Show more. Show less. About the Authors. He graduated from Medicine with Honors from Edinburgh University and has published and presented research extensively and internationally in the fields of radiology and medical education.
Mark is also involved in teaching medical students through his roles as a Clinical Tutor Associate for the University of Edinburgh and lecturer for the Edinburgh Student Radiology Society. He graduated with distinction from the university of Southampton, and has published and presented research work extensively and internationally in the fields of pharmacology and medical education. Whilst working in Edinburgh he was part of the leadership team developing a near peer teaching programme, where by junior doctors, throughout south east scotland, were both trained to teach, and delivered teaching across every hospital in the area.
Non contrast f esCT pyrig However, they have now been superseded Cocalculi. Copy rig is the imaging modality of o C pyrigIt is a low dose non- choice. It is readily available and ureters and bladder KUB once the contrast is within quick to perform. As it is a non-contrast examination, the urinary collecting system. Additionally, urinary tract ht of t ourinary Zescalculi.
Standard contrast t o f ZesCT can identify enhanced h rig rig ig opyitruses a higher dose of radiation Copy assessment of the other abdominalCand opypelvic organs, Cbut urinary tract calculi, helping to identify or exclude other differential than CT KUB and requires intravenous contrast.
It does, although the accuracy for this is limited by the low however, provide a better assessment of the abdominal i shi organs. Additionally, a delayed phase u i dose nature of the Q resh uexamination and the lack of urepelvic and Q Q resh scan, s h n acontrast. As discussed in Question 3, eshan ha n intravenous of Z e t of Z where the patient is imaged when the o Zescontrast f urogram is being righatsmall proportion of urinary tract calculi ighnot rare excreted into the urinaryytract rig h t CT , would help Abdominal o p y o p y Cop calculi as these would appear X-Rays C visible on CT; however, there may stillC be secondary identify non-radio-opaque signs of urinary tract calculi, such as perinephric and as filling defects in the urinary tracts.
The correct answer is D Conservative approach supportive treatment with shi shi X-ray KUBs [if the stone is ureshi n Qure and anti-emetics and follow analgesia n urewith Qup Q Z e s h a Z e s h a Z e s han ht of visible on X-ray] until the hstone t of has passed.
Most ureteric are used as 1st line , anti-emetics and IV fluids if calculi are accessible. However, results are best for dehydrated. If t o t o ofsuch t of righ igh opyr reserved visible on X-rays, the progress r i g h stones can be Copy Incorrect. If the stone fails to large stones.
An external energy source causes shock pass after weeks, the pain becomes intolerable, waves which are targeted towards the stone. The aim is or if the patient develops an infected, obstructed to fragment stones toeallow hi them to pass through the collecting hi system, an alternative treatment option is i ureters. It is usually reserved for large patients with an obstructed kidney and super-added or complex stones or patients in which ESWL and infection.
It is usually performed under sedation ureteroscopy have failed. Orthopaedic This introduction shthe f Zeto f Zes f Zes o o o X-Rays Further g h t ridetails h t igfindings discussed below are coveredpmore and examples of the specific X-rays h t rig extensively in the Copy cases later in the chapter and theCbonus opyr Co y example X-ray chapter. Projection Copy Copy 4. Obvious abnormalities 2. Patient details 5. Systematic review of the X-ray 3. Technical hi adequacy 6.
This iseuseful h fused han Q t of Zesh t o f Zes because the types of injury andhpathology t o f Z s vary CoAp yrigh Copy rig h rig Copy and mature patients. B between skeletally immature res hi res hi Key pOiNt s hi a n Qu a n Qu a n Qure t of Zesh t of Zesh Remember: children develop Zes t ofrates h and Cop yrigh Cop yrigh mature at Copy i g h different r and therefore the age of a patient does not tell you whether they are skeletally mature or not.
Q ures e shan f ZeThese n sha X-rays dramatically show why one view n shatoo few! However, the anterior humeral humerus is not intact. These are line now does not transect the the injuries most often associated capitellum.
This is hisCX-ray. I would want to see a lateral X-ray of the hip to complete my radiological assessment of the fracture. The initial management of this fracture preseNt involves which of the following? What grade is this fracture available. A 1 hi shi hi any further assessment. What is the best hi surgical management for this s i ures shi the left hip. It is ana Qure intracapsular n 75 n year a Qold patient if they are independent a n Qure subcapital t Zesh of the femoral offracture t esh of Zand t of Ze sh i g h i g h medically fit prior to the i g hinjury?
Q u resh Q u resh n n n esha and f Zsclerosis ha esHemiarthroplasty f ZA Zesh a subchondral h t o h t o t of pyrig Cosubchondral cysts consistent with Cop yrig B Total hip replacement Cop yrigh osteoarthritis.
Which of these is absolutely Copy r i g h necessary prior femoral vessels bilaterally, in to the patient having surgery? The initial management of this fracture involves which of the following? Stabilising all trauma shaC nQTake a n Qu Orthopaedic patients s h eis important however there are other of Ze mechanism of injury — Correct.
Patients should t Z X-Rays y r i g himportant y r i g htbe mechanism of injury is r very y i g himportant. Cop is any concern about major trauma.
Stabilisation includes fluid resuscitation and early pain relief. D Take a full social history — Correct. It is important to takehai full social history from all patients who hi Analgesia should be e u shi rprescribed using the WHO pain ures fractures to the femoral neck. This ures ladder assahguide, a Q n starting at the most appropriate shan sustained Q a n Qincludes e s h t of AZnerve block is a very effective method hstep.
The degree of independence will B Identify any medical issues — Correct. Patients with impact on surgical decision-making. These include chronic co-morbid h t of Ze preoperative planning — Incorrect. The mainCquestions which needs to be disease and dementia as well as acute problems which answered for preoperative planning are whether the may have contributed to the fall e.
AP and lateral X-rays can almost always s h i s h i hi n Qure and treated early to These must be identified n answer Q ure these questions. CT of the hip can n uresif be used Q a h patient for surgery. Patients may alsoZesh a there is high clinical suspicion of a hip a fracture but no optimise esthe t oonf Zwarfarin. This will need to be reversed t of to evidence on the X-rays. MRI Zesh imaging of alternate ist an r i g h be r i g h prior r i g h Copy surgery.
However, the indication for py Cowarfarin must be strategy in such cases. Copy considered before reversing it, as the risks of stopping it may be high. In these cases, or if you are in doubt, you should discuss thescase i with a haematologist i i for advice.
What grade is this fracture using the Garden Classification? The Garden sintracapsular hi Classification is used n to Q u r e categorise the degree of displacement n Q u of r ane femoral neck fracture, n Q ures esha sha a Orthopaedic of Zesupply to the femoral head has been t of Zalso defines how likely it is that the tblood and as such, Zesh t ofdisrupted.
X-Rays h igh igh pyrig CoThe C opyr C opyr classification system goes from 1 to 4, where 1 and 2 are undisplaced and 3 and 4 are displaced. In Garden 1 fractures, the trabeculation lines in the shi shi shi a n Qurehead point vertically in comparison a n to uthe Q re normal.
Cotrabeculations Copy i has rdisplaced ri but returned to its normal alignment Copy and so the are all in line. A 1 — Incorrect. In Garden 1 fractures, there is an B 2 — Incorrect.
In Garden 2 fractures, the fracture is i at the fracture i hi Q resh incomplete fracture withuimpaction reshundisplaced and again surgical fixation completeuand Q Q ures a n sh head tilted into a valgus more a n sishpossible as the risk of AVN is low.
Thisf fracturea n site with the femoral of Ze Therefore, the capsule is likely toight of Ze often grouped with Garden 1 fractures esh is o asZundisplaced upright i g h tposition. Surgical fixation using screws prevents as the fracture is complete there is a higher risk of displacement of the fracture and is the best option displacement if the fracture is treated non-operatively.
In Garden shi ures head reduces the risknofQdislocation or need for C 3 — Correct. In the majority Zesh tofofpatients, h yrigh h a pyrig could potentially be treated without fracture Coand C opsurgery py r i hemiarthroplasty or THRCisonecessary. D 4 — Incorrect. In Garden 4, the fracture is fully displaced. For the vast majority of patients, THR or ure shi hemiarthroplasty u i resh is required.
The classification is fromt o1ftoZ4enot sh A to D. Undisplaced fractures have i g ha f Ze t olower risk of AVN in comparison to i h t of Z displaced g e C opyr opy r r Copyof displacement fractures.
Use the C Garden Classification to consider the degree and then this will help guide your surgical decision making. Cannulated screws n Q ucansbe used in undisplaced fractures n Q ures ha ha ha h t o f Zes Garden 1 or 2 , whereas anhtarthroplasty o f Zes is usually required for o displaced h t f Zes rig rig rig Copy fracture Garden 3Candopy4. Austin Moore is an outdated type Copofy arthroplasty.
What is the best surgical management for this 75 year old patient if they are independent and medically fit prior to the injury? A hemiarthroplasty Copy C Surgical fixation — Incorrect. In this age group, it is is a half hip replacement. The ball of the ball and not advisable to attempt fixation for a displaced socket joint is replaced but the socket is left alone.
However, if the fracture hi resh hi Q ures the implant differs from of dislocation. The riskooff Z h t AVN g ri return to full function. It is thereforeousually g pyri reserved g ri may be much lower in Copy for patients with limited premorbidCmobility.
Intracapsular hi present in the acetabulum. In a THR, the ball t of Ze time, as this fracture is displaced t Zesintracapsular, of and r i g h yr i g h i g h Copy and socket are replaced, allowing for Coapbetter the likelihood is the o pyr will not heal non-union C fracture correction of the prior anatomy and a better return and the patient will be left immobile with all the to function.
This treatment be considered for independent patients with a option may be considered in very frail patients who displaced intracapsular s h i fracture of the neck of the hi arerexpected to die from an underlying or acutereshi ure Qno Q u es u femur who e s h a n need more than one stick to mobilise.
There is also a higher chance E Early mobilisation — Incorrect. Very occasionally, of dislocation. However, by replacing both the ball patients will present with an undisplaced and socket, it is possible to get a more anatomical intracapsular fracture where the fracture is old and h i i i implant which allowsQ u s rebetter return to function.
Q u reshor the patient is able to mobilise. In such healed Q u resh han han circumstances, it is possible to avoid an anhoperation. If this fracture occurred in C pyand well 20 year old, which would a ofit Copy be the best surgical option? Young patients are usually fit and the fracture is often associated with high-energy trauma.
They are hi hi of the native femoral hip is crucial hi n Q ures and be more active. Therefore,npreservation expected to live longer Q ures n Q uresin esha with an intracapsular fracture. This surgical option D Traction and bed rest — Incorrect. This is not appropriate would provide a poor outcome for a 20 year old, for patients in this age group with this fracture. Z eItsishaalso ht o o o pyrighip replacement — Incorrect. If the femoral right right B CoTotal Copyhead Copy to present with a very unlikely for a young person does not survive or surgical fixation is not possible, healing intracapsular fracture, as this is a high-energy then this is the best surgical option.
However, a THR injury which will be picked up on initial presentation. Therefore, Q ures Q ures a n ha n Key pOiNt ha n Orthopaedic it is usually bestestohattempt surgical fixation see C in o f Zwith o f Zes o f Zes X-Rays youngrig h t patient femoral neck fractures regardless rig h t rig h t Coofpydegree of inital displacement. Ideally, the patient needs to considered for surgical fixation go straight to theatre. The fracture can be accurately of their intracapsular neck of s i hscrews s hi femur fracture within 6 hours hi reduced and fixed with either n Qu r e3 or a short n Qu r e n Q ures dynamic hip screw a eshand a second screw.
There is still a of Zesh a sh a h t significant o f Zof risk AVN of the femoral head, which h wouldt of injury. Doing sot o h f Zereduce may g pyri a further operation. However, as this g pyri is the riskCofop g yri and preserve AVN Corequire Copatient young and fit, the risks of further surgery are relatively the femoral head, improving low.
Which of these is absolutely resh i necessary prior to the patient reshhaving surgery? Copy i i In an emergency situation, ureshi Q u reshnecessary for a patient to have an None of these are absolutely Q u resh operation.
Q you may notZbee an to wait for the patient to be adequately shable e shan fasted or to consent the patient shanare ifethey f f Z f Z ht o Similarly, blood results may not unconscious. Q hi uresfor 6 hours — Incorrect. It is generallyn Qures hi should be obtained n hafrom the patient or guardian. This reduces person h t o Z srisk f the pyrig surgeon or someone who can perform Cooperating Copythe rig rig Copyon the anaesthetic of aspiration of gastric contents operation.
If not, then the person consenting should induction. Although this applies for all surgical patients, have a full understanding of all the risks and benefits this is especially relevant in trauma, which itself delays of a surgery together with the technical steps of the gastric emptying. Again, in some circumstances, this operation. The patient should u r e sbehiallowed sufficient may not u ber e shi and emergency surgery should ureshi possible, time to come toeash an Q In some circumstances, such decision.
Although not absolutely undergoing surgery for femoral neck fractures are necessary, these should all be done for the standard at risk of significant intra-operative blood loss and patient with a neck of femur fracture. If there is hi resh i n Q ures is at high risk of bleeding, n Q ures Qu concern that hathe Zesshould patient ftoZes ha shan then h t o f they have blood cross-matched prior h t o ight of Ze rig pyrig opyr Copy surgery.
In an emergency, waiting for Cocross-matched C blood is not necessary as O negative or type specific blood is readily available. X-Rays righ righ arden 1 and 2 are at lowe Copy conditions and most take several medications.
Copy o p y risk of AVN, as theC capsula r These can adversely affect their renal function r blood vessels are less lik and electrolyte balance, which needs to be to be damaged. These patie ely nts can be considered for recognised and addressed prior to surgery. In emergency situations, the arthroplasty. Hemiarthrop lasty is a good option full blood result may not be available at the time for minimally mobile elderl of surgery.
In such cases, the y patients who are frail. If the younge r patient then develops AVN, theyi are young and fi hi rendshopera t enough to survive a shi nQ ures n Qseuco tion. Copy yrig you to view Copallows they Looking through a CT scan axial, coronal and sagittal planes of the body A CT scanner essentially consists of an X-ray tube figure 2.
The standard CT image is the axial which spins around the CT table figure 1. The transverse image hi and on this the left side of thereshi ure shi ures u X-ray tube is housedain n the Q gantry, which is the image n Q corresponds an Q to the right side of thehbody Z e s h Z e s ha Z e s donut shaped f part of the scanner.
The C o couch sided structure, is on the o C right side of the image. To further enhance the clinical relevance, each case has 5 clinical and radiology-related multiple-choice questions with detailed answers. These are aimed to test core knowledge needed for exams and working life, and illustrate how the X-ray findings will influence patient management. One of the keys to X-ray interpretation is practice, practice and more practice.
The bonus X-ray chapter provides over 50 further X - ray cases to help consolidate the reader's knowledge and provide an opportunity to practice the skills they have learnt. In addition to these four core chapters the introductory chapter covers the very basic science behind X-rays, the relevant legislation controlling X-rays and tips on how to request radiology examinations. Additionally a chapter is devoted to other important imaging investigations, such as computed tomography CT , magnetic resonance imaging MRI and ultrasound, covering the details of what the examinations involve, their common indications and contraindications and key imaging findings.
This book teaches systematic analysis of Orthopaedic X Rays. The reader is asked to interpret the X-ray before turning over the page to reveal a model report accompanied by a fully colour annotated version of the X-ray. All cases provide high quality, fully annotated, fully reported images, meaning that even beginners can follow the thinking of an expert.
This book teaches systematic analysis of ChestX Rays. This book teaches systematic analysis of Abdominal X Rays. The Unofficial Guide to Medical Research, Audit and Teaching will teach you the skills expected of students and today's graduates beyond just clinical medicine. It contains convenient checklists for critical appraisal which may be used as a day-to-day reference by professionals, as well as suggestions for audits, and tips for teaching effectively.
This book covers all the non-clinical competencies that will make you an excellent doctor, and highly competitive on the job market. This book is an informed, educational and abundantly illustrated guide to the imaging knowledge that medical students in the clinical years of their undergraduate studies will be required to get to know, understand and recall in order to negotiate successfully their finals exams.
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