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Flashcards in Paediatric Deck (37)
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1

Necrotising enterocolitis
RF

onset directly proportional to GA
Premature infants

Distension - symmetric, asymmetric with focal distension, persistent loop sign
Pneumatosis
Portal venous air
Pneumoperitoneum

2

Common associations of intestinal malrotation
5

CDH
Omphalocoele
Gastroschisis
Prune Belly Xd
Heterotaxy

3

DDH - Demo, RF
4
Ossification is delayed

F>M (5:1)
Bilateral 25%, L>R
Breech
Oligohydramnios
Swaddling
FHx

4

Perkins line
Hilgenreiner line

vertical line tangential to outer margin of acetabulum

Intersects proximal femoral metaphysis in inner third

Horizontal line through tri-radiate cartilage

5

Acetabular angle
<28 at birth
<22 at 1 year

Angle formed by line tangential to bony acetabulum and horizontal line through triradiate cartilage

6

Perthes disease
Demo

5-8 years
M>F 4:1
Caucasians
Bilateral in 15%, asymmetric

7

SCFE
Demo

12-15yrs
M>F
African Americans
Obese/tall
Bilateral 20-30% asymmetric

8

Bowing of legs
Genu vara/tibia vara
6 causes

Physiological upto 2 yrs
Blounts
Rickets
Renal osteodystrophy
Osteogenesis imperfecta
Fibrous dysplasia

9

Prostaglandin periostitis

Administration of PG to maintain patency of ductus causing diffuse, symmetrical periosteal reaction in neonates.

10

Pentalogy of Cantrell

Cephalic fold defect

CHD
Ventral hernia
Sternal defect
Absent anterior diaphragm
Pericardial defect

11

Choledochal cyst types
6

type I: most common, accounting for 80-90% 1 (this type can present in utero)
Ia: dilatation of extrahepatic bile duct (entire)
Ib: dilatation of extrahepatic bile duct (focal segment)
Ic: dilatation of the common bile duct portion of extrahepatic bile duct

type II: true diverticulum from extrahepatic bile duct

type III: dilatation of extrahepatic bile duct within the duodenal wall (choledochocoele)

type IV: next most common
IVa: cysts involving both intra and extrahepatic ducts
IVb: multiple dilatations/cysts of extrahepatic ducts only

type V: multiple dilatations/cysts of intrahepatic ducts only (Caroli disease)

type VI: dilatation of cystic duct.

12

Oesophageal atresia types
5

type A: isolated esophageal atresia (8%)
type B: proximal fistula with distal atresia (1%)
type C: proximal atresia with distal fistula (85%)
type D: double fistula with intervening atresia (1%)
type E: isolated fistula (H-N type) (4%)

13

Duodenal atresia

No recanalisation - atresia
Partial recan - stenosis/web
80% distal to ampulla of Vater
Assoc : annular, preduodenal PV, other atresias, CHD, Down(30%), VACTERL

14

Functional immaturity of the colon

Abnormal colonic motility

Infants of diabetic mothers, mothers on Mg SO4

No assoc with CF

15

Urachal anomalies
4
Complication 1

Patent urachus (50%)
Urachal cyst ( 30%)
Urachal sinus (15%)
Vesicourachal diverticulum (5%)

complication : (mucinous) adenocarcinoma

16

VUR Grade
5

grade 1: reflux limited to the ureter

grade 2: reflux up to the renal pelvis

grade 3: mild dilatation of ureter and pelvicalyceal system

grade 4
tortuous ureter with moderate dilatation
blunting of fornices but preserved papillary impressions

grade 5
tortuous ureter with severe dilatation of ureter and pelvicalyceal system
loss of fornices and papillary impressions

17

Lost face sign in CT kidney

Loss of normal renal pelvic fat at hilar level in duplicated systems

18

Weigert Mayer Rule

Upper pole ureter inserts ectpically inferomedially with associated ureterocoele

Lower pole ureter inserts normally and is prone to reflux.

Upper pole seen on USS (hydronephrotic)
Lower pole seen on MCUG ( reflux)

19

Most common stone types forming staghorn calculi

Struvite

Cystine/uric acid less common

20

Associations of simple renal cysts (HU<20) in paediatrics (<0.5%)
4

TS
VHL
Carolis
NF

21

Multicystic dysplastic kidneys

Most common cystic renal disease in infants.
Extra renal atresia causing abnormal cystic expansion of tubules

Usually unilateral ( bilateral- lethal)
NON communicating cysts of varying sizes

30-50% contralateral anomalies

Rare - malignancy (wilms/RCC)

DTAP - void. No excretion.

22

ADPKD

50% cysts within 1st decade
Associated cysts ( liver 75%, pancreas 10%, cerebral berry (5-10%)

23

ARPKD

enlarged hyperechoic kidneys
1-2mm cysts
Periportal fibrosis and duct dilatation
Pancreatic fibrosis
Striated nephrogram

24

Von Hippel Lindau
manifestations

AD multisystem
Haemiangioblastomas
Renal cysts/RCC
Adrenal phaeo ( Type II)
Pancreatic cysts
Islet cell cystadenomas

25

Wilms tumour
demo
B/L
Signs

mean age 3 yrs
Bilateral 5% (Beckwith)
Claw sign/pseudocapsula
Calcifications
CE +
Tumour thrombus

26

Paediatric renal malignancy with frequent bone metastases

Renal medullary carcinoma
(frequent in sickle cell trait, clear cell sarcomas)

27

`Frontonasal masses

fonticulus frontalis >frontonasal suture

Prenasal space > foramen caecum

Epidermoid/dermoid - anywhere along the tract of patent foramen caecum(prenasal space)

"glioma" - misnomer, brain heterotopia, 15% connection to subarachnoid space.

Encephalocoele - meningo or meningoencephalocoele (naming : roof-floor eg frontonasal

Pott's puffy tumour - frontal sinusitis > frontal osteomyelitis> subperiosteal abscess

Fibrous dysplasia (leontiasis ossea)

28

2nd Branchial cleft cyst (80-90%) - mandibular angle
Bailey Classification
4

Type I : superficial to SCM
Type II : between scm and carotid sheath
Type III : splays ICA/ECA
Type IV : deep to carotid, touches pharyngeal mucosa

29

1st Branchial cleft cyst
Arnot Classification
associated with parotid gland

Type 1 - no connection to EAC
Type 2 - tail or communication with floor of EAC

30

Paediatric H&N : Cystic masses
6

Encephalocoele
Branchial cleft cyst
(Dermoid/epidermoid)
Thyroglossal duct cysts
Ranula/diving ranula
Lymphatic malformations
Lemierre Xd : septic jugular v thrombophlebitis