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  • anatomy & x rays for semsema

    <hr style="color: rgb(209, 209, 225);" size="1"> <!-- / icon and title --> <!-- message --> Shabab teb
    Mohamad Abu-Safieh

    X-ray & Anatomy: don’t worry, the exam is very easy<o:p></o:p>

    Place: 1<sup>st</sup> floor in el faransawi hospital..go through the main gate, then ascend the stairs in front of you. then to the left, hall 1<o:p></o:p>

    Questions: true or false<o:p></o:p>

    1. Mammography, malignant lesion<o:p></o:p>

    - this is a plain x ray study <o:p></o:p>

    - cystic<o:p></o:p>

    - FNA is useful<o:p></o:p>

    - there are micro calcifications<o:p></o:p>

    - alpha feto ptn is high <o:p></o:p>

    2. Trans femoral aortography, occlusion of the left side<o:p></o:p>

    - this is burger disease<o:p></o:p>

    - this film is sufficient to decide ttt ( no you need the rest of the film)<o:p></o:p>

    - acute ischemia is a complication of this investigation<o:p></o:p>

    - there is left leg pain<o:p></o:p>

    - trans lumbar study<o:p></o:p>

    3. PTC, high malignant obstruction of the CBD<o:p></o:p>

    - IV cholangiography<o:p></o:p>

    - lesion in the lower part of CBD<o:p></o:p>

    - there is OJ<o:p></o:p>

    - percutaneous trans hepatic drainage of bile is useful<o:p></o:p>

    - cholangiocarcinoma is a possible cause<o:p></o:p>

    4. Achalasia of the cardia<o:p></o:p>

    - Retrosternal pain is the first complaint<o:p></o:p>

    - precancerous lesion<o:p></o:p>

    - pneumatic dilation is the standard ttt<o:p></o:p>



    5. lung metastases, plain x ray<o:p></o:p>

    - this is a contrast study<o:p></o:p>

    - surgery is useful<o:p></o:p>

    - there are hemoptysis and dyspnea<o:p></o:p>

    - cancer colon is the main cause<o:p></o:p>


    6. Ectopia vesica: <o:p></o:p>

    - fracture pelvis<o:p></o:p>

    - congenital disease<o:p></o:p>

    - associated with undescended testis<o:p></o:p>

    - precancerous lesion<o:p></o:p>

    - ttt is best at age of 10<o:p></o:p>

    7. Intestinal obstruction: erect <o:p></o:p>

    - erect position<o:p></o:p>

    - air under diaphragm ( no)<o:p></o:p>

    - cancer rectum is the commonest cause<o:p></o:p>

    - there is painless constipation<o:p></o:p>

    - abdominal tenderness & rigidity indicate surgery <o:p></o:p>

    8. Unstable fracture, cervical spine <o:p></o:p>

    - skull traction is indicated<o:p></o:p>

    - this condition is fatal<o:p></o:p>

    - the patient may need mechanical ventilation <o:p></o:p>

    - this is a plain x-ray study<o:p></o:p>

    - there is hypovolemic shock <o:p></o:p>

    9. Sternomastoid<o:p></o:p>

    10. Radial Nerve<o:p></o:p>

    11. Stomach<o:p></o:p>

    12. long saphenous vein <o:p></o:p>

    Good luck
    ازاى الاولاد ؟

    وانا كمان ;)

  • #2
    رد: anatomy &amp; x rays for semsema

    Shabab teb
    Mohamed Taher

    peace be upon u all:
    - the exam is 12 stations: 8 x-ray & 4 anatomy
    - each station A,B,C,D,E statements
    - u just mark ' / ' or ' x ' on the statements
    - the time is more or less enough
    - anatomy: no jars . it is pictures ' from Atlas ' . i don't know of course which atlas
    - in anatomy: they marked:
    * Sartorius muscle
    * External iliac vessles
    * Masseter muscle
    so take care [ the pictures are more or less so clear ]
    - I think it was easy
    -finally: they start early, so don't be late

    - I forgot to tell u that: they bring normal x-rays
    e.g. today there was t-tube cholangiogram: normal
    - read the comments beside each picture very well while u revise before the exam.
    - it is data show

    good luck
    ازاى الاولاد ؟

    وانا كمان ;)


    • #3
      رد: anatomy &amp; x rays for semsema

      Shabab teb
      May selim

      according to X-rays exam, i recommend ketab shayeb x-rays and answer all questions beta3to (mofida).
      we got in the exam:
      1- osteosarcoma of bone
      3-stone in submandibular gland
      4-t tube cholangiography
      6-cancer oesophagus
      7-double ureter
      el anatomy kan bashe3 shewaya
      9-quadriceps femoris, u should know which head vastus medialis we keda
      10- masseter and questions kanet 3ala structures inside parotid
      11-drawing lel lower abdomen wel testis, questions kanet 3ala internal spermatic and external spermatic fascia (my personal worst x-ray)
      12-drawing lel breast dissected bas we sa2al 3al arterail supply internal mamary and so.
      in short the surgical x-rays were fine, el moshkela kanet fel anatomy. don't just do dr. medhat's questions.
      exam starts at 8:00 sharp
      bey2olo awel magmouma shala, i am living proof that it is not :-)
      good luck :-)
      ازاى الاولاد ؟

      وانا كمان ;)


      • #4
        رد: anatomy &amp; x rays for semsema

        Shabab teb
        Mohamed Taher

        1- stone in submandibular gland:
        * this is sialogram
        * patient presents by exccessive salivation
        * this condition is more in parotid gland
        * presents by recurrent sialadenitis
        2- T-tube cholangiogram: [ normal ]
        * this is ERCP
        * it shows free flow to doudenum
        * the dye fills the gall bladder
        * it is recommended to remove the tube ( / )
        3-arteriography: [ iliac stenosis ]
        * it shows iliac stenosis
        * due to atherosclerosis
        * the patient presents by claudication in gluteal & thigh
        * this investigation is essential for all cases of claudication
        * contrast is injected directly in an artery
        4- cancer oesophagus:
        - * histolgically most probably adenocarcinoma
        * main presentation is dysphagia and weight loss
        * best next investigation is ultrasound
        *chemotherapy has a main role in palliation
        5- double ureter:[ ivu]
        * one complication of this contrast is allergy
        * " " " " " " pyelonephritis
        * it shows horse shoe kidney
        * this is harmless condition
        6- diverticulosis coli:
        * it has typical distribution
        * causes severe bleeding per rectum
        * this investigation is contraindicated in acute diverticulitis
        7- hemopnumothorax: [ Rt ]
        * theres marked tracheal shift
        * there is subcutaneous emphysema on left side
        * chest tube inserted in 5th space midaxillary line
        8- osteosarcoma:
        * in lower femur
        * no new bone formation
        * blood metastases mainly to lungs
        1- Breast:
        * this is deltoid muscle
        * " " pectoralis major
        * breast related directly to pectoral fascia
        * " supplied by perforators of internal mammary artery
        * " " " 1st & 2nd parts axillary artery
        2- Massetr muscle:
        * this is masseter
        * parotid duct pierces it
        * facial nerve is deep to parotid
        * injury facial n. result in loss sensation over that side of face
        3- abdomen:
        * this is external iliac vessles ( / )
        then questions about inguinal canal
        4- L.L.:
        * This is vastus medialis muscle ( x )
        * this is sartorius muscle ( / )
        * of quadratus femoris is only from femoral nerve
        * the femoral artery is directly related to saphenous nerve in the subsartorial canal

        this is what i could remember, don't worry , the time is enough
        good luck
        ازاى الاولاد ؟

        وانا كمان ;)


        • #5
          رد: anatomy &amp; x rays for semsema

          Shabab teb

          concerning Anatomy and X-rays: I was group 2

          1) Fracture dislocation of the spine:
          dayman first Q what type of modality?
          Main presentation is hopovolaemic shock?
          ttt by skull traction?
          May need endotracheal intubation?
          2) Ectopic vesica
          3) Lung metastasis
          4) Soft tissue mamography suspecious for breat ca
          5) PTC
          6) Lt ilaic block
          7) Achalasia
          8) Intestinal obstruction erect abd.XR

          1)Long saphenous vein
          2)Radial nerve and deltoid ms
          4)sternomastoid ms
          Sorry could not remember even the Q after we left the exam room 3ala
          tool keteer awey to remember 60 Q(12X5)
          But the time is enough and only some Q are not straight forward!!

          yalla rabena ma3akom
          ازاى الاولاد ؟

          وانا كمان ;)


          • #6
            رد: anatomy &amp; x rays for semsema

            Shabab teb
            Ismail Fathy

            mafeesh 7aga esmaha esa3a 11 am zay ma maktob fel gadwal
            1)x-rays and anatomy: el exam started at 8:00 fel kasr el ainy el faransawy... 8 xrays and 4 anatomy slides, they were shown by a projector... 5 ques true or false on each... el anatomy makansh slides 4 jars,,, kan kollo drawings zay el fe ay atlas... kol el slides kanet wad7a awy wel xrays kanet kolaha mn el cd beta3 el koleya... am sorry i don remember exactly the questions bas el anatomy kan fe kteer mn el questions beta3et dr med7at, wel x rays kan fe mn el comments el maktooba fel cd beta3 el koleya. el exam kan too easy bas shwaya tricky
            ازاى الاولاد ؟

            وانا كمان ;)


            • #7
              رد: anatomy &amp; x rays for semsema

              Shabab teb
              DR.TARIQ ZIAD"

              i see some colleagues want to know something about surgical x ray exam
              its was easy w alhamdulellah and i'll tell all i remember:
              -OTEOSARCOMA:they asked about it is in metaphysis ,in growing (10-20y)
              bone formation,metrastases to liver nooo (x)its to lung.
              -DIVERTICULOSIS OF SIGMOID: if it is a precancerous lesion or cause
              -STONE IN SUBMANDIBULAR DUCT:plain x ray,cause saladenitis and its
              more in ubmandibular than parotid.
              -OSEOPHAGEAL CANCER:not adenocarcinoma ,if ultra sound is useful and
              about dysphagia if its important symptom
              -DOUBLE URETER
              dah elly fakro men el x rays w anatomy kan 4 diagrams but it was not
              as easy as x rays i remeber they asked if there is a relation between
              femoral arety and saphenous nerve???????
              they also aked about parotid duct is it pierces masseter and they put
              an arrow pointig on masseter in another question they also pointed to
              sartorius muscle

              sorry that all i remember i hope its useful
              ازاى الاولاد ؟

              وانا كمان ;)


              • #8
                رد: anatomy &amp; x rays for semsema

                Shabab teb
                amer trkmani

                UL : muscle{-deltoid
                -pectoralis major
                -latissmus dorsi
                nerve{ulnar- radial-median
                LL : muscle{qudricepce
                artery{femoral- poplitial
                vein {short&long saphenous
                head&neck : thyroid- sternomastoid_masseter-parotid
                abdomen :all is important
                this topic are is important to know

                x_ray :web site of collague&elearning web site
                ازاى الاولاد ؟

                وانا كمان ;)


                • #9
                  رد: anatomy &amp; x rays for semsema

                  Shabab teb
                  mm mm

                  Alsalamu Alikom all
                  we had xray & anatomy today alhmdulah it went so smooth, no problem in time at all and the seats were fine 2 or 3 ppl complained as they had forgotten their glasses and they changed their seats but otherwise everybody was comfortable alhmdulah and u can see from anywhere u sit aslan el shasha kbera...
                  GO EARLYYYY , the first shift started at 8:15 they were few , i was in the 2nd shift we started about 9:30..
                  dr medhat's lesson was very useful alhmdulah and many Qs came from the 20 papers that he gives especially the last papers written by his handwriting... the cd of dr. Amr mohsen was enough for the xray and try to do Qs as much as u can from dr Amr el Shayeb's book.. Qs were simple anyway so dont worry
                  here is our exam as much as i can remember :

                  1- Supracondylar # humerus:
                  - elbow stiffness my follow ?
                  - there is disturbed relation between olecranon process & epicondyles?
                  - this trauma in extension?
                  - may lead to injury brachial artery?
                  2- PTC: (wasnt so clear actually, u see large white area with tree like projections)
                  - this is ERCP?
                  - there is a stone seen in CBD? (i have no idea ! )
                  - bleeding tendency may occur due to hypoprothrombinemia ?
                  - vitamin K should be given few days before this procedure?
                  - this patient complains of jaundice, dark urine, and pale stool?
                  3- Bilateral Staghorn stone:
                  - this is bilat. staghorn stone?
                  - ttt is percutaneus nephrolithotomy?
                  - underlying infection is usually present?
                  - stone is purely uric acid?
                  - CT is needed ?
                  4- CT splenic cyst (written above: male patient from yemen with RT upper abd pain)
                  - there is splenic cyst?
                  - most common cause is hydatid cyst?
                  - rupture leads to anaphylaxis?
                  - there is liver cyst? (NO)
                  - splenectomy is only indicated in patients with failure medical ttt?
                  5- Tension Pneumothorax Lt: (wad7a alhmdulah jet blak+ mediast shifted)
                  - underlying cause is traumatic?
                  - there is hemothorax on the Rt ? (NO)
                  - there is surgical emphysema where the arrow points? (yes)
                  - patient presents with dyspnea and congested neck veins?
                  - CT is urgent to confirm diagnosis?
                  6- Cancer sigmoid:
                  - this is Ba meal follow through?
                  - there is narrowing in sigmoid?
                  - lesion is malignancy?
                  - stool culture is needed after that for diagnosis?
                  - patient presents with long standing dyspepsia ?
                  7- Sliding Hiatus hernia:
                  - patient is standing?
                  - carida is above diaphragm?
                  - cardiomyotomy is indicated in complicated cases?
                  - may lead to stricture?
                  - patient presents with chest pain and recurrent shocking attacks?
                  8- Rt profunda femoris block:
                  - there is Rt profunda femoris block?
                  - there is Lt superficial femoral block? (no)
                  - there is distal run off? (no)
                  - this study is indicated in sever ischemic manifestations?
                  - patient complains of claudications in calf muscles on walking?

                  anatomy >> colored drawings from atlas arrows were clear and pointing to 1 structure
                  (i brought the answers from dr. medhat's papers as much as possible)
                  9- Spleen:
                  - this structure is completely retroperitoneal? (no)
                  - venous drainage to IVC? (no)
                  - may be injured in chest trauma? (yes)
                  - related to pancreas? (yes)
                  - normally palbable? (no)
                  10- Ulnar nerve : (kan maktob 3leh aslan bkhat soghyar :D bs m7adesh y2ol )
                  - this is median nerve? (no)
                  - may be injured in fracture surgical neck of humerus? (no)
                  - injury leads to claw hand? (yes)
                  - injury leads to loss of fingers adduction? ?
                  - passes behind medial epicondyle? (yes)
                  11- Thyroid gland :
                  - develop embryologically from tongue or foramen cecum ( i dont remember)?
                  - RLN may be injured in ligation of upper vessels ?
                  - blood supply completely from external carotid?
                  - enclosed in prevertebral fascia?
                  - drain to submandibular LNs?
                  12- Femoral artery : (the arrow points below the inguinal lig.)
                  - pulsations normally felt on midinguinal point? (yes)
                  - this is one of the 2 terminal branches of external iliac? (NO, its continuation)
                  - enclosed in femoral sheath? (Yes)
                  - gives rise to profunda femoris? (yes)

                  Good Luck all... aham 7aga fe3lan el do3aaa2 w hdoo2 el a3sab
                  ازاى الاولاد ؟

                  وانا كمان ;)


                  • #10
                    رد: anatomy &amp; x rays for semsema

                    Shabab teb
                    marwa sayed
                    -this is suprachondylar extension type
                    -this is the commonest type
                    -it cause injury to brachial artery
                    -malunion affects the carrying angle
                    -internal metal fixation is the rule


                    2--PLAIN X RAY KIDNEY
                    -RT. side show stag horn storn
                    -the yellow arrow points to a bladder stone
                    -the red arrow points to pure uric acid stone (uric acid is radioluscent)
                    -IVU is indicated
                    -hypoparathyroidism may be a cause

                    __________________________________________________ _

                    -this is transfemoral
                    -this cause impotence in male
                    -the commenest cause is atheroscelerosis
                    -at this level cause gluteal pain
                    -popliteal & tibial arteries are patent femoro-popliteal bypass indicated

                    __________________________________________________ __-

                    4--BARIUM SWALLOW OESOPHAGUS
                    -this is barium swallow x ray
                    -this patient suffer dysphagia to fluid more than solid
                    -operative tt in complicated cases
                    -this suggest oesophageal malignancy
                    -oesophagoscopy &biopsy indicated
                    5--ULNAR NERVE
                    -this is the ulnar nerve
                    -injuried in lateral epichondyle fracture
                    -pass deep to flexor retinaculum
                    -it's injury affect thumb opposition
                    -injury affects extension elbow

                    6--PSOAS MAJOR
                    -its insertion to greater trochanter
                    -gonadal vessels anterior to it
                    -acute appendicitis affects it
                    -its fascia form the inguinal ligament
                    -ureter is lateral to it

                    7--MIDDLE MENINGEAL ARTERY
                    -its a branch from I.C.A
                    -its injury causes extradural hge
                    -its injury causes cerebral ischemia
                    -it pass through foramen spinosum
                    -it pierce dura at level of pterion

                    8- LATERAL POPLITEAL NERVE
                    -this is medial popliteal nerve
                    -its injury lead to foot drop
                    -injuried in upper fibula fracture
                    -its branch from femoral nerve
                    -it supply gastrocnemius

                    9--BARIUM ENEMA RT.COLON CARCINOMA
                    -this is barium enema study
                    -this is irregular filling defect
                    -alfapheto protien incerease
                    -usual symptos anorexia ,weakness, weight loss
                    -this is carcinoma of RT colon

                    10-Tention hydropneumothorax-

                    -the usual presentation sever cough
                    -the patient is dyspnic
                    -the next step is urgent MRI
                    -urgent chest tube needed
                    -neck veins is congested

                    __________________________________________________ ________
                    11- T. tube cholangiography
                    -this is PTC
                    -there is no stons in CBD
                    -free flow to duodenum
                    -removed safely now
                    -this done 2 days after cholecystectomy

                    __________________________________________________ _
                    12- CT abdomen
                    -this is acyst related to pancreas
                    -this is commenly after biliary stone
                    -may be complicated by infection &abscss formation
                    -aspiration percutaneous is better than trans-gastric
                    -this is not optimum time to treat
                    ازاى الاولاد ؟

                    وانا كمان ;)


                    • #11
                      رد: anatomy &amp; x rays for semsema

                      transfemoral aortography with left superficial femoral block
                      rt pneumothorax
                      intestinal obstruction (sigmoid volvulus)
                      fracture shaft femur
                      IVU with delay in rt kidney excretion by ureteric stone
                      ct scan of liver lesion (??)
                      extradural hematoma
                      sliding hiatus hernia

                      the problem is not in the recognition (except in CT) but try to concentrate in the questions

                      in each station, usually 3 questions are easy and the other 2 are relatively difficult

                      good luck
                      ازاى الاولاد ؟

                      وانا كمان ;)


                      • #12
                        رد: anatomy &amp; x rays for semsema

                        1.supracondylar fracture humerus:
                        -is it supracondylar fracture humerus.
                        -injury to muscuocutaneous nerve may occur.
                        -ttt is done by plaster cast in flextion
                        -volkman's ischemic contracture can occur.
                        -duptryne palmar fascia contracture may occur.

                        2.pharyngeal pouch
                        - this is barium swallow.
                        - it commonly occur in old age.
                        - it leads to aspiration pneumonia.
                        - ttt is done by dissection of the spastic middle constrictor of the pharynx.

                        3. eaten apple core tumor of sigmoid colon
                        - this is double enema
                        - it is suggestive of malignancy
                        - fever & acute abdomen is of the clinical picture
                        - there is diverticulosis of the colon

                        - both common iliac arteries are attenuated
                        - this lesion indicates atherosclerosis
                        - if the distal arteries are patent bifemoroaortic bypass can be done
                        - best graft is reversed saphenous vein

                        5.multiple liver metastases (CT) , primary was removed:
                        - CEA is incresed
                        - Alfa feto ptn is increased
                        - removal of liver & liver transplantation is curative in this patient
                        - this is multiple liver metastases

                        6.pseudopancreatic cyst (CT):
                        - this is a lesion in tail of pancreas
                        - the arrow points to spleen
                        - the circle is aroud IVC
                        - ttt is by cystogastrostomy

                        7.stone in urinary bladder (phosphate stone):
                        - laminated appearance & smooth surface indicate oxalate stone
                        - this stone is formed in infected urine
                        - nephrolithotomy is the only ttt
                        - radio-opaque shadow in pelvis is a stone in urinary bladder

                        8.Rt sided hemopneumothorax:
                        - the pleural cavity in obliterated on Rt side
                        - the pleural cavity in obliterated on Lt side
                        - endotracheal intubation & mechanical ventilation is necessay before tube insertion
                        - tube insertion in 5th space midaxillary line is indicated

                        9. median nerve:
                        - this nerve arises from both medial & lateral roots
                        - this nerve supplies one muscle in the arm
                        - this nerve passes between two heads of pronator teres
                        - its injury leads to paralysis of opponens pollicis

                        10. sternomastoid
                        - it overlies parotid at its lower part
                        - it covers the carotid sheath
                        - it is supplied by ansa cervicalis
                        - cervical plexus appears at its posterior border

                        11.rectus abdominis:
                        - it is supplied by intercostal nerves
                        - tendenious intersections are addherant to the muscle
                        - the anterior rectus sheath is defecient below
                        - direct inguinal hernia passes through it
                        - in paramedian incision the muscle is displaced laterally to expose its posterior aspect.

                        12. short saphenous vein
                        - it passes behind the lateral malleolus
                        - it ends in popliteal vein
                        - it is communicating with long saphenous by many veins
                        - it is valveless

                        N.B.: each station has 5 questions
                        ازاى الاولاد ؟

                        وانا كمان ;)


                        • #13
                          رد: anatomy &amp; x rays for semsema

                          X ray anatomy<o:p></o:p>

                          الشيفت التانى <o:p></o:p>

                          الاسئلة الى حد ما معقولة <o:p></o:p>


                          GASTRIC ULCER<o:p></o:p>

                          COMMINUTED FRACTURE<o:p></o:p>


                          STAGE HORN STONE<o:p></o:p>

                          AIR UNDER DIAPHRAGM<o:p></o:p>




                          ULNER NERVE<o:p></o:p>


                          M M A<o:p></o:p>
                          RT KIDNEY
                          ازاى الاولاد ؟

                          وانا كمان ;)