Our radiology exam had just begun and I sat with my head in my hands, already frustrated. I could feel my eyes quickly becoming sore from straining while attempting to analyze the radiographs on the small computer screen. An hour left to go and I was already mentally checked out for this exam.
Radiology has always been one of my favorite areas of veterinary medicine (but it’s definitely not my best subject). I love being able to assess a picture and then use my knowledge of anatomy and pathology to come up with a diagnosis. It is always satisfying when you evaluate the history and physical exam, develop a hunch on the underlying problem, and then have it confirmed by your radiographic assessment. I had one of these eureka moments during our radiology midterm.
One of the last questions on the exam was a lateral abdominal radiograph of a ferret. I could feel myself getting upset as we had never learned about ferrets in class, nor had I ever seen a ferret radiograph. It seemed entirely unfair that we would be tested on material we had never learned before. I took a moment, a deep breath, and started assessing the radiograph.
I typically use a systems-based approach. I work cranially to caudally, looking at each important organ before making an interpretation. Not that I know what a normal ferret radiograph looks like, but it was apparent that there was an abnormal radio-opaque area in zone two of the abdomen. The organs within zone two (at least in dogs) are the liver, gallbladder, pancreas, and duodenum. I was not expected by the professor to make an exact pathological diagnosis, but instead a generalized radiographic diagnosis. ‘Zone two abdominal mass’ may have been a sufficient answer for this exam, but I wanted to be as accurate as possible.
Thinking back to the history and my knowledge of ferrets, I concluded that this must be a form of neoplasia. The two most prominent forms of neoplasia in ferrets are adrenal gland tumors and insulinomas. Due to this mass originating in zone two, it was easy enough to take an educated guess that the tumor was in the pancreas, leading to the diagnosis of insulinoma. This diagnosis could obviously not be guaranteed without a biopsy and a more rigorous history, but I felt it was important to follow my gut and take a chance.
I felt this moment was an important lesson in learning to trust myself and to not underestimate my knowledge. We are all strong in different areas based on our interests and clinical backgrounds. If I had just continued to feel upset that our professor had ‘tricked us’ I would have written off the question and probably would have gotten it wrong.
