The document describes various radiological findings seen on imaging studies like CXR, CT, MRI etc. It provides descriptions of abnormalities seen in conditions like pulmonary edema, pneumonia, pneumothorax, bronchiectasis, pancreatic cancer, renal calculi, intestinal obstruction, rheumatoid arthritis, cerebral hemorrhage, subdural hemorrhage, thymoma, atrial flutter and atrial tachycardia among others. It also lists the possible causes and differentials for these conditions.

1. OSCE- Radiology Phase IIIa sienmingoat

4. CXR- pulmonary edema Describe? Perihilar shadowing (bat’s 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

5. 50yo man Hemoptysis

6. CXR- opacity Describe? Opacity at R lower zone Mediastinal shift Causes? Bronchogenic carcinoma TB (tuberculoma) pneumonia

8. 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

9. 42yo female cough + fever 1 week SOB 2 days

10. 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)

12. 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

13. 50yo man, productive cough + LOW

14. 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

16. 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

18. 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)

20. 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: Whipple’s pancreaticoduodenectomy Palliative bypass: choledochojejunostomy

22. 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)

23. 50yo man, intermittent R loin pain

24. 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)

26. Esophageal CA What is it? Barium swallow Describe? Irregular stricture Shouldering of upper end Dx? Ca esophagus Presenting S&S? Dysphagia LOW LOA

28. 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, Crohn’s 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

29. Presented with abd distension, vomiting

30. 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)

32. 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)

34. Hand X-ray- RA Describe? Bony erosions Joint deformities Reduced joint space Dx? Rheumatoid arthritis 2 abnormalities in CXR? pleural effusion pulmonary fibrosis Caplan’s 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)

35. 20yo man, acute headache, unconscious

36. 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

37. Stroke patient aft fall, previous hx of atrial valve dz, on anticoagulation

38. 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

39. 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

41. 56yo palpitation 1 day

42. 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

44. 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