BackgroundThe number of medical students accepted into medical programs is increasing, which has made the traditional long/short case style of examination difficult to conduct. At Dammam University, the program is shifting to the use of the Objective Structural Clinical Examination (OSCE), which may solve some of these difficulties, including issues with reliability, validity index and exam duration.ResultsA pilot study was conducted over one semester. A total of 207 examinees in three groups took the OSCE and written exams. The OSCE consisted of 18 clinical stations and required 3–4.3 h/day. The written exam contained 80 multiple-choice questions. The Cronbach’s alpha for each group was 0.7, 0.8, and 0.9. Correlations for all stations ranged from 0.7 to 0.8, which indicated good stability and internal consistency with minor differences in the progression of the indexes. The reliability of the written exam was 0.79, and the validity of the OSCE was 0.63, as assessed using Pearson’s correlation.ConclusionNo single reliability index can be considered a perfect assessment tool to solve this issue. Thus, at least two to three indexes should be used to ensure the reliability of the OSCE.

HighlightsEctopic Thyroid Tissue in the mediastinum is very rare.ETT can be associated with normal thyroid function and normal thyroid anatomical location.ETT should be differentiated from substernal goiter.

HighlightsLaparotomy is the best treatment method for trichobezoare.Psychiatric management should be done for any patient with trichotillomania to avoid trichobezoar.Endoscopic treatment can only be successful for small trichobezoar.

Background: Primary thyroid lymphoma (PTL) is a rare disease, accounting for 5% of all thyroid malignancies. Diffuse B-cell lymphoma (DBCL) is the most common type of PTL. The diagnosis of PTL depends on biopsy results, and its management depends on the histological type. Case Presentation: A 66-year-old female complained of a huge neck mass on the right side that had started growing 3 months previously and was associated with compressive and B symptoms. She had undergone left hemithyroidectomy 20 years previously. On examination, a huge neck mass measuring 10 × 6 cm was detected on the right side that had shifted the trachea to the contralateral side. CT scanning revealed a huge soft tissue mass in the neck with compressive signs. Fine-needle aspiration (FNA) showed variably sized lymphocytes and large epithelial cells with occasional atypical cells. Tissue biopsy revealed DBCL, which is suggestive of PTL. Discussion: PTL affects only the thyroid gland and the regional lymph nodes. Most PTL originate from B cells, especially DBCL, which accounts for 50–80% of all PTL. FNA may have limited capability to differentiate between anaplastic carcinoma of the thyroid and thyroid lymphoma. If FNA fails to determine PTL tissue, it should be determined using biopsy. A multidisciplinary approach is the best management technique for PTL. Radiotherapy, surgery, or both can be used for local control, while chemotherapy can be used for disseminated or hidden disease. Conclusion: Tissue biopsy is needed to exclude other differential diagnoses, whereas a multidisciplinary approach is needed to manage PTL.

Primary pulmonary Hodgkin lymphoma (PPHL) is very rare and typically involves the superior portion of the lung. Pulmonary involvement is observed in 15–40% of Hodgkin lymphoma patients. Three such patients who presented with an unusual form of PPHL in radiological studies, i.e., multiloculated cavitary lesions, were admitted to our hospital. These lesions represent a new pathological and radiological feature of PPHL.