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34 Cards in this Set
- Front
- Back
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Severe pulmonary hypoplasia is associated with what?
• Congenital diaphragmatic hernia • CCAM • Sequestration |
• Answer: A Congenital Diaphragmatic hernia. There are numerous causes. However, most commonly hypoplasia results from PROM and oligohydramnios. Choices not recalled. Hernia is listed as #2 cause. Number 3 is renal anomalies.
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In Swyer-James, all of the following are correct except?
• Air trapping • Hyperlucency • Increased lung volume • Bronchiectasis • Hypoplasia of pulmonary artery |
increased lung volume is false. From fraser, the volume is seldom if ever increased.
Angiography Findings: The pulmonary artery and its branches are small and hypoplastic on the involved side. Collateral vessels may be present, but are unusual • Areas of lung hyperlucency • Air trapping upon expiration • Bronchial/bronchiolar disease with wheezing paucity of bronchial subdivisions +/- proximal bronchiectasis • Unilateral small chest http://www.emedicine.com/radio/topic666.htm |
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One day old with mass between rectum and bladder
• Rectal duplication • Sacrococcygeal teratoma • Hydrometrocolpos • Neuroblastoma • Rhabdomyosarcoma |
nswer is C. Hydrometrocolpos. Repeat
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Which is most likely to present with CHF?
• Tetrology of Falot • Aberrant left coronary artery • absent pulmonary valve • Bicuspid aortic valve • Right ventricular muscle band |
• Ans: B. Anomalous Left Coronary, didn’t give pdA as answer choice, which was on prior recalls.
• Left to right shunt lesions most commonly present with CHF. Large VSD, PDA, Cushion defect… Most coronary artery anomalies are clinically silent and do not affect the quality of life or lifespan of the affected individuals. Specific forms of anomaly, such as the origin of the left main coronary artery from the pulmonary trunk, the aberrant course of the arteries between the great vessels in association with anomalous and slitlike ostium, and large coronary artery fistulas, may be associated with sudden death, myocardial ischemia, or congestive heart failure. The exact incidence of these associated clinical events is not known. A large patent ductus arteriosus may cause CHF AS usually is not detected until individuals are school aged. AS exists in up to 2% of those who are younger than 70 years. http://www.emedicine.com/med/topic445.htm |
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Myocardial ischemia/infarction with an aberrant left coronary artery is due to
• Steal phenomenon • deoxygenated blood from the pulmonary arteries • spasm/intermittent flow • small caliber of the vessel • abnormal distribution of the left coronary artery. |
• Steal phenomenon
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The Cervical spine injury most associated with neurologic damage in a child is?
• Jefferson’s fx • UID • Hangman’s fx • C5 anterior teardrop |
• C5 anterior teardrop
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Newborn with enlarged scrotum with multiple calcifications
• Meconium pertonitis • Neuroblastoma • Teratoma • Tuberculous peritonitis • Hemangiomatosis |
A Meconium Peritonitis
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NEC caused by all except
• Hypoxia • Oral feds • Infections |
Answer ?, Oral Feeds not a listed cause, but oral feedings increase metabolic demands of the bowel and can exacerbate ischemic conditions. Hypoxia and infection are known causes.
• Necrotizing Enterocolitis (NEC): Pathogenesis • • Bowel disease of infants subjected to multifactorial hypoxic stress • • Bacterial invasion may follow ischemic mucosal injury • NEC: Risk Factors • • Prematurity (80%) • • Term infants may have Hirschprung or congenital heart disease • • PROM • • Maternal DM • • Umbilical artery catheter • • Hyperosmolar or early feeds • NEC: Clinical Findings [Figure 6-1-1] • • Onset 3-6 days of age • • Typically 1000-1500 gram premie with RDS • • Abdominal distention • • Vomiting • • Bloody stools • • Metabolic acidosis • • Temp. lability, hypotension, apnea, jaundice |
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What is false regarding NEC?
• associated with hyperosmolar feedings • see pneumatosis • strictures of colon are right sided • Most commonly involves the right colon and ileum • Associated with bacterial infection • Associated with UAC catheter |
Ans: C.
The complications of NEC are strictures, enterocyst formation, malabsorption, inflammatory polyps, and enteric fistulae. Intestinal strictures may follow either medical or surgical management of NEC and occur in 10% to 20% of survivors. Although NEC mostly affects the distal ileum and right colon, most strictures occur in the left colon, and most often occur in or adjacent to the splenic flexure. Of colonic (large intestine) strictures, 60% involve the left side of the colon and the most common site is that portion of the colon, which exists in the left upper area of the abdomen (21%). http://www.eapsa.org/parents/NEC.htm |
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Precocious puberty, ovarian mass, most likely ?
• Brennan’s tumor • Granulosa thecal cell tumor • Kirkeburg tumor • Benign ovarian cyst |
• Ans: B. (repeat) Granulosa
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Most characteristic of tethered cord?
• Scoliosis • Back pain • Recurrent UTIs • Diarrhea • leg paralysis |
• Answer: A Scoliosis
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Which does not cause increased alfa fetal protein
• Down’s • Fetal demise • Gastroschesis • Anencephaly • Multiple gestation • Neural tube deficiencies |
ns: A (repeat) Down’s syndrome
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Telangectasia osteosarcoma can be confused with which of the following on radiographs?
• ABC • Giant Cell Tumor • NOF • Chondrobalstoma |
• Answer is A. Simliar to ABC(Repeat)
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NF II is associated with
• Café au lait spots • Optic gliomas • Meningiomas |
Answer C. Meningioma
• NIH Diagnostic Criteria of NF Type 1: Need 2 from list • • Cafe-Au-Lait spots • ➢ 6 or more • ➢ 5 mm child, 15 mm adult • • Neurofibromas – 2 or more • • Plexiform Neurofibroma – 1 • • Axillary (Intertriginous) Freckling • • Optic Glioma • • Lisch Nodules (Iris) – 2 or more • • “Distinctive Bone Lesions” • • Relative with NF-1 • Meningioma is not listed in type 1 NF-2 (“CENTRAL”), 1 OR MORE • • Bilateral VIIIth Masses • • Relative with NF-2 and either: • ➢ Unilateral VIIIth Mass • ➢ Any Two: • ❖ “Neurofibroma”, Meningioma, Glioma, Schwannoma, (Congenital) • Lens Opacity • NEUROFIBROMATOSIS – Type 2 • • NEJM 319:278-83, 1988 (Gulf of Mexico) • • 23 Pts. (15M/8F), Kindred of 137 • • 0.95 Penetrance • • 18 Acoustic Schwannoma (17 bil.) • • 8 Meningioma (3 mult.) • • 4 Ependymoma • • 2 Spinal “Neurofibroma” |
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Physiologic periostitis occurs at
• 1 month • 3 months • 12 months • Puberty |
Answer B. 3 months, range is 2-8 months.
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What is not related to Langerhan’s cell histiocytosis?
• Vertebrae plana • Renal failure • Diabetes insipidus • Skull lesion |
• Renal failure
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Hirshsprung’s disease- what is false?
• aganglionic segment is proximal to ganglionic segment • dilation is proximal to affected segment |
• Ans: A (Repeat).
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Child with limp, most likely cause?
• toxic synovitis • Arthritis - JRA, post-infectious • Legg-Calve-Perthes • Hemophilia |
• Ans: A (Repeat). Toxic synovitis
• Also consider Septic arthritis. Others are less common. But can all present with hip pain/limp. • Fluid distends joint capsule • • >2mm difference abnormal • • Fluid echogenicity unreliable • • Doppler flow unreliable • Septic Arthritis • • Fever • • Elevated WBC, ESR, CRP • • Symptoms more severe • • Staph, strep, H. flu • • Must obtain fluid for Dx AFIP Notes pg 1356 |
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Young kid with tumor in testicle, most likely:
a) seminoma b) yolk sac tumor c) mixed germ cell tumor d) choriocarcinoma e) embyronal tumor |
Ans: B. Yolk Sac Tumor. This is a tricky question. The most common tumor in childhood for boys is a yolk sac tumor. Other tumors that occur in childhood are Sertoli and Leydig (the hormone-producing tumors).
Then, the most common tumor in young men (20’s) is the Mixed Germ Cell Tumor. Finally, Seminoma is most common in older men (30’s). In old men (70’s) lymphoma is most common. Additionally, most tumors in the testicles are mixed, with a predominant component of one type or the other. Of the tumors that are NOT mixed at all, seminoma is the most common. (Woodward, AFIP notes pg 535). |
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• The 4 chamber view of the heart on US can diagnose?
• DORV • Coarctation • Aortic stenosis • Some type of VSD |
• some types of VSD
The four chamber view can evaluate: 1. position of heart within thorax; 2. number of cardiac chambers; 3. ventricular proportion; 4. integrity of atrial and ventricular septa; 5. position + size + excursion of AV valvesTherefore could diagnose some types ov VSD Dähnert 5th p997 |
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A child is 2 weeks s/p bone marrow transplant, presents with multiple lung nodules bilaterally which have a halo of ground-glass. Likely cause?
• CMV • Fungus • staph. • TB • MAI |
• Fungus
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Six-month-old child presents with patchy pulm opacities, FTT, and malabsorption. Which of following not associated?
• meconium ileus • Sterility • Intussusception • Polyposis • sinusitis |
Polyposis
• – not associated with CF, which is what the question is getting at. Dan5th 481-82 |
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Which not associated with Down’s?
• Duodenal atresia • CHD • Anal atresia • HPS • echogenic bowel • glossoptosis |
HPS – no association in dan 5th, 68-9
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In a 5-year-old girl with enuresis since birth, what would be the best initial w/u?
• IVP • US • VCUG • CT • MRI |
Not sure about this one.
Maybe the question was not completely recalled. Urinalysis is done 1st. Emedicine reference, http://www.emedicine.com/ped/topic689.htm, mentions US, VCUG, and MRI, depending on the clinical history. We usually do both US/VCUG. A second internet ref also mentions US/VCUG as w/u, http://www.aafp.org/afp/20030401/1499.html. |
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In a child with UTI, neurogenic bladder, and chronic constipation, what would be the best initial test?
• US • CT • Lumbar MRI • Brain MRI |
Best guess is lumbar MRI, for tethered cord/myleomenigocele.
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• Which of the following is false concerning achondroplasia?
a. primarily mesomelic abnormalities b. defect in enchondral ossification c. trident hands d. spinal stenosis |
• A. achondroplasia is the prototypical rhizomelic dwarfism
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• What is true with respect to a “stuck twin”?
a. dichorionic diamniotic b. monochorionic diamniotic c. monochorionic monoamniotic d. dichorionic monoamniotic |
• B. monochorionic, diamniotic
• see Dähnert 5th p. 1057 • The stuck twin is part of the twin-twin transfusion syndrome. The easiest-to-understand explanation is that within the single placenta of a monochorionic twin pair, there are arteriorvenous communications between the circulation’s of the twins. One twin (the donor) shunts blood to the other (recipient) twin. The donor does not grow well, it looses its amniotic fluid, thus cannot swallow, cannot urinate, and eventually it is shrink-wrapped in its amnion. |
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• Microcolon is most associated with which of the following? (2001 repeat)
• Duodenal atresia • Hirschsprung disease • Meconium plug • Meconium ileus • Anal atresia |
• D. Meconium illeus.
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• Which of the following is the earliest sign of NEC:
• a) pneumatosis intestinalis • b) portal venous air • c) diffuse bowel dilatation • d) pneumoperitoneum • e) thickened bowel wall |
• c) diffuse bowel dilatation
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• Which of the following does not show dense enhancement in a child with abdominal trauma and hypovolemic shock?
– IVC – Liver – Spleen – Kidneys – Adrenals – Bowel wall |
Spleen and pancreas can be decreased
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• Multiple T/F: Which of the following organisms are found in increased incidence with cystic fibrosis?
a. P. Aeruginosa b. S. aureus c. H. influenzae d. P. cepacia e. Klebsiella pneumoniae |
• All True.“The organisms most often responsible for pulmonary infection are P. aeruginosa of the mucoid and nonmucoid types, S. aureus, and H. influenzae. The presence of P. cepacia is associated with the terminal stages of the disease.” Fraser 2nd p. 685.Some differences of opinion may be secondary to age group; one article reported:
- Pseudomonas spp was cultured from respiratory secretions of 51 (42%) - Staphylococcus spp in 18 (15%) - Klebsiella spp in 8 (7%) - Hemophilus influenzae in 2 (2%) patients http://www.medscape.com/viewarticle/459366 “The most common bacterial pathogens in the sputum of patients with CF are Haemophilus influenzae, Staphylococcus aureus, P aeruginosa, Burkholderia cepacia, Escherichia coli, and Klebsiella pneumoniae.” http://www.emedicine.com/PED/topic535.htm |
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• Which of the following is true regarding C-spine injuries in kids?
a. fractures are more common than soft tissue injuries b. flexion teardrop fractures are the most commonly missed injuries c. C1-C2 injuries are more common than C6-C7 injuries |
C1-C2 injuries are more common than C6-C7 injuries
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• Which of the following is false regarding ultrasound evaluation of hypertrophic pyloric stenosis?
a. not useful status post surgical pylorotomy b. muscle is hyperechoic to normal mucosa c. muscle thickness better than length d. should not empty stomach before imaging e. 3-4 mm muscle thickness considered abnormal |
• B. muscle is hyperechoic to normal mucosaChoice B is the False statement (and thus the answer)—on U/S, pyloric stenosis will show a “target sign”, which is a hypoechoic ring of hypertrophied pyloric muscle around an echogenic mucosa centrally on cross-section. Dähnert 5th p. 833Pyloric muscle wall thickness ≥ 3mm is abnormal. [Dähnert] Muscle thickness is better than length because HPS is an abnormality of the circular muscles—longitudinal muscles are unaffected. Gastric contents are used as an US window.(Req 2nd p. 87-88)
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• Which of the following is not a risk factor for necrotizing enterocolitis?
a. Hypoxia b. C-section c. hyperalimentation d. prematurity |
• B. C-Section
• Risk factors for NEC: < 2500 g, < 37 wk, PROM, preeclampsia, DM, multiparity, early feeding with high osmolar formula, placement of UAC and UVC. (Req 2nd p. 83) Also Hypoxia, stress, CHD (Dähnert 5th p. 851) Prematurity is the major single risk (50-80%); 90% of cases develop within 1st 10 days of life. |
