ICM Flashcards
What is this?
Staghorn Calculus of the left kidney
What is this?
Calcified gallstone
What is the abnormality and what is visible in the colon?
Watch batteries are visible in the stomach and faeces is visible in the colon
What is this?
Ureteric calculus
What is wrong in this X-ray?
Missing left leg
What is the pathology here and what may have caused it?
Air is present in the biliary tree, possibly caused by a cholecystectomy
What are the folds called in the large bowel and are they complete or incomplete?
Haustra, and they are incomplete
What are the folds in the small bowel called and are they complete or incomplete?
Valvulae conneventes- they’re complete
What is the most common cause of large bowel obstruction?
Tumour
Other causes- Sigmoid volulus of the sigmoid colon.
What is the pathology visible here?
Dilation of the small bowel
What can cause small bowel obstruction?
Adhesions
Hernias
Peritoneal tumour
What is visible in this x-ray?
Air under the diaphragm
Could be caused by bowel perforation
What is the name of the sign in this film?
Rigler’s sign
What signs indicate small bowel dilatation?
Valvulae conneventes (go all the way across)
Multiple loops
Central
No faeces present
4 signs that help you to determine it is the small bowel you are looking at on a abdominal radiograph?
- Folds go all the way across- Valvulae Conniventes
- No faeces present
- Central location and cannot be traced all the way around
- There is bowel adjacent to bowel
What position is an abdominal radiograph taken in?
Supine
What diameter indicates small bowel dilatation?
> size indicates 3cm
What is the maximum normal diameter of the large bowel?
6cm
Is this large or small bowel?
Small bowel
What are the 3 main causes of small bowel dilatation?
- Obstruction from adhesions
- Hernias
- Peritoneal malignancy
What is the typical lesion seen in the large bowel when a tumour is present?
‘Apple core’ lesion
What is this and what causes it?
Sigmoid volvulous and it is caused by twisting of the bowel
What sign is present in these radiographs and what does it indicate?
Rigler’s sign
It indicates there is free air in the abdominal cavity
What is wrong in this radiograph?
Two fractures in the rt. pubic rami
Present this radiograph
- Initially, no name, Hospital Number, Date film taken
- There is a marker
- No AP / PA marker – assume AP
- No indication of whether supine or erect – assume supine at start
- Bowel dilated –
- Position – central and bowel next to bowel
- Folds (valvulae conniventes) go all way across
- ie. Small Bowel Dilation
- Need erect Chest X-Ray to exclude perforation
What does each number refer to in this radiograph?
- Trachea
- Hilum – remember this comprises the bronchus, pulmonary blood vessels and the lymph nodes
- Lungs
- Hemidiaphragm
- Heart
- Aortic Arch
- Ribs
- Scapula or axilla
- Breast shadows
- Cardio-phrenic angle
- Costa-phrenic angle
What do you expect in a normal in a chest x-ray?
Position is PA and erect
Cardio-thoracic ratio should be less than 50%
What is wrong in this CXR?
It’s overexposed
Medical clips in the left lung
Patient has Situs inverta (NOT detrocardia as the stomach is also on the other side)
What is the pathology here?
Rt. Tension pneumothorax
How will a tension pneumothorax present?
Patient will be unwell
- Tracheal deviation
- Decreased chest expansion on right side
- Hyperesonance on right side
- No breath sounds on right side
What signs are worrying in this CXR?
Shadow in the Rt. lung
Unilateral pleural effusion (Lt. sided blunting of the costophrenic and cardiophrenic angles)
Increased Hilar markings
What is the pathology here?
Left pneumothorax
What will the rate be if there are 3 large squares beetween R waves?
How is this calculated?
100bpm
Number of large squares/ 300
What is the sign visible in this abdominal x-ray and what causes it?
Thumbprinting
Occurs during mucosal oedema- Ulcerative colitis
A 21-year-old woman is thrown from her horse at a local event. On the way to hospital she has become increasingly drowsy and the paramedics have inserted
an oropharyngeal airway and given high flow oxygen via a face-mask. Inspired oxygen 40% (FiO2 0.4)
**ABG shows: **
normal values
PaO2 18.8 kPa >10 kPa (75 mmHg) on air
pH 7.19 7.35 – 7.45
PaCO2 10.2 kPa 4.7 – 6.0 kPa
Bicarbonate 23.6 mmol l-1 22 – 26 mmol l-1
Is the patient Adidotic or alkalotic?
Acidotic
pH= 7.19
What does this ECG show and what is the sign callled?
Atrial flutter
- Saw-tooth sign
What is happening in this ECG?
Atrial fibrillation
What does this ECG show?
Ventricular fibrillation
What does this ECG show?
Ventricular tachycardia
What are the shockable rhythms in cardiac arrest?
Ventricular fibrillation
Pulseless ventricular tachycardia
What inspiratory sounds are there , where do the arise and what do the indicate?
Snoring (Pharynx)- obstruction by soft tissues, soft palate, epiglottis of the larynx and tongue.
**Stridor (large diameter extrathoracic airways: larynx, trachea)- **indicates that the airway diameter is < 50% or < 4.5mm.
**Hoarseness (larynx)- **Oedema as above, tumours, trauma.
Gurgling (pharynx)- Liquid/semisolid: vomit, blood, secretions.
**Crowing (larynx)- **Spasm of the laryngeal muscles: stimulation when the airway reflexes are intact eg with instrumentation.
Drooling (pharynx and larynx)- Infection eg retropharyngeal abscess, acute epiglottis. Inability to swallow saliva.
What expiratory sounds are there?
Stridor
Wheezing
What signs show hypercapnoea?
Increased sympathetic activity: tachycardia, arrhythmias and hypertension.
How do you open a patients airway without any equipment?
Head tilt, chin lift
What are the contraindications to performing head tilt/chin lift?
Unstable cervical spine or trauma
Chin lift only or Jaw thrust
What do you do when an adult is conscious, choking with an ineffective cough?
5 back blows
5 abdominal thrusts
How long should it take to assess for ‘signs of life’ in a child before starting CPR?
A maximum of 10s
How deep should chest compressions be?
A minimum of 1/3 the AP depth
In paediatric BLS what ratio should chest compressions to rescue breaths be?
15:2
A child is unresponsive, after shouting for help and opening the airway they are still not breathing properly.
What do you do next?
5 rescue breaths
What does this abdominal x-ray show?
Intersussesception
What are the layers of the appendix, colon and rectum wall?
Mucosa
•Muscularis mucosa
•Submucosa: fat, nerves, blood vessels
•Muscularis propria: two layers of smooth muscle
•Serosa: layer of mesothelial cells (peritoneum)
What tissue is this?
What are the layers indicated in the picture?
A section of the colon
A- Mucosa
B- Lymphoid follicle
C- Submucosa
D- Muscularis propria
E- Serosa
What is ecchymosis?
Bruising not caused by any trauma
Caused by low platelet count
What lines the crypts of the mucosa in the colon?
goblet cells
columnar cells with brush borders.
Endocrine cells.
Stem cells at the base
What is this and what is the most common cause?
Impetigo
Staph aureus
What is this and what is it associated with?
Eczema or atompic dermatits
Associated with asthma and hayfever
What is this?
Basal cell carcinoma
Caused by sunlight exposure
Pearly white and has rolled edges
What is this?
Melanocytic naevus
What is this and what features distiguish it?
Malignant melanoma
Asymmetrical, irregular border and colour,
increasing size
What is this and how does it characteristically present?
Squamous cell carcinoma
rapidly expanding, painless,
ulcerated nodule, rolled indurated margin.
Commonly ulcerate and bleed
What’s this condition and what is it associated with?
Psoriatic plaques
Psoriatic arthritis
What is this condition called, how are the lesions described and what can cause it?
Erythema multiforme- target lesions
barbiturates, aspirin, sulphonamides,
herpes simplex , TB, mycoplasma, typhoid,
pregnancy, vit c deficiency, collagen vascular
disease, IBD
What causes this condition and what is the treatment?
Shingles is caused by herpes zoster
Aciclovir 800mg 5x/day for 7 days
What’s the treatment for this condition?
Treatment for ringworm is topical antifungal therapy
Oral terbenfaine/itraconazole
What is this?
Erythema nodosum
What is this and what is it associated with?
Pretibial myxedema
Associated with Grave’s disease
What conditions is this associated with?
Butterfly rash is associated with:
SLE, Pellagra, Dermatomyositis
What can be used to try and restore sinus rhythm in an unstable patient with a tachycardia (>150bpm or >100bpm if serious chronic disease)?
Synchronised cardioversion
If this fails then 300mg Amiodarone over 20mins then re-attempt cardioversion
What are the 4 steps in ALS that need to be taken to treat an adult tachycardia with a pulse before medications or shocks should be considered?
Assess using the ABCDE approach
Give oxygen if appropriate and obtain IV access
Monitor ECG, BP, SpO2 , record 12-lead ECG
Identify and treat reversible causes (e.g. electrolyte abnormalities)
What does this ECG tracing show?
Torsades de pointes
According to ALS guidelines, what factors determine whether you use cardioversion or medivcation to treat tachycardia?
If the patient is stable or there are no adverse features (Shock, syncope, MI or heart failure) then medical management should be used. Otherwise cardioversion is the treatment of choice.
Accodring to ALS guidelines if a patient has bradycardia and adverse features (Shock, syncope, MI, heart failure) what should be given?
Atropine 500mcg IV
What’s the difference between a direct and an indirect inguinal hernia?
A DIRECT hernia, pushes into the inguinal canal and enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle)
An INDIRECT hernia, is the protrusion of the viscus through the deep inguinal ring.
What does this ECG show?
An inferior STEMI
- ST elevation visible in aVF, II and III
What does this ECG show?
Inferior STEMI
