OSCE- Radiology

Phase IIIa
sienmingoat

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
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: Whipples 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, Crohns 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
Caplans 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