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 y...
Answers
1. Cyanotic Congenital Heart Disese
Probably TOF
– The heart size is normal
– Pulmonary vascular markings are decr...
Answers
2. Knee Chest Position
Morphine
3. Hyperoxia Test
4. X-ray appearances
a. Egg Shaped Heart Transposition of great ...
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. Nam...
Answers
1. NEC Stage II
2. Pneumoperitoneum
3. Any two of following
Hirschsprung's
disease, Pseudomembranous
enterocolitis...
• 6 weeks infant
• Case of Cholestatic
jaundice (Extra-Hepatic
Biliary Atresia)
• c/o swelling left thigh
www.dnbpediatric...
Questions
1. What is the likely cause of fracture femur
in this case?
2. How can this complication be prevented?
3. How do...
Answers
1. Metabolic Bone disease (secondary to
Vitamin D deficiency due to
malabsorption of fat soluble vitamins)
2. Repl...
• Previously healthy 7
years girl c/o
• Sudden onset
weakness right upper
and lower limb
• Facial palsy right
(UMN)
• Norm...
Questions
1. What is the level of lesion on MRI?
2. What are the structures marked
c
t
3. Which hemoglobinopathy can be
as...
Answers
1. Infarct in the left basal ganglia, the
posterior limb of internal capsule, and the
head of the caudate
2
www.dn...
Answers
2. C Caudate
nucleus
T Thalamus
P Putamen
G Globus pallidus
White arrows indicate
the ant and post limbs
of intern...
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 ...
Answers
1. Intraparenchymal ring-enhancing lesion
in the left parietal lobe
2. Neurocysticercosis
3. Tuberculoma
4. Cortic...
1. Diagnosis
2. What are the
embryologic
events that lead to
this development?
3. What are three
causes of
respiratory dis...
Answers
1. Congenital Diagphragmatic Hernia
2. The posterolateral portion of the diaphragm
has remained open between the n...
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...
www.dnbpediatrics.com
Questions
1. Describe the X-ray appearance
2. Pathogenesis of the appearance
3. Possible Diagnosis
4. Which disorder is mo...
Answers
1. Sunray appearance
2. Medullary widening
3. Chronic hemolytic anaemia
4. Hereditary spherocytosis
5. Corrected r...
Below is a midline sagittal cut of a MRI scan of the brain.
View the midline anatomic diagram of the brain and identify
th...
Answer
• S - Suprasellar cistern
• P0 - Pons
• P - Midbrain (cerebral peduncles)
• M - Medulla
• C - Quadrigeminal plate (...
www.dnbpediatrics.com
Question
1. Diagnosis?
2. What is the emergency management of
the condition?
3. What is subsequent management after
the em...
Answers
1. Pneumothorax,
with mediastinal shift
2. Put in a needle in second intercostal
space
3. Intercostal drain
1
1
1
...
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...
Answers
1. Rickets
2. a) Cupping
b) Slaying
c) Fraying
3. Calcium, Phosphorus, Alkaline
phosphatase
4. Injection Vitamin D...
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 whi...
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...
Answers
1. Epiglottitis 1
2. Hemophilus influenzae type B 1
3. Cephalosporins/ Ampicillin/ sulbactam 1
www.dnbpediatrics.c...
www.dnbpediatrics.com
Questions
1. Diagnosis
2. By what gestational age would this
defect occur?
3. This can be prevented in subsequent
pregnanc...
Answers
1. Occipital Encephalocele
2. 26 days post conception
3. Folic acid
Dose: 0.4mg/day
Periconceptional period
1
1
1
...
Questions
1. Diagnosis
2. What is the clinical
picture?
3. What is the
requirement of echo
before surgery?
www.dnbpediatri...
Answers
1. Tracheo-esophageal fistula
2. Excessive drooling
Respiratory distress
3. To rule out associated
Congenital hear...
• 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...
Questions
1. What grade of VUR
is shown in MCU?
2. How is VUR
graded?
3. What is normal
bladder capacity?
4. Surgery is th...
Answers
1. Grade V
2. Grade I: Ureter only
Grade II: Ureter, pelvis, and calices; no dilation, normal
caliceal fornices
Gr...
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
...
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https://www.facebook.com/groups/dnbpediatrics/
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Os i2

  1. 1. OSCE PEDIATRICS IMAGING part two X-Rays/CT/MRI www.dnbpediatrics.com
  2. 2. www.dnbpediatrics.com
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 3 day neonate with • Lethargy • Feed refusal • Abdominal distension www.dnbpediatrics.com
  7. 7. 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
  8. 8. 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
  9. 9. • 6 weeks infant • Case of Cholestatic jaundice (Extra-Hepatic Biliary Atresia) • c/o swelling left thigh www.dnbpediatrics.com
  10. 10. 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
  11. 11. 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
  12. 12. • 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
  13. 13. 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
  14. 14. Answers 1. Infarct in the left basal ganglia, the posterior limb of internal capsule, and the head of the caudate 2 www.dnbpediatrics.com
  15. 15. 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
  16. 16. Answers 3. Sickle cell anemia 4. Compression of 3rd cranial nerve 1 1 www.dnbpediatrics.com
  17. 17. • 5 years girl c/o • Right focal seizureL www.dnbpediatrics.com
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. www.dnbpediatrics.com
  23. 23. Questions • Describe the lesion? • Give two D/D • What is the triad of tumor lysis syndrome? www.dnbpediatrics.com
  24. 24. Answers • Osteolytic lesion of skull • Histiocytosis Metastasis • Hyperuricemia, hyperkalemia, and hyperphosphatemia 1 1 1 3 www.dnbpediatrics.com
  25. 25. www.dnbpediatrics.com
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. www.dnbpediatrics.com
  31. 31. 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
  32. 32. 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
  33. 33. www.dnbpediatrics.com
  34. 34. 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
  35. 35. 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
  36. 36. www.dnbpediatrics.com
  37. 37. • Describe the lesion? • Give atleast two D/D www.dnbpediatrics.com
  38. 38. • Osteolytic lesion of skull • Histiocytosis Metastasis www.dnbpediatrics.com
  39. 39. www.dnbpediatrics.com
  40. 40. Questions 1. Describe the X-ray appearance 2. Pathogenesis of the appearance 3. Possible Diagnosis www.dnbpediatrics.com
  41. 41. Answers 1. Sunray appearance 2. Medullary widening 3. Chronic hemolytic anaemia 1 1 1 www.dnbpediatrics.com
  42. 42. www.dnbpediatrics.com
  43. 43. 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
  44. 44. Answers 1. Pneumopericardium 2. Hammans sign 3. Invasive ventilation with high pressures 1 1 1 www.dnbpediatrics.com
  45. 45. • X-ray neck lateral view in a child with respiratory distress www.dnbpediatrics.com
  46. 46. 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
  47. 47. Answers 1. Epiglottitis 1 2. Hemophilus influenzae type B 1 3. Cephalosporins/ Ampicillin/ sulbactam 1 www.dnbpediatrics.com
  48. 48. www.dnbpediatrics.com
  49. 49. 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
  50. 50. 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
  51. 51. Questions 1. Diagnosis 2. What is the clinical picture? 3. What is the requirement of echo before surgery? www.dnbpediatrics.com
  52. 52. Answers 1. Tracheo-esophageal fistula 2. Excessive drooling Respiratory distress 3. To rule out associated Congenital heart diseases Right sided aorta www.dnbpediatrics.com
  53. 53. • If patient presents with fever and toxaemia, give three differential diagnosis • Give three modalities of management www.dnbpediatrics.com
  54. 54. 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
  55. 55. 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
  56. 56. 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
  57. 57. 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
  58. 58. www.dnbpediatrics.com https://www.facebook.com/groups/dnbpediatrics/

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