2)  All of the following are true regarding meconium ileus EXCEPT:

The presenting symptom in 85% of cystic fibrosis patients, rather 10-15% of patients with CF present with meconium ileus.

3)  Problem: inability to pass NG tube. What is the diagnosis?

Esophageal atresia with a tracheoesophageal fistula.

    The NG tube is looped within the esophageal pouch. Air is in the stomach indicating presence of a tracheoesophageal fistula.

4) In Hirschsprung disease the most common transition site is the rectosigmoid colon

True. 

    The transition zone is the junction between the proximal normally innervated colon and the distal aganglionic segment. The normally innervated proximal colon becomes dilated.

5)  Appendicitis can present with which of the following?

All of the above.

    It can present with small bowel obstruction, an appendicolith and right lower quadrant pain

6) What is the diagnosis?

Necrotizing enterocolitis.

    There is extensive pneumatosis (air in the bowel wall) seen as bubbly lucencies overlying the bowel. This is the most definitive radiographic finding of NEC.

7) In hypertrophic pyloric stenosis, all of the following are true EXCEPT

Bilious vomiting.

    Patients with this entity present with nonbilious projectile vomiting.

8) Treatment of intussusception includes air or fluid enema under fluoroscopic guidance or surgery if these methods fail

True.

    Note that the choice of studies performed varies among institutions.

9) Where is the coin lodged?

Esophagus.

    A coin in the esophagus has its widest dimension on the AP view and a coin lodged in the trachea has its widest dimension on the lateral view

10) Malrotation with midgut volvulus is a surgical emergency because it may lead to bowel necrosis

True

11) The umbilical venous catheter tip should be within 1 cm of the diaphragm, in the IVC

True

12) If there is a question of pneumoperitoneum on a supine XR, the following X-rays can be obtained for confirmation

Left side down decubitus or cross table lateral.

13) What is the diagnosis?

Pneumothorax.

    The right heart border is sharp in appearance and the right costophrenic angle is hyperlucent, diagnostic of a pneumothorax.
 

14) Transient tachypnea of the newborn is characterized by all of the following EXCEPT

Typically affects premature infants.

    TTN usually affects neonates born at term.

15) Congenital diaphragmatic hernia can be diagnosed on prenatal ultrasound

True

16) What is the image depicting?
 

Normal thymus.

    Note the sharp, well-defined lateral and inferior borders of the normal appearing thymus projected along the right superior mediastinum

17) Primary tuberculosis can present with all of the following EXCEPT

Diffuse small uniform nodules.

    Miliary TB results from secondary infection and is characterized by diffuse small uniform nodules in the lungs.

18) Thickening of the epiglottis in acute epiglottitis, as seen on the lateral view, is called the "thumb sign"

True

19) What is the diagnosis?

Cystic fibrosis.

    The CXR demonstrates bronchiectasis, mucous plugging and hyperinflation consistent with CF.

20) The deep sulcus sign is diagnostic of a pneumothorax

True

21) The early filling film in a voiding cystourethrogram (VCUG) allows visualization of a ureterocele, if present

True

22) You identify vesicoureteral reflux while performing a VCUG on a 2 year-old boy. The patient's siblings do not need to be screened for vesicoureteral reflux

False.

    There is an increased incidence of vesicoureteral reflux in siblings of children with VUR, in children of parents who had VUR, and in non-African Americans as opposed to African American children.

23) What grade of reflux is being depicted?

Grade 5.

    There is severe hydronephrosis and tortuosity of the ureter.

24) All of the following are true regarding autosomal recessive polycystic kidney disease EXCEPT

Associated with intracranial aneurysms.

 Autosomal dominant polycystic kidney disease is associated with intracranial aneurysms.

25) Hydronephrosis is the most common cause of an abdominal mass in the neonate

True

26) What is the diagnosis?

 
 

Hydronephrosis.

    The cystic appearing spaces communicate in hydronephrosis as opposed to multicystic dysplastic kidney where the large cysts do not communicate.

27) Mesoblastic nephroma can be reliably differentiated from a Wilms tumor on imaging

False.

    Because imaging cannot differentiate mesoblastic nephroma from a rare early Wilms tumor, it must be surgically removed

28) Most neuroblastomas arise from the adrenal gland and present with a palpable abdominal mass

True.

     Neuroblastomas can arise anywhere along the course of the sympathetic chain, but most commonly do so from the adrenal gland.

29) What is the diagnosis?



Neuroblastoma.

    There is a large hypodense mass crossing the midline and encasing the aorta and its branches. It does not arise from the kidney (absent "claw sign").

30) Wilms tumor can invade the renal vein/IVC and displace vessels whereas neuroblastoma encases vessels

True

31) All Salter-Harris fractures involve the growth plate

True.

    In addition, Salter-Harris fractures are divided into 5 types based on whether there is also metaphyseal, epiphyseal or solely physeal involvement.

32) Radiographic findings suggestive of non-accidental trauma include

Metaphyseal corner fractures, posterior rib fractures near the costoverterbral junction, and multiple fractures at different stages of healing.

33) What is the diagnosis?

Legg-Calve-Perthes disease.

    The subchondral lucency in the femoral epiphysis represents the crescent sign seen in LCP disease.

34) All of the following are true regarding Developmental Dysplasia of the Hip EXCEPT

More prevalent in males than females.

    It is more prevalent in females than males (9:1).

35) A child presents with a fever and a painful hip. It is important to exclude septic arthritis because of the unfavorable sequelae if undiagnosed and untreated

True.

     If septic arthritis is left untreated, it can lead to joint destruction.

36) What is the diagnosis?
 

Osgood-Schlatter disease.

    There is fragmentation of the tibial tuberosity, thickening of the inferior patellar tendon, and soft tissue swelling inferior to the patella

37) Classic radiographic findings of Langerhans cell histiocytosis include

Punched out lytic skull lesions, vertebra plana, and "floating teeth" appearance in the mandible.

38) Achondroplasia results in a pelvis with tall flared iliac wings and increased acetabular angles whereas mucopolysaccharidoses result in rounded iliac wings with decreased acetabular angles

False.

    The reverse is true. The pelvis in achondroplasia has a "tombstone" appearance with rounded iliac wings and decreased acetabular angles.

39) What is the diagnosis?

Lead poisoning.

    This is a classic example of lead poisoning with sclerotic metaphyseal bands involving the distal femurs, proximal tibias and proximal fibulas. The dense metaphyseal bands seen in normal variants do not typically involve the proximal fibula. Leukemia causes lucent metaphyseal bands.

40) Radiographic findings of Osteogenesis Imperfecta include all of the following EXCEPT

Metaphyseal corner fractures.

    These are highly specific for non-accidental trauma.

41) Grade IV germinal matrix hemorrhage is parenchymal hemorrhage from direct extension of a germinal matrix hemorrhage

False.

    Grade IV hemorrhage is a parenchymal venous infarction hemorrhage rather than extension from a germinal matrix hemorrhage.

42) Associated findings of Chiari I malformation include hydrocephalus and hydrosyringomyelia (syrinx)

True.

43) What is the diagnosis on this sagittal head ultrasound?

Periventricular leukomalacia.

    Cystic changes along the right lateral ventricle represent PVL.

44) All of the following are true regarding a vein of Galen malformation EXCEPT

Treatment is surgical removal. Rather, treatment is typically arterial embolization.

45) An arachnoid cyst in the posterior fossa will exert mass effect on the underlying cerebellum

True.

    A mega cisterna magna does not exert mass effect on the adjacent brain.

46) What is the diagnosis?

 
 

Sturge-Weber syndrome.

    Note the atrophic left hemispheric gyri with serpiginous calcifications.

47) In Tuberous sclerosis all of the following can be present EXCEPT

Bilateral acoustic schwannomas.

    These are seen in Neurofibromatosis 2.

48) Herpes encephalitis typically affects the temporal lobes in neonates who get the infection during birth

False.

    Any part of the brain can be affected under these circumstances.

49) What is the diagnosis?



Neurofibromatosis 2.

    There are bilateral acoustic schwannomas, right optic nerve meningioma, and posterior meningioma.

50) Ependymomas typically arise from the floor of the 4^th ventricle whereas medulloblastomas arise from the roof of the 4^th ventricle

True.