Instructions
You are a medical student on placement in general practice. Your next patient is Vivian Kwok, 48, presenting with two months of cough and blood-streaked sputum. She has come to follow up a chest X-ray taken yesterday; its findings are printed for you.
Take a focused history
Outline to the examiner:
- Your findings
- Your interpretation of the results
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
- You do not need to examine the patient; the examiner will give you any findings you ask for
- Ask the examiner for any further results you need
Chest X-ray (PA), taken yesterday
| Item | Value | Reference range |
|---|---|---|
| Projection and adequacy | PA erect. Not rotated; adequate inspiration (10 posterior ribs) and penetration. | - |
| Trachea and mediastinum | Trachea central; mediastinum not widened. Left hilum enlarged, dense and lobulated; right hilum normal. | - |
| Lung fields by zone | Left upper zone: rounded soft-tissue opacity about 4 cm across with a lobulated, irregular edge; no cavity, calcification or air bronchogram. Left mid and lower zones and the right lung clear. | - |
| Cardiac silhouette | Normal size; heart borders clear. | - |
| Diaphragm and costophrenic angles | Both hemidiaphragms normal in height and outline; costophrenic angles sharp. | - |
| Bones, soft tissue and lines | No rib destruction or other bony lesion; soft tissues normal; no lines. | - |
Vivian Kwok, 48, female. No previous films available for comparison.