Allow yourself ONE MINUTE to consider the following clinical information. After this time click the Next button to show the OSCE scenario image.
Mr Smith is a 56 year old bus driver, ex-smoker. Recently, he has found work increasingly difficult and in the last 2 days has found it impossible to sleep due to breathlessness when lying down.
He is distressed when you see him in the emergency department.
Previous medical history includes lumbar pain and sciatica which he has tolerated for years with conservative treatment. He mentions recent increasing thoracic back pain which he has found less tolerable but which is reasonably well controlled with anti-inflammatories.
Having examined him you request a chest X-ray which you will see on the next page.
After presenting your findings you will be asked about the clinical signs you are likely to have encountered on examination. You will be asked to link the radiological findings with the clinical features and you will be expected to offer suggestions regarding further management.