Os i2

OSCE PEDIATRICS
IMAGING part two
X-Rays/CT/MRI
www.dnbpediatrics.com

Questions
1. Diagnosis?
2. What are the first two steps in treatment of
hypoxic spell?
3. In a cyanotic newborn, how can you
distinguish pulmonary disease from cyanotic
congenital heart disease?
4. Which cardiac conditions are associated with
following
a. Egg Shaped Heart
b. Snowman silhouette
c. Rib notching

Answers
1. Cyanotic Congenital Heart Disese
Probably TOF
– The heart size is normal
– Pulmonary vascular markings are decreased
– A hypoplastic main pulmonary artery
segment contributes to the formation of the
“boot-shaped” heart.
1.5
Pediatric cardiology
Myung K Park 5th ed

Answers
2. Knee Chest Position
Morphine
3. Hyperoxia Test
4. X-ray appearances
a. Egg Shaped Heart Transposition of great arteries
b. Snowman silhouette Total anomalous pulmonary
venous return (supracardiac)
c. Rib notching Co-arctation of aorta (long
standing)
1
1
1
0.5
0.5
0.5

3 day neonate with
• Lethargy
• Feed refusal
• Abdominal
distension

Questions
1. What stage of NEC is depicted in the
X-ray?
2. What is the radiological feature of Bell
stage III NEC?
3. Name two more conditions associated
with pneumatosis intestinalis?

Answers
1. NEC Stage II
2. Pneumoperitoneum
3. Any two of following
Hirschsprung's
disease, Pseudomembranous
enterocolitis, Neonatal ulcerative colitis,
Ischemic bowel disease
1
1
2

• 6 weeks infant
• Case of Cholestatic
jaundice (Extra-Hepatic
Biliary Atresia)
• c/o swelling left thigh

Questions
1. What is the likely cause of fracture femur
in this case?
2. How can this complication be prevented?
3. How do you manage pruritus in these
patients?
4. An infant with cholestasis, triangular
facies, and a pulmonic stenosis murmur
is likely to have what syndrome?

Answers
1. Metabolic Bone disease (secondary to
Vitamin D deficiency due to
malabsorption of fat soluble vitamins)
2. Replace 5,000-8,000 U /d of D2,or
3 -5 µg/kq/d of 25-hydroxycholecalciferol
3. Ursodeoxycholic acid l5-20 mg/kg/day
4. Alagille syndrome
(Arteriohepatic dysplasia)
1
1
1
1

• Previously healthy 7
years girl c/o
• Sudden onset
weakness right upper
and lower limb
• Facial palsy right
(UMN)
• Normal sensorium
• No fever/ trauma/
seizures
L
c
t

Questions
1. What is the level of lesion on MRI?
2. What are the structures marked
c
t
3. Which hemoglobinopathy can be
associated with this kind of presentation?
4. A dilated and unreactive pupil indicates
the compression of what structure?

Answers
1. Infarct in the left basal ganglia, the
posterior limb of internal capsule, and the
head of the caudate
2

Answers
2. C Caudate
nucleus
T Thalamus
P Putamen
G Globus pallidus
White arrows indicate
the ant and post limbs
of internal capsule
0.5
0.5

Answers
3. Sickle cell anemia
4. Compression of 3rd cranial nerve
1
1

• 5 years girl c/o
• Right focal seizureL

Questions
1. Describe the CT finding specifically the
location of lesion.
2. What is the most probable diagnosis?
3. Name one infectious etiology D/D.
4. What is the treatment?

Answers
1. Intraparenchymal ring-enhancing lesion
in the left parietal lobe
2. Neurocysticercosis
3. Tuberculoma
4. Corticosteroids starting 2-3 days before
and continuing 2-3 days after
antihelminth
Albendazole
0.5
0.5
1
1
1
1

1. Diagnosis
2. What are the
embryologic
events that lead to
this development?
3. What are three
causes of
respiratory distress
in a baby born with
this condition?

Answers
1. Congenital Diagphragmatic Hernia
2. The posterolateral portion of the diaphragm
has remained open between the ninth and
tenth weeks of gestation as a result the viscera
will pass into the chest, and a CDH will result.
3. a) Mechanical compression of the lungs from
the herniated viscera
b) Pulmonary hypoplasia from compression of
the developing lungs in utero
c) Pulmonary hypertension

Questions
• Describe the lesion?
• Give two D/D
• What is the triad of tumor lysis syndrome?

Answers
• Osteolytic lesion of skull
• Histiocytosis
Metastasis
• Hyperuricemia, hyperkalemia, and
hyperphosphatemia
1
1
1
3

Questions
1. Describe the X-ray appearance
2. Pathogenesis of the appearance
3. Possible Diagnosis
4. Which disorder is most commonly
associated with an elevated MCHC?
5. How is the corrected reticulocyte count
calculated?

Answers
1. Sunray appearance
2. Medullary widening
3. Chronic hemolytic anaemia
4. Hereditary spherocytosis
5. Corrected retic count
= reticulocyte % × (patient Hct/normal Hct)
1
1
1
1
1

Below is a midline sagittal cut of a MRI scan of the brain.
View the midline anatomic diagram of the brain and identify
the following structures

Answer
• S - Suprasellar cistern
• P0 - Pons
• P - Midbrain (cerebral peduncles)
• M - Medulla
• C - Quadrigeminal plate (superior
and inferior colliculi)
• Q - Quadrigeminal cistern
• V - Fourth ventricle
1 mark eachwww.dnbpediatrics.com

Question
1. Diagnosis?
2. What is the emergency management of
the condition?
3. What is subsequent management after
the emergency management is over?

Answers
1. Pneumothorax,
with mediastinal shift
2. Put in a needle in second intercostal
space
3. Intercostal drain
1
1
1
1

Questions
1. What is the diagnosis?
2. Describe three features seen on the X-
ray of the disease?
3. What biochemical test would help clinch
the diagnosis?
4. What is the treatment of the condition?

Answers
1. Rickets
2. a) Cupping
b) Slaying
c) Fraying
3. Calcium, Phosphorus, Alkaline
phosphatase
4. Injection Vitamin D 6 lac unit IM stat
PO Calcium
1
0.5
0.5
0.5
1.5
1
1

• Describe the lesion?
• Give atleast two D/D

• Osteolytic lesion of skull
• Histiocytosis
Metastasis

Questions
1. Describe the X-ray appearance
2. Pathogenesis of the appearance
3. Possible Diagnosis

Answers
1. Sunray appearance
2. Medullary widening
3. Chronic hemolytic anaemia
1
1
1

Questions
2. What is the clinical sign for the diagnosis
called as?
3. Name one intervention which can lead to
this?

Answers
1. Pneumopericardium
2. Hammans sign
3. Invasive ventilation with high pressures
1
1
1

• X-ray neck
lateral view
in a child with
respiratory
distress

Questions
2. Which is the commonest organism
implicated in this disease?
3. What antibiotics are useful in this
condition?

Answers
1. Epiglottitis 1
2. Hemophilus influenzae type B 1
3. Cephalosporins/ Ampicillin/ sulbactam 1

Questions
1. Diagnosis
2. By what gestational age would this
defect occur?
3. This can be prevented in subsequent
pregnancies by intake of Folic acid. Folic
acid should be taken in what dose and
started when?

Answers
1. Occipital Encephalocele
2. 26 days post conception
3. Folic acid
Dose: 0.4mg/day
Periconceptional period
1
1
1
1

Questions
1. Diagnosis
2. What is the clinical
picture?
3. What is the
requirement of echo
before surgery?

Answers
1. Tracheo-esophageal fistula
2. Excessive drooling
Respiratory distress
3. To rule out associated
Congenital heart diseases
Right sided aorta

• If patient presents with fever and
toxaemia, give three differential diagnosis
• Give three modalities of management

1. Lung Abcess
2. Infected Bronchogenic cyst
3. Infected Hydatid Cyst
1. Antibiotics (anaerobic +aerobic)
2. Chest physiotherapy
3. Percutaneous CT guided aspiration
0.5 each
Total 3 markswww.dnbpediatrics.com

Questions
1. What grade of VUR
is shown in MCU?
2. How is VUR
graded?
3. What is normal
bladder capacity?
4. Surgery is the initial
treatment in which
grades of VUR?

Answers
1. Grade V
2. Grade I: Ureter only
Grade II: Ureter, pelvis, and calices; no dilation, normal
caliceal fornices
Grade III: Mild dilation and/or tortuosity of the ureter
and mild dilation of the renal pelvis; minor blunting
of the fornices
Grade IV: Moderate dilation and/or tortuosity of the
ureter and moderate dilation of the renal
Grade V: Significant blunting of most fornices; papillary
impressions are no longer visible in most of the
calices; gross dilation and tortuosity of the ureter;
gross dilation of the renal pelvis and calices
1
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0.5
0.5
0.5
0.5

Answers
3. Volume (in ounces) = Patient's age (in
years) + 2.
4. Grade III/IV bilateral reflux
Grade V reflux
0.5
0.5
0.5

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