As is the case with many examination stations, this scenario does not reflect real life. You are not told certain important clinical information, such as the side of the chest pain, but this would make things too easy.
Regarding the images in this OSCE you are tested on your ability to see a pneumothorax. This is a favourite radiology OSCE stations as there is a very clear pass/fail standard.
Poor candidate
Fails to see the pneumothorax on the first image. If you don't see it then you will definitely fail the examination station. If you don't see the second pneumothorax the examiner may argue that you should fail medical finals altogether.
Poor candidates also call a pneumothorax a 'lung collapse.' This is incorrect and may be considered in the same light as not seeing a pneumothorax. This is because lung collapse implies endobronchial obstruction and has a completely different clinical significance. If you don't use the specific term 'pneumothorax' then you risk failing.
Average candidate
Demonstrates a systematic approach to chest X-ray interpretation and includes assessment of heart size
Quickly spots the pneumothorax on both images
Describes the physical signs associated with a pneumothorax
Shows awareness of the need for intervention based on the clinical findings at the time of the second image
Good candidate
As for average candidate and the following...
Shows good awareness of the factors which determine management of pneumothorax in accordance with British Thoracic Society guidelines
