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Random_15 Flashcards

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Leptomeningitis

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Insufficiency fracture associated with bisphosphonate treatment

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DDx for posterior vertebral body scalloping

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  • achondroplasia
  • intraspinal masses
    • spinal astrocytoma, ependymoma
    • spinal schwannoma
    • neurofibroma seen in NF-1
  • dural ectasia
    • NF-1
    • hereditary connective tissue disorder such as Marfan’s, Ehlers-Danlos
  • mucopolysaccharidoses
  • acromegaly
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Ileal diverticulosis

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Meckel’s diverticulum

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  • Ileal diverticulosis - mesenteric border
  • Meckel diverticulum - antimesenteric border
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22
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Small bowel diverticula

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  • Non-Meckel diverticula of the small bowel are acquired diverticula that arise along the mesenteric border of the bowel at sites where vessels penetrate the bowel wall.
  • This is in contradistinction to a Meckel diverticulum, which arises along the antimesenteric border of the small bowel.
  • Small bowel diverticula are most commonly associated with the duodenum > jejunum > ileum.
  • Although ileal diverticulosis is typically asymptomatic, complications such as diverticulitis, perforation, hemorrhage, and obstruction can occur. Ileal diverticulitis may mimic other acute abdominal disorders such as appendicitis and inflammatory bowel diseases.
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23
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Most common location of osteoblastoma

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Posterior elements of the spine

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24
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DDx for retroperitoneal masses of unknown origin

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  • retroperitoneal sarcoma
    • think about rhabdomyosarcoma in pediatric patients
  • lymphoma
  • GIST
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DDx for newbord with no output
* normal colon * Hirchsprung dz * meconium plug * microcolon - small calibar colon throughout!! * meconium ileus * ileal atresia
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Watch for pulmonary artery sarcoma angiosarcoma when seeing "PE"
Clues that pointing towards pulm angiosarcoma * enlarging * expanding the vessel * extending outside the vessel * enhancement if having trouble --\> do PET/CT
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Signs and symptoms of neuroblastoma vary with site of presentation. Generally, symptoms include abdominal pain, emesis, weight loss, anorexia, fatigue, and bone pain. Hypertension is an *_uncommon*_ sign of the disease and is generally _*caused by renal artery compression, not catecholamine excess_*. Chronic diarrhea is a rare presenting symptom secondary to tumor secretion of vasoactive intestinal peptide secretion.
Signs and symptoms of neuroblastoma vary with site of presentation. Generally, symptoms include abdominal pain, emesis, weight loss, anorexia, fatigue, and bone pain. Hypertension is an *_uncommon*_ sign of the disease and is _*generally caused by renal artery compression, not catecholamine excess_*. Chronic diarrhea is a rare presenting symptom secondary to tumor secretion of vasoactive intestinal peptide secretion.
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Subdural effusion vs Benign enlargement of CSF spaces in infants
* Benign enlargement of CSF spaces in infants * prominent subarachnoid space * veins running through * Subdural effusion * subdural space * no vessels (displaced(
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Scalp swelling in infants: Caput succedaneum vs subgaleal hematoma vs cephalohematoma
* caput succedaneum * serosanguineous, subcutaneous, extra-periosteal fluid collection in the scalp * extends across the midline and over suture lines * resolves over first few days * subgaleal hematoma * bleeding in the pontential space b/t the periosteum and galea aponeurosis * crosses midline * most commonly associated with vacuume assisted delivery, but can be seen following head trauma * resolves over weeks - month * cephalohematoma * subperiosteal hematoma * bound by the periosteum and cannot cross sutures * may become calcified over time * resolves spontanenously * gradually incorporate into calvaria by ossification
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Urachal remnant spectrum * urachal remnant * patent urachus - draining urine * urachal sinus - opening to the skin - may drain epithelial secretions * urachal cyst * urachal divertium - opening to the bladder
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Reveler ## Footnote a person who is enjoying themselves in a lively and noisy way. "the city's traditional Labor Day bash usually attracts more than 100,000 revelers"
Reveler ## Footnote a person who is enjoying themselves in a lively and noisy way. "the city's traditional Labor Day bash usually attracts more than 100,000 revelers"
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Subperiosteal orbital hematoma
Subperiosteal orbital hematoma * due to trauma * more commonly in children * superior orbits in location * may need surgical decompression or IV steroids Rx to prevent compression of optic nerves
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Dysplasia epiphysealis hemimelica = Trevor disease
Dysplasia epiphysealis hemimelica = Trevor disease
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Congenital nasal pyriforma apersture stenosis CNPAS
CNPAS * rare cause of nasal obstruction due to narrowing of the anterior nasal aperture * 1/5-1/3 the incidence of cloacal atresia * the pyriform aperture is the most anterior and narrow opening of the bony nasal airways * may be an isolated finding or in association with dysmorphic features such as holoprosencephaly, hypopituitarism, a single central mega incisor, hypotelorism, cleft palate, or clinodactly * Rx is based on severity of symptoms - most patients dont need treatment as the airway will grow with age
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Duodenal atresia vs Jejunal or Ileal atresia
Duodenal atresia - due to failure of recanalization of the duodenal lumen during the embryological process between weeks 8–10 of gestation. Jejunal or ileal obstruction, which often occurs secondary to vascular accidents.
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Duodenal web Wind sock sign
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What is paraganglioma essentially?
Paragangioma = Extra-adrenal pheochromocytoma
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CT findings of celiac disease
* watery diarrhea * steatorrhea * jejunization of the ileum * jejunum loses its normal folds * mesenteric LAD, may even be necrotic * large SMV, may be larger than aorta! * look for small bowel lymphoma!!
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Nutcracker syndrome
* compression of left renal vein b/t SMA and aorta * angle b/t the SMA and aorta \< 45 degrees * left renal vein stenosis * collateral drainage pathway - dialted and tortuous left gonadal vein * symptoms * left flank pain * hematuria (rupture of thin-walled veins in the left collecting system) * left renal vein thrombosis * varicocele
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Replaced hepatic arteries
Replaced right hepatic artery from SMA Replaced left hepatic artery from left gastric artery
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What is the location of sudural hemorrhage in child abuse?
SDH along the interhemispheric falx
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Phase of fracture healing
* soft tissue swelling 0-1 week * soft callus (periosteal reaction) 2-3 weeks * hard callus (bony bridging) \> 3 weeks
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Spiral fractures
* abnormal in infants - think about child abuse * can happen in toddlers
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Most commonly injured viscera in child abuse
Small bowel often associated with ascites
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What is the Dx for cystic scrotal tumor in a patient with VHL?
Epididymal cystadenoma
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Menetrier's Disease Menetri-ei's disease
* gastric mucosal hypertrophy * most commonly gastric fundal region
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Note that secondary osteogenic sarcoma can arise from other pathology such as bone infarcts, Paget's etc... Undifferentiated high-grade pleomorphic sarcoma (previously known as malignant fibrous histiocytoma - FMH) is a rare neoplasm that may arise de novo or secondarily in a pre-existing osseous lesion such as bone infarction, chronic osteomyelitis, Paget disease, etc.
Undifferentiated high-grade pleomorphic sarcoma aka Malignant fibrous histiocytoma (MFH) can arise: * de novo * secondarily from pre-existing osseous lesion * bone infarcts * chronic osteomyelitis * Paget disease
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The Haller index (maximal transverse diameter/ narrowest AP length of chest) is used assess severity. Normal Haller index is 2.5. Significant pectus excavatum has an index greater than 3.25.
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Incus bone
* interparietal wormian bone * situated at the lambdoid suture * Inca bones in humans were first found in the skulls of contemporary indigenous peoples of the southern Andes as well as in those of mummies of the Inca civilization.
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Pituitary macroadenima is rare in kids Pituitary lesion in a teenager DDx?
* germinoma * craniopharyngioma * LCH * rathke cleft cyst *
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How to best assess hyperinflation in kids?
Hyperinflation * flattening of the diaphragms * increased retrosternal airspace
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Abnormal hip US
* synovial thickness \> 5mm * difference in thickness \> 3mm compared from side to side
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DDx for hip effusion in kids
* infants - transient synovitis * children - toxic synovitis * septic/infected * reactive
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Which lymph nodes are allowed to measure up to 1.5cm in short axis?
* subcarinal * submandibular * inguinal
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Branching order of the right lower lobe bronchi? The difference b/t RLL and LLL bronchi?
* branching pattern of the RLL bronchi - LMAP * lateral * medial * anterior * posterior * difference b/t the LLL and RLL * anteriomedial basal segment of LLL
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How do you differentiate subdural vs subarachnoid collections
Give IV contrast!!! * subdural collection - few vessel running through (the bridging veins) * subarachnoid collection - many more veins running through NOTE: this helps you differentiate benign prominent subarachnoid spaces in kids and subdural hemorrhages
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Rx for fibromuscular dysplasia (FMD)
Angioplasty NOT stenting! You can repeatedly balloon angioplasty FMD with good result
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First branch of the SMA
Gastroduodenal branches
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Biggest branch of the splenic artery
Dorsal/greater pancreatic artery
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Self-expanding stent vs Balloon expandable stent
* Self-expanding stent - strong; go through corners without damage * Balloon-expandable stent - precise - can gauge how much pressure you want the stent to put on the stenosis; but can be easily crushed by movement and corners - not good for popliteal or subclavian artery
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Most common site of stenosis in dialysis AVF
Venous stenosis 4cm withint the arterial-venous anastomosis
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Commonly used dose for Fentanyl Midazolam
Fentanyl - 50-100 microgram Midazolam - 1-2 mg
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How long should be the patient off Aspirin before IR or Bx?
5 to 7 days Aspirin half day - 15 days
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Commonly used epinephrine dosage
SC - 0.3-0.5 ml of 1/1,000 IV - 1ml of 1/10,000
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Epiglottitis * red arrow - enlarged epiglottis * white arrow - thickened aryepiglottic fold - the true cause of airway obstruction
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Swyer James Syndrome * bronchiolitis obliterans * necrotizing viral lower resp tract infection leading to destruction and scarring of airways * usually adenovirus * Xray - unilateral, smaller, but hyperlucent lung * CT - hyperlucent lung & diminished vascularity
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CNS cryptococcus infection
* most commonly - meningitis - but due to immunosuppression, meningeal enhancement may not be present. therefore, most common finding is hydrocephalus * dilated Virchow-Robin spaces - filled with capsular material - also called *_gelatinous pseudocysts_* - follow CSF signal intensities - do NOT enhance * cryptococcoma - may enhance In the images, b/c the dilated periventriclar spaces/virchow robin spaces enhance, they are not gelatinous pseudocysts! They must be cryptococcoma!
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Half life of Tc99m and FDG-18F
* Half life of Tc99m = 6 hours * Half life of FDG-18F = 110 min
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CXR findings of following CHD? TOF TGA TAPVR Ebstein anomaly Endocardial cushion defect/AVSD
* TOF - boot-shaped heart * TGA - egg-on-a-string * TAPVR - snowman/figure-of-8 * Ebstein anomaly - box-shaped heart * Endocardial cushion defect/AVSD - goose neck deformity
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Congenital absence of pericardium Frontal and lateral chest radiographs demonstrate an unusually-shaped (yellow arrow) levopositioned (green arrow) heart. The heart is displaced upward from the left hemidiaphragm (white arrow) and there is a clear space between the sternum and the heart (blue arrow) on the lateral image. On fluoroscopy, abnormal motility of the heart within the chest can be seen.
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Foramen of Winslow hernia
Foramen of Winslow hernia * 8% of all internal hernias * involvement of small bowel is most common; followed by cecum and ascending colon * risk factor - long mobile mesentery, large foramen of Winslow * abdominal Xray * gas containing loops of bowel high in the abdomen medial to the stomach * ascending or cecum is not visible in the RLQ * abdominal CT * bowel loops in the upper abdomen with a "beak" oriented toward to foramen of Winslow * absence of ascending colon or cecum in the RLQ * presence of gas/fluid in the lesser sac * vessels and mesentery in b/t main portal vein (anterior) and IVC (posterior)
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Anatomy of foramen of Winslow
anterior : the free border of the lesser omentum, known as the hepatoduodenal ligament; there are two layers and within these layers are the common bile duct, hepatic artery, and portal vein posterior : the peritoneum covering the inferior vena cava superior : the peritoneum covering the caudate lobe of the liver inferior : the peritoneum covering the commencement of the duodenum and the hepatic artery, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum left lateral : gastrosplenic ligament and lienorenal ligament
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Hypodense dural venous sinuses
Anemia * hypodense venous sinuses -- anemia * \< 35HU * hyperdense venous sinuses -- venous sinus thrombosis or hemoconcentration/polycythemia * in aorta on unenhanced CT * \> 45 HU in women * \> 50 HU in men * can exclude anemia
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most common cause of coronary artery aneurysm
atherosclerosis (50%)
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most common cause of a right sided arch
truncus arteriosus (33%)
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Purpose of drug eluting coronary stents
To prevent neointimal hyperplasia
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Gallium scan has advanage over Indium111-WBC scan in what situations?
* osteomyelitis of the spine * lung infections and inflammation * chronic infections that is b/c gallium can bind to neutrophil membrane, even after neutrophil death
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US NRC limit of occupation radiation exposure normally vs pregnant women
* normal occupational exposure dose \< 50mSv * pregnant women exposure \< 5mSv
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Typical description of small bowel lymphoma
Long segment of small bowel involvement with circumferential mural thickening and aneurysmal dilation
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North America includes Mexico and a bunch of small countries Cuba 125,500 5 Dominican Republic 85,391 6 Guatemala 69,958 7 Costa Rica 51,130 8 Panama 43,725 9 El Salvador 43,640 10 Honduras
North America includes Mexico and a bunch of small countries Cuba 125,500 5 Dominican Republic 85,391 6 Guatemala 69,958 7 Costa Rica 51,130 8 Panama 43,725 9 El Salvador 43,640 10 Honduras NOTE: Mexico has high gross GDP than Canada
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late BLOOMER
late BLOOMER
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Most common location for enteric duplication cysts
Ileal duplication cysts
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Why do pancreas and renal transplant
Often in patients with type 1 diabetes mellitus chronic renal failure secondary to DM-1
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Most common cause of graft failure in pancreas transplant?
Rejection
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What is considered an "enlarged" vestibular aqueduct in children?
If the vestibular aqueduct is larger than posterior semicircular canal
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Ash leaf spots
Hypomelanic nodules Seen in tuberous sclerosis
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Natural history of UBO and plexiform neurofibroma in NF-1 patients?
* UBO - usually regreses with age; may rarely have malignant degeneration * Plexiform neurofibroma - need surveillance as it may degenerate into neurofibrosarcoma - the #1 cause of death of NF-1 patients under 40 y/o
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Fanconi anemia
* Genetic disease * Ashkenazi Jews and Afrikaners in South Africa * genetic defect in a cluster of proteins responsible for DNA repair * majority of patients develop cancer - most common AML * 90% develop bone marrow failure * 60-75% develop congenital defects - short stature, abnormality of skin, arms, head, eyes, kidneys, and ears, and developmental disabilities
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DDx for a large abdominal mass with chunky calcifications in a pediatric patient
* neuroblastoma * teratoma
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Tullio phenomenon
Tullio phenomenon, sound-induced vertigo, dizziness, nausea or eye movement (nystagmus) was first described in 1929 by the Italian biologist Prof. Pietro Tullio. The cause is usually a fistula in the middle or inner ear, allowing abnormal sound-synchronized pressure changes in the balance organs
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Insall-Salvati ratio
The Insall-Salvati ratio is the ratio of the patella tendon length (TL) to the length of the patella (PL) - TL/PL. This can be measured on a lateral knee xray or sagittal MRI. Ideally the knee is 30 degrees flexed. Patellar length (PL) is the greatest pole - pole lenghth Patellar tendon length (TL) is defined as the length of the post surface of the tendon from the lower pole of patella to its insertion on the tibia. patella alta: \> 1.2 (\>1.5) patella baja: \< 0.8 (\<0.74)
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The development of the corpus callosum occurs between the 12th and 16-20th weeks of gestation 2,4. It begins with the genu and then continues posteriorly along the body to the splenium. The rostrum is the last part to be formed. In primary agenesis parts of the corpus callosum which form before the insult will be present whereas later parts will be absent. Presence of the rostrum essentially excludes primary agenesis. One apparent exception to this rule is holoprosencephaly in which it is the anterior parts of the corpus callosum which are absent 7. This has been termed atypical callosal dysgenesis. Myelination of the corpus callosum occurs in the opposite direction, from the splenium forwards.
The development of the corpus callosum occurs between the 12th and 16-20th weeks of gestation 2,4. It begins with the genu and then continues posteriorly along the body to the splenium. The rostrum is the last part to be formed. In primary agenesis parts of the corpus callosum which form before the insult will be present whereas later parts will be absent. Presence of the rostrum essentially excludes primary agenesis. One apparent exception to this rule is holoprosencephaly in which it is the anterior parts of the corpus callosum which are absent 7. This has been termed atypical callosal dysgenesis. Myelination of the corpus callosum occurs in the opposite direction, from the splenium forwards.
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The pineal gland typically measures 7 x 6 x 3mm in size and is situated in a groove between the laterally placed thalamic bodies. Appearing to arise from the gland are two laminae. Above is the habenular commissure and below it is the posterior commissure. Relations anteriorly - third ventricle (pineal recess) posterioinferiorly - superior cerebellar cistern superiorly - internal cerebral veins, vein of Galen (posteriorly), stria medularis, splenium of the corpus callosum and velum interpositum inferiorly - superior colliculi of the midbrain
The pineal gland typically measures 7 x 6 x 3mm in size and is situated in a groove between the laterally placed thalamic bodies. Appearing to arise from the gland are two laminae. Above is the habenular commissure and below it is the posterior commissure. Relations anteriorly - third ventricle (pineal recess) posterioinferiorly - superior cerebellar cistern superiorly - internal cerebral veins, vein of Galen (posteriorly), stria medularis, splenium of the corpus callosum and velum interpositum inferiorly - superior colliculi of the midbrain
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What structure in the lateral knee can mimic tear of the lateral meniscus?
Popliteus tendon
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Coronoid process
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Clinical presentation of hypothalamic hamartoma ## Footnote
Lesions can cause * gelastic seizures, * precocious puberty, * visual problems, * and behavioural problems
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Inflammatory abdominal aortic aneurysm AAA
* Inflammatory AAA is a distinct clinical entity with the triad * thickened aneurysm wall * fibrosis of the adjacent retroperitoneum * adherence of the adjacent structures to the anterior aneurysm wall * Complications related to inflammatory aneurysms include * involvement/obstruction of a ureter * aortic-sigmoid colon fistula * secondary bacterial infection * CT often reveals an enhancing hypodense mass with thickening of the aortic wall, which is usually spared posteriorly. * This is in contrast to lymphoma, which also occurs posteriorly and often displaces the aorta anteriorly. * Medical treatment usually includes corticosteroids or other anti-inflammatory or immunosuppressive therapies (eg, prednisone, methotrexate, cyclophosphamide, and azathioprine).
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