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is a broad general rule. The way I go about in interpreting a chest X ray is starting by introducing the patient on the X ray itself, then going on with the qualities on just extra if you can stop them off clear. Got a multi that this is a good time to kind of mentioned it before you go on to the deep and also of the film. However, if you can see this and that's completely okay, you can move on to analyzing the film itself. After you do this, you can definitely just going to do the A B C D. Approach, which I'm going to be talking thoroughly about today, where you cover the different spectrum in a chest film and then at the end can summarize of findings to wherever you're presenting to you. Okay, the introduction. How I would start producing a chest X ray to say this is just extra just radiograph off. Patient expert on this today taking on the stage This is on the background of whatever the medication here waas. And if there is a previous image to compare or not, that's what everything to mention here. One important thing to mention is people tend to hate when you call chest films X rays because the X rays are they raised themselves. It's the radiation itself. So this is a just radiograph in the chest X ray. Um, so when you're presenting, if you say chest radiograph, people will be more inclined to kind of be impressed by you if you carry on with talking about the the qualities off the image itself. Just have a moment to look at this image here and try to answer this question. Please pop your answers in the hole. Okay? We'll go through the correct answer in a little bit. Um, so let's carry on with the topic itself. So the way one goes about looking at the qualities of the film is by looking at the ripe is against the food. There is welcome to make it easy to remember what right here is rotation, inspiration, projection and exposure. Taking them on my one rotation, you want to see what the patient waas basically standing in the middle with no not tilting one way or another when the film was taken, so the clavicles should be about the same distance from the spine when you look at the film inspiration, Um, this related to half brother there from is and depends on if I signifies how much of the lungs can actually see in the film. Because if the patient has been taking a deep enough breath, then you're only going to be able to see a very small area of the chest as that would be quite high up. And it won't be showing you everything that you want to see To do this. What you do is count the ribs. Um, you can either count up into your, uh, the posterior ribs. So 5 to 6 anterior ribs is a good amount able to see in about eight posterior is also good amount to see, and you should be able to see the cost of panic angles, which will go through a second projection. You need to be able to know if this is a PA or in AP film. So Pa film is when the film was taken from the back to front. So if the if the machine was placed in back of the patient was taken from the back when the patient's back facing and 80 from his other way around. So posterior anterior and and until posterior. If the film doesn't know what kind of says it is, most likely Pa and you can be confident presented, this is a PA film. The thing with the PA film is that the patient would need to have a good deal of ability to be able to take P a film. So even the PA film is preferable for a couple of reasons. We're going to discuss it a little bit. It's not always possible. And you can't comment on everything that you can come in from pa forms in an AP film Exposure. Um, it's basically how white or black the the film itself is And have you assess for adequate exposure is you're looking at, um, whether you can see the left him from and follow along up to the spine and if you can see the different individual vertebrae behind the hot shadow. So if you have quick look at this image, you can see that this is pretty much an ideal chest X ray, and there are reasons why this is the case. First of all, as you can see, the topicals are pretty much equal distance from the spine, so there is no evidence of irritation next, counting the number of visits that can be seen, you can definitely see an adequate number of anterior ribs here, so therefore, there's an adequate inspiration. And since there's a note of whether this film's a prp A, you can go on and safety issue that this is a PA film finally is. They can see you can both follow the they're from along to the spine. Anything also see them to be a little spine spinal processes behind the heart so you didn't have any constantly getting exported, drove this film. So following the initial introduction of the patient that we've discussed before, you can go on to say this is a PA film or any people and instantly an adequate or if it's not, explain in which way the film isn't technically adequate, and next you're going to, you're pointing out the most of these abnormality if you can see it and then we're going to the NBC. But before we go into the obesity, I wanted to give you the answer to the question that we previously covered. So this film is shows evidence of poor inspiration and also under exposure. Um, you can only see about six anterior ribs in this film, which shows evidence of a good inspiration and not being able to see the left hemidiaphragm properly and not being able to see the spine behind the heart that is evidence of under exposure. While this film is an AP film, that's not a comment on the films adequacy. It's just a comment that you need to be able to make to be able to analyze the film properly. However, just because of film is AP does not mean that it's not good enough. It's a little bit. It's that it doesn't it doesn't mean that it's not good next week on with a B, C, D or Chest X ray. How would you like? This is a raise breathing cardiac they're from, and then everything else started with a raise. The main thing you're concerned about is the trachea and the bronchitis. You can see them breathing. You both get the lungs on themselves, and you also look at the edges of the lungs. So the pleura next looking at the heart. What you're concerned about is the size of the heart. The aorta and the quick are different angles. The dye from you want to see how fast it is if it's overly flat or if it's overly at the top in the king. Issues with inspiration, you can infer whether there's parts of that from, if one of the from him from Zar way about the other one. And you can also have a look at the cost of earning angle of which will give you quite a bit of information. Everything else this can roughly about three basic things. You want to quickly get the highly structures, which are the lymph nodes in the lungs. You have to take a brief look at the bones, and you can have to have a look for the gastric bubble, and we'll cover all of this in more detail now. But before we do that, a couple more questions before we carry on. If you can pop your answers to the pole, that would be great. Okay, yeah, I can just say question the chat. Staying. What was everything else divided to do? So the main things that you want to look at other bones, the highlights, structures and the gastric bubble. So now that the answer to this question is has come through, I'm gonna go into the next question. If you can put your answers to do the whole once again, they'll be amazing. Okay, great. Now we can go on to covering the details of a TUI. So airways, the first thing you want to look at is to see if the trachea is in the middle. So please put in the chest what you think might be because the trick your deviation. Okay, lots of people are saying tension. The majority season, pleural effusions and humor's, that's all really good. Answer is so thank you. Um, carrying on with the depression diagnoses that I haven't done here so roughly can think off for your deviation as being as a tricky being pushed on the trachea being pulled towards the 12. Because basically, if it is being pulled towards the cause, then it's most likely a low bone collapse. If it's being pushed, it could be a tension pneumothorax. It could be a very large pleural infusion, or there could be a mass something like a malignancy, pushing it away from where it's meant to be with breathing. As I said, you start by having you get a lung. Age is themselves. If you if you can see the thickening in the lining edges and that maybe that might be indicative of a musical your mob. If the languages are not where they need to be on the edges, then you might want to think about some like a pneumothorax. And once you start to think about that, you might want to think about what this is. A simple or attention rex next. After looking at the lung edges, have a quick look at the lungs. Owns these include the upper middle and lower zones. But just bear in mind that these imagine results that you look at 12 in your neck straight do not necessarily correspond to the lobes of the lungs. Okay, do you want to quickly put in the check what you think might be causing the abnormality? And this these two X rays radiographs. Lots of interesting responses in the chat? Um, people who are saying pneumothorax are correct. I understand what you're saying. He be. However, that's not the main thing that we worried about here. Um, a couple of people are saying that the stomach is talking about the one on the left saying that it's hyperinflated and COPD. That's an interesting comment and a comment on that nurse second, Um, but, yes, the thing here are the thing that you're looking for here is pneumothorax, the film on the left. It's a simple pneumothorax, and you see the line where the lung kind of ends and the film on the right is showing attention. Pneumothorax is you can see, the trachea has been push out of the way, and the heart's kind of people shovel out of its place is well, and I'm not a very nice picture, is it? In terms of new authorities, you can divide them into spontaneous or traumatic and primary or secondary in terms of spontaneous. A primary pneumothorax happens when there's no underlying cause. And second, during pneumothorax happens when there's an underlying with speech pathology. So people who said that the first image might have been COPD hyper expansion or that kind of stuff, Um, I'm not sure about the patient's issue, obviously, but if that's the case, then this would most likely be a secondary, spontaneous pneumothorax. When it's a traumatic pneumothorax when there was a direct cause that would that cause this pneumothorax in the history? Then you can see if there's a simple one or attention one bear in mind. Simple name of the receipts can reverse the detention if they don't treat it as well. And I'm just going to briefly talk about how tenuous worked authorities occur. So what happens is when there's a flap that's open, uh, this lady and error once the a renter's along and, um, the pressure in the lungs bills, the flap can shuts itself down, which causes the air that going to be not be able to leave out in expiration. So when you're inspiring again, more air is able to enter the lungs. However, when you expire, it's not getting in getting back out. So we keep building out until that's Taliban chest just keeps being filled with more and more and more air, pushing everything from that side to the other side. And this can cause your heart to be stuck in, kind of not not be able to contract properly your lungs being not being to work properly. A trickier being deviated is actually horrible thing. Next, I want to briefly talk about consultation and opposite medication. Interesting stories. Um, this is anything where there's increased whiteness. Where black lungs. You should be again. If you could put a couple of answers as to what might be some causes of consultation or Pacific A shinin chest X rays in the chat would be great. I'm starving for putting you on this one. I just think that more useful that way. All right. Again. Lots of really didn't correct answers in the in the chat. So things like pneumonia years neoplasms cancers of any cause, fibrocysts and eczema. I'm going to call the top three now, and we're going to talk about it in my in a little bit. Um, interesting that someone said honey coming. I will talk about how you coming in a minute as well, if you give me a minute. So what do you think is going on in this pill? Popping the samples? Excellent. This one's showing low one lobe, uh, pneumonia, most likely in the right middle lobe. Um, so pneumonia's can appear in various different shapes and forms. They can be hospital acquired, community acquired or aspiration. Um, and they present with all the signs of pneumonia they can think of. So cough, shortness of breath, fevers, that kind of stuff. I'm purposely not going into the too much about the pathology behind these presentations, as I don't think that really goes under the ramipril this lecture. But there's some basic information way you look. The slides for information. If you're stuck for a quick visit of information like this, I also want to be like Curb 65. So curbs 65 is. What do you use to assess the severity off pneumonia in patients and the higher your purpose. 65 score The more severe your pneumonia is, and this tends to in malls, trusts dictate were about if your stuff, um which patient? As with increasing scores, a more potent antibiotics or potentially IV rather than P O antibiotics is given to the patient to you help fight the infection. So, see, here's the confusions. If the patient's confused, that's one score. If the your eyes off seven, that's another. Another point. If the respirator is above 30 that's one more point. If the BP is less than than to the systolic or less than 60 that's still like this. One more point. And if the patient is older than 65 that's also one point. As you can see with increasing crib schools, your mortality rate also goes up, which is why you can change your treatment targets on your treatment guidance based on the 65 score. Again, Please put in the chat. What's going on here? This is slightly more difficult one. And I don't think this is something that you need to worry about all that much. But I just wanted to mention it just because it's good to have a gun awareness of this. If, you know, I'm sure that's completely fine as well. They're getting lots of very good. Reasonable to a French was there? Um, there's one person saying it might be cold bit, which I think is very interesting, because that's probably a reasonable guess. But what's going on here is a broken bone. You, uh, say bronchopneumonia is defined as acute inflammation of the bronchitis, leading to influence actually within the lungs. There are being supplied by those broken the bronchioles, and you can see this is normal lung with patches of information from basically the patches of consolidation And this is what it looks like is a dagger around us more cartoonish, basically. So you can understand, like the pathology and how it looks. Basically. What about this one? Guys, I'm against for you for putting you on the spot. But if you get, let me know what you think is going on here as well. That be great And euro pretty much on the spot with this one. What about this one? If you've been following our SPS on social media and then you would have seen the exact same picture on there as well, which I wanted to kind of include here is Well, um, we are posted in questions on there quite often. So do engage with them as well as that's a good learning. Fortunately for everyone and yes, these are horrible mess is indeed. Um, So what you can see here is malignancy, um, off any kind of combat primary secondary, especially one on the left, The one on the right. It's the one that we've talked about mats that is most commonly caused by renal cancer. However, it can be caused by plenty of other cancers, like choriocarcinoma and pretty much anything but it's just much more rare in cancer. They're not renal in origin. UM, isn't a very common finding, but it does happen in terms of the lung cancer. The main risk factors. As you all probably know, it's smoking. The vast, vast majority of people who get like cancer will have smoked a spaces. It's border. And previous evidence of fibrosis of any etiology also increases your risk of lung cancer. Exponentially, any guys think of some kinds of land cancer that you might want to put in the chest for me, that's so yeah, broadly. They're divided into small cell and non small cell. However, non small cell is further divided within itself to further kinds. I'm only going to talk about too specific, mainly for about two specific kinds of lung. Witness here in terms of the ones that have originated in the lungs, because these are the ones that are the most common. So I want to talk about a small cell carcinoma and other carcinoma. Small cell carcinoma most commonly occurs in smokers, and it's the most common kind of kind of length cancer, and it tends to be a century located, um, lesion. So if you have a look at this one here, the one on the left. This one, I would say, is a pretty high chance of being a, um, small cell carcinoma. The other kinda that I want to briefly mentioned is other than carcinoma. This is less common, but interestingly, it is more commonly seen in people who don't who have never smoked. And I believe also in people who were second and smokers. And this has to be located more peripherally in films. And I said, there are other kinds that a large cell squamous cell and all that kind of stuff. And there's also a chance Is that a four gated elsewhere and have metastasis eyes to the lungs. You guys know which cancers common limit exercise to the lungs? Yeah, it's pretty much anything can, but most commonly is going to be stuff like breast Incorrect full on, had a neck ounces. So things are they're not all that far away in terms off the distance. Yeah, and you guys know which what parts of the body primary Lung cancer metastasize to. Yes. So lung cancer tends to go to the bone, brain and the liver. Most commonly so really good. And I wanted to include a brief image of the musically Omar. As you can see, the opacifications this patchy religion is pretty much along the corner of the lung along the lining. And this is very much a result of a specific order, more often than not, especially for the purpose of SPS for exams. So she's always quit right down. So when it comes to me 23, almost. Okay, one more chest x ray for you guys. What do you think is going on here? Okay, instead of giving me different chills, would you like to tell me how one describes this appearance? 26 tree. So I'm guessing that you're giving are reasonable. I get what you're coming from with the fluid level and all that kind of stuff. But this kind of shows a cavity. It in lesion a little differential you've given me above are reasonable as well. They're correct. Um, but do you want to pop me some answers for cause of capital lesions in the chat for me, please? Yeah. Yes. TB is a very common cause of, um, cabinet in lesions on chest x rays. Um, however, just keep in mind that any respiratory infection can cause an abscess, which can in turn, appear as a career conversion. That's for gialamas or fungal infections from a specialist. Fun guy can also cause this. And what I've come to notice is a lot of rheumatological stuff causes a lot of lung stuff. Stuff like grandma to assist with. Polyangiitis also causes these couple of lesions, and so can secretaries. This and I believe September like can also do this as well. As someone pointed out in the chat The What's going on here? Feel free to give me the described appearance or give me the differential for this, please. Excellent. So what this what this image is showing is lung fibrocysts. How I would describe this is increased global shadowing with ground glass opacity. What I would say about honey coming is that that's a CT future. And you cannot really see honey comes in a six pray, because if you imagine a CT slice from that, you you can actually see pockets of, uh, tissues. I brought cysts that looks like vague. Looks like honey comes, which is why you can kind of comment on that show. in a CT. However, in a chest X ray, we all we can see some blow. Be great lines, then honey coming is not the most appropriate description. Discomfort brought this. It is a correct description for Seti's with fibrosis. However, I don't think, you know, like that inference. Just by looking at your sex rate so I would stick with seeing Grandma City in this case. And what can cause lung fibrosis? It can be idiopathic. You can just pure and so on. And that's kind of horrible, because once it comes on you, there's not all that much. Um, you can do, um, but it can also be due to stuff like pepper sensitivity, morning pneumonitis and other rheumatological stuff like promoter arthritis, a silly and ankylosing spondylitis. And there is a whole lot of medication that can also induce this. I can't really remember Mom. I had which medications these are, but there's a few medications that also cause this before I move, when I can see a question asking how we can differentiate from bronchopneumonia. Um, with bronchopneumonia. What you can see is a little bit of a Pacific a shins that I'm more Focalin shape So it's going to be in bed symbols here and the air, whereas with like fibrosis, is going to be kind of extending all over the place and could use lines like you see here is well, so having seen the questions that we've having seen the stuff that we've seen, I just want to go through the answers to the questions that I had asked you a while back. So this question I really want to give you guys a little bit of attention with. Actually, you know what to do when you ever see one. This is attention pneumothorax on I think pretty much advancement. You got this, correct. Um, and it's the same. Which is I using the supplies as well. Basically, um, you can fold languages there. Kind of signified an orange. Here it is, muscle displaced and the trachea is deviated away from the pneumothorax is being pushed by the air that's entering the lungs and what I want to point out about attention. Name of the disease is never, ever, ever x ray someone with a suspicion of tension, pneumothorax as that is, wasting precious time. These stations, if they appear relatively well, right Now they will it here it really quickly, and they will have a cardiac arrest. So if you suspect anyone with, if suspect that anyone has eight, someone has attention. Pneumothorax. Just stop them with a needle in either the States triangle or the second intercostal space with particular line. Um, but never, ever set up for next week. This this extra should never have been done. The second question here was this area off consultation in the right lower zone. Um, I think a lot of years that this is most likely to be a commute put pneumonia, and I I don't understand why, However, um, however, the most likely answer here is actually operation pneumonia. Um, when you see right, lower zone consideration immediately. Think of aspiration pneumonia. This patient, Pacific Lee has a history of Parkinson's, which comes with potential problems with swallowing, which one cause a separation in which can cause aspiration pneumonia. Um, there's every reason why, um, aspiration pneumonia presents, as I was on a consultation. And that's basically because the right main bronchitis is both thicker than the left side, and it's also it is that a more court vertical angle. So when something wrong goes down the trachea. It's going to much easily, much easier make its way into the right but one cup bronchus than the left bronchus before I kill him with the the C, d and E. I'm just going to give you guys a little bit of time to breathe. I know I've been talking a lot, Um, and we can carry on in a couple of seconds. And if you do have any questions, it's not going to put them in the chart. And I can try to answer that about my abilities. Okay, if everyone's that a chance to take a quick breath, I want to kind of work through the rest of the presentation and make sure that we cover the basics of the rest of Well, so the C is the cardiac, uh, the cardio cardio and the cardio on the hot The D is that from and eat everything else with the heart. Where you want to do is assess the size and have a look at the car. Different angles were there. From what I've said before, you want to look to see if it's or really flat. If you can see the cost of angles. And if it's symmetrical and as someone else is, just a question before again with everything else vaguely is a very general rule. What you need to look at are highly structures, bones and what brought it down from. So if you can see in evidence of, um, anything wrong done there as well? Um, and ah, you had kindly pointed out of the chair as well. In addition to what I've said here, you might also want to look at things that commonly get missed, such as a piece of the lungs, which you should always have a look at doing the, um, be off it old. And to see if there's any evidence of surgical emphysema. If there's a hiatus, hernia and if there's a low over collapse, I'm not going to go into these individual pathologies in this lecture because I think that's a bit too. It would take too long. It's like she would never finish, um, but this, like she's going to do another quit covering the basics of citrate. Hopefully. So if you guys could pop in some answers to this question on our pull, the great. So there's a very mixed responses to this question. Um, and we'll go for the cartels running a little bit. Yeah, and this question doesn't have any options. I just wanted to quickly ask for any answers. That question in the chat, if you don't want to post public constantly feel food too private, message them to me is well on room. That's completely fine by me. Okay. In Kristiansson. See here. Um fine. Okay. This carry on. I want to briefly touch upon heart failure. So heart failure presents with million the shortness of breath on expression and coughing with pink. Fourth, the sputum and the shortness of breath. Tennessee also be worse on lying down. You might be able to hear a third heart sound. And there might be beautiful Dema in terms of common clinical findings. Good. And when it comes to hot failures, heart failure and its findings on chest X rays, this also has a very interesting of a B C D e. And you can see the a little in the semen. Sheer. Do you want up what this is? We will go through the right, answer the questions in a second. So specifically with this one I'm asking for you guys to give me that A in the ab CD for heart failure, which I think a couple of people are doing correctly. Um, so this is showing ocular of your eczema and because it kind of vaguely looks like that twins. They call it back in a positive he's but just me, you know, um, fine. So obviously alert of your Indian mom mainly points as and I y it Nissen the general area in the lungs on basically doesn't quite look the same as pneumonia. I've made it easy with the second one would be off it all. What do you think? The big issue. Yes. So yep. The be here is curly, be lines. And what can you see here? That might be the C in heart failure. That's correct. That's cardiomegaly. Um, in terms of cardiomegaly, I just want to briefly explain how you determine cardiomegaly so cardiomegaly can only be inferred, inferred in a PA filled. You cannot comment on the heart size. If it's an AP film, and in the PA film, the heart should be less than about 50% off the lung fields. If it is more than 50% and you're like to have some cardiomegaly. What about the What is he here? I can see why you would say deviated trachea, and in this case, potentially maybe, um, but the main thing that we that's a part of the heart failure A B C D e is up a little diversion. And what pill of diversion is is increased vessels and all that kind of the whiteness coming up from the highly region going towards the upper upper sides off the lung areas rather than going down? If there's a lot going up like in this case here, then is likely to be a full of diversion. And the again I wanted to provide a very obvious picture for you guys to get used to what it looks like an ideal scenario. Um, what's the, um I have a question asking why d happens in heart failure. I have no idea. I'm sorry. It just happens. He here is perfusion. And yes, a little effusion is the heart failure. And it happens because off the adequate profusion, good function of the heart leading Teo fluid building up in the lungs the same reason as a happening as well. And here's two more, um, images showing pleural effusions. So is this appearance with the medicine list and the cardio friend again? The cost different angles are blunted. Someone's asked if I can show really be lines again, which I will quickly do that before moving on. They're these tiny, tiny, tiny horse until the lines of the sides of the film. It's in real life. I just don't think something that you really should be worried about. However, from and example ski perspective, I think just be aware of what A. B, C, D, e and heart failure is interesting rays and be aware that curly be lines exist. I don't think many people expect you to be able to quit do the blood test extremely like Oh, here actually be lines, however, just know that they're feature of heart failure and you hear answering the questions I can answer. So thank you for that. So previously before going, that's the curly be lines we were covering. Well, a fusions. So do you guys know how we roughly categorize pleural effusions in clinical practice? Excellent. Yes. What we do is we guys into transitive and expletive so exudate is when the the fluid in the rural area is rich and protean and this happens due to infections, neoplasms, inflammation, infection, um, due to increased in capital permeability. And if it is not rich in protein and then it's like to be transitive. And this happens in all the failures. A heart failure, liver failure, renal failure. Here. What can you see in this film here? Yes. The main finding here is that the lungs are hyperinflated. You can both see the spider flattening of the data from. And you can also see that there's an increased number of visible ribs so you can see more than six anterior or 10 Posterior rib is above the diaphragm, and this happens in things like asthma and COPD obstructive lung disease. This is when you Kenbrell the air in. But you have trouble kind of exhaling back house, which is impacting on your ability to breathe even more air in. So it's kind of it difficult situation to be. And sadly, what about this one? What can you see in this film? Okay. John has said preparation. Um, can you expand it up, please? Yes. New pertinent here is the correct. Answer. Um, so when you look at a chest film, especially with your ex one with the patient's standing up, the the appearance of a single bubble on the left side is completely normal. That's the gastric bubble. That's Aaron, the in the stomach, and it is completely fine. However, when there is a second blood off Aaron, the right side, that's very pathological. And this indicative off perforation of GI Tracts and your creatinine, um, was quickly having a look. The checks. That's probably something like like a tube of oxygen, that connected film that don't think that's anything to worry about in terms of the the neck closely a necklace. But given that it's all still sitting in the patient, is has no opportunity. Um, it's most likely going to be something like a line curing a prison or something else. So it's at, in fact, what should you should always be having a look for. It should always be looking for things like pacemakers and inserted lines and that kind of things in just X rays and that also goes under the everything else category. So I can't spoil this earlier because I was trying to go back inside, but I couldn't. This is showing highly. Lift them pretty. Can you guys read it on the shots and causes of hard inflammacin for me, please? Okay. So high lymphadenopathy can be caused by I think, like infection. Mainly stuff like tuberculosis. My complex. Um Ah, and all that kind of stuff. Um, sarcoidosis and malignancy and silicosis. Berlioz's this. And finally, what is the most off of the multi in this film here? So someone has said that this patient as cardiomegaly would they might or not, When you can't quite comment on it actually can instigate something. And it's not quite two high, about 50% So I wouldn't say that is very conclusive for Cardiomegaly, however, there are two broken clavicle. There's a lot of people have pointed out that this is a kind of infection with they look out for and see things like broken bones and be able to comment on them. Both chemicals are broke and right from the middle. As someone said in the check, it might be something like the players. Who else and here are the circles around the the brakes in the clavicle, So always be on the lookout for things like bone stuff going through the questions I asked you guys, which are the following findings. You cannot conclude from the film here, so this shows you a an AP film off someone with heart failure. And since there's an AP film, you cannot see where this patient has cardiomegaly or not. You can't quite comment on that. It looks as though the patient probably has cardiomegaly. But you would need a pa film to be able to confirm to say that the heart is enlarged. I'm not. I don't think you can see all five findings of cardio cardiac failure in this X ray. However, if you read the questions care question carefully, it's not really ask. Your you can see in the specific film is asking us for possible to be seen based on the features of the some and this question here again, they were lows of very interesting responses, Um, but the most likely cause of what's going on with this patient is a and in fact, exacerbation of COPD. As you can see, there is a an evidence of increase opacifications in the right middle and lower zones, which might be in the clear of pneumonia and the chest is clearly hyperinflated. Which means that this patient most likely has an effective thing going on on the off their COPD or smoke, most likely going to be COPD. So that's all in terms of my slides. I'm happy. Teo, try to answer any questions you guys might have for a few minutes to put them in the chat. And I'm sure are you here is also happy to you feeling where I can't, Um, please, do you make sure to fill in the feedback that that really helps us out a lot to improve and, um to improve and hopefully do better for you guys throughout the year. Would you have a lot of things coming up? A lot of further course is that we want to, um, carry out in the next few months. I think, uh, you have a link for the feedback where she's going to share in the chat as well. And again, Please do shake follow our instagram page for further updates on what's going on. And the best way to receive the links for all the teaching is either through metal or clicking, going on our even pages for the course. Um and that's about all from from me for today. Thank you very much for cheating in. It was a pleasure talking to you today. Good teaching. Was Bill good teaching you? Just remember, he's He's one of my new faces. Also is going to be a regular for it. There's going to be important part the six PM Siris going forward. So what? I don't understand. It's tough in the next next lecture that you did not just one of all of one of our one of our weapon. Our providers. Yeah, finding of Oz bottles. Actually, it was actually I mentioned in the chat one. So I went back on. I've done general surgery for about a year. Funny enough, even I'm going down the I see you met on better call her up because of Cove it on. I had a case where we didn't direct chest X ray findings, and it's very rare. Goes on. I was looking at the gastric bubble thinking that Castro bubble just there's no something looks a bit dodgy about. It causes a gastric bubble. We're gonna have the line of air extending a little bit past it like like a straight line with kind of look like How do I say, like and upside down deeper, what extended lines down, the down the back of it, basically, And I said, I said to myself, Just doesn't quite look right. And he presented with abdominal pain and that had a history of diverticular disease, and it came in with a little bit of fever. Chemical contact is always so important on, uh, we fought to ourselves. Now this might be a perfect We ended up doing the CT scan. They had a small diver, diverticulitis or a perforation. Basically, that's that's what we haven't ever seen. The the which mukula the pneumoperitoneum on the same side as the gastric bubble alone. Very wet. Yeah, aside, upset in the chair as well. If the patient has had a recent surgery, mainly laparoscopic surgery, then there's the inflate the patient with carbon dioxide to be able to see everything better during the operation so it takes a while to go down. So if you imagine century shortly after laparoscopic ablation, then you're like to be able to see you got three trouble. That's not really the medical um, fun Fact. I was asked this question by Microsoft. Um, I did my placement in Jensen urge. Why do we inflate the patient with the 02 and not with any other gas? The two reasons for this is it's in order to not going to react with it. That's in there, and it's awesome. Nonflammable. So if something blows up, just I shouldn't be talking about that. But yeah, it it makes you just make you think, how important just to think about this fixed. Get that good? There's one other comment that maybe chuckle, which was a description for the testicle. I don't remember who said it, but it was a little one with a capitation lesion. Someone said, Well, that's pocket. I just made me Chuck. I would I wouldn't say it. Correct. Discussion would, uh, we'll leave this open for a few more minutes. Should be sales, but just some people can keep shot. Uh, yeah. Tomorrow guys again join us that six pm I'm gonna be doing electrolyte abnormalities. Uh, tomorrow, uh, which have done probably the fourth time. Whole time teaching that now. So you will go smoothly, guys. And I will be on time this time on? Yeah, as possible. Said please, please, please. Word of mouth. Tell all of the other medical students or anybody else from the foundation course who's on. I'm seeing lots of 54 years joining us, but not many first or second years. So if you can spread the word guys will be much appreciated if you guys also have anyways the you you'd like to be involved in six PM Syrians. Do you throw us to the M in our social media, as you probably going to be checking to me through the EMS? I'm the one kind of looking at the most frequently since some of the social media leaders well, if you were interested in joining the team in any capacity, do let us know and hopefully we'll to figure something out for you, and that's about it. Terrorism. You plug in the six PM Siris. I'll be back on Monday with the session abdominal X rays. I don't think is going to require as long, but I'm going to try to cover the basics of abdominal X rays on DWIs through them, and I'd like to see you guys back for that so we can talk on the phone. Already mentioned comments before we end was I think I already mentioned it. But just remember, guys, if they're smokers with really bad pneumonias chest X rays, how to say chest X rays are mess. About 25% of things I've got, study said. But chest X rays on the be all end all basically sometimes early pneumonias don't appear on there and it can miss lots of things. So chest X ray, just because someone's not showing something on a chest X ray, it doesn't mean that they don't necessarily have it. That's the one last thing I want to mention my chest. It's just remember they can miss lots of lots of things, especially cancers. Yeah, I know I haven't provided a lot of history for a lot of the cases that we've covered today. But in the clinical setting is very important to take. Take the film with the history that it comes with. It doesn't really mean much without without the district exactly. Okay, Britain, I think will end there. Thanks very much. Going to see tomorrow it again in six pm before we go. Actually, Did you guys managed to get access to the catch up stuff for yesterday's finger just to make sure that was all okay on metal. It's up there. The both the slides on the video to make sure the metal stuff is okay. Anybody still here? That maybe Look, I think they're me know. Yes, yes. And same thing. Tomorrow is bills, hospitals, lecturer and video will be uploaded tomorrow again as catch up with a once. A lot of feedback been completed and compelled for today. So please fill it out. Please fill it out. Good teacher. Thank you. All right. I think we're in the early Thank you guys. Are you guys on Monday jizz, right?