Chest Radiology Practice Questions

Q: What is the most likely diagnosis based on the provided chest X-ray findings?

Pericardial effusion. ***Pericardial effusion*** - Classic **"water-bottle" or flask-shaped cardiac silhouette** on chest X-ray due to fluid accumulation in the pericardial space. - The heart appears **enlarged and globular** with loss of normal cardiac contours and waist. *Patent Ductus Arteriosus (PDA)* - Shows **increased pulmonary vascularity** with prominent pulmonary arteries and left heart enlargement. - **Left atrial and ventricular enlargement** may be present, but not the characteristic globular heart shape. *Constrictive pericarditis* - Often shows **pericardial calcification** on chest X-ray, particularly visible on lateral views. - Heart size is typically **normal or small**, not enlarged like in pericardial effusion. *Emphysema* - Characterized by **hyperinflation** with increased lung volumes and **flattened diaphragms**. - Shows **increased retrosternal airspace** and vertically oriented heart, not an enlarged cardiac silhouette.

Q: Pallas sign is seen in which of the following conditions?

Pulmonary embolism. **Explanation:** **Pallas sign** is a classic radiological sign seen on a chest X-ray in patients with **Pulmonary Embolism (PE)**. It refers to the **enlargement of the right descending pulmonary artery**, which takes on a "sausage-like" appearance. This occurs due to the physical presence of a large embolus (often a saddle embolus) distending the vessel or due to acute pulmonary hypertension. **Why the correct answer is right:** In Pulmonary Embolism, Pallas sign is a marker of significant clot burden. It is often seen alongside **Westermark sign** (focal oligemia/translucency distal to the embolus) and **Hampton’s hump** (a wedge-shaped opacity representing pulmonary infarction). While CT Pulmonary Angiography (CTPA) is the gold standard, these X-ray signs are high-yield for exams. **Why the incorrect options are wrong:** * **Sarcoidosis:** Characterized by bilateral hilar lymphadenopathy (Stage I) and interstitial lung disease (Garland’s triad/1-2-3 sign), not focal arterial enlargement. * **Emphysema:** Shows signs of hyperinflation, such as flattened diaphragms, increased retrosternal space, and a "sabre-sheath" trachea. * **Myeloma:** Radiologically presents as "punched-out" lytic lesions in the ribs or spine and generalized osteopenia. **NEET-PG High-Yield Pearls:** * **Most common X-ray finding in PE:** Normal Chest X-ray or Atelectasis/Pleural effusion. * **Most specific X-ray signs for PE:** Westermark sign and Hampton’s hump. * **Fleischner sign:** Prominent central pulmonary artery (similar mechanism to Pallas sign). * **Knuckle sign:** Abrupt tapering of a pulmonary artery branch distal to an embolus.

Q: The X-ray provided suggests which of the following conditions?

Hydropneumothorax. ***Hydropneumothorax*** - Characterized by a classic **horizontal air-fluid level** in the pleural cavity, representing both air and fluid collection. - The **air-fluid interface** appears as a straight horizontal line that changes position with patient positioning, distinguishing it from other conditions. *Normal x-ray* - Would show **clear lung fields** with normal vascular markings and no abnormal densities or air collections. - The presence of an **air-fluid level** clearly indicates pathology, ruling out a normal chest X-ray. *Hydatid cyst* - Appears as a **well-defined, round opacity** with possible **rim calcification** or **water lily sign** if ruptured. - Does not typically present with a **horizontal air-fluid level** unless complicated by secondary infection or rupture into pleural space. *Allergic bronchopulmonary aspergillosis (ABPA)* - Shows **central bronchiectasis** with **finger-in-glove** appearance due to mucoid impaction. - May demonstrate **fleeting pulmonary infiltrates** and **upper lobe predominance**, but not horizontal air-fluid levels in pleural space.

Q: The chest CT scan shown below demonstrates the presence of which of the following findings?

Bronchiectasis. ***Bronchiectasis*** - Classic CT features include the **signet ring sign** (dilated bronchus with adjacent pulmonary artery), **tram-tracking** (parallel lines representing thickened airway walls), and **airway wall thickening**. - Airways are **abnormally dilated** and fail to taper normally, often with associated **mucus plugging** and **air-fluid levels**. *Pneumatocele* - Appears as **thin-walled air-filled cysts** within lung parenchyma, typically round or oval cavities. - Usually develops after **pneumonia** or **trauma**, lacking the characteristic dilated airway pattern seen in bronchiectasis. *Normal scan* - Would show **normal bronchial caliber** tapering distally with **thin airway walls** and no abnormal dilation. - Airways should **not be visible** peripherally and should maintain normal **broncho-arterial ratio** of approximately 1:1. *Lung cancer* - Presents as **discrete mass lesions**, **pulmonary nodules**, or **consolidation** with possible **hilar lymphadenopathy**. - May show **spiculated margins**, **cavitation**, or **pleural involvement**, but lacks the characteristic dilated airway pattern.

Q: Stratosphere sign is seen in which of the following conditions?

Pneumothorax. **Explanation:** The **Stratosphere sign** (also known as the **Barcode sign**) is a classic finding in **M-mode ultrasonography** of the chest, diagnostic of a **Pneumothorax**. **Why it occurs:** In a normal lung, M-mode ultrasound shows the "Seashore sign": the stationary chest wall appears as horizontal parallel lines (the sea), while the sliding visceral pleura against the parietal pleura creates a granular, sandy appearance (the beach). In a pneumothorax, air collects between the pleural layers, preventing the ultrasound waves from reaching the moving lung. Consequently, only the stationary chest wall is visualized as a series of linear, horizontal parallel lines extending throughout the image, resembling a barcode or the stratosphere. **Analysis of Incorrect Options:** * **Pleural effusion:** Characterized by an echo-free (anechoic) space between the parietal and visceral pleura. On M-mode, it may show the "Sinusoid sign" due to the movement of the lung within the fluid. * **Rib fracture:** Diagnosed by a cortical break or disruption on ultrasound or X-ray; it does not produce the Stratosphere sign. * **Bronchogenic carcinoma:** Typically appears as a solid, hypoechoic mass with irregular margins on imaging. **High-Yield Clinical Pearls for NEET-PG:** 1. **Lung Point Sign:** The most specific ultrasound sign for pneumothorax (100% specificity); it represents the physical transition point where the lung re-contacts the chest wall. 2. **Absence of Lung Sliding:** A sensitive but non-specific early sign of pneumothorax on B-mode ultrasound. 3. **Deep Sulcus Sign:** The characteristic radiological finding of pneumothorax on a **supine** chest X-ray.

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

All of the above. **Explanation:** **Miliary mottling** refers to the presence of numerous, small (1–3 mm), discrete, rounded opacities scattered throughout both lung fields on a chest X-ray. The term originates from the resemblance of these spots to millet seeds. While **Miliary Tuberculosis** is the most classic cause, this pattern is a manifestation of various granulomatous, infectious, and neoplastic processes. **Analysis of Options:** * **Histoplasmosis:** This fungal infection often presents with a miliary pattern during the acute disseminated phase, particularly in immunocompromised individuals. Over time, these nodules may calcify. * **Sarcoidosis:** Stage II and III sarcoidosis can present with a micronodular or miliary distribution, typically following a perilymphatic pattern. * **Metastases:** Certain "seed-like" hematogenous spread of malignancies can mimic miliary TB. While common in thyroid (medullary/papillary), renal cell, and melanoma, it is also seen in **colonic and breast carcinomas**. **Why "All of the above" is correct:** The miliary pattern is non-specific. Since Histoplasmosis (fungal), Sarcoidosis (inflammatory), and certain Metastases (neoplastic) can all produce diffuse 1–3 mm nodules, all three options are recognized causes. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Miliary Mottling (MISHAP):** **M**-Metastasis/Miliary TB, **I**-Inorganic dust (Silicosis), **S**-Sarcoidosis, **H**-Histoplasmosis/Hemosiderosis, **A**-Alveolar microlithiasis, **P**-Pneumoconiosis. * **Differential Diagnosis by Nodule Size:** If nodules are larger (>5 mm), consider "Cannon-ball" metastases (RCC, Choriocarcinoma). * **HRCT Finding:** In Miliary TB, the distribution is **random**, whereas in Sarcoidosis, it is **perilymphatic**.

Q: On a chest X-ray, which structure forms the left border of the heart?

All of the above. The cardiac silhouette on a chest X-ray (CXR) is formed by the interface between the heart/great vessels and the aerated lungs. Understanding these borders is fundamental for identifying chamber enlargement or mediastinal masses. **Explanation of the Correct Answer:** The **left border** of the heart (and mediastinum) on a PA view is not formed by a single structure but is a composite of several segments. From superior to inferior, these are: 1. **Aortic Arch (Aortic Knuckle):** The most superior convexity. 2. **Left Pulmonary Artery (Pulmonary Segment):** Located just below the aortic knuckle. 3. **Left Auricle (Left Atrial Appendage):** A small segment between the pulmonary artery and the ventricle (often flat or slightly concave unless enlarged). 4. **Left Ventricle:** Forms the lower, most prominent convex part of the left border and the apex. Since options A, B, and C all contribute to the formation of the left cardiac/mediastinal silhouette, **Option D (All of the above)** is the correct answer. **Clinical Pearls & High-Yield Facts:** * **Right Border:** Formed primarily by the **Superior Vena Cava (SVC)** superiorly and the **Right Atrium** inferiorly. Note: The Right Ventricle does *not* form a border on the PA view (it is the most anterior chamber). * **Mitral Stenosis:** Classically causes "straightening of the left heart border" due to left atrial appendage enlargement. * **Boot-shaped heart (Coeur en sabot):** Seen in Tetralogy of Fallot, caused by right ventricular hypertrophy uplifting the left ventricular apex. * **Water-bottle heart:** Characteristic of large pericardial effusions. * **Silhouette Sign:** Loss of the left heart border usually indicates pathology in the **Lingula** of the left lung.

Q: The "Golden S" sign is seen in which of the following conditions?

Right upper lobe collapse. ### Explanation The **Golden S sign** (also known as the S-sign of Golden) is a classic radiological sign seen on a frontal chest X-ray. It is most characteristically associated with **Right Upper Lobe (RUL) collapse** caused by a centrally located mass (usually bronchogenic carcinoma). **1. Why Right Upper Lobe Collapse is Correct:** When the RUL collapses, the minor fissure shifts superiorly and medially. If a central mass is obstructing the RUL bronchus, the fissure cannot retract fully at the hilum. This creates a contour resembling a reverse "S": * The **superior/lateral** concave segment is formed by the displaced minor fissure. * The **inferior/medial** convex segment is formed by the margin of the obstructing mass. This sign is critical because it indicates that the collapse is not simple (e.g., from a mucus plug) but is likely due to an underlying malignancy. **2. Why Other Options are Incorrect:** * **Left Upper Lobe Collapse:** While a similar "S" shape can theoretically occur, LUL collapse typically presents with the "Luftsichel sign" (air crescent around the aortic arch) and a hazy opacification shifting anteriorly. * **Right/Left Middle Lobe Collapse:** These present as wedge-shaped opacities that obscure the right heart border (silhouette sign) but do not produce the characteristic "S" contour of the minor fissure and a central mass. **3. Clinical Pearls for NEET-PG:** * **Most common cause:** Bronchogenic carcinoma. * **Key Anatomy:** The sign specifically involves the **minor (horizontal) fissure**. * **Luftsichel Sign:** Associated with LUL collapse (hyperexpanded superior segment of the left lower lobe). * **Juxtaphrenic Peak Sign:** A small triangular peak of the diaphragm seen in upper lobe collapse due to traction on the inferior accessory fissure or phrenic nerve.

Question 1

What is the most likely diagnosis based on the provided chest X-ray findings?

Accepted Answer

Pericardial effusion

Answer

Patent Ductus Arteriosus (PDA)

Answer

Constrictive pericarditis

Answer

Emphysema

Question 2

Pallas sign is seen in which of the following conditions?

Accepted Answer

Pulmonary embolism

Answer

Sarcoidosis

Answer

Emphysema

Answer

Myeloma

Question 3

The X-ray provided suggests which of the following conditions?

Accepted Answer

Hydropneumothorax

Answer

Normal x-ray

Answer

Hydatid cyst

Answer

Allergic bronchopulmonary aspergillosis (ABPA)

Question 4

Which of the following is NOT a criterion of a solitary benign pulmonary nodule on chest X-ray?

Accepted Answer

Cavitation

Answer

Less than 5cm size

Answer

Peripheral location

Answer

Concentric calcification

Question 5

The chest CT scan shown below demonstrates the presence of which of the following findings?

Accepted Answer

Bronchiectasis

Answer

Pneumatocele

Answer

Normal scan

Answer

Lung cancer

Question 6

Stratosphere sign is seen in which of the following conditions?

Accepted Answer

Pneumothorax

Answer

Pleural effusion

Answer

Rib fracture

Answer

Bronchogenic carcinoma

Question 7

A retrocardiac shadow showing an air-fluid level is seen in which of the following conditions?

Accepted Answer

Hiatus hernia

Answer

Pleural effusion

Answer

Pericardial effusion

Answer

Carcinoma of the colon

Question 8

Miliary mottling on chest X-ray is typically seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Histoplasmosis

Answer

Sarcoidosis

Answer

Metastases from carcinoma of the colon

Question 9

On a chest X-ray, which structure forms the left border of the heart?

Accepted Answer

All of the above

Answer

Aortic arch

Answer

Left pulmonary artery

Answer

Left ventricle

Question 10

The "Golden S" sign is seen in which of the following conditions?

Accepted Answer

Right upper lobe collapse

Answer

Left upper lobe collapse

Answer

Right middle lobe collapse

Answer

Left middle lobe collapse

Chest Radiology — MCQs

Chest Radiology — MCQs

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