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Final FRCR Part B Viva: 100 Cases and Revision Notes
Richard White, Robin Proctor, Ian Zealley
Preparing for the exam
Recent changes to the Final FRCR Part B viva
Different types of examiner
The examination set-up
Using a structured response for each image
A brief silence
Describe the image(s)
Describe any positive findings
Summarise
Diagnosis and differential diagnosis
Suggested further investigation or management
Discussion
Summary
Conditional differential diagnosis
(Ultra) simplified surgical sieve
Closing
Requesting additional information
What to do if you get stuck
‘Bad’ cases
Complex cases
Talk about the really important elements first
Be systematic
Multiple similar findings
Summarising
Diagnosis or differential diagnosis?
What about a syndrome you don't recognise?
If you can't put it all together
A few specifics and exceptions
Mention lines and tubes first
Lumps and masses
Changing your mind
Terminology
Radioisotope examinations
Trauma
Chest radiographs
Arthropathies
Mammograms
Emergency management
And finally …
Personal appearance
If your first language is not English or you have a strong regional accent
Homework
Case 1
Suggested response
Diagnosis
Tips: mediastinal mass on a chest radiograph
Key points
Pericardial cyst
Case 2
Suggested response
Diagnosis
Tips: aggressive bone lesions
Key points: focal bone lesion description
Differential diagnosis
Osteosarcoma
Fibrous cortical defect and non-ossifying fibroma
Case 3
Suggested response
Diagnosis
Tips: lobar collapse on chest radiographs
Key points
Lobar collapse
Case 4
Suggested response
Diagnosis
Tips: erosive arthropathy (hands)
Key points
Psoriatic arthropathy
Case 5
Suggested response
Diagnosis
Tips: breast cancer
Key points: chest radiograph
Key points: mammograms
Key points: ultrasound
Breast cancer
Case 6
Suggested response
Diagnosis
Tips: indolent lucent bone lesions
Key points: non-aggressive (or indolent) bone lesions
Eosinophilic granuloma
Case 7
Suggested response
Diagnosis
Tips: large bowel obstruction
Key points
Differential diagnosis
Sigmoid volvulus
Case 8
Suggested response
Suggested response
Diagnosis
Tips: a solitary lung mass
Key points
Differential diagnosis
Solitary pulmonary mass
Case 9
Suggested response
Suggested response
Diagnosis
Tips: spondyloarthropathy
Key points and differential diagnosis
Ankylosing spondylitis
Case 10
Suggested response
Diagnosis
Tips: bilateral airspace shadowing
Key points and differential diagnosis
Fat embolism
Case 11
Suggested response
Diagnosis
Tips: craniofacial trauma
Key points
Le Fort injuries
Case 12
Suggested response
Diagnosis
Tips: small bowel dilatation
Key points and differential diagnosis
Obturator hernia
Case 13
Suggested response
Diagnosis
Tips: solitary intracranial mass lesions
Key points
Primitive neuroectodermal tumours (medulloblastoma)
Case 14
Suggested response
Diagnosis
Tips: pneumoperitoneum
Pneumoperitoneum
Case 15
Suggested response
Diagnosis
Tips: a retroperitoneal mass
Key points
Differential diagnoses
Myelolipoma
Case 16
Suggested response
Diagnosis
Tips: trauma chest radiographs
Key points
Traumatic injury to the aorta
Case 17
Suggested response
Diagnosis
Tips: focal oesophageal narrowing
Key points
Differential diagnoses
Primary achalasia
Case 18
Suggested response
Diagnosis
Tips: unilateral increased transradiancy
Differential diagnoses
Poland's syndrome
Case 19
Suggested response
Diagnosis
Tips: cystic lung disease
Key points
Lymphangioleiomyomatosis
Case 20
Suggested response
Suggested response
Diagnosis
Tips: intracranial calcification
Key points
Differential diagnosis
Tuberous sclerosis
Case 21
Suggested response
Diagnosis
Tips: cervical spine trauma diagnosis
Key points
Unilateral facet joint dislocation
Case 22
Suggested response
Suggested response
Diagnosis
Tips: neonatal low bowel obstruction
Key points
Meconium ileus
Case 23
Suggested response
Diagnosis
Tips: renal transplant
Key points: ultrasound
Key points: plain films and fluoroscopic images
Renal transplant imaging
Case 24
Suggested response
Diagnosis
Tips: intravenous urography
Key points on the control film
Differential diagnosis for nephrographic patterns
Differential diagnosis for calyceal clubbing
Pelviureteric junction obstruction
Case 25
Suggested response
Diagnosis
Tips: a lump in the neck
Key points and differential diagnosis
Thyroglossal duct cyst
Case 26
Suggested response
Diagnosis
Tips: bowel wall thickening on abdominal radiographs
Key points and differential diagnosis
Ulcerative colitis
Case 27
Suggested response
Diagnosis
Tips: acute imaging of stroke
Key points
Cerebral infarction
Case 28
Suggested response
Diagnosis
Tips: sickle cell disease
Key points
Sickle cell disease
Case 29
Suggested response
Diagnosis
Tips: a solitary spinal bone lesion
Key points and differential diagnosis
Myeloma
Case 30
Suggested response
Diagnosis
Tips: catheter angiograms
Key points
Differential diagnosis
Popliteal artery entrapment syndrome
Case 31
Suggested response
Diagnosis
Tips: intracranial haemorrhage
Key points
Subarachnoid haemorrhage
Case 32
Suggested response
Diagnosis
Tips: small bowel barium studies
Key points
Small bowel barium studies
Case 33
Suggested response
Diagnosis
Tips: unilateral airspace opacification
Key points
Differential diagnosis
Airspace opacification
Case 34
Suggested response
Diagnosis
Tips: tuberculosis
Key points
Tuberculosis
Case 35
Suggested response
Diagnosis
Tips: intracranial extra-axial collection
Key points
Subdural empyema
Case 36
Suggested response
Diagnosis
Tips: pleural thickening
Key points
Malignant mesothelioma
Case 37
Suggested response
Suggested response
Diagnosis
Tips: calcifications in the abdomen or pelvis
Key points
Differential diagnosis
Abdominal aortic aneurysm
Case 38
Suggested response
Diagnosis
Tips: bronchiectasis
Key points
Differential diagnosis
Cystic fibrosis
Case 39
Suggested response
Suggested response
Diagnosis
Tips: possible non-accidental injury
Key points
Differential diagnosis
Non-accidental injury
Case 40
Suggested response
Diagnosis
Tips: hyperparathyroidism
Key points
Hyperparathyroidism
Case 41
Suggested response
Diagnosis
Tips: paediatric hip radiographs
Key points
Slipped upper femoral epiphyses
Case 42
Suggested response
Diagnosis
Tips: bilateral hilar enlargement
Key points
Sarcoidosis
Case 43
Suggested response
Diagnosis
Tips: knee trauma
Key points
Segond fracture
Case 44
Suggested response
Suggested response
Diagnosis
Tips: a paraspinal mass
Key points
Differential diagnoses
Nerve sheath tumours
Case 45
Suggested response
Diagnosis
Tips: hand/wrist trauma
Key points
Lunate and perilunate dislocations
Case 46
Suggested response
Diagnosis
Tips: rib notching
Key points and differential diagnosis
Aortic coarctation
Case 47
Suggested response
Diagnosis
Tips: a gastrointestinal fistula
Key points
Gastrointestinal tract fistulation
Case 48
Suggested response
Diagnosis
Tips: a cavitating lung lesion
Key points
Differential diagnosis
Cavitating tumours
Case 49
Suggested response
Diagnosis
Tips: lesions(s) in the liver
Key points
Differential diagnoses
Liver haemangiomas
Case 50
Suggested response
Diagnosis
Tips: neonatal chest radiographs
Key points
Respiratory distress syndrome
Case 51
Suggested response
Diagnosis
Tips: strictures on a contrast enema
Key points
Colonic metastases
Case 52
Suggested response
Diagnosis
Tips: congenital heart disease
Key points
Left atrial enlargement
Case 53
Suggested response
Diagnosis
Tips: chest radiographs in the intensive care unit
Key points
Inadvertent subclavian artery cannulation
Case 54
Suggested response
Diagnosis
Tips: diffuse bony sclerosis
Differential diagnosis
Metastatic prostate cancer
Case 55
Suggested response
Suggested response
Diagnosis
Tips: congenital renal disorders
Differential diagnosis
Multicystic dysplastic kidney
Case 56
Suggested response
Diagnosis
Tips: shoulder trauma
Key points
Shoulder dislocation
Case 57
Suggested response
Diagnosis
Tips: metastatic renal cell carcinoma
Key points
Differential diagnosis
Metastatic renal cell carcinoma
Case 58
Suggested response
Suggested response
Diagnosis
Tips: an intracranial ring-enhancing lesion
Key points
Differential diagnosis
Cerebral abscess
Case 59
Suggested response
Diagnosis
Tips: salivary gland abnormalities
Key points
Submandibular abscess
Case 60
Suggested response
Diagnosis
Tips: upper zone interstitial lung disease
Key points
Silicosis
Case 61
Suggested response
Diagnosis
Tips: absence of the distal clavicle
Key points and differential diagnosis
Osteolytic metastases
Case 62
Suggested response
Diagnosis
Tips: a finding of a filling defect on intravenous urography
Key points and differential diagnosis
Bladder TCC
Case 63
Suggested response
Suggested response
Diagnosis
Tips: surgical emergencies
Megacolon
Case 64
Suggested response
Diagnosis
Tips: a stress fracture
Key points and differential diagnosis
Insufficiency fractures
Case 65
Suggested response
Diagnosis
Tips: renal tract gas
Key points and differential diagnosis
Emphysematous cystitis
Case 66
Suggested response
Suggested response
Diagnosis
Tips: pancreatitis
Key points
Pancreatitis
Case 67
Suggested response
Diagnosis
Tips: diffuse periosteal reaction
Key points
Hypertrophic osteoarthropathy
Case 68
Suggested response
Diagnosis
Tips: paediatric congenital lung disease
Key points
Differential diagnoses
Congenital cystic adenomatoid malformation
Case 69
Suggested response
Diagnosis
Tips: a structural abnormality of the thoracic cage
Key points
Pectus excavatum
Case 70
Suggested response
Diagnosis
Tips: soft tissue calcification in the extremities
Differential diagnosis
Dermatomyositis
Case 71
Suggested response
Diagnosis
Tips: portal venous gas
Key points
Necrotising enterocolitis
Case 72
Suggested response
Diagnosis
Tips: testicular tumours
Differential diagnosis
Seminoma
Case 73
Suggested response
Diagnosis
Tips: posterior vertebral scalloping
Key points
Differential diagnosis
Achondroplasia
Case 74
Suggested response
Diagnosis
Tips: linitis plastica
Differential diagnosis
Malignant linitis plastica
Case 75
Suggested response
Diagnosis
Tips: mesenteric masses
Key points
Carcinoid tumour
Case 76
Suggested response
Diagnosis
Tips: gallstone ileus
Key points
Gallstone ileus
Case 77
Suggested response
Diagnosis
Tips: suspected diaphragmatic hernia
Key points
Differential diagnosis
Traumatic diaphragmatic hernia
Case 78
Suggested response
Diagnosis
Tips: defects in the dural venous sinuses
Key points
Dural sinus thrombosis
Case 79
Suggested response
Diagnosis
Tips: paediatric lines and tubes
Key points
Patent foramen ovale
Case 80
Suggested response
Diagnosis
Tips: lower zone interstitial lung disease
Key points and differential diagnosis
Pulmonary asbestosis
Case 81
Suggested response
Diagnosis
Tips: a paediatric abdominal mass
Key points and differential diagnosis
Paediatric hydronephrosis
Case 82
Suggested response
Suggested response
Diagnosis
Tips: vertebral endplate changes
Key findings and differential diagnosis
Discitis
Case 83
Suggested response
Diagnosis
Tips: paediatric cranial ultrasound
Key points
Dysgenesis of the corpus callosum
Case 84
Suggested response
Diagnosis
Tips: a cystic lesion of the mandible
Key points and differential diagnosis
Keratocystic odontogenic tumour
Case 85
Suggested response
Suggested response
Diagnosis
Tips: paediatric upper airways disease
Key points
Croup
Case 86
Suggested response
Suggested response
Diagnosis
Tips
Key points
Intussusception
Case 87
Suggested response
Diagnosis
Tips: bilateral renal tract calcifications
Key points
Medullary sponge kidney
Case 88
Suggested response
Diagnosis
Tips: foot and ankle trauma
Key points
Lisfranc injuries
Case 89
Suggested response
Diagnosis
Tips: bowel polyps
Key points
Gastrointestinal polyposis
Case 90
Suggested response
Diagnosis
Tips: enchondromas
Key points
Differential diagnosis
Ollier's disease (multiple enchondromatosis)
Maffucci's syndrome
Case 91
Suggested response
Suggested response
Diagnosis
Tips: pneumomediastinum
Key points
Oesophageal perforation
Case 92
Suggested response
Suggested response
Diagnosis
Tips: ultrasound images that you do not initially recognise
Imaging appendicitis
Case 93
Suggested response
Diagnosis
Tips: bowel ischaemia
Key points
Portal vein thrombosis
Case 94
Suggested response
Diagnosis
Tips: foci of discrete renal tract calcification
Key points
Horseshoe kidney
Case 95
Suggested response
Diagnosis
Tips: air trapping
Key points
Differential diagnosis
Foreign body aspiration
Case 96
Suggested response
Diagnosis
Tips: an apical lung lesion
Key points and differential diagnosis
Pancoast tumour
Case 97
Suggested response
Diagnosis
Tips: MRI of the female pelvis
Key points and differential diagnosis
Imaging of the female pelvis
Case 98
Suggested response
Diagnosis
Tips: the loss of arterial flow voids
Key points
Carotid artery dissection
Case 99
Suggested response
Diagnosis
Tips: joint destruction
Key points
Neuropathic arthropathy
Case 100
Suggested response
Diagnosis
Tips: spinal cord pathologies
Key points
Spinal cord infarction
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