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OSCE- Radiology Phase IIIa sienmingoat
 
 
CXR- pulmonary edema <ul><li>Describe?  </li></ul><ul><ul><li>Perihilar shadowing (bat’s wings)= alveolar edema </li></ul>...
50yo man  Hemoptysis
CXR- opacity <ul><li>Describe? </li></ul><ul><ul><li>Opacity at R lower zone </li></ul></ul><ul><ul><li>Mediastinal shift ...
 
Lung fibrosis <ul><li>Describe? </li></ul><ul><ul><li>Reticular-nodular/ground glass/honeycomb </li></ul></ul><ul><ul><li>...
42yo female cough + fever 1 week SOB 2 days
CXR- Pneumonia <ul><li>Describe? </li></ul><ul><ul><li>Consolidation of R middle lobe </li></ul></ul><ul><li>Dx? </li></ul...
 
CXR- pneumothorax <ul><li>Abnormalities seen? </li></ul><ul><ul><li>L lung hollow/black lung field & loss vascular marking...
50yo man, productive cough + LOW
CXR- R upper lobe collapse <ul><li>Describe? </li></ul><ul><ul><li>Opacities/haziness in RUZ + perihilar </li></ul></ul><u...
 
CXR- globular heart <ul><li>Describe? </li></ul><ul><ul><li>Large globular heart </li></ul></ul><ul><ul><li>Massive cardio...
 
CXR- bronchiectasis <ul><li>Describe? </li></ul><ul><ul><li>Ring shadow/honey comb </li></ul></ul><ul><ul><li>Tramline @ p...
 
ERCP + X ray + CT scan- Ca pancreas <ul><li>Pathology? </li></ul><ul><ul><li>Macro: infiltration, hard, irregular </li></u...
 
IVU/IVP <ul><li>Type of imaging? </li></ul><ul><ul><li>Intravenous urogram/pyelogram </li></ul></ul><ul><li>Abnormalities?...
50yo man,  intermittent R loin pain
AXR/KUB- renal calculi <ul><li>Describe? </li></ul><ul><ul><li>Radio-opaque mass noted at R kidney </li></ul></ul><ul><li>...
 
Esophageal CA <ul><li>What is it? </li></ul><ul><ul><li>Barium swallow </li></ul></ul><ul><li>Describe? </li></ul><ul><ul>...
 
AXR- small bowel obstruction <ul><li>Describe? </li></ul><ul><ul><li>Ladder pattern of dilated loops </li></ul></ul><ul><u...
Presented with abd distension, vomiting
AXR- intestinal obstruction <ul><li>3 abnormalities? </li></ul><ul><ul><li>Dilated bowel </li></ul></ul><ul><ul><li>Multip...
 
Barium enema- Ca colon <ul><li>Ix name? </li></ul><ul><ul><li>Barium enema </li></ul></ul><ul><li>Describe? </li></ul><ul>...
 
Hand X-ray- RA <ul><li>Describe? </li></ul><ul><ul><li>Bony erosions </li></ul></ul><ul><ul><li>Joint deformities </li></u...
20yo man, acute headache, unconscious
CT brain- hemorrhage <ul><li>Name this Ix? </li></ul><ul><ul><li>CT scan of brain </li></ul></ul><ul><li>Describe? </li></...
Stroke patient aft fall, previous hx of atrial valve dz, on anticoagulation
CT- subdural hemorrhage <ul><li>Describe? </li></ul><ul><ul><li>Hyperdense crescent-shaped hematoma </li></ul></ul><ul><ul...
CXR- Thymoma <ul><li>Describe? </li></ul><ul><ul><li>Sail shape? </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>50% asy...
 
56yo palpitation 1 day
Atrial flutter <ul><li>Cardiac rhythm? </li></ul><ul><ul><li>Atrial flutter with various AV-nodal block </li></ul></ul><ul...
 
Atrial tachycardia <ul><li>Describe? </li></ul><ul><ul><li>Tachycardia (regular narrow QRS) </li></ul></ul><ul><ul><li>Cle...
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Osce radiology

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Osce radiology

  1. 1. OSCE- Radiology Phase IIIa sienmingoat
  2. 4. CXR- pulmonary edema <ul><li>Describe? </li></ul><ul><ul><li>Perihilar shadowing (bat’s wings)= alveolar edema </li></ul></ul><ul><ul><li>Upper lobe diversion </li></ul></ul><ul><ul><li>Kerley B lines= interstitial edema </li></ul></ul><ul><ul><li>Cardiomegaly (LVF) </li></ul></ul><ul><ul><li>Pleural effusion? </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Pulmonary edema </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Cardiogenic: LVF, mitral stenosis, arrhythmias </li></ul></ul><ul><ul><li>Non-cardiogenic: acute lung injury/ARDS, sepsis, nephrotic/RF/LF </li></ul></ul>
  3. 5. 50yo man Hemoptysis
  4. 6. CXR- opacity <ul><li>Describe? </li></ul><ul><ul><li>Opacity at R lower zone </li></ul></ul><ul><ul><li>Mediastinal shift </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Bronchogenic carcinoma </li></ul></ul><ul><ul><li>TB (tuberculoma) </li></ul></ul><ul><ul><li>pneumonia </li></ul></ul>
  5. 8. Lung fibrosis <ul><li>Describe? </li></ul><ul><ul><li>Reticular-nodular/ground glass/honeycomb </li></ul></ul><ul><ul><li>Area: midzone/apical/basal- bilateral </li></ul></ul><ul><ul><li>Shrinkage of lung </li></ul></ul><ul><ul><li>Heart border/diaphragm blurring </li></ul></ul><ul><ul><li>Shift of mediastinum & trachea toward shadowing </li></ul></ul><ul><ul><li>Less distinct vascular marking </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Pulmonary fibrosis </li></ul></ul><ul><li>3 signs? </li></ul><ul><ul><li>Progressive SOB </li></ul></ul><ul><ul><li>Clubbing </li></ul></ul><ul><ul><li>Fine end-inspi crackles </li></ul></ul><ul><li>Ix? </li></ul><ul><ul><li>Spirometry (restrictive) </li></ul></ul><ul><ul><li>CT/HRCT lung </li></ul></ul>
  6. 9. 42yo female cough + fever 1 week SOB 2 days
  7. 10. CXR- Pneumonia <ul><li>Describe? </li></ul><ul><ul><li>Consolidation of R middle lobe </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Lobar pneumonia of R middle lobe </li></ul></ul><ul><li>2 etiological agents? </li></ul><ul><ul><li>Strep. Pneumoniae </li></ul></ul><ul><ul><li>Hemophilus Influenzae </li></ul></ul><ul><ul><li>* Staphy. Aureus (bilat cavitating bronchopneumonia) </li></ul></ul>
  8. 12. CXR- pneumothorax <ul><li>Abnormalities seen? </li></ul><ul><ul><li>L lung hollow/black lung field & loss vascular markings </li></ul></ul><ul><ul><li>Mediastinal/tracheal shift to right </li></ul></ul><ul><ul><li>L collapsed lung </li></ul></ul><ul><ul><li>Lung edge visible </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>L pneumothorax </li></ul></ul><ul><li>4 precipitating factors/causes? </li></ul><ul><ul><li>Trauma/rib fracture/iatrogenic (CVL) </li></ul></ul><ul><ul><li>Spontaneous </li></ul></ul><ul><ul><ul><li>Primary: Tall thin young man </li></ul></ul></ul><ul><ul><ul><li>Secondary </li></ul></ul></ul><ul><ul><ul><ul><li>COPD/Chronic asthma </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pneumonia/TB </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Emphysema </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Rheumatoid lung dz </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Marfan syndrome </li></ul></ul></ul></ul><ul><ul><ul><ul><li>CF/histiocytosis X/sarcoidosis </li></ul></ul></ul></ul>
  9. 13. 50yo man, productive cough + LOW
  10. 14. CXR- R upper lobe collapse <ul><li>Describe? </li></ul><ul><ul><li>Opacities/haziness in RUZ + perihilar </li></ul></ul><ul><ul><li>R horizontal fissure prominent </li></ul></ul><ul><ul><li>R tracheal deviation </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>R upper lobe collapse </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Lung Ca/foreign body </li></ul></ul><ul><ul><li>PTB/pneumonia </li></ul></ul><ul><li>2 Ix? </li></ul><ul><ul><li>Sputum FEME + cytology + AFB </li></ul></ul><ul><ul><li>Bronchoscopy + biopsy </li></ul></ul>
  11. 16. CXR- globular heart <ul><li>Describe? </li></ul><ul><ul><li>Large globular heart </li></ul></ul><ul><ul><li>Massive cardiomegaly </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Pericardial effusion </li></ul></ul><ul><ul><li>Cardiac tamponade </li></ul></ul><ul><ul><li>Dilated cardiomyopathy </li></ul></ul><ul><ul><li>Severe ASD </li></ul></ul><ul><li>Other Ix? </li></ul><ul><ul><li>ECG (axis? low voltage?) </li></ul></ul><ul><ul><li>Echo/TEE </li></ul></ul>
  12. 18. CXR- bronchiectasis <ul><li>Describe? </li></ul><ul><ul><li>Ring shadow/honey comb </li></ul></ul><ul><ul><li>Tramline @ periphery </li></ul></ul><ul><ul><li>Tubular shadow (solid thick white <8mm) </li></ul></ul><ul><ul><li>Glove finger shadow </li></ul></ul><ul><li>DX? </li></ul><ul><ul><li>Bronchietasis (H.influ, S.pneu, S.aureus, P.aeruginosa) </li></ul></ul><ul><li>Presentation? </li></ul><ul><ul><li>Persistent cough, copious sputum, intermittent hemoptysis </li></ul></ul><ul><ul><li>Clubbing, coarse inspi creps, wheeze/rhonchi </li></ul></ul><ul><li>Cx? </li></ul><ul><ul><li>Pneumonia/effusion/pneumothorax/hemoptysis </li></ul></ul><ul><ul><li>Cerebral abscess, amyloidosis </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Congenital </li></ul></ul><ul><ul><ul><li>Ciliary dysfx syndrome (Kartagener/ 1 ciliary dyskinesia) </li></ul></ul></ul><ul><ul><ul><li>CF </li></ul></ul></ul><ul><ul><ul><li>1 hypogamma-globulinemia </li></ul></ul></ul><ul><ul><li>Acquired </li></ul></ul><ul><ul><ul><li>Pneumonia (supp/viral)/PTB </li></ul></ul></ul><ul><ul><ul><li>Bronchial tumour/foreign body </li></ul></ul></ul><ul><ul><ul><li>Whooping cough/measles (childhood) </li></ul></ul></ul>
  13. 20. ERCP + X ray + CT scan- Ca pancreas <ul><li>Pathology? </li></ul><ul><ul><li>Macro: infiltration, hard, irregular </li></ul></ul><ul><ul><li>Micro: adeno/acinar cell/cystadeno-Ca, undiff </li></ul></ul><ul><li>Spread? </li></ul><ul><ul><li>Direct: CBD, duodenum, portal vein, IVC </li></ul></ul><ul><ul><li>Lymphatic: adjacent + porta hepatis </li></ul></ul><ul><ul><li>Blood: liver, lung </li></ul></ul><ul><ul><li>Transcelomic: peritoneal seeding, ascites </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>Painless progressive jaundice </li></ul></ul><ul><ul><li>Pain: epigastric, dull continuous, radiate upper lumbar </li></ul></ul><ul><ul><li>Intermittent jaundice: if necrosis of tumour </li></ul></ul><ul><ul><li>DM/glycosuria, thrombophlebitis migrans </li></ul></ul><ul><ul><li>LOW LOA </li></ul></ul><ul><li>Ix? </li></ul><ul><ul><li>Imaging (U/S, endoscopy, Barium swallow) </li></ul></ul><ul><ul><li>Serum amylase (rarely increase), biochem of obs jaundice </li></ul></ul><ul><li>Rx? </li></ul><ul><ul><li>Surgical resection: Whipple’s pancreaticoduodenectomy </li></ul></ul><ul><ul><li>Palliative bypass: choledochojejunostomy </li></ul></ul>
  14. 22. IVU/IVP <ul><li>Type of imaging? </li></ul><ul><ul><li>Intravenous urogram/pyelogram </li></ul></ul><ul><li>Abnormalities? </li></ul><ul><ul><li>Dilated L renal calyse and L ureter </li></ul></ul><ul><ul><li>L unilateral hydronephrosis and hydroureter </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Mechanical obstruction </li></ul></ul><ul><ul><li>Luminal: stone, blood clot, sloughed papilla, renal/ureteric/bladder tumour </li></ul></ul><ul><ul><li>Intramural: congenital/acquired stricture, posterior urethral valve, neuropathic bladder, schistosomiasis, bladder neck stenosis, PUJ obstruction </li></ul></ul><ul><ul><li>Extramural: abd/pelvic/prostate mass/tumour, retroperitoneal fibrosis, pregnancy, periurethral abscess/hematoma </li></ul></ul><ul><li>General/neurological : </li></ul><ul><li>post-op </li></ul><ul><li>CNS dz (MS, tabes, spinal tumour) </li></ul><ul><li>drugs (anticholinergic, antidepressant) </li></ul>
  15. 23. 50yo man, intermittent R loin pain
  16. 24. AXR/KUB- renal calculi <ul><li>Describe? </li></ul><ul><ul><li>Radio-opaque mass noted at R kidney </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Renal staghorn calculi </li></ul></ul><ul><li>Cx? </li></ul><ul><ul><li>Hydronephrosis/pyelo-nephrosis/-nephritis </li></ul></ul><ul><ul><li>Renal failure </li></ul></ul><ul><ul><li>SCC </li></ul></ul><ul><li>2 other Ix? </li></ul><ul><ul><li>IVU (filling defect/impaired renal fx) </li></ul></ul><ul><ul><li>Renal U/S (exclude hydronephrosis/hydroureter) </li></ul></ul>
  17. 26. Esophageal CA <ul><li>What is it? </li></ul><ul><ul><li>Barium swallow </li></ul></ul><ul><li>Describe? </li></ul><ul><ul><li>Irregular stricture </li></ul></ul><ul><ul><li>Shouldering of upper end </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Ca esophagus </li></ul></ul><ul><li>Presenting S&S? </li></ul><ul><ul><li>Dysphagia </li></ul></ul><ul><ul><li>LOW </li></ul></ul><ul><ul><li>LOA </li></ul></ul>
  18. 28. AXR- small bowel obstruction <ul><li>Describe? </li></ul><ul><ul><li>Ladder pattern of dilated loops </li></ul></ul><ul><ul><li>Central position </li></ul></ul><ul><ul><li>Striations complete across width of loops (valvulae conniventes/circular mucosal fold) </li></ul></ul><ul><ul><li>>3cm <5cm </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Luminal: fecal/food, gallstone ileus, pedunculated tumour </li></ul></ul><ul><ul><li>Intramural: congenital atresia, tumour, Crohn’s dz, diverticulitis </li></ul></ul><ul><ul><li>Extramural: strangulated hernia, volvulus/intussusception, adhesion/banding </li></ul></ul><ul><li>2 S&S? </li></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Abd pain </li></ul></ul><ul><ul><li>Abd distension </li></ul></ul><ul><ul><li>constipation </li></ul></ul><ul><li>Vs large bowel: </li></ul><ul><li>Peripheral </li></ul><ul><li>Haustrations of taenia coli </li></ul><ul><li>>5cm </li></ul>
  19. 29. Presented with abd distension, vomiting
  20. 30. AXR- intestinal obstruction <ul><li>3 abnormalities? </li></ul><ul><ul><li>Dilated bowel </li></ul></ul><ul><ul><li>Multiple air fluid level (normal <4) </li></ul></ul><ul><ul><li>Paucity of air distal to obstruction </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Intestinal obstruction </li></ul></ul><ul><li>2 causes? </li></ul><ul><ul><li>Adhesion/banding </li></ul></ul><ul><ul><li>Tumour (pedunculated/intramural) </li></ul></ul>
  21. 32. Barium enema- Ca colon <ul><li>Ix name? </li></ul><ul><ul><li>Barium enema </li></ul></ul><ul><li>Describe? </li></ul><ul><ul><li>Filling defect + shouldering (apple-core) </li></ul></ul><ul><ul><li>Annular stricture (irregular) </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Ca colon </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>Altered bowel habit (> rectosigmoid) </li></ul></ul><ul><ul><li>LOW LOA anemia (> cecum) </li></ul></ul>
  22. 34. Hand X-ray- RA <ul><li>Describe? </li></ul><ul><ul><li>Bony erosions </li></ul></ul><ul><ul><li>Joint deformities </li></ul></ul><ul><ul><li>Reduced joint space </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Rheumatoid arthritis </li></ul></ul><ul><li>2 abnormalities in CXR? </li></ul><ul><ul><li>pleural effusion </li></ul></ul><ul><ul><li>pulmonary fibrosis </li></ul></ul><ul><ul><li>Caplan’s syndrome (presence of rheumatoid lung nodules in combination with pneumoconiosis) </li></ul></ul><ul><li>Why need lateral cervical spine X-ray? </li></ul><ul><ul><li>Atlanto-axial subluxation  threaten cord </li></ul></ul><ul><li>* heart: pericardial rub, murmur (AR) </li></ul>
  23. 35. 20yo man, acute headache, unconscious
  24. 36. CT brain- hemorrhage <ul><li>Name this Ix? </li></ul><ul><ul><li>CT scan of brain </li></ul></ul><ul><li>Describe? </li></ul><ul><ul><li>Hyperdense (recent hemorrhage, calcified lesion, contrast enhancement) </li></ul></ul><ul><ul><li>Mass effect: displace compress lat ventricles </li></ul></ul><ul><ul><li>Midline shift </li></ul></ul><ul><ul><li>Ventricular dilatation (CSF obs/atrophy of brain tissue) </li></ul></ul><ul><ul><li>Widened cortical sulci (brain atrophy) </li></ul></ul><ul><ul><li>Cerebral edema?? </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Cerebral hemorrhage </li></ul></ul><ul><li>Common causes? </li></ul><ul><ul><li>Hypertension (Charcot-Bouchard aneurysm) </li></ul></ul><ul><ul><li>Aneurysm </li></ul></ul><ul><ul><li>AVM </li></ul></ul><ul><li>Other Ix? </li></ul><ul><ul><li>CT/MRI brain </li></ul></ul><ul><ul><li>angiography </li></ul></ul><ul><li>Hypodense (black): </li></ul><ul><li>Neoplasm/infarction </li></ul><ul><li>Edema (surrounding) </li></ul>Cerebral hemorrhage: usually in the region of the internal capsule by the rupture of the lenticulostriate artery
  25. 37. Stroke patient aft fall, previous hx of atrial valve dz, on anticoagulation
  26. 38. CT- subdural hemorrhage <ul><li>Describe? </li></ul><ul><ul><li>Hyperdense crescent-shaped hematoma </li></ul></ul><ul><ul><li>Midline shift </li></ul></ul><ul><ul><li>Compress ventricle </li></ul></ul><ul><li>Dx? </li></ul><ul><ul><li>Subdural hemorrhage </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Head injury (venous rupture) </li></ul></ul><ul><li>Risk factor? </li></ul><ul><ul><li>Elderly </li></ul></ul><ul><ul><li>Alcoholic (accident prone + atrophic brain) </li></ul></ul><ul><ul><li>Anticoagulant </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>Headache, drowsy, confusion (fluctuate) </li></ul></ul><ul><ul><li>Long latent interval btw injury & symptoms </li></ul></ul>
  27. 39. CXR- Thymoma <ul><li>Describe? </li></ul><ul><ul><li>Sail shape? </li></ul></ul><ul><li>S&S? </li></ul><ul><ul><li>50% asymptomatic </li></ul></ul><ul><ul><li>30% local symptoms (encroachment to adjacent structures): cough, chest pain, SVC compression </li></ul></ul><ul><ul><li>20% identified during Ix of MG </li></ul></ul><ul><li>Ix? </li></ul><ul><ul><li>CT scan (contrast enhancement) </li></ul></ul><ul><ul><li>Mediastinoscopy + biopsy </li></ul></ul><ul><li>Thymoma- assoc condition : </li></ul><ul><li>MG </li></ul><ul><li>haematologic cytopenia </li></ul><ul><li>hypo gamma-globulinaemia </li></ul><ul><li>autoimmune dz </li></ul>
  28. 41. 56yo palpitation 1 day
  29. 42. Atrial flutter <ul><li>Cardiac rhythm? </li></ul><ul><ul><li>Atrial flutter with various AV-nodal block </li></ul></ul><ul><ul><li>sawtooth/F waves </li></ul></ul><ul><li>2 other abnormalities? </li></ul><ul><ul><li>Reverse tick = digitalis use </li></ul></ul><ul><ul><li>Regular tachycardia (if 2:1 block) </li></ul></ul><ul><ul><li>narrow QRS </li></ul></ul><ul><li>3 causes? </li></ul><ul><ul><li>CVS: IHD, HPT, chronic rheumatic valvular dz </li></ul></ul><ul><ul><li>Others: sepsis, atrial enlargement, digoxin, thyrotoxicosis </li></ul></ul>
  30. 44. Atrial tachycardia <ul><li>Describe? </li></ul><ul><ul><li>Tachycardia (regular narrow QRS) </li></ul></ul><ul><ul><li>Clear visible P wave precedes each QRS </li></ul></ul><ul><ul><li>RP interval longer/equal PR interval (VS: AV reciprocating tachycardia) </li></ul></ul><ul><li>Causes? </li></ul><ul><ul><li>Digoxin toxicity </li></ul></ul><ul><ul><li>IHD, RHD, cardiomyopathy </li></ul></ul><ul><ul><li>Sick sinus syndrome </li></ul></ul><ul><ul><li>COPD </li></ul></ul>

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