All pathological CXR look the same to me?

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WutJob..
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#1
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#1
All I can spot is consolidation and all diseases such as pneumonia, TB and cancer look very similar? Is that normal? Can you guess the disease from the film? or do you have to do a biopsy and other examinations to be sure.
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nexttime
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You need more teaching and more practice on the wards, then. Subtle signs can be really hard and for definitive diagnoses of things like cancer do require samples yes, but lobar consolidation, oedema, effusion, solid tumour masses, pneumothorax, all do look different yes and you should be able to tell the difference by the end of med school.

There are some reasonable websites (though be cautious of getting bogged down in technicalities) and if you always ask about each XR you see on the wards you should make progress in good time.
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Nottie
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#3
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(Original post by WutJob..)
All I can spot is consolidation and all diseases such as pneumonia, TB and cancer look very similar? Is that normal? Can you guess the disease from the film? or do you have to do a biopsy and other examinations to be sure.
In real life (or even exam) you will be given some relevant information along with the CXR to aid your diagnosis.
From my understanding you are a pre-clinical years student so you don't have to worry too much about that now. However, if you are very keen or just like radiology I'd recommend getting "unofficial guide to radiology". It explains all common signs you would be looking for and has quite a few examples so you can test your skills. Dont however expect to be an expert at that point: a big proportion of clinicians still rely on consultant radiologists to read the CXR and some changes can be reaaally subtle.
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Beska
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(Original post by WutJob..)
All I can spot is consolidation and all diseases such as pneumonia, TB and cancer look very similar? Is that normal? Can you guess the disease from the film? or do you have to do a biopsy and other examinations to be sure.
In addition to what nexttime said, you'd never be expected to guess the diagnosis from the film (at most, a differential). You'll always (always) get a clinical history to corroborate the film and the two make the diagnosis. This is the same reason you should always give a good history when you request imaging.
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Kyalimers
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#5
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(Original post by WutJob..)
All I can spot is consolidation and all diseases such as pneumonia, TB and cancer look very similar? Is that normal? Can you guess the disease from the film? or do you have to do a biopsy and other examinations to be sure.
It is not always necessary to get a diagnosis from a radiograph, as others have alluded to above.

Are you aware of the ABCDE technique of assessing a chest radiograph?
A = airways, B = bones, C = cardiac borders, D = diaphragm, E = everything else (or extras)

So essentially, start off by looking at the trachea, the bronchi and the lungs. Move on to bones (clavicles, ribs and shoulder in particular), then to the cardiophrenic angles, then the costophrenic angles and the space under the diaphragm (including stomach). The extras is things such as ECG leads, drains etc.

Go and look at each and every CXR with this structured manner and even if you don't know exactly what is going on, you will pick up what is abnormal and where.
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WutJob..
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#6
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(Original post by Beska)
In addition to what nexttime said, you'd never be expected to guess the diagnosis from the film (at most, a differential). You'll always (always) get a clinical history to corroborate the film and the two make the diagnosis. This is the same reason you should always give a good history when you request imaging.
(Original post by Nottie)
In real life (or even exam) you will be given some relevant information along with the CXR to aid your diagnosis.
From my understanding you are a pre-clinical years student so you don't have to worry too much about that now. However, if you are very keen or just like radiology I'd recommend getting "unofficial guide to radiology". It explains all common signs you would be looking for and has quite a few examples so you can test your skills. Dont however expect to be an expert at that point: a big proportion of clinicians still rely on consultant radiologists to read the CXR and some changes can be reaaally subtle.
(Original post by nexttime)
You need more teaching and more practice on the wards, then. Subtle signs can be really hard and for definitive diagnoses of things like cancer do require samples yes, but lobar consolidation, oedema, effusion, solid tumour masses, pneumothorax, all do look different yes and you should be able to tell the difference by the end of med school.

There are some reasonable websites (though be cautious of getting bogged down in technicalities) and if you always ask about each XR you see on the wards you should make progress in good time.
Thanks for all the advice! I am in year 2, and our lecturer was making us guess diseases from CXRs! It made me worried and anxious as I couldn't spot any.
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WutJob..
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#7
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(Original post by Kyalimers)
It is not always necessary to get a diagnosis from a radiograph, as others have alluded to above.

Are you aware of the ABCDE technique of assessing a chest radiograph?
A = airways, B = bones, C = cardiac borders, D = diaphragm, E = everything else (or extras)

So essentially, start off by looking at the trachea, the bronchi and the lungs. Move on to bones (clavicles, ribs and shoulder in particular), then to the cardiophrenic angles, then the costophrenic angles and the space under the diaphragm (including stomach). The extras is things such as ECG leads, drains etc.

Go and look at each and every CXR with this structured manner and even if you don't know exactly what is going on, you will pick up what is abnormal and where.
That's a really good and simple technique on how to approach a CXR, did you read this somewhere or make it up? Thanks!
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Nottie
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(Original post by WutJob..)
Thanks for all the advice! I am in year 2, and our lecturer was making us guess diseases from CXRs! It made me worried and anxious as I couldn't spot any.
If you ever get stuck just describe what you are seeing. As Beska said, they won't ask you for a definite diagnosis based on just 1 X-ray. And it's a good practice to always consider differentials
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Kyalimers
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#9
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#9
(Original post by WutJob..)
Thanks for all the advice! I am in year 2, and our lecturer was making us guess diseases from CXRs! It made me worried and anxious as I couldn't spot any.
I think that is a bit overzealous on his part.

(Original post by WutJob..)
That's a really good and simple technique on how to approach a CXR, did you read this somewhere or make it up? Thanks!
It's a relatively common teaching approach for CXRs. Just remember that the 'B' is not breathing (you can't assess breathing on a radiograph, after all)!
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Angury
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(Original post by WutJob..)
Thanks for all the advice! I am in year 2, and our lecturer was making us guess diseases from CXRs! It made me worried and anxious as I couldn't spot any.
You don't need to guess the disease from the CXR, especially not in Year 2. I always found this website useful:

https://www.radiologymasterclass.co....t_system_start

It's a good way of approaching CXRs. Another great book that has already been mentioned is the 'Unofficial Guide to Radiology.' Again, it goes through a basic approach in reading CXRs before moving onto different types of pathology. In OSCEs I was never expected to 'guess the diagnosis' from a CXR but just be able to describe the CXR using a basic approach (such as ABCDE mentioned above) and point out the 'most obvious pathology' and have a go at differentials based on the clinical history. That should be more than enough.

Picking up disease comes with practice. For now, focus on using a structured approach when looking at CXRs so that you look at everything without being overwhelmed. Knowing what is abnormal comes with knowing what is normal first.
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nexttime
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#11
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#11
(Original post by WutJob..)
Thanks for all the advice! I am in year 2, and our lecturer was making us guess diseases from CXRs! It made me worried and anxious as I couldn't spot any.
That's just a radiologist showing off what he can see and what you can't. Its pretty common.

More useful teaching comes from better teachers and teachers on the wards. It comes with practice, and if you are only year 2 i really wouldn't worry.

(Original post by Beska)
In addition to what nexttime said, you'd never be expected to guess the diagnosis from the film (at most, a differential). You'll always (always) get a clinical history to corroborate the film and the two make the diagnosis.
Will you though? I'm pretty sure at med school I've had MCQs which were literally an XR and 5 diagnoses to choose from. ECGs too. Albeit not in year two.

I don't think that's necessarily unreasonable either - a pneumothorax seen on CXR doesn't have too many differentials and really shouldn't be missed. You could say the same about a few other findings - they should be recognised in isolation.

In real life things are rarely so clear-cut as medical exams though. obviously
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Beska
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#12
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(Original post by nexttime)
Will you though? I'm pretty sure at med school I've had MCQs which were literally an XR and 5 diagnoses to choose from. ECGs too. Albeit not in year two.

I don't think that's necessarily unreasonable either - a pneumothorax seen on CXR doesn't have too many differentials and really shouldn't be missed. You could say the same about a few other findings - they should be recognised in isolation.

In real life things are rarely so clear-cut as medical exams though. obviously
We've always had a clinical history alongside an XR when we're asked for a diagnosis in exams. The radiologist always has a clinical history (even if it's "pyrexia ?LTRI" or something so brief) so makes no sense to examine otherwise. We have had exams where we need to describe an XR without a clinical history and give a differential, but you don't necessarily need a clinical history to give a description of an image and you can give a reasonable (and broad) one without any details as well. A pneumothorax is probably fair enough, but I've seen pleural plaques, large bullae and external objects look like pneumothacies - including in a radiology viva prize exam (so probably a lot less common in real life). So very little can be diagnosed in isolation without a differential without a clinical history, at least imo.

ECGs probably rely less on clinical history than CXR given you can work out so much about the muscle from them so would feel more confident about diagnosing a single condition from an ECG without a history. At least knowing if there's chest pain would be useful though
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