Pediatric Radiology — MCQs
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Investigation of choice for the diagnosis of congenital hypertrophic pyloric stenosis is:
What is the most common cause of periventricular calcification?
A child presents with unilateral white reflex (leukocoria) and raised intraocular pressure, raising suspicion of retinoblastoma. Which of the following investigations is the most appropriate to perform?
Features of periostitis on X-ray of the hip in a child suggest
What is the cardiothoracic ratio in children?
Pediatric Radiology Indian Medical PG Practice Questions and MCQs
Question 101: Investigation of choice for the diagnosis of congenital hypertrophic pyloric stenosis is:
- A. USG (Correct Answer)
- B. Barium meal
- C. Barium meal follow through
- D. CT scan with contrast
Explanation: ***USG*** - **Ultrasound** is the preferred initial imaging modality due to its non-invasiveness, lack of radiation, and high accuracy in visualizing the thickened pyloric muscle. - The classic ultrasound findings include a **pyloric muscle thickness** of ≥ 4 mm and a **pyloric channel length** of ≥ 14 mm. *Barium meal* - While a barium meal can show findings like the "string sign" or "shoulder sign," it involves **radiation exposure** and is generally considered a second-line investigation. - Its diagnostic accuracy is good, but it is less convenient and riskier than ultrasound for this condition. *Barium meal follow through* - This procedure tracks barium through the entire gastrointestinal tract, which is **excessive and unnecessary** for diagnosing pyloric stenosis, which is a localized obstruction. - It also involves significant **radiation exposure** and a prolonged examination time. *CT scan with contrast* - A **CT scan** involves significant **radiation exposure** and is not typically used for diagnosing congenital hypertrophic pyloric stenosis. - It is also less sensitive than ultrasound for visualizing the specific soft tissue changes in the pyloric muscle.
Question 102: What is the most common cause of periventricular calcification?
- A. Toxoplasmosis
- B. Cytomegalic infection (Correct Answer)
- C. Congenital syphilis
- D. Tuberous sclerosis
Explanation: ***Cytomegalic infection*** - **Periventricular calcification** is a classic finding in congenital Cytomegalovirus (CMV) infection due to the virus's predilection for the **subependymal germinal matrix**. - CMV is the **most common congenital infection** and the leading infectious cause of **sensorineural hearing loss** and neurodevelopmental delay, often presenting with such calcifications. *Toxoplasmosis* - Congenital toxoplasmosis typically causes **diffuse scattered intracranial calcifications** rather than the periventricular pattern seen with CMV. - While it is a significant cause of congenital neurological damage, its calcification pattern is usually **randomly distributed** throughout the brain parenchyma. *Congenital syphilis* - Congenital syphilis primarily affects the **bones, skin, liver, and eyes**, but typically does not cause intracranial calcifications. - Neurological manifestations in congenital syphilis are more commonly related to **meningitis** or **hydrocephalus**, without characteristic calcifications. *Tuberous sclerosis* - Tuberous sclerosis causes **subependymal nodules** that may calcify and can appear in a periventricular distribution. - However, these are **hamartomas** (non-infectious lesions) and are part of a broader neurocutaneous syndrome, distinguished from CMV by associated features like **cortical tubers**, **cardiac rhabdomyomas**, and **skin findings** (ash-leaf spots, shagreen patches).
Question 103: A child presents with unilateral white reflex (leukocoria) and raised intraocular pressure, raising suspicion of retinoblastoma. Which of the following investigations is the most appropriate to perform?
- A. Ultrasound imaging of the eye
- B. Measurement of intraocular pressure
- C. Detailed examination under anesthesia (Correct Answer)
- D. CT imaging of the orbit and head
Explanation: ***Detailed examination under anesthesia*** - A **detailed examination under anesthesia (EUA)** is crucial for accurately assessing the extent of intraocular lesions in children, particularly those with suspected retinoblastoma. It allows for a thorough and precise evaluation of tumor size, location, and multifocality that is otherwise difficult to achieve in an awake child. - EUA often includes fundus photography, ultrasonography, and sometimes anterior segment examination, all performed systematically without the child moving. It is the gold standard for **diagnosing and staging retinoblastoma**. *Ultrasound imaging of the eye* - **Ocular ultrasound** is a key component of the investigation and can help identify the intraocular mass and detect calcifications, which are characteristic of retinoblastoma. - However, ultrasound alone is often insufficient to fully characterize the tumor's extent or for precise staging, and it doesn't replace the need for direct visualization and comprehensive examination. *Measurement of intraocular pressure* - **Raised intraocular pressure** is a symptom that can be present in retinoblastoma but is not a diagnostic tool for the condition itself; it indicates secondary glaucoma due to the tumor. - While important for clinical management, measuring IOP does not directly visualize or characterize the tumor to confirm the diagnosis of retinoblastoma. *CT imaging of the orbit and head* - While **CT imaging** can detect orbital and intracranial extension of retinoblastoma, it involves **ionizing radiation**, which is a significant concern in children, especially those with an increased genetic risk for secondary cancers. - **MRI** is generally preferred over CT for assessing extraocular extension and possible central nervous system involvement due to its superior soft tissue contrast and lack of radiation exposure.
Question 104: Features of periostitis on X-ray of the hip in a child suggest
- A. Syphilis (Correct Answer)
- B. Toxoplasma
- C. CMV
- D. Rubella
Explanation: ***Syphilis*** - **Congenital syphilis** is known to cause **periostitis**, especially in long bones, which can be visualized on X-rays as new bone formation. - Features often include **widespread bony lesions**, including periosteal thickening, osteitis, and metaphysitis due to the systemic nature of the infection. *Toxoplasma (affects CNS and eyes)* - **Congenital toxoplasmosis** primarily affects the **central nervous system** (e.g., hydrocephalus, intracranial calcifications) and eyes (e.g., chorioretinitis). - It does not typically cause **periostitis** or bony changes visible on X-ray of the hip. *CMV (typically leads to systemic disease)* - **Congenital cytomegalovirus (CMV)** infection often presents with **systemic manifestations** like hepatosplenomegaly, thrombocytopenia, and neurological deficits. - While CMV can cause **bony lesions** in severe cases, classical periostitis, especially as a prominent isolated feature on hip X-ray, is not characteristic. *Rubella (primarily causes cardiac and ocular abnormalities)* - **Congenital rubella syndrome** classically involves a triad of **cardiac defects** (e.g., patent ductus arteriosus), **ocular abnormalities** (e.g., cataracts, glaucoma), and **sensorineural hearing loss**. - While it can cause some bone lesions (e.g., "celery stalk" appearance in metaphyses), **periostitis** of the hip is not a primary or common finding associated with rubella.
Question 105: What is the cardiothoracic ratio in children?
- A. 30-35%
- B. 40-45%
- C. 50-55% (Correct Answer)
- D. 60-65%
Explanation: ***50-55%*** - The normal **cardiothoracic ratio** in children is generally considered to be **50-55%** on a **posterior-anterior (PA) chest X-ray**. - In **infants and young children (under 2 years)**, the ratio can be **up to 55-60%** due to relatively larger cardiac size and more horizontal positioning of the heart. - In **older children (over 2 years)**, the normal ratio approaches adult values of **less than 50%**. - A ratio consistently greater than 55% could indicate **cardiomegaly**, which warrants further investigation. *30-35%* - This range is typically too low and would suggest an **unusually small heart** for the chest cavity, which is not a normal finding in children. - A very low ratio like this is not characteristic of the pediatric population and may indicate technical issues with the radiograph. *40-45%* - While this range approaches normal values for **older children and adults**, it is generally on the lower side for the average **pediatric cardiothoracic ratio**. - This percentage alone is not the best answer when considering the entire pediatric age spectrum, including infants and younger children. *60-65%* - A cardiothoracic ratio in this range would typically be considered **abnormal** and indicative of **cardiomegaly** in children beyond infancy. - Such an elevated ratio would suggest an enlarged heart, prompting further cardiac evaluation including **echocardiography** to assess for structural heart disease.
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