Online OSCEs - Station ONE - Chest X-ray

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A 45 year-old gentleman is admitted to hospital short of breath.

A chest x-ray was performed:

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Question 1: What projection is this chest x-ray? (1 mark)

Question 2: What technical points about a chest x-ray must be considered? (3 marks)

Question 3: Describe your findings. (4 marks)

Question 4: What could cause this abnormality? (3 marks)

Question 5: What other investigation might one consider? (1 mark)

Answer 1:	What projection is this chest x-ray? Postero-anterior projection (1 mark) (This is the standard preferred projection)
Answer 2:	What technical points about a chest x-ray must be considered? Rotation Inspiration Penetration (One point scores 0.5, two scores 1 and all 3 points scores 3 marks.)
Answer 3:	Describe you findings. Opacification of the left hemi-thorax (1 mark) A meniscus is seen at the lateral chest wall (1 mark) Radiological findings suggestive of a pleural effusion (1 mark) Normal contra-lateral hemi-thorax/remainder of film normal (1 mark)
Answer 4:	What could cause this abnormality? Causes of pleural effusion: Para-pneumonic Primary or secondary lung tumour Mesothelioma Pulmonary embolus/infarction Pancreatitis Rheumatoid disease Congestive cardiac failure Renal Failure Liver Failure Hypoalbuminaemia (These causes usually associated with bilateral pleural effusions) (One mark for any of these causes to a maximum of three marks)
Answer 5:	What other investigation might one consider? (1) Pleural aspiration (to aid diagnosis)