Chest Radiology Practice Questions

Q: Differential diagnosis of a solitary pulmonary nodule includes all of the following except?

Neurofibroma. ### Explanation A **Solitary Pulmonary Nodule (SPN)** is defined as a single, well-circumscribed, discrete opacity $\leq$ 3 cm in diameter that is completely surrounded by lung parenchyma (no associated atelectasis, hilar enlargement, or pleural effusion) [1]. **Why Neurofibroma is the Correct Answer:** Neurofibromas are neurogenic tumors. While they can occur in the thorax, they are typically found in the **posterior mediastinum** or along the chest wall (intercostal nerves) [2]. Because they are not entirely surrounded by lung parenchyma and originate from extrapulmonary structures, they do not meet the strict radiological definition of an SPN [2]. **Analysis of Incorrect Options:** * **Hamartoma:** The most common benign tumor of the lung. It typically presents as a peripheral SPN with characteristic "popcorn calcification" on CT. * **Tuberculoma:** A common infectious cause of SPN in endemic regions like India. It represents a healed or persistent focus of tuberculosis, often showing "satellite lesions" or solid/laminar calcification. * **Bronchial Adenoma:** This is an older term for low-grade malignancies like **Carcinoid tumors**. These can present as peripheral solitary nodules, though they are often central and endobronchial. **NEET-PG High-Yield Pearls:** 1. **Size Matters:** If the lesion is $>3$ cm, it is termed a **Lung Mass**, which has a much higher risk of malignancy. 2. **Calcification Patterns:** Benign nodules often show popcorn (Hamartoma), concentric, or diffuse calcification. Eccentric or stippled calcification suggests malignancy. 3. **Doubling Time:** Malignant nodules typically double in volume between 20 to 400 days. Stability for $>2$ years is a strong indicator of benignity [1]. 4. **Management:** The first step in evaluating an SPN is always to **compare with previous chest X-rays/CT scans** [1].

Q: An 81-year-old woman presented with a 1-week history of vomiting. What is the most likely diagnosis?

Paraesophageal hernia. ***Paraesophageal hernia*** - **Retrocardiac gas bubble** with **air-fluid level** on chest X-ray in an elderly patient with vomiting is pathognomonic for paraesophageal hernia. - Common in elderly women, presents with **gastric volvulus** leading to **mechanical obstruction** and recurrent vomiting. *Lung abscess* - Would show a **cavitary lesion** with **thick walls** and air-fluid level within the **lung parenchyma**, not retrocardiac. - Associated with **fever**, **productive cough**, and **foul-smelling sputum**, which are not mentioned here. *Perforated duodenal ulcer* - Chest X-ray would show **pneumoperitoneum** (free air under the diaphragm), not a retrocardiac air-fluid level. - Presents with **sudden severe epigastric pain** and **peritoneal signs**, not isolated vomiting. *Epiphrenic diverticulum* - Rare condition affecting the **distal esophagus**, typically presents with **dysphagia** and **regurgitation**. - Would not cause the characteristic **retrocardiac gas bubble** seen with paraesophageal hernia on imaging.

Q: What does the "sea shore sign" on ultrasound indicate?

Normal lung. **Explanation:** The **"Sea Shore Sign"** is a characteristic finding on **M-mode (Motion mode)** ultrasonography of a **normal lung**. It represents the interface between stationary and moving structures: 1. **The "Sea" (Linear patterns):** The top half of the image consists of horizontal parallel lines representing the stationary chest wall tissues (skin, subcutaneous fat, and intercostal muscles). 2. **The "Shore/Beach" (Granular/Sandy appearance):** Below the hyperechoic pleural line, the image appears grainy or speckled. This "sandy" appearance is caused by the dynamic movement of the lung sliding against the pleura during respiration. **Analysis of Incorrect Options:** * **A. Pneumothorax:** In a pneumothorax, air separates the parietal and visceral pleura, abolishing lung sliding. On M-mode, this appears as horizontal parallel lines throughout the entire depth of the image (both above and below the pleural line), known as the **"Barcode Sign"** or **"Stratosphere Sign."** * **C. Pleural Effusion:** This typically presents as an anechoic (black) space between the parietal and visceral pleura. On M-mode, the lung may be seen floating in the fluid, often referred to as the **"Sinusoid Sign."** * **D. Pulmonary Edema:** This is characterized by **B-lines** (comet-tail artifacts) on B-mode ultrasound due to thickened interlobular septa. **High-Yield Clinical Pearls for NEET-PG:** * **Lung Sliding:** Its presence (B-mode) or the Sea Shore sign (M-mode) has a **100% Negative Predictive Value** for pneumothorax at that specific point. * **Lung Point:** This is the most specific sign of a pneumothorax, representing the transition zone where the lung begins to separate from the chest wall. * **A-Lines:** Horizontal hyperechoic lines (reverberation artifacts) seen in normal lungs or pneumothorax.

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: 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

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 2

Differential diagnosis of a solitary pulmonary nodule includes all of the following except?

Accepted Answer

Neurofibroma

Answer

Hamartoma

Answer

Tuberculoma

Answer

Bronchial adenoma

Question 3

An 81-year-old woman presented with a 1-week history of vomiting. What is the most likely diagnosis?

Accepted Answer

Paraesophageal hernia

Answer

Lung abscess

Answer

Perforated duodenal ulcer

Answer

Epiphrenic diverticulum

Question 4

What does the "sea shore sign" on ultrasound indicate?

Accepted Answer

Normal lung

Answer

Pneumothorax

Answer

Pleural effusion

Answer

Pulmonary edema

Question 5

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 6

Pallas sign is seen in which of the following conditions?

Accepted Answer

Pulmonary embolism

Answer

Sarcoidosis

Answer

Emphysema

Answer

Myeloma

Question 7

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 8

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 9

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 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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