Part 2 book “Primary FRCA: OSCEs in anaesthesia” has contents: Cardiovascular examination, respiratory examination, collapsed obstetric patient, malignant hyperthermia, airway examination, failed intubation, rapid sequence induction, invasive blood pressure, noninvasive blood pressure, and other contents. | Section 6 Radiology Chapter 1. Chest X-ray 6 Candidate’s instructions Please look at this X-ray of a 34-year-old intravenous drug user who has presented with acute shortness of breath and a history of nonproductive cough, fever and rigors. Questions 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Please interpret this X-ray Is active infection likely? Is there any evidence of left lower lobe collapse? Which abnormality needs immediate management? Can this occur during anaesthesia? Is there any evidence of surgical emphysema? What single intervention is required before intubation and ventilation? Is nitrous oxide safe to use in this patient? Why? Why might the patient experience cardiovascular collapse? Give three causes of pneumothorax. 135 Section 6: Radiology – Chest X-ray 136 Answers 1. This is a mobile AP (anteroposterior) X-ray of the chest. The most obvious abnormalities are a large right-sided pneumothorax with mediastinal and tracheal deviation to the left. There are significant bilateral infiltrates with left upper lobe opacification and left lower lobe collapse. 2. Yes. The history is more important here than the X-ray findings (although they are also suggestive of active infection). This chest X-ray actually demonstrates active TB with formation of a cavitating lesion. 3. There is left lower lobe collapse. Although difficult to determine because of mediastinal shift, you can make out the more dense collapsed left lower lobe that gives the appearance of a double heart border. 4. The pneumothorax needs immediate attention as it could quickly progress to a tension pneumothorax. 5. Yes. Pneumothorax is a recognised complication of positive pressure ventilation. 6. There is no surgical emphysema. Surgical emphysema might be more likely if there were rib fractures or if a chest drain had been inserted. 7. Before considering intubating and ventilating this patient, you would insert a chest drain. Positive pressure ventilation without a chest drain in this case would .
