Chest Radiology Practice Questions

Q: Which of the following is NOT an X-ray finding of Staphylococcus pneumonia?

Hilar lymphadenopathy. **Explanation:** *Staphylococcus aureus* pneumonia is a necrotizing bacterial infection characterized by rapid progression and tissue destruction. Understanding its radiological signature is crucial for NEET-PG. **Why Hilar Lymphadenopathy is the Correct Answer:** Hilar lymphadenopathy is **not** a typical feature of Staphylococcal pneumonia. It is more characteristically associated with Primary Tuberculosis, Sarcoidosis, Lymphoma, or fungal infections (like Histoplasmosis). In pyogenic bacterial pneumonias like Staph, the inflammatory process is localized to the parenchyma and pleura rather than the lymphatic chains. **Analysis of Other Options:** * **Pneumatocoele (Option A):** These are thin-walled, air-filled cystic spaces that develop due to a check-valve mechanism in the small airways. They are a **hallmark** of Staph pneumonia, especially in children. * **Empyema (Option B):** Staph is highly pyogenic. It frequently causes parapneumonic effusions that rapidly progress to empyema (pus in the pleural space) and bronchopleural fistulas. * **Absent Air Bronchogram (Option D):** Unlike *Streptococcus pneumoniae*, which causes "lobar pneumonia" where airways remain patent (showing air bronchograms), *Staphylococcus* causes "bronchopneumonia." The inflammatory exudate fills both the alveoli and the bronchioles, leading to the **absence** of air bronchograms. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of secondary pneumonia** following an Influenza infection is *S. aureus*. * **IV Drug Abusers:** Often present with bilateral, peripheral, patchy opacities due to septic emboli from right-sided endocarditis. * **Radiological Triad:** Patchy infiltrates + Pneumatocoeles + Empyema = Think *Staphylococcus aureus*.

Q: A chest X-ray of a patient reveals hyperlucency of the right lung. What is the probable diagnosis?

Poland syndrome. **Explanation:** The correct answer is **Poland syndrome**. This condition is characterized by the congenital unilateral absence of the pectoralis major muscle (and sometimes the pectoralis minor). On a chest X-ray, the absence of this soft tissue mass results in decreased attenuation of X-rays on the affected side, leading to **unilateral hyperlucency**. This is a "false" hyperlucency because the lung parenchyma itself is normal, but there is less chest wall tissue to absorb the radiation. **Analysis of Options:** * **Lung Collapse (B):** This typically presents as **increased opacity** (whiteness) due to the loss of air and volume in the lung, often accompanied by a mediastinal shift toward the side of the collapse. * **Pulmonary Embolism (A):** While a large PE can cause focal hyperlucency distal to the occluded vessel (**Westermark sign**) due to oligemia, it rarely involves the entire lung uniformly. * **Pulmonary Arterial Hypoplasia (D):** This can cause hyperlucency (e.g., Swyer-James-MacLeod Syndrome), but it is usually associated with a **small/hypoplastic lung** and reduced vascular markings. In Poland syndrome, the lung volume and vascularity are typically normal. **Clinical Pearls for NEET-PG:** * **Poland Syndrome Triad:** Unilateral absence of pectoralis major, symbrachydactyly (short, webbed fingers), and ipsilateral breast/nipple hypoplasia. * **Differential for Unilateral Hyperlucency:** 1. **Technical:** Patient rotation. 2. **Chest Wall:** Mastectomy, Poland syndrome. 3. **Airway/Lung:** Pneumothorax, Obstructive emphysema (Foreign body), Swyer-James-MacLeod Syndrome. 4. **Vascular:** Westermark sign (PE). * **High-Yield Tip:** If the hyperlucency disappears on a film taken with different centering or if the lung markings are normal, always suspect a chest wall abnormality like Poland syndrome or a prior mastectomy.

Q: All of the following show a miliary shadow on chest X-ray except?

Staphylococcal pneumonia. **Explanation:** The term **"miliary shadow"** refers to a pattern of fine, discrete, small nodules (1–3 mm in diameter) distributed uniformly throughout the lungs, resembling millet seeds. This pattern typically represents **hematogenous spread** or diffuse interstitial involvement. **Why Staphylococcal pneumonia is the correct answer:** Staphylococcal pneumonia typically presents with **patchy bronchopneumonia**, consolidation, or abscess formation. A hallmark feature in children is the development of **pneumatoceles** (thin-walled, air-filled cysts). It does not present with a diffuse miliary pattern; instead, it shows localized or multifocal opacities. **Analysis of incorrect options:** * **Miliary Tuberculosis:** The classic cause of this pattern, resulting from the hematogenous spread of *Mycobacterium tuberculosis*. * **Pneumoconiosis:** Occupational lung diseases like Silicosis or Coal Worker’s Pneumoconiosis (CWP) often present with diffuse nodular opacities that can mimic a miliary pattern. * **Sarcoidosis:** Specifically Stage II sarcoidosis can present with a micronodular/miliary distribution, often accompanied by bilateral hilar lymphadenopathy. **NEET-PG High-Yield Pearls:** * **Differential Diagnosis for Miliary Shadows:** Remember the mnemonic **"MIST"**: **M**iliary TB/Metastasis (Thyroid, Renal Cell Carcinoma, Melanoma), **I**diopathic Pulmonary Fibrosis (early), **S**ilicoses/Sarcoidosis, **T**ropical Pulmonary Eosinophilia (TPE) or Histoplasmosis. * **Snowstorm Appearance:** Often used interchangeably with miliary patterns in the context of Metastatic Choriocarcinoma or Silicosis. * **Staph. aureus:** Look for "pneumatoceles" and "pyopneumothorax" in clinical vignettes involving post-viral (influenza) pneumonia.

Q: A 40-year-old male presented to the OPD with fever and breathlessness. His X-ray is shown below. What is the most probable diagnosis?

Pneumonia. ***Pneumonia*** - Fever and breathlessness with **consolidation** and **air bronchograms** on chest X-ray are classic features of pneumonia. - The acute presentation with respiratory symptoms strongly supports **community-acquired pneumonia** rather than chronic conditions. *Tuberculosis* - Typically presents with **upper lobe cavitation** or **miliary pattern** on chest X-ray, not consolidation. - Usually has a more **chronic course** with night sweats, weight loss, and hemoptysis over weeks to months. *Pleural effusion* - Chest X-ray would show **meniscus sign** and **homogeneous opacification** obscuring lung markings. - Clinical presentation includes **dull percussion note** and **reduced breath sounds** rather than consolidation features. *Bronchogenic carcinoma* - X-ray findings include **lung mass**, **hilar enlargement**, or **collapse/consolidation** due to obstruction. - Typically presents with **chronic cough**, **weight loss**, and **hemoptysis** rather than acute fever and breathlessness.

Q: Kerley B lines are seen in which of the following conditions?

Pulmonary edema. **Explanation:** **Kerley B lines** are thin, short (1–2 cm), horizontal lines seen at the lung bases, perpendicular to the pleural surface. They represent **thickened interlobular septa** caused by fluid accumulation or cellular infiltration. 1. **Why Pulmonary Edema is Correct:** In congestive heart failure and pulmonary edema, increased pulmonary venous pressure leads to fluid transudation into the interstitial spaces. This fluid collects in the interlobular septa, making them visible on a chest X-ray as Kerley B lines. They are a hallmark sign of **interstitial pulmonary edema**. 2. **Why Other Options are Incorrect:** * **Pulmonary Embolism:** Typically presents with a normal X-ray or specific signs like Hampton’s hump (wedge-shaped opacity) or Westermark sign (focal oligemia), but not septal lines. * **Carcinoma Bronchus:** Usually presents as a focal mass, hilar enlargement, or post-obstructive atelectasis. While *Lymphangitis Carcinomatosa* can cause Kerley lines, "Carcinoma bronchus" refers to the primary tumor itself. * **Lung Abscess:** Characterized by a thick-walled cavity with an air-fluid level, not diffuse septal thickening. **High-Yield Clinical Pearls for NEET-PG:** * **Kerley A lines:** Longer (2–6 cm) lines radiating from the hila toward the periphery (represent thickening of deep central connective tissue). * **Kerley C lines:** Short, reticular lines forming a "spider web" appearance (represent thickening of anastomotic lymphatics). * **Differential Diagnosis for Kerley B lines:** Remember the mnemonic **"CHAL"**: **C**HF (Pulmonary edema), **H**umidifier lung (Hypersensitivity pneumonitis), **A**lveolar proteinosis/Asbestosis, **L**ymphangitis carcinomatosa/Lymphoma. * **Stage of Edema:** Kerley B lines appear when the Pulmonary Capillary Wedge Pressure (PCWP) is between **18–25 mmHg**.

Q: In pulmonary embolism, what are the characteristic findings on a perfusion scan?

Perfusion segmental defect. In Pulmonary Embolism (PE), the hallmark finding on a V/Q (Ventilation/Perfusion) scan is a **segmental perfusion defect** in the presence of normal ventilation. ### Why Option A is Correct A pulmonary embolus physically obstructs a branch of the pulmonary artery. This leads to a complete lack of blood flow (perfusion) to the specific lung segment supplied by that vessel. On a perfusion scan (using Technetium-99m MAA), these areas appear as "cold spots." Because the defect follows the anatomical distribution of the bronchopulmonary segments, it is characterized as **segmental**. ### Why Other Options are Incorrect * **Option B:** While a perfusion defect occurs, the term "normal lung scan" is ambiguous and technically incorrect because the perfusion scan itself is abnormal. The classic finding is a **V/Q mismatch** (abnormal perfusion with normal ventilation). * **Option C:** Tenting of the diaphragm is a non-specific sign often associated with pleural effusions, basal atelectasis, or phrenic nerve palsy, but it is not a diagnostic feature of PE on a perfusion scan. * **Option D:** A normal perfusion scan virtually excludes PE (high negative predictive value), but it is not the *finding* of PE. ### High-Yield Clinical Pearls for NEET-PG * **V/Q Mismatch:** The classic triad for PE is a perfusion defect + normal ventilation + normal chest X-ray. * **Westermark Sign:** Focal oligemia (decreased vascularity) distal to the embolus on a Chest X-ray. * **Hampton’s Hump:** A wedge-shaped opacity at the periphery (pleura-based) representing pulmonary infarction. * **Gold Standard:** CT Pulmonary Angiography (CTPA) is now the investigation of choice. V/Q scans are primarily used when CTPA is contraindicated (e.g., renal failure or pregnancy). * **Palla’s Sign:** Enlarged right descending pulmonary artery on X-ray.

Q: Miliary shadows on chest X-ray are typically seen in which of the following conditions?

All of the above. **Explanation:** Miliary shadows on a chest X-ray refer to fine, discrete, 1–3 mm micronodular opacities scattered uniformly throughout both lung fields. The term "miliary" is derived from the resemblance of these nodules to millet seeds. While classically associated with hematogenous spread of tuberculosis, this pattern is a morphological finding that can occur in several granulomatous, inflammatory, or neoplastic conditions. **Breakdown of Options:** * **Tuberculosis (A):** The most common cause. It represents hematogenous dissemination of *Mycobacterium tuberculosis*. Nodules are typically uniform in size and distribution. * **Rheumatoid Arthritis (B):** Can present with miliary-sized rheumatoid nodules or as part of an interstitial lung disease (ILD) pattern. * **Pneumoconiosis (C):** Occupational lung diseases like Silicosis, Coal Worker’s Pneumoconiosis (CWP), and Siderosis frequently present with diffuse micronodular opacities that mimic miliary TB. Since all three conditions can manifest with this radiological pattern, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis (Mnemonic: M.S. PANT):** **M**iliary TB, **S**ilicosis/Sarcoidosis, **P**neumoconiosis, **A**lveolar Cell Carcinoma (now Adenocarcinoma), **N**odular Metastases (e.g., Thyroid, Melanoma, Renal Cell Carcinoma), **T**ropical Pulmonary Eosinophilia. * **HRCT:** High-Resolution CT is the gold standard for characterizing these nodules. In miliary TB, the distribution is typically **random**, whereas in Silicosis/Sarcoidosis, it is often **perilymphatic**. * **Stannosis and Barium inhalation:** These produce the most "radio-opaque" (dense) miliary shadows.

Q: What is a Phantom Tumor?

Interlobar effusion. ### Explanation A **Phantom Tumor** (also known as a **Vanishing Tumor** or **Pseudotumor**) is a classic radiological sign seen on a chest X-ray. It occurs due to a **loculated interlobar effusion**, most commonly found within the **horizontal (minor) fissure**. #### Why Interlobar Effusion is Correct: The "tumor" appearance is created when pleural fluid accumulates within a pulmonary fissure. Because the fluid is confined by the pleural layers of the fissure, it assumes a biconvex, lenticular, or lemon-shaped morphology. On a frontal radiograph, this mimics a solid lung mass or tumor. It is termed "phantom" or "vanishing" because it characteristically disappears rapidly following diuretic therapy or treatment of the underlying cause (typically Congestive Heart Failure). #### Why Other Options are Incorrect: * **Loculated Pleural Effusion:** While a phantom tumor is a *type* of loculated effusion, the term specifically refers to fluid trapped within the **fissures** (interlobar). General loculated effusions often occur in the peripheral pleural space due to adhesions (e.g., empyema). * **Subpulmonic Effusion:** This refers to fluid collected between the lung base and the diaphragm. It presents as an "elevated hemidiaphragm" with lateral displacement of the peak (dome), not as a lung mass. * **Pericardial Effusion:** This involves fluid in the pericardial sac, leading to a "water-bottle" heart sign or globular enlargement of the cardiac silhouette, rather than a focal pulmonary mass. #### High-Yield Pearls for NEET-PG: * **Most Common Cause:** Congestive Heart Failure (CHF). * **Most Common Site:** Horizontal (minor) fissure. * **Key Diagnostic Feature:** Disappears with diuresis. * **Lateral View:** On a lateral X-ray, the "mass" appears tapered at the ends where it follows the line of the fissure, confirming its interlobar origin.

Question 1

Which of the following is NOT an X-ray finding of Staphylococcus pneumonia?

Accepted Answer

Hilar lymphadenopathy

Answer

Pneumatocoele

Answer

Empyema

Answer

Absent air bronchogram

Question 2

A chest X-ray of a patient reveals hyperlucency of the right lung. What is the probable diagnosis?

Accepted Answer

Poland syndrome

Answer

Pulmonary embolism

Answer

Lung collapse

Answer

Pulmonary arterial hypoplasia

Question 3

All of the following show a miliary shadow on chest X-ray except?

Accepted Answer

Staphylococcal pneumonia

Answer

Pneumoconiasis

Answer

Sarcoidosis

Answer

Miliary tuberculosis

Question 4

A 40-year-old male presented to the OPD with fever and breathlessness. His X-ray is shown below. What is the most probable diagnosis?

Accepted Answer

Pneumonia

Answer

Tuberculosis

Answer

Pleural effusion

Answer

Bronchogenic carcinoma

Question 5

A patient presents with a solitary pulmonary nodule on chest x-ray. What is the most appropriate investigation to establish a diagnosis?

Accepted Answer

Image-guided biopsy

Answer

Magnetic Resonance Imaging (MRI)

Answer

Computed Tomography (CT) Scan

Answer

Ultrasonography (USG)

Question 6

Kerley B lines are seen in which of the following conditions?

Accepted Answer

Pulmonary edema

Answer

Pulmonary embolism

Answer

Carcinoma bronchus

Answer

Lung abscess

Question 7

In pulmonary embolism, what are the characteristic findings on a perfusion scan?

Accepted Answer

Perfusion segmental defect

Answer

Perfusion defect with normal lung scan and radiography

Answer

Tenting of diaphragm

Answer

Normal chest scan

Question 8

A 35-year-old chronic smoker (10 years) presents to the emergency room 3 hours after an accident with signs of blood loss. The patient was transfused with a fixed component ratio of the same blood group. Four hours post-transfusion, the patient developed breathlessness and cough. A chest X-ray was advised. What is the most common blood component transfusion that leads to this condition?

Accepted Answer

Plasma transfusion

Answer

Packed Red Blood Cells (PRBC) transfusion

Answer

Platelet transfusion

Answer

Whole blood transfusion

Question 9

Miliary shadows on chest X-ray are typically seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Tuberculosis

Answer

Rheumatoid Arthritis

Answer

Pneumoconiosis

Question 10

What is a Phantom Tumor?

Accepted Answer

Interlobar effusion

Answer

Loculated Pleural Effusion

Answer

Subpulmonic effusion

Answer

Pericardial effusion

Chest Radiology — MCQs

Chest Radiology — MCQs

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