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Os i1

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  • 1. OSCE PEDIATRICS IMAGING part One X-Rays/CT/MRI www.dnbpediatrics.com
  • 2. • If patient presents with fever and toxaemia, give three differential diagnosis • Give three modalities of management www.dnbpediatrics.com
  • 3. 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
  • 4. • What is the lesion ? • Give two management modalities. • What complication can occur during management & how can it be prevented? www.dnbpediatrics.com
  • 5. Q1: • NCC 1 Q2: • Anticonvulsants 1 • Albendazole • Increase in Cerebral Edema 1 • Use steroid cover Total 3 marks www.dnbpediatrics.com
  • 6. • Describe the lesion. • What are the management modalities of such lesions especially if they are leading to complications ? www.dnbpediatrics.com
  • 7. • Haemangioma scalp 1 • Conservative 2 • Oral steroids • Local steroids • PDL: pulse dyed laser • IFN alfa interferon (in case of haemangiomas causing pressure effects or erosion leading to significant morbidity) Total 3 markswww.dnbpediatrics.com
  • 8. • What are two imp radiological abnormalities? • What is the diagnosis ? • What are the three imp investigations ? • What are the metabolic abnormalities expected? • What is the management ? www.dnbpediatrics.com
  • 9. • Q1Distension of stomach • No gas in the intestines • Q2Pyloric Stenosis • Q3USS abdomen: pyloric thickness >4mm/ pyloric length >14 mm S electrolytes Ba studies • Q4Hypochloremic, hypokalemic, metabolic alkalosis • Q5Management of the fluid & electrolytes Ramstedt’s pyloromyotomy 0.5 each Total 5 markswww.dnbpediatrics.com
  • 10. • What is the diagnosis ? • What is the management ? www.dnbpediatrics.com
  • 11. Pnematoceles 1 Likely organism Staphylococcus 1 Total 2 markwww.dnbpediatrics.com
  • 12. • Give five radiological findings ? • What is the diagnosis ? • What is the management ? www.dnbpediatrics.com
  • 13. • 1 Ground glass appearance of bone 2 • 2 Thinned cortex • 3 Periosteal calcification • 4 White line of Fraenkel (well calcified cartilage) • 5 Wimberger’s sign (white ring) • Q2 Scurvy 1 • Q3 1 Vit C 100-200 mg/ day 1 2 Dietary Therapy Total 4 marks www.dnbpediatrics.com
  • 14. • What was the lesion ? • What was the procedure carried out ? • What are the complications ? www.dnbpediatrics.com
  • 15. • VSD 1 • Device implant 1 • Device displacement 2 • Emboli formation • Haemolytic Anaemia Total 3 markswww.dnbpediatrics.com
  • 16. • Name the Investigation ? • What is the diagnosis ? • What are the further investigations ? www.dnbpediatrics.com
  • 17. • MCU • Posterior urethral Valves • DTPA (diethylene tetra amine pentoic acid) Function • DMSA (dimercapto succinic acid) -scarring Total 3 markswww.dnbpediatrics.com
  • 18. • What is the abnormality? • What is the diagnosis ? • How is it suspected clinically ? • What is the management ? www.dnbpediatrics.com
  • 19. 1. Bowel loops in lt hemithorax, mediastinal shift to righ 1 2. Congenital diaphragmatic hernia 1 3. Respiratory distress 1 Mediastinal shift Bowel sounds in the thorax Scaphoid abdomen 4. Avoid Bag &Mask vent 2 prop up and decompress stomach Ventilate Treat PPHN Surgical correction Antenatal tracheal ligation www.dnbpediatrics.com
  • 20. What is the abnormality? What is the likely diagnosis? Delineate management. Mention 3 complications www.dnbpediatrics.com
  • 21. • Multiple fluid levels. gasless lower abdomen 1 • Small bowel obstruction 1 • Surgical correction 1 • Dyselectrolytemia 1 Perforation Exaggerated hyperbilirubinemia Dysmotility syndrome www.dnbpediatrics.com
  • 22. • Describe the X –ray • Diagnosis • Give three recent advances in management www.dnbpediatrics.com
  • 23. • Hyper inflated lung fields with areas of atelectasis interspersed with areas of overinflation 1 • MAS 1 • Lung lavage surfactant instillation HFOV NO liquid ventilation 2 www.dnbpediatrics.com
  • 24. www.dnbpediatrics.com • What is the abnormality • Three high risk situations when this condition is imminent • Management
  • 25. • Pneumothorax 1 • CDH Ventilation Post surfactant ventilation 2 • Chest tube drainage 1 www.dnbpediatrics.com
  • 26. www.dnbpediatrics.com • What is the abnormality • What is it a complication of
  • 27. • Pneumomediastinum 1 • Forceful ventilation 1 www.dnbpediatrics.com
  • 28. www.dnbpediatrics.com • Identify the abnormality • Clinical presentation • Treatment
  • 29. • Pneumopericardium 1 • Shock with weak pulses 1 • Drainage 1 www.dnbpediatrics.com
  • 30. • What is the diagnosis ? www.dnbpediatrics.com
  • 31. 1 markwww.dnbpediatrics.com
  • 32. • What are the MRI findings ? • What is the DD • What further inv will you do on the CSF to confirm the diagnosis ? www.dnbpediatrics.com
  • 33. 3 marks Acute disseminated encephalomyelitis www.dnbpediatrics.com
  • 34. www.dnbpediatrics.com
  • 35. Oligoclonal bands are also found in: • Multiple sclerosis • Devic's disease • Systemic lupus erythematosus • Neurosarcoidosis • SSPE • Subarachnoid haemorrhage • Syphilis • CNS Lymphoma www.dnbpediatrics.com
  • 36. • What are the MRI findings ? • What could be the etiology ? www.dnbpediatrics.com
  • 37. • Multifocal cerebral & cerebellar encephalomalacia • Sequel of ischaemic injury in the perinatal period. 2 markswww.dnbpediatrics.com
  • 38. • What is the likely diagnosis ? • What is the IP? • Which is the commonest site?
  • 39. • TB Spine 1 • 2 YRS 1 • Thoraclumbar area of max stress valveless venous drainage 2 4 markwww.dnbpediatrics.com
  • 40. • What are the MRI findings ? • Likely etiology • Likely CSF picture www.dnbpediatrics.com
  • 41. 3 mark Q2 TBM Q3 Increased proteins Increased cells likely lymphocytes Low sugar www.dnbpediatrics.com
  • 42. • What is the X ray suggestive of ? • What is the likely organism? • What are the complications? • What is the drug of choice? • What is the duration of therapy? www.dnbpediatrics.com
  • 43. • Lobar Pneumonia • Pnemococous/Staphylococcus • Synpneumonic effusion, empyema, • Penicillin for susceptible org and cefotaxime / vancomycin for penicillin resistant org • 10-14 d 5 marks www.dnbpediatrics.com
  • 44. www.dnbpediatrics.com
  • 45. Questions 1. What is the anatomical structure in which coin is lodged? 2. What is the location of carina with respect to thoracic vertebrae? 3. What are the anatomical areas of esophageal narrowing? 4. How can this foreign body be removed? www.dnbpediatrics.com
  • 46. Answers • Esophagus When foreign bodies lodge in the esophagus, the flat surface of the object is seen in the AP view * • T 4 • Anatomic areas of esophageal narrowing – Cricoid – Tracheal bifurcation – Gastro-esophageal junction • Endoscopy * 1 1 3 1 www.dnbpediatrics.com
  • 47. L www.dnbpediatrics.com
  • 48. Question 1. What is the diagnosis? 2. Fill in the blanks In an exudative pleural fluid a. Proteins > b. Pleural Fluid LDH > …………. c. Fluid to serum LDH ratio > ……….. d. Cell count ……… 3. What does VATS stand for? www.dnbpediatrics.com
  • 49. Answers 1. Pleural Effusion (Right) 2. Fill in the blanks In an exudative pleural fluid a. Proteins > 3.0 g/dL b. Pleural Fluid LDH > 200 IU/L c. Fluid to serum LDH ratio > 0.6 d. Cell count > 1000 3. Video Assisted Thoracoscopic Surgery 2 0.5 0.5 0.5 0.5 1 www.dnbpediatrics.com
  • 50. www.dnbpediatrics.com https://www.facebook.com/groups/dnbpediatrics/