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Answer Trial Radio

Onn Azli bin Puade

Question 1 A 46 years old gentleman came to you with headache, confusion and fever for 4 weeks duration a) Name the radiological procedure (1 mark) b) State 3 findings in this patient (6 marks) c) State your provisional diagnosis (1 mark) d) State 2 risk factors of developing the above condition (2 marks)

Question 1
a) Contrasted T1 weighted MRI (Coronal Section)
Fluid (hypointense) Fat (hyperintense) Bone (hypointense)

Question 1
a) Findings
a) Thin rim-enhancing lesion involving the area of caudate and lentiform nucleus extended to right lateral ventricle b) Brain oedema surrounding the lesion c) Obliteration of right anterior ventricle

Question 1
a) Brain toxoplasmosis b) HIV/AIDS, IVDU, Immunocompromised patient

Question 2 A 25 yeas old came to you for Barium swallow investigations a) State 2 findings in the investigations (2 marks) b) State 2 differential diagnosis (2 marks) c) Name 1 other investigation you would like to do in order to confirm your diagnosis (1 mark) d) State 3 expected findings in the investigations (3 marks) e) State the treatment based on your provisional diagnosis (2 marks)

Question 2
a) Findings
a) Dilatation of lower oesophageal body b) Stricture of the gastro-oesophageal junction

Question 2
a) Differential diagnosis
a) Achalasia cardia b) Oesophageal stricture (fibrosis)

b) Oesophageal manometry/ OGDS c) Findings based on the investigations d) Hertels myomectomy/ Balloon dilatation

Question 3 Choose 1 best answer State your diagnosis a) Tetralogy of Fallot b) Total anomalous pulmonary venous drainage c) Transposition of great arteries d) Tricuspid atresia e) Hypoplastic left heart syndrome (2 marks)

Question 3
B) Snowmans heart seen in TAPVD

Question 4 A 4 months old boy was born cyanosed was admitted for failure to thrive a) Describe 3 findings on the Chest radiograph (3 marks) b) State the most likely diagnosis (2 marks) c) State 1 further investigation to confirm your diagnosis (1 mark) d) Name 2 other complications of the disease (2 marks) e) State 1 pharmacological and 1 surgical treatment in this patient (2 marks)

Question 4
a) Findings
a) Narrowing of superior mediastinum b) Globular shaped heart and cardiomegaly c) Increase pulmonary vascular marking

b) Transposition of great arteries

Question 4
a) Echocardiography b) Complications
a) Heart failure b) Pulmonary hypertension

c) Treatment
a) Pharmacological Prostaglandin b) Surgical Arterial Switch operation

1.5 cm

3 cm

Question 5 The above image serves as one of the method to assess the heart a) b) c) d) e) Name the investigation (1 mark) What does it measure? (1 mark) Base on the measurement given, state the function of the heart (3 marks) Name 3 other use of the investigation (3 marks) Name 2 condition that will reduce the function of the heart (2 marks)

Question 5
a) Echocardiograph b) Ejection-fraction c) 1.5 / 3.0 x 100 = 50% (heart function is acceptable) d) Functions of echo
a) Valvular heart lesion b) Structural integrity of the heart c) Flow of the blood (Doppler)

e) Right ventricular dilatation/hypertrophy, obstructive cardiomyopathy

Question 6 A 42 years old female came to you with swelling of the wrist for 5 months duration a) State 3 findings in the radiograph (3 marks) b) State 2 differential diagnosis (2 marks) c) State 1 investigation to confirm your diagnosis (1 mark)

Question 6
a) Findings
a) Cortical destruction with expansion of distal radius b) Soap-bubble appearance c) Lesion extended to the articular surface

Question 6
a) Differential diagnosis
Aneurysmal bone cyst Giant cell tumour

b) Definitive investigation
Biopsy and histopathological examination

Question 7 Name the deformity of the diagram A and B and state your diagnosis (4 marks)

Question 7

A Dinner fork deformity in Colles fracture B Gunstock deformity in malunion of supracondylar fracture

Question 8

A 54 years old gentleman presented to you with haematuria for 5 months duration a) Name the investigation (2 marks) b) State 3 findings (3 marks) c) Give 2 differential diagnosis (2 marks)

Question 8
a) Intravenous pyelogram b) Findings
a) Obstruction of contrast outflow of right kidney b) Dilatation of right renal calyces and pelvis c) Normal left kidney

c) Differential diagnosis
a) Ureteric stone b) Ureteral stricture

Question 9
New born skull X-ray with fused sutures and abnormal looking orbit. There are A - Harlequin eye B - Fused sagittal suture C - Fused coronal suture D - Copper beaten skull E Thickened skull vault (5 marks)

Question 9
New born skull X-ray with fused sutures and abnormal looking orbit. There are A - Harlequin eye (T) B - Fused sagittal suture (F) C - Fused coronal suture (T) D - Copper beaten skull (F) E Thickened skull vault (F)

Harlequin eye

Question 10 The diagram labeled A is a normal thyroid scintigraphy A B a) State your diagnosis of B, C and D (3 marks)

Question 10
B Multinodular goiter C Graves disease D Functioning thyroid adenoma

Question 11
This is a hand radiograph of 19 years old gentleman with chronic renal failure a) State 3 findings in the hand radiograph (3 marks) b) State the most likely lesion pointed by the arrow (2 marks) c) State your most likely diagnosis (2 marks) d) List 1 other cause of the above appearance (1 mark)

Question 11
a) Findings
Irregular, frayed and ill-defined cortical outline, pronounced at radial aspect of middle phalanges Multiple lytic expansile lesions Osteosclerosis

b) Brown tumours c) Secondary hyperparathyroidism (renal) d) Aluminium intoxication

Question 12 Choose 1 best answer a) Rigid cervical collar should be applied in this patient b) 3rd generation cephalosphorin should be given to this patient c) Intubation should be done in 95% of the cases d) Spinal shock is a complication e) This is a case of unstable fracture and 2 column is involved (2 marks)

Question 12
3rd generation cephalosphorin should be given to this patient

Question 13
The statement below can be describe this diagram A - Laminar periosteal reaction B - Lytic bone lesion C - Well defined lesion D - Calcification E - Multiple lesions

(5 marks)

Question 13
The statement below can be describe this diagram A - Laminar periosteal reaction (F) B - Lytic bone lesion (T) C - Well defined lesion (F) D Calcification (F) E - Multiple lesions (T)

Question 14 Choose 1 best answer a) Patient will be presented with triad of Beck b) Pericarditis is a complication c) Anti-ischaemic therapy and anti-failure therapy should be started d) Intubation is the treatment of choice e) Needle decompression is the treatment of choice

(2 marks)

Question 14
(E) Needle decompression is the treatment of choice

Question 15 Choose 1 best answer Regarding intervention shown in the diagram on the left a) Chiari malformation type 2 is a complication b) Indicated in Dandy-Walker syndrome c) Contraindicated in intraventricular hemorrhage d) Metronidazole is the antibiotics of choice if infected

(2 marks)

Question 15
(B) VP, VA or VPL shunt is Indicated in DandyWalker syndrome

Question 16 Choose 1 best answer Regarding intervention and disease shown in the diagram on the left a) The condition affects males predominantly b) Mortality rate in this patient was 2 % c) Needle decompression should be done on the right lung to promotes lung expansion d) Radiotherapy needed to be done in this patient e) TRAM flap can be performed in this patient if the patient request (2 marks)

Question 16
(E) TRAM flap can be performed in this patient if the patient request patient with postmastectomy

Question 17 Choose 1 best answer Regarding the radiograph a) Continuous manipulation and reduction with POP cast is the appropriate management b) Anatomical reduction needed in this case c) Complication of the fracture is femoral nerve palsy d) Salter-Harris fracture grade 1 e) External fixation is indicated

(2 marks)

Question 17
Anatomical reduction needed in this case (intra-articular fracture)

Question 18
U T V

Question 17
Label the diagram T, U, V, W, X (5 marks)

W
X

Question 18

T Gallbladder U Stomach V Pancreas W Ribs X Left adrenal gland

Question 19
The statement below can be describe this diagram A Organ 12 received blood supply from left gastroomental artery B 11 is a fundal gas C 8 drained the blood to portal vein D stone in the 9 is called cholelithiasis E the pH inside the organ 10 is 5

(5 marks)

Question 19
The statement below can be describe this diagram A Organ 12 received blood supply from left gastro-omental artery (F) B 11 is a fundal gas (T) C 8 drained the blood to portal vein (F) D stone in the 9 is called cholelithiasis (F) E the pH inside the organ 10 is 5 (F)

Marking
Total Mark - 100 Pass mark - >50 C 50 59 B 60 69 A 70 80 A+ - 80 89 A++ - 90 - 100