Neonatal Brain Anatomy and Conditions
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Questions and Answers

Which fontanelle is open until approximately 2 years of age?

  • Anterior fontanelle (correct)
  • Lambdoid fontanelle
  • Posterior fontanelle
  • Frontal fontanelle

What structure connects the lateral ventricles to the third ventricle?

  • Cavum septum pellucidum
  • Foramen of Monroe (correct)
  • Aqueduct of Sylvius
  • Foramen of Luschka

Which component of the brain is responsible for most cerebrospinal fluid production?

  • Coronary plexus
  • Cerebral cortex
  • Choroid plexus (correct)
  • Corpus callosum

What is the primary function of the falx cerebri?

<p>Separates the two cerebral hemispheres (B)</p> Signup and view all the answers

Which of the following lobes of the brain is located posteriorly?

<p>Occipital lobe (A)</p> Signup and view all the answers

At what age is the posterior fontanelle typically closed?

<p>3 months (D)</p> Signup and view all the answers

Which suture separates the frontal bones from the parietal bones?

<p>Coronal suture (A)</p> Signup and view all the answers

Which part of the brain serves as the connecting bridge between the two cerebral hemispheres?

<p>Corpus callosum (A)</p> Signup and view all the answers

Which statement accurately describes the anatomy of the acetabulum?

<p>It is cup-shaped and articulated with the femoral head. (A)</p> Signup and view all the answers

In which position is the hip considered to be in a 'neutral position'?

<p>Hip at rest without any additional movements. (C)</p> Signup and view all the answers

What contributes to the increased risk of developmental dysplasia of the hip (DDH) in infants?

<p>Skull molding and foot deformities. (B)</p> Signup and view all the answers

What is the caudothalamic notch (CTN)?

<p>The junction where the caudate nucleus and thalamus meet. (D)</p> Signup and view all the answers

Which grade of hemorrhage is characterized by a bleed confined to the caudothalamic notch?

<p>Grade I hemorrhage (A)</p> Signup and view all the answers

Which classification describes a condition where there is partial coverage of the femoral head by the acetabulum?

<p>Subluxation (B)</p> Signup and view all the answers

What factor increases the risk of developmental dysplasia of the hip (DDH) in infants?

<p>Being born in a breech position (C)</p> Signup and view all the answers

Which imaging view provides the most comprehensive visual of breast tissue?

<p>MLO view. (B)</p> Signup and view all the answers

Which imaging technique is preferred for assessing hip dysplasia in infants?

<p>Ultrasound (D)</p> Signup and view all the answers

What is one of the primary functions of the parathyroid glands?

<p>To maintain blood calcium levels. (A)</p> Signup and view all the answers

Which of the following best describes the appearance of the thyroid gland on ultrasound?

<p>Medium to high level echoes, hyperechoic to surrounding musculature. (B)</p> Signup and view all the answers

Which hemorrhagic type occurs when a clot goes into the lateral ventricles?

<p>Intraventricular hemorrhage (IVH) (C)</p> Signup and view all the answers

What happens to the echogenicity of a hematoma as it ages?

<p>It decreases in echogenicity. (C)</p> Signup and view all the answers

What is a common disadvantage of the MLO mammography view?

<p>It exposes the patient to radiation. (B)</p> Signup and view all the answers

Which of the following is NOT a reason X-rays are not ideal for assessing hips in infants?

<p>Considered a soft tissue assessment method (C)</p> Signup and view all the answers

Which directional term indicates a structure located towards the front of the body?

<p>Anterior (D)</p> Signup and view all the answers

What is one of the oldest sites for germinal matrix hemorrhage (GMH)?

<p>Caudate nucleus (A)</p> Signup and view all the answers

What anatomical components are connected by the triradiate cartilage?

<p>Ilium, pubis, and ischium. (D)</p> Signup and view all the answers

Which of the following treatments is used for severe cases of DDH?

<p>Spica cast or closed reduction (D)</p> Signup and view all the answers

During the Barlow maneuver, what is being tested?

<p>Stability of the hip joint. (C)</p> Signup and view all the answers

At what point in life does germinal matrix hemorrhage primarily occur?

<p>Within the first 7 days of life (A)</p> Signup and view all the answers

Which aspect of the thyroid gland's anatomy connects the right and left lobes?

<p>Isthmus. (D)</p> Signup and view all the answers

What is the typical length range of a parathyroid gland?

<p>5-7 mm. (B)</p> Signup and view all the answers

What part of the neonatal brain does the cavum septum pellucidum (CSP) primarily relate to?

<p>Closure in older infants (A)</p> Signup and view all the answers

What is the primary anatomical change in the hip during the first year of life?

<p>Presence of cartilage in the acetabulum (A)</p> Signup and view all the answers

Which hormone is primarily secreted by the thyroid gland?

<p>Thyroxine (T4). (D)</p> Signup and view all the answers

Why is an ultrasound performed after the presence of a hip click in infants?

<p>To confirm a dislocated hip (A)</p> Signup and view all the answers

Which imaging technique can be used as an adjunct to mammography?

<p>Ultrasound. (A)</p> Signup and view all the answers

Which structure is located inferolateral to the frontal horn and body of the lateral ventricles?

<p>Caudate nucleus (A)</p> Signup and view all the answers

What treatment method involves using two diapers to manage DDH?

<p>Double diapering (C)</p> Signup and view all the answers

In a CC view of a mammogram, if a mass is located on the line between lateral and medial sections, where is it located?

<p>At 12:00 (B), At 6:00 (D)</p> Signup and view all the answers

What measurement technique is considered more accurate for locating a lesion when using a CC view?

<p>Measuring with a ruler starting from the nipple (A)</p> Signup and view all the answers

Which characteristic margin is most specific for malignancy?

<p>Spiculated margins (B)</p> Signup and view all the answers

What is the primary limitation of mammography in women with dense breasts?

<p>Limited detection of tumors (A)</p> Signup and view all the answers

What are clustered microcalcifications usually associated with?

<p>Fibroadenoma or malignancy (A)</p> Signup and view all the answers

What term describes the benign changes occurring in the female breast that include cyst formation and fibrosis?

<p>Fibrocystic changes (B)</p> Signup and view all the answers

Why is it difficult to distinguish between normal and abnormal tissue based on mammographic density alone?

<p>Because of overlapping densities (A)</p> Signup and view all the answers

What is a significant concern when using an MLO view for locating lesions?

<p>It is slightly oblique (C)</p> Signup and view all the answers

Which type of calcifications are almost exclusively associated with malignancy?

<p>Linear branching calcifications (C)</p> Signup and view all the answers

When assessing mammographic findings, what aspect is considered the least predictive in determining benign versus malignant findings?

<p>Lesion density (C)</p> Signup and view all the answers

What is the recommended method for differentiating benign changes from cancer in cases of fibrocystic changes?

<p>Biopsy (D)</p> Signup and view all the answers

What should be considered if a lesion appears lateral on a CC view?

<p>It may appear higher than it does on the MLO view (A)</p> Signup and view all the answers

What is the primary function of the Montgomery's glands located within the areola?

<p>Storing milk until suckling (B)</p> Signup and view all the answers

How often should women perform clinical breast examinations between the ages of 20 and 40?

<p>Every 3 years (A)</p> Signup and view all the answers

Which mammographic view is considered the most valuable for imaging breasts?

<p>Medio-lateral oblique view (D)</p> Signup and view all the answers

What is the main purpose of compression during a mammogram?

<p>To thin the breast for even x-ray exposure (D)</p> Signup and view all the answers

The terminal ductal lobular units (TDLU) are primarily associated with which of the following?

<p>Pathological processes (B)</p> Signup and view all the answers

What is a commonly palpable structure in the breast that is often mistaken for a mass?

<p>Fibrous ridge (D)</p> Signup and view all the answers

What is the role of the retromammary layer in breast structure?

<p>Consists mainly of muscle and connective tissue (D)</p> Signup and view all the answers

Which imaging method is currently considered the most important for breast cancer diagnosis?

<p>Mammography (D)</p> Signup and view all the answers

Which of the following layers of breast tissue contains glandular tissue and ducts?

<p>Mammary layer (A)</p> Signup and view all the answers

What type of view is typically performed to focus on a specific area of the breast?

<p>Spot compression view (D)</p> Signup and view all the answers

How many lobes is the breast typically divided into?

<p>15 to 20 (B)</p> Signup and view all the answers

In the context of mammography, what is a diagnostic mammogram primarily used for?

<p>To further investigate abnormalities (A)</p> Signup and view all the answers

Which of the following breast imaging methods requires directing radiation through the breast tissue?

<p>Mammography (C)</p> Signup and view all the answers

What is the primary purpose of breast self-examinations?

<p>To detect any abnormal changes or lumps (B)</p> Signup and view all the answers

Flashcards

Neonatal brain follow-up

Monitoring of newborns with a history of hydrocephalus or prenatal diagnoses, and intracranial hemorrhages.

Anterior Fontanelle

The most common "soft spot" on a baby's head, usually open until around 2 years old but can be scanned until 12-14 months.

Posterior Fontanelle

A soft spot on a baby's head, usually closing by 3 months old. Useful for viewing intraventricular hemorrhage and ventricular horns.

Cerebral Ventricles

Fluid-filled spaces inside the brain.

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Lateral Ventricles

Two large ventricles (cavities) in the cerebrum that contain CSF.

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Choroid Plexus

Structures in ventricles responsible for producing most of the cerebrospinal fluid (CSF).

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Corpus Callosum

A bundle of nerve fibers connecting the two brain hemispheres.

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Cavum Septum Pellucidum

A thin membrane separating the two frontal horns of the lateral ventricles.

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Caudate nucleus

A brain structure located near the lateral ventricles, often a site of germinal matrix hemorrhage (GMH).

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Germinal Matrix Hemorrhage (GMH)

Bleeding in the germinal matrix, a region in the brain where nerve cells develop.

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Subependymal Hemorrhage (SEH)

Most common type of GMH, bleeding just below the lining of the brain's ventricles.

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Intraventricular Hemorrhage (IVH)

GMH where the blood enters the brain's fluid-filled spaces (ventricles).

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Intraparenchymal Hemorrhage (IPH)

GMH where the blood goes into the brain tissue itself.

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Cavum Septum Pellucidum (CSP)

A fluid-filled space in the brain, often larger in younger babies.

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Caudothalamic Groove

Where the caudate nucleus and thalamus meet in the brain.

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Developmental Hip Dislocation (DDH)

A spectrum of disorders affecting the hip, leading to partial or complete dislocation.

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Acetabulum

The hip socket that receives the ball-shaped head of the thigh bone.

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Hip laxity

Increased flexibility of the hip joints, often seen at birth.

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Ultrasound use in hip exams

Better for assessing hips in babies because it doesn't expose the baby to radiation (x-rays) and shows the flexibility and growth of the hip joints.

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Grade I hemorrhage

Sub-ependymal hemorrhage confined to the caudothalamic groove.

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Grade II hemorrhage

GMH extending into the occipital horn.

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Grade III/IV hemorrhage

Intra-parenchymal hemorrhage with extensive clot formation in the brain tissues.

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Femoral Head

The rounded upper end of the femur that fits into the acetabulum, forming the hip joint.

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Labrum

A ring of cartilage that extends outward from the acetabulum, deepening the socket and providing stability to the hip joint.

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Triradiate Cartilage

A Y-shaped cartilage that connects the ilium, pubis, and ischium, forming the acetabulum.

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Barlow Maneuver

A clinical test for developmental dysplasia of the hip (DDH) where the examiner's finger pushes the femoral head out of the acetabulum.

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Subluxation

A partial dislocation where the femoral head is only partially covered by the acetabulum, indicating a potential for DDH.

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Anatomic Position

The standard reference position for the body, standing upright, feet together, palms facing forward.

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Median Sagittal Plane

A vertical plane that divides the body into equal right and left halves.

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Coronal Plane

A vertical plane that divides the body into front (anterior) and back (posterior) sections.

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Transverse Plane

A horizontal plane that divides the body into upper (superior) and lower (inferior) sections.

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Thyroid

An endocrine gland located in the neck, responsible for producing hormones that regulate metabolism.

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Thyroxine (T4)

The main hormone produced by the thyroid gland, responsible for most of the thyroid hormone activity.

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Triiodothyronine (T3)

A thyroid hormone that is less abundant than T4, but more potent.

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Isthmus

A narrow band of thyroid tissue that connects the two lobes of the thyroid gland.

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Mammography

A medical imaging technique that uses low-dose x-rays to examine breast tissue for abnormalities.

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Breast Layers

The breast is organized into three layers: subcutaneous, mammary, and retromammary. The subcutaneous layer contains fat and Cooper's ligaments. The mammary layer houses glandular tissue, ducts, and connective tissue. The retromammary layer is composed of fat, muscle, and connective tissue.

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TDLU

Terminal Ductal Lobular Unit (TDLU) is a structure in the breast composed of terminal ducts and acini. It's the most common site of origin for most breast pathologies.

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Cooper's Ligaments

Fibrous bands of connective tissue that support the breast tissue and provide shape and structure. They are visible on imaging.

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Montgomery's Glands

Small bumps on the areola surrounding the nipple, they are sebaceous glands that secrete a lubricating substance during breastfeeding.

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Breast Self-Examination

A monthly routine where women visually inspect and palpate their breasts for any changes or abnormalities. It's an important tool for early detection of breast cancer.

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Compression in Mammography

Applying pressure to the breast during mammograms is vital for clearer images. It reduces scatter and overlap, revealing more detail.

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Medio-lateral Oblique (MLO) View

The most important mammographic view, capturing the breast tissue from the axilla to the chest wall.

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Cranio-caudal (CC) View

Another essential mammographic view, capturing the breast tissue from top to bottom.

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Lateral View

A mammographic view taken from the side, showing the breast tissue in a side profile.

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Spot Compression View

A specialized mammographic view focusing on a specific area of the breast for closer investigation.

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Cleavage View

A mammographic view specifically addressing the inner portions of both breasts, useful for suspected lesions in the medial region.

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Axillary Tail View

A mammographic view focused on the axillary tail, which is an extension of the breast tissue into the armpit.

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Rolled Views

Mammographic views obtained by repositioning the breast to help identify and confirm the location of a lesion.

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Mammogram Views

Mammograms are taken in two main views: Mediolateral Oblique (MLO) and Craniocaudal (CC). These views provide complementary information about the breast tissue.

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MLO View Regions

In the MLO view, "superior" is above the nipple, "inferior" is below, and there's no lateral/medial distinction. A mass on the line between superior and inferior is located at 3:00 or 9:00 on the breast clock.

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CC View Regions

In the CC view, "lateral" is from the nipple towards the marker (axilla), "medial" is from the nipple away from the marker, and there's no superior/inferior distinction. A mass on the line between lateral and medial is located at 12:00 or 6:00.

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Measuring Lesion Location

To pinpoint a lesion's location, measure the distance from the nipple using a ruler. Place the ruler at the nipple and line it up with the lesion. This is more accurate for CC view than MLO.

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MLO vs. CC Lesion Location

Lesions appearing medial on MLO may be higher than they appear because the view is slightly oblique. On the CC view, medial lesions may be higher, and lateral lesions may be lower than on the MLO.

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Mammographic Densities

Different tissues absorb x-rays differently, creating varying shades of gray. This is density. Recognizing density is crucial for reading mammograms.

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Fat Density

Appears radiolucent (darker gray on the mammogram) and indicates tissues like fat, cysts, and lipomas.

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Mixed Density

Appears middle gray and often indicates lymph nodes, galactocele, and tissues containing both fat and water.

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Water Density

Appears radiopaque (lighter gray on the mammogram) and indicates tissues like glandular tissue, connective tissue, ducts, muscles, and some tumors.

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Calcium Density

Appears white (radiopaque) on the mammogram and indicates dense structures like calcifications. Calcifications can be either benign or malignant.

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Mammographic Margins

The boundary of a lesion is referred to as the margin. Margins provide crucial clues about the nature of a lesion - benign or malignant.

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Smooth Margins

The lesion has a well-defined, smooth border, often suggesting a benign process.

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Circumscribed Margins

The lesion is clearly separated from the surrounding tissues with a distinct border, suggesting a benign growth.

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Angular Margins

The lesion has jagged, irregular borders, highly suggestive of malignancy. It may be growing into surrounding tissues.

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Spiculated Margins

Straight lines radiate out from the center of the lesion, indicating a strong likelihood of malignancy. This is a highly specific characteristic.

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Fibrocystic Changes

A common benign condition affecting breasts, characterized by cyst formation, fibrosis, and epithelial hyperplasia. This is usually not concerning but needs to be distinguished from cancer.

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Study Notes

Neonatal Brain

  • Follow-up: For hydrocephalus or abnormal prenatal diagnoses.
  • Intracranial Hemorrhage: Possible cause of brain abnormalities.
  • Fontanelles: Soft spots on the baby's head.
    • Anterior Fontanelle: Closes by 2 years but scanned up to 12-14 months.
    • Posterior Fontanelle: Closes by 3 months; useful for assessing intraventricular hemorrhage and ventricular horns.
  • Sutures: Fibrous connections between skull bones.
    • Sagittal Suture: Separates the parietal bones.
    • Coronal Suture: Separates the frontal and parietal bones.
    • Lambdoid Suture: Separates parietal and occipital bones.
  • Falx Cerebri: Fold of dura mater within the inner hemispheric fissure.
  • Frontal Suture: Separates the frontal bones.
  • Brain Divisions: Cerebrum, brainstem, and cerebellum.
    • Cerebrum Lobes: Frontal, parietal, temporal, and occipital.
  • Cerebral Ventricles: Cavities filled with cerebrospinal fluid (CSF).
    • Lateral Ventricles (2)
    • Third Ventricle: Midline structure.
    • Fourth Ventricle: Midline structure.
    • Foramen of Monroe: Connects lateral ventricles to the third ventricle.
    • Aqueduct of Sylvius: Connects the third and fourth ventricles.
    • Foramen of Luschka: Connects the fourth ventricle to the subarachnoid space and spinal canal.
  • Corpus Callosum: Large nerve fiber bridge connecting hemispheres.
  • Choroid Plexus: CSF production site.
    • Hyperechoic appearance.
    • Produces ~800 cc CSF daily, but only ~140 cc present.
  • Lateral Ventricle Anatomy: Frontal, body, occipital, and temporal horns; Trigone.
  • Thalami: Homogenous structures inferior to lateral ventricle bodies.
  • Cavum Septum Pellucidum (CSP): Hypoechoic structure separating frontal horns; cystic in fetuses.
  • Caudate Nucleus: Relative hyperechoic; inferolateral to frontal horn and ventricle body.
  • Caudo-thalamic Groove (CTN): Junction of caudate nucleus and thalamus; common GMH site.
  • Germinal Matrix Hemorrhage (GMH): Types.
    • Subependymal Hemorrhage (SEH): Most common.
    • Intraventricular Hemorrhage (IVH): Clot into lateral ventricles.
    • Intraparenchymal Hemorrhage (IPH): Clot into frontal/parietal lobes.
  • GMH Grades: Echogenicity changes with age.
  • Midline Structures Landmarks: Uses anatomical terms to locate brain structures

Pediatric Hip

  • Ultrasound Importance (Hip): Useful for assessing infant hips, especially up to 1 year old due to cartilage, for dislocations, and treatment follow-ups.
  • X-Ray Limitations (Hip): Poor view of cartilage, soft tissue components (especially during first year). Exposure to radiation.
  • Developmental Hip Dysplasia (DDH): A spectrum of disorders impacting hip socket (acetabulum) and femur head; risk factors and classifications also discussed.
    • Risk Factors: Multifactorial, including maternal estrogen, pelvic relaxation, family history, oligohydramnios, breech position, skull/foot deformities.
    • Treatment: Diapering techniques, harnesses, surgical procedures.
    • Anatomy: Acetabulum (socket), femur head, neck, shaft, trochanters.
    • Scanning Planes: Lateral/posterior-lateral, supine/prone, flexed, abduction/adduction, transverse/coronal planes.
    • Stress Maneuvers: Barlow maneuver.
    • Classification: Normal, subluxation, dislocation depending on the coverage of the femur head

Thyroid

  • Indications for Thyroid Ultrasound: Detecting masses, monitoring nodules, Post-thyroidectomy followups, screening for head/neck irradiation history.
  • Hormones: Thyroxine (T4), Triiodothyronine (T3), Calcitonin.
  • Anatomy: Right & left lobes connected by isthmus, possible pyramidal lobe.
  • Location: Lateral: CCA, IJV; Medial: trachea; Anterior: strap muscles; Posterior: Longus colli, parathyroid glands.
  • Size: Normal size parameters; increased volume with age, weight, iodine deficiency, and certain conditions. Decreased volume with some treatments.
  • Appearance: Medium to high echoes; hypoechoic to surrounding muscles; highly vascular.
  • Blood Supply: Superior & inferior thyroid arteries & veins.
  • Parathyroid Glands: Located posterior to thyroid; 4 common but can vary in number; hypoechoic, small structures.

Mammography

  • Types: Screening (asymptomatic) and diagnostic (symptomatic).
  • Routine Views: Craniocaudal (CC), Mediolateral Oblique (MLO).
  • CC View: Identifies medial/lateral breast tissue.
  • MLO View: More complete view; tail of Spence, pectoralis muscle, upper/lower portion.
  • Advantages (MLO): Whole breast view, calcification visualization, interventional procedure suitability.
  • Disadvantages (MLO): Radiation exposure, not ideal for pregnant women, difficulties for dense breasts.
  • Breast Tissue Layers: Subcutaneous, mammary, retromammary.
  • TDLU (Terminal Ductal Lobular Units): Site of most breast pathologies.
  • Breast Exam Methods: Self-examinations, clinical breast exams, mammography.
  • Mammographic Views: Two standard views for screening (CC & MLO) and additional views for diagnostics.
  • Compression Importance: Thins breast tissue, reduces radiation scattering, minimizes motion.
  • Mammographic Findings Evaluation: Understanding the method used to record the image and possible causes of abnormalities.
  • Measuring Lesions: Locating a lesion by measurements from the nipple.
  • Mammographic Density: Different tissues absorb x-rays differently; Important to note to evaluate.
  • Margins: Describe lesion borders (smooth, circumscribed, ill-defined).
  • Density: Describe tissue density or types of material the lesions are made of, including fat, mixed, water.
  • Calcifications: Can be benign or malignant; various types.
  • Fibrocystic Changes: Common, benign, and sometimes produce palpable lumps.
  • Mammographic Density (Breast Tissue Concerns): Dense fibrous/glandular tissue can obscure tumors, screening limitations in women with dense tissue.

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This quiz covers critical aspects of neonatal brain anatomy, including definitions of fontanelles, sutures, and brain divisions. Test your knowledge on conditions related to the neonatal brain, such as hydrocephalus and intracranial hemorrhage.

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