Deck 20: A Review of Thoracic Imaging

Question 1

Which of the following is a major limitation of magnetic resonance imaging (MRI) of the chest?

A)cannot visualize large vessels
B)cannot be used in patients with pacemakers
C)cannot be used to examine hilar structures
D)interpretation difficult

Answer 1

B

Question 2

What chest x-ray view is best used to identify excess pleural fluid?

A)posteroanterior
B)anteroposterior
C)lateral decubitus
D)apical lordotic

Answer 2

C

Question 3

Which of the following structures in the chest is NOT typically examined using MRI?

A)lung parenchyma
B)hilar structures
C)large vessels in the lung
D)structures in the mediastinum

Answer 3

A

Question 4

What problem exists when interpreting an over exposed chest film?

A)There is difficulty in seeing the peripheral blood vessels.
B)The ribs appear wider than normal.
C)The heart shadow is blurred.
D)The lymph nodes in the mediastinum cannot be seen.

Question 5

Which of the following statements is NOT true regarding the use of ultrasound to image the chest?

A)It is useful to image the heart.
B)It is useful to image pleural abnormalities.
C)It is useful to image lung tissue.
D)It uses sound waves that echo back to the sensor.

Question 6

In the standard posteroanterior chest film, what proportion of the chest width should the heart shadow not exceed?

A)33%
B)40%
C)50%
D)65%

Question 7

What lung problem is ventilation/perfusion ( $\dot { V } / \dot { Q }$ ) scanning used to detect?

A)asthma
B)pulmonary embolism
C)pneumonia
D)lung cancer

Question 8

Which radiographic view of the chest allows the physician to read the best quality film?

A)anteroposterior
B)posteroanterior
C)lateral
D)lordotic

Question 9

Which of the following diseases is NOT typically evaluated using high-resolution CT?

A)emphysema
B)asthma
C)bronchiectasis
D)interstitial lung disease

Question 10

In what pulmonary condition does the chest radiograph often "lag behind" the clinical status of the patient?

A)pulmonary embolism
B)emphysema
C)pneumonia
D)congestive heart failure

Question 11

What is indicated by an air-fluid level in the pleural space?

A)tension pneumothorax
B)hydropneumothorax
C)pleural effusion
D)an aerobic infection

Question 12

CT angiography is most often used to evaluate the patient for which of the following conditions?

A)pulmonary emboli
B)chronic obstructive pulmonary disease
C)congestive heart failure
D)bilateral pneumonia

Question 13

Computed tomography (CT) scanning of the chest would be LEAST useful for which of the following?

A)to evaluate the large vessels of the mediastinum
B)to evaluate the pleura
C)to evaluate lung masses
D)to evaluate patients with asthma

Question 14

Your patient just had an anteroposterior chest film taken. When you view the film, what may be a consideration?

A)The lungs may appear smaller than they really are.
B)The heart may appear less dense then it really is.
C)The ribs may appear more horizontal than normal.
D)The heart may appear larger then it really is.

Question 15

What abnormality may appear to be present on the chest x-ray but is simply due to abnormal rotation of the patient during production of the film?

A)enlarged lungs
B)enlarged heart
C)widened mediastinum
D)thickened pleura

Question 16

In which of the following situations is obtaining a chest radiograph least useful?

A)following intubation
B)following placement of a central venous pressure line
C)when the static pressure drops by 2 cm H₂O during CMV
D)when the patient's oxygenation status deteriorates for no known reason

Question 17

What is indicated by rounding of the costophrenic angles seen on the posteroanterior or lateral chest film?

A)emphysema
B)excess pleural fluid
C)obesity
D)rib fractures

Question 18

Which of the following structures will result in the most radiopaque shadow on the chest radiograph?

A)aorta
B)heart
C)lungs
D)ribs

Question 19

What is the earliest sign of a left-sided pleural effusion on an upright chest radiograph?

A)an increased distance between the inferior margin of the left lung and the stomach gas bubble
B)inability to see small pulmonary blood vessels over the left lower lung
C)a widened mediastinum
D)elevation of the right hemidiaphragm

Question 20

The right heart shadow is NOT visible on the chest radiograph. Which of the following pathologies may explain this?

A)right middle lobe pneumonia
B)right lung pneumothorax
C)bilateral emphysema
D)bleb in the right lower lobe

Question 21

In which of the following would loculation of pleural fluid NOT be as likely to occur?

A)empyema
B)exudative fluid
C)hemothorax
D)congestive heart failure

Question 22

Which of the following findings on the chest radiograph is considered a secondary sign of emphysema?

A)flattening of the diaphragm
B)widening of the cardiac shadow
C)narrowing of the space between the ribs
D)blunting of the costophrenic angle

Question 23

What is the most common cause of lobar atelectasis?

A)bronchial obstruction
B)loss of surfactant
C)viral pneumonia
D)pleurisy

Question 24

Which of the following statements is NOT true regarding the recognition and treatment of a tension pneumothorax as seen on the chest radiograph?

A)The hemidiaphragm on the affected side will be pushed downward.
B)The mediastinum will be pushed towards the unaffected side.
C)It requires immediate insertion of a chest tube.
D)The patient should be intubated.

Question 25

Which of the following is the most common type of interstitial lung disease?

A)asbestosis
B)silicosis
C)sarcoidosis
D)scleroderma

Question 26

What imaging technique would be most useful to determine which patients with emphysema may benefit from lung volume reduction surgery?

A)chest HRCT
B)CT angiography
C)MRI
D)ultrasound

Question 27

What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery or needle insertion?

A)hemothorax
B)pneumothorax
C)empyema
D)CHF

Question 28

Which of the following is NOT true regarding the visualization of air bronchograms on the chest film?

A)They indicate fluid in the pleura.
B)They are caused by air-filled airways surrounded by consolidation.
C)They are the hallmark of alveolar consolidation.
D)They signify air space disease.

Question 29

What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood?

A)consolidates
B)infiltrates
C)alveolar lesions
D)densities

Question 30

Which of the following is NOT a common radiographic finding seen in patients with volume loss due to atelectasis?

A)elevation of the hemidiaphragm
B)narrowing of the space between the ribs
C)increase in the retrosternal airspace
D)shift of the mediastinum

Question 31

Which of the following statements best describe the typical findings on a chest radiograph for a patient with interstitial lung disease?

A)unilateral upper lobe infiltrates
B)diffuse bilateral infiltrates
C)diffuse pulmonary hyperinflation
D)diffuse pleural inflammation

Question 32

What term is used to describe the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs as seen on the chest film?

A)bat's wing
B)hilar wings
C)butterfly wings
D)heart wings

Question 33

What type of imaging is most useful for diagnosing idiopathic pulmonary fibrosis?

A)conventional chest radiography
B)CT angiography
C)HRCT
D)MRI

Question 34

Which of the following is NOT a typical cause of pulmonary edema as seen on the chest radiograph?

A)left heart failure
B)renal failure
C)cor pulmonale
D)fluid overload

Question 35

How many solitary pulmonary nodules (SPNs) would be encountered for every 1000 routine chest radiographs?

A)1 or 2
B)10 to 15
C)30 to 40
D)80 to 100

Question 36

Which of the following is NOT a typical cause of atelectasis?

A)abdominal surgery
B)rib fracture
C)hepatomegaly
D)pleurisy

Question 37

Which of the following statements is NOT true regarding the use of the chest x-ray to detect a pneumothorax?

A)An expiratory film may be best for a small pneumothorax.
B)The standard chest film is of limited use in detecting a pneumothorax.
C)The film will show a lack of vascular markings in the affected region.
D)The lung margin is often visible with a pneumothorax.

Question 38

What is the cause of idiopathic pulmonary fibrosis?

A)a virus
B)inhaled dusts
C)drug reaction
D)unknown

Question 39

Which of the following findings on a chest film is most consistent with the pulmonary edema seen with acute respiratory distress syndrome (ARDS)?

A)cephalization
B)Kerley B-lines
C)cardiomegaly
D)bilateral patchy infiltrates of edema

Question 40

What is the most common cause of cephalization as seen on the upright chest film?

A)renal failure
B)left heart failure
C)hypoxemia
D)empyema

Question 41

Why should a chest radiograph be obtained following placement of the central venous pressure catheter?

A)to confirm proper placement
B)to allow better interpretation of the results
C)to identify when to change the line
D)all the above

Question 42

What are the two most common reasons for placing a chest tube?

A)pneumothorax and pleural effusion
B)pneumothorax and empyema
C)hemothorax and hydrothorax
D)to place medicine in the pleural space and to withdraw excess fluid

Question 43

Which of the following is LEAST likely to cause pneumomediastinum?

A)chest trauma
B)esophageal rupture
C)thyroid surgery
D)pericarditis

Question 44

What is the best imaging technique for examining mediastinal masses?

A)conventional lateral chest radiography
B)chest CT
C)MRI
D)ultrasound

Question 45

What is the optimal position of the endotracheal tube following intubation as seen on the chest radiograph?

A)1 to 2 cm above the carina
B)3 to 4 cm above the carina
C)5 to 7 cm above the carina
D)in the upper third of the carina

Question 46

Radiographically, into how many compartments is the mediastinum divided?

A)two
B)three
C)four
D)five