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Flashcards in pediatricradiologyflash Deck (231):
1

Heart shape in transposition of great vessels and tetralogy of Fallot

TOGV: Narrow cardiac base. Egg on string. TOF: Boot shape.

2

Pilon Fracture

Medial malleolus. Distal tibia metaphysis. Tibia plafond extension

3

Precursor to Wilms tumor

Nephroblastomatosis (primitive rests of cells with tumor potential)

4

Tillaux fracture

Salter Harris III fracture of anterolateral tibia epiphysis. Seen in older children and adolescents. Distal physis fuses medial to lateral. Lateral distal tibia prone to avulsion injuries.

5

Abdominal tumors associated with Beckwith- Wiedemann syndrome

Wilms tumor. Hepatoblastoma. Adrenal cortical carcinoma

6

Objective sign of active congestion. increased pulmonary blood flow. and over-circulation

Diameter of right interlobar pulmonary artery (PA) is greater than trachea

7

Acute hydrops of the gallbladder

Markedly enlarged. tender gallbladder with a thin wall. Acute acalculous cholecystitis causes less gallbladder distention with wall thickening.

8

Acyanotic Heart Disease With Increased Pulmonary Vascularity

VSD. ASD. PDA

9

Adrenal calcifications and associated disease?

Adrenal neuroblastoma: Fine. punctate calcifications. Calcified adrenal hemorrhage: coarse calcifications

10

Age group for intussusception?

Peaks at age 2

11

Age group for Wilm's tumor and neuroblastoma?

Birth to 5 years

12

Anterior mediastinal masses

4Ts and a C: Thyroid (ectopic thyroid is often mentioned. never seen. Terrible lymphadenopathy. Teratoma. Thymoma. Cystic hygroma

13

ASD heart chamber changes

RA and RV enlargement.

14

Asplenia syndrome

Bilateral right-sidedness: Absent spleen. Bilateral three-lobed lung. Bilateral superior vena cava.

15

Pulmonary blood flow in tetralogy of fallot

Decreased blood flow to left lung.

16

Atrioventricular discordance

LA connected to RV. RA connected to LV.

17

Beckwith Wiedemann syndrome triad

Macroglossia. Omphalocele. Visceromegaly.

18

Bezoars may consist of

Hair (trichobezoar). Milk products (lactobezoar). Vegetable material (phytobezoar). Cloth.

19

Biliary atresia HIDA scan results?

Liver uptake of radionuclide without bowel excretion. Gallbladder is not seen.

20

Biliary atresia ultrasound findings

Gallbladder is small or absent. Normal gallbladder in 20% of patients. Triangular echogenic atretic biliary plate measures greater than 4 mm along anterior wall of right portal vein.

21

Bilious vomiting in infants aged 2 months to 2 years

Midgut volvulus. Small bowel obstruction. Intussusception

22

Bronchogenic cysts

Lined with respiratory epithelium and filled with mucoid liquid. Occur in lung parenchyma or mediastinum. Subcarinal location is common. Some are connected to bronchial tree and are air filled.

23

Bronchopulmonary Dysplasia

Damage to structurally immature lung by oxygen and positive pressure ventilation.

24

Calcification in Wilm's tumor and neuroblastoma?

Neuroblastoma calcification is common. Wilms tumor calcification is uncommon.

25

Causes of lobar collapse in children

Common: Mucus plugging in postoperative and asthmatic patients. Uncommon: Extrinsic masses such as lymph nodes (tuberculosis. infections. or lymphoma) or bronchogenic cysts.

26

Causes of Ascites in Older infants and children

Liver disease. Nephrotic syndrome. Portal vein obstruction. Traumatic intestinal injury. Peritonitis. Hypoproteinemia. Pancreatitis. Ruptured abdominal cyst. Intestinal lymphangiectasia. GI ischemia. Bile duct perforation.

27

Causes of Ascites in the newborn

Hydrops fetalis. Chylous ascites. Urinary tract obstruction. Iatrogenic (line perforation). Intestinal perforation (necrotizing enterocolitis).

28

Causes of childhood Focal Alveolar Consolidation

Bacterial pneumonia: Streptococcus pneumoniae. Mycobacterium. Staphylococcus. Haemophilus influenzae. Nonbacterial infection: Tuberculosis. Actinomycosis. Pulmonary infarction. Pulmonary contusion.

29

Causes of childhood Miliary Nodules

Infection: Tuberculosis, Histoplasmosis, Viral. Idiopathic pulmonary hemosiderosis. Metastatic disease.

30

Acute and chronic causes of childhood Parahilar Peribronchial Opacity

Acute (infection): Viral, Mycoplasma, Chlamydia, Pertussis. Chronic: Asthma, Cystic fibrosis, Immunologic deficiency disease, Chronic aspiration

31

Causes of Colonic Obstruction

Meconium plug syndrome (small left colon). Hirschsprung disease. Functional megacolon. Ectopic (imperforate) anus. Colon atresia/stenosis. Inflammatory stricture. Volvulus. Trauma. Neoplasm.

32

Causes of Duodenal Obstruction

Atresia/stenosis/diaphragm. Annular pancreas. Duodenal band. Midgut volvulus. Hematoma. Neoplasm (duodenum. pancreas. liver). Peptic ulcer disease.

33

Causes of Echogenic Renal Pyramids

Normal neonate. Tamm-Horsfall proteinuria. Sickle-cell disease. Hypercalciuria. Renal tubular acidosis. Medullary sponge kidney. Hyperparathyroidism. Drugs (furosemide. steroids. vitamin D). Prolonged immobilization. Bartter syndrome. Williams syndrome. Autosomal recessive polycystic kidney disease. Storage diseases. Glycogen-storage disease type 1A. Hurler mucopolysaccharidosis. Lesch-Nyhan syndrome. Oxalosis.

34

Causes of Gastric Obstruction

Atresia/antral diaphragm. Duplication cyst. Pylorospasm. Hypertrophic pyloric stenosis. Gastritis/ulcer disease. Volvulus. Microgastria.

35

Causes of more distal abdominal obstruction presenting in the newborn include

Ileal and colonic atresia. Aganglionosis (Hirschsprung's disease).

36

Causes of multiple Renal Cysts

Multicystic dysplastic kidney. Polycystic kidney disease. Glomerulocystic disease. Medullary cystic disease (juvenile nephronophthisis). Tuberous sclerosis. Turner syndrome. von Hippel-Lindau disease. Zellweger syndrome. Beckwith-Wiedemann syndrome. Meckel-Gruber syndrome.

37

Causes of Pediatric Esophageal Obstruction

Congenital atresia/stenosis. Web/diverticulum. Foreign body. Stricture (peptic, caustic). Extrinsic compression (cysts, neoplasms, vascular). Achalasia.

38

Causes of pediatric Unilateral Obstructive Emphysema

Bronchial foreign body. Mucous plug. Congenital lobar emphysema. Bronchial stenosis/atresia. Tuberculosis. Vascular anomalies. Mediastinal masses.

39

Causes of single Renal Cyst

Simple cyst. Caliceal diverticulum. Abscess. Multilocular cystic nephroma.

40

Causes of Small Intestinal Obstruction

Atresia/stenosis. Meconium ileus. Incarcerated hernia. Intussusception. Perforated appendicitis. Regional enteritis. Posttraumatic hematoma/stricture.

41

Causes of Unilateral Renal Enlargement

Hydronephrosis. Duplication anomaly. Compensatory hypertrophy. Crossed fused ectopia. Multicystic dysplastic kidney. Renal abscess. Renal neoplasm. Renal vein thrombosis.

42

Caustic esophagitis with stricture usually results from

Alkaline substanceingestion: sodium hydroxide, potassium hydroxide (lye), alkaline disk batteries. Acids produce more superficial burns.

43

Chest Wall Masses

Malignant: Ewing sarcoma, Primitive neuroectodermal tumor (Askin tumor), Neuroblastoma, Leukemia, Lymphoma, Rhabdomyosarcoma. Benign: Osteochondroma, Aneurysmal bone cyst, Mesenchymal hamartoma, Langerhans cell histiocytosis, Fibrous dysplasia, Hemangioma, Lymphangioma, Teratoma, Abscess, Calcifying fibrous pseudotumor, Osteoid osteoma.

44

Children with hemihypertrophy have a predilection for what tumors?

Wilms tumor. Hepatoblastoma.

45

Choledochal cysts

Congenital malformations of intraor extrahepatic bile ducts. May present with jaundice, pain, right upper quadrant mass. Most common is type 1: fusiform or saccular dilation of common bile duct below the cystic duct.

46

Findings of an anterior pneumothorax

Increased lucency of hemithorax. Increased sharpness of mediastinal border.

47

2 forms of aorta coarctation

Juxtaductal (adult) type lies at or just distal to the ductus arteriosus. Preductal (infantile, rare) form generally is a long-segment narrowing.

48

Coarctation of aorta associated cardiac anomalies

Bicuspid aortic valve. PDA. VSD.

49

Common abdominal masses of 1 month to 2-year-olds?

Wilms tumor. Neuroblastoma. Mass from intussusception.

50

Common causes of bilateral lung hyperexpansion

Asthma. Bronchiolitis. Cystic fibrosis.

51

Common complications of esophageal atresia repair

Anastomotic strictures (40%). Anastomotic leakage (14% to 21%). Recurrent fistula (3% to 14%). Esophageal dysmotility. GER.

52

Complete transposition of the great vessels (D-transposition)

Most common form of cyanotic congenital heart disease with increased pulmonary blood flow. Positions of aorta and PA are reversed. Aorta arises anteriorly from RV. PA arises posteriorly from LV. VSD, ASD, or PDA allow for survival.

53

Congenital Hutch diverticulum

Adjacent to ureterovesical junction. Increased incidence of VUR.

54

Congenital pulmonary hypoplasia

Hypoplasia or absence of ipsilateral pulmonary artery. Sometimes associated with tetralogy of Fallot or persistent truncus arteriosus.

55

Cor triatriatum

Rare cause of obstruction of venous emptying into LA. Pulmonary veins empty into a common vein incorporated into the LA. Partial membrane creates an extra chamber along the posterosuperior LA.

56

Corrected transposition of the great vessels (L-transposition)

Ventricular inversion with functional correction of transposition. Blood circulates through RA to LV to PA to lungs to LA to RV to aorta to body. Anatomic RV functions as LV and vice versa. Aorta lies anteriorly and to the left hence L-transposition.

57

CSF Pseudocyst

VP shunt tip fluid collection causing shunt malfunction.

58

CT findings of acute appendicitis

Distended appendix greater than 6mm. Fatty infiltration (stranding). Appendicolith (20-40%). Complications of perforation: fluid collections and free air.

59

Cystic adenomatoid malformation

Congenitallung lesion containing dysplastic adenomatous tissue with communicating cysts of variable sizes. Vary from solid lesion to multiple tiny cysts to large, thin-walled cysts. May mimic congenital lobar emphysema. Cysts can enlarge leading to respiratory distress. Usually are unilateral and can affect any portion of the lung.

60

Dermoid versus teratoma

Dermoids contain only ectodermal elements. Teratomas contain elements from all dermal layers.

61

Describe course of umbilical artery catheter?

Enters umbilical artery, Proceeds caudad in iliac vessels, Ascends left of midling in abdominal aorta.

62

Describe course of umbilical vein catheter?

Pass into left portal vein through ductus venosus and into inferior vena cava.

63

Dextrocardia

Cardiac apex lies to the right of the spine. Levocardia is the normal position of the cardiac apex.

64

Dextroversion

Right-sided rotation of heart. RA and RV become more posterior. LA and LV lie anterior. Chamber inversion does not occur.

65

DiGeorge syndrome

Thymic aplasia. Absence of parathyroid glands. Cardiovascular anomalies. Faulty development of third and fourth pharyngeal pouches.

66

Distinguishers of neuroblastoma from Wilm's tumor?

More common in neuroblastoma: Calcification. Spinal involvement. Nodal encasement.

67

Distinguishes GI duplication cyst from Mesenteric and omental cysts at ultrasound

Cyst wall has a single layer rather than a double layer (gut signature) seen with GI duplication cysts.

68

Distinguishing ileal atresia from meconium ileus

Air-fluid levels in the dilated small bowel are more commonly seen with ileal atresia. Ileal atresia is corrected surgically whereas meconium ileus is often treated with water-soluble contrast enema.

69

Drash syndrome

Male pseudohermaphroditism. Glomerular disease. Wilms tumor.

70

Ebstein anomaly

Malformed, enlarged tricuspid valve that is displaced downward. Atrialization of RV. Severe TR. Atrial right-to-left shunting results in cyanosis in the more severely affected patients.

71

Echogenicity of neonatal renal cortex

Approximates or exceeds liver echogenicity

72

Favorable neuroblastoma features

Intrathoracic. Less than 12 months old.

73

Foregut. midgut. and hindgut boundaries?

Midgut extends from ampulla of Vater (2nd portion duodenum) to midtransverse colon. Foregut, bowel proximal to ampulla of Vater. Hindgut, bowel distal to midtransverse colon.

74

Functional megacolon

Common condition in childhood. Spasm of puborectalis muscle. Prominence of puborectalis sling. Patients can hold large volumes of stool in colon.

75

GI cystic masses

Duplication cyst. Mesenteric cyst. Meconium pseudocyst. Lymphangioma. Appendiceal abscess.

76

Helps distinguish obstructive emphysema from compensatory hyperinflation?

Obstructive emphysema generally results in diminished size of pulmonary vessels due to compression and hypoxia-induced reflex arterial spasm. In compensatory hyperinflation pulmonary vessels are normal or even increased in size.

77

Hemangioendothelioma possible complications

High-output cardiac failure. Hemorrhage. Jaundice. Hemolytic anemia. Thrombocytopenia (Kasabach-Merritt syndrome) sequestration of platelets. DIC.

78

Hepatic adenomas are rare in childhood but have been reported in association with

Fanconi anemia. Glycogen-storage disease type 1. Hurler disease. Severe combined immunodeficiency.

79

Hepatic hemangioendothelioma features?

Benign. Most diagnosed within first 6 months of life. Hepatomegaly and high-output congestive heart failure are common. May present with platelet sequestration (Kasabach-Merritt syndrome) or DIC.

80

Hepatobiliary cystic masses

Gallbladder hydrops. Choledochal cyst. Mesenchymal hamartoma. Abscess/parasitic cyst.

81

Hepatoblastoma features

Occurs in children under the age of 5 years. May extend into portal veins, hepatic veins, and inferior vena cava. Prematurity is a risk factor. Usually well-circumscribed, solitary mass. May be multifocal.

82

Hepatoblastoma routes of spread

Local: Portal vein. Hepatic vein. IVC. Lymph nodes. Diaphragm. Peritoneum. Remote: Lungs.

83

Hepatoblastoma occurs at what age and with what syndromes?

Early childhood, presenting before 3 years of age. Beckwith-Wiedemann syndrome. Familial adenomatous polyposis.

84

Epidermolysis bullosa effect on esophagus

Hereditary condition. Inflammatory skin and mucosal lesions that can heal with fibrosis. May result esophageal stricture.

85

Hirschsprung disease features

Contracted aganglionic distal colon. Abnormal peristalsis and inability to effectively evacuate colon. Rectum is always involved. Extent of proximal involvement varies. Colon caliber transition more common in older infants. Tortuosity or corrugation of narrowed aganglionic segment of the colon is commonly seen. Diagnosis made with rectal biopsy. Necrotizing enterocolitis is an uncommon but serious complication.

86

How long does it take for gas to reach the rectum in a normal newborn?

May take up to 24 hrs. Occurs by 12 h in most healthy infants.

87

Hydrometrocolpos versus hematometrocolpos

Both are congenital vaginal obstructions. Hydrometrocolpos anechoic fluid in the newborn. Hematometrocolpos echogenic blood in the adolescent.

88

Hypertrophic pyloric stenosis features:

Common between 2 and 10 weeks of age. Hypertrophy of pyloric muscle. 4 mm or more in thickness. Pyloric channel elongated beyond 15 mm.

89

Hypoplastic right heart

Tricuspid atresia. Usually with pulmonary atresia or stenosis. Underdeveloped RV. Common features are small RV with right-to-left shunting through an ASD causing cyanosis.

90

Imaging sequence of at risk infants (neonate to 3 years) for suspected pyelonephritis?

Nuclear scan with 99mTc -DMSA or 99mTc-GH. If positive, ultrasound and or voiding cystourethrogram.

91

Imperforate or ectopic anus

Range from simple membranous anal atresia to arrest of colon as it descends through puborectalis sling. Fistula formation may occur to genital or urinary tract.

92

Contrast enema with cecum not in the right lower quadrant, suspect

Malrotation or malfixation of midgut.

93

In a neonate a right-sided aortic arch may be inferred if

Carina is midline or to the left.

94

In a neonate buckling of the trachea is

Normal. Occurs during expiration.

95

In a neonate decreased pulmonary vascularity, though difficult to detect may be seen in

severe pulmonic stenosis or atresia.

96

In a neonate the ideal position of the endotracheal tube is at the level of

Inferior margins of the clavicles.

97

Neonate with low lung volumes and fine lung opacities with air bronchograms

Hyaline membrane disease. Group B b-hemolytic streptococcal pneumonia.

98

In children, infarction of the spleen may occur in

Sickle cell anemia. Leukemia. Gaucher disease. Cardiac valvular disease.

99

In neonates, pulmonary vessels can be seen peripherally only as far as

Medial third of lungs.

100

Common causes of GI bleeding in neonates

Necrotizing enterocolitis. Milk allergy. Enterocolitis that sometimes accompanies Hirschsprung disease.

101

In the newborn, prolonged jaundice (over 2 weeks) is most commonly due

Neonatal hepatitis. Biliary atresia.

102

Infants with increased lung volumes and fine lace-like strands or cysts.

Pulmonary interstitial emphysema. Bronchopulmonary dysplasia.

103

Neonate with increased lung volumes and localized lung opacity.

Pneumonia

104

Neonate with increased lung volumes with multiple coarse areas (strand-like densities following bronchovascular patterns).

Meconium aspiration. Retained fetal fluid (TTN).

105

Infant GER is best imaged with

Nuclear scintigraphy. Tc-99m sulfur colloid formula (best sensitivity)

106

Intussusception

Generally occur after 6 months of age. Most are ileocolic and the cause is idiopathic. Treatment is water-soluble or air enema reduction. Contraindicationsto enema reduction: Free air, Signs of peritonitis. Recurrent intussusception occurs in 5% to 10% of cases.

107

Unilateral hyperexpansion of one or two lobes in children, common causes

Aspirated foreign body. Hilar nodes compressing bronchus.

108

Hyperinflated lung findings

Flattening or inversion of diaphragm. Widening of rib interspaces. Larger retrosternal and retrocardiac clear spaces.

109

Lung disease correlate with gestational age: Near term (34-37 weeks) and term (38-42 weeks)

Retained fetal fluid. Aspiration syndromes, including meconium aspiration. Persistent pulmonary hypertension.

110

Lung disease correlate with gestational age: Premature (24-34 weeks)

Immature lung. Hyaline membrane disease. Persistent pulmonary hypertension.

111

Malignant Wilms tumor spread

Local: Renal vein. Inferior vena cava. Perirenal lymph nodes. Contiguous invasion of liver. Remote: Lungs. Liver. Bone.

112

Malrotation

Duodenal-jejunal junction is not properly fixed by ligament of Treitz. Results in duodenal obstruction by peritoneal bands or twisting of duodenum (midgut volvulus).

113

Meconium Aspiration

Intrauterine fetal distress can lead to passage of meconium. Aspirated meconium particles cause obstruction of small peripheral bronchioles. Results in areas of subsegmental atelectasis and areas of overdistension. Coarse reticulonodular or nodular appearance of lungs.

114

Meconium aspiration radiographic findings.

Increased lung volumes. Patchy perihilar opacities.

115

Meconium ileus features

Earliest manifestation of cystic fibrosis. Thick meconium plugs can't pass through ileocecal valve. Multiple dilated loops of small intestine. Bubbly intestinal contents represent retained meconium. Often treated with water-soluble contrast enema.

116

Meconium peritonitis

Intrauterine intestinal perforation from bowel obstruction or ischemia. Extruded meconium mayh calcify. Scattered amorphous or curvilinear calcifications throughout peritoneum. Snowstorm ultrasound appearance.

117

Meconium plug syndrome also known as small left colon syndrome

Transient functional immaturity and abnormal peristalsis of distal colon. Normal to dilated proximal colon filled with meconium. Empty distal descending colon. More common in normal large infants and infants of diabetic mothers. Often treated with rectal stimulation or saline enemas.

118

Megacystis-microcolon-hypoperistalsis (MMH) syndrome

Disorder of smooth muscle in urinary and GI tract. Almost exclusively in girls. Insufficient abdominal muscles. Very large dysfunctional bladder. Bladder exstrophy may occur: Widened pubic symphysis. Splaying of pelvic bones. Decreased peristalsis leads to poor evacuation of colon.

119

Mesenteric adenitis

Self-limiting, usually viral inflammatory condition of mesenteric lymph nodes Normal appendix. Cluster of large right lower quadrant lymph nodes.

120

Microgastria occurs with

GI atresias. VACTERL syndrome. Polysplenia/asplenia syndromes.

121

Middle mediastinum mass (an abnormality for each organ)

Esophagus: Duplication cyst. Great vessels: Aneurysm. Hila: Large lymph nodes (Leukemia, Lymphoma, Tuberculosis). Trachea: Bronchogenic cysts. Pericardium: Cyst

122

Midgut volvulus vascular compromise

Superior mesenteric vessels: vein before artery.

123

Most Common Causes of GI Tract Obstruction by Age. 0-1 month:

Congenital anomalies: Atresia/stenosis, Malrotation/volvulus, Hirschsprung disease. Meconium plug/small left colon syndrome. Meconium ileus.

124

Most Common Causes of GI Tract Obstruction by Age. 1-5 months:

Hernias

125

Most Common Causes of GI Tract Obstruction by Age. 3 years and older

Perforated appendicitis. Adhesions. Regional enteritis.

126

Most Common Causes of GI Tract Obstruction by Age. 5 months - 3 years

Intussusception.

127

Most common childhood tumors to metastasize to liver (descending order)

Neuroblastoma. lymphoma. leukemia. and Wilms tumor.

128

Most GI duplication cysts are asymptomatic except for those that

Contain ectopic gastric or pancreatic tissue. May ulcerate or hemorrhage.

129

Most of the time the right lung hilum is lower than the left. but it is never

Higher

130

Syndrome with multiple nonossifying fibromas along with cafe-au-lait spots

Jaffe-Campanacci syndrome

131

Necrotizing enterocolitis (NEC)

Occurs in premature and newborn infants. Thought to be infection and or ischemia of the gut. Findings: Dilated bowel loops. Pneumatosis intestinalis (air in wall of the bowel). Portal venous gas. Free air. Later may develop strictures, commonly in the colon. Treatment: Withholding feedings. Administering antibiotics. Blood transfusions.

132

Neonatal hepatitis HIDA scan results?

Poor liver uptake.

133

Neonate to 2 months with bilious vomiting

Midgut volvulus. Small bowel obstruction. Bowel atresia in newborn. Hirschsprung disease

134

Neonate to 2 months with nonbilious vomiting

Overfeeding Chalasia (gastroesophageal reflux). Pyloric stenosis.

135

Neonates at risk for TTN or retained fetal fluid

Neonates with tracheobronchial obstruction. Cesarean section delivered neonates.

136

Nephroblastomatosis.

Primitive metanephric blastema thought to be precursor of Wilms tumor. Commonly seen in neonate kidneys. Normally regress by 4 months of age. Bilateral lobulated and enlarged kidneys. Marked compression and stretching of pelvicaliceal structures. Large echogenic and lobular kidneys. May demonstrate diffuse hypoechoic cortical thickening. Nephrogenic rests are generally cortical, hypoechoic, low attenuationand T1 hypointense.

137

Neuroblastoma features

Arise along axis of sympathetic nerves (paraspinal). 66% are abdominal. Intraspinal involvement is common. Majority occur between 6 months and 5 years. Present with weight loss. irritability. fever. and/or anemia. Frequently show stippled calcification. Poor prognosis with abdominal involvment in patients over 1 year of age. MIBG avid.

138

Nonbilious vomiting in infants aged 2 months to 2 years the possibilities include:

Often just GER. Infections: Meningitis. Urinary tract infection.

139

Nonvisualized kidney causes

Congenital absence. Surgically removed. Ectopic kidney. Multicystic dysplastic kidney. Renal artery thrombosis. Renal vein thrombosis. Tumor.

140

Normal or decreased lung volumes and fine granular opacities (ground glass) with air bronchograms.

Hyaline membrane disease (RDS and HMD). Group B b-hemolytic streptococcal pneumonia

141

Of the talar and calcaneal joint coalitions which is rarest

Calcaneocuboid

142

Older children develop adrenal hemorrhage as a result of

Accidental and nonaccidental trauma. Meningococcemia. Anticoagulant therapy.

143

Ollier's disease

Multiple enchondromas generally presentingÿin childhood. Generaly asymptomatic. Risk ofÿmalignant transformation.

144

Ostium secundum versus ostium primum atrial septal defects?

Ostium secundum: Most common type of ASD. Occurs centrally at foramen ovale. Ostium primum: Endocardial cushion defect. Commonly occurs in trisomy 21.

145

Overcirculation. increased arterial flow. and increased vascularity suggest

Left-to-right shunt.

146

Passive congestion

Increased pulmonary venous pressure. Commonly caused by left heart failure. Progressed from dilated veins to indistinct pulmonary vessels to interstitial edema to alveolar edema and pleural effusions.

147

PDA heart chamber changes

Enlarged LA, LV, PA, and proximal Aorta.

148

Pediatric neoplasms that cause caval tumor thrombus.

Wilms tumor. Hepatoblastoma.

149

Persistence of fetal circulation after birth is called

Persistent pulmonary hypertension.

150

Plain film findings of intussusception?

Abdominal mass. Signs of bowel obstruction: dilated bowel and air-fluid levels.

151

Polysplenia syndrome

Bilateral left-sidedness: Multiple spleens. Bilateral bilobed lungs. Interrupted inferior vena cava with azygos continuation. Biliary atresia

152

Possible Causes of childhood Bilateral Lung Hyperinflation

Diffuse peripheral obstruction: Viral bronchitis/bronchiolitis. Asthma. Cystic fibrosis. Immunologic deficiency diseases. Chronic aspiration. Graft versus host disease. Central obstruction: Extrinsic (Vascular anomalies, Mediastinal masses). Intrinsic (Tracheal foreign body, Tracheal neoplasm/granuloma).

153

Possible routes of neuroblastoma spread

Local: Lymph nodes and extensive nodal masses. Invasion of neuroforamina. Encasement of great vessels. Remote: Bone. Liver. Central nervous system (extradural space and orbit)

154

Posterior mediastinum mass (T. E. N)

Tuberculosis (Pott's disease) or any spinal infection. Extramedullary hematopoiesis (almost always in adults). Neurogenic tumors: Neuroblastoma. Ganglioneuroma. Neurofibroma. Neurenteric cyst.

155

Posterior urethral valve findings

Most common cause of urethral obstruction in males. Dilated posterior urethra. Bladder wall thickening and trabeculation. VUR.

156

Premature infant mechanical ventilation complications

Pulmonary interstitial emphysema. Pneumomediastinum. Pneumothorax. Pneumopericardium.

157

Presacral childhood masses

Sacrococcygeal teratoma. Neuroblastoma. Rhabdomyosarcoma. Sacral chordoma. Anterior sacral meningocele. Neuroenteric cyst.

158

Primary megaureter versus refluxing megaureter?

Primary megaureter: Contracted ureterovesical junction. Refluxing megaureter: widely patent ureterovesical junction.

159

Primary Vesicoureteral reflux (VUR) is caused by

Short. submucosal tunnel of distal ureter at ureterovesical junction. Faulty valve.

160

Prune belly (Eagle-Barrett) syndrome

Almost exclusively in males. Absent or deficient abdominal musculature. Large, vertically oriented urinary bladder. Severe hydronephrosis and ureterectasis. Cryptorchidism. Urethral dysfunction leading to functional bladder obstruction. Urachal remnants.

161

Pulmonary lymphangiectasia

Rare condition. Dilated lymphatics within lung interstitium. Diffuse reticular or reticulonodular lung opacities. May cause chylothorax. May have hyperinflated lungs and pleural effusions.

162

Pulmonary sequestration

Lung tissue lacking a bronchial connection. Supplied by abnormal artery from descending aorta. Extralobar (covered by own pleura). Intralobar (covered by adjacent lung pleura). Triangular or oval-shaped mass in inferomedial lung. Left side more common. Ma become secondarily infected.

163

Radiographic signs of a patent ductus arteriosus in an infant

Enlarging heart and liver. Increasing pulmonary vascularity.

164

Renal/adrenal cystic masses

Hydronephrosis. Renal cysts. Multicystic dysplastic kidney. Adrenal hemorrhage (resolving).

165

Rhabdomyosarcoma features

16% arise in genitourinary system. Occur at any pediatric age group. Arise from skeletal muscle mesenchyme. Most common lower urinary tract tumor. Prostate gland in boys. Vagina in girls.

166

Rhabdomyosarcoma routes of spread?

Local: Direct invasion of adjacent viscera. Retroperitoneal lymph nodes. Remote: Lungs. Bones. Liver.

167

Right-sided aortic arch congenital heart disease associations

Truncus arteriosus. Tetralogy of Fallot.

168

Risk factors for neonatal adrenal hemorrhage.

Large babies. Obstetric trauma. Neonatal sepsis. Hypoxia.

169

Sacrococcygeal teratoma

Often large. May extend externally from region of coccyx. Usually deforms sacrococcyx. Frequently contains calcifications (tooth).

170

Seventy percent of abdominal and pelvic masses in neonates originate in what organs?

Genitourinary tract. Urinary masses: Hydronephrosis (UPJ and UVJ obstruction and reflux). Multicystic kidneys. Genital masses: Hydrometrocolpos. Ovarian cysts.

171

Signs of increased pulmonary arterial flow include:

Enlarged central vessels. Equalization of vessel size between upper and lower lungs on erect film.

172

Sinding-Larsen-Johansson syndrome

Osteochondrosis of inferior patella at tendon insertion. Results from persistent traction at cartilaginous junction of developing inferior patella. Usually occurs preteen or teen-age boys. Similar to Osgood-Schlatter disease (occurs at developing tibial tuberosity at tendon insertion).

173

Single large kidney causes

Tumor. Renal vein thrombosis. Pyelonephritis. Abscess. Hematoma. Obstruction or reflux.

174

Single small kidney causes

Congenital hypoplastic kidney (renal artery stenosis). Postinfectious nephropathy. Reflux.

175

Visceral situs inversus

Reversed viscera. Stomach on right. Liver on left.

176

Situs solitus

Normal position of viscera.

177

Sources of Diffusely Hazy or Reticular Lungs in the Neonate

Decreased lung volumes: Poor inspiration. Hyaline membrane disease. Normal to increased lung volumes: Retained fluid. Aspiration (amniotic fluid/meconium). Pneumonia. Pulmonary edema. Pulmonary lymphangiectasia

178

Sources of Multiple childhood Patchy Lung Opacities

Infection: Staphylococcus. Mycoplasma. Fungal. Opportunistic organisms. Aspiration. Hydrocarbon ingestion. Near drowning. Immune-mediated pneumonitis. Milk allergy. Hypersensitivity pneumonitis. Pulmonary hemorrhage. Pulmonary edema

179

Split pleural sign

Enhancement of parietal and visceral pleura displaced by low-density fluid. Suggests empyema.

180

Such high-output hydronephrosis is rare but may be seen with

Bartter syndrome. Diabetes insipidus. Psychogenic water drinking.

181

Superior mesenteric vein and artery relative positions in intestinal malrotation.

Normally superior mesenteric vein is right of artery. In malrotation vein is anterior or left of artery.

182

Surfactant deficiency disease features

Most common cause of respiratory distress in neonates. Most common in premature infants and term infants of diabetic mothers. Low lung volumes. Fine granular opacities. Air bronchograms extend to lung periphery.

183

Surgical causes of abdominal pain in children?

Incarcerated hernia. Intussusception. Appendicitis. Midgut volvulus.

184

Swyer-James Syndrome

Acquired hypoplastic lung following severe obliterative bronchiolitis. Air trapping causes little change in lung size on expiration (different from congenital hypoplastic lung).

185

Tetralogy of Fallot

High VSD. Pulmonary stenosis (usually infundibular. with or without valvular stenosis). Right ventricular hypertrophy. Aorta overrides VSD.

186

Aortic arch frequently cannot be seen in a neonate. Its position must be inferred from the position of the

Carina. Carina normally overlies the right pedicles with a left aorta arch.

187

Initial examination to identify a bleeding Meckel diverticulum

Technetium-99m-pertechnate scan

188

Findings in VSD

PA enlargement. Increased pulmonary vascularity. Cardiomegaly.

189

Ideal location for tip of the umbilical venous catheter

in the right atrium

190

Length of the kidney should be no greater than ________ vertebral bodies.

4-4.5 vertebral bodies.

191

Most common anomaly to cause diminished pulmonary vascularity and is most common cause of cyanotic congenital heart disease.

Tetralogy of Fallot.

192

Most common benign liver tumor encountered in infancy

Hemangioendothelioma

193

Common causes of cholelithiasis in children

Sickle cell disease. Congenital obstructive anomalies of the biliary tract. Total parenteral nutrition. Furosemide treatment. Dehydration. Hemolytic anemia. Short gut syndrome.

194

Common causes of pleural effusion in children

Infection. Congestive heart failure (if unilateral. always on the right). Chronic renal disease.

195

Most common causes of distal small bowel obstruction in the neonate

Ileal atresia. Meconium ileus.

196

Most common childhood malignant tumor of the small intestine.

Non-Hodgkin lymphoma

197

Most common childhood ovarian tumor

Benign teratoma.

198

Most common malignancies to involve the chest wall in children

Ewing sarcoma. Primitive neuroectodermal tumor (Askin tumor).

199

Most common pancreatic pediatric endocrine tumor is

Benign islet cell adenoma (insulinoma).

200

Most common posterior mediastinal mass in a child

Neurogenic tumor: Neuroblastoma. Ganglioneuroma. Neurofibroma.

201

Most common pulmonary mass in children is

Pseudomass caused by spherical pneumonia

202

Most common renal tumor in neonate

Mesoblastic nephroma. Usually considered benign. Metastasis can occur.

203

Most common soft tissue tumor in children

Rhabdomyosarcoma

204

Most common tumor in newborns

Sacrococcygeal teratoma

205

Most common type of cardiac malposition

Mirror-image dextrocardia.

206

Only part of the airway not seen on a neonatal plain film

Nasal airway.

207

Plain film findings of acute appendicitis

Appendicolith (10%). Free fluid in right lower quadrant (separation o colon from properitoneal fat line). Sentinel loop of bowel (air-fluid level) in right lower quadrant. Scoliosis with concavity to the right (splinting).

208

Terminal ileum has a nodular appearance in children due to

Normal lymphoid tissue of Peyer's patches.

209

Thymus may be seen in some children up to the age

of 4-5 years

210

Umbilical arterial line tip may be at

L4-5 (bifurcation of the aorta). T8 above the diaphragm

211

Fat babies are seen in

Diabetic mothers.

212

To make diagnosis of hyaline membrane disease, you must see granular opacities where?

All the way out to the edge of the lungs.

213

TORCHS infections

Toxoplasmosis. Rubella. Cytomegalic inclusion disease. Herpes. Syphilis

214

Total anomalous pulmonary venous return (TAPVR)

Pulmonary veinsreturn blood to right side of the heart via: RA. Coronary sinus. Systemic vein. Type 1 anomaly is the snowman heart: . Large, inverted U-shaped vessel empties into superior vena cava.

215

Two common causes of nonbilious infantile vomiting

GER. Hypertrophic pyloric stenosis.

216

Two large kidneys DDx:

Polycystic disease. Hydronephrosis (Neurogenic bladder. Posterior urethral valves). Leukemia. Lymphoma. Sickle cell disease. Glycogen storage disease. Amyloidosis. Bilateral Wilms' tumor. Acute glomerulonephritis. Acquired immune deficiency syndrome (AIDS).

217

Two of the more common underlying etiological factors predisposing to hyaline membrane disease.

Prematurity. Maternal diabetes.

218

Two small kidneys DDx:

Reflux nephropathy. Postinfectious nephropathy.

219

Ultrasound findings of appendicitis?

Noncompressible appendix greater than 6mm in width. Blood flow may be increased.

220

Upper and lower pole moiety bladder insertions of duplicating collecting system

Upper pole ectopically inserts below normal insertion and may form ureterocele. Lower pole inserts at normal location but often refluxes.

221

Urachal anomalies

Asymptomatic vesicourachal diverticula (obliterated of urachus ends). Urachal sinus, patent urachus extending from urinary bladder to umbilicus.

222

Ureterocele

Saccular dilated segment of distal ureter. Invaginates into bladder lumen. May cause urinary obstruction.

223

Vascularity of a newborn becomes much easier to see in the lateral two-thirds of the lung under what conditions

Vascular congestion due to congestive heart failure or over-circulation(left-to-right shunts).

224

Vertebra plana causes

MELTS. Metastasis. Myeloma (rare in children). Ewing?s sarcoma. LCH. Leukemia. Lymphoma. Trauma. Tuberculous osteomyelitis. Steroid use.

225

VUR grading system and treatment

Grade I: reflux of ureter (low dose antibiotics). Grade II: reflux of ureter. pelvis. calyces (low dose antibiotics). Grade III: reflux of collecting system with mild dilation (low dose antibiotics). Grade IV: reflux of collecting system with moderate dilation (surgery). Grade V: reflux of collecting system with severe dilation (surgery).

226

WAGR syndrome

Wilms tumor. Aniridia. Genitourinary abnormalities. Mental retardation.

227

What causes ductus bump in a neonate and when does is disappear?

Superimposition of main pulmonary artery, left pulmonary artery, and ductus arteriosus. Disappears usually by day 3 of life.

228

When should repeat film in suspected round pneumonia be obtained to ensure resolution?

15 days

229

Most common causes of 3rd and 4th portion duodenal obstructions.

Duodenal diaphragm. Malrotation with midgut volvulus or obstructing peritoneal band.

230

Wilm's tumor features?

Intrarenal tumor. Peak incidence between 2 and 5 years. Hematuria 20%. Uncommonly calcify.

231

Wolman disease

Rare lipidosis. Enlarged, densely calcified adrenal glands. Usually fatal at an early age.