When faced with a chest X-ray in the heat of the examination, it is vital to have a system of interpretation and presentation, particularly if the diagnosis does not jump out at you.

It is always difficult to know whether to present an X-ray starting with the diagnosis and following up with the supporting findings, or whether to use your system to present the findings and then reach a diagnosis.

For example: ‘This chest X-ray shows the features of mitral stenosis which are…’ or ‘There is a double heart border and calcification… These features suggest a diagnosis of mitral stenosis.’

In the Long Case you will have had a chance to view the chest X-ray and can therefore be more confident mentioning a diagnosis first. If the abnormality or diagnosis is ‘barn-door’ (e.g. large, cavitating lesion), then the examiners may not be impressed if you take 5 minutes to mention it! In the Short Cases you may be given chest X-rays that are more of a ‘spot diagnosis’ (such as pneumothorax) and you should try to mention the gross abnormality first. You should then use your system to make sure you do not miss other abnormalities (such as a bilateral pneumothorax!). Other chest X-rays may be more subtle (such as features of cardiac failure) and these may be better dealt with by using the systematic approach.