Spends too long considering patient rotation
Does not diagnose a pneumothorax or calls it 'collapse'
Guesses heart size
Describes all X-ray features succinctly and accurately with a systematic approach and states that heart size cannot be accurately assessed
Comments on possible mediastinal shift but acknowledges difficulty in assessment due to patient rotation (image 1)
Explains all physical signs and symptoms
Requests the post drain insertion chest X-ray, notices the chest drain and diagnoses pneumothorax with residual effusion - hydropneumothorax
Answers questions correctly and succinctly
If you are unable to diagnose a pneumothorax at finals you cannot expect to pass. Some candidates fail because they use incorrect terminology such as 'lung collapse.'
It does not take long to describe a pleural effusion. Homogeneous density with lack of air bronchogram, and a 'meniscus' are characteristic features. Image 2 gives you a chance to show you know that effusions have a horizontal surface when directly in contact with air - hydropneumothorax.