Uptight? About this? Of course. Like I said, people who cheat shouldn't be drawn and quartered. But it is NOT ok.
Oh, look, this guy has altered mental status and is confused, I bet it's meningitis, let's get an LP and gram stain.
Oh, look his brain just herniated through his foremen magnum.
Whoops, that wasn't meningitis, maybe I should of checked his ICP first before doing that LP.
^Anyone could make that mistake. It could happen if someone is too tired, or distracted, or any number of things. But it would be much, much more likely to be caused by someone who skated by via cheating than someone who sat down and put the work in--actually did the reading.
That's all that exams are--testing if you put the work in and took the time to read what you need to know. Would someone get through med school cheating? I highly doubt it. But if they were cheating in the first place they're probably prone to cut corners when they can, and one of those corners they cut could lead to a mistake, which could lead to a bad outcome for a patient.