1
Q
Order of cranial suture closure?
A
- Metopic
- Coronal
- Lambdoid
- Sagittal
(‘MCLS’)
2
Q
What is trigonocephaly?
A
Premature closure of the metopic suture, resulting in a triangular head and a quizzical eye appearance. Assoc e cognitive disorders
3
Q
What is premature closure of the coronal suture referred to as?
A
Brachycephaly
4
Q
Brachycephaly appearance?
A
Harlequin eyes, ipsilateral orbit elevation, usually unilateral
5
Q
Turricephaly?
A
Premature closure of the lambdoid suture (bilateral). Tall cranium
6
Q
Which premature closure conditon is Marfan’s associated with?
A
Scaphocephaly
7
Q
Positonal plagiocephaly vs true lambdoid synostosis?
A
Lambdoid craniosynostosis - ipsilateral ear will be POSTERIOR and there will be CONTRALATERAL frontal bossing
(Next steps…CT with 3D recons)
8
Q
What conditions is Kleeblattschadel (clover leaf skull) associated with?
A
Thanatophoric dysplasia
Apert syndrome
Crouzon syndrome
Carpenter syndrome
9
Q
Apert syndrome manifestations?
A
Brachycephaly
Syndactyly
10
Q
Crouzon syndrome manifestations?
A
(The ‘C’s)
BrachyCephaly
1st arch (Can’t Chew)
HydroCephalus
Chiari I
PDA and aortic Co-arctation
Rhizomelia (short Central bones)
11
Q
What is copper-beaten skull associated with?
A
Increased ICP:
- Craniosynostosis
- Obstructive hydrocephalus
12
Q
What is Luckenschadel (lacunar) skull associated with?
A
Chiari II
13
Q
Radiology of LCH in the skull?
A
Sharp lytic skull defect with bevelled edges
14
Q
Most common bone site of LCH?
A
Calvarium
15
Q
Parietal foramina manifestations?
A
Normal variants. If large, can be associated with cortical and venous abnormalities
16
Q
What are wormian bones?
A
Intersutural bones around the lambdoid suture
17
Q
How many wormian bones are considered idiopathic?
A
Less than 10
18
Q
> 10 wormian bones and absent clavicle?
A
Cleidocranial dystotosis
19
Q
Differentials for wormian bones?
A
(PORK CHOP)
Pyknodysosdtosis
Osteogenesis imperfecta
Ricketts
Kinky hair syndrome
Cleidocranial dystostosis
Hypothyroidism/hypophosphatasia
‘One too many chromosomes’ (Trisomy 21)
Primary acro-osteolysis
20
Q
Caput succedaneum location
A
Superficial to aponeurosis
21
Q
Cephalohaematoma location
A
Subperiosteal. Does not cross suture lines. Can be complicated by infection
22
Q
Subgaleal haemorrhage location
A
Forms underneath aponeurosis. Not limited by suture lines
23
Q
Leptomeningeal cyst pathology
A
Dural tear from a fracture allows leptomeninges to herniate. Overtime, CSF pulsations widen the fracture site
24
Q
Sinus pericranii radiology and modality?
A
Usually midline/parasagittal. Skull defect. CTV/MRV can be used to further characterise
25
MRI sequences for head injury in NAI?
DWI: parenchymal injury
SWI and T2*GRE: haemorrhage
T1 Gd+: chronic SCH membranes
26
Rad of BESSI?
Positive cortical vein sign (veins towards inner table)
Enlarged cisterns (suprasellar)
27
Most common cause of macrocephaly?
BESSI
28
Initial findings in HIE?
T1/T2 normal initially with signal changes becoming more conspicuous over days. Restricted diffusion in first 1-10 days
29
Most important sequence in HIE?
DWI
30
DWI changes in HIE over time?
1 - 10 days: restricted diffusion
8 - 10 days: pseudonormalisation
31
Sequence to assess germinal matrix haemorrhage in HIE?
T2*GRE
32
Most common location of GMH?
Caudothalamic groove
33
Grading of GMH?
I: limited to germinal matrix
II: intraventircular haemorrhage
III: IVH with ventriculomegaly
IV: parenchymal infarct developing into porencephalic cyst
34
What condition causes inward bowing of the maxillary sinus and a solitary median maxillary incisor?
Pyriform aperture stenosis
35
Which midline maformation presents with respiratory distress that is worse when feeding and relieved with crying?
Choanal atresia
36
Which malformation is characterised as a soft tissue mass in the nose which does not change size and does not enhance?
Nasal glioma
37
Dacryocystocele rad?
Thin-walled cyst located inferiorly and medial to the globe
38
Most common location of ectopic thyroid?
Base of tongue
39
Which cancer are patients with thyroid duct cyst at risk of?
Papillary
40
Next rad steps for thyroid duct cyst?
Look for ectopic. Initial US plus MIBI or I-123
41
Which H+N condition has a sac of marbles appearance?
Dermoid cyst of the neck
42
Most common type of branchial cleft cyst?
Type II
43
Most classic location of branchial cleft cyst?
Angle of mandible
44
What is Lemierre syndrome?
Septic thrombophlebitis/jugular vein thrombosis secondary to recent ENT procedure
45
Causative organism in Lemierre syndrome and next steps?
Fusobacterium necropharum
Image lungs to look for septic emboli
46
Timeframe of infantile haemangioma?
NOT present at birth, rapid growth at 6 months and then involution
47
Cystic hygroma associations?
Down's
Turner's
Aortic coarctation
48
Rad of cystic hygroma?
Posterior triangle mass. T2 bright, no enhancement. Septations confer worse outcome
49
Presentation of firbromatosis coli?
'Mass' of SCM and tortacollis towards affected side
50
Most common extra-ocular orbital malignancy?
Rhabdomyosarcoma
51
Rad of choice for characterising adenoidal hyertrophy?
Lateral PF
52
Which condition presents with steeple sign of the trachea and a bark-like cough?
Croup (parainfluenza)
53
Causative organism in epiglottitis?
H influenzae
54
Causative organism in exudative tracheitis?
S aureus
55
What is subglottic haemangioma associated with?
50% cutaneous haemangiomas
7% PHACES
56
Rad features of subglottic haemangioma?
Narrowing on ONE side, L>R
57
Rad appearance of laryngeal cleft?
Contrast in trachea buy not from the top
58
Lobulated lesion in airway with airtrapping?
Papilloma
59
Respiratory distress, linear peri-hilar opacities and asymmetric hyperinflation in a newborn term baby?
Meconium aspiration
60
Diffuse bilateral increased lung markings +/- pleural effusion in a newborn baby
TTN
61
Bilateral granular opacities and low lung volumes in a premature neonate?
RDS
62
Complications of surfactant replacement therapy?
Pulmonary haemorrhage
PDA
63
Most common pneumonia in newborns?
Beta-haemolytic strep pneumonia (GBS)
64
Rad appearances of GBS?
Low lung volumes, granular opacities and pleural effusion
65
GBS vs non-GBS rad findings?
GBS - LOW lung volumes
Non-GBS - HYPERinflation, pleural effusion more likely
66
PIE rad findings?
Linear lucencies and hyperexpanded segment due to positive ventilation pressures. Complicated by PTX
67
Chronic lung disease (CLD) - onset and rad?
3-4 weeks postnatal. A result of prolonged ventilation. Reticular opacities and cystic lucencies
68
Neonatal lung conditions presenting with high volumes?
Meconium aspiration
TTN
Non-GBS pneumonia
69
Neonatal lung conditions presenting with low volumes?
RDS
GBS pneumonia
70
Most common congenital diaphragmatic hernia?
Bochdalak
71
CPAM rad appearances?
Mixed solid/cystic masses, usually involving one lobe
72
Rad of bronchopulmonary sequestration?
Usually left lower lobe opacity with aortic feeder vessel
73
Intra vs extralobar bronchopulmonary sequestration?
INTRA: adolescence, recurrent infections, no pleural cover, pulmonary venous drainage
EXTRA: infancy, congenital association, pleural cover, systemic venous return
74
Bronchogenic cyst rad?
Unilocular, DOES NOT communicate with airway
75
Most commonly affected lobe in CLE?
Left upper lobe
76
What modality would you use in CLE if you wanted to exclude sequestration?
CT angiogram
77
Primary lung tumour vs congenital malformation - how does antenatal imaging help?
Normal 2nd trimester scan would suggest primary lung tumour
78
What presents as a huge lung mass that is mixed cystic and solid? No rib invasion or calcification seen
Pleuropulmonary blastoma (PPB)
79
Lung mass in children that is calcified, solid and lobulated with T2 high signal?
Inflammatory myofibroblastic tumour (IMT)
80
Normal UVC position?
IVC and right atrial junction
81
UAC normal position?
Either high (T8-T10) or low (L3-L5)
82
Contraindication to UAC?
Omphalocele
83
ECMO CXR findings?
Complete white out (expected). Mimics foetal physiology
84
ECMO finding that confers increased risk for ischaemic neurological complications?
Ligation of the carotid artery, done in V-A ECMO
85
Most common causative organism in round pneumonia?
Strep pneumoniae
86
Transient round pleural-based mass at the apex in a neonate?
Neonatal atypical peripheral atelectasis (NAPA)
87
Rad of inflammatory pseudotumour?
Heterogenous appearance - often solitary mass which is peripheral with calcification and found in the lower lobes
88
Swyer James?
Unilateral lucent lung, usually post-viral bronchiolitis obliterens
89
Rad of papillomatosis?
| Pulmonary
Multiple lung nodules with cavitation
90
Sickle cell findings on CXR?
Lung opacities if acute crisis
Cardiomegaly
Bone infarct
H-shaped vertebrae
Cholecystectomy clips
91
CXR findings in CF?
Bronchiectasis
Upper lobe predominant changes
Hyperinflation
Mucous plugging (finger in glove)
92
What syndrome is primary ciliary dyskinesia associated with?
Kartagener's
93
Rad of primary ciliary dyskinesia?
Bronchiectasis of LOWER lobes
94
RSV rad?
Hyperinflation
Peri-bronchial thickening
Atelectasis
95
Measles rad?
Interstitial pneumonia
Encephalitis
96
What are the red flag signs of an abnormal thymus?
Abnormal size for age
Calcification
Heterogeneous
Compression of airway/vessel
97
Most common type of lymphoma in mediastinum in children?
Hodgkin's
98
What syndrome are extra-gonadal GCTs associated with?
Klinefelter's
99
Which GCT presents with haemorrhage and necrosis with invasion of the lung?
NSCGT
100
Which extra-gonadal GCT is lobulated and straddles the midline?
Seminoma
101
Which abx causes a rash in mononucleosis?
Amoxicillin
102
Location of bronchogenic duplication cysts?
Middle mediastinum or hilum
103
Rad of oesophageal duplication cysts?
Abut oesophagus and sometimes communicate with lumen (air/fluid levels)
104
Most common posterior mediastinal mass in a child <2?
Neuroblastoma
105
Rad of Askin tumour?
Chest wall mass. Displaces rather than invades. Heterogeneous with enhancement of solid components
106
Neuroenteric cyst rad?
Favours lower cervical and thoracic regions. Does NOT communicate with CSF
107
Soft tissue density lesion around the spine below T6, smooth and bilateral - Dx?
Extramedullary haematopoiesis
108
Commonest type of trachea-oesophageal fistula?
N type
109
VACTERL?
Vertebral
Anal (imperforate)
Cardiac
Tracheo-oesophageal fistula/atresa
'Esophageal'
Renal
Limb
110
Appearance of coins in trachea?
Skinny appearance in frontal
111
Management of battery ingestion?
Disc: remove
AA and AAA: monitor with serial XR
112
Most common symptomatic vascular ring abnormality?
Double aortic arch
113
Double bubble pattern on XR - Dx and its associations?
Duodenal atresia
Assoc: Trisomy 21 (30%)
114
Management of duodenal atresia?
Duodenoduodenostomy
115
Triple bubble sign - Dx?
Jejunal atresia
116
Differentials for double bubble with distal gas seen?
Duodenal web, stenosis, midgut volvulus. Requires UGI.
(Duodenal atresia excluded)
117
Non-bilious vomiting in the neonate - Dx and next steps?
Pyloric stenosis needs to be excluded. Proceed to US abdomen
118
Bilious vomiting in the neonate - Dx and next steps?
Midgut volvulus until proven otherwise. Proceed to UGI study
119
Complications of malrotation?
1. Midgut volvulus
2. Ladd's bands
3. Internal hernia
120
Classic UGI appearance of midgut volvulus?
Corkscrew twisting of small bowel
121
US appearances of malrotation?
SMA to the right of the SMV
122
Which anatomical variant is associated with duodenal obstruction but not the cause of it?
Preduodenal portal vein
123
Pyloric stenosis timeframe and management?
2 - 12 weeks
Pyloromyotomy
124
Greater curvature and antrum locations in mesenteroaxial gastric volvulus?
Greater curvature is lower down. The antrum sits high, next to the GOJ
125
Which gastric volvulus type is more common in children?
Mesenteroaxial (can result in ischaemia)
126
Presentation of gastric volvulus?
Barehardt triad:
1. Cannot pass NGT
2. Retching without vomiting
3. Epigastric pain
127
Which condition has windsock deformity on XR?
Duodenal web (older children)
128
Dx for short microcolon?
Colonic atresia
129
DDx for long microcolon?
1. Meconium ileus
2. Distal ileal atresia
130
Rad of meconium plug syndrome?
Calibre change on lower GI study
131
Rad of Hirschsprung disease?
1. Rectum < sigmoid with a radio of <1
2. Sawtooth rectum
132
How is diagnosis confirmed in Hirschsprung disease?
Biopsy taken just below transition point
133
Rad of meconium peritonitis?
Calcified mass in mid-abdomen
134
Inguinal hernia in children - most common type?
Indirect
135
Most common cause of bowel obstruction in a baby 1month - 1year?
Inguinal hernia
136
What conditions is intussusception associated with?
HSP
Meckel diverticulum
Enteric duplication cysts
137
Gastroschisis vs omphalocele?
Gastroschisis: No surrounding membrane, right-sided, bowel/stomach/liver evisceration
Omphalocele: surrounding membrane, midline, syndrome associated (Trisomy 18)
138
Omphalocele associations?
Edward syndrome (T18)
Cardiac abnormalities
Turner's
Klinefelter's
Beckwidth-Wiedeman
Pentalogy of Cantrell
139
Pentalogy of Cantrell?
1. Omphalocele
2. Ectopia cordis
3. Diaphragmatic defecgt
4. Pericardial/sternal cleft
5. Cardiovascular
140
Which segment is most affected in duodenal haematoma?
D3
141
Duplication cyst vs mental cyst - difference?
Duplication cyst will have gut signature
142
What is Shwachman-Diamond syndrome? Clin and rad?
Second commonest cause of pancreatic insufficiency in paediatrics.
Clin: diarrhoea, short stature, eczema
Rad: lipomatous pseudohypertrophy of pancreas
143
Paediatric neoplasms by age? (3)
| Pancreatic
1y/o: pancreatoblastoma
6y/o: adenocarcinoma
15y/o: SPEN
144
Infantile hepatic haemangioma - associations?
Cardiomegaly
Kasabach-Merritt
Skin haemangiomas (50%)
145
Which blood marker is elevated in infantile hepatic haemangioma?
Endothelial growth factor
146
Which liver tumour is associated with Wilms, has a raised AFP and presents with precocious puberty?
Hepatoblastoma
147
Which liver tumour has portal vein feeding branch sign?
Mesenchymal hamartoma
148
Liver tumour in >5y/o with raised AFP?
HCC
149
Undifferentiated embryonal sarcoma rad?
Aggressive liver tumour
Cystic
Septated, hypodense
Pseudocapsule (can rupture)
150
What is Caroli?
AR disease with intrahepatic duct dilatation. Associated with ARPKD and medullary sponge kidney
151
Commonest type of choledocal cyst disease?
Type 1
152
Rad of HHT (Osler Weber Rendu)?
Multiple AVMs in lungs and liver
Cirrhosis
Dilated hepatic artery
Brain abscess as complication
153
Rad of biliary atresia?
Triangular cord sign (US)
Absent gallbladder
99m Tc-(H) IDA scintigraphy - no bowel uptake at 24hr
154
Left vs right heterotaxy?
RIGHT: asplenia, left IVC
LEFT: polysplenia, azygous continuation
155
Unilaterally renal genesis sequela in males and females?
FEMALES: unicornuate uterus
MALES: ipsilateral seminal vesicle cyst (Zinner), absent vas deferens
156
Bilateral renal agenesis - associated syndrome?
Potter sequence
157
Which syndrome is horseshoe kidney associated with?
Turner
158
Appearance of cross-fused renal ectopia?
Both kidneys same side, lower kidney is ectopic
159
ARPKD rad?
Echogenic kidneys, loss of corticomedullary differentiation, tubular cysts spare cortex
160
Which side is more common in renal vein thrombosis of the neonate?
Left
161
What complication of UAC presents with severe HTN?
Renal artery thrombosis
162
Triad of prune belly (Eagle Barrett)?
1. Abnormal musculature deficiency
2. Hydroureteronephrosis
3. Cryptorchidism
163
Dx for reverse J/fish-hook sign of ureter?
Retrocaval ureter
164
Duplicated system appearance?
Upper pole ureter inserts inferior and medially. Upper pole has ureterocele, lower pole has reflux
165
What does ectopic ureter present with?
Urinary incontinence in females
166
Rad of PUV?
Abrupt calibre change between posterior and anterior urethra on MCUG
167
Next steps...antenatal diagnosis of hydronephrosis
1. Repeat postnatal US. If persistent...
2. MCUG (gold standard)
3. Adjunctive MAG-3 for evaluation of function and drainage
168
What is hutch diverticula?
Outpouching that occurs at or adjacent to the VUJ and is associated with VUR (requires surgery)
169
What cancer does uranus predispose to?
Adenocarcinoma
170
Cloacal malformation?
Common GI and GU tract drainage (females)
171
Which renal mass is a precursor to Wilm's and presents with a hypodense 'rind appearance?
Nephrobalstomatosis
172
Mesoblastic nephroma - age range and characteristics?
Neonates, age 0 - 3
Solid, hamartoma, benign
173
Features of multicystic dysplastic kidney (MCDK)?
Multiple small cysts
No functioning renal tissue
No excretory function on MAG-3
174
Neuroblastoma vs Wilm's
Neuroblastoma: <2y/o, calficiation, encases IVC, poorly marginated, bone mets
Wilm's: 4y/o, rarely calcifies, invades/displaces vessels, well circumscribed, lung mets
175
Syndromes associated with Wilm's?
Beckwith-Wiedermann
Sotos
WAGR
DRASH
176
Clear cell Wilm's - bone features?
Lytic bone lesions
177
Multilocular cystic nephroma characteristics?
Non-communicating fluid-filed locales
Thick fibrous capsule
Protrudes onto renal pelvis
Bimodal distribution
178
Most common RCC in children?
Translocation
179
What is clear cell RCC associated with in children?
VHL
180
What syndromes is neuroblastoma associated with?
NF-1
Hirschsprung's
DiGeorge
Beckwith-Wiedermann
181
Which paraneoplastic syndrome is seen in neuroblastoma?
Opsomyoclonus
182
Which modality is favoured in neuroblastoma for assessment of bone metastasis?
MIBG
183
MRI appearances of neonatal adrenal haemorrhage?
Low T2
184
If left-sided adrenal haemorrhage, what is the underlying aetiology?
Renal vein thrombosis
185
Most common cause of idiopathic scrotal oedema in children?
HSP
186
Rad of orchitis?
Hypoechoic affected testis with increased vascularity
187
Which testicular tumour is associated with Peutz-Jegher's?
Sertoli
188
Which NSGCT is seen in <2y/o with a raised AFP?
Yolk sac
189
Which testicular tumour of teenagers is highly aggressive with haemorrhage metastasis and raised b-HCG?
Choriocarcinoma
190
Salter-Harris classification?
I: slipped
II: above, fracture involving metaphysis
III: lower, involvement of epiphysis
IV: through/two, involvement of metaphysis and epiphysis
V: compression of growth plate
191
Most common elbow fracture?
Supracondylar
192
CRITOE?
Capitellum, age 1
Radial head, age 3
Internal (med) epicondyle: age 5
Trochlea: age 7
Olecranon: age 9
External (lat) epicondyle: age 11
193
Medial epicondyle elbow fracture - characteristics?
3rd most common
Extra-articular, therefore effusion may not be evident
Look for fragments on post-reduction film
194
When is a lateral condylar fracture considered unstable?
If it passes through the capitello-trochlear groove
195
What is ulnar shaft fracture associated with?
Monteggia's pattern (associated radial head dislocation)
196
What is Galeazzi fracture?
Fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint
197
Avulsion injuries - what attaches to ASIS, AIIS, greater and lesser trochanters?
ASIS: sartorius
AIIS: rectus femoris
Greater trochanter: gluteus
Lesser trochanter: iliopsoas
198
Patellar groove avulsion - rad?
Acute avulsion fracture of the inferior patellar pole with soft tissue swelling
199
Sinding-Larson-Johansson vs Osgood Schlatter?
SLJ is chronic traction injury at the insertion of the patellar tendon
OS: microtrauma to patellar tendon at the tibial tuberosity (more inferiorly)
200
Which infection gives rise to celery stalk appearance from generalised lucency of metaphysis?
Congenital rubella
201
Which infection causes metaphysical lucent bands and periostea reaction of long bones with Wimburger sign?
Syphilis
202
Caffey's disease?
Self-limiting disorder of soft tissue swelling, periosteal reaction and irritability.
Hot mandible on bone scan
203
Which malignancy of newborns results in bony metastasis?
Neuroblastoma
204
What part of the bone is affected in osteomyelitis of children?
Usually metaphysis of long bones
205
What is rhizomelia?
Short humerus and femurs
206
Features of achondroplasia?
Rhizomelia
Tombstone pelvis
207
Gorlin syndrome manifestations?
Bifid ribs
Basal cell carcinomas
Odontogenic keratocysts
Fibromas
208
Rad of osteopetrosis?
Sclerosis parallel to growth plate
Bone-in-bone appearance
Rugger jersey spine
'Black bone' on MRI
209
What is Klippel Feil?
Congenital fusion of cervical spine (skinny appearance of bodies)
210
Gaucher's disease (lysosomal storage) - rad?
AVN of femoral heads
H-shaped vertebrae
Erlenmeyer flask femur
211
Hindfoot valgus and varus causes
VALGUS > pes planus > flexible or rigid
VARUS > club foot (talipes equino varus)
212
Normal alpha angle on US?
>60 degrees
213
Normal acetabular angle on PF?
>30 degrees
214
Perthes disease rad?
Subchondral lucency (crescent sign)
Asymmetric small ossified femoral head
215
Criteria for assessing likelihood of septic arthritis?
Kocher's
216
Rad of Rickets (vit D)?
Cupping of physeal margins
Long bone bowing
Rachitic rosary appearance of ribs
217
What presents with frayed metaphyses and bowed long bones in the newborn?
Hypophosphatasia
218
Rad of scurvy (vit C)?
Subperiosteal haemorrhage
Haemarthrosis
Scorbutic rosary
(Does not occur before 6 months)
219
What presents with wide sclerotic metaphyseal line in an area of rapid growth?
Lead poisoning
220
What is myelomeningocele?
Protrusion of neural placode through midline defect with posterior expansion of subarachnoid space
Assoc e Chiari 2
221
What is myelocele?
Protrusion of neural placode with NO posterior expansion of subarachnoid space
Assoc e Chiari 2
222
What is a meningocele?
Herniation of CSF filled sac without the presence of neural tissue
223
Currarino triad?
1. Anterior sacral meningocele
2. Anorectal malformation
3. Sacrococcygeal osseous defect
FRCR 2A
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