Chest Radiology Practice Questions

Q: Ground-glass appearance on HRCT is seen in which of the following conditions?

Silicosis. ***Silicosis***- While simple silicosis shows small, **fibrotic nodules**, acute or accelerated silicosis (**silicoproteinosis**) often presents with diffuse alveolar filling and inflammation, which manifests radiologically as prominent **ground-glass opacities** on HRCT.- Ground-glass opacity in this context represents airspace filling by lipoproteinaceous material and associated **alveolitis**, characteristic of the severe, rapidly progressive form of the disease.*Asbestosis*- The classic HRCT finding in asbestosis is the presence of **pleural plaques** (calcified or non-calcified) and lower lobe predominant reticular opacities leading to **honeycomb lung**.- Ground-glass opacities are generally not considered a primary or characteristic finding in established asbestosis, which reflects diffuse **interstitial fibrosis**.*Anthracosis*- Anthracosis (simple Coal Worker's Pneumoconiosis) is characterized by small, dense **coal macules** (centrilobular nodules) on HRCT, often concentrated in the upper lobes- Advanced forms lead to **Progressive Massive Fibrosis (PMF)**, which appears as large opacities, not primarily diffuse **ground-glass opacities**.*Bagassosis*- This is a form of **Hypersensitivity Pneumonitis (HP)** caused by moldy sugarcane residue and typically shows centrilobular nodules and **mosaic attenuation** on HRCT.- Although **ground-glass opacities** are a common feature of acute/subacute HP, the question asks for silicosis as the correct answer, which can also exhibit this feature in its acute, infiltrative forms.

Q: What is the most probable diagnosis based on the image provided?

RUL collapse. ***RUL collapse*** - RUL collapse (atelectasis) is identified radiographically by signs of **volume loss**, including superior displacement of the right hilum and cephalic bowing/displacement of the **minor fissure**. - The collapsed lobe causes increased opacification in the upper zone, often associated with the **"S" sign of Golden** if an obstructing hilar mass is present. *RUL consolidation* - Consolidation is characterized by filling of the airspaces with fluid/exudate, causing increased density but typically **without volume loss** (unlike collapse). - A key differentiating feature is the presence of a **patent air bronchogram**, meaning air-filled bronchi are visible against the opaque lung parenchyma. *Bronchogenic carcinoma* - While **bronchogenic carcinoma** is a very common cause of RUL collapse (due to endobronchial obstruction), the primary diagnosis based on the visible lung changes (**volume loss and opacification**) is the collapse itself. - The term carcinoma refers to the underlying **etiology**, not the specific radiological pattern of atelectasis shown in the image. *Lung abscess* - A lung abscess is defined by a localized area of necrosis and pus formation, typically appearing as a **thick-walled cavity**. - The defining characteristic feature that differentiates it from collapse is the presence of an **air-fluid level** within the cavity.

Q: In croup, the characteristic radiographic finding of subglottic narrowing on a frontal chest X-ray creates a tapering appearance of the upper trachea. This diagnostic sign is commonly referred to as which of the following?

Steeple sign. ***Steeple sign*** - The **steeple sign** on a frontal chest radiograph refers to the **subglottic narrowing of the trachea**, resembling a church steeple or an inverted V, which is characteristic of **croup**. - This narrowing is caused by **edema** in the subglottic region, typically due to **parainfluenza virus infection**. *Ballooning of the hypopharynx* - **Ballooning of the hypopharynx** is not a characteristic radiographic sign of croup. - This finding is sometimes associated with **epiglottitis**, a different airway emergency, but not croup. *Narrowing of the subglottic trachea* - While **narrowing of the subglottic trachea** is the underlying pathology in croup and the visual finding of the steeple sign, this option is too general. - The term "steeple sign" specifically describes the **radiographic appearance** of this narrowing, making it the more precise answer. *Tonsillar exudates* - **Tonsillar exudates** refer to pus or fluid on the tonsils, which are a common finding in **pharyngitis** or **tonsillitis**. - This is a clinical finding related to tonsil inflammation and is not a radiographic sign of croup.

Q: The following X-ray shows:

Right sided pansinusitis. ***Right sided pansinusitis*** - The image shows **opacification and mucosal thickening** in the **right maxillary, frontal, and ethmoid sinuses**, which is consistent with **pansinusitis**. - The sinuses on the left appear relatively clear compared to the complete opacification seen on the right side. *Fracture of mandible* - There is **no clear evidence of discontinuity or displacement** of the mandibular bone on the provided X-ray. - Mandibular fractures typically present as a **break in the cortical outlining** of the mandible, which is not visible here. *Orbital floor blowout* - An orbital floor blowout fracture would typically show **herniation of orbital contents** into the maxillary sinus, often accompanied by **air-fluid levels** or a **"teardrop" sign**, neither of which is clearly discernible. - While there is some soft tissue density in the right maxillary sinus, it's more representative of generalized inflammation rather than specific orbital contents. *Normal study* - The distinct **opacification of multiple sinuses** on the right side indicates an abnormality and is inconsistent with a normal study. - A normal sinus X-ray would show **clear, air-filled sinuses** with thin mucosal linings.

Q: A 35-year-old female presents with a large thyroid swelling. Her chest X-ray is shown below. What is the most likely diagnosis?

Retrosternal goiter. ***Retrosternal goiter*** - A large thyroid swelling coupled with a chest X-ray showing widening of the superior mediastinum and possible **tracheal deviation or compression** (indicated by the arrows), strongly suggests a retrosternal goiter. - The thyroid gland, when enlarged, can extend into the thorax behind the sternum, known as a **retrosternal (or plunging) goiter**, which is a common cause of a superior mediastinal mass. *Sarcoidosis* - Sarcoidosis primarily causes **hilar and mediastinal lymphadenopathy** and pulmonary infiltrates, not typically a large, unilateral mediastinal mass pushing the trachea. - While it can cause superior mediastinal widening due to lymph nodes, it usually doesn't present as a distinct mass readily associated with a thyroid swelling. *Thymoma* - Thymomas are typically found in the **anterior mediastinum** and can present as a mediastinal mass, but are not usually associated with a palpable thyroid swelling. - The imaging features of a thymoma would generally be a well-defined mass in the anterior mediastinum, rather than a mass clearly originating from the neck and descending. *Superior vena cava syndrome* - Superior vena cava syndrome (SVCS) is a clinical syndrome caused by obstruction of the superior vena cava, leading to symptoms like **facial swelling, distended neck veins, and dyspnea**. - While a mediastinal mass can cause SVCS, SVCS itself is a **clinical manifestation** (a syndrome), not a diagnosis for the mass itself. The question asks for the most likely diagnosis of the mass.

Q: The chest X-ray of a cystic fibrosis patient shows presence of:

Bronchiectasis. ***Bronchiectasis*** - The X-ray shows diffuse, bilateral **peribronchial thickening** and **cystic lucencies**, particularly in the lower lobes, which are classic signs of bronchiectasis in a patient with cystic fibrosis. - **Bronchiectasis** is a common and progressive complication of cystic fibrosis due to recurrent infections and inflammation leading to permanent dilation and damage of the bronchi. *Left lower lobe pneumonia* - While pneumonia can occur in cystic fibrosis, the image demonstrates chronic changes rather than an acute consolidation typically seen with **left lower lobe pneumonia**. - **Pneumonia** would typically present with a more focal area of increased density, possibly with air bronchograms, which are not the predominant features here. *Bronchopneumonia* - **Bronchopneumonia** would show patchy areas of consolidation scattered throughout the lungs, often involving multiple lobes. - While there are opacities, the prominent **cystic changes** and **tram track lines** are more indicative of bronchiectasis than acute bronchopneumonia. *Right middle lobe collapse* - **Right middle lobe collapse** would manifest as a triangular opacity in the right mid-lung field, often associated with a shift of the right heart border and horizontal fissure. - This specific pattern of collapse is not observed; instead, there are generalized changes consistent with diffuse airway disease.

Q: Identify this condition?

Prune belly syndrome. ***Prune belly syndrome*** - The image shows the characteristic **wrinkled, prune-like appearance** of the abdominal wall due to **absent or deficient abdominal wall musculature**. - This condition is part of a triad including **urinary tract abnormalities** and **undescended testes** in males, with the distinctive loose, redundant abdominal skin. *Omphalocele* - An **omphalocele** presents with **abdominal contents herniating through the umbilical ring**, covered by a peritoneal membrane. - The image does not show any **herniated organs** or a sac-like protrusion at the umbilical area. *Gastroschisis* - **Gastroschisis** involves an **abdominal wall defect** typically to the right of the umbilical cord with **exposed bowel loops**. - No evidence of **herniated intestinal contents** or abdominal wall dehiscence is visible in this image. *Peritonitis* - **Peritonitis** is an **inflammatory condition** of the peritoneum presenting with abdominal rigidity and systemic signs. - This is not a structural abnormality visible externally but rather an **internal inflammatory process** requiring clinical assessment.

Question 1

Ground-glass appearance on HRCT is seen in which of the following conditions?

Accepted Answer

Silicosis

Answer

Bagassosis

Answer

Anthracosis

Answer

Asbestosis

Question 2

Which of the following is the earliest radiological sign of acute respiratory distress syndrome (ARDS) on chest X-ray?

Accepted Answer

Bilateral diffuse alveolar infiltrates (ground-glass opacities)

Answer

Cardiomegaly

Answer

Pleural effusion

Answer

Kerley B lines

Question 3

A 65-year-old male smoker presents with hemoptysis and weight loss. Chest X-ray shows a central hilar mass with mediastinal widening. Which imaging modality is most appropriate for staging the extent of disease?

Accepted Answer

PET-CT scan

Answer

MRI chest

Answer

Contrast-enhanced CT chest with abdomen and pelvis

Answer

Bronchoscopy with biopsy

Question 4

What is the most probable diagnosis based on the image provided?

Accepted Answer

RUL collapse

Answer

Bronchogenic carcinoma

Answer

Lung abscess

Answer

RUL consolidation

Question 5

In croup, the characteristic radiographic finding of subglottic narrowing on a frontal chest X-ray creates a tapering appearance of the upper trachea. This diagnostic sign is commonly referred to as which of the following?

Accepted Answer

Steeple sign

Answer

Ballooning of the hypopharynx

Answer

Narrowing of the subglottic trachea

Answer

Tonsillar exudates

Question 6

The following X-ray shows:

Accepted Answer

Right sided pansinusitis

Answer

Fracture of mandible

Answer

Orbital floor blowout

Answer

Normal study

Question 7

The CT chest shows presence of:

Accepted Answer

Meniscus sign

Answer

Crescent sign

Answer

Tree in bud sign

Answer

Loculated empyema

Question 8

A 35-year-old female presents with a large thyroid swelling. Her chest X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Retrosternal goiter

Answer

Sarcoidosis

Answer

Thymoma

Answer

Superior vena cava syndrome

Question 9

The chest X-ray of a cystic fibrosis patient shows presence of:

Accepted Answer

Bronchiectasis

Answer

Left lower lobe pneumonia

Answer

Bronchopneumonia

Answer

Right middle lobe collapse

Question 10

Identify this condition?

Accepted Answer

Prune belly syndrome

Answer

Omphalocele

Answer

Gastroschisis

Answer

Peritonitis

Chest Radiology — MCQs

Chest Radiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?