Abdominal X-ray - Scenario 1
Scenario discussion

Scenario discussion

Poor candidate

  • Spends too long considering image quality
  • Does not suggest bowel obstruction as a possible diagnosis

Average candidate

  • Describes all X-ray features succinctly and accurately with a systematic
    approach and states that the large bowel is dilated likely indicating obstruction
  • Suggests performing an ERECT chest X-ray in this context
  • Is aware of the causes and management of (large) bowel obstruction

Good candidate

  • Succinctly describes the radiological features of large bowel
    obstruction, suggesting the descending colon as the level of disease
  • Without prompting offers a management plan of 'drip and suck' (IV fluids
    and naso-gastric tube insertion) in the context of general resuscitation
  • Suggests CT as a definitive radiological test
  • Makes a sensible suggestion regarding the purpose of the stent

Large bowel obstruction

  • There are very few abdominal images you are likely to be shown in a radiology examination. If you can't diagnose obstruction radiologically you will fail the station.
  • Remember you are not being tested just on radiology skills but also on your ability to plan management. Don't wait to be asked what you would do in this setting, go ahead and tell the examiner your differential diagnosis and how you and your team would proceed.
  • You may not have come across devices such as the colonic stent before. If this happens in any part of the examination process, don't panic. Try to make sensible suggestions about what it could be and how it fits with the clinical scenario.
  • Remember the examiner is on your side and the scenario is not trying to catch you out.

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2016