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Osce radiology

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OSCE- Radiology Phase IIIa sienmingoat
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Page 1: Osce  radiology

OSCE- Radiology

Phase IIIa

sienmingoat

Page 2: Osce  radiology
Page 3: Osce  radiology
Page 4: Osce  radiology

CXR- pulmonary edema

• Describe? – Perihilar shadowing (bat’s 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

Page 5: Osce  radiology

50yo man

Hemoptysis

Page 6: Osce  radiology

CXR- opacity

• Describe?– Opacity at R lower zone– Mediastinal shift

• Causes?– Bronchogenic carcinoma– TB (tuberculoma)– pneumonia

Page 7: Osce  radiology
Page 8: Osce  radiology

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

Page 9: Osce  radiology

42yo female

cough + fever 1 week

SOB 2 days

Page 10: Osce  radiology

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)

Page 11: Osce  radiology
Page 12: Osce  radiology

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

Page 13: Osce  radiology

50yo man, productive cough + LOW

Page 14: Osce  radiology

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

Page 15: Osce  radiology
Page 16: Osce  radiology

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

Page 17: Osce  radiology
Page 18: Osce  radiology

CXR- bronchiectasis• Describe?

– Ring shadow/honey comb– Tramline @ periphery– Tubular shadow (solid thick white <8mm)– Glove finger shadow

• DX?– Bronchietasis (H.influ, S.pneu, S.aureus, P.aeruginosa)

• Presentation?– Persistent cough, copious sputum, intermittent hemoptysis– Clubbing, coarse inspi creps, wheeze/rhonchi

• Cx?– Pneumonia/effusion/pneumothorax/hemoptysis– Cerebral abscess, amyloidosis

• Causes?– Congenital

• Ciliary dysfx syndrome (Kartagener/ 1 ciliary dyskinesia)• CF• 1 hypogamma-globulinemia

– Acquired • Pneumonia (supp/viral)/PTB• Bronchial tumour/foreign body• Whooping cough/measles (childhood)

Page 19: Osce  radiology
Page 20: Osce  radiology

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: Whipple’s pancreaticoduodenectomy– Palliative bypass: choledochojejunostomy

Page 21: Osce  radiology
Page 22: Osce  radiology

IVU/IVP• Type of imaging?

– Intravenous urogram/pyelogram

• Abnormalities?– Dilated L renal calyse and L ureter– L unilateral hydronephrosis 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, retroperitoneal fibrosis, pregnancy, periurethral abscess/hematoma

General/neurological:

• post-op

• CNS dz (MS, tabes, spinal tumour)

• drugs (anticholinergic, antidepressant)

Page 23: Osce  radiology

50yo man,

intermittent R loin pain

Page 24: Osce  radiology

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)

Page 25: Osce  radiology
Page 26: Osce  radiology

Esophageal CA• What is it?

– Barium swallow

• Describe?– Irregular stricture– Shouldering of upper end

• Dx?– Ca esophagus

• Presenting S&S?– Dysphagia– LOW– LOA

Page 27: Osce  radiology
Page 28: Osce  radiology

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

• Causes?– Luminal: fecal/food, gallstone ileus, pedunculated tumour– Intramural: congenital atresia, tumour, Crohn’s dz,

diverticulitis– Extramural: strangulated hernia, volvulus/intussusception,

adhesion/banding

• 2 S&S?– Vomiting– Abd pain– Abd distension– constipation

Vs large bowel:

• Peripheral

• Haustrations of taenia coli

• >5cm

Page 29: Osce  radiology

Presented with abd distension, vomiting

Page 30: Osce  radiology

AXR- intestinal obstruction

• 3 abnormalities?– Dilated bowel– Multiple air fluid level (normal <4)– Paucity of air distal to obstruction

• Dx?– Intestinal obstruction

• 2 causes?– Adhesion/banding– Tumour (pedunculated/intramural)

Page 31: Osce  radiology
Page 32: Osce  radiology

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)

Page 33: Osce  radiology
Page 34: Osce  radiology

Hand X-ray- RA• Describe?

– Bony erosions– Joint deformities– Reduced joint space

• Dx?– Rheumatoid arthritis

• 2 abnormalities in CXR?– pleural effusion– pulmonary fibrosis– Caplan’s syndrome (presence of rheumatoid lung nodules in

combination with pneumoconiosis)

• Why need lateral cervical spine X-ray?– Atlanto-axial subluxation threaten cord

* heart: pericardial rub, murmur (AR)

Page 35: Osce  radiology

20yo man, acute headache, unconscious

Page 36: Osce  radiology

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

Page 37: Osce  radiology

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

Page 38: Osce  radiology

CT- subdural hemorrhage• Describe?

– Hyperdense crescent-shaped hematoma– Midline shift– Compress ventricle

• Dx?– Subdural hemorrhage

• Causes?– Head injury (venous rupture)

• Risk factor?– Elderly– Alcoholic (accident prone + atrophic brain)– Anticoagulant

• S&S?– Headache, drowsy, confusion (fluctuate)– Long latent interval btw injury & symptoms

Page 39: Osce  radiology

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

Page 40: Osce  radiology
Page 41: Osce  radiology

56yo palpitation 1 day

Page 42: Osce  radiology

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

Page 43: Osce  radiology
Page 44: Osce  radiology

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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