Deck 21: Review of Thoracic Imaging

Question 1

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

Answer 1

C
Explanation: The chest radiograph often lags behind the clinical condition of the patient. This is common in pneumonia where the patient may come in with high fever and cough typical for pneumonia but an infiltrate on the chest film may not appear for 12 to 24 hr.

Question 2

What lung problem is ventilation/perfusion ( ) scanning used to detect?

A) Asthma
B) Pulmonary embolism
C) Pneumonia
D) Lung cancer

Answer 2

B
Explanation: Ventilation/perfusion scanning (also known as scanning) is often used in evaluating for pulmonary embolism.

Question 3

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

Answer 3

C
Explanation: Patient's rotation will make the mediastinum appear unusually wide.

Question 4

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

A) Anteroposterior
B) Posteroanterior
C) Lateral
D) Lordotic

Question 5

What problem exists when interpreting an overexposed 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 6

Which of the following structures in the chest is typically examined using MRI?
1) Lung parenchyma
2) Hilar structures
3) Large vessels in the lung
4) Structures in the mediastinum

A)2, 3, and 4 only
B)2 and 3 only
C)4 only
D)1, 2, 3, and 4

Question 7

Blunting of the costophrenic angles seen on the posteroanterior or lateral chest film typically indicates:

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

Question 8

The right heart shadow is not visible on your patient's 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 9

In the standard posteroanterior chest film, the heart shadow should be less than what proportion of the chest width?

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

Question 10

Which of the following statements is false 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 11

Which of the following diseases are typically evaluated using high-resolution CT?
1) Emphysema
2) Asthma
3) Bronchiectasis
4) Interstitial lung disease

A)1 and 3 only
B)1, 3, and 4 only
C)2 and 3 only
D)1, 2, 3, and 4

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

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

A) Posteroanterior
B) Anteroposterior
C) Lateral decubitus
D) Apical lordotic

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 than it really is.

Question 15

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 16

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 is difficult.

Question 17

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 18

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 19

An air-fluid level in the pleural space typically indicates:

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

Question 20

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 21

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

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

Question 22

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 23

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 24

In which of the following would loculation of pleural fluid be as likely to occur?
1) Empyema
2) Exudative fluid
3) Hemothorax
4) Congestive heart failure

A)4 only
B)2 and 3 only
C)1, 2, and 4 only
D)1, 2, and 3 only

Question 25

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 26

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 27

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

A) Abdominal surgery
B) Rib fracture
C) Hepatomegaly
D) Pleurisy

Question 28

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 29

Radiographically, into how many compartments is the mediastinum divided?

A) Two
B) Three
C) Four
D) Five

Question 30

Which of the following is false 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 airspace disease.

Question 31

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 32

Which of the following statements is false 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 toward the unaffected side.
C) It requires immediate insertion of a chest tube.
D) The patient should be intubated.

Question 33

What is the most common cause of pulmonary fibrosis?

A) A virus
B) Inhaled dusts
C) Drug reaction
D) Unknown

Question 34

Which of the following are typical causes of pulmonary edema as seen on the chest radiograph?
1) Left heart failure
2) Renal failure
3) Cor pulmonale
4) Fluid overload

A)2 only
B)1 and 3 only
C)1, 2, and 4 only
D)1, 2, 3, and 4

Question 35

Which of the following statements is false 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 36

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 37

Which of the following are common radiographic findings seen in patients with volume loss due to atelectasis?
1) Elevation of the hemidiaphragm
2) Narrowing of the space between the ribs
3) Increase in the retrosternal airspace
4) Shift of the mediastinum

A)1 only
B)3 only
C)1, 2, and 4 only
D)3 and 4 only

Question 38

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 39

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

A) Asbestosis
B) Silicosis
C) Sarcoidosis
D) Scleroderma

Question 40

What is the most common cause of lobar atelectasis?

A) Bronchial obstruction
B) Loss of surfactant
C) Viral pneumonia
D) Pleurisy

Question 41

What is the optimal position of the tip of an intra-aortic balloon pump?

A) 2 cm above the carina
B) 4 cm above the carina
C) 7 cm above the carina
D) In the upper third of the carina

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

A 49-year-old COPD patient arrives to the ER complaining of shortness of breath (SOB) and difficulty breathing. The physical examination reveals bilateral coarse crackles throughout the lung fields, pedal edema, and hepatomegaly. The chest x-ray shows bilateral fluffy infiltrates with a "bat's wing" configuration. What clinical condition you may suspect on this patient?

A) Acute coronary syndrome
B) COPD exacerbation
C) Hypertensive crisis
D) Left heart failure

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

A high-resolution CAT scan of a 62-year-old smoker has revealed several nodules on the right lung. Which of the following procedures would you suggest to assess the "malignancy" of these nodules?

A) Ultrasound tomography
B) Positron emission tomography
C) Magnetic resonance imaging
D) CAT scan angiography

Question 46

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 47

Which of the following is least likely to cause pneumomediastinum?

A) Chest trauma
B) Esophageal rupture
C) Thyroid surgery
D) Pericarditis