Viva · Specialty
Paediatric Radiology Viva Questions
Oral-exam style questions and answers on paediatric radiology for MD, DNB and super-specialty practical examinations. Each answer links back to the playbook or Library entry it was written from.
- What is the Modified Bell classification used for?
- It grades the severity of neonatal necrotising enterocolitis using systemic, intestinal and radiographic findings.
- How many stages are included in the Modified Bell classification?
- There are six substages: IA, IB, IIA, IIB, IIIA and IIIB.
- Which finding distinguishes stage IB from stage IA?
- Stage IB has gross rectal bleeding, whereas stage IA may have only occult blood in the stool.
- Which radiographic finding establishes definite NEC at stage IIA?
- Pneumatosis intestinalis establishes definite NEC and is the characteristic radiographic finding of stage IIA.
- At which Modified Bell stage is portal venous gas encountered?
- Portal venous gas is included in stage IIB, usually with pneumatosis intestinalis and possible ascites.
- What distinguishes stages IIIA and IIIB?
- In stage IIIA the bowel remains intact, whereas stage IIIB has intestinal perforation demonstrated by pneumoperitoneum.
- Does the absence of pneumoperitoneum exclude advanced or perforated NEC?
- It does not exclude advanced NEC, because stage IIIA has severe disease without perforation. Clinically suspected perforation may also require further assessment despite an equivocal radiograph.
- What is the radiographic progression to remember in Modified Bell staging?
- The sequence is non-specific ileus, pneumatosis intestinalis, portal venous gas, definite ascites and finally pneumoperitoneum.
- What does the Papile classification grade?
- It grades germinal matrix–intraventricular haemorrhage according to subependymal haemorrhage, ventricular involvement, ventricular dilatation and historical parenchymal involvement.
- Enumerate the four Papile grades.
- Grade I is subependymal germinal matrix haemorrhage; grade II is IVH without ventricular dilatation; grade III is IVH with ventricular dilatation; and grade IV historically denotes IVH with parenchymal haemorrhagic involvement.
- How does Volpe grade germinal matrix–intraventricular haemorrhage?
- Grade I has no or minimal IVH occupying less than 10% of the ventricular area, grade II occupies 10–50%, and grade III occupies more than 50% and usually distends the lateral ventricle.
- What is the principal difference between Papile grade II and grade III?
- Papile grade II is IVH without ventricular dilatation, whereas grade III is IVH associated with ventricular dilatation.
- Why is the term Papile grade IV potentially misleading?
- The parenchymal lesion is not usually caused by direct extension of intraventricular blood. It generally represents periventricular haemorrhagic venous infarction caused by impaired medullary venous drainage.
- How should periventricular haemorrhagic infarction be reported?
- Report it separately from the IVH grade and describe its side, anatomical location, extent and whether it is unilateral or bilateral.
- What is Sarnat staging?
- It is a clinical and electroencephalographic system that grades neonatal encephalopathy as Stage I mild, Stage II moderate or Stage III severe.
- What are the three Sarnat stages?
- Stage I is mild encephalopathy, Stage II is moderate encephalopathy and Stage III is severe encephalopathy.
- What are the characteristic findings of Stage I encephalopathy?
- The neonate is hyperalert with normal or increased activity and tone, brisk reflexes and no seizures. The EEG is usually normal.
- What are the characteristic findings of Stage II encephalopathy?
- The neonate is lethargic with decreased activity, hypotonia, weak suck, incomplete Moro and periodic breathing. Seizures are common and the EEG background is abnormal.
- What are the characteristic findings of Stage III encephalopathy?
- The neonate is stuporous or comatose, with absent activity, flaccidity, absent primitive reflexes, autonomic instability and a markedly suppressed or inactive EEG.
- Why may clinical seizures be uncommon in Stage III encephalopathy?
- Profound cerebral dysfunction may prevent an organised clinical seizure despite severe brain injury. Continuous EEG is therefore important for detecting electrographic seizures.
- How does Sarnat staging influence therapeutic hypothermia?
- Moderate or severe encephalopathy supports eligibility for therapeutic hypothermia when the infant also meets the required perinatal, biochemical, gestational-age and treatment-window criteria.
- Does Sarnat staging establish that neonatal encephalopathy was caused by hypoxia–ischaemia?
- No. It grades the severity of encephalopathy but does not prove its aetiology; metabolic, infectious, genetic, vascular and drug-related causes must be considered.
Papile and Volpe Grading of Germinal Matrix–Intraventricular Haemorrhage
Papile and Volpe Grading of Germinal Matrix–Intraventricular Haemorrhage
Papile and Volpe Grading of Germinal Matrix–Intraventricular Haemorrhage
Papile and Volpe Grading of Germinal Matrix–Intraventricular Haemorrhage
Papile and Volpe Grading of Germinal Matrix–Intraventricular Haemorrhage
Papile and Volpe Grading of Germinal Matrix–Intraventricular Haemorrhage