OSCE PEDIATRICS
IMAGING part One
X-Rays/CT/MRI
www.dnbpediatrics.com
• If patient presents with fever and toxaemia,
give three differential diagnosis
• Give three modalities of management
www...
1. Lung Abcess
2. Infected Bronchogenic cyst
3. Infected Hydatid Cyst
1. Antibiotics (anaerobic +aerobic)
2. Chest physiot...
• What is the lesion ?
• Give two management modalities.
• What complication can occur
during management & how can it
be p...
Q1:
• NCC 1
Q2:
• Anticonvulsants 1
• Albendazole
• Increase in Cerebral Edema 1
• Use steroid cover
Total 3 marks
www.dnb...
• Describe the lesion.
• What are the management modalities of
such lesions especially if they are leading
to complication...
• Haemangioma scalp 1
• Conservative 2
• Oral steroids
• Local steroids
• PDL: pulse dyed laser
• IFN alfa interferon (in ...
• What are two imp radiological abnormalities?
• What is the diagnosis ?
• What are the three imp investigations ?
• What ...
• Q1Distension of stomach
• No gas in the intestines
• Q2Pyloric Stenosis
• Q3USS abdomen: pyloric thickness >4mm/
pyloric...
• What is the diagnosis ?
• What is the management ? www.dnbpediatrics.com
Pnematoceles 1
Likely organism Staphylococcus 1
Total 2 markwww.dnbpediatrics.com
• Give five radiological findings ?
• What is the diagnosis ?
• What is the management ? www.dnbpediatrics.com
• 1 Ground glass appearance of bone 2
• 2 Thinned cortex
• 3 Periosteal calcification
• 4 White line of Fraenkel (well cal...
• What was the lesion ?
• What was the procedure carried out ?
• What are the complications ?
www.dnbpediatrics.com
• VSD 1
• Device implant 1
• Device displacement 2
• Emboli formation
• Haemolytic Anaemia
Total 3 markswww.dnbpediatrics....
• Name the Investigation ?
• What is the diagnosis ?
• What are the further investigations ?
www.dnbpediatrics.com
• MCU
• Posterior urethral Valves
• DTPA (diethylene tetra amine pentoic acid)
Function
• DMSA (dimercapto succinic acid) ...
• What is the abnormality?
• What is the diagnosis ?
• How is it suspected clinically ?
• What is the management ?
www.dnb...
1. Bowel loops in lt hemithorax, mediastinal shift to righ 1
2. Congenital diaphragmatic hernia 1
3. Respiratory distress ...
What is the abnormality?
What is the likely
diagnosis?
Delineate management.
Mention 3 complications
www.dnbpediatrics.com
• Multiple fluid levels.
gasless lower abdomen 1
• Small bowel obstruction 1
• Surgical correction 1
• Dyselectrolytemia 1...
• Describe the X –ray
• Diagnosis
• Give three recent advances in management
www.dnbpediatrics.com
• Hyper inflated lung fields with areas of
atelectasis interspersed with areas of
overinflation 1
• MAS 1
• Lung lavage
su...
www.dnbpediatrics.com
• What is the abnormality
• Three high risk situations when this condition is
imminent
• Management
• Pneumothorax 1
• CDH
Ventilation
Post surfactant ventilation 2
• Chest tube drainage 1
www.dnbpediatrics.com
www.dnbpediatrics.com
• What is the abnormality
• What is it a complication of
• Pneumomediastinum 1
• Forceful ventilation 1
www.dnbpediatrics.com
www.dnbpediatrics.com
• Identify the abnormality
• Clinical presentation
• Treatment
• Pneumopericardium 1
• Shock with weak pulses 1
• Drainage 1
www.dnbpediatrics.com
• What is the diagnosis ?
www.dnbpediatrics.com
1 markwww.dnbpediatrics.com
• What are the MRI findings ?
• What is the DD
• What further inv will you do on the CSF to
confirm the diagnosis ? www.dn...
3 marks
Acute disseminated encephalomyelitis
www.dnbpediatrics.com
www.dnbpediatrics.com
Oligoclonal bands are also found in:
• Multiple sclerosis
• Devic's disease
• Systemic lupus erythematosus
• Neurosarcoido...
• What are the MRI findings ?
• What could be the etiology ?
www.dnbpediatrics.com
• Multifocal cerebral & cerebellar
encephalomalacia
• Sequel of ischaemic injury in the perinatal
period.
2 markswww.dnbpe...
• What is the likely
diagnosis ?
• What is the IP?
• Which is the commonest
site?
• TB Spine 1
• 2 YRS 1
• Thoraclumbar
area of max stress
valveless venous drainage 2
4 markwww.dnbpediatrics.com
• What are the MRI findings ?
• Likely etiology
• Likely CSF picture
www.dnbpediatrics.com
3 mark
Q2 TBM
Q3 Increased proteins
Increased cells likely lymphocytes
Low sugar
www.dnbpediatrics.com
• What is the X ray suggestive of ?
• What is the likely organism?
• What are the complications?
• What is the drug of cho...
• Lobar Pneumonia
• Pnemococous/Staphylococcus
• Synpneumonic effusion, empyema,
• Penicillin for susceptible org and
cefo...
www.dnbpediatrics.com
Questions
1. What is the anatomical structure in which
coin is lodged?
2. What is the location of carina with
respect to t...
Answers
• Esophagus
When foreign bodies lodge in the esophagus, the flat
surface of the object is seen in the AP view *
• ...
L
www.dnbpediatrics.com
Question
1. What is the diagnosis?
2. Fill in the blanks
In an exudative pleural fluid
a. Proteins >
b. Pleural Fluid LDH ...
Answers
1. Pleural Effusion (Right)
2. Fill in the blanks
In an exudative pleural fluid
a. Proteins > 3.0 g/dL
b. Pleural ...
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https://www.facebook.com/groups/dnbpediatrics/
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  1. 1. OSCE PEDIATRICS IMAGING part One X-Rays/CT/MRI www.dnbpediatrics.com
  2. 2. • If patient presents with fever and toxaemia, give three differential diagnosis • Give three modalities of management www.dnbpediatrics.com
  3. 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. 4. • What is the lesion ? • Give two management modalities. • What complication can occur during management & how can it be prevented? www.dnbpediatrics.com
  5. 5. Q1: • NCC 1 Q2: • Anticonvulsants 1 • Albendazole • Increase in Cerebral Edema 1 • Use steroid cover Total 3 marks www.dnbpediatrics.com
  6. 6. • Describe the lesion. • What are the management modalities of such lesions especially if they are leading to complications ? www.dnbpediatrics.com
  7. 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. 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. 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. 10. • What is the diagnosis ? • What is the management ? www.dnbpediatrics.com
  11. 11. Pnematoceles 1 Likely organism Staphylococcus 1 Total 2 markwww.dnbpediatrics.com
  12. 12. • Give five radiological findings ? • What is the diagnosis ? • What is the management ? www.dnbpediatrics.com
  13. 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. 14. • What was the lesion ? • What was the procedure carried out ? • What are the complications ? www.dnbpediatrics.com
  15. 15. • VSD 1 • Device implant 1 • Device displacement 2 • Emboli formation • Haemolytic Anaemia Total 3 markswww.dnbpediatrics.com
  16. 16. • Name the Investigation ? • What is the diagnosis ? • What are the further investigations ? www.dnbpediatrics.com
  17. 17. • MCU • Posterior urethral Valves • DTPA (diethylene tetra amine pentoic acid) Function • DMSA (dimercapto succinic acid) -scarring Total 3 markswww.dnbpediatrics.com
  18. 18. • What is the abnormality? • What is the diagnosis ? • How is it suspected clinically ? • What is the management ? www.dnbpediatrics.com
  19. 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. 20. What is the abnormality? What is the likely diagnosis? Delineate management. Mention 3 complications www.dnbpediatrics.com
  21. 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. 22. • Describe the X –ray • Diagnosis • Give three recent advances in management www.dnbpediatrics.com
  23. 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. 24. www.dnbpediatrics.com • What is the abnormality • Three high risk situations when this condition is imminent • Management
  25. 25. • Pneumothorax 1 • CDH Ventilation Post surfactant ventilation 2 • Chest tube drainage 1 www.dnbpediatrics.com
  26. 26. www.dnbpediatrics.com • What is the abnormality • What is it a complication of
  27. 27. • Pneumomediastinum 1 • Forceful ventilation 1 www.dnbpediatrics.com
  28. 28. www.dnbpediatrics.com • Identify the abnormality • Clinical presentation • Treatment
  29. 29. • Pneumopericardium 1 • Shock with weak pulses 1 • Drainage 1 www.dnbpediatrics.com
  30. 30. • What is the diagnosis ? www.dnbpediatrics.com
  31. 31. 1 markwww.dnbpediatrics.com
  32. 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. 33. 3 marks Acute disseminated encephalomyelitis www.dnbpediatrics.com
  34. 34. www.dnbpediatrics.com
  35. 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. 36. • What are the MRI findings ? • What could be the etiology ? www.dnbpediatrics.com
  37. 37. • Multifocal cerebral & cerebellar encephalomalacia • Sequel of ischaemic injury in the perinatal period. 2 markswww.dnbpediatrics.com
  38. 38. • What is the likely diagnosis ? • What is the IP? • Which is the commonest site?
  39. 39. • TB Spine 1 • 2 YRS 1 • Thoraclumbar area of max stress valveless venous drainage 2 4 markwww.dnbpediatrics.com
  40. 40. • What are the MRI findings ? • Likely etiology • Likely CSF picture www.dnbpediatrics.com
  41. 41. 3 mark Q2 TBM Q3 Increased proteins Increased cells likely lymphocytes Low sugar www.dnbpediatrics.com
  42. 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. 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. 44. www.dnbpediatrics.com
  45. 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. 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. 47. L www.dnbpediatrics.com
  48. 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. 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. 50. www.dnbpediatrics.com https://www.facebook.com/groups/dnbpediatrics/
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