osce radiology
DESCRIPTION
TRANSCRIPT
OSCE- Radiology
Phase IIIa
sienmingoat
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
50yo man
Hemoptysis
CXR- opacity
• Describe?– Opacity at R lower zone– Mediastinal shift
• Causes?– Bronchogenic carcinoma– TB (tuberculoma)– pneumonia
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
42yo female
cough + fever 1 week
SOB 2 days
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)
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
50yo man, productive cough + LOW
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
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
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)
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
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)
50yo man,
intermittent R loin pain
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)
Esophageal CA• What is it?
– Barium swallow
• Describe?– Irregular stricture– Shouldering of upper end
• Dx?– Ca esophagus
• Presenting S&S?– Dysphagia– LOW– LOA
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
Presented with abd distension, vomiting
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)
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)
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)
20yo man, acute headache, unconscious
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
Stroke patient aft fall, previous hx of atrial valve dz, on anticoagulation
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
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
56yo palpitation 1 day
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
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