Radiology

Question 1

why are babies and children poor subjects for CXR

Answer 1

inadequate inspiration and rotation may falsely simulate disease

Question 2

what must you be aware of in CXR of babies and children

Answer 2

thymus

Question 3

features of the thymus on CXR of children

Answer 3

visible on CXR up to 2 years
often massive in neonates - particularly if unwell
can simulate mediastinal mass or lung opacity
has angel wing morphology
sometimes nodular

Question 4

common causes of neonatal respiratory distress

Answer 4

transient tachypnoea of the newborn
surfactant deficiency
pneumonia
meconium aspiration

Question 5

after which gestation is surfactant deficiency rare

Answer 5

> 36/40

Question 6

CXR features of surfactant deficiency/respiratory distress syndrome/hyaline membrane disease

Answer 6

onset within a few hours 
small volume lungs (bell shaped thorax)
diffuse granular opacification 
bronchograms 
ventilation related air leaks

Question 7

what is TTN

Answer 7

slow clearing of pulmonary fluid

Question 8

onset and duration of TTN

Answer 8

onset within 24 hours of birth

clears in 1-2 days

Question 9

CXR findings of TTN

Answer 9

normal/overinflated lungs
interstitial lines and pleural effusions
fluid in fissures
air space opacification
looks like pulmonary oedema you would see in adults

Question 10

onset of meconium aspiration

Answer 10

onset at birth- must ask if there was meconium at birth in the history

Question 11

CXR findings of meconium aspiration

Answer 11

patchy opacities
overinflated lungs
air leaks
atelectasis

Question 12

onset of neonatal pneumonia

Answer 12

from birth to several weeks

Question 13

CXR findings of neonatal pneumonia

Answer 13

patchy opacities
overinflation
atelectasis

Question 14

what is the correct tip position for an ET tube in a neonate

Answer 14

2cm above the carina at about T2-3

Question 15

what happens if you put an ET tube too far down

Answer 15

it can end up in one main bronchus resulting in the non ventilated lung collapsing

Question 16

neonatal CXR are obtained supine/erect

Answer 16

supine

Question 17

where does air accumulate in neonatal pneumothorax

Answer 17

anteriorly rather than superiorly, in lateral costophrenic sulci
not over lung apices

Question 18

features of pneumomediastinum

Answer 18

air may outline the heart, thymus and mediastinal vessels

Question 19

what is the correct position for the tip of a neonatal NG tube

Answer 19

stomach

Question 20

where should the tip of an umbilical vein catheter be

Answer 20

at or just above the right hemidiaphragm

Question 21

where should the tip of an umbilical artery catheter be

Answer 21

lower lumbar in the aorta (L3-4) or above the central branches of the aorta

Question 22

what are common causes of respiratory symptoms in infants (1-4yr)

Answer 22

viral - bronchiolitis
bacterial pneumonia
inhaled foreign body

Question 23

CXR signs of bronchiolitis

Answer 23

overinflated lungs / normal
perihilar haze
scattered atelectasis
rarely - diffuse opacifications

Question 24

CXR signs of bacterial pneumonia

Answer 24

fluffy consolidation with air bronchograms
rounded, lobar or multifocal patterns
effusion
pneumatocele / pneumothorax

Question 25

is radio opaque seen easily on CXR

Answer 25

no | radiolucent objects are

Question 26

a coin in the trachea would orientate in the sagittal/coronal plane

Answer 26

sagittal

Question 27

how can you tell which lung has the inhaled foreign body

Answer 27

the affected lung would be lucent due to air trapping

Question 28

Role of imaging for childhood UTI

Answer 28

identify structural abnormalities that could predispose to UTI exclude vesico ureteric reflux quantify renal scarring from previous UTI

Question 29

all children under which age should get an USS for UTI

Answer 29

<6 months | 4 months later they get a VCUG and renogram if US abnormal

Question 30

what should be done in the case of suspected NAI

Answer 30

skeletal survey

Question 31

what would an isotope bone scan show in the case of NAI

Answer 31

increased osteoblastic activity due to healing fractures

Question 32

skeletal injuries that are suspicious of NAI

Answer 32

metaphyseal corner # (as a result of twisting) posterior / lateral rib # multiple # in different healing stages sternal, scapular and spinous process # spinal injuries with no clear history any fracture in a baby who is too young to walk or crawl

Question 33

fracture patterns specific to children

Answer 33

buckle # greenstick # plastic bowing growth plate injury

Question 34

childrens bones are soft/hard in comparison to adults

Answer 34

soft therefore bend or bow instead of snapping

Question 35

in children the physis is lucent and so may mimic a #, true or false

Answer 35

true

Question 36

what classification is used for growth plate fractures

Answer 36

salter harris 1-5

Question 37

what is a risk of growth plate injury

Answer 37

growth deformity

Question 38

difficulties when imaging children

Answer 38

``` difficulty following instructions high dose ionising studies irritable anatomy varies contrast agents specific disease processes affecting kids ```

Question 39

TORCH infections - neonatal pneumonia

Answer 39

``` toxoplasmosis other (syphilis, VZV, parovirus B19) rubella CMV HSV ```

Question 40

which lines are specific to neonates

Answer 40

umbilical vein and artery catheters

Question 41

path of umbilical artery catheter

Answer 41

umbilicus R/L internal iliac artery common iliac artery aorta

Question 42

how can you tell between an umbilical artery or venous catheter in a neonate

Answer 42

artery will dip down in pelvis before coming up

Question 43

how can you tell between an umbilical artery or venous catheter in a neonate

Answer 43

artery will dip down in pelvis before coming up

Question 44

conditions associated with urine stasis or reflux that could predispose to UTI

Answer 44

``` ureteral duplication posterior urethral valve spina bifida ureteric calculus horseshoe kidney ```

Question 45

conditions associated with urine stasis or reflux that could predispose to UTI

Answer 45

``` ureteral duplication posterior urethral valve spina bifida ureteric calculus horseshoe kidney ```

Question 46

order of ossification centres of the elbow

Answer 46

``` CRITOL capitellum radial head trochlea olecranon internal epicondyle lateral epicondyle ```