Does not suggest small bowel obstruction as a possible diagnosis or does not know to request an erect chest X-ray
Does not mention digital rectal examination
Average candidate
Describes all X-ray features succinctly and accurately with a systematic approach and states that the small bowel is dilated likely indicating
obstruction
Suggests performing an ERECT chest X-ray in this context
Is aware of the causes and management of bowel obstruction starting with appropriate resuscitation
Good candidate
Succinctly describes the radiological features of small bowel obstruction, mentioning that in this case the whole small bowel is
dilated suggesting a distal level of obstruction
Without prompting offers a management plan of 'drip and suck' (IV fluids and naso-gastric tube insertion) in the context of general resuscitation
Notices the urinary catheter and notices there is no visible naso-gastric tube on the image
Notices the pubic symphysis is abnormal
Suggests CT as a definitive radiological test
Shows awareness of the precautions required prior to transfer the patient to the Radiology Department for a CT scan
Small bowel obstruction
If you can't diagnose small obstruction radiologically from the image provided, then you will fail this examination station.
Remember you are not only being tested on radiology skills but also on your awareness of the clinical scenario and 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.
Listen to the questions carefully. In this scenario you are asked the possible clinical findings rather than what you would expect to find. You should show the ability to think about the clinical scenario, not just the findings relating to the image shown.
