How to use this book

This section goes over simple investigations you could be asked to interpret for each system. Once again, be systematic. Begin by stating the patient’s identity (e.g. Mr George Smith), the investigation you are looking at (e.g. a PA chest radiograph) and adequacy of that investigation (e.g. a rotated film). This gives you time to look for abnormalities. Start with the template but don’t be surprised if the examiner wants you to cut to the chase due to time constraints. If there is an obvious abnormality, say so after identifying the investigation. Remember that you need not be at radiologist/cardiologist level when interpreting radiographs/ECGs. If you can spot the abnormality, you can then show it to your senior or a specialist who can worry about the details.

It is helpful to understand that there is a physical, concrete reason behind what you see on a radiograph/ECG. Imagining what you’re actually looking at in the human body, the pathology and why it looks like that allows you to understand and therefore interpret the results.

There are certain ways you expect pathology to show up, e.g. tracheas shift (either pushed or pulled by a lesion), costophrenic angles become blunt, QRS complexes are either wide or narrow, ST segments become depressed or elevated, while T waves invert. Focus on each element of the investigation in turn, see how they are behaving and look out specifically for those changes that commonly occur.






Thinking Medicine