Haematology, Biochem and Imaging

Question 1

What are air bronchograms?

Answer 1

Air within bronchioles - darker patches within consolidation which suggets pneumonia often

Question 2

What is purple blood bottle for?

Answer 2

• Haematology - contain EDTA to stop clotting
• For FBC, ESR, blood film, reticulocytes, red cell folate, HbA1C

Question 3

What is yellow blood bottle for?

Answer 3

• Biochemistry - seperated serum for analysis
• U&E, CRP, LFT, amylase, bone profile, magnesium, iron studies, lipid profile, TFTs, vitamins, troponins, creatine kinase, Urate, osmolality

Question 4

What is blue bottle for?

Answer 4

• Clotting - buffered sodium citrate = reversible anticoagulant
• aPTT, PT, TT, fibrinogen, INR, Anti-Xa (LMWH monitoring if high dose)

Question 5

Pink bottle function

Answer 5

• Transfusion - hand write bottle at bedside
• Group and save, crossmatch (for transfusion, tell how mnay units you think will be needed)

Question 6

How many samples are needed for group and save before crossmatch can be done?

Answer 6

2x group and save are needed
From 2 different sites, different occasions

Question 7

Resus fluids

Answer 7

500ml bolus of 0.9% saline over 15 minutes
250ml if elderly or risk of overload eg HF
If very low - give straight away

Question 8

NEWS2 when to be worried

Answer 8

3 - ok
4/5 - not emergency but needs help
5 or more - emergency

Question 9

What retention do we catheterise at?

Answer 9

400-500mls
If less than this can damage bladder so NO

Question 10

Blood culture samples - which one to do first

Answer 10

• Aerobic sample 1st - in case some air in needle
• Then anaerobic sample
• Need at least 10 mls (which is 2 increments on bottle)

Question 11

When to give abx for CRP and suspected infection?

Answer 11

CRP >100 = IV abx
CRP >50 - infection suggested
CRP <50 - could be another cause

Question 12

What 4 things to do before analysing x-ray?

Answer 12

• Right pt?
• Right film?
• Right way round?
• Everything of interest on here?

Question 13

Confirming details of X-ray

Answer 13

• Patient details
• Date and time of x-ray
• Previous imaging - compare

Question 14

RIPE CXR

Answer 14

R - equal distance clavicles to spinous process
I - 5-6 anterior ribs, 10 posterior
P - AP or PA - no scapulae = PA
E - can see spinous processes under heart? hemidiaphragm visible to spine?

Question 15

ABCDE

Answer 15

A - trachea, carina, bronchi and hilar
B - lungs and pleura
C - heart size and borders
D - costophrenic angles
E - mediastinal contours, bones, soft tissue, tubes, valves, pacemakers and review

Question 16

Scoring for suspected pneumonia

Answer 16

CURB 65
Confusion - disorientation, mental test score 8 or less
Urea >7mmolL
Resp rate 30 or more
BP <90 systolic or <60 diastolic
65 years or older

Question 17

CURB 65 score and management from this

Answer 17

0-1 - low risk –> outpatient
2 - intermediate risk –> inpatient
3-5 - high risk –> ITU?

Question 18

How to think about investigations?

Answer 18

• History
• Examination
• Bedside - eg obs, bladder scan
• Bloods
• Imaging - eg CXR, CT

Question 19

Describing criss cross and dot pattern on CXR

Answer 19

Reticulonodular shadowing

Question 20

What to call general haziness on CXR?

Answer 20

Alveolar shadowing