

Answer 10

17.
a) True
b) True
c) False - proximal to the Ampulla of Vater
d) False - Down’s syndrome, oesophageal atresia, imperforate anus, malrotation
e) True

Question 11

@# 22. Concerning congenital diaphragmatic hernias:
a) Most congenital hernias are of the Morgagni type
b) Bochdalek hernias are usually left-sided
c) Defective closure of the pleuroperitoneal membranes leads to a Bochdalek hernia
d) Right-sided hernias may have a delayed presentation
e) Congenital cystic adenomatoid malformation is a differential diagnosis

Answer 11

22.
a) False - 85-90% are Bochdalek hernias
b) True
c) True
d) True
e) True

Question 12

@# 25. Regarding normal lung anatomy:
a) The azygous fissure contains 2 layers of pleura
b) The inferior accessory fissure separates the medial and anterior basal segments of a lower
lobe
c) The right pulmonary artery passes posterior to the right main bronchus
d) The left superior pulmonary vein lies directly anterior to the left pulmonary artery
e) The anterior junctional line extends above the clavicles

Answer 12

25.
a) False - 4 layers
b) True
c) False - anterior
d) False - the bronchial tree lies in between the two structures
e) False - posterior junctional line

Question 13

@# 26. In bronchopulmonary sequestration:
a) Intralobar sequestration typically presents in the neonatal period
b) Sequestered segments have delayed contrast enhancement on dynamic CT scanning
c) The condition may be diagnosed antenatally
d) Intralobar sequestered segments are covered by visceral pleura
e) There is usually communication with the bronchial tree

Answer 13

26.
a) False - later presentation is typical, with 50% asymptomatic
b) False - early or normal enhancement
c) True
d) True
e) False - communication may occur following infection

Question 14

@# 27. Concerning mediastinal masses in childhood:
a) Lymphomatous hilar lymph node enlargement usually occurs without mediastinal
involvement
b) Paracardiac lymph nodes are a common site for primary hematological malignancy
c) Bronchogenic cysts are usually solitary
d) Pericardial cysts usually arise from the right cardiophrenic angle
e) Malignant teratomas are more common than benign teratomas

Answer 14

27.
a) False - rare without mediastinal involvement
b) False - an important site of lymph node recurrence
c) True
d) True
e) False - benign cystic teratomas are the commonest mediastinal germ cell tumour

Question 15

@# 28. The following are features of cystic fibrosis:
a) Meconium ileus is the most common mode of presentation
b) Lung involvement predominates in the lower zones
c) Skull X-ray shows generalised hypoplasia of the paranasal sinuses
d) There is a known association with situs inversus
e) Contrast enemas are often therapeutic with meconium ileus

Answer 15

28.
a) False - only 10-15% of cases present this way
b) False - upper zone predominance
c) False - frontal sinus hypoplasia. The remainder are normal
d) False - situs inversus and bronchiectasis are part of the immotile cilia syndrome
e) True

Question 16

@# 30. Causes of symmetrical periosteal reaction in childhood include:
a) Leukaemia
b) Juvenile idiopathic arthritis
c) Caffey’s disease
d) Rickets
e) Scurvy

Answer 16

30.
a) True - due to cortical involvement by tumour cells
b) True - in 25%
c) True - Caffey disease (Infantile cortical hyperostosis) is an osteosclerotic dysplasia characterized by acute inflammation with massive subperiosteal new bone formation usually involving the diaphyses of the long bones, as well as the ribs, mandible, scapulae, and clavicles
d) True
e) True

Question 17

@# 32. Concerning the paediatric parotid gland:
a) The parotid gland is hyperechoic to muscle on ultrasound
b) Branchial cysts most often develop from the second branchial pouch
c) Parotid haemangiomas are usually hypoehoic on ultrasound
d) Warthin’s tumours are bilateral in 25-50%
e) Warthin’s tumours are poorly defined masses

Answer 17

32.
a) True
b) True
c) True
d) False - only 10% are bilateral
e) False - well circumscribed, homogenous masses

Question 18

@# 36. In duodenal atresia:
a) The double bubble sign may be seen on ultrasound examination
b) The double bubble sign is specific for duodenal atresia
c) Polyhydramnios is typical in the 3rd trimester
d) Over 50% are associated with Down’s syndrome
e) Bowel gas is not seen distal to the atretic segment

Answer 18

36.
a) True - plain film, ultrasound and contrast studies may show this sign
b) False - also seen in duodenal stenosis, annular pancreas, preduodenal portal vein
c) True
d) False - one third are associated with trisomy 21
e) False - this may occur with a bifid CBD insertion

Question 19

@# 37. Causes of dense metaphyseal bands include:
a) Normal variant
b) Treated leukaemia
c) Healing rickets
d) Lead toxicity
e) Hypervitaminosis D

Answer 19

37.
a) True
b) True
c) True
d) True
e) True

Question 20

@# 38. Regarding congenital cardiac anomalies:
a) A left-sided SVC drains into the left atrium
b) A patent ductus arteriosus arises proximal to the left subclavian artery
c) In pulmonary artery sling, the aberrant left pulmonary artery passes between the trachea
and oesophagus
d) An aortopulmonary window connects the descending thoracic aorta to the pulmonary trunk
e) Ebstein anomaly affects the tricuspid valve

Answer 20

38.
a) False - drains into the right atrium via the coronary sinus
b) False - distal to the right subclavian artery
c) True
d) False - ascending thoracic aorta to the pulmonary trunk
e) True

Question 21

@# 41. Medulloblastoma:
a) Is the most common paediatric CNS malignancy
b) Typically has a brief history (< 3 months)
c) Typically arises within the cerebellar hemispheres
d) Is usually hypodense on pre-contrast CT
e) Post-contrast shows heterogenous enhancement

Answer 21

41.
a) True
b) True
c) False - cerebellar vermis
d) False - 89% show some degree of hyperattenuation pre-contrast
e) True

Question 22

@# 42. Regarding Sturge-Weber syndrome:
a) It involves a port-wine stain affecting the trigeminal nerve distribution
b) It is accompanied by leptomeningeal angiomas on the contralateral side
c) Underlying cortical calcification is common
d) Angiomas are more common over the frontotemporal regions
e) Cortical gliosis is a feature

Answer 22

42.
a) True
b) False - ipsilateral side
c) True
d) False - parieto-occipital region
e) True

Question 23

@# 46. Features of dysostosis multiplex include:
a) Calvarial thickening
b) J shaped sella
c) Narrow anterior rib ends
d) Odontoid hypoplasia
e) Dysplastic femoral heads

Answer 23

46.
a) True
b) True
c) False - narrow posterior ribs, with wide anterior rib ends
d) True
e) True

Question 24

@# 50. Regarding brain development:
a) Adult sulcal pattern is obtained by 38 weeks gestation
b) On T2 weighted MRI, white matter maturation is seen as a reduction in signal intensity
c) Thinning of the corpus callosum is pathological
d) Myelination progresses uniformly throughout the brain
e) On MRI, the basilar cisterns remain prominent during infancy

Answer 24

50.
a) False - the sulci are formed, but will continue to obtain increasing depth
b) True
c) False - thinning between posterior body and splenium is a normal variant
d) False - pathways undergoing use mature first (e.g. motor pathways)
e) True