Y6 PACES > Images > Flashcards

Images Flashcards

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NG tube position checklist

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Extradural

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Contusion

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Subdural haematoma

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Intracapsular NOF

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Digital subtraction angiography showing occlusion of left common iliac artery

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Sigmoid volvulus

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Apple core lesion - oesophageal carcinoma

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ERCP with stone in common bile duct

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Colles’ fracture

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Pneumothorax

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Hiatus hernia

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Diaphragmatic hernia

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Misplaced NG

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Barium enema - diverticulosis

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Ruptured AAA

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AAA

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Polycystic kidney disease

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Raised hemidiaphragm (phrenic nerve injury) due to lung cancer

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C6 fracture

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Radioisotope bone scan showing metastases

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Small bowel obstruction

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Large bowel obstruction

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Fracture in left parietal bone with fracture under scalp

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Pneumoperitoneum
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AC joint dislocation
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Dynamic hip screw (DHS)
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Hip replacement
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Extracapsular NOF
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Tibia and fibula fractures
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This is therefore a **junctional supraventricular tachycardia (SVT):** a narrow-complex tachycardia originating from the AV node. Treatment includes vagal manoeuvres followed by adenosine. Atrial flutter would be a reasonable differential as the rate is regular and close to 150. However, there is no variation in the baseline and not a hint of sawtooth appearance so this is less likely than SVT.
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**IVH** - On CT imaging it appears as hyperdensity within the dark CSF spaces within the ventricles.
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**Colles - ‘dinner fork type deformity’** Features of the injury 1. Transverse fracture of the radius 2. 1 inch proximal to the radio-carpal joint 3. Dorsal displacement and angulation of the distal radius
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**Smith's fracture (reverse Colles' fracture)** 1. Volar angulation of distal radius fragment (Garden spade deformity) 2. Caused by falling backwards onto the palm of an outstretched hand or falling with wrists flexed
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Optic disc swelling secondary to raised ICP – **papilloedema** Mimics: * Papillitis = inflammation of optic disc, optic neuropathies * Malignant HTN * Uveitis * Graves’ compressive ophthalmopathy * Pseudopapilloedema (optic disc drusen, hypermetropic discs, tilted discs) Investigations: * BP * Urgent neuroimaging with MR venography to rule out cavernous sinus thrombosis
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**Heart failure** Alveolar batwing shadowing Kerley B lines Cardiomegaly Upper lobe Diversion Pleural Effusion
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**R renal stones** (also horseshoe kidney)
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**Pleural effusion** Opaque shadowing with blunting of costophrenic angle and meniscus Transudative (protein <25): CCF, nephrotic syndrome, CLD, hypothyroidism, Meig’s syndrome Exudative (protein >35): infection, inflammation, malignant Light’s criteria used if protein 25-35. Exudative if: * Effusion:serum protein >0.5 * Effusion:serum LDH >0.6 * Pleural LDH >⅔ upper limit of normal serum
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**AV nipping – Grade 2** **Hypertensive retinopathy** Grade 1 – mild-moderate arteriolar narrowing 🡪 copper wiring Grade 2 – moderate-severe arteriolar narrowing; exaggerating light reflex; arteriovenous crossing changes 🡪 silver wiring, AV nipping Grade 3 – retinal arteriolar narrowing and focal constriction, retinal oedema, retinal haemorrhage, cotton wool spots Grade 4 – above + optic disc swelling
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**Gout of MTP** Soft tissue swelling in early disease Periarticular erosions ‘punched out lesions’ in late disease Normal joint space
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**Type B aortic dissection** - decending aorta
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**Ring enhancing lesion** (T1 w/contrast) DDx - abscess, TB, neurocysticercosis, mets, glioblastoma, lymphoma, toxo
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**Sub retinal haemorrhage** = rupture of choroidal vessels under fovea in interface between choroid and retina Commonly a/w age-related macular degeneration
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**Psoriatic arthropathy** Pencil in cup X-ray showing some of changes in seen in psoriatic arthropathy. Note that the DIPs are predominately affected, rather than the MCPs and PIPs as would be seen with rheumatoid. Extensive juxta-articular periostitis is seen in the DIPs but the changes have not yet progressed to the classic 'pencil-in-cup' changes that are often seen.
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Pancreatic cancer - lumpy area in the middle
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Small bowel obstruction
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**tension pneumothorax** Small chest drain in situ Basal atelectasis left Surgical emphysema within mediastinum and soft tissue
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Digital Subtraction Angiogram Left leg demonstrating occlustion of the left SFA – reconstituting lower through collaterals
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Left NOF
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Barium enema demonstrating diverticular disease within the sigmoid colon
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AP Pelvis demonstrating a Left THR
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Left subdural with some midline shift
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Achalasia
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Double contrast enema. Apple core stricture with lead piping of sigmoid colon (UC). Some diverticular disease
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UC with loss of haustration, lead piping
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Autosomal Dominant Polycystic Kidney Disease
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Autosomal dominant polycystic kidney disease ## Footnote CT of the abdomen (coronal reformats) demonstrates both kidneys to be markedly enlarged by innumerable cysts ranging in size from a few millimetres to multiple centimetres. These cysts also vary in density: most are near-water density, some are hyperdense, others are calcified. Also present are numerous cysts in the liver. The pancreas is unremarkable. Features are consistent with autosomal dominant polycystic kidney disease, which was subsequently confirmed.
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Sigmoid volvulus ## Footnote dilation causes the classic coffee-bean sign, a pathognomonic of sigmoid volvulus.
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Patient presenting with hypercalcaemia
Multiple osteolytic lesions secondary to multiple myeloma Also know as 'rain-drop skull'
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Subcapital fracture (intracapsular)
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Pneumothorax
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Causes of white out on CXR
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Pleural plaques: associated with asbestos exposure (but also previous empyema or radiotherapy); classically apex sparing
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Upper zone opacification RUL = limited by horizontal fissure LUL = indistinct heart border if lingula
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Middle lobe opacification Indistinct heart border
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Lower lobe opacification Indistinct diaphragm border
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Lobar collapse on CXR
raised hemidiaphragm, tracheal deviation - may be from obstruction WITHIN airway e.g. tumour/mucous plugging/inhaled FBAO or OUTSIDE the airway e.g. tumour/lymphadenopathy
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Right upper lobe collapse
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Right middle lobe collapse Depression of the horizontal fissure with subtle middle zone pacification
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Right lower lobe collapse Sail sign = triangular opacity with double R heart edge
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Left upper lobe collapse Veil sign = whole left lung field covered by veil (extends from left hilum and fades inferiorly) with elevated left hemidiaphragm and tracheal deviation
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Left lower lobe collapse Sail sign = triangular retrocardiac opacity with apparent double R heart edge
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Retrocardiac mass: lung cancer until proven otherwise
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General approach for AXR interpretation
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SBO vs LBO
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Sigmoid vs caecal volvulus
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Pneumatosis intestinalis (intramural gas): ischaemia until proven otherwise - shows as foci of gas densities that outline bowel wall
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Pneumoperitoneum: perforated viscus; Rigler's sign may be visible; proceed to erect CXR after 15 minutes
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Anterior vs posterior shoulder dislocation on XR
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Anterior shoulder dislocation
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Posterior shoulder dislocation
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Hill Sachs
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Bankart lesion
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Normal XR elbow
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Radial head dislocation
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Classification of supracondylar fractures
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Supracondylar fracture (Gartland 1 - minimally displaced)
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Supracondylar fracture (Gartland 2 - displaced, posterior cortex intact)
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Colles vs Smith fracture
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Supracondylar fracture (Gartland 3 - displaced, complete)
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Colles fracture ## Footnote Typically FOOSH forwards Extra-articular radial # with dorsal (posterior / back of hand) angulation and displacement
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Smith Fracture ## Footnote Typically FOOSH back of hand Extra-articular radial # with volar (anterior / palmar) angulation and displacement
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Monteggia vs Galeazzi
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Galeazzi Injury Galeazzi = Radial # (near wrist) Ulnar dislocation ## Footnote GRUesome MURder
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Monteggia Injury Monteggia = Ulnar # (near elbow) Radial dislocation ## Footnote GRUesome MURder
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Radial styloid fracture typically blunt trauma or FOOSH (AKA Chauffeur / Hutchinson)
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Ulnar styloid fracture: typically blunt trauma or FOOSH
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Scaphoid fracture: FOOSH / sporting / steering wheel injury Presents with pain in anatomical snuffbox / on telescoping thumb +/- wrist joint effusion
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Boxer's fracture Fracture neck 5th metacarpal (little finger) due to axial loading
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Bennett fracture Forced abduction of the thumb = intra-articular fracture proximal first metacarpal
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Osteoarthritis
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Rheumatoid arthritis
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Psoriatic arthritis
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Arthritis hands: compare osteoarthritis, rheumatoid arthritis and psoriatic arthritis
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Normal hip xray
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Anterior hip dislocation
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Posterior hip dislocation
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Intracapsular (Garden classification)
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Intracapsular NOF fracture Garden classification type I
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Intracapsular NOF fracture Garden classification type II
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Intracapsular NOF fracture Garden classification type III
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Intracapsular NOF fracture Garden classification type IV
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Extracapsular (intertrochanteric) fracture
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Extracapsular (subtrochanteric) fracture
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Knee XR: gout vs pseudogout
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congenital bipartite patella
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Patella dislocation
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Subdural on CT head
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Extradural on CT head
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Subarachnoid haemorrhage on CT head
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SAH
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Causes of a ring enhancing lesion on CT/MRI
DR MAGICAL
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Cerebral oedema: loss of greywhite matter differentiation; may be result of: - Vasogenic oedema (disrupted BBB) - Cytotoxic oedema (normal BBB, ischaemic damage)
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Hydrocephalus: ventriculomegaly with compression of the brain parenchyma
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**Intraventricular haemorrhage**: hyperintense (bright) blood within the ventricles (with a fluid level); may be **primary**: started in ventricles or **secondary**: extension of extra-ventricular bleed (usually SAH or intracerebral e.g. basal ganglia)
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Basal ganglia bleed
Y6 PACES
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