Osce Radiology 110401045630 Phpapp01

8/11/2019 Osce Radiology 110401045630 Phpapp01

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OSCE- Radiology

Phase IIIa

sienmingoat


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CXR- pulmonary edema

Describe?

Perihilar shadowing (bats wings)= alveolar edema Upper lobe diversion

Kerley B lines= interstitial edema

Cardiomegaly (LVF)

Pleural effusion?

Dx? Pulmonary edema

Causes? Cardiogenic: LVF, mitral stenosis, arrhythmias

Non-cardiogenic: acute lung injury/ARDS, sepsis,

nephrotic/RF/LF


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50yo man

Hemoptysis


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CXR- opacity

Describe? Opacity at R lower zone

Mediastinal shift

Causes? Bronchogenic carcinoma

TB (tuberculoma)

pneumonia


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Lung fibrosis

Describe?

Reticular-nodular/ground glass/honeycomb Area: midzone/apical/basal- bilateral

Shrinkage of lung

Heart border/diaphragm blurring

Shift of mediastinum & trachea toward shadowing

Less distinct vascular marking

Dx? Pulmonary fibrosis

3 signs? Progressive SOB

Clubbing

Fine end-inspi crackles

Ix? Spirometry (restrictive)

CT/HRCT lung


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42yo female

cough + fever 1 week

SOB 2 days


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CXR- Pneumonia

Describe?

Consolidation of R middle lobe

Dx?

Lobar pneumonia of R middle lobe

2 etiological agents?

Strep. Pneumoniae

Hemophilus Influenzae

* Staphy. Aureus (bilat cavitating bronchopneumonia)


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CXR- pneumothorax Abnormalities seen?

L lung hollow/black lung field & loss vascular markings

Mediastinal/tracheal shift to right L collapsed lung

Lung edge visible

Dx?

L pneumothorax

4 precipitating factors/causes? Trauma/rib fracture/iatrogenic (CVL)

Spontaneous Primary: Tall thin young man

Secondary COPD/Chronic asthma

Pneumonia/TB

Emphysema

Rheumatoid lung dz

Marfan syndrome

CF/histiocytosis X/sarcoidosis


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50yo man, productive cough + LOW


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CXR- R upper lobe collapse

Describe?

Opacities/haziness in RUZ + perihilar R horizontal fissure prominent

R tracheal deviation

Dx? R upper lobe collapse

Causes? Lung Ca/foreign body

PTB/pneumonia

2 Ix? Sputum FEME + cytology + AFB

Bronchoscopy + biopsy


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CXR- globular heart

Describe? Large globular heart

Massive cardiomegaly

Causes? Pericardial effusion Cardiac tamponade

Dilated cardiomyopathy

Severe ASD

Other Ix? ECG (axis? low voltage?)

Echo/TEE


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CXR b hi t i


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CXR- bronchiectasis Describe?

Ring shadow/honey comb

Tramline @ periphery

Tubular shadow (solid thick white


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ERCP + X ray + CT scan- Ca pancreas

Pathology?

Macro: infiltration, hard, irregular

Micro: adeno/acinar cell/cystadeno-Ca, undiff

Spread?

Direct: CBD, duodenum, portal vein, IVC

Lymphatic: adjacent + porta hepatis

Blood: liver, lung

Transcelomic: peritoneal seeding, ascites

S&S?

Painless progressive jaundice

Pain: epigastric, dull continuous, radiate upper lumbar

Intermittent jaundice: if necrosis of tumour

DM/glycosuria, thrombophlebitis migrans

LOW LOA

Ix?

Imaging (U/S, endoscopy, Barium swallow)

Serum amylase (rarely increase), biochem of obs jaundice

Rx?

Surgical resection: Whipples pancreaticoduodenectomy Palliative bypass: choledochojejunostomy


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IVU/IVP

Type of imaging?

Intravenous urogram/pyelogram

Abnormalities? Dilated L renal calyse and L ureter

L unilateralhydronephrosis and hydroureter

Causes? Mechanical obstruction

Luminal: stone, blood clot, sloughed papilla,renal/ureteric/bladder tumour

Intramural: congenital/acquired stricture, posterior urethral valve,neuropathic bladder, schistosomiasis, bladder neck stenosis,PUJ obstruction

Extramural: abd/pelvic/prostate mass/tumour, retroperitonealfibrosis, pregnancy, periurethral abscess/hematoma

General/neurological:

post-op

CNS dz (MS, tabes,

spinal tumour)

drugs(anticholinergic,

antidepressant)


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50yo man,

intermittent R loin pain


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AXR/KUB- renal calculi

Describe?

Radio-opaque mass noted at R kidney

Dx? Renal staghorn calculi

Cx? Hydronephrosis/pyelo-nephrosis/-nephritis

Renal failure

SCC

2 other Ix? IVU (filling defect/impaired renal fx)

Renal U/S (exclude hydronephrosis/hydroureter)


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Esophageal CA What is it?

Barium swallow

Describe? Irregular stricture

Shouldering of upper end

Dx? Ca esophagus

Presenting S&S? Dysphagia

LOW

LOA


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AXR- small bowel obstruction

Describe? Ladder pattern of dilated loops

Central position Striations complete across width of loops (valvulae

conniventes/circular mucosal fold)

>3cm 5cm


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Presented with abd

distension, vomiting


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AXR- intestinal obstruction

3 abnormalities?

Dilated bowel Multiple air fluid level (normal


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Barium enema- Ca colon

Ix name? Barium enema

Describe?

Filling defect + shouldering (apple-core) Annular stricture (irregular)

Dx? Ca colon

S&S? Altered bowel habit (> rectosigmoid)

LOW LOA anemia (> cecum)


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Hand X-ray- RA Describe?

Bony erosions

Joint deformities Reduced joint space

Dx? Rheumatoid arthritis

2 abnormalities in CXR? pleural effusion

pulmonary fibrosis

Caplans syndrome (presence of rheumatoid lung nodules in

combination with pneumoconiosis)

Why need lateral cervical spine X-ray? Atlanto-axial subluxationthreaten cord

* heart: pericardial rub, murmur (AR)


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20yo man, acute

headache, unconscious

CT b i h h


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CT brain- hemorrhage Name this Ix?

CT scan of brain

Describe? Hyperdense (recent hemorrhage, calcified lesion, contrast enhancement)

Mass effect: displace compress lat ventricles

Midline shift

Ventricular dilatation (CSF obs/atrophy of brain tissue)

Widened cortical sulci (brain atrophy)

Cerebral edema??

Dx? Cerebral hemorrhage

Common causes? Hypertension (Charcot-Bouchard aneurysm)

Aneurysm AVM

Other Ix? CT/MRI brain

angiography

Hypodense (black):

Neoplasm/infarction

Edema (surrounding)

Cerebral hemorrhage:

usually in the region of the

internal capsule by the

rupture of the

lenticulostriate artery


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Stroke patient aft fall, previous hx of atrial valve dz,

on anticoagulation


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CXR- Thymoma

Describe? Sail shape?

S&S?

50% asymptomatic 30% local symptoms (encroachment to adjacent

structures): cough, chest pain, SVC compression

20% identified during Ix of MG

Ix? CT scan (contrast enhancement)

Mediastinoscopy + biopsy

Thymoma- assoc condition:MG

haematologic cytopenia

hypo gamma-globulinaemia

autoimmune dz


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56yo palpitation 1 day

At i l fl tt


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Atrial flutter

Cardiac rhythm? Atrial flutter with various AV-nodal block

sawtooth/F waves

2 other abnormalities?

Reverse tick = digitalis use Regular tachycardia (if 2:1 block)

narrow QRS

3 causes? CVS: IHD, HPT, chronic rheumatic valvular dz

Others: sepsis, atrial enlargement, digoxin,thyrotoxicosis


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At i l t h di


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Atrial tachycardia

Describe?

Tachycardia (regular narrow QRS) Clear visible P wave precedes each QRS

RP interval longer/equal PR interval (VS: AV

reciprocating tachycardia)

Causes?

Digoxin toxicity

IHD, RHD, cardiomyopathy Sick sinus syndrome

COPD

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Osce Radiology 110401045630 Phpapp01

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