Chest X-ray - Scenario 4
Scenario discussion

Scenario discussion

Poor candidate

  • Spends too long considering quality
  • Does not mention hyperexpansion
  • Ignores the bone abnormalities

Average candidate

  • Demonstrates systematic approach
  • Mentions hyperexpansion and explains its relevance (obstructive lung disease)
  • Mentions the bone abnormalities and attempts to explain them

Good candidate

  • Fluently describes radiological features and explains all physical signs and symptoms
  • Offers a coherent summary of the clinical and radiological findings

Descriptive terms

  • This scenario tests the candidate's ability to put together clinical and radiological features.
  • The X-ray shows signs of emphysema. This is also evident in the history.
  • Chest pain and point tenderness is easily explained by the multiple rib fractures evident on the X-ray.
  • Clinical details such as drug history may seem irrelevant at first, but should not be ignored. Steroid treatment for obstructive pulmonary disease has led to reduced bone density with resulting multiple rib fractures secondary to trivial trauma, in the form of coughing.

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

Last reviewed: February 2016