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Paeds DDx Flashcards

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1
Q

Hepatic Mass in child < 5yrs:

A 
Hepatoblastoma (Raised AFP)
Congenital Haemangioma
Infantile Haemangioma
Hepatic Mets (neuroblastoma / Wilms)
Mesenchymal Hamartoma
Abscess
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2
Q

Hepatic Mass in Child > 5yrs:

A 
Infantile haemangioma
Focal nodular Hyperplasia
Mets (neuroblastoma, Wilms, lymphoma)
HCC (Raised AFP).
Hepatic adenoma
Abscess
Undifferentiated sarcoma
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3
Q

Multiple liver lesions:

A 
Infantile haemangiomas
Focal Nodular Hyperplasia
Mets (Neuroblastoma, Wilms, Lymphoma)
Abscesses
Cat scratch disease
Lymphopriliferative disease
Hepatic adenomas secondary to Fanconi anaemia or Gaucher disease.
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4
Q

Retroperitoneal Mass:

A

Most solid retroperitoneal masses are malignant.

Lymphoma:
- > 5yrs, hyper dense nodes.

Neuroblastoma:

  • < 5yrs.
  • Along SNS chain, commonly contain Ca++.
  • large masses cross midline.
  • MIBG uptake.

Abscess

Lymphatic malformation.

Metastases:

Haematoma

Plexiform neurofibroma.

Ganglioneuroma

Paraganlgioma

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5
Q

Causes of bronchiectasis:

A 
CF
Allergic Bronchopulmonary aspergillosis
Post infectious
Tracheobronchomegaly (Mounier Kuhn)
Aspiration
INtra lobar sequestration.
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6
Q

Unilateral hyper lucent lung DDX:

A

Endo bronchial FB:
- acute SOB, persistent expansion of dependent lung on decubitus view.

Pneumothorax:
- Acute SOB, pleural edge

Swyer James Syndrome:
- Previous constrictive bronchiolitis.

Congenital Lobar emphysema:
- Primary middle or upper lobes

CPAM with large cyst:
- History of recurrent infections.

Poland Syndrome:
- abnormal chest wall, arm / hand abnormalities.

Pulmonary hypoplasia.

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7
Q

DDX diffuse pulmonary disease new born: High lung volumes, streaky peri hilarious densities:

A

Meconium Aspiration
TTN
Neonatal pneumonia

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8
Q

DDX diffuse pulmonary disease new born: low lung volumes, granular opacities:

A

Surfactant deficiency syndrome (no effusion)

Group B Strep Infection (effusion)

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9
Q

Causes of acute diffuse pulmonary consolidation in neonate:

A 
Oedema: patent ductus arteriosus
Haemorrhage
Diffuse micro atelectasis
Worsening surfactant deficiency
Pneumonia.
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10
Q

Focal lung lesion in neonate: Lucent lesion:

A 
Congenital Lobar emphysema 
CPAM
PIE
Congenital diaphragmatic hernia
Necrotising pneumonia
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11
Q

Focal lung lesion in neonate: solid lesion:

A

Sequestration

Bronchogenic Cyst.

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12
Q

DDX anterior mediastinal mass child:

A 
Normal thymus: usually < 10yrs, homogenous.
 - Thymic rebound
Lymphoma: usually teenager
Germ Cell tumour:
 - Teratoma.
 - Seminoma
 - Non Semenomatous germ cell tumour.
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13
Q

DDX middle mediastinal mass child:

A

Lymphadenopathy:

  • Inflammatory
  • Neoplastic

Duplication cysts:

  • Bronchogenic
  • Enteric
  • Neuroenteric (Usually associated vertebral anomaly)
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14
Q

DDX posterior mediastinal mass child:

A

Neurogenic tumours:

  • Neuroblastoma: < 10yrs
  • Ganglioneuroblastoma
  • Ganglioneuroma > 10yrs

Neurofibroma
Lateral meningocele
Ewing sarcoma / Askin Tumour (posterior chest wall)

Discitis
Haematoma
Extra Medullary haematopoiesis - check liver/spleen.
Neuroenteric cyst - vertebral anomalies / scoliosis.

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15
Q

Aggressive chest wall mass in child DDX:

A

Ewing Sarcoma / Askin Tumour

Mesenchymal harmatoma:
- wild / aggressive, dysplastic before becoming agressive.

Metastatic neuroblastoma
Metastatic lymphoma
Metastatic leukaemia

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16
Q

Umbilical Lines Ideal position:

A

High position UAC: Tip T8 - T10
Low position UAC: tip below L3
Never positioned between T10 - L3

UVC: tip at IVC - RA junction at hemidiaphragm level.

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17
Q

Acyanotic Heart Disease DDx:

A

Pulmonary oedema:

  • Hypoplastic left heart
  • Extra cardiac shunt: Vein of Galen, hepatic haemangioendothelioma.
  • Coarctation.

Shunt vascularity:

  • ASD
  • VSD
  • PDA
  • AVSD (T21)
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18
Q

Cyanotic Heart Disease:

A

Reduced Pulmonary Vasculature:

  • Massive cardiomegaly:
    - > Ebstein anomaly
    - > Pulmonary atresia with intact septum.
  • No cardiomegaly:
    - > TOF: boot shaped heart.

Increased Pulmonary vasculature: (4 T’S)

    - > TGA: egg on string
    - > Tricuspid atresia
    - > Truncus arteriosus
    - > TAPVR: snowman
    - > Single ventricle.
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19
Q

Surfactant Deficiency Disease CXR features:

A 
Pre term
Low lung volumes
Granular hazy opacities
\+/- air bronchograms
No pleural effusion
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20
Q

Pulmonary Interstitial emphysema CXR features:

A

Barotrauma, 1st week of life
Bubble like / linear non branching lucencies, focal or diffuse.
Static lung volumes.

Progression to Bronchopulmonary dysplasia:

  • Oxygen dependence > 28 days, usually born early 32 weeks.
  • Hazy opacity progressing to course markings and bubble like lucencies.
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21
Q

Transient tachypnea New Born CXR features:

A

C section / maternal diabetes
Interstitial oedema, indistinct vasculature
Pleural fluid
Normal / increased lung volumes.

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22
Q

Meconium aspiration CXR features:

A

Increased lung volumes
Asymmetric patchy opacities, ropey, peri hilar appearance.
Alternating hyperinflation / atelectasis.
Pneumothorax 20-40%

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23
Q

Neonatal pneumonia CXR features:

A

PROM
Increased lung volumes
Patchy asymmetric peri hilar opacities
+/- pleural fluid

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24
Q

Group B strep CXR features:

A

Low lung volumes
Bilteral granular opacities
Pleural fluid.

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25
PHACES Syndrome
``` P: Posterior fossa - Dandy Walker H: Haemangioma A: Arterial anomalies C: Coarctation / cardiac defects E: eye anomalies S: Sub glottic haemangiomas. ```
26
Bowel Obstruction DDX: AIMS:
A: appendicitis, Adhesions I: Internal hernia, Intussecption M: Meckels, Malrotation
27
Causes of micro colon:
Meconium Ileus: - Filling defects in bowel -> CF - Scrotal / peritoneal Ca++ Ileal or colon atresia: - abrupt cut off Total colonic Hirschsprungs
28
High Neonatal bowel Obstruction DDx:
``` Mid gut volvulus and malrotation Duodendal atresia and stenosis Duodendal web Annular pancreas jejunal atresia ```
29
Low neonatal bowel obstruction DDX:
``` Hirschsprung disease Meconium plug syndrome - Transition point splenic flexure. Ileal atresia Meconium ileus (CF) Anal atresia / ano rectal malformations. ```
30
Low neonatal Bowel obstruction -> assess with contrast enema:
No Micro colon: - Normal - Meconium plug syndrome - Hirschsprung Microcolon: - Ileal atresia - meconium ileus (CF) - Total colonic Hirschsprung
31
Bubble approach on AXR:
Single bubble = antral / pyloric atresia Double Bubble = duodendal atresia (T21, polyhydramnios) Tripple Bubble = jejunal atresia (vascular insult) Single bubble with gas = normal, or with bilious vomiting concerning for volvulus -> upper GI study. Double bubble with distal gas - excludes atresia: duodendal web, duodendal stenosis, mid gut volvulus -> upper GI study. Multiple diffusely dilated loops = low obstruction -> contrast enema. If normal -> upper GI study to exclude volvulus.
32
Pancreatic Mass:
Pancreaticoblastoma - age 1 Adenocarcinoma - age 6 Solid papillary epithelial neoplasm (SPEN) - age 15.
33
Solid Renal Mass:
Neonate: - Nephroblastomatosis - Mesoblastic nephroma Child 4yrs: - Wilms - Wilms variants - Lymphoma - Multilocular cystic nephroma Teenager: - RCC - Lymphoma.
34
Horse shoe kidney:
``` Increased risk of trauma Increased risk of stones Increased risk of infection Increased risk of cancer: - Wilms - TCC - Renal carcinoid Association with Turners. ```
35
Prune Belly Syndrome:
Deficiency anterior abdominal wall muscles Hydro-uretero-nephrosis Cryptochordism Associations: - T18, T 13 - Congenital heart disease - Intestinal malrotation - Imperforate anus - Polydactyly / syndactyly Other renal tract anomalies: - Enlarged bladder - Vesico-uretral reflux - Dilated posterior urethra without obsturction.
36
Duplex System - Weigert Meyer Rule:
Upper renal moiety: - Ectopic insertion inferior and medial - Ends in ureterocele -> obstruction Lower renal moiety: - Normal insertion - Refluxes.
37
Bowel Wall thickening immunocompromised DDX:
Pseudomembranous colitis Neutropenic colitis Graft vs Host disease Post transplant lymphoproliferative disorder
38
Double Bubble DDX:
Duodendal atresia / stenosis Malrotation with volvulus Annular pancreas Duodendal web
39
Vascular causes of oesophageal / tracheal compressions:
Aberrant right subclavian artery: - Posterior oesohageal compression. Double aortic arch - May cause anterior tracheal and posterior oesphageal compression. Right aortic arch with aberrant left subclavian Pulmonary sling - only malformation posterior compression on trachea and anterior compression on oesophagus. Innominate artery syndrome. - Higher compression anterior trachea.
40
Endobronchial lesion:
``` Foreign body Papilloma Carcinoid tumour Inflammatory polyp Salivary gland neoplasm. ```
41
Permeative Bone Lesion < 5yrs:
Osteomyelitis LCH / Eosinophilic granuloma Neuroblastoma Mets
42
Permeative bone lesion > 5yrs:
Osteomyelitis Ewing Sarcoma Lymphoma / Leukaemia LCH / Eosinophilic granuloma.
43
Focal scelerotic lesions:
Osteoid osteoma Chronic osteomyelitis Stress Fracture Osteosarcoma
44
Multifocal bone lesions:
Multifocal osteomyelitis LCH Mets Multiple hereditary exostoses Enchondromatosis: - Ollier disease - Maffucci syndrome. Polyostotic fibrous dysplasia - McCune Albright syndrome Neurofibromatosis
45
Dysaplsia:
Rhizomelic: - Proximal shortening - Achondroplasia - Thantophoric dwarfism Mesomelic: - Middle shortening Acromelic: - Distal shortening - Asphyxiating thoracic dystrophy / Jeune syndrome - Chondroectodermal dysplasia.
46
Wormian Bones: "PORK CHOP"
``` P: Pyknodysostosis O: Osteogenesis Imperfecta R: Rickets K: Kinky hair syndrome C: Cleidocrainal dysostosis H: Hypothyroidism / Hypophosphatasia O: one too many chromosomes: T21 P: Primary acro osteolysis. ```
47
Elbow ossification CRITOE:
``` C: Capitellum - 1 year R: Radial head: 3 year I: Internal medial epicondle: 5 year T: Trochlea: 7 year O: Olecranon: 9 year E: External lateral epicondyle: 11 year ```
48
Lucent metaphyseal Bands: "LINE"
L: Leukaemia / lymphoma I: Infection - TORCH N: Neuroblastoma Met E: Endocrine: Rickets / Scurvy.
49
Posterior Vertebral Scalloping:
Dural ectasia: - Marfans - NF 1: assess for lateral meningocele. - Schwannoma Mucopolysaccharidosis Achondroplasia Osteogenesis Imperfecta Spinal cord Tumour: Ependymoma.
50
Pre Sacral Mass DDX:
``` Saccrococcygeal Teratoma Anterior meningocele Rectal Duplication Cyst Lymphoma Germ Cell tumour Adnexal Mass ```
51
Long Bone aggressive lesion:
``` Osteosarcoma Ewing Sarcoma Osteomyelitis LCH Mets ```
52
Erlenmeyer FLask Deformity:
``` Osteopetrosis Gaucher disease Haemoglobinopathies: - Thalaesaemia - Sickle Cell Fibrous dysplasia Multiple hereditary Exostoses Craniometaphyseal dysplasia Niemann Pick disease ```
53
Lytic lesion in skull:
``` LCH Epidermoid cyst Neoplasm: - Leukaemia - Ewing - Metastatic neruoblastoma Infection Leptomeningeal cyst ```
54
Femoral Head avascular Necrosis:
``` Perthes Disease Trauma Sickle Cell disease Corticosteroids Gaucher disease Meyer Dysplasia ```
55
features of infantile Haemangioma:
Absent at birth, rapid growth, regression. Elongated lobulated well defined vascular soft tissue mass. High vessel density, multiple arterial tracing with low resistance index, no arterilised veins. Associated with PHACES syndrome
56
Venous Malformation features:
Low Flow vascular malformation Klippel-Trénaunay-Weber syndrome (KTWS) is a syndrome combination of capillary malformations, soft-tissue or bone hypertrophy, and varicose veins or venous malformations. It is considered an angio-osteo-hypertrophic syndrome. KTS classically comprises a triad of: - port wine nevi - bony or soft tissue hypertrophy of an extremity (localized gigantism) - varicose veins or venous malformations of unusual distribution Maffucci syndrome congenital nonhereditary mesodermal dysplasia characterized by multiple enchondromas with soft-tissue venous malformations (hemangiomas). On imaging, it is usually portrayed by a short limb with metaphyseal distortions due to multiple enchondromas, which may appear grotesque, and soft tissue masses with phleboliths depicting hemangiomas.
57
Abdominal Ca++
``` Meconium peritonitis Neoplasm: - Neuroblastoma - Teratoma - Hepatoblastoma Adrenal Haemorrhage ``` RUQ: - Gall stones - Hapatoblastoma - Hepatic TORCH infection: CMV and toxoplasmosis.
58
Stippled epiphyses DDX:
Chondrodysplasia puncta - short limb dwarfism (rhizomelic) Multiple epiphyseal dysplasia (Fairbank disease): Hypothyroidism Complications post maternal warfarin use in a newborn
59
Grades of germinal matrix haemorrhage:
Grade 1: haemorrhage confined to germinal matrix at caudothalamic groove. Grade 2: haemorrhage extends into ventricles without ventriculomegaly Grade 3: Haemorrhage extends into ventricles with ventriculomegaly. Grade 4: Haemorrhage extends out ventricles into the parenchyma.
60
Neonatal CMV vs Toxo vs other CNS TORCH:
CMV: - Most common TORCH - Likes germinal matrix, periVentricular tissue necrosis - PeriVentricular Ca++ - Highest association with polymicrogyria Toxo: - Random Ca++, commonly basal ganglia - Associated hydrocephalus. Rubella: - Vasculopathy / ischaemia, high T2 signal less Ca++ HSV: - Haemorrhage Infarct, hydranencephaly. HIV: - brain atrophy frontal lobes
61
DDx for endo bronchial lesion:
Leiomyoma Harmatoma mucoepidermoid carcinoma carcinoid tumour
62
DDx for thickened / enhancing pituitary stalk
``` Sella Germinoma (presenting with Diabetes insipidus) LCH Lymphocytic hypophysitis Lymphoma Leukaemia Neurosarcoidosis Pituicytoma ```
63
DDx for acute coalescent otomastoiditis:
Infective otitis media LCH Rhabdomyosarcoma Cholesteatoma
64
CHARGE syndrome
``` Colobloma Heart defect Atresia of choanal Retarded growth Genito-urinary abnormalities Ear abnormalities. ```
65
PHACES syndrome:
``` Posterior Fossa - Dandy Walker Haemangiomas Arterial anomalies Coarctation of aorta / cardiac defects Eye abnormalities Subglottic haemangiomas. ```
66
BFM in chest of Kid:
``` Askin tumour - rib destruction (>10yrs) Pleuropulmonary blastoma (<2yrs). ```
67
Neonatal chest xray volumes:
Anterior ribs: 3-4 = expiratory 5-6 = inspiratory 7 or more = hyperexpanded. Posterior ribs: 9-10 = adequate. Other hyperinflation signs: flattened diaphragms, horizontal ribs, increased lucency under heart.
68
VACTERAL
``` Vertebral anomalies (37%) Anal / imperforate anus (63%) Cardiac (77%) TracheoEosphageal fistula / Esophageal atresia (40%) Renal (72%) Limb / radial ray (58%) ```
69
Radial dysplasia:
VACTERL Holt oram Fanconi anaemia Thrombocytopenia Absent Radius (thumb present)

A DDx (14 decks)

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