Board Tutorial Viva

first 31 cases Are emergency

1- Ask venus phase , Local LNE,  incidental lesion.

2- Ask Lab B-HCG, WBC& haemodynamic status to lower DDX , ask CT.

3- Periportal Hypodense volume overload.

4- acute pain , uterus toward same side.

5- Gradenigo syndrome. DDX( CH GR, Glom Jug, Mets, Mucocele, CH=hong chlsteatoma . 

6- R/O Wall ischemia, perforation, Transition point, previous SX, GSI, Tumor. Hernia, volvulus.

7- all findings with history of early morning dark urine. causes . ascitis, collateral, cirrhosis, nutmeg liver.

8- Nutmeg liver: central enhancement peripheral mottled hypo enhancement.

9- GB wall Rupture, biloma  ,No enhancement, Bleeding, Cholecystitis. R/O Stone.

10- Perforation + Combined pancreatic cystic lesion DDX: Pseudocyst, IPMN, Cystadenoma, Mets ( R/O local invasion, vascular involvement, LNE).

11- U/S GB R/O linear wall Echogenic air esp. in DM Pt. , exclude perforation, abscess.

12- GIT /    DDX.  Ask Tri-phasic CT to R/O other types of panc. tumour ( which is hype-rvasc on arterial) and to R/O SMA & Coeliac invasion(portal & SMV still resectable). Local LNE.

13- MSK / any ankle fr. with lower tibiofib. syndismosis injury should ask upper leg x-ray to R/O maisonaive fr.

14- Chest / contineous diaphragm sign pneumomediastinum

15- GUT /   REnal abscess +  RV thrombosis.

16- GUT / pyonephrosis

17- PEDS GUT/   PUV+ PYOEPHROSIS . any hydroneph. in pads should R/O puv by MCUG.

18- GUT / XGPN. DDX , abscess , lymphoma, RCC mets, TB.

19- Cardiac/  CXR,   any cyanosis DDX  TGA, truncus arteriosus, TAPVR and single ventricle. 

20- cardiac TOF : "boot shaped" heart  , elevated cardiac apex  , concave pulmonary arterial segment ,  pulmonary oligaemia    ,     right sided aortic arch

21- PEDS/CHEST  /    HMD:  PNX, reticulogran pat.  because ET tube no loss of lung vol. check all tubes.

22- GIT / Sub-hepatic appendisitis complicated by appendicular abscess.

23- Vascular / Mycotic AAA + renal emboli: multilobulated, fat stranding, abscess , LNE, embolic thrombus to kidney. perforate to bowel, +/- gas( pathognomonic) , also involve posterior wall to exclude inflam. AAA. exclude pseudoanurysm due to rupture.

24- Vascular / Mycotic aneurysm of the abdominal aorta with pseudoaneurysm due to rupture.

25-  GUT / Ovarian torsion: R/O cause (cyst, dermoid, mass), if clear :give DX. If not clear : do CT & MRI to exclude mass.

26-  GUT / Ovarian torsion+ Dermoid . rchetansky nodule.

27- Chest/  PE + westermark sign.

28- Chest/ Pericarditis PE Protocol negative.

29- CNS /  Central pontine myelinolysis ; DDX : Infarct esp post circulation, MS & ADEM, Mets & Astrocytoma. NEXT: MRA MRV ; HX of previous treatment of hyponatremia.

30- CNS /  Central pontine myelinolysis Another case ; DDX : Infarct esp post circulation, MS & ADEM, Mets & Astrocytoma. NEXT: MRA MRV ; HX of previous treatment of hyponatremia.

31- MSK / TB septic arthritis and osteomyelitis: X-ray: Joint eff.+ Symmetrical Joint space loss.  MRI: Subchondral erosion and Synovial thickening, abn. BM and Synovial enhancement. NEXT: CXR, Isolation , U/S Guided aspiration, DDX : Osteosarc Less likely.