Visual Knowledge: - knowing what the case is by what it looks like Factual Knowledge: - Efficiency o learn facts only

if the following is all fulfilled 1: I didn't already know it 2: It seemed important OR it seemed counterintuitive enough that it would be asked 3: I couldn't guess it 4: I could learn it (i.e. even though a list of 12 bizarre syndromes associated with ASD might fit the first three criteria, it wouldn't be worth dealing with it) - make up differential lists and mnemonics o keep it short Case Taking Points: - say what you see; say what you are thinking - step back and keep differentials inclusive o e.g. BAC as bibasal airspace process – go through the airspace opacity differential and mention possibilities (water, protein, cells, pus, blood) o even if you know what the case is, mention what less likely but similar appearing differentials are - don’t discount a particular diagnosis based on limited visual experience o e.g. big parasellar aneurysm - don’t discount a particular diagnosis because the lesion is GIANT - don’t guess - if stuck, say what you are looking for – systematic approach to case Specific Aids: - PLATINUM (VERY USEFUL) DIFFERENTIALS: o P.S. don’t forget lymphoma and iatrogenic  PCP and AIDS/immunocompromised related disorders  Sarcoidosis and other granulomatous disorders – TB, Crohns  Lymphoma  Iatrogenic • Surgery • Medication o Pulmonary infiltrates; adenopathy; effusions • Radiation - ALMOST PLATINUM o Metastases  Children (Wilms, sarcoma)  Young (Breast, Melanoma)  Likely primaries (common) • Lung • Breast • Melanoma (goes everywhere) - GOLD

lymphoma and metastases (neuroblastoma) for multiple lesions – can also be considered for solitary lesions o Consider imaging the contralateral side for comparison – useful in bone and trauma o Dense metaphyseal lines – check for lead poisoning o Look for signs of appendicitis in every film (common and can cause death) CHEST: o Look for cancer on all films  Especially if patient is old o Look for collapse on all films  Can have underlying cancer! o Consider aneurysm first for any central mass – may not include it later o Consider PE for all normal looking films – can be lethal and look normal. decide:  Airspace or interstitial  Acute or chronic  Then give differentials for each o Ask for old films to compare! MAMMO: o Ask for old films in every case o Physical exam and history in every case – focus interpretation o Spot compression and ultrasound in every case - - . mediastinal shift with respiration (?) o Think of intusussception in every appropriately aged case o Think of malrotation in every abdominal case  Any pattern can be seen on plain film – GI study need to be performed if clinically suspicious o BONE:  Consider infection and EG for ANY BONE CASE  Leukemia. and gastric bubble in neonatal chest o Foreign body  Fluoro to look at oblique airway.o THINGS THAT WOULD BE NEGLIGENT IF MISSED (lawsuit or death) o THINK OF FURTHER IMAGING WHICH NEEDS TO BE DONE TO COMPLETE THE STUDY/CASE o DIAGNOSES WITH VARIED APPEARANCES THAT ALMOST ALWAYS NEEDS TO BE CONSIDERED PAEDIATRICS o Consider NAI in every case  Acute or Chronic fractures can be subtle (posterior rib fractures) o AIRWAY and bones in chest xray  Subglottic narrowing in croup o Airway. and is common o If an infiltrate is seen. aortic arch.

we would perform plain films to assess for calcification and mineralisation o Consider bone scan to assess for multiple lesions o Ask for history – PAIN suggests aggressive process CARDIOVASCULAR o Consider aneurysm  Bad if missed o Injection and filming rates for angiography o Basic drugs in angio and doses NEUROLOGY o Consider aneurysm first for any remotely appropriate location lesion  Bad if missed  Can look strange on MR - - - . Spot compression to ensure it is real  Ultrasound to rule out a cyst o Spot magnification views for calcification for better detail  CC and lateral to look for layering  Consider skin calcification – get tangential views NUCLEAR o Consider artefacts in every case  Something on patient  Camera problems  Injection problems  Preparation problems o Know causes of false positives and negatives for major studies o Consider leaks for strange abdominal findings  Biliary  Urine  Blood o Consider physical examination o SPECT – multiplanar (? Is this all)  Evaluate a focal skeletal abnormality o CXRAY before interpreting V/Q  Ask for previous VQ • Past PE can cause mismatch o Know normal distribution of the radioisotopes  What a normal looks like? MSK o Visual knowledge is important – many Aunt Minnies o Consider infection and Fibrous dysplasia in adults  FD is not very aggressive o Mets and myeloma in age over 50 o Plain films to help with MR  In my institution.

rule out vascular lesion o Ask for HCG when appropriate o Get TV study on female pelvic exams  Especially in pregnancy cases o Look at amniotic fluid and placenta FIRST in obstetric cases  Often forgotten o Known RUQ anatomy in ultrasound GENITOURINARY o SHOCK related to contrast induced reaction on IVP (?)  Mention possibility of reaction o Known treatment for contrast reaction o Consider delayed/obliques/tomograms for IVP o Check preliminary/scout/pre-contrast CT to look for calcium GASTROINTESTINAL o Adenocarcinoma. intraventricular. intraparenchymal o Check cisterns for mass effect o Myelogram – Get two views  Don’t attempt location of lesion until orthogonal views are obtained o Ask for Brain MRI for strange cord lesions  MS  Metastases o Source MRA images contain less artefact than the recons ULTRASOUND o Check colour Doppler – look for aneurysm.o Look for blood – extra-axial. metastasis and lymphoma for any lesion in GIT  Kaposi’s if appropriate  Amyloidosis can look like anything o Check for air in the wrong places o Look for signs of appendicitis in every film (common and can cause death) o Consider additional films - - .