Brant And Helms - Pediatrics

Front 1

What should be considered with consolidation and adenopathy?

Back 1

TB
Measles
Mono
Anthrax

Front 2

Ddx for anterior mediastinal masses?

Back 2

Thymic Hyperplasia
Lymphoma
Germ cell(Teratoma)

Front 3

Differential for middle mediastinal masses?

Back 3

Lymphadenopathy
Duplication cyst

Front 4

Differential for posterior mediastinal masses?

Back 4

Neuroblastoma

Front 5

What types of children are prone to atelectasis?

Back 5

Ashthma
Viral bronchiolitis

Front 6

Differential for patchy opacities?

Back 6

Staphy
Mycoplasma
Opportunistic
Aspiration
Hemorrhage
Edema

Front 7

Differential of parahilar peibronchial opacities?

Back 7

Viral
Mycoplasma
Pertussis(shaggy heart)
Asthma
CF

Front 8

What is the complication of a large congenital diaphragmatic hernia?

Back 8

Pulmonary hypoplasia

Front 9

Various branching of right aortic arch?

Back 9

1. Mirror image
2. Duplicated arch- Right arch is bigger, higher up
3. Right arch with aberrant left subclavian – Diverticulum of Kommeral

Front 10

ASD (3 types)

Back 10

1. Sinus venosus defects – associated with PAVR
2. Ostium secundum – centrally located
3. Ostium primum – Endocardial cushion – trisomy 21

Front 11

Differential for cardiomegaly, increased vascularity, non-cynanotic?

Back 11

1. ASD: enlarged RA, RV, PA
2. VSD(2nd most common to bicuspid aortic valve): most common- (RV enlargement, PA enlargement, vascularity, LA)
3. PDA: big LA, LV, Aorta

Front 12

CXR – normal heart and intersitional thickening, ddx

Back 12

- Noncardiogenic edema
- Viral infection

Front 13

Differential for venous congestion and normal heart size? (venous blockage)

Back 13

1. Hypoplasia left heart
2. Pulmonary vein atresia
3. TAPVR III
4. Cor triatriatum
5. Lymphangiectasia

Front 14

Describe three types of TAPVR

Back 14

I. At brachiocephalic (Snowman heart)
II. At level of the heart (drains at level of heart, egg on a string)
III. Below heart, has to go through diaphragm, obstructing vein and venous return

Front 15

Difference between atrial flutter and atrial fibrillation

Back 15

- A flutter – RA problem – Maze procedure
- A fib – LA problem – do pulmonary vein ablation at ostia of pulmonary vein, can get pulm vein stenosis post procedure, similar to pulmonary vein atresia

Front 16

Differential for increased shunt vascularity and cyanosis (4 Ts)

Back 16

1. Truncus arteriosis (higher association associated with right arch)
2. TAPVR, I, II (increased vessels in periphery, (not III), venous congestion
3. Transposition
4. Taussig Bin

Front 17

Two types of transposition

Back 17

- D – deadly
- L – living

Front 18

Differential for decreased vascularity, cyanotic child (2T’s)

Back 18

- TOF
- Tricuspid atresia – no communication from RA to RV(hypoplastic right heart)
- Ebstein's

Front 19

TOF

Back 19

- Pulmonary artery stenosis – infundibular/subvalvular
- RV Hypertrophy
- Overriding aorta
- VSD – high

Front 20

What is an Ebstein Anomaly?

Back 20

Tricuspid valve is low – septal leaflet, too low, atrialization of RV

Front 21

What is Uhl’s anomaly?

Back 21

- Dysplastic RV

Front 22

Cause of supravalvular aortic stenosis?

Back 22

- Williams syndrome – facial dysmorphism, hypercalcemia

Front 23

Coarctation of the aorta is associated with?

Back 23

- Turner syndrome
- bicuspid aortic valve

Front 24

What is cor triatriatum?

Back 24

- Obstructing web in RA

Front 25

Asplenia versus polysplenia

Back 25

- Asplenia(Bilateral right sided) - three lobes heart, 3 SVC
- Polysplenia(multiple splenis, 2 lobes, interrupted IVC, biliary atresia)

Front 26

What do you use to measure Pectus excavatum and correct it?

Back 26

- Haller index – normal at 2.5
- Surgical procedure – Nuss, for greater than 3.2

Front 27

Most common cause of distal obstruction at 0-1 months?

Back 27

1. Meconium ileus/plug
2. Small left colon – large kids of diabetic mothers
3. Congenital – atresia, malrotation, Hirschsprung, volvulus

Front 28

Where does intusseception usually start?

Back 28

- Usually start at the illeocecal valve from lymphoid hyperplasia

Front 29

Most common cause of distal obstruction in patients greater than 3 years old?

Back 29

1. Perforated appendicitis
2. Regional enteritis
3. Adhesions

Front 30

Failure to pass NG tube – Differential

Back 30

1. Most common – atresia and tracheobronchial fistula
2. Isolated Atresia – no air in stomach bubble
3. Proximal esophageal fistula – no atresia – “H type”
(trisomy 21)

Front 31

What do you see in utero ultrasound in esophageal atresia?

Back 31

- Polyhydramnios
- No stomach bubble

Front 32

Most common cause of GER?

Back 32

- Lax GE jcn
- Gastric outlet obstruction – spasm, stenosis, ulcer

Front 33

How do you distinguish a peptic ulcer vs a Barrett ulcer?

Back 33

- Peptic – at GE jcn
- Barnett – more prox

Front 34

Two types of gastric volvulus (check location of pylorus and GE junction)

Back 34

- Organoaxial
- Mesoaxial

Front 35

What types of gastric volvulus in older vs young patients?

Back 35

1. Organoaxial – more common in old ladies
2. Mesoaxial – more prone in kids

Front 36

What are the measurements of pyloric stenosis?

Back 36

- Rule of pi – 3 mm, 14 mm in length

Front 37

Where do you look for pyloric stenosis?

Back 37

- Under left lobe of the liver, roll on right side down and look for fluid to accumulate

Front 38

What is the caterpillar sign?

Back 38

- Hyperperistalsing stomach trying to get through a closed stomach in pyloric stenosis

Front 39

Types of bezoars

Back 39

- Tricho – hair – middle age nervous girl
- Lacto – milk
- Phyto – veggie

Front 40

Causes of double bubble sign?

Back 40

1. Duodenal atresia
2. Annular pancreas

Front 41

If you see double bubble on plain film, what is differential? Obstruction

Back 41

If you see double bubble on plain film, what is differential? Obstruction
1. Malrotation/volvulus – ladd band, hi cecum, SMA/SMV, corkscrew
2. Hematoma (non accidental trauma, seat belt)
3. Diaphragm – web
(2 and 3 are non surgical)

Front 42

Ddx with distal obstruction in a neonate with dilated bowel loops?

Back 42

- Ileal atresia – air fluid levels
- Meconium ileus – medical management
- Both with microcolon – water soluble enemia, if no reflux in TI – surgery

Front 43

Early plain film findings of appendicitis?

Back 43

- Focal ileus
- Appendicolith – 10-15% incidental
- Scoliosis with curvature toward appendix
- Gasless – n/v

Front 44

Diagnostic key for Hirschsprung’s disease?

Back 44

- Transition point – from small rectum to sigmoid colon
- Biopsy shows no ganglion cells

Front 45

What is Hirschspring’s disease associated with?

Back 45

- Trisomy
- Congenital neuroblastoma

Front 46

What diagnosis is considered if distal obstruction and abnormal sacrum?

Back 46

- Ectopic anus
- Imperforate anus

Front 47

Ddx of failure to pass meconium after 24 hours?

Back 47

- Meconium ileus
- Meconium plug
- Hirschspring’s dz
- Small left colon-diabetic mothers
- Ileal atresia

Front 48

What is mesenteric adenitis/enteritis?

Back 48

- Lots of nodes, peristalsis

Front 49

What does meconium peritonitis?

Back 49

- Calcifications everywhere, performation in utero – calcifies over time.

Front 50

How do you treat meconium ileus?

Back 50

- Gastrograffin- hyperosmotic sucks water in

Front 51

What is ddx for cholestatic jaundice?

Back 51

- Bilary atresia
- Neonatal hepatitis

Front 52

How do you exclude biliary atresia with a HIDA?

Back 52

- If tracer gets through into the bowel can excluse atresia, if the tracer does not get in bowel, can’t exclude either biliary atresia or neonatal hepatitis

Front 53

How do you rev up liver to do HIDA scan?

Back 53

- Give phenobarbitial

Front 54

If you see a GB on ultrasound, can you still have atresia?

Back 54

- Yes, do an intra-op cholangiogram to rule

Front 55

Differential diagnosis of rectal bleeding in children?

Back 55

- Juvenile inflammatory polyps(#1)
- Meckel’s
- Intusseption
- Fissure

Front 56

What is primary megaureter?

Back 56

- Aperistaltic segment

Front 57

What are type syndromes with a large urinary bladder?

Back 57

1. Prune Belly syndrome(Eagle Barrett)
2. Megacystis microcolon hypoperistalsis

Front 58

Describe Prune Belly syndrome(Eagle Barrett)?

Back 58

- No abdominal muscles
- Large bladder
- Cryptorchidism

Front 59

Discuss megacystis microcolon hypoperistalsis

Back 59

- Occurs in females
- Get bladder extrophy (see wide pubic symphysis on x-ray)

Front 60

Where do rhabdomyosarcomas occur in males/females

Back 60

- Male – prostate/trigone
- Female – vagina

Front 61

What part of the urethra is affected by posterior valves?

Back 61

- Distal prostatic – Keyhole Bladder
- Importance of getting voiding shot of males

Front 62

What is the most common cause of bowel gas in the center on a plain film?

Back 62

- Hydronephrosis pushes bowel loops in

Front 63

Most common cause of calcified abdominal mass in a child < 5 years old?

Back 63

- Neuroblastoma – adrenal

Front 64

Ddx of abdominal masses in child < 5 years?

Back 64

- Neuroblastoma – adrenal
- Hemorrhage
- Sequestration

Front 65

Ddx of liver tumors in new borns?

Back 65

1. Hemangioendothelioma
2. Hepatoblastoma
3. Hamartoma

Front 66

Differential of sacral masses in newborns?

Back 66

- Sacrococcygeal teratoma
- Neuroblastoma
- Chordoma
- Anterior meningocele

Front 67

Differential for lower urinary tract obstruction and bilateral hydronephrosis in newborn females?

Back 67

1. Cloacal abnormality(#1)
2. Urogenital sinus
3. Megacystic microcolon hypoperistalsis

Front 68

Differential for lower urinary tract obstruction and bilateral hydronephrosis in newborn males?

Back 68

1. Posterior urethral valves(#1)
2. Urethral atresia
3. Prune Belly(Eagle Barrett)

Front 69

Types of Gastric volvulus?

Back 69

1. Mesoaxial - kids - short axis, pylorus to the left
2. Organoxaial - adults - longitudinal axis

Front 70

What is associated with renal agenesis in females or males?

Back 70

Females
- uterine didelphus
Males
- Seminal vesicle cysts

Front 71

Nephrocalcinosis - ddx

Back 71

Distal RTA
Medullary Sponge Kidney - Caroli
HyperPTH
Lasix

Front 72

Most common abdominal mass in children?

Back 72

Hydronephrosis

Front 73

What is Scimitar Syndrome?

Back 73

- also known as hypogenetic lung syndrome
- pulmonary venolobar syndrome
Pulmonary vein drains below heart
Accessory diaphragm
Absent IVC

Front 74

Potter syndrome

Back 74

Bilateral renal agenesis
Pulomary hypoplasia

Front 75

Differential for Oligohydramnios

Back 75

DRIPS
Demise
Renal agenesis
I
P
S

Front 76

Two main causes of vascular rings?

Back 76

1. Double arch - R>L
2. R arch with aberrant left sublavian

Front 77

Pulmonary sling

Back 77

- only vessel between tracheal and esophagus
-asssociated with complete cartilagenous rings of the trachea(napkin ring)

Front 78

Ddx for hyperlucent lung?

Back 78

1. Foreign Body
2. Congenital lobar emphsemia
3. Bronchial atresia
4. Swyer James

Front 79

Finger in glove?

Back 79

CF
ABPA
Obstruction endobronchial tumor carcinoid
bronchial atresia

Front 80

Causes of pneumatoceles?

Back 80

Trauma
Infection(Pneumocystic pna)
Hydrocarbon injection
EG

Front 81

Hallmark of surfactant deficiency?

Back 81

Low lung volumes
Premuature
Granular glass opacity

Front 82

Potential complications of positive pressure ventilation?

Back 82

Pneumothorax
Alveolar damage and ruptuures (Pulmonary interstitial emphysema, BPD)
- persistent fetal circulation

Front 83

What is appearance of retained fetal lung fluid?

Back 83

TTN
Streaky parahilar opacities

Front 84

Ddx for Neonatal respiratory distress?

Back 84

CHIMPS
Cardiovascular
HMD/RDS
Immature Lung (Surfactant deficiency - low lung volumes)
Meconium Aspiration
P - Neonatal pneumonia

Plus TTN

Front 85

Meconimum aspiration? Mature or preterm infants?

Back 85

Won't see in preterm infants, not post term

Front 86

Pentology of Cantrell

Back 86

1. Omphalocele
2. Anterior diaphragmantic hernia
3. Sternal cleft
4. Ectopic cordis
5. Intracardiac defect(wither VSD or diverticulum of LV)

Front 87

Newborn with jaundice Ddx

Back 87

Biliary atresia
Hepatitis

Front 88

Dddx for abdominal masses in children?

Back 88

Renal (5%)
Wilm's Tumor
Hydronephrosis
Cystic Disease
Hematoma
Multilocular cystic nephroma
Nephrobastomatosis(Precursor to Wilm's)

Front 89

Weigert Meyer Rule

Back 89

Ectopic ureteral orific in upper pole moiety is inferor and medial to its normal pole location

Front 90

Duplex kidney
(rule of vowels and Consonants.

Back 90

Lower Pole
- Normal ureteral insertion.
- Refluxes

Upper Pole
- Obstructs
- Ectopic Insertion
- Ureterocele

Front 91

3 categories of testicular masses in Children?

Back 91

1. Germ Cell tumors
- Seminoma
- Embryonal cell ca.
- Teratoma
- Yolk Sac Tumor
- Choriocarcinoma
2. Stromal cell Tumors
- Leydid
- Sertolid
- Gonadoblastoma
3. Mets
Neuroblastoa
Rhadomyosarcoma
Ewing's

Front 92

Common causes of Intestinal Obstruction in older children?

Back 92

Take AAIIMM
Adhesions
Appendicitis
Intussusection
Incarcerated inguinal hernia
Malrotation and volvulus
Meckel's diverticulum

Front 93

Prune Belly Syndrome (Eagle Barrett Syndrome)

Back 93

Triad
1. Hypoplasia of Abdominal Muscles
2. Cryptochordism
3. Abnormalities of the urinary tract

Front 94

Wimberger corner sign?

Back 94

- most specific finding of syphyllis and consists of destruction of the medial portion of the proximal etaphysis of the tibia
- also in congenital get non specific metaphyseal lucent bands and persistent periosteal reaction along the shaft of the long bones.

Front 95

Malformative anomalies (PHACES)

Back 95

Posterior fossa malformation
Hemangiomas
Arterial Abnormalities
Coarctation of the Aorta
Eye Abnormalities

Front 96

Traumatic Splenic Injury - Classsic Radiolographic Triad?

Back 96

1. Elevated left hemidiaphram
2. Pleural effusion
3. LLL atelectasis

Front 97

Monteggia fracture?

Back 97

ulnar fracture with anterior radial head dislocation

Front 98

Jaffe-Campanacci Syndrome

Back 98

- multiple NOFs with extraskeletal congenital anomalies including cafe au lait spots
-mental retardation
-hypogonadism or cryptorchidism
-ocular abnormality
-CV malformations

Front 99

Crainipharyngioma (C cubed)

Back 99

Craniopharyngioma
Calcifications
Cysts
Contrast enhancement

Front 100

Pleomorphic Xanthoastrocytoma

Back 100

- low grade astrocytic tumor often with leptomeningeal involvement
- most common in temoral lope 49%
- corntially based
- arise in periphery of hemisheres often with enhancing nodule abutting the pia arachnoid

Front 101

Dysemembryoplastic Neuroepithelia tumor (DNET)

Back 101

- Cortically based benign mass
- High frequency of surrounding cortical dysplasia
- presents with intractable seizures
- 60 % temporal lobes
-30% frontal lobes

Front 102

Sistrunk procedure?

Back 102

Excisions of thyroglossal duct

Front 103

Holoprosencephaly - Endocrine dysfunction?

Back 103

75% have diabetes insipidus

Front 104

Asparinginase significance?

Back 104

Chemo drug in Hodgkins and non Hodgkin's lymphoma
- pancreatitis occures in 5010% of patients
- may cause venous sinus thrombosis, leading to profound neuro deficits

Front 105

Chest findings in Down's

Back 105

- Hypersegemtation of Sternum
- 11 rib pairs
- postnatal subpleural lung cysts

Front 106

Rickets x ray

Back 106

cuppining - expansion of metaphysis, may produce soft tissue swelling as a clinical resentartion (also responsible for rickety rosary - expansion of the metaphysis at the junction of bone and cartilage at the anterior ribs

Front 107

Most common renal tumor in newborns?

Back 107

Mesoblastic nephroma - benign course but requires resection for diagnostic confirmation
- could be a Wilm's tumor

Front 108

What is myoclonic encephaliopathy of infancy?

Back 108

Paraneoplastic syndrome in neuroblastoma
-cerebellar ataxia and opsomyocluns, so-called dancing feet, dancing eyes", or is usually seen in thoracic primaries
- only 50% pts with MEI have neuroblastoma

Front 109

Characteristic behavior difference between neuroblastoma and Wilm's tumor?

Back 109

Neuro blastoma - tends to creep behand aorta and encases mesenteric and great vessels, in contrast to Wilm's
- neuroblastoma encases, Wilm''s displaces

Front 110

Differential diagnosis for prenatal adrenal mass?

Back 110

1. Neuroblastoma
2. Pulmonary sequestration
3. Adrenal hemorrhage

Front 111

Neuroenteric cyst - Discussion

Back 111

- rarest form of bronchopulmonary foregut malformations
- Embryologic - persistent connection between spinal canal and the primitive foregut that is thought to be due to splitting of the notochord
- if notochord splits, endodermal lined gut can herniate through the gap, resulting in a cyst or fistula
- may extend to and communicate with spinal canal
- ***prevents the normal fusion of the anterior aspects of the thoracic vertebral bodies, leading to vertebral segmentation anomalies

Front 112

Extralobar sequestration - drainage

Back 112

Directly into IVC or azygous system

Front 113

Intralobar Sequestration- drainage

Back 113

Dranate to pulmonary system and left atriaum, creating a left to left shunt

Front 114

Which type of sequestitration is associated with other congenital anomalies?

Back 114

- Congenital Diaphragmatic Hernia
- Congenital Heart disease
-- CCAM

Front 115

Which sequestration has its own pleura?

Back 115

Extralobar - separate, from the normal long and is invested in its own pleural layers

Front 116

Which type of sequestration is not discovered until adulthood?

Back 116

Intrealobar
- normal not to be diagnosed in children and older adults
- extralobar usually present in first 6 months of life with cyanosis and other breathing difficulty

Front 117

Shone's Syndrome?

Back 117

Multiple left lesided obstructive lesions with coarctation

Front 118

What ribs have inferior notching in Coaractation of aorta?

Back 118

Ribs 4-7 - intercostal arteries serve as collateral arteries from internal mammary arteries with retrograde flow to the descending aorta
- ribs 1-3 not involved because the intercostals at these levels arise from the thyrocervical trunk

Front 119

Hyperlucent lung - How to differentiate congenital lobar emphysema from Swyer James?

Back 119

Swyer James
Swyer James
- Small or normal sized lung
- Bronchiectasis
- Air trapping on expiration

Congenital Lobar Emphysema
- Overinflated lung
- Gets resected because of mass effect
- LUL, RML, RUL

Front 120

Hydronephrosis in neonate - ddx

Back 120

Posterior urethral valves
VUR
UPJ Obstruction
Obstructed upper pole Duplex

Front 121

Hernia of Littre

Back 121

Inclusion of Meckel's Diverticulum in a hernia

Front 122

VACTERL

Back 122

Vertebral anomalies
Anal atresia/imperforate anus
Cardiovascular anomalies
Tracheoesophageal fistula
Renal anomalies
Limb defects

Front 123

UVC Catheter pathway

Back 123

Umbilical vein -->left portal vein --> ductus venosus --> middle or left hepatic vein -->IVC --> RA

Front 124

UAC Catheter Ideal high and low position

Back 124

High -T6-T10
Low - L3-L5

Front 125

UVC Catheter ideal position

Back 125

Just beyond IVC/RA

Front 126

Most common chromosomal abnormality with alobar holoprosencephaly

Back 126

Trisomy 13

Front 127

Strawberry shaped skull associated with?

Back 127

Trisomy 18

Front 128

Syndrome associated with clover leaf skull

Back 128

Thantophoric Dwarfism

Front 129

Spading sign?

Back 129

Overlapping skull Bones