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D in us ha n Ra v e en dra n dr3 2 0@i c .a c .u k M ENT I C ODE: 2 5 00 29 2 2 Imaging & Bloods MedEd Y3 Written Exam Lecture 2025SESSION STRUCTURE Chest X-rays Imaging Menti Liver function tests (LFTs) Acid-base (ABGs) Bloods Menti Disclaimer: I am not an expert – exam-focused high yield topicsPre-session Menti Presenting Chest X-rays ABCDE (Airway, Assess image quality Breathing, Cardiac, Confirm Details (RIPE) Diaphragm, Summarise Everything else) Presenting Chest X-rays Confirm Details • Name 1 • DOB • Hospital number • Date/time x-raytaken • Rotation 2 Assess image quality (RIPE) • Inspiration • Projection: AP or PA film • Exposure Presenting Chest X-rays • Tracheal deviation Airway • Hilar structure asymmetry 3 Breathing • asymmetry?ch zone – any 4 • Opacification? • Lung markings (?absent) Presenting Chest X-rays Cardiac • Heart size: <50% (cannot 5 comment if AP view) • (?consolidation)rders Presenting Chest X-rays Diaphragm • Sub-diaphragmaticair? 6 • Costophrenic angles (any blunting?) • Bones (?fractures) 7 Everything else • Lines/tubes/pacemaker • Soft tissueSESSION STRUCTURE Chest X-rays Imaging Menti Liver function tests (LFTs) Acid-base (ABGs) Bloods MentiMenti ImagingMenti ImagingMenti ImagingMenti ImagingHeart failure CXRMenti ImagingMenti ImagingBowel obstruction AXR Large Bowel Obstruction Small Bowel Obstruction 3/6/9 rule: 3 Peripheral Central cm = small >6cm >3cm bowel, 6 cm = Haustration – do not traverse Valvulae conniventes – large bowel, 9 bowel traverse small bowel cm = caecumPlease fill in feedback! Email: dr320@ic.ac.ukSESSION STRUCTURE Chest X-rays Imaging Menti Liver function tests (LFTs) Acid-base (ABGs) Bloods Menti Liver function tests simplified Alcoholic hepatitis Viral hepatitis Liver ↑ AST + ALT Hepatic steatosis Gallstones Biliary ↑ ALP + GGT PSC/PBC Cholecystitis & CholangitisInterpreting LFTs: Key concepts Most liver diseases Increase in ALT > Increase in AST e.g. viral hepatitis Alcoholic hepatitis AST:ALT > 2:1 Acute alcohol inta↑ GGT Needs to be elevated with GGT – ALP can come from BONE! suggestive of biliary diseaseInterpreting LFTs: Key concepts Isolated unconjugated Gilbert’s syndrome OR haemolysis hyperbilirubinemia Conjugated hyperbilirubinaemia + dark urine + pale stools Post-hepatic (obstructive) jaundice If normal stools think hepatic jaundiceSESSION STRUCTURE Chest X-rays Imaging Menti Liver function tests (LFTs) Acid-base (ABGs) Bloods Menti ABG Interpretation: Worked example 1 pH 7.31 Reference ranges: pCO 2.8 pH 7.35 – 7.45 HCO 3 24.1 pCO 2.7-6.0 kPa pO 2.9 HCO -322-26 mmol/L Base excess +1.6 pO 10-13 kPa 2 Base excess: -2 to +2 mmol/L 1) pH = Acidosis 2) High CO 2 Respiratory cause 3) Normal HCO /BE = uncompensated 3 4) Very mild hypoxaemia Uncompensated respiratory acidosis with very mild hypoxaemia ABG Interpretation: Worked example 2 pH 7.55 Reference ranges: pCO 2.7 pH 7.35 – 7.45 HCO 3 44.0 pCO 427-6.0 kPa pO 2.3 HCO -322-26 mmol/L Base excess +20.3 pO 10-13 kPa 2 Base excess: -2 to +2 mmol/L 1) pH = Alkalosis 2) High CO =2Doesn’t explain alkalosis, ?compensating 3) High HCO /BE = metabolic cause 3 4) Mild hypoxaemia Since pH isstill abnormal, this is partially compensated metabolic alkalosis with mild hypoxemiaABG Interpretation Reference ranges: pH 7.35 – 7.45 pCO 2.7-6.0 kPa HCO 3 22-26 mmol/L pO210-13 kPa Base excess: -2 to +2 mmol/LSESSION STRUCTURE Chest X-rays Imaging Menti Liver function tests (LFTs) Acid-base (ABGs) Bloods MentiBloods MentimeterBloods MentimeterBloods MentimeterBloods MentimeterTHANK YOU! Please fill in feedback! Email: dr320@ic.ac.uk