Radiology

Question 1

What can cause Rigler’s sign (double bowel wall on XR)?

Answer 1

Free gas in the peritoneal cavity (pneumoperitoneum)

Question 2

What sign is suggestive of a sigmoid volvulus?

Answer 2

Coffee bean sign

Question 3

What sign is suggestive of a caecal volvulus?

Answer 3

Fetal appearence

Question 4

Define the 3/6/9 rule

Answer 4

Upper limits of bowel diameters - 3cm small bowel, 6cm colon, 9cm caecum

Question 5

Features of IBD on XR

Answer 5

Thumb printing due to oedema and inflammation

Featureless ‘lead-pipe’ colon

Question 6

What radiology should be performed if bowel perforation is suspected?

Answer 6

Erect chest XR so free gas can be seen accumulating under the diaphragm

Question 7

Image quality - how is rotation checked on a chest XR?

Answer 7

Medial aspect of each clavicle should be equidistant from spinous processes

Question 8

ABCDE approach to chest XR

Answer 8

Airway - trachea, bronchi and hilar 
Breathing - lungs and pleura 
Cardiac - heart size and borders 
Diaphragm - plus costophrenic angles
Everything else - bones, mediastinum, tubes, valves, pacemakers

Question 9

Causes of tracheal deviation

Answer 9

Trachea deviates AWAY from pleural effusion and tension pneumothorax

Trachea devantes TOWARDS lobar collapse

Question 10

How can NG placement be checked on XR?

Answer 10

NG should bisect the carina

Question 11

Causes of hilar enlargement

Answer 11

Asymmetrical enlargement suggestive of malignancy

Symmetrical enlargment suggestive of sarcoidosis

Question 12

What can cause blunting of the costophrenic angles?

Answer 12

Fluid, consolidation, hyperinflation

Question 13

What may indicate right middle lobe consolidation?

Answer 13

Reduced visibility of right heart border