Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

to do that. Um, let's get started now with on It's always good to start with a six on day. So I sort of just redid this labeled argument a chest X ray. Just basically, I'm sure this little and just certainty points I just want to go through him to a lot of, you know, disorder e on it. So the greener is quite important off in the future. And your best ones I mentioned there, Um, yet I said the primary rascal a German. Most of this will go through in more detail. But just you know, this is the general. Your water consists of a chest X ray because they're a lot of another thing that we can't see on the chest X ray. And therefore the emphasis is working can actually visualize. Um, fine. So just going through the same step by step, I've got the tricky a going centrally, the point of the point of which I forbids he's the Carina. And this is what important, especially when it comes through in G tubes on or did you place like, um, Onda got just going along the side that you caught another prominent mediastinal landmark which is your technical, which is where The arch of the year position to the descending on. So, yeah, you got the two long highlight regions. Now the highland is sort of an area of the world would waste Anyway, You have your memory vessels and you're punk. Your muscles on your bronchitis itself passed through. So it's a concentration of musculature on a raise on that form prominent markers on a chest X ray. One important point, just a note is and the left highland should never be lower than the white Highland on. This is to give you the anatomical arrangement of the vessels themselves and which you could look up more. Teach our hostages the magicians on if you want. But the main point is the left highland ship more than the right time. And if the right island is above the level of the left, I'll, um, you are You should be concerned about something so and the right eye, LeMarque or depressing left island to be causing that. And now, with regards to the highly region, we mentioned the primary teacher. This is probably the most only bit of that, and you got the pulmonary arteries coming off from the right ventricle. And that's what gives this sort of spread on both sides or anything from them. And that's what we can actually visualize. And some of the big on treatment on churches, off reoccurrence and it starts. And now something that I was initially confuse it, but in med school on but me involved in my hand around. But the idea that, yes, you caught a complicated three D structure that's your fax on. But what we've got on here is a to be representation of that. So whenever we were talking about the lung fields specifically, we referred to stones along. When it comes to the chest, it very rarely we mention directly over there. Is this technology in this low on the early second time we do that is, if you got some of their indication of blood, Um, but otherwise, whenever you're talking about pathology, for example, there's a solitary lesion in the right, a big, so I would refer to it with the solitary on circumstances lesion in the right upper zone on, I would not say it's a fight, uh, write something so yeah, it's just that I mean the question of terminology slightly different with intestine trees on more cross sectional imaging. But they need to worry about that. Just stick designs on the bones are fairly straightforward. It's roughly a third of a run for your T on. Yeah, I don't think there's much wanted, he said about that, Um, no, ma'am, forgive me. If this is basics, we'll just quickly go through this and places um, again. It's a basic, and that but the right kidney from the left, from the right to me from his superior, generally competitive left me die from on. That's because of the fact that you've got this ankle women beneath. Of course, the liver, especially it It's a fairly You've got the two sets of angles where the dye from in tracks with the mediastinum. The purpose as one of the is the cardia phrenic angles on. This is important because if you have this blood, it would suggest it's pathology there, and you can localize that further, which is something you're going to more detail later on. Similarly, got your cost of phrenic angles of pasta bread. Um, friend die from on guard here again, heart and diaphragm. So the names, please. And you've also got the speed tracked around here, and we don't really interpret much on a test positive in the stomach. Trouble is important in certain aspects, particularly hernias on any trips. Placement? Exactly, exactly. So that is something that be aware off on. Do keep an eye out for on now, just a smidgen early for the angle being formed here on that once Greece is now, this piece is important because in, yeah, normal he a thumb. If you have any fluid letting in the bulls, Islam in mind between the artificial for you, for the potentials instead on if there is something that causes fluid accumulating that most common cold things like infection Artane you malignancy. And that's where we can treat you late at the bottom off the old faces until this is a very sensitive indicator off on if there is a future, and that's why that's quite important, that we refer to it as blunting of the cost of panic angle. But you meant to see this nice, sharp outline a way down on def that gets irritated now. This is also important concept. Um, it's quite simple in the sense that you're just looking at the's audio climate and competitively in class and on. Did should be less than 50% of patients on decision, because it's an important our failure because on in a drawing toward disease, you end up it irritation of the muscles because it's trying to compensate for all sorts of causes, weakness, maybe previous infarct, etcetera. It could even be congenital on That is awesome cardiomegaly. That's important because you're likely to have heart failure that can have lots of prognostic indications. Surgery, etcetera, etcetera. Also, they could explain some of the scientists, since that was probably so. We'll go through that in more detail later. But the main thing to take radia is that cold big girl, less than 30% doesn't need to be very precise. Usually, if it's 1% worse and 49% doesn't really make a bigger difference. That's still person after normal. In cardiomegaly, it's usually quite obvious, and often you find other signs to suggest that this patient's heart on one of the thing I just wanted to add here is that yes, you got the four chambers of the heart you call the operator and then you put the ventricles. But when you look at it on a chest, the orientation of the anatomy is actually not a straightforward. So you've got the right atrium, which informs the hard part on the right here on the left. While it's roughly symmetrical on the testicle, it's not the left leg to the left atrium, actually, is the radar to running? Actually, the person emerged chamber and you don't actually usual eyes A that go on the chest. Um, what you see is actually the border of the left ventricle on the the right ventricle on the left atrium are normal normally, usual eyes that daily on the standard six and rather said indications you look for on it can be indirectly have seen in radiographs, expectedly and lateral views or barium soldiers zone. But you guys don't need to worry about that. So your exam's remember, these are the orders. This is what actually constitutes the border, right? Atrium on the right, on the ankle. And sorry, um, now just one toe, um, bit about the two years from itself. Now, when we look at radio growths on there, certain indicators we need to look at the Requip because if it's not returned that also parents with Polident, I'm sure your glasses little about this earlier. I'm just very treat again. I'm just a few of the bad basics. So the baby is. Expectation is we look at these countries in the anterior aspect, which would be the medial aspect. We look at the structure on the press here on the chest, which in this case, our spinal prices on a biologic being. If you've got something that's a front and put something in the back on their aligned coffee perfectly and then the film, it's not irritated if you get a change in this. So if you see that the distance between them it's not Rafik Resistant suggested got irritation ever to the right, which is not uncommon, especially in situations, especially in 80 lbs. Possibly the films you will see that, and that is something you have to deal with because it's not also position the patient normally. But while presenting if it is something to comment upon, to see if there's an irritation of the show, but that the media had probable or line with them draw a line in between it's finest station. They should be roughly equal amount of the right. Um, so, yeah, that's that. Now I'm in the future to look at his penetration now. Modern days. We can do a lot of wind bearing on change. The here it's off Next Ray, which you might have seen being done on. But it is still important to know if what we need bipennate gration is how much on yes, simplest explanation is what that can just send in structure Clearly. So here, for example, we should be able to clearly make out distinctly identify a separate quarter breath through the carton chapter. That's a rough rule of thumb to say that because you're going through soft tissue and you're still being able to distinguish there. And if a film is not adequate, thumb is not adequately penetrated. And they will be certain problems. For example, people people still in it and really the margin between the heart from the spine here, which example? If there's a hiatus hernia here, which is the active and if it's not expected when we will see me in my back and it wouldn't really need it just and sometimes it can also lead people. Also, it's human and rather you can't really comment on instead of it's it would be. That's why it's important. Um, now inspiratory effort is something that we learned a lot about off life, with patients lost in finding struggling, especially if their places. But that's what we are. And probably the way this is measured is, um, for minimal amount of inspiratory effort, and you should have the middle. I'm a little line on that are from Should insect any superior to the anterior aspect of it? His matter If it's the right or the left, right here on the right, because it's for me on on, it shouldn't be more than seven ribs on, because if it is your thinking, is this hyperinflated, which would be someone just being very keen and trying to take a very deep breath or more for your thinking off? Think this is a This year in the contract is you see that on often those in those cases, you also see a flattening of the diaphragm. You might get some blunting of the cost angle as well, so it's not usually seen in isolation. It's a cluster of things, but this is roughly the angle to look a seam or extra traits that you don't necessarily need to always have to count, you know, hunting down the ribs on doing so. But if you're ever in sure, that's always the best, like it's tearing big political. A line drawn imaginary line should be under more than the seven. And I took the, you know here aspect pretty well that, um, fine. But now one thing I do want to touch upon specifically, he's It was just your protection on how that's important in the text off. Um, so basically because of the grade schools on the is on ranging and 80 from, which makes it more convenient to take take a picture in someone who can apply. So it's includes at the too unwell, just corporate enough to having their own side of the way in from to four. On Dwight, you end up is a slight magnification off the apartment. Our choice, because it's basically the force and therefore it shadow. It's slightly bigger. And what that means is that if you see a slightly enlarged heart on an e cheese, um, and you cannot diagnose, it is fair to say that it is difficult to comment on on the heart size on any and if the heart size is some normals of it. It's a 25% of your book of the process gration on an AP film because of the way it words that the heart's a seem to be magnified. That's okay, because that would usually indicate that the heart isn't a large. So it's sort of words as a negative marker in that if the heart size is not enlarged and maybe from that's, that's fine. But if it is enlarged in the Navy from down, jump in and pull the automatically unless you call other signs of submitting a patient and then just walking break something. But that's just something to do to, you know, generally speaking menstrual. I've always said this was in a he from. Therefore, it's difficult to comment on our toys and know whenever you need me for that. And if you're ever stuck in the back, Um, no, just every day through would eyes as my expectorants to presenting, and this doesn't mean that you have all of it. Everyone does. It's likely differently. And so whatever helps her room a strong as you look through a limp or tint. Sections can be visualized on a chest X ray on everything that's fine accidents, so the way I do. But it is. It's just easy for me to remember even middle of insulin, for example, on Do is just a BCG a is your airways be is your breathing, which I use has a memory, told the lung fields. And look at the different zones. Comment upon them. Tease your cardiac chad Oh cardiomegaly in Texas cardio, which is just the car being on the right hand side, left hand side on. All still also referred to the heart orders on to see if there's any. It's optional. If there's any pathology behind the ear on D, I just prefer to ask the bone. Always forget about it, so I just, um, because you can have fractures. It would be good mean for them to terrorists. Extra two. With the only abnormality being a fraction worse and, um, having and some minimally displayed factor of the scapula, that will be mean. But the other common fracture that people do miss. It's really practice. So it's always worthwhile that even though you look through the lung fields, look through the Brits, make sure that a symmetrical and show that they don't show any obvious breaks or anything like that or any implants, except fine. Now he and so I mean in cancer, bone needing. He I use a natural time for everything else on, but I know doesn't help. But it basically refers to there is that I have a mist, which, where that is one the center of the chest X ray. You've got your two island. You call it a mediastinal point knuckle, for example, in some, before on everything else that we can add. Another way to think of it is the for external objects have wood she's ordering nine on. But we'll go through cases, and a lot of this is just repeatedly it again and again. Still getting this. Um, Now I'm sure you've heard this time being very about on the on This is a bit of the MS name a really what they're referring to, But you're normal and a normal cigarette on your chest X ray on you got something that's disrupted. So what it actually refers to it is, and the loss of your more more providence would pay for me. Um, I just mentioned some common on points here. This is no means extensive, but insisted based, except of things to remember. And so if you got anything securing the same guy from on either side and that tends to be low, low disease on if you put something again, bear in mind that called the retrocardiac part of the lung as well, which is the area off mist. And if got something there that fuzzy indistinct, it doesn't matter if you don't know exactly what it is and you can't exactly traces outside. Basically, if you can't, if something looks abnormal behind the car checkers or on dot So there is something politics day, percent cancer. It could be and going along there if you've got on something, that's something The left of the doctor, for example, on upload pathology there. If you've got a disruption off the and border of the right atrium on, that's right middle. That's a strong indication for this Look, These are one of the few indications where you can actually comfortably say this pathology is most likely questions and because but other words generally zones and again, if you're not sure yet. So that's basically that was not right now in the thing. And what I'll be going through is a B in cases on some specific signs. Now these returns that that turn around, look at me during medical, remember, distinctly and you could always what they worked. I just want to go through the Lasix again. So this is an example. We've got a distinct area. I've been stealing, treated in the left middle left, and in that you can see what your numbers in a a broncho brand is nothing but the fact that you've got your small anyways, um, would child care in them and why they appear dark because I'm a chest X ray. Things that are fried higher density, bit of a darker, lower density in the areas minimal, then stayed away. The other soft tissue in bed. So which appeared star and you've got that highlighted in both sites where basically gone on this case, thinking in America, what's there? Probably combination off, plus white cells floating to the area. Bacteria, necrotic tissue, edema, inflammatory changes, whole host of things. But what the results is bunk surrounding the airways. That's why you see this very nice clear pattern you could almost a pencil going to go out to different areas extending beyond the hydro, I said. That's what's known as any, um, and that's a half in the morning sign for a bar or consolidation rather on that right? So I just thought, sort of summarize a lot of what I mentioned. This is how a on said Ways Now, with a lot of my case, I have to apologize is that I haven't had a thing. So, like the name of the lesion in the taking on the eight just a month. But you might be given that example. Even in your month on it is worthwhile. A look at this, a habit to stay. This is a year off sounds old. This is so and so they can on whatever dated this. Now, then comment upon is the film is technically adequate on so forth that active basic principle little combat is a rotation, doesn't appear to be irritated in there and got off the material, the midline, so that's fine. So imagine a line there that just that's fine. It's adequately penetrated. I can see the pedicles off the breath through the heart itself in the midline, which is fine, and it can distinctly make us from legend. It's treated, um, on There is good inspiratory effort on both sides is no blunting off the cost, a frantic angles. And there's no flattening of the time from to suggest is hyper inflation. I s O. It's a technically added scan, then commented on Go Even Jesus happen here central, which is your airway? Generally on Ben. You've got fields there, just having a look there, and I know it's one sentence, but make sure you have a look. Compare. You decide the other opposite own middle zone lowers, and that appears to be fine and the heart is not enlarged. You don't need to measure the whole, you know, roughly that it's within and 50% of your oral for a civilian, which is fine, and the cost on Prada frantic Angel's are clear. They're very crisp, nice as you can see on both sides here, so there's no fluid or any much that we're worried about at the Mediastinal countries are normal by media. Son of interest. One of the things I mentioned Is the a technical going along there? And they're on their You're also looking at the right paratracheal traits of this line here on usually if you have any destruction or masses there, but yet the mediastinal contacts normal that we might. We usually refer disruption of the pattern widening of the time. Um, there's no bony abnormality, so I'm looking through the different There's no fractures there. Have occult normal. What is visualized the scapula. It doesn't show any break. Um, on nursing, if you have these s 01 thing I should have mentioned earlier when it looked everything else is such eczema. But that's something I actually remember. People go through. That's a police, it and that Finally, some right, you're finding. So it's going to be technically at it. No, I'm out chest X ray. So that's just a yeast in introduction to out which just have water with instant. Does anyone have any questions at this point that they want me to go through, go through the basis? Yeah, have a speaker. Okay, I don't think that happened, and and so that's that. Now on what I want is sort of like make it as much of it on the single most important thing with these kind of things. This so no, this would be possible. But I deal e care. It would be happy to practice. They're they're in technique or the medicine that we just three on on each of the cases in. Otherwise, we'll just leave you talking, which I'm happy to do. But ultimately, practice is what we make these points taken. So anyone feeling particularly adventures and you on try this case once, um, me one before happy to listen to these reminder of the session. Let's see. So this, um, the I wanted to use this as an example of how to to approach and just, uh, g two, because this is something that's not important. It's he never event in. And you you I just wanted to do this. Like what? A normal that would look like So certain man marks here. So whenever you're looking at MG, you got to get stuff going on with the weight on which is the days look like that doesn't go along the way here. Um, does it go pass a greener, which it must always, too, because the most common mistake. Is it going to the Carina then finding out that usually like a compass. And you've ended up getting a feeding them right into the lung, which is which bad on you then and with severe aspiration. So make sure that you come and gone. So it's gone down the midline below the level of three across the gastric junction, which is roughly around there. Or you could even get some pizza. Convention attention itself. I'm going down below. The level of the dice on then has turned to the left of the time, which is what we see here. Now, this is basically the maintenance like a Z followed in steps. It's gone down the midline as a hospital. Rena as across the level of the diaphragm. Is it to the left? You actually fire Chief? That's really strange. And even if you have to rinse and spit, you have trouble on the other side. Um, it's just as long as it is in red gastric bubble, you're saying And now, um, that's just to go to the basics off, don't you? Um, now, this is, um, uh the case that I just wanted through here. So here we've got And, um, most form. Does anyone actually want to strike out what they think the most abnormal is? We might have some potential, uh, people who are keen. I really Would you like to have a good? Yes, I will, though. Yeah, this stuff is going to cause some upset, but a moment? Um, yeah. So Okay, so this is Ah, chest radiograph. No, no unknown person. The rest of the details of them are known as well, um, rotation, inspiration, penetration on Plavix. And most obvious abnormality is that and pneumoperitoneum, which is the the older by diet from and so just carrying on, um, the trachea. I mean, it doesn't to be slightly going up to the right, but let's say that was, um that was normal on that could be wrong. The lung markings, they don't see any, like signs of them. Um, a fire after anything like that. Um, the highland look normal and the hard borders. I mean, there's something I don't know if there's something going on with the heart, but it also looks like where the hilum is. It just doesn't look quite as Christmas it as it should. Bill but they there's no if, assuming that Sorry, it's human. This is a p A view, which which I'm assuming. If it doesn't say over wise and then the heart's about the right size, it's not more than 50% of their ratio. Um, on, then just looking at the bones don't know. Is any abnormalities in the bones? Ah, on. But there's no over extra features. So in summary, out say, this is a, um, abnormal, while the some kind of pathology going on June today. So some GI I pathology perforation do today a run the the data from which is perfectly, which is a very good presentation, actually like that between this. Practiced a lot previously. I just wanted to ask falling on that. What was your next step be if you see an excess extra. Basically, what I was getting at is, if you do ever seen numerous exactly as I mentioned that, most likely you'll suspecting a perforation unless this patient is known Glocer gery In the very recent past, you would get a surgical opinion. Yes, they were on on some of those such intense find out why, but I don't if I that seem to, but yet that's that's something extra points. But you mentioned is that and you also got a bit of power. Yeah, it's abnormal. I suspect it is. Actually, that's from the sides here because normally with the gastric about you wouldn't see this coming along. The 100 are from, so yeah, you correctly like this. They're very human by coming from, probably also on the other side, As love doesn't really change there on here, I wonder, actually, I mean, I don't that much. And I was but elected the texture. But I wonder if this slide your okay to the air It's looking at where the spinal cord is Is is in relation to on the right was just really left on. In this particular case, that doesn't really change the the assessment on Testim say it. Really, But that's that's something. Have night. I, um this someone wanted on the look of this. Yeah. Yeah. And just one second I'm trying to see from the I'll keep an eye on the chart box for you. If you guys want, you could just type in the mountains on there. I mean, if people want to, um, it's great. It's not just when you're suggestions, Give that to 20 seconds, and then I will go to the answer. Alex, did you want to give it a go? Uh, yeah, sure. I'm happy to see. Um, I'm active part of the committee, but all of the anyway, if anyone else one stick. Um, so this is a a p X ray of unknown patient. I'm starting with, um, adequacy doesn't appear to be slightly rotated. Looking at clavicles. Penetration is good on. Do you conceal all of the bones and the start of the shoulder joint? Um, moving on to a airway, the trachea doesn't look deviated, and there's no obstruction. Um, breathing lung fields appear clear to me, and you can see both cost a frantic and goes on the cartia phrenic angle on circulation. Heart is within normal size. Um, and then D bones, I don't see any perforations. Um, well, I would say I see is potentially five to honest with you, I'm not sure. I would say it's a normal X ray. Maybe it's a virus tested those people, but I found really, actually what I wanted to highlight. Actually, some of these things is the sample. Um, actually, the next this is, you know, but you're normal. The the the right. The border actually isn't a specific. Normally the writing transmitted is flying, and they would go along that you should seeing in old. Yes, you have your normal vasculature going through actually obscured the rescue less I am this on watching mean that? Yes. This is elective about. Do you need it? That would normally expect. And if you line along there, say the previous and you can see that is often, um, yeah. So this will be some sort of going off in the middle on. And this will basically me and I lost it here. In this case, is it lots of the white middle ear rather than would you buy you getting this ends there must a supposed to, you know, control the HDL, which is a bit more. But you rather me this mass. And so that's something to be careful, because see anyone? Um, fine. So that's that, Um So both in on next just indicated people about 2030 seconds to look at it on after them on beyond. Yeah. Yeah, That will be just looking at it's again a similar thing. You really got some dizziness along here. If you look along, order on. And this is the next thing in this instance. Look at the previous case you can see the nice long there. You can see the future. You can see it in a shin, which is not normal. And in this particular case, because nice and normal along along on it for your attention, normal cleaning suited much more fuzzy on which would suggest that there's something it's a medication would probably be in the last week off. Doesn't matter if you can identify what I'm just trying to get you guys. To be that up is because on orders on their schedule is toward more minutes. And if you see a deviation from that these cradle or have the high suspicion of Jackson, I said, What do you think of this? Well, 10, 30 seconds on, then way will be going to the I will be, Thanks to the answer after that. Yeah. Okay. Yeah. So in this particular cleanest, it would be, Yeah. Case off a little pneumonia. You've got a white head stays in extending the middle zones, and they're in my my seasons the Hemi die from. Actually, I see they're very clearly long. They're suggesting that this isn't if you're not sure in the exam room, stress about it, just say that it's more likely. Um, now the point I want to focus on here is unity conceding. But these would be very similar. Watching TV, you can really see areas off with, um, areas off balloting of hypertensity in the middle. On what that translates, as we were talking about earlier in the surrounding space with Erin's. This is up in the morning, right? So the next case I have your answers out of your head or in the and we will, um it's like that. Yep. Well, that's a That's the right consultation. And so I would probably say that it extends to be Lotrisone as well, but most prominently yet. So yes, indeed. That is correct. For this, I would say I can. Usually, this is a, um off Mr. X rated yesterday. Actually, it's an adequate film that doesn't appear to be protection there. Adequate inspiratory effort. It seems to be slightly under penetrated. I can't make be while I can make up the borders of the world with the spine, the back lines I can't make out the individual where to brought that well, so I would stay off the IV under penetrated. But, um, every central now, anything to the lung fields, the thing that stands out, why the hilum which you normally see. So this is bilateral high level, probably exactly as I remember on a factors or any of the candles can find the MS. I don't know if your example get us mentioned differentials or not. Um, I'm a very based on what they tell you. Okay? And that just would like You can also have what the cause is TV. I'm not sure if I haven't gone to any significant. There are different. Let's looking at, you know, usually when it's president, it's not. It's it's usually not subtle. It's using it quite prominent with the stuff for his exams. So they tend to go for the moment. So it's just committed memory. Sort of roughly that kind of apparently, you see on okay, who wants all of this? Tell me what you think is affecting here and have to pick up the quality on. We will discuss it in a three seconds since you've I'm maturing, Sleep out of pocket. No worries, man. That if you want, then and I mean most of these basis. Yes, I would probably say that. Yeah, and still make a good angle, actually, anything this maybe it's like wanting on the left, but on the right you got there. There's something else I just want So one of the things to look out for. Uh, yes, there is a fracture. Yes, there is a fracture. I'm sorry. Yes, indeed. You've got left rib fracture there. Now, now we almost got there. What else can you notice surrounding? Exactly? Yeah, so I agree. It's a hemothorax. Just to highlight that, Um, it's a simple media simple, newer books. So, yeah, as you can probably see the lung markings going away along there at the very end of the field on you can see, always compare prisons the best. You've got a margin going all along there. And when he falls the code for marching along here, you can feel laziest acting along there. So what this person probably has is a simple Matic or X. Um, no. Um, you try to draw the abdomen, Arjun. It would be going from, or flea along there. And if you can, I hope that's protecting weather enough for you guys to make out, then increasing it on the phone or on the It's not something like that. But you got a lung markings going all the way to the margin off this thing here. That there. And then it suddenly drop. This is all along there, and that's yours. There. It's a simple name of your X, because there is no tension on by tension. What we mean is, there's no mediastinal. Indications 29 TV's if you saw a similar sort of picture, but they were shift. Wouldn't be wrong to call that attention, Imitrex or attention pneumothorax. Fine. Just right. So what is going on with this port chaplain? Um, so one on some expensive invention, The often is youthful, so you know that that's a reason you notice something patient. Yeah, so Yeah, 30 40 seconds. Yeah, that's perfectly right. So, um, it's much more obvious here. There's complete collapse off the right side. Exactly. Mention you can see sort of this damn say this is probably belong that sort of collapsed and just hold it on its article. If you imagine a balloon that up, it just, um there is no the sensor. Exactly. And that's what makes it. And you can't really appreciate that. You got the spinal spirits here being roughly the midline, and you got your away long. They're clean it all the way along there through the art itself, on that outside as well. And I am the fracture on the right side. Um, are you talking about that? Barely. It's may. So I have to circle dicks. I thought that was probably in. Yes. Yeah. No. So that's normal, right? Yeah. Um, just the thank you. And just every day, Um, I just like a point. Yeah, that is fine. I think everyone's on it is. And he sounds often called on that shouldn't have been taking because sentient something treat. And that might be something that may asking the exams are treat attention or X on. But just if it's this wondering that if not, it's because of the cannula just in there are you doing with that? I don't know if it's because you're expected to know that, but if not, that's something you could just look up because it is a laxative on. But I've done it once before in my life, and it is also one of the scariest thing you can ever do. You going up to someone just started living. The chest is yours, but yes, anyway, So that's what that looks like. It's a favorite exams. It's very good that you asked that about normal because usually the reason for it on day often have with the fractures, as far as I know, Have a long day. Fine. Okay, so what people think is going on here seems to be around the busy. Yes, it's nicely under, um, might be recorded repeating that is true. Or it might just be an enlarged heart. And it's pretty hard to say next, right? Um, but the main thing I wanted them people's attention is just is a classic heart failure. Um, now, with the heart failure, congestive heart failure, I should say, and the signs to look for number of different things of your blood, of your prostate here being along there or the patient being absolutely more than interest, I'm holding it and you've got up a load vibration of people say it's basically as your low looks congested the upper. Let's try to slap functions. It's the same thing. The thing you see on a chest X ray is that the escalator going to the upper leg is more prominent because of that. So that's what you see here. You can see that the upper lobe vasculature is more expected to be on. I. I have in my very amateur. It's way through have what's possibly hold back shattering. But this is a winter. Still, this is fluid that's like that into your lung on the patient's classically describe this with the sensation that they're drowning because anyway, they aren't wrong. They literally are leaking in today spaces for the heart just to mix fluid in this case, and see if this is your classic picture of it, part ailure and and it's again the favorite off examiners. Now I've destroyed to highlight here it's here. Now, this is something that everyone I've been about you, my exam is love. Asking me about is really, really being lines, basically fluid accumulated in the second basis, which are not normally visualized, but because it's through the day you can to come in many different forms. There's only a B C D, which is actually something that the old textbooks and these are really be line started the perforate of the lung field and extend Linnean. And they often form this kind of bladder or step like appearance. It is, actually, quite sometimes if you go back to the previous, um, if you zoom in, you might actually be able to see you might be able to see, you know, going along there, that that kind of as you can see, they they are very small. But if you do see it, it's a moment, um, demon second. So I didn't mean to sound really smart. And if you can't don't worry about that. It is in subtle time. Just make note of all the other features that will probably do it. And, um, no. Okay, so moving on to the next place that I think now, um, along the same lines got in a case here on of 30 40 seconds, see what you think and then try to go through it with you. So, um, in this case, it is another case with you now things that we're giving this away. Here is one quarter replacement cancer. Just in that it's a single eat pacemaker with, um, I would say card in it, but it's hard common because it's just so much. But I would say it is quite likely that this is our living there. Definitely. You've got a lot of interstitial lines there. You got some upper lobe diversion and probably more prominently seen on the left. But also present on the right. You began. Got this back thing parents off interstitial from, um, redeem a most prominently in the lower zones on the our presents here on now, this is just something on a good year on, but this is probably some detail. But if you can get this to you great early line space. We come in different formats cultural curly lines, which is what you guys can make up blue be lines because extent and every and go linearly along there because clearly a line which are these septal lines that words region and you've got your policy lines would sort of don't external right there again as long as you just say I can see a curly lines present which indicates and institutional inflammation of instances of fluid. Second Dema, That's it. That's the exciting time. I'm right. Moving on to the next case now. Um uh, yet so that should be fine. Really. Probably speed up a bit now on on. But I'm just going to fly through these. So here you've got very clear up in a mountain here. What is your plastic roll season? And they give you a seven years that we've got administration with Diffusion. This is sort of the white part of the area on you've got a little more superior that usually for refuge in. She can also better mediastinal shift. But it's still hard to see you because everything is like on this side and decide it might be better, if ever it on. If you have a white out of love, you receive more prominent and fine. And now, in this case, there is two things that I want people to give you guys 15 seconds and on then that. So So This is a case of surgical Emphysema is very You have exactly what well supported. What did you guys actually got? It all started. Yet? You've got AARP wrapped in tissues. It's quite problems when you see it looks quite scary. And the reason for that is you can see this. It's going across there. It's probably equals. It may have had a new door exit 0.3 on down in the process of inspecting the test range course, Um, treat into the good issue on that sort of the picture. Sort of fits. So that's just something I want. You guys notice that there's another drain going along there as well that I didn't like this even be aware of fine on. So that's that chest rain. It's better that in mind. They come in different forms, but you got your and, um, usually associate. In fact, I suspect that's probably the easiest on the right hand. Um, fine. Okay. So what do people make off this? Very good. Give it another 15 20 seconds. Densely. Essentially. Yes, yes, yes. So there's bilateral careful, widespread, disseminated, bang glass shattering. Now, I don't know if you guys a lot in the current context. What does that make you think? Yes, exactly. So this is sort of your picture of moderate, severe covered. This patient is intraday tid. You can see an endotracheal tube and they're buried mind endotracheal tube of mental And And if they could be on that one line, you can see the bottom edge of the end. It's acute to you on here. Just bear with me. Let me just You can see the bottom in off. No. So that's the trick. You'll be going along there and you can just about that. He's also got a leanest line there, right? Which is located into the probably going a bit in the right atrium. Usually want it higher than that. Leave for multiple reasons. Leaves along everywhere. And you've got three patient, probably like two. You probably not doing very well on basis. Spect They might throw this in the exam since one still in the midst of thing. And then, um and you also, um, got an mg pissed along there on actually seeing area aspect of the two on just because the films probably not aimed at looking at 90 all the way, and you have. So those are most of the prominent since I've been here. So yeah, you might be I don't know if you guys could be wrong, but even if you are a something multiple sheets and lines in there yesterday for them. Systematically. Remember your basic anatomy. This is roughly where the this this's roughly with the right treatment. Anything. Remember the carina? That's an important landmarks. Got a tube going, Austin. That's most likely an MG tube that should go to below. It got to terminating just above that, That could be tracked. The ostomy. Or it could be a tricky a tube on Onda. Yes. Yeah. So that's the main points I want. And how are we doing the time thinking maybe another 5. 10 minutes. Max on. Okay, that's fine. Um Yep. Label them. Um, do you guys still want to? Because I think I ordered mention maybe it would break between the two year old. You guys just I don't mind if we don't carry on. I think. Yeah. Uh, ready Is general feeling going on? I think I'm happy to carry on. And then if you have a bit more time pregnant, if you have a bit more time, we can. They're just more cases. There's no shortage of places to go through, and Okay, fine. So similar to, um, and just a trace. I've sort of always used this sort of happen And after XT a simple person. And I remember this simple with Onda. So within the context of a nap, a phone, if the air is outside of about, that's usually very, very bad. It also makes it a story and and raise this one from what I think it would take. Maybe I will be done with a pretreat in the next 10 minutes or so. Maybe 15 minutes. It's a stretch. And then I spoke. I'm not sure if you could if you could maybe wrap this up in five minutes because mine's going to be probably 40 minutes, and then we can try and finish on time at 7. 30. Okay, that's what. Yeah, let's see this. Nice to don't. I'm fine. So roughly around 7. 30 under is the I'm sorry, I'm going to say eight. Sure. Okay. Yes, right. I'm so yes, Going to have you got your air after that bad? Well, that's part of our get rid. That's neato. Dances and complications have not gone through into much detail here, but we can talk about people want off the shirt in organs and external artifacts which are obvious that every day life, let's see right, this is a highlights, that big box. This is where you probably see the large bowel a long day. You can also see some little small bottle along that cecum, and on the right hand side on, you've got your rectum and sigmoid with sending her along on the Spanish, you can often see the usually about gassy in the usually August seem centrally tends to be small about not always that roughly. That's the outline of really expected. I would see more in cases at soft tissues. No guns is a sort of think you can see, um, often not very probably, unless there's something wrong going on, but leave it in severely but transfers along with the Spanish fraction. That'll be really important. And your kidneys, you could be bladder insulin, term really highlighted, have a concept, and fortunately the rest muscle. So it is a so s abscess or something like that might be, I think, some genes going to drop. What factors? There are strictly severe factors. You concede well, something better in mind. That's just a That's just a rough every of the B. C. What I mean and these lights are available now that the most important thing is looking for on differentiating very it's located. So you got you interested couple, which is on the right ear, Right? Superior left? Yeah. On. So the the light of looking the way you look, you got a very common, um taste, which basically 10 months of the go away along the you just find on. Then you've got your house stroke, which are in complete, and that won't go all the way across. That's usually have you distinguished. These are all. Basically, this is probably one of the most important. Think we will learn here is that usually you're only meant to see one side off out if you can see two sides of the vial on bed of If you can see our own bed, sides have a double one side. And that means that there is free gas surrounding because you've got a cast from the inside as from the outside, that means you see, put cytology at single most important thing. You take a bit of heat has ever been a perforation or potentially this person had recent surgery. But if you're not giving the context for it. Always mention it. I mean on lettuce. But yes, and the other thing is a 36 months, and it's all one that's basically a recent weeks, roughly what it's that's more about exactly the most, like, well, seeking being. One exception it's allowed to be like looking for use in case is I'm just going to be. It's for these on this kind of not only here in So it's trending away from the rectum is your classic appearance on So, um, people loading on D on this'll be small boat. If you can differentiate, it's dilated them by permanently. It's going away through on began, just another example of small bowel. This is a large out. It's much larger. You got incomplete on going on with groups, and that's gives a very large Well, this is another case of life for obstructions. Vacates the toxic megacolon more kids of ways typing on the left hand side, which is where you got to be lost faster for an argument with a medical emergency, Um has mentioned waste awards mentioning this is worsening of the football time. You got a Reformation big, small bowel obstruction on Also, you can see clearly the double world sign as well. The's are probably going to have to go back to on Look at a lawn slide on are highlighted that Well, if you can use your imagination looks like this. Your classic off being sign I want to be to do with it more over this. Um, and it will be pointing if it's hunting based. Appear to be pointing from the purpose on anything other than the right side of the abdomen. It would be nice on get No, I think that is probably what I'm going to give it to stop on because probably locked in a very short of time. On Sorry. Last, because a bit. But everything is basically on the slides, and you will be getting this lives. Tried my first kind of and so, yeah, I think I will stop there. That's a favorite. You guys. Yeah. Okay, guys, we'll get started, if that's okay. Um, whoever is still on the brake, don't worry. Just come and join us one of your back. So I'm gonna be talking about muscular, skeletal playing thumbs. Um, it's quite underrepresented. Tropic. In medical school, I feel that when the police were now, what was my experience when I was doing it? Uh, there's obviously a lot of teaching on chest radiographs, but less so in Abdo and even less I feel on on muscular, skeletal side of things. So it's quite broad topic. There's lots of different parts of the body that we can image. So the point of this talk isn't really to go through every single hard the body and how different types fractures Naylor cry, etcetera. It's more to give you guys sort of a structure so that when you if you do come across it on the osteo bi, it's not something completely alien to you on. It's not going to be something like a chest X ray. I don't think we're in entire stations. Just could be based on this. It probably is going to get add on to maybe, like a muscular special examination or not on to something else. But, uh, if you just have the structure that we're going to go through you, I think it will make a big difference on, um when you presented. Okay, So sorry. Excuse me. Working. Fantastic. So the outline we're going to do for this talk is first of all, goes to the systematic approach I just mentioned. We're going to go a little bit about describing fractures because I think that's what the key is going to be here. So the two main pathologies realistic. They're gonna come across in the 30 or ski or even in your finals actually is either fracture or dislocation. And I've got around seven cases, which I'm hoping we can This with through and hopefully up as much participations you guys can get on. Uh, yeah, well, hopefully finish by one time at 8 30. So here's the approach that I I tend to use. People have different approaches, but whatever you've been taught, as long as that kind of covers roughly what's covered on the slide, I think it's absolutely fine, which have approach ma'lik take. So just remember, and you ask you this all the tick box process, so the diagnosis is going to only be one small percentage, and you can pass without getting the diagnosis. So that's why it's really important not to neglect the simple stuff like demographic details and checking adequacy, because of the end of the day If you see an X ray and you don't know what the abnormality is, don't panic. Go through your systems. Seems like you've presented before seem confident even inside. You don't feel like it on then you at the end, you say? Okay, I haven't found that dramatic, But look, I have got system and I know have to take a plain film and that's what the most important thing the example. Okay, so it's specifically for So let me just but this specifically four musculoskeletal pain from so the first thing to do as fancy. It also said, same thing for a chest X ray. The same thing for any X ray that you make sure you present the demographic details. So you have to say this is a blocked radiograph or block X ray off Mr X, Y and Z 76 year old man, and combined up with that Is it adequate? Was inadequate. Now there's lots of rules. The chest X ray with musculoskeletal plain films. It's a little bit more tricky. Uh, I don't think they're going to penalize you as much, and I don't think they're going to give you inadequate X ray, but I think simple things like make sure the entire bet that you want to look at his desk. You're not having fun for humorous Cropped up, for example, if that's what you're looking up. Uh, but I wouldn't stress too much, but I would just kind of keep it simple and safe. It looks all right. Um, technically adequate, as opposed to chest radiograph. I think you do have to have a bit more for systematic approach is that which fancy, but And with Mskube films, describing the radiograph is really important. So or chest X rays. I need a pa or a very simple Where is, uh, in Mskube? Have to have sort of some idea where you're looking at the, um, the body part. So, for example, you may say this is a lateral view off the tibia on a p view of the humerus, and it's really important to have that little afraid to show that you know how to look at the scale. Okay. And then just like chest radiograph sixties fracture jumping out at you, go straight for that and start describing it, and that will go through that in the next light. But if for whatever reason, you don't see an extraneous thinking. Oh, God, What do I do? Don't worry. Just stop and say Okay, I can't see anything immediately. Abnormal. I'm now going to adopt my systematic approach, and that's the phrase that I use. And I'll have some What I've heard from you guys presented, you got equally valid faces. It just slows you down and shows the example that you are going to be phased by something which you haven't seen before. You have not quite create, like the answer is so the first thing you're doing your systematic approach is you make sure whatever bone is presented you carefully in your mind or even with a pencil going trace the cortical outline. What you want to make sure that there's no steps in the cortex or any obvious breaks or any several breaks as you're going through all the way around about Okay. And then hopefully. Then once he started the fracture. You describe it, and that's the big I'll go through separately. Uh, it's this eight would, regardless of that does a fracture. Not the next thing to do is Then you assess the joints. Uh, mainly, I think in the Oscar for dislocation. You do look at other things, for example, things like joint space narrowing. But I think you'll be very mean for them to start giving you things like rheumatoid. I wouldn't worry too much. And then I send it to the chest X ray. You look at the soft tissue. So remember the chest X ray last bones, this off tissue bones you obviously have already been looking at. So remember the soft tissue gets off the bones and soft tissue and then wrapping up. So what? I mean by wrapping up. So that's sort of a slick ways. You to, um, kind of have a conclusion at the end of kind of move the moved on from the presentation because one of the things that really makes the standard of the Candida in the Austin is presenting it. But then, if you stop afterwards, they'll kind of the Examiner will have them have to prompt you, which is absolutely fine, but really good way of sort of really standing out and making sure you get those boxes and really quickly. It's just to kind of continue and just say right in conclusion, does this and then a management. But what I tended to do was have, ah, sort of one sentence conclusion to have a description of the fracture itself. But then you say in conclusion, there is a history of fracture on your kind of go into almost kind of robotic. Most if they won't probably show you hopefully to views. But they have shown you just one view after the fourth organ of you. And what I mean both organized is they're giving an AP Austral axle. They've given you a lateral aspirin a day. Okay, Uh, sometimes it's appropriate asked. It's a joint problem joint below. On. We've got one case where that's appropriate on, then go three of management plan. So with fracture manage when I have this mantra torturously the orthopedic surgeons when I was a beauty optimized, reduced hold rehabilitate. I'm not sure if you're going to come across that, but it's a really simple way of just saying this is how advantage of fracture optimize means things like resuscitate patient. If they're unstable, they got open fractures except cetera. Reduced means getting the fraction of back into its normal alignment code. The things like a cluster of Paris. Well, operative procedures like nails and plates and screws and that kind of stuff and then rehabilitate, which is sort of an MD T inputs where you get the patient on their feet or whatever part of the bone that fractured get them their function back. Uh, the other thing that I didn't write on here, it's it's really important for you both your written exams and the osteo sister Emma. Remember, If there is a fracture, make sure you always mention a you'll assess your of us very important. Okay, so I'm sure you guys have a pneumonic fatigue by now. I've got another new monitor, I'm afraid, but the know memorize it in the morning isn't as important. If you are confident once you've brought this in a head that you have a pattern. But you go ahead with Okay, so they're demonic Island was paid the pattern anatomy, interest, last extraarticular deformity or soft tissue. Uh, and so what? I what I mean by that? So if you see a fracture, describe the pattern. What is a look? And I'll put in some phrases and that that you might find youthful when describing, uh, so first thing I say is that completely and it is a good all the way through the bone or just not with, uh, community. Uh, does anyone know what community it is? Yes, Miles, the oxygen before us research produced restrict. We have this even better. That's even better. Good, Absolutely so lots of it's multi part. That's absolutely right. So if you see multiple fragments and you use about community I, then with simple fractures, there are different orientations that you may, um, look into apologies for my spelling mistake that that's meant to say, Transfer us. This transfers the bleak spiral and complex, and I'll show you some pictures that before we go through the cases of what they look like, not to me. So very simply, Which part of the vote for, say, Well, which phone first of all is it? The tibia fracture is the humerus. Is it the ah superior pubic Ramus? I say which part? Especially with long bones. This is where I'm having. The idea of thirds comes in handy. So is that the proximal third? This is the middle third. Is that the distal third? I'm just a simple description like that will make it seem very accurate that you know where you see the. The third thing is whether it's interest or extra articular on. What I mean by that is this. The fracture in extent involved the articular surface of the adjacent joint because I've just changed management and the fourth one is very important of deformity. There's lots of different kind of components that come into this, and I'll go through some of the pictures to describe them as well. On finally asked the soft tissue. So that's gone and again with the, uh, be check with before as well. So just bear with me guys. Yeah, lovely. So yeah, and finish off describing the soft tissue so commonly the soft tissue abnormalities. You'll see your things like soft tissue swelling. Very simple thing. But even it's saying it will show that you've got a very systematic approach. It's probably your fractures. Don't always see it, but it's usually if you have seen it on of joint effusions. This is a really important thing to keep in mind, particularly in the knee on the elbow. If you guys can know what a knee and elbow joint effusion is, looks like it's very in terms of describing fractures. I'm just kind of quickly go through some of them. So this is what transfer structure is. Looks like green just across the horizontally or ent action. This one's a linear fracture. That's the sort of perpendicular to be transferred structure. Oblique. Ignore this one and then the spiral, so that's kind of like a staircase going up there very useful. If you do see, it usually happens the long bones. And this is what a Communist it once, just like you described before multiple fragments. And then these are the deformity says you still have some of these phrases as well, so the most common one is displacement. So that's when you have the bone completely moving angulations where? So if you have one bit actually the pivot and the rest of the bone kind of angulated, if you can kind of get on your head, shortening where basically, as you can see the overlap of bone and you have the overall length of the bone shortening, I'm the most difficult one, I think to describe it. I wouldn't worry too much about this one, but rotation. We're basically the orientation off the cortex remains roughly enough in alignment. But theatrical shaft rotates on that access. That kind of makes sense. But, um, the whole point of kind of going through one of this is they don't want a beautiful 1000 word description. They just want you to make sure that you go through each of these steps to make sure you're assessing your process deformity process. A partner of fracture, the process location of bone and having some kind of attempted describing Okay, is all right, guys, Any other questions at this stage, I think we have to go onto the cases. Yes, we are. Just give a minute. If anyone wants to type anything in the chart. Good. Okay. I don't think there's any questions. Is that, um see? No, there's no questions, that's all. Brilliant. Thank you guys. Great predictor. Can I get someone to volunteer for this first extra piece? I know it's daunting guys doing it in front of your, uh, your classmates and all that, but, uh, if you guys can do a all right presentation here, you know, if it's completely wrong, if you get over that fear here, the Oscar will be a breeze. Honestly, because they're giving up your two hours if the evening to do this. So, um, I think you'll be really helpful if the least some of that you guys presented. That's right. You have any takers? Okay. For brilliant. Really? I leave. Fantastic. You have help you to get cracking. Yeah. So I'm currently looking at I'm assuming it's the right arm. Um, off this patient on there's adequate exposure. And I've gotten a a pa and lateral view, um, on looking at the bones. So looking at the couple bones, they look all intact on what conceited off the metacarpals they look intact, e then looking at the radius in the older eso the owner, it looks intact, and I can't see any visible deformity. But looking at the radius, there is a deformity. The proximal most sorry, the distant third off the radius. And it looks like his extra articular. Um, it looks community community. Um, I think this moley displacement. Um I believe this might be a cold fracture on there's visible swelling of the soft tissue surrounding the joint. Good. So in conclusion, in conclusion, I believe that this is a whole structure. It needs manipulation under anesthesia on putting in a blow elbow back slog, Um, on. Then re X ratings. Make sure that is incorrect position followed by physiotherapy. And if it if it fails to unite, we need to do a possible or perfect, very, very good answer. And I think that would have definitely got your past in the skin, so Well, definitely. So this is absolutely right. This is a colleague fracture on. I think what really stood out early was the fact that it was clear that you used systematic approach. So just out of interest. And he Did you spot the fracture immediately or Yeah, I did. And then I tried to do it. That's fine. I really like how you did it. If you do about the fracture straight and if you're confident, just go for it and say there is a start describing if you find the osteo like you're not sure about the fracture, you wanna have it. I don't think about it. Your approach was absolutely fine. It's not just to buy yourself some thinking time, because the way you did it came across up completely fine. So I'm happy with either. So the only thing I would change is, um so maybe describe the pattern of the fracture. First of four. So it's a It's a transfer structure. So I don't know if I can convince its factions orientated this way. Yeah, on. Um, just be careful about your door. Solve. This is older. So dorsum of the hand is which is my hand up like that, Comparing the stuff off the district last I don't actually have my camera on, do I? I do apologize, But anyway, we're not getting The idea is fantastic for you, that's what. So this is the This is the dorsum of the hand, and this is the palm of the hand of the boat aspects actually does Does a lot angulations and dose of this does not make sense. Everyone. I mean on that. Okay, so but the rest of the presentation was fantastic. Brilliant. And I got a second take of this one. You guys can have a look and then decide. Uh, I'm happy to do it. No one else is that These are Alex. Yeah. Brilliant. Yes. Please go ahead. Uh, okay. So this is a lateral view off the lower leg on, you can see the ankle joint Onda the foot on the this off tibia and fibula visualized in this and the penetration is good and moving down through the boat, I think I can see a tibial fracture in the mid shaft region. Onda the fracture looks slightly oblique. So I want to say it's maybe a spiral fracture. Um, moving further down to the ankle joint. Can't say for certain, but I think the ankle joint looks like is intact. Um and that's that's it. So in terms off, summing up, I'd say this is a midshaft tibial fracture, and you'd want to reduce it and hold it with a bologna back slap. Good. Fantastic. And, uh, is there any anything else you want to do? Radio Logically. I would want a alternative use of the AP. So make sure you remember to say that because I think if this does come up in your skin, But I think it is very potentially a but very, very good presentation. Alex. Yeah, you absolutely right. So I think in terms of other things you could have mentioned s o uh remember to describe the deformity to say in this case. Probably the reason why you didn't mention is because there isn't much deformity. But just remember to just may just mention the, um if it's the two of you like this off taking Oh, yeah, well, they were going through soft tissue as well, but what I meant is in terms of the deformity off the bone off the fracture, the the way I would describe this is there's a distal tibia fracture, which is minimally Yes, sir. That phrase minimally displaces quite handy because you kind of just It's in a lot that things together in the same tells yourself or tell the Examiner, right? Actually assess the deformity. There isn't much. Okay, Uh, the other thing, I would say so, Yeah. Soft tissue. It's not such a big deal here, I would say, but you could. You could say there's no significant sufficient swelling, I would say, because if you notice the other skin is like, not too swollen here on, I think you are absolutely right in saying the ankle joint is well maintained. That's why I want another view. Wanted him? It's the ankles, any because that's where usually the, uh, instability of any uncle dislocations better seen. Yeah, it's good that you mentioned that. And the other thing I would mention is whether it's interesting. Extra thinking about, to be honest, because you mentioned is meant if you it's assumed that it's this. But it's good thing just with you. If it's on there, it's no, it's extra. It's just such an easy win. And it's those kind of little things that if they have to put it in the exam, we know exactly sure what they have. The tickets is safer to just mention everything then to and does that make sense, guys? Good. Fantastic. So I'm very impressed with the standard of presentation. Super. We're gonna make it a little bit thick. You. Now, uh, I say that that means that no one's gonna volunteers and way just have ah, a couple questions. Oh, sure. Okay. Yeah. So my shopping them out for me? Yeah. Maybe after what happened. Fracture is a complete of legal spiral, so yes. So apology. So electric activity. Right? This is a spiral. So this is why I asking for an AP is really helpful because we'll confirm it. But if you can kind of follow my hair. Oh, it's got that. Yeah. Stay away from North Ology. You can convince yourself it's on a bleak would kind of just looked just about the fact that it's going like that under now it's going up is more in keeping with this. Does that make sense? Yes. Thank you. Great. Thank you very much. The second question is would you need other view to be sure on the displacement, etcetera? Yes. Yes, you would. You would. Absolutely. Which is why in your osteo when they if they're giving you one of you, you can only comment on that one view. But that's why it's really important when you're concluding. Indiana say, Okay, this is the fracture that I've seen. But I would like an AP view to assess that. Yeah, but you can only describe what you see is the one get penalized that there is massive natural with sweets and on the AP, which you're not seeing here based on this a lot on this natural, you can only say that many of these this place. Yep. Good. Should we move on? If there's no more questions? Uh, can I get a lot of tips for this? one is love. Just gonna keep a time. Anyone, Please. I'll have to go if you want. Lovely. Who's that is Sarah? They're fantastic. Okay, so, uh, I'm looking at an AP view off the right ankle in an unknown patient taking it on under in time. Um, I can see the exposures. No, great. But it has Guess is adequate. On the most obvious deformity I can see is a fibula fracture. The syndesmosis or thereabouts. Ah, the tibia looks intact, and it doesn't I can't see any tailors shift. I don't think that there might be a little bit, Um, so this patient would probably need the fracture reduced on, but in a bologna back slab. If it's at the centers Moses on, then review in about four weeks and then physio and all the rest of it lasted Probably. No, that's perfect. Perfect. Well done. So, uh, that was a really nice presentation. So you're absolutely right. It's a distal fibula. Factual. So I don't know if you mentioned so did you mention way? But I don't miss stops. No, I just said it's out. This in. There was no cyst. Be right. Yes, that's right. So this is we're away because occasionally come in handy. But even of the osteo. If you don't remember it, you're not gonna get penalized. But it's like this. Help you some of the radiograph. Ah, bit most exactly. But it's it's really not gonna come up with marks. Give anything like that. We are Absolutely. So that's the way I describe this is there is a pistol, a fibula fracture, which extensive level of the of the centers basis. It is minimally displaced extraarticular on. Um, I know you mentioned the thing about the tater ship. I would say there's no, uh, evidence sophistication. So the rule is this medial clear space here. The big have my hair at the moment should be lasting for four millimeters. So just in print this in your head. This this is what is normal is in the Oscar. They're not going to be cruel and give you something supple. If there's tater shift, it will be like, really, really obvious teach. Okay, so I think that's the general rule with your third. You're asking Do not worry about the if you have the start of with Allah. Geez, I think this what I've given you here is probably are subtle as it's going to get. Okay, Good on everything cerebral. I really liked and just didn't forgot to pick it up for the previous cases. It's a really small one, but I know it's artificial that I haven't put the name or anything, but in the examine, even if they don't know the name, make sure the beginning. You say this is a, uh, well about radio, often unknown patient taking on unknown time or something to that. So this is just to make sure that they have ticked off that you've checked them a graphic details or lack there off? Yeah, because that will be a real, real easy. Take books and make sure you include that with any X ray. Okay. Uh, so we just have another question. Um, it's masses asking How do we work out the more teeth from an AP view and something like this? What? What do you mean by that? Just meet yourself. If you don't mind. If you're able to just ignore the background music, but it looks I don't know. For me, it looks quite similar. Is there like some sort of way to work out whether this is because I know they do the angle of the foot in, like, dorsiflexion and all of that. How do you work out, which is which all like they are. You trying asking? How do you work out with mortars, You know? Yeah. House. My coat is a pa or more tests are fine. Okay. I really wouldn't stress about that. They will if they're going to give you a one of the osteo bi. It's gonna be a medium manufacture for a lateral malleolus fracture. And we we Well, many overwhelming be a a TV mortis do is basically where you'll see this this paler go nicely in profile. Definitely. At this stage, don't stress yourself up about, uh, differentiating between the two, because I would just keep it simple and to say because even mortars do is it's all right. Brilliant. Thank you. No worries. All right, guys. So, uh, who wants to do the next one? I'll put it up first so you guys can have a look. So but more complex. So this is where I want to ever. It's presenting this to really slow down and use that, uh, checklists that I used before. I mentioned before because I think it would come in handy for this. Quite complex. Okay, please don't worry about getting it. Because I think this is probably one of the hardest ones on here In terms of you can do this one. You're doing really well. Um, recent husband go. Is that mass ago? Yes, Yes, please. Mass if you don't mind. Okay. It looks like we've got a lateral X ray off the forum of another medication on dumb unknown arm. Um, in terms off the adequacy since fine. Can see everything. Conceive both for a little bit of the distal radio owner joint on the elbow joints. The most prominent things I can see on the is a fracture of the throat. Small. Great. Just trying to work out. Which is it? Oh, yeah. Yeah, it's tricky. Uh, the proximal owner. Yeah. It seems to be a completely displaced with also angulations off the, um, proximal half on the distal half doesn't seem to be angulated as much. And I though it's right. There was It seems to be a dislocation of the radio heads in the door. So no is dislocated, and it's the way on. So other than that, there seems to be a tissue swelling on nothing else to note the bone itself within the cortex and the medulla looks, it looks to be a good quality bone. Doesn't seem like there's any underlying pathology there. Um, I would say that this is is to Radiohead. Fracture. Lend. It's either one ta, uh, factor, Um, on this patient would need or if on dumb splinting in the rest of it and cast. But did you have anything else touch? I don't like to see a, um a p view. Um, Andi, I'd also like to see, um, a TV off the forearm and the elbow joint on D if I couldn't be cheek it Want to see the short of doing it because it looks like it's high trauma. Okay. Yeah, by very good. Fantastic presentation. I'm very impressed that so I have very little data. That s I think one of the main things that was difficult was working out with It's the radius on that. Would you say a mask? Yeah. I had to double check, you know, don't worry. So I also use to struggle with this so the way you need to remember it is like the with the bone near the elbow. A look at the with the bone, the other breast. If it's bigger at the elbow, it's the ulnar. It is big and the wrist is the radius that can you guys see that? So how wide this bone is here for the elbow? Because small, this one is this big one is the all night and this morning the radius. And then it goes the other way around when the close to get dressed and they all know gets smaller on the radio. Does that make sense? Okay, so you're absolutely right. There's lots of elements of this, so I think you hit pretty much more like fit and you've got the demographic details, which is really important. You mentioned that the lateral one on one subtle thing which um, you said which is really important is that you said unknown arm, I think which is really important, because when it comes to describing these fractures, you can say everything like humorous except for etcetera. But it's really important to mention the laterality as well. So if it's mentioned like, for example, on this one. There's a nice are on here. That's your crew. To say, like That's a simple thing is saying this is ah, AP radiograph of the right ankle is ready for someone. Don't I'm not eso. This is a transfer structure. I would say off the proximal on that with significant displacement. Assess it with radio hyper stick, which is exactly what he said. So this is why it's really important. The beginning. That check wrist? Uh, not it is important to know your describing fractures. Remember, there's also other pathology. Is that that's why I said things like that. Make sure once you've described the fracture, make sure you always assess the joints on. Always assess it makes. That's the thing that when you're going through your revision and maybe if you are using the slides of which have a resource of using, make sure that I'm printing your okay. Great goes through this one myself because the little bit difficulty running a slightly short on time. So this is a, um, lateral view off the humerus. On the most obvious abnormality is a transplant structure off the mid funeral shot with some anterior to space. Enough. Uh, there is a nose, little bit of surrounding soft tissue swelling. But the most important thing is to look at the background of what the bone looks like. So if you compare how this bone except which is nice and normal, you compare here. So this is what we kind of describes a permitted period. So the background bonus abnormal and has a permit of the periods. And this raises suspicion of a pathological pathological fractures Where your refraction, Well, it's breaking because the underlying bonus disease rather than because the trauma itself Okay, so it would be really means to them to give this to, you know, osteo, I think I just said you guys are where you're sort of when you got stopped working. It's at once, which won't be very long from now. Um, just that this entity. Yeah. Great. Have one quick question on the elbow. Yeah, on the elbow. Fracture the elbow. Yeah. Yes. Um, it's just asking if the electric electric on this drug pregnant it to that. Ah, yeah. So this is a really important point. So juicy that election on yet there is a line going through there. But you see, there's also minds going through here in the distal humerus. Yeah, Through the radius. Yes. Through the distal radius is Well, look in anyone. Explain what those lines and they represent, child. Yeah, exactly. It's a pediatric, your x ray. So don't get thrown off. Which is why I included image. Don't get thrown off by a pediatric princess again. They shouldn't give me a pediatric one. But just in case they do remember, there's multiple lines going through ends of the boat. I think this is a child. Ignore that. They will give you an obvious fracture. Okay. And have you got any other questions? Okay, So these ones I don't want anyone to present and I've been the chopped box. What they think this is on Alex. So however, if you don't mind, I think what people are saying in general, like she could get it up here, get fantastic. Fantastic. So leaves the shoulders vacation more specifically, anterior dislocation, which is the more comment off too. So it would be mean for them to give you a pasta. Just think it's because they are hard spot. But as long as you're imprinted this, um, it's that this is the bladder of the green noise joint will do where the glenohumeral joint should be. You should What? You should not have the humerus nicely up against this note here. That's all the way down. Yeah. Fantastic. And, uh, the other one I wanted to put in Waas. Sorry. Nope. That's very slow. That with me, guys, we'll be done very soon. So I think I only have two more cases up to this. And it will be okay soon as my laptop starts working. Yeah, I love me. Okay. There's no fracture here. Obvious fracture, anyway. But tell me what? The abnormality when this one is another one that's worthwhile. So specifically, it goes back to what I was saying about looking to soft tissues. There was two things I mentioned. One was making a soft tissue swelling. There was another entity, which is what? This is any answers yet. So we have Ah, fat pad or sales on. Okay, Okay, So sale sign is interesting. It is roughly the same entity, but the sale sign only happens in the elbow. So you don't call it the feel signed here, which is the knee, right? That's that's the same thing. Uh, get the check box up here. We've had we've had the talent dislocation as well as a suggestion. Okay, so patella just icky a shins, usually on the A piece, because on the lateral, we can move side to side and you won't be able to tell us clearly. Also is probably getting there is. Well, it's like, how early did you guys are getting that there is kind of something to do with that and blood, So this is likely most races. Okay, so what you're seeing here is you see kind of the layer off fluid density kind of right up here where this is where you get joint effusions and me. See, what you do is you look at the patella, you look above the patella, and that's where joint effusions tent accumulates in the in the knee. So this is what we call a super patella effusion. If it was just destroyed, insisting, Now what you're seeing on top is this layer and then they were fact entity about that. That makes it a like a monstrous. It's a stock density and with fluid density, and that's specific for, like, chemo through. This is That's usually an indicator of some minimally displaced fracture, which you may not pick up on a next day. I'm usually these patients go on to have a CT. Okay, good. Okay, I'm going to wrap up bit quicker now, if that's right, you cooking any questions you have Ah, and I'll go through them as we go through. Okay. Hip X rays. I'm sorry, which hip X rays is very sort of the unique thing, and I think probably the most likely thing they're going to ask you in the hospital that does come up under the main thing is actually along with your usual system of tracing outlines. Is being aware of this idea called shunting. So tracing this medial cortex of the proximal fever and making sure that it's in continuity where my mouse is with the superior pubic Ramus like this, I hear what we can see. Sometimes there might be discontinuity that this continuity may make You are kind of suspicious for a hip fracture. The other concept is I'm sure you've seen this diagram when you're revising, feel writtens and stuff is this concept of intravesical and he just the knee thing that you need to be aware of it. Terms of the pathology blood flow in the proximal fever goes from the distal aspect or lower down to the approximate, you know, cough the intracapsular. When you fracture the FEMA, you are more likely to lose the block of like with this femoral head. And that's why it changes management. Where is more distant? E. You kind of have other blood vessels that can keep the blood blood supply. Okay, so I have two cases. Yeah. Would anyone like to present this? Okay, just two more guys. I promise we'll be. We'll be done. You've been very patient. I want to get as many people involved. It's possible. See you guys. So we'll go away. Think you've got something out of this session as well, so I'll give it a go. Really? Is that are in? Um, So So So this is an A p X ray off the pelvis off a known patient. Um, and then looking at D, I assume it's adequate X ray. So the main concerned I see right now is off a left intracapsular neck. A few a fracture? Um, it's it was his transfer. Or, um, it's not displaced. Um, we're not seeing any of the deformities anywhere else. Yeah, that's a martial arts. Is that remember? Go through your pneumonic pay. So you have you describe the button you trust? Absolutely anatomy. So you said interrupted or femoral neck. And you said left this well, which is really good, because there are two femurs. It's really intra extraarticular. Probably not as relevant here. I agree. Deformity. That's the main one. Okay, so is that like, what is this place exactly? Yes. Ah. So it doesn't seem to be what? The fracture itself doesn't seem to be this place. I don't think. Yeah, so there's probably this calling minimal displacement. That's the phrase I would use because it's not completely enjoying. So you see how completely on this place fracture? You'll have a line going through it. But you see this nice shape being maintained. Yeah, they lost that shape. There is a bit of movement. There is a bit of displaced from going, So they say minimally. Okay. Coming in Terms of man has been radiologically. What would you like? Eso Depending on the patient, I would either do a total hip replacement or a hemiarthroplasty so depending of the independent or no independent and so in the every day. Lovely. Yes, that's that's right. That's how you manage the fracture. And before that radiologically I would you What would you do? Anything else? So I would let it have a lateral x ray. Very good. Very good. So, yeah, that's right. So all most intracapsular fractures, as you correctly said, depending on their life expectancy in their fitness, would be considered either for a t h r or Uh huh. So that's fantastic. So I think that's, um Don't think you missed anything else up, so it's very good. Thank you are in on this last case. What I'll do is if people can shout out what they think is going on for this one or tackle check. Mark, you prefer, right? Yes, Very good. So, yes, it is a right extracapsular MCA femur fracture and other absolutely truck and Terek fracture. Very good. So this is an intertrochanteric fracture. So the trick, Countess, this is the lesser trochanter. And this is the greater TROCHANTER on If there's a fracture going through, like here, as which is exactly what's happening on the right. You call it an intertrochanteric fracture, which is an extra copy you kind of, if you can put both those traces in. That's really, really good shows the examining. You know exactly how to describe it on the reason why that these two cases is these are the two that you're realistically going to get. You're going to get an intracapsular like the previous days, which are in presented or extracapsular into trick control. What is the only other thing I've described for this one is I would also say this is minimally displaced or slightly displaced, and you see that there's multiple positives. That's the proximal femur, the distal femur and then this foot, which is the lesser, you could say, a multi multi part fracture, intertrochanteric fracture with some displacement or shortening? Uh, probably the phrase I'm using this one. So that's my last case guy. So basically, take her messages of these pain from ones with the escape. Rainstorms Rather do not panic. People really simple have the systems that I went through the beginning at your disposal. Don't forget to include really simple stuff. I know it's going to sound really annoying doing it again and again. That's what she was the ostium. Therefore, it's just have to make sure you like a driving test go through everything in your take box like a robot on at the end. Once you've covered everything, even if you get the answer completely wrong, as long as you've gone through the system, you should be getting up to the point where your where your fasting and the rest of it's sort of just going through the common fractures that you might encounter and maybe practicing with your friends or family, even get them to put up a thing for you. And you just practice in front of a mirror to them and just get into the habit of sort of going through that system so that, you know, um, having to sort of look into a book or look a checklist, it should all be going through very smoothly and your head by the end. Okay, if I will, uh, great. So that's my last case. Uh, do you have any more questions? I was thinking I was very sorry. It's over a little bit, guys, but I hope that was worth your time. That that's okay. So we've just put the feedback from the chats. If you guys could, feelings would be really helpful for us. Definitely got same, and Vance would be very, really grateful that you could feel it and even if it's