• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Os i2
 

Os i2

on

  • 2,146 views

 

Statistics

Views

Total Views
2,146
Views on SlideShare
569
Embed Views
1,577

Actions

Likes
1
Downloads
100
Comments
0

1 Embed 1,577

http://www.dnbpediatrics.com 1577

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Os i2 Os i2 Presentation Transcript

    • OSCE PEDIATRICS IMAGING part two X-Rays/CT/MRI www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions 1. Diagnosis? 2. What are the first two steps in treatment of hypoxic spell? 3. In a cyanotic newborn, how can you distinguish pulmonary disease from cyanotic congenital heart disease? 4. Which cardiac conditions are associated with following a. Egg Shaped Heart b. Snowman silhouette c. Rib notching www.dnbpediatrics.com
    • Answers 1. Cyanotic Congenital Heart Disese Probably TOF – The heart size is normal – Pulmonary vascular markings are decreased – A hypoplastic main pulmonary artery segment contributes to the formation of the “boot-shaped” heart. 1.5 Pediatric cardiology Myung K Park 5th ed www.dnbpediatrics.com
    • Answers 2. Knee Chest Position Morphine 3. Hyperoxia Test 4. X-ray appearances a. Egg Shaped Heart Transposition of great arteries b. Snowman silhouette Total anomalous pulmonary venous return (supracardiac) c. Rib notching Co-arctation of aorta (long standing) 1 1 1 0.5 0.5 0.5 www.dnbpediatrics.com
    • 3 day neonate with • Lethargy • Feed refusal • Abdominal distension www.dnbpediatrics.com
    • Questions 1. What stage of NEC is depicted in the X-ray? 2. What is the radiological feature of Bell stage III NEC? 3. Name two more conditions associated with pneumatosis intestinalis? www.dnbpediatrics.com
    • Answers 1. NEC Stage II 2. Pneumoperitoneum 3. Any two of following Hirschsprung's disease, Pseudomembranous enterocolitis, Neonatal ulcerative colitis, Ischemic bowel disease 1 1 2 www.dnbpediatrics.com
    • • 6 weeks infant • Case of Cholestatic jaundice (Extra-Hepatic Biliary Atresia) • c/o swelling left thigh www.dnbpediatrics.com
    • Questions 1. What is the likely cause of fracture femur in this case? 2. How can this complication be prevented? 3. How do you manage pruritus in these patients? 4. An infant with cholestasis, triangular facies, and a pulmonic stenosis murmur is likely to have what syndrome? www.dnbpediatrics.com
    • Answers 1. Metabolic Bone disease (secondary to Vitamin D deficiency due to malabsorption of fat soluble vitamins) 2. Replace 5,000-8,000 U /d of D2,or 3 -5 µg/kq/d of 25-hydroxycholecalciferol 3. Ursodeoxycholic acid l5-20 mg/kg/day 4. Alagille syndrome (Arteriohepatic dysplasia) 1 1 1 1 www.dnbpediatrics.com
    • • Previously healthy 7 years girl c/o • Sudden onset weakness right upper and lower limb • Facial palsy right (UMN) • Normal sensorium • No fever/ trauma/ seizures L c t www.dnbpediatrics.com
    • Questions 1. What is the level of lesion on MRI? 2. What are the structures marked c t 3. Which hemoglobinopathy can be associated with this kind of presentation? 4. A dilated and unreactive pupil indicates the compression of what structure? www.dnbpediatrics.com
    • Answers 1. Infarct in the left basal ganglia, the posterior limb of internal capsule, and the head of the caudate 2 www.dnbpediatrics.com
    • Answers 2. C Caudate nucleus T Thalamus P Putamen G Globus pallidus White arrows indicate the ant and post limbs of internal capsule 0.5 0.5 www.dnbpediatrics.com
    • Answers 3. Sickle cell anemia 4. Compression of 3rd cranial nerve 1 1 www.dnbpediatrics.com
    • • 5 years girl c/o • Right focal seizureL www.dnbpediatrics.com
    • Questions 1. Describe the CT finding specifically the location of lesion. 2. What is the most probable diagnosis? 3. Name one infectious etiology D/D. 4. What is the treatment? www.dnbpediatrics.com
    • Answers 1. Intraparenchymal ring-enhancing lesion in the left parietal lobe 2. Neurocysticercosis 3. Tuberculoma 4. Corticosteroids starting 2-3 days before and continuing 2-3 days after antihelminth Albendazole 0.5 0.5 1 1 1 1 www.dnbpediatrics.com
    • 1. Diagnosis 2. What are the embryologic events that lead to this development? 3. What are three causes of respiratory distress in a baby born with this condition? www.dnbpediatrics.com
    • Answers 1. Congenital Diagphragmatic Hernia 2. The posterolateral portion of the diaphragm has remained open between the ninth and tenth weeks of gestation as a result the viscera will pass into the chest, and a CDH will result. 3. a) Mechanical compression of the lungs from the herniated viscera b) Pulmonary hypoplasia from compression of the developing lungs in utero c) Pulmonary hypertension www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions • Describe the lesion? • Give two D/D • What is the triad of tumor lysis syndrome? www.dnbpediatrics.com
    • Answers • Osteolytic lesion of skull • Histiocytosis Metastasis • Hyperuricemia, hyperkalemia, and hyperphosphatemia 1 1 1 3 www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions 1. Describe the X-ray appearance 2. Pathogenesis of the appearance 3. Possible Diagnosis 4. Which disorder is most commonly associated with an elevated MCHC? 5. How is the corrected reticulocyte count calculated? www.dnbpediatrics.com
    • Answers 1. Sunray appearance 2. Medullary widening 3. Chronic hemolytic anaemia 4. Hereditary spherocytosis 5. Corrected retic count = reticulocyte % × (patient Hct/normal Hct) 1 1 1 1 1 www.dnbpediatrics.com
    • Below is a midline sagittal cut of a MRI scan of the brain. View the midline anatomic diagram of the brain and identify the following structures www.dnbpediatrics.com
    • Answer • S - Suprasellar cistern • P0 - Pons • P - Midbrain (cerebral peduncles) • M - Medulla • C - Quadrigeminal plate (superior and inferior colliculi) • Q - Quadrigeminal cistern • V - Fourth ventricle 1 mark eachwww.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Question 1. Diagnosis? 2. What is the emergency management of the condition? 3. What is subsequent management after the emergency management is over? www.dnbpediatrics.com
    • Answers 1. Pneumothorax, with mediastinal shift 2. Put in a needle in second intercostal space 3. Intercostal drain 1 1 1 1 www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions 1. What is the diagnosis? 2. Describe three features seen on the X- ray of the disease? 3. What biochemical test would help clinch the diagnosis? 4. What is the treatment of the condition? www.dnbpediatrics.com
    • Answers 1. Rickets 2. a) Cupping b) Slaying c) Fraying 3. Calcium, Phosphorus, Alkaline phosphatase 4. Injection Vitamin D 6 lac unit IM stat PO Calcium 1 0.5 0.5 0.5 1.5 1 1 www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • • Describe the lesion? • Give atleast two D/D www.dnbpediatrics.com
    • • Osteolytic lesion of skull • Histiocytosis Metastasis www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions 1. Describe the X-ray appearance 2. Pathogenesis of the appearance 3. Possible Diagnosis www.dnbpediatrics.com
    • Answers 1. Sunray appearance 2. Medullary widening 3. Chronic hemolytic anaemia 1 1 1 www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions 1. What is the diagnosis? 2. What is the clinical sign for the diagnosis called as? 3. Name one intervention which can lead to this? www.dnbpediatrics.com
    • Answers 1. Pneumopericardium 2. Hammans sign 3. Invasive ventilation with high pressures 1 1 1 www.dnbpediatrics.com
    • • X-ray neck lateral view in a child with respiratory distress www.dnbpediatrics.com
    • Questions 1. What is the diagnosis? 2. Which is the commonest organism implicated in this disease? 3. What antibiotics are useful in this condition? www.dnbpediatrics.com
    • Answers 1. Epiglottitis 1 2. Hemophilus influenzae type B 1 3. Cephalosporins/ Ampicillin/ sulbactam 1 www.dnbpediatrics.com
    • www.dnbpediatrics.com
    • Questions 1. Diagnosis 2. By what gestational age would this defect occur? 3. This can be prevented in subsequent pregnancies by intake of Folic acid. Folic acid should be taken in what dose and started when? www.dnbpediatrics.com
    • Answers 1. Occipital Encephalocele 2. 26 days post conception 3. Folic acid Dose: 0.4mg/day Periconceptional period 1 1 1 1 www.dnbpediatrics.com
    • Questions 1. Diagnosis 2. What is the clinical picture? 3. What is the requirement of echo before surgery? www.dnbpediatrics.com
    • Answers 1. Tracheo-esophageal fistula 2. Excessive drooling Respiratory distress 3. To rule out associated Congenital heart diseases Right sided aorta www.dnbpediatrics.com
    • • If patient presents with fever and toxaemia, give three differential diagnosis • Give three modalities of management www.dnbpediatrics.com
    • 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
    • Questions 1. What grade of VUR is shown in MCU? 2. How is VUR graded? 3. What is normal bladder capacity? 4. Surgery is the initial treatment in which grades of VUR? www.dnbpediatrics.com
    • Answers 1. Grade V 2. Grade I: Ureter only Grade II: Ureter, pelvis, and calices; no dilation, normal caliceal fornices Grade III: Mild dilation and/or tortuosity of the ureter and mild dilation of the renal pelvis; minor blunting of the fornices Grade IV: Moderate dilation and/or tortuosity of the ureter and moderate dilation of the renal Grade V: Significant blunting of most fornices; papillary impressions are no longer visible in most of the calices; gross dilation and tortuosity of the ureter; gross dilation of the renal pelvis and calices 1 0.5 0.5 0.5 0.5 0.5 www.dnbpediatrics.com
    • Answers 3. Volume (in ounces) = Patient's age (in years) + 2. 4. Grade III/IV bilateral reflux Grade V reflux 0.5 0.5 0.5 www.dnbpediatrics.com
    • www.dnbpediatrics.com https://www.facebook.com/groups/dnbpediatrics/