Vgt voorjaar 2010 kind deel1

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