IMAGE BASED SESSION

Dr. Siraj Ahmad, MD

The foreign body is lodged in
Trumpet blower with shown swelling
in neck?
Identify the sinus
 The shown instrument is used for
• Dacryocystorhinostomy
• Kerrison Rongeur
1. The shown structure mainly derived
from this brachial arch
A. Brachial arch 1
B. Brachial arch 2
C. Brachial arch 3
D. Brachial arch 4
 2. The given condition is due to:
A. Fusion of branchial
arches
B. Fusion of branchial
pouches
C. Incomplete fusion
of branchial arch
D. Incomplete fusion
of branchial
pouches
 3. The marked area of pinna is
supplied by
A. Greater auricular nerve
B. Lesser occipital nerve
C. Vagus nerve
D. Auriculotemporal nerve
 4. The shown muscle in the image
originates from this wall:
A. Middle ear, medial
wall
B. Middle ear lateral
wall
C. Middle ear anterior
wall
D. Inner ear lateral
wall
MIDDLE EAR
5. As shown in the section of cochlea, what
is the structure marked with arrow called?
A. Hair cell
B. Deiter cell
C. Hensen cell
D. Tectoral membrane
 6. The shown image is section taken
from:
A. Cochlea
B. Vestibule
C. Semicircular canal
D. Bill’s bar
 7. The proper age for correction of
shown condition is:
A. Treat as soon as possible
B. After 17-18 years of life
C. At 5-7 years of age
D. Neonatal period within
one year
 8. Diagnosis based on your otoscopic
finding:
A. Acute otitis media
B. Chronic otitis media
C. Serous otitis media
D. Serous otitis externa
 9. The given audiometry image is for
testing:
A. Right ear, air conduction
B. Left ear, air conduction
C. Right ear, bone conduction
D. Left ear, bone conduction
 10. All are true about given condition
EXCEPT
A. Repeated trauma to auricle is
a cause
B. If get infected, staph is the
commonest pathogen
C. Condition is also called boxers
ear
D. Main treatment modality is
antibiotics and incision &
drainage
 11. A 17 year male presented with ear complaints. Otoscopy
reveals following finding. There is history of ATT intake 1 year
ago for unrecalled period. True about given condition are all
EXCEPT:
A. Multiple perforation is
classic sign
B. Painful otorrhea is a
presenting symptom
C. Hearing loss mainly is
conductive type
D. Facial nerve paralysis is a
common complication
 12. You are posted in ENT department as an intern. A random
patient visited you with this investigation and asked about it.
Based on your knowledge What is the origin this tallest wave:

A. Cochlear nerve
B. Superior olivary
complex
C. Lateral lemniscus
D. Inferior colliculus
 13. Name the device
A. Brainstem anchored
hearing aid
B. Cochlear implant
C. Meniett’s device
D. In the canal hearing
aid
Cochlear implant
 14. A 14 year male from chhattisgharh presented with swelling
of nose which is increasing gradually from last 3-4 months. Upon
examination, nose has woody touch. Possible diagnosis:

A. Rhinoscleroma
B. Rhinophyma
C. Rhinosporidiosis
D. Rhinohyperplasia
15. This patient was prepared for surgery. Your senior
resident did this marking before proceeding the
incision. What is the name of this:
A. Ohngren’s line
B. Weber fergusson
incision
C. Lederman incision
D. Frontal sinosotomy
16. A 44 year male from India, presented with painless neck swelling, which is
pulsatile. Upon examination, bruits can be heard with stethoscope. MR
angiography finding is given below. What is the diagnosis on this basis:

A. Chemoductoma
B. Cystic hygroma
C. Tubercular lymph node
D. Branchial cyst
 17. Spot diagnosis
A. Laryngeal papilloma
B. Vocal cord polyp
C. Vocal cord nodule
D. Vocal cord granuloma
http://entkidsadults.com/wp-content/uploads/2013/11/vocal-cord-lesions.jpg
Vocal cord nodule
Laryngeal papilloma/Juvenile P.
 18. A 13 year male patient presented with history of
recurrent epistaxis. Upon general evaluation you noted
the swelling of cheek. Most likely diagnosis:
A. Rhinoscleroma
B. Angiofibroma
C. Antral polyp
D. Ethmoidal polyp
 19. A baby with high grade fever and respiratory
distress. X-Ray neck shows following finding. which of
the following is FALSE:
A. Caused by hemophilus
influenza type B
B. Can lead to ICU admission
C. Diagnosis is made by
direct laryngoscopy
D. Management usually on
OPD basis
20. A 42 year patient presented to you with hoarseness of voice.
Upon examination this is your finding (image- arrow shows
abnormal side). Thyroplasty of choice in this patient:

A. Type 1
B. Type 2
C. Type 3
D. Type 4
 21. True statement:
A. X: Thyroid, Y:
Arytenoid, Z: Cricoid
B. X: Corniculate, Y:
Thyroid, Z: Cricoid
C. X: Corniculate, Y:
X
Cuneiform, Z: tracheal
ring
D. X: Corniculate, Y: Y
Arytenoid, Z: Cricoid Z
LARYNGOPHARYNX
 22. The given image is used for:
A. Cleaning the external
auditory canal
B. Visualizing the whole
external ear
C. Packing ear canal or
nasal cavity
D. Checking the mobility
of tympanic
membrane
23. A 35 year male patient presented with tonsillar fossa pain which radiates
on ipsilateral side. He also complains that this pain aggravates upon
swallowing. Radiological exam of skull given below. Most likely diagnosis:

A. Adenoid abscess
B. Eagles syndrome
C. Foreign body in neck
D. Devil’s teeth syndrome
24. The below given sign is seen in:
A. Otosclerosis
B. Cholesteatoma
C. Lateral sinus
thrombophlebitis
D. Laryngeal pathology
 25. The X-Ray view is:
A. Caldwell view
B. Water’s view
C. Towne’s view
D. PA view
Caldwell view
 26. What is the grading of fracture
according to Le-fort classification:
A. I
B. II
C. III
D. IV
 27. Spot Diagnosis:
A. Tongue tie
B. Potato tumor
C. Ranula
D. Thyroglossal cyst
 28. In the given investigation, suggest
a possible cause for B line
A. Myringus perforation
B. Ossicular damage
C. Stapedial fixation
D. Glue ear
 29. Name the instrument:
A. MacEwen curette
B. Lempert curette
C. Mastoid gauge
D. Farabeuf periosteal
elevator
Lempert curette
Farabeuf
 30. Name and use of the shown
intrument
A. Walsham forceps for
septal reduction
B. Asch’s forceps for
septal reduction
C. Walsham forceps for
nasal bone reduction
D. Asch’s forceps for
nasal bone reduction
31. True about the instrument:

A. Used before tonsillectomy

B. Cuts and crushes the pedicle
C. Increases bleeding often
time
D.Its is peritonsilar abscess
forceps
 32. Which surgery is most likely being
performed here:
A. FESS
B. Cald well luc’s
operation
C. Antral lavage
D. Tonsillectomy
 Spot diagnosis:
A. Pneumoniae
B. Pneumothorax
C. Brochiectasis
D. Atelectasis
X-RAY Image
 RUL
RUL
LUL
RML

RML RLL

RLL LLL
 PROMINENT MEDIALLY
TAPERS PERIPHERALLY

PULMONARY VASCULAR MARKINGS

 MORE
PROMINENT
INFERIORLY

PULMONARY VASCULAR MARKINGS

NORMAL ATELECTASIS = LOSS OF VOLUME
 Collapsed
PulmonaryAir
vascular
spacesmarkings Crowded vascular markings
Air spaces

Shifting
Increased
Fissures Towards the
opacification
Side of collapse

Normal Lung
Mediastinal
Structures
Atelectatic Lung
 ATELECTASIS
DIRECT SIGNS INDIRECT SIGNS

Fissural displacement Mediastinal shift

Crowding of Elevation of
pulmonary markings diaphragm
Increased Narrowing of
opacification intercostal spaces
Compensatory
hyperinflation of
contralateral lung
Minor fissure

•UPWARD DISPLACEMENT OF THE MINOR FISSURE

•LOSS OF VOLUME

RUL ATELECTASIS
RUL ATELECTASIS
 Most likely diagnosis of this CXR:
A. Pneumonia left upper
segment
B. Pneumonia left
lingular lobe
C. Pneumonia left lower
lobe
D. Pleural effusion left
sided
Peumonia- 2 helpful signs

1.Air bronchogram

2.Silhoutte sign
 AIR BRONCHOGRAM
• Branching lucencies
within the opacified
lung
• Denotes air space
disease
• Absent in mass and
pleural disease
 Air bronchogram- Branching
lucencies within the opacified lung
 AIRWAY
Pores of AIR BRONCHOGRAM
Kohn
AIR SPACE

NORMAL INFILTRATE
AIR BRONCHOGRAM
AIR-BRONCHOGRAM SIGN
 SILHOUETTE SIGN

An intrathoracic lesion obscuring the cardiac border, aorta, and

diaphragm is ANATOMICALLY CONTIGUOUS with that structure

Right
RML
cardiac Pneumonia
border

Left cardiac Lingular

border Pneumonia

Basal
Diaphragm pneumonia
 SHADOWS MERGE
ADJACENT STRUCTURES

N ABSENT BORDERS

LESION
 TWO SHADOWS
NON-CONTIGUOUS STRUCTURES

DISTINCT
MARGIN
SILHOUETTE SIGN

OBSCURED RIGHT CARDIAC BORDER

RIGHT MIDDLE LOBE PNEUMONIA
SILHOUETTE SIGN

OBSCURED LEFT CARDIAC BORDER

LINGULAR PNEUMONIA
SILHOUETTE SIGN PRESENT OR
ABSENT??

LOWER LOBE PNEUMONIA

DIAGNOSIS?

PNEUMONIA RUL, RML AND LLL

LLL AND LINGULAR PNEUMONIA
Diagnosis?

LUNG ABSCESS
Diagnosis of the typical CXR
Golden S Sign- Bronchogenic CA
 This patient presented with fever of 1 week associated with
productive sputum. Possible diagnosis based on CXR:

A. Tuberculosis
B. Pneumonia Right mid
lobe
C. Pneumonia Right
lower lobe
D. Pneumonia lingular
lobe
 Neonate presented with following X-
Ray. True statement:
A. It shows angel wing sign
B. It is Pneumoperitoneum
C. Neonatal pneumothorax
D. Neonatal mediastinal
effusion
 Pneumo-mediastinum
continuous diaphragm sign
Spinnaker sail sign
 Spot Diagnosis of this typical CXR:
A. Bronchiectasis
B. Friedlander
pneumonia
C. Community acquired
pneumonia
D. Hospital acquired
pneumonia
KLEBSIELLA/Friedlander PNEUMONIA
A 50 year smoker presented with productive cough of 3
month duration. CT chest reveals following finding.
Possible diagnosis:
A. TB lung
B. CA lung
C. Bronchiectasis
D. Pulmonary fibrosis
Bronchiectasis
BRONCHIECTASIS

NORMAL

BRONCHIECTASIS
 BRONCHIECTASIS

Cluster of grape app

In this saggital view of CT chest what is
the structure marked with arrow:
• Right atrium
• Right ventricle
• Left atrium
• Left ventricle
 This type of Persistent truncus
arteriosus is:
A. Type I
B. Type II
C. Type III
D. Type IV
A 60 year old man developed severe acute onset breathlessness
within few hours of an aortic valve replacement. X-Ray of the
patient is given below. Possible diagnosis:

A. Gross bilateral pleural

effusion
B. Left tension
pneumothorax
C. Pericardial tamponade
D. Entire left lung
collapse
Possible differential diagnosis of given
X-Ray spine:
A. Osteopetrosis
B. Renal osteodystrophy
C. Both
D. None
Rugger jersey
 Box car ventricles as shown on MRI is
seen in this condition:
A. Corpus callosum
agenesis
B. Huntington’s disease
C. Hypertrophy of
caudate nucleus
D. Cerebral edema
 CC
Agenesis
 Bracket calcification as shown on CT
head is seen in this condition:
A. Corpus callosum
lipoma
B. Hellervorden spatz
disease
C. Wilson disease
D. Calcification due to
ageing
 Diagnosis of the given condition:
A. Multiple myeloma
B. Eosinophilic granuloma
C. Mucopolysachharidosis
D. Achondroplasia
 Figure of 8 shaped brain as shown on
image is diagnostic of:
A. Lissencephaly
B. Holoprocencephaly
C. Sturge weber
syndrome
D. Schizencephaly
Abnormal cleft/slit
 A child resents with seizures and developmental delay and a
large head. A MRI was performed which revealed the findings as
in the image. What is the probable diagnosis:

A. Arnold Chiari
malformation
B. Dandy Walker
malformation
C. Joubert syndrome
D. Corpus callosum
agenesis
 Q.NO. 109

Comment on MRI finding

Molar Tooth appearance

 Spot diagnosis:
A. Kidney stone
B. Kidney with contrast
C. Kidney with
tuberculosis
D. Polycystic kidney
 GENITOURINARY TUBERCULOSIS
• SECOND MOST COMMON SITE NEXT TO THE
LUNGS
• Unilateral involvement
• PARENCHYMAL CALCIFICATIONS (70%)
• “Putty” kidney: mottled and amorphous
calcifications of the kidneys
 Ureter TB
• “Corkscrew” ureter: multiple infundibular and
ureteral stenosis → HALLMARK
• “Pipestem” ureter: narrow rigid aperistaltic
segment
• “Purse-string” renal pelvis: cicatricial stenosis
of the pelvis
Putty kidney
 Diagnosis:
A. Benign gastric ulcer
B. Malignant gastric ulcer
C. Foreign body in
stomach
D. Gastric perforation
• Benign posterior wall
gastric ulcer showing
radiating folds
extending to ulcer
crater
 Benign or Malignant?

• Malignant antral ulcer

with thickened margin
and folds amputated
short of the ulcer
crater
 String of beads sign in arteriogram is
diagnostic of?
A. Renal embolism
B. Fibro muscular
dysplasia
C. Sub adventitial
fibroplasia
D. Mural hyperplasia
 Spot diagnosis:
A. Pleural effusion
B. Pneumothorax
C. Hydropneumothorax
D. Pneumoniae
AIR- FLUID LEVEL = HYDROPNEUMOTHORAX
A 28 year male presented with this CXR. History
reveals trauma due chest in a mob fight
A. Pleural effusion
B. Pneumothorax
C. Hydropneumothorax
D. Pneumoniae
 Pneumothorax

Forms:
1. Traumatic: Most common cause
2. Spontaneous
a. Primary
b. Secondary
3. Tension
 Pneumothorax

Absent lung
markings
Collapsed lung

pneumothorax
•VISIBLE VISCERAL PLEURA
•ABSENT LUNG MARKINGS
 Possible diagnosis based on CXR
finding:
A. Pericardial effusion
B. LV enlargement
C. Mitral stenosis
D. Pulmonary stenosis
Postero-Anterior (PA) View

• Right border
– Superior vena cava
– Right atrium
– Inferior vena cava
Postero-Anterior (PA) View

• Right border
– Superior vena cava
– Right atrium
– Inferior vena cava

• Left border
– Aortic knob
– Main pulmonary trunk
– Left ventricle
 PA View

Left Atrial Appendage Left

and
Main Right
Superior
Right
Atrial
Left Ventricle
Pulmonary
Right
Aorta Arteryare not border forming
Ventricle
Ventricle
Appendage
Vena
Atrium
Cava
Lateral View

Right
LeftAorta
Left Ventricle
Atrium
Ventricle
Cardiothoracic Ratio

• A “Rough” Estimation of
cardiac size
• Vertical line is drawn through
the midsternal line
• Maximal distances of the right
and left heart borders from the
midsternal line are added
• Greatest transverse diameter
1 of thorax is obtained
2

Greatest Cardiac Diameter

Greatest Thoracic Diameter

Normal Value = <50 %

Chamber Enlargement

Left Ventricle
Left Atrium
Right Ventricle
Right Atrium
 Chamber Enlargement
• Left Ventricle
• Extends posteriorly
• a 2.0 cm vertical line is drawn
from the junction of the IVC
and LV
• A horizontal line is drawn
perpendicular to the vertical
line
• Measurement should not be
2.0 cm
more than 1.8 cms
Chamber Enlargement

• Left Ventricle
– Extends farther laterally
and inferiorly
 INFEROLATERAL
DISPLACEMENT OF LV

NORMAL LV ENLARGEMENT
 INFEROLATERAL
DISPLACEMENT OF LV

LV ENLARGEMENT
 POSTERIORLY
DISPLACED LV

NORMAL LV ENLARGEMENT
 Chamber Enlargement

<1.8 cm
2.0 cm >1.8 cm
2.0 cm

NORMAL ENLARGED LV
Chamber Enlargement

• Right Ventricle
– Straightening of the
cardiac waistline
– Displacement of the apex
superiorly
Chamber Enlargement

• Right Ventricle
– Obliteration of the
retrosternal space
 NORMAL STRAIGHT CARDIAC
CADIAC WAISTLINE
WAISTLINE

SUPERIOR
DISPLACEMENT
OF APEX
 RETROSTERNAL
SPACE RETROSTERNAL SPACE
OBLITERATED

NORMAL RV ENLARGEMENT
Chamber Enlargement

• Left Atrium
– Widening of the carina
– “Double density”
– Bulging of the Left Atrial
Appendage
 0 0
Normal carinal angle = 60 -70
 0
Carinal angle > 70
 LEFT ATRIUM

RIGHT DOUBLE
ATRIUM DENSITY
DOUBLE
CONTOUR
Aorta

MPA

LA
Appendage

LV
NORMAL LA ENLARGEMENT
Chamber Enlargement

• Right Atrium
– Displacement of the Right
cardiac border laterally
 RIGHT
ATRIUM

RA ENLARGEMENT
 Heart chamber NOT enlarged in this
given condition:
A. Right atrium and right
ventricle
B. Left atrium and left
ventricle
C. Right atrium and left
atrium
D. Right ventricle and Left
ventricle
Patent Ductus Arteriosus

DA
 SVC LUNGS
&
IVC PV

RA LA
Tricuspid V Mitral V

RV LV
Pulmonic V Aortic V

Pulmonary Aorta
ARTERIES

LUNGS Systemic
Circulation
 A child was brought with given CXR.
Your impression:
A. TGA
B. TAPVR
C. TOF
D. Ebstein anomaly
Tetralogy of Fallot
Boot shaped
 Pink Tetralogy of Fallot = Tetralogy with MILD
PULMONARY STENOSIS

• TRILOGY of Fallot = Tetralogy minus VSD

or Pulmonary stenosis w/ intact ventricular septum

• PENTALOGY of Fallot = Tetralogy plus ASD

PSEUDOTRUNCUS ARTERIOSUS = Tetralogy

with PULMONARY ATRESIA
 Transposition of the Great Arteries
(d-TGA)
RADIOGRAPHIC FEATURES:

• Increased vascularity:
• Cardiomegaly: most often
difficult to determine since all
chambers are enlarged

• Cardiac silhouette:
– “Egg on its side”
– “Apple on a stem”
TGA
 Ebstein’s Anomaly
Downward displacement of septal & posterior leaflets of the dysplastic tricuspid valve with
ventricular division into a large atrialized and small inferior functional chamber with
shortened chordae tendineae
 Ebstein’s Anomaly

RADIOGRAPHIC FEATURES:

• Decreased vascularity
• Marked cardiomegaly
• Right atrial prominence
• “Balloon-” or “box-shaped”
 Possible diagnosis:
A. TOF
B. TAPVR
C. COA
D. Ebstein anomaly
Coarctation of the Aorta

• Localized obstruction
at the junction of
aortic arch &
descending aorta
secondary to a fibrous
ridge protruding into
aortic lumen
 Coarctation of the Aorta

3- sign
 Coarctation of the Aorta
• Normal vascularity
• Cardiomegaly
• Left ventricular prominence
• “3” sign
• Rib notching
Name the organ maked with arrow
A. Stomach
B. Kidney
C. Pancreas head
D. Spleen
Review of Abdominal CT Scan Anatomy
Liver Stomach
Spleen
 Review of Abdominal CT Scan Anatomy
Spleen

Pancreas
Kidneys
Duodenum

Liver
 Spot diagnosis:
A. Intuseusseption
B. Pneumoperitoneum
C. Sigmoid volvulus
D. Small bowel
obstruction
• Sigmoid
Volvulus
(inverted “U”
and absent
haustra)
• Small Bowel
Obstruction
• Small Bowel
Obstruction
• Small Bowel
Obstruction
(“STRING OF
PEARLS” sign)
 In the given XRay, air is lined around middle
umbilical ligament. What do you call this sign:
A. Riggler sign
B. Cupola sign
C. Urachus sign
D. Needle sign
Pneumoperitoneum

"Saddlebag sign”
“Mustache sign”
“Cupola” sign
 Pneumoperitoneum

“Falciform Ligament
sign”

◼ Supine abdominal
radiograph shows a
falciform ligament
Pneumoperitoneum Click to see larger picture

“Inverted V sign”

◼ Outline of both lateral

umbilical ligaments
(containing inferior
epigastric vessels)
Pneumoperitoneum

“Urachus sign”

◼ outline of middle
umbilical ligament
APPLE CORE DEFORMITY
 The following ERCP report shows?
• Stone
• Cholangitis
• Stricture
• Choledochal cyst
 True statement are all EXCEPT:
A. Usual cause is trauma
B. Rupture of cortical
bridging veins
C. Lucid interval can be
seen
D. IOC is CT scan
 The given image of CT is suggestive of:

a. Tuberculosis
b. Invasive
aspergillosis
c. Primary Malignancy
d. Metastasis
 The given CT chest pattern is
popularly known as:
a. Crazy pavement
b. Interstitial air trap
sign
c. Miliary
shadowing
d. Tram track sign
Abnormal intra-alveolar
accumulation of surfactant-like
lipoproteinaceous material.
 Identify the
Imaging modality
A 60 year male presented with dysphagia to solid and liquid food
both. Barium study shows following finding. Diagnosis:

a. Achalasia cardia
b. Diffuse esophageal
spasm
c. Malignancy
d. GERD
 Identify the artery:
a. Posterior cerebral
artery
b. Posterior
communicating artery
c. Basilar artery
d. Vertebral artery
 MCA

VA VA
 Identify the structure marked with
arrow:
a. Symphysis pubis
b. Obturator foramen
c. Ischial foramen
d. Acetabulum
On IVP following findings were noted.
Diagnosis:
a. Duplex ureter
b. Horse shoe kidney
c. Cross fused ectopic
kidney
d. Nephrolithiasis
Spot Diagnosis?
The shown fracture is classified by
A. Mirel classification
B. Salter and harris
classification
C. Caspar classification
D. Anderson and Gustillo
classification
 Gustillo and Anderson
classification of Open #
 Diagnosis:
A. Bankart frature
B. Posterior bankart
fracture
C. Hill sach’s lesion
D. Reverse hill sach’s
lesion
Bankart lesion
Hill sach’s lesion
 Which test is being performed in this
given image:
A. Bryant’s test
B. Callway’s test
C. Dugas test
D. Hamilton test
 Tests for shoulder dislocation
• BRYANT’S (axilliary fold- @ low level)

•DUGAS- touch opp sholder and bring

elbow to chest
• CALLWAY’S (circumference)
• HAMILTON RULER

• Mn: BDCH
 Which test is being performed here:
A. Varus stress test
B. Valgus stress test
C. Lachman test
D. Mc Murray test
 Name the fracture:
A. Rolando fracture
B. Mallet finger
C. Bennet fracture
D. Boxers fracture
 Some common fractures
• CHAUFFEUR’S #
• GALLEAZI #→ distal 3rd radius # w/ D/L of R-U
jt. (GRD)
• MONTEGGIA #→ proximal ulna # w/ d/L R-U
jt. (MUP)
• Smith # → Reverse Colle’s
• Golfer’s elbow
• Tennis elbow
• Student’s elbow
• Bennet Due to forced abduction; base of
thumb #
• Rolando #: Intra-articular comminuted #
of base of 1st metacarpal.
• Boxer’s #: 5th metacarpal neck #
• Jefferson and Hangman #
Bennet’s fracture
Rolando #
 The shown test is used to diagnose:
A. Anterior shoulder
dislocation
B. Posterior shoulder
dislocation
C. Subscapularis tear
D. Clavicular fracture
 A patient with Genu varum, beading of costochondral
junction with widening of bony ends as shown in XRay.
Diagnosis:
A. Rickets
B. Scurvy
C. Fluorosis
D. Hyper parathyrodism
A 30 year old male from rural India presented with lower back pain of nearly
3 months duration. He gives the history that pain improved upon activity in
beginning. Later on this pain became persistent and hence this consult. X Ray
reveals following finding. Diagnosis:

A. Ankylosing spondylitis
B. Disc prolapse
C. Infection
D. Reiter syndrome
A 32 year patient presented with complaints of pain and decreased mobility
at elbow joint. There is a history of trauma few months back for which he
underwent massage with a local quack. XRay reveals the following finding
(image). Most likely diagnosis of the given image:

A. Myositis ossificans
B. Fractured elbow
C. Dislocated elbow
D. Malignancy
In the given image of chronic osteomyelitis
choose the correct sequence:
• A- Normal, C-
sequestrum, E-
Involucrum, D- Cloacae
• A- Normal, C- Involucrum,
E- Sequestrum, D-
Draining sinus
• A- infected, C- reactive
bone, E- dead bone, D-
draining sinus
• A- infected, C- dead bone,
E- reative bone, D-
Draining sinus
 Spot diagnosis:
A. Malgaigne fracture
B. Straddle fracture
C. Pubic rami with penile
fracture
D. Sacroiliac joint
dislocation only
STRADDLE #
MALGAIGNE #
 False statement about the shown
condition
A. Usually due to fall on
outstretched hand
B. Fractured distal radius
C. Dinner fork deformity
is most common
complication
D. Hand shaking cast
used
 Most common nerve damaged in the
shown fracture:
A. Radial nerve
B. Ulnar nerve
C. Anterior interosseous
nerve
D. Median nerve
 The shown condition is seen due to:
A. Paronychia
B. Felon
C. Infected extensor
tendon
D. Infected flexor tendon
Tenosynovitis: Kanavel sign
 Spot diagnosis based on the
examination finding:
A. ACL tear
B. PCL tear
C. MCL tear
D. LCL tear
 CRUCIATE LIGAMENTS
• MAJOR STABILIZER OF KNEE? ACL
• MC INJURED:?? ACL
• TESTS FOR ACL vs PCL
ACL TEST (Mn- Ant. LAP) PCL TEST (Mn- PPQR)
• LACHMANN TEST @ 20* • POSTERIOR TIBIAL SAG
• ANT. DRAWER TEST @ 90* • POSTERIOR DRAWER TEST
• PIVOT SHIFT TEST • QUADRICEPS ACTIVE TEST
• REVERSE PIVOT SHIFT TEST
• PIVOT SHIFT- @ 30* FLEXION- One hand
at tibiofibular joint and other below calf
muscle… try to extend the leg while
putting valgus force
Diagnosis?
Test name?
 Based on the shown image, which
pathology you might suspect:
A. Anterior hip
dislocation
B. Posterior hip
dislocation
C. Hip joint effusion
D. Stage I TB
The shown fracture also known as:
A. Lover’s fracture
B. Pott’s fracture
C. Cotton’s fracture
D. Lis franc fracture
Diagnosis?

Trimalleolar/Cotton’s
Diagnosis?
Bimalleolar/Pott’s
 The shown splint is used for
A. Ulnar nerve damage
B. Median nerve damage
C. Anterior interosseous
nerve
D. Posterior interosseous
nerve
 IMPORTANT SPLINTS & THEIR USE

• Cock-up Splint: RADIAL N. INJURY

• Knuckle bender : ULNAR N. > MEDIAN N.
• Aeroplane splint- BRACHIAL PLEXUS INJ.
• Turn buckle splint- VIC
• Figure of 8 bandage- CLAVICLE
• Dennis brown slint- CTEV
 IDENTIFY SPLINT

Aeroplane splint

Knuckle bender
Cock up splint
 Identify?

Figure of 8 bandage
Dennis brown splint
 Condition to use this method:
A. Age > 2 years
B. Weight 10-12 kg
C. Age more than 5 years
D. Male gender
 Important casts and their use
• Broom stick cast- PERTHES DISEASE

• Minerva cast- CERVICAL SPINE DISEASE

• Riser’s cast- SCOLIOSIS

• U-slab/Hanging cast- # HUMERUS

• Hip Spica- # FEMUR (< 5 YRS)

• Gallows Traction: # FEMUR (< 2yrs)

• Glass holding cast: SCAPHOID #

IDENTIFY CAST?
GALLOW’S
 The shown angle is
A. Bohler angle
B. Gissane angle
C. Pauwel’s angle
D. Carrying angle
 Spot diagnosis:
A. Fractured tibia
B. Osteochondroma
C. Ewing’s sarcoma
D. Osteosarcoma
 TUMORS ACCORDING TO LOCATION
EPIPHYSIS (Mn: ECG)

• Chondroblastoma- before physeal closure

• Giant cell tumor- after physeal closure

• Xray- soap bubble app:
• Rx: Extended curretage by phenol and bone
graft
METAPHYSIS (Mn: ME-BOO)- MC SITE
– Enchondroma (short bones)
– Bone cyst (upper humerus)
• UBC- fallen sign, central location
• ABC- expansile lytic lesion, cortical location
– Osteochondroma (EXOSTOSIS)
– Osteosarcoma
– Osteoblastoma
DIAPHYSIS: (Mn: DEMO-A)
–Ewing’s sarcoma
–Multiple myeloma (punched out lytic
lesion)- MC site: Lumbar V.
–Osteoid osteoma (NIDU)
–Adamantioma (Mandible>tibia; soap
bubble)
Diagnose?
Diagnosis?
Osteochondroma
A young patient presented with history of bone pain,
which is releived upon taking certain medication. Xray
reveals following finding. Diagnosis:

A. Osteosarcoma
B. Fibroma
C. Fibrous dysplasia
D. Osteioid osteoma
Diagnosis of Mammographic image
Diagnosis?
Broadie’s Abscess:
Q. Identify pathological sign in picture
A and B?
A B
Based on these X-ray, diagnosis?
 Ans: Thalassemia
• Classical finding on X-Ray in case of thalassemia:
– Hair on end appearance
– Cortical thinning
• Take note of Hair on end appearance on skull
• In phalanges take note of Marrow expansion and
cortical thinning.
• Other C/F
– Frontal bossing
– Chip munk facies
 Q.NO. 173. The given X-ray humerus
shows;

a. Aneurysmal bone cyst

b. Ewing sarcoma
c. Posterior dislocation
of shoulder
d. Fibrous dysplasia
Bowing deformity
Shepherd crook
deformity
 Q.NO. 174. What does the following
radiograph show?

a. Rickets
b. Scurvy
c. Osteoid osteoma
d. Haemophilia
 Q.NO. 175. A patient complains of episodes of
dysphagia and chest pain. The barium study
presentation of the patient is shown below. A
radiologist will describe this condition as all except:

a. Corkscrew appearance
b. Rosary bead esophagus
c. Pseudodiverticula
d. Cobble stone appearance
 Q.NO. 176. The given NCCT
shows presence of:
a. Left intraventricular
hemorrhage
b. Right intraventricular
hemorrhage
c. Left intraparenchymal
hemorrhage
d. Right intraventricular
hemorrhage
 Q.NO. 177. Identify the
neurocutaneous disorder:
a. Sturge Weber
syndrome
b. Von – hippel
landau syndrome
c. Tuberous
sclerosis
d. Ataxia
telangiectasia
 Patient presented with following
findings. Diagnosis:
a. Tuberous sclerosis
b. Neurofibromatosis
c. Acne rosacea
d. Acne vulgaris
Ash leaf macule
Koenen tumor/Periungal fibroma
 Q.NO. 183. A child presented with pain in the
forearm following a trauma. An AP and lateral X
–ray of the forearm reveal the findings as
shown. What is the most likely diagnosis?

a. Monteggia fracture
b. Colles fracture
c. Smith’s fracture
d. Galeazzi’s fracture
 Q.NO. 184. Spot the diagnosis:
a. Malgaigne fracture
b. Straddle fracture
c. Pubic rami with
penile fracture
d. Sacroiliac joint
dislocation only
 Name the splint baby is earing:
A. Von rosen splint
B. Dennis brown splint
C. Aeroplane splint
D. Broom stick splint
 A 12 year child presented to you with complaints of decreased sensation over
cheek. Upon examination you noticed enophthalmos. X-Ray revealed the
following finding. Which of the following is the most likely cause of this condition:

A. Ethmoid bone fracture

B. Maxillary bone
fracture
C. Lateral wing of
sphenoid fracture
D. Zygomatic bone
fracture
 The shown instrument is
A. Goldman tonometer
B. Indentation tonometer
C. Perkins tonometer
D. None
 GOLDMAN
TONOMETER
Schiotz tonometry
Hand held tonometer- Perkins
Hand held tonometer- Tono pen
Rebound
Air puff tonometer
 The structure marked with “L” is
developed from:
A. Surface ectoderm
B. Neuroectoderm
C. Neural crest
D. Mesoderm
 The given apparatus is used for the
test of:
A. Squint
B. Stereopsis
C. Colour vision
D. Binocular vision
 True statement about the given test
are all EXCEPT:
A. It the most sensitive
test
B. Can detect red green
color blindness
C. Used as screening test
D. The test is ishihara test
 The shown instrument is:
A. Ishihara
pseudoisochromatic test
B. Naegle’s anamloscope
C. FM 100 hue test
D. Holmgreen wool test
A 28 year old gymnast presented to you with red eyes
and decreased vision. Upon examination this is your
finding (image). Diagnosis:
A. Neovascular glaucoma
B. Pigmentary glaucoma
C. Phacomorphic
glaucoma
D. Phacolytic glaucoma
Krekenberg spindle
 The below shown image of retina is
seen in case of:
A. CSR
B. CRAO
C. CRVO
D. RP
Vascular Occlusion
Hypertensive Retinopathy
Splashed tomato fundus
 Spot diagnosis:
A. CSR
B. CRAO
C. CRVO
D. RP
Cystoid Macular Edema
CSR
True statement about the given image
are all EXCEPT:
• Degenerative disease of
rodes
• Can be associated with
Deafness
• Ring scotoma is clinical
feature
• Early detection can stop
the progression
Retinitis Pigmentosa
 Spot diagnosis:
A. Chalazion
B. Pinguecula
C. Pterygium
D. Conjunctivitis
Pinguecula vs Pterygium
 The below shown cataract is seen in:
A. Wilson disease
B. Myotonic dystrophy
C. Muscular dystrophy
D. Diabetes mellitus
Metabolic cataract
OTHER TYPES OF CATARACT
 All are true about the given condition
EXCEPT:
• Due to involvement of
trigeminal nerve
• Condition is known as
Hutchinson sign
• Usually painless
condition
• Due to reactivation of
latent chicken pox
 The shown pathology on cornea is
seen in:
A. Granulomatous uveitis
B. Non granulomatous
Uveitis
C. Corneal ulcer
D. Posterior uveitis
 A patient of glaucoma was prescribed with an unrecalled drug.
After intake of the medication, he developed this (shown image).
What could be the possible agent:

A. Adrenergic agonist
B. Cholinergic agonist
C. Prostaglandin
analogue
D. Dorzolamide
 Treatment of Glaucoma
Must Know Questions
• First line DOC for ACG?
• TOC for ACG?
• DOC for OAG?
• Most powerful anti glaucoma drug?
• DOC for OAG in India?
• Safest anti-glaucoma for children?
 Increase Outflow

Trabecular Uveoscleral

PG’s
PILOCARPINE
Latanoprost

First line world

EPINEPHRINE wide
Most potent
Epinephrine has dual action
Trabecular vs Uveoscleral Outflow
 The below shown image of retina is
characteristic of:
• CSR
• CRAO
• CRVO
• CME
 The shown instrument is used for:
A. Pin hole test
B. Corneal curvature
C. To differentiate cause
of color halo
D. Checking pupil size
A person from village presented with this finding. There
was history of trauma while he was working in field few
days ago. Diagnosis:
A. Bacterial keratitis
B. Fungal keratitis
C. Viral keratitis
D. Protozoal keratitis
Fungal Keratitis
 A person from slums presented with itching, redness and
lacrimation. Examination reveals following finding. Diagnosis:

A. Trachoma
B. Inclusion conjunctivitis
C. Spring catarrhalis
D. Allergic conjunctivitis
WHO Classification of trachoma
Important findings in trachoma (SAPH)
• Sago grain follicles- Pathognomonic/hallmark
• Arlt’s line (scarring)
• Pannus/Herbert’s pit- on upper lid due to
resolved follicle
• IOC: Mc Coy Culture
• Upon conunjctival smear: Leber Cells and HP
bodies
• Rx: SAFE Strategy
This patient presented with recurrent change of
glasses. Upon examination this is your finding.
Diagnosis:
A. Glaucoma
B. Cataract
C. Lenticonus
D. Keratoconus
CORNEAL DEGENERATION
KERATOCONUS
 All are true about the given procedure
are all EXCEPT?
A. Used to check retinal
detachment of the
patient
B. Reflex moves in same
direction in emmetropia
C. Reflex moves in opposite
direction in myopia >1 D
D. Patient between patient
and doctor is 1 meter
Goodness! I’ve been cloned!?!?
Questions?