34
VGT voorjaar 2010 KIND
VGT voorjaar 2010
KIND
84
Voorafgaand aan een X-colon bij verdenkingop Morbus Hirschsprung moet u afzien vandarmvoorbereiding.
A. Juist B. Onjuist C. Weet niet
84• absence of the ganglion cells that innervate the colon.• The denervated colon spasms and causes a functional
obstruction.– affected portions of colon are small therefore in calibre– more proximal, normally innervated colon is dilatated
secondary to the obstruction.
• there are no skip leasions.• Most patients (90%) present in the neonatal period
with failure to pass meconium.– However, patients can present later in life with problems
related to constipation.
84
• Boys:girls = 4:1• associated with Down syndrome in 5% of cases.• Patients with Hirschsprung disease may present with
associated colitis.• In patients who are suspected to have Hirschsprung
disease and are ill, contrast enemas should be avoided.
• Definitive diagnosis is obtained by rectal biopsy• Treatment by surgical resection of the denervated
segment.
84
Voorafgaand aan een X-colon bij verdenking op Morbus Hirschsprung moet u afzien vandarmvoorbereiding.
Juist
85
Een bronchogene cyste heeft eeninfradiafragmale arteriële bloedvoorziening.
A. Juist B. Onjuist C. Weet niet
85• Bronchogenic cysts occur secondary to abnormal
budding of the tracheobrochial tree during development
• Occur in the lung parenchyma or the middle mediastinum.– Mediastinal lesions are reportedly more common,
making up between 65% tot 90% of cases of bronchogenic cysts.
• When bronchogenic cysts occur in the lungs, they are most commonly central in location, often in a perihilar distribution.
85• Bronchogenic cysts are almost always solitary
lesions– multiple bronchogenic cysts are very uncommon.
• Compression of the distal trachea or bronchi is not uncommon.
• They can be quite large.• They appear as well-defined cystic structures on
imaging.• Like sequestrations, they do not contain air until
they become infected and therefore may appear as well-defined soft tissue attenuation or cystic air-fluid-containing masses.
85
• Sequestration – area of congenital abnormal pulmonary tissue
that does not have a normal connection to the bronchial tree
– characteristic imaging feature is demonstration of an anomalous arterial supply to the abnormal lung via a systemic artery arising from the aorta.
– The most common location is within the left lower lobe.
85
Een bronchogene cyste heeft eeninfradiafragmale arteriële bloedvoorziening.
Onjuist
86
Een bekende complicatie van taaislijm ziekte(of cystic fibrosis) is een pneumothorax.Een spanningspneumothorax is hiervoorkenmerkend.
A. Juist B. Onjuist C. Weet niet
86
• Genetic disease that most commonly affects the respiratory and gastrointestinal tracts.
• In the respiratory system, abnormally viscous mucus leads to airway obstruction and infection that causes bronchitis and bronchiectasis.
• Children may initially present with recurrent respiratory tract infections.
86
• Radiography may be normal at young ages but eventually demonstrates– Hyperinflation; increased peribronchial markings; mucus
plugging; bronchiectasis;– prominent hilar areas because of a combination of
• lymphadenopathy secondary to the chronic inflammation• enlarged central pulmonary arteries related to the development of
pulmonary arterial hypertension
• Chest radiography is used to monitor the disease and evaluate for complications during acute exacerbations.
• Such complications include focal pneumonia, pneumothorax, and pulmonary haemorrhage.
86
Een bekende complicatie van taaislijm ziekte(of cystic fibrosis) is een pneumothorax.Een spanningspneumothorax is hiervoorkenmerkend.
Onjuist
87
Een normale X-thorax bij een kind met eenasthma-exacerbatie is een zeldzaamheid.
A. Juist B. Onjuist C. Weet niet
87
• Plain radiographs are not commonly used to make a diagnosis of asthma
• Radiographs often are normal– and visible abnormalities in this disease usually
are nonspecific.
• Radiography also has limited usefulness in patients with an established diagnosis of asthma who suffer an acute attack.
87
Een normale X-thorax bij een kind met eenasthma-exacerbatie is een zeldzaamheid.
Onjuist
88
Een mengbeeld van atelectase enHyperinflatie is typisch voor de X-thoraxvan een neonaat met meconiumaspiratie.
A. Juist B. Onjuist C. Weet niet
88
• Intrapartum or intrauterine aspiration of meconium
• Usually secondary to stress, such as hypoxia, and more often occurs in term of postmature neonates.
• The aspirated meconium causes both– obstruction of small airways secondary to its
tenacious nature– chemical pneumonitis
• The degree of respiratory failure can be severe.
88
• Radiographic findings include hyperinflation and asymmetric lung densities that tend to have a ropy appearance and a perihilar distribution.
• Commonly there are areas of hyperinflation alternating with areas of atelectasis.
• Pleural effusions can be present.• Because of the small-airway obstruction by
the meconium, air-block complications are common, whith pneumothorax, occurring in 20 to 40% of cases.
88
Een mengbeeld van atelectase enHyperinflatie is typisch voor de X-thoraxvan een neonaat met meconiumaspiratie.
Juist
89
De “moderator band” bevindt zich in hetrechter ventrikel.
A. Juist B. Onjuist C. Weet niet
89• The septomarginal trabecula (moderator band) in
the right ventricle passes from the interventricular septum to the base of the anterior papillary muscle.
• The important feature of this trabecula is that it carries the right branch of atrioventricular bundle (RBB) in its substance.– This ensures early contraction of papillary muscles so
that chordae tendinae are already taut before the ventricular contraction begins.
• From its attachments it was thought to prevent overdistension of the ventricle, and was named the "moderator band".
89
De “moderator band” bevindt zich in hetrechter ventrikel.
Juist
90
Een persisterende open ductus arteriosus ismeestal asymptomatisch.Als er wel symptomen zijn, staat cyanoseop de voorgrond.
A. Juist B. Onjuist C. Weet niet
90While some cases of PDA are asymptomatic, commonsymptoms include:• Tachycardia• respiratory problems• shortness of breath• continuous machine-like murmur• enlarged heart• Left subclavicular thrill• Bounding pulse• Widened pulse pressure (= systolic – diastolic mmHg)• Patients typically present in good health, with
normal respirations and heart rate.• Poor growth
Categorization ofcongenital heart disease
Blue• Decreased flow– Normal heart size
• Tetralogy of Fallot– Giant heart size
• Ebstein anomaly• Pulmonary atresia with
intact ventricular septum– Increased flow
• Truncus arteriosus• Total anomalous
pulmonary venous return– Variable flow
• D-transposition of the great arteries
• Tricuspis atresia
Pink• Increased pulmonary
arterial flow and left tot right shunt– VSD, ASD, PDA,
atrioventricular canal• Increased pulmonary
venous flow– CHF in the newborn
• Normal pulmonary flow– Obstructive lesions
• Coarctation of the aorta• Aortic stenosis• Pulmonary artery stenosis
– Postsurgery
90
Een persisterende open ductus arteriosus ismeestal asymptomatisch.Als er wel symptomen zijn, staat cyanoseop de voorgrond.
Onjuist
91
Een rechter aberrante arteria subclaviageeft een impressie op de achterzijde vande oesofagus.
A. Juist B. Onjuist C. Weet niet
91
• Most common thoracic arterial anomaly• Rarely causes symptoms• Last vessel from the arch and extends dorsal to
trachea and esophagus• Dorsal diagonal impression on the esophagus
91
Een rechter aberrante arteria subclaviageeft een impressie op de achterzijde vande oesofagus.
Juist
92
Invaginaties zijn vaker colo-colisch danileocoecaal.
A. Juist B. Onjuist C. Weet niet
92• Intussusception is the telescoping of a segment
of bowel into an adjacent segment• Great majority of cases are ileocolic (90%)• Lymphoid hyperplasia is the cause in the vast
majority• The classic clinical triad is– abdominal pain– currant-jelly stool– palpable abdominal mass
• Most patients are6 months to 2 years.
92
Invaginaties zijn vaker colo-colisch danileocoecaal.
Onjuist
