Vgt voorjaar 2010   kind deel1
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Vgt voorjaar 2010   kind deel1 Vgt voorjaar 2010 kind deel1 Presentation Transcript

  • VGT voorjaar 2010 KIND
  • 84
    • Voorafgaand aan een X-colon bij verdenking
    • op Morbus Hirschsprung moet u afzien van
    • darmvoorbereiding.
    • 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 van
    • darmvoorbereiding.
    • Juist
  • 85
    • Een bronchogene cyste heeft een
    • infradiafragmale 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 een
    • infradiafragmale arteriële bloedvoorziening.
    • Onjuist
  • 86
    • Een bekende complicatie van taaislijm ziekte
    • (of cystic fibrosis) is een pneumothorax.
    • Een spanningspneumothorax is hiervoor
    • kenmerkend.
    • 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 hiervoor
    • kenmerkend.
    • Onjuist
  • 87
    • Een normale X-thorax bij een kind met een
    • asthma-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 een
    • asthma-exacerbatie is een zeldzaamheid.
    • Onjuist
  • 88
    • Een mengbeeld van atelectase en
    • Hyperinflatie is typisch voor de X-thorax
    • van 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 en
    • Hyperinflatie is typisch voor de X-thorax
    • van een neonaat met meconiumaspiratie.
    • Juist
  • 89
    • De “moderator band” bevindt zich in het
    • rechter 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 het
    • rechter ventrikel.
    • Juist
  • 90
    • Een persisterende open ductus arteriosus is
    • meestal asymptomatisch.
    • Als er wel symptomen zijn, staat cyanose
    • op de voorgrond.
    • A. Juist B. Onjuist C. Weet niet
  • 90
    • While some cases of PDA are asymptomatic, common
    • symptoms 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 of congenital 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 is
    • meestal asymptomatisch.
    • Als er wel symptomen zijn, staat cyanose
    • op de voorgrond.
    • Onjuist
  • 91
    • Een rechter aberrante arteria subclavia
    • geeft een impressie op de achterzijde van
    • de 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 subclavia
    • geeft een impressie op de achterzijde van
    • de oesofagus.
    • Juist
  • 92
    • Invaginaties zijn vaker colo-colisch dan
    • ileocoecaal.
    • 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 are
    • 6 months to 2 years.
  • 92
    • Invaginaties zijn vaker colo-colisch dan
    • ileocoecaal.
    • Onjuist