Chest X-ray - Scenario 7
Scenario discusssion

Scenario discussion

  • You may be asked to look at a CT examination in your finals radiology OSCE. If you are, then don't worry as the findings are likely to be fairly obvious, as in this case. Remember to view the image systematically, starting with the patient's details, just as you would when presenting a chest X-ray.

Poor candidate

  • Fails to suggest cancer as the most likely diagnosis (you don't need the imaging to come to this conclusion)
  • Offers no suggestions for further imaging

Average candidate

  • Demonstrates a systematic approach to both the chest X-ray and the CT, starting by checking the patient's details for both
  • Comments on heart size on the chest X-ray but does not waste too much time doing so
  • Quickly identifies the large lung abnormality and correctly describes it as a lung 'cavity' with a dense and irregular edge
  • Notices the bone abnormalities (although due to old trauma in this case, you would not be marked down for suggesting they are new and related to bone metastases)
  • Fluently lists the common sites for lung metastases

Good candidate

  • Answers all questions correctly and confidently
  • Offers a differential diagnosis for lung cavities which at least mentions 'infection' and 'malignancy'
  • Shows awareness of the difficulties with sampling the lung lesion and suggests imaging-guided liver biopsy

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

Last reviewed: February 2016