Cardiothoracic and Vascular - Warm Up

Question 1

1. Chest X-ray appearances of left atrial enlargement include: (T/F)

a) Splaying of the carina

b) A double shadow of the right heart border

c) Rounding of the apex of the heart

d) Filling in of the concavity of the left heart border above the left main bronchus

e) Displacement of the descending aorta to the left

Answer 1

1.
a) True

b) True

c) False - this is a sign of left ventricular enlargement

d) False this is a feature of enlargement of the infundibulum of the right ventricle. Left atrial enlargement with specific enlargement of the left atrial appendage occurs below the main bronchus

e) True - but rare

Diagnostic Radiology. A Textbook of Medical Imaging. 4th edition. Grainger and Allison.
Churchill Livingstone. 2001: 683-7.

Question 2

2. Features of mycotic aneurysms include: (T/F)

a) Fusiform structure

b) Gradual enhancement with contrast

c) Adjacent vertebral osteomyelitis

d) Adjacent reactive lymph node enlargement

e) Tuberculosis is the commonest infective organism

Answer 2

2.

a) False - saccular

b) False - rapid contrast enhancement

d) True

e) True

f) False - Staphylococcus aureus. It is associated with intravenous drug abuse/subacute bacterial endocarditis

Radiology Review Manual. 5th edition. Dahnert. Lippincott, Williams and Wilkins, 2003: 606.

Question 3

3. The following are true concerning ultrasound: (T/F)

a) The frequency of ultrasound used for medical imaging is in the range of 25-40 MHz

b) The velocity of ultrasound waves is proportional to frequency

c) The velocity of sound in soft tissues is 330 metres per second

d) Acoustic impedance is proportional to density

e) At increased frequency there is decreased attenuation of sound waves

Answer 3

3.

a) False - 1 - 20 MHz

b) False

c) False - 1540 metres per second

d) True

e) False - increased attenuation

Physics for Medical Imaging. Farr, Allisy-Roberts. Bailliere Tindeli, 1996: 183-213.

Question 4

4. Buerger’s disease (thrombo-angitis obliterans): (T/F)

a) Is associated with cigarette smoking in 90-95%

b) More commonly affects the upper limb

c) Initially affects the proximal vessels and progresses distally

d) Has multiple corkscrew-shaped collaterals on angiography

e) Has skip lesions as a recognized feature

Answer 4

4.

a) True

b) False - 80% affect the lower limb

c) False initially affects the distal vessels and progresses proximally

d) True

e) True

Radiology Review Manual. 5th edition Dahnert. Lippincott, Williams and Wilkins, 2003: 616.

Question 5

5. Conditions associated with aortic regurgitation include: (T/F)

a) Syphilitic aortitis

b) Ankylosing spondylitis

c) Reiter’s syndrome

d) Tuberous sclerosis

e) Rheumatoid arthritis

Answer 5

5.

a) True

b) True

c) True

d) False

e) True

Radiology Review Manual. 5th edition. Dahnert. Lippincott, Williams and Wilkins, 2003: 610-
1.

Question 6

6. Regarding aortic dissection: (T/F)

a) The Stanford Classification Type B aortic dissection involves the ascending aorta

b) Aortic dissections involving the ascending aorta account for 60-70%

c) Contrast-enhanced CT is more accurate than transoesophageal echocardiography at identifying aortic dissections

d) There is an increased risk in Ehlers-Danlos syndrome

e) Displacement of calcification in the aortic knuckle by >10 mm is a useful sign

Answer 6

6.

a) False - Type A involves the ascending aorta

b) True

c) False

d) False - in Ehlers-Danlos syndrome there is an increased risk of aneurysms but not dissection

e) True

Diagnostic Radiology. A Textbook of Medical Imaging. 4th edition. Grainger and Allison.
Churchill Livingstone, 2001: 956-8.

Question 7

7. Causes of a large left ventricle include: (T/F)

a) ASD

b) VSD

c) PDA

d) Thyrotoxicosis

e) Myocarditis

Answer 7

7.

a) False

b) True

c) True

d) True

e) True

Diagnostic Radiology. A Textbook of Medical Imaging. 4th edition. Grainger and Allison.
Churchill Livingstone, 2001: 682-9.

Question 8

8. Regarding renal artery stenosis: (T/F)

a) There is an association with neurofibromatosis

b) Fibromuscular dysplasia causes stenosis of the proximal renal artery

c) There is elevation of the renin levels on renal vein sampling of the affected kidney by 50%

d) On IVU, there is early appearance of contrast material in the affected kidney

e) Duplex ultrasound is the investigation of choice

Answer 8

8.

a) True

b) False - stenosis is seen in the mid and distal renal artery. In atherosclerotic disease, stenosis is seen in the proximal renal artery

c) True

d) False - there is delay due to reduced glomerular filtration rate.

e) False - MRI is the investigation of choice. Ultrasound is inadequate in up to 50%

Radiology Review Manual. 5th edition. Dahnert. Lippincott, Williams and Wilkins, 2003: 947-
50.

Question 9

9. The following statements regarding subclavian steal syndrome are true: (T/F)

a) It is most commonly due to congenital abnormalities

b) On ultrasound there is reversal of contralateral vertebral artery flow

c) Partial steal syndrome is characterised by retrograde flow in systole and antegrade flow in diastole in the vertebral artery

d) There is an association with syphilitic arteritis

e) There are additional lesions of extracranial arteries in 80-90%

Answer 9

9.
a) False - atherosclerosis accounts for >90%

b) False - reversal of ipsilateral vertebral artery flow

c) True

d) True

e) True

Radiology Review Manual. 5th edition. Dahnert. Lippincott, Williams and Wilkins, 2003; 647-
8.

Question 10

10. Concerning carotid artery ultrasound: (T/F)

a) A low frequency linear probe is used

b) Ultrasound tends to underestimate the degree of stenosis relative to angiography

c) Patients with stenosis of more than 70% of the internal carotid artery are expected to benefit from surgical repair

d) An increase in stenosis of the internal carotid artery is characterised by a reduction in the peak diastolic velocity

e) At the carotid bifurcation, the external carotid artery lies deep to the internal carotid artery

Answer 10

10.

a) False - high frequency linear probe

b) False - overestimates degree of stenosis

c) True - some symptomatic patients with 60-70% stenosis may also have some benefit

d) False - an increase in the peak diastolic and systolic velocity

e) False - internal carotid artery lies deep

Sabeti, et al. Quantification of Internal Carotid Artery Stenosis with Duplex Ultrasound. Radiology 2004; 232: 431-9.

Question 11

@# 11. The following conditions are associated with atrial septal defects: (T/F)

a) Turner’s syndrome

b) Down’s syndrome

c) Klippel-Feil syndrome

d) Noonan syndrome

e) Von Recklinghausen’s disease

Answer 11

11.

a) False

b) True - ostium primum defect

c) True. Klippel-Feil syndrome (KFS) is a rare skeletal disorder characterized by the congenital fusion of two or more vertebrae of the cervical spine within the neck.

d) True. Noonan syndrome (NS) is a genetic disorder that may present with mildly unusual facial features, short height, congenital heart disease, bleeding problems, and skeletal malformations.

e) False. Neurofibromatosis 1 (NF1), historically called von Recklinghausen’s disease, is a genetic disorder characterized by increased risk of developing noncancerous (benign) and cancerous (malignant) tumors, as well as various other physical and neurological manifestations.

Radiology Review Manual. 5th edition. Dahnert. Lippincott, Williams and Wilkins, 2003: 568- 9.

Question 12

12. Regarding iodinated intravenous contrast agents: (T/F)

a) Non-ionic, low osmolar agents are 5-10 times safer than high osmolar ionic agents

b) Patients are advised to remain in the department for at least 15 minutes after the injection

c) There is a specific cross-reactivity between shellfish and low osmolar contrast agents

d) Metformin should be withheld 48 hours before and after intravenous contrast, if serum creatinine is normal in a diabetic patient

e) Breast feeding should be suspended for 7 days following contrast

Answer 12

12.

a) True

b) True - if high risk then should stay in department for at least 30 minutes after the injection

c) False

d) False - if serum creatinine is elevated then this is the case. If serum creatinine is normal then it should be simply omitted for 48 hours after contrast injection

e) False - only a very small percentage enters the breast milk and almost none is absorbed across the gastrointestinal tract

Question 13

13. Features of primary pulmonary hypertension include: (T/F)

a) Right descending pulmonary artery more than 25 mm wide on plain radiograph

b) Oligaemia

c) Pulmonary artery wider than the aorta on CT images

d) Dilatation of subsegmental vessels on angiography

e) Mosaic attenuation of the lungs on high resolution CT (HRCT)

Answer 13

13.

a) True

b) True

c) True

d) False - there is pruning/tapering of subsegmental vessels

e) True - due to localised variations in lung perfusion

Radiology Review Manual. 5th edition. Dahnert. Lippincott, Williams and Wilkins, 2003: 643-
4.

Question 14

14. Causes of oligaemia (decreased pulmonary blood flow) with cyanosis include: (T/F)

a) Truncus arteriosus

b) Transposition of great vessels

c) Total anomalous pulmonary venous return

d) Aortic atresia

e) Tetralogy of Fallot

Answer 14

14.

a) False - plethora and cyanosis

b) False - plethora and cyanosis

c) False - plethora and cyanosis

d) False - plethora and cyanosis

e) True

Aids to Radiological Differential Diagnosis. 4th edition. Chapman and Nakielny. W.B. Saunders, 2003: 209.

Question 15

15. Regarding calcification of the aortic valve: (T/F)

a) Bicuspid aortic valve is the commonest cause of aortic valve calcification in patients <30 years of age

b) Rheumatic valve disease is the commonest cause of aortic valve calcification in patients 30-60 years of age

c) Post-stenotic dilatation of the ascending aorta is usually associated with degenerative aortic valve stenosis

d) On a PA chest radiograph the aortic valve lies superior and medial to the pulmonary valve

e) On a lateral chest radiograph the aortic valve lies superior and posterior to the mitral valve

Answer 15

15.

a) True

b) True - in patients >65 years of age, aortic valve calcification is due to atherosclerosis in 90%

c) False - associated with bicuspid aortic valve

d) False - inferior and medial to the pulmonary valve, superior to mitral and tricuspid valves

e) False - superior and anterior to the mitral valve

Question 16

@# 16. The following are features of cardiac angiosarcoma: (T/F)

a) Involves the pericardium in 10-20%

b) Metastasises in 5-10%

c) Most commonly found in the left atrium

d) Usually has a homogenous enhancement pattern on CT

e) Commonly presents in children 3-8 years old

Answer 16

a) False - pericardial involvement in 80%

b) False - metastases at presentation in 70-90%

c) False - right atrium

d) False - heterogenous with central necrosis, haemorrhage

e) False - disease of middle-aged men. Rarely seen in children

Question 17

@# 17. The following statements regarding primary cardiac lymphoma are true: (T/F)

a) It usually affects children 5-10 years of age

b) It is typically of non-Hodgkin’s type

c) The right ventricle is the most typical location

d) More than one chamber is affected in less than 5% of patients

e) It presents as a hyperechoic nodule on ultrasound

Answer 17

17.
a) False - mean - mean age is 60 years of age
b) True
c) False - the right atrium is commonest location
d) False - multiple chambers are involved in up to 75% of patients
e) False-hypoechoic

Question 18

18. The following structures are enlarged on a PA chest radiograph of a patient with a patent ductus arteriosus: (T/F)

a) Ascending aorta

b) Aortic arch

c) Left atrium

d) Left ventricle

e) Left pulmonary artery

Answer 18

18.
a) True
b) True
c) True
d) True
e) True - right ventricle and atrium will also dilate with pulmonary hypertension Fundamentals of Diagnostic Radiology. 2nd edition. Brant and Helms, Lippincott, Williams and Wilkins, 1999: 532-5.

Question 19

19. Regarding the pulmonary arteries: (T/F)

a) The main pulmonary artery is completely confined within the pericardium

b) The right pulmonary artery passes posterior to the superior vena cava

c) The lingula is supplied by the ascending branch of the left pulmonary artery

d) A Judkins-type catheter is commonly used for pulmonary angiography

e) Pulmonary artery pressure of >70 mmHg is a relative contraindication to pulmonary angiography

Answer 19

19.
a) True

b) True-posterior to the aorta and superior vena cava

c) False - descending branch supplies lingula and lower lobe

d) False - a pigtail catheter is used. Judkins catheters are used for coronary artery angiography

e) True - other contraindications include left bundle branch block, bleeding abnormalities, right ventricular end-diastolic pressure >20 mm Hg and renal insufficiency

Question 20

20. Causes of thymic hyperplasia include: (T/F)

a) Addison’s disease

b) Graves’ disease

c) Acromegaly

d) Diabetes

e) Post-chemotherapy

Answer 20

20.
a) True
b) True
c) True
d) False
e) True

Question 21

@# 21. Fibrosis predominantly affecting the upper lobes is seen in: (T/F)

a) Rheumatoid arthritis

b) Tuberculosis

c) Bronchopulmonary aspergillosis

d) Sarcoidosis

e) Amiodarone-induced lung fibrosis

Answer 21

21.
a) False - lower lobe
b) True
c) True
d) True
e) False lower lobe

Question 22

22. Regarding anatomy of the diaphragm: (T/F)

a) The left crus of the diaphragm attaches to the body and discs of L1, L2 and L3 vertebrae

b) The lateral arcuate ligament is a thickening of the fascia over quadratus lumborum

c) The central tendon is fused with the pericardium

d) The inferior vena cava pierces the diaphragm with the right phrenic nerve.

e) Partial reduplication of the diaphragm is commoner on the right side

Answer 22

22.
a) False - the right attaches to L1-L3 and the left attaches to L1 and L2
b) True - the medial arcuate ligament is a thickening of the fascia over the psoas muscle
c) True
d) True - at the level of T8. Oesophagus pierces diaphragm at T10 and aorta, azygous vein and thoracic duct at T12
e) True - this is also known as accessory hemidiaphragm

Question 23

23. The following are causes of a cavitating lung lesion: (T/F)

a) Carcinoma of the bronchus

b) Wegener’s granulomatosis

c) Rheumatoid nodule

d) Hamartoma

e) Sarcoidosis

Answer 23

23.
a) True
b) True
c) True
d) False
e) True

Question 24

24. Regarding Goodpasture’s syndrome: (T/F)

a) Hilar lymph nodes may be enlarged

b) Acute presentation is with air-space consolidation typically at the lung apices

c) Signs of renal failure precede pulmonary complaints

d) Changes are commonly unilateral

e) Prognosis is good

Answer 24

24.
a) True - during acute episodes
b) False - the apices are usually spared
c) False - pulmonary features present before renal
d) False - bilateral
e) False - poor prognosis, usually death within 3 years of diagnosis

Question 25

25. The following statements regarding pulmonary hamartomas are correct: (T/F)

a) 5-10% undergo malignant transformation

b) Calcification is seen in 30-35%

c) 80% are located endobronchially

d) 95% are identified in patients over 40 years

e) Central fat density is identified on CT imaging

Answer 25

25.
a) False - benign lesions
b) True
c) False - less than 10% are endobronchial. 90% are intrapulmonary and usually within 2 cm
of the pleura
d) True
e) True

Question 26

@# 26. Regarding pulmonary Infections: (T/F)

a) The characteristic pattern of Legionella pneumophila is air space opacification which is initially peripheral

b) Klebsiella pneumonia can present with a bulging interlobar fissure

c) Pseudomonas pneumonia has a predilection for the upper lobes

d) Progressive primary pulmonary tuberculosis is most common in neonates

e) In primary tuberculosis, unilateral pleural effusions are seen in 25% of cases

Answer 26

26.
a) True
b) True
c) False
d) False - most common in older children/teenagers
e) True

Question 27

27. Regarding lymphangioleiomyomatosis: (T/F)

a) It is found exclusively in females

b) Pulmonary abnormalities are similar to those seen in tuberous sclerosis

c) Cysts commonly have a bizarre outline

d) Cysts show sparing of the apices

e) There is an association with chylothorax

Answer 27

27.
a) True
b) True
d) False - usually uniform round cysts. In Langerhans’ cell histiocytosis the cysts have bizarre irregular outlines
e) False - cysts are uniformly distributed. In Langerhans’ cell histiocytosis there is sparing of the apices
f) True

Question 28

28. Regarding ventilation/perfusion imaging: (T/F)

a) The 99Tc-DTPA aerosol scan is performed before the perfusion study

b) 81m-Krypton is the cheapest available aerosol for ventilation scanning

c) Severe pulmonary hypertension is a contraindication to ventilation/perfusion scanning

d) Blood should be drawn into the syringe prior to injection of radioisotope for perfusion scanning

e) For the perfusion scan, the patient must remain in position for 15-20 minutes before particles become fixed in the lungs

Answer 28

28.
a) True
b) False - expensive and limited availability, but does allow for a simultaneous ventilation and perfusion scan
c) True
d) False - this must be avoided to prevent clumping
e) False - the patient must remain in position for 2-3 minutes, then imaged in the sitting position

Question 29

29. Regarding respiratory CT: (T/F)

a) HRCT uses 1 mm slices at 10-20 mm intervals

b) Spatial resolution of HRCT is maximised by using a small field of view

c) 50 ml of contrast medium is used for a CT pulmonary angiogram

d) High resolution CT is performed in full expiration

e) CT-guided lung biopsy can be performed as an outpatient with no patient preparation required

Answer 29

29.
a) True
b) True
c) False - 150 ml of contrast medium is used
d) False - in full inspiration
e) False - clotting screen is required before the procedure but it can be performed as an outpatient

Question 30

30. Causes of ground glass opacity on high resolution CT include: (T/F)

a) Sarcoidosis

b) Alveolar proteinosis

c) Pulmonary haemorrhage

d) Lymphoma

e) Pneumocystis carinii pneumonia

Answer 30

30. a) True
    b) True
    c) True
    d) True
    e) True

Question 31

31. Regarding the plain chest radiograph: (T/F)

a) The lateral radiograph is more sensitive than the erect PA film at detecting pleural fluid

b) A supine view of the chest is most sensitive in detecting pneumothoraces

c) On an erect film an azygous vein of>10 mm in diameter is seen in right heart failure

d) The lateral chest radiograph is more sensitive than the erect PA film at detecting free intraperitoneal gas

e) Small pneumothoraces are better visualised on an inspiratory view

Answer 31

31.
a) True - 50 ml of pleural fluid can be seen on the lateral radiograph and 200 ml of pleural fluid on the erect film
b) False
c) True - presents as an ovoid deformity above the right main bronchus
d) True - free intraperitoneal gas is seen on 98% of lateral chest radiographs and 80% of erect PA films
e) False - expiratory view

Question 32

@# 32. Causes of eggshell calcification of lymph nodes include: (T/F)

a) Rheumatoid arthritis

b) Silicosis

c) Histoplasmosis

d) Amyloidosis

e) Scleroderma

Answer 32

32.
a) False
b) True
c) True
d) True
e) True

Question 33

33. The following are features of lymphocytic interstitial pneumonitis: (T/F)

a) Association with Sjögren’s syndrome

b) The course in children is more aggressive than in adults

c) Pleural effusions are seen in more than 90%

d) Lymph node enlargement is common

e) Appearance is of bilateral reticulonodular shadowing most pronounced in the mid andlower zones

Answer 33

33.
a) True
b) False - more aggressive in adults
c) False - pleural effusions are seen in 15%
d) False - lymph node enlargement is not seen. If present it should raise the suspicion of lymphoma
e) True

Question 34

34. These chest X-ray signs are associated with the following abnormalities: (T/F)

a) Corona radiata spiculations - primary malignancy

b) Air bronchogram - lymphoma

c) Central calcification - granuloma

d) Decrease in size over time - benign lesion

e) Vessels leading to a mass - rheumatoid nodule

Answer 34

34.
a) True
b) True
c) True - peripheral calcification is associated with malignancy
d) True
e) False - AV malformation

Question 35

35. Causes of a left-sided pleural effusion include: (T/F)

a) Rupture of the oesophagus

b) Dissecting aneurysm of the aorta

c) Pancreatitis

d) Gastric neoplasm

e) Transection of the proximal thoracic duct

Answer 35

35.
a) True
b) True
c) True
d) True
e) False-right-sided effusion

Question 36

@# 36. Concerning bronchial adenomas: (T/F)

a) They can arise in the trachea

b) 80-90% are located centrally in the lung

c) Lesions do not enhance on contrast-enhanced CT

d) Haemoptysis is the presenting feature in 10-15% of patients

e) On CT images, peripheral calcification is seen in 70-80%

Answer 36

36.
a) True
b) True
c) False - there is marked enhancement
d) False - features in 40-50% of patients
e) False - peripheral calcification is seen in 30-35%

Question 37

37. Squamous cell carcinoma of the lung: (T/F)

a) Is most often centrally located

b) Has the highest incidence of distant metastases

c) Is the most likely cell type to cause a Pancoast tumour

d) Is the most likely cell type to cause superior venous obstruction

e) Is the commonest lung tumour to cavitate

Answer 37

37.
a) True
b) False - lowest
c) True
d) False - small cell carcinoma is the most likely cell type to cause superior venous
obstruction
e) True

Question 38

38. Regarding bronchogenic cysts: (T/F)

a) Mediastinal bronchogenic cysts account for 85-90%

b) They are associated with spina bifida

c) They may contain air fluid levels

d) Mediastinal bronchogenic cysts are more common on the left

e) Intrapulmonary bronchogenic cysts are found more commonly in the lower lobes

Answer 38

38.
70.
a) True - intrapulmonary bronchogenic cysts account for 15%
b) True
c) True
d) False - more common on the right
e) False - more common in the upper lobes

Question 39

39. The following are features of round pneumonia: (T/F)

a) More common in adults than children

b) Haemophilus influenzae is a causative agent

c) Usually located in the upper lobes

d) Demonstrate a gradual increase in size

e) Posterior location

Answer 39

39.
a) False
b) True
c) False - usually in the lower lobes
d) False - rapid increase in size
e) True

Question 40

40. Causes of haemorrhagic lung metastases include: (T/F)

a) Choriocarcinoma

b) Renal cell carcinoma

c) Melanoma

d) Cervical carcinoma

e) Thyroid carcinoma

Answer 40

40.
a) True
b) True
c) True
d) False
e) True

Question 41

41. Features of pulmonary asbestosis include: (T/F)

a) Increased severity in sub-pleural zones

b) Upper lobe massive fibrosis

c) Hilar adenopathy

d) Thickened interlobular septa on HRCT

e) Increased incidence of bronchio-alveolar cell carcinoma

Answer 41

41.
a) True - asbestos fibres have their highest concentrations under the pleura
b) False - lower lobe fibrosis
c) False - no hilar adenopathy
d) True
e) True

Question 42

42. Features of Pneumocystis carinii include: (T/F)

a) Prophylactic use of pentamidine redistributes infection to upper lobes

b) Pleural effusion

c) Hilar lymphadenopathy

d) Pneumatocoeles seen in 10-15% of patients

e) Spontaneous pneumothorax in 30-40%

Answer 42

42.
a) True
b) False
c) False
d) True
e) False - spontaneous pneumothorax in 5%

Question 43

43. The following statements concerning emphysema are true: (T/F)

a) Location of the right hemidiaphragm below the anterior aspect of the 6th rib is a sign of overinflation

b) Centrilobular emphysema is related to alpha-1 antitrypsin deficiency

c) Panlobular emphysema is related to cigarette smoking

d) Centrilobular emphysema has a lower lobe predominance

e) Paraseptal emphysema in young adults can present with spontaneous pneumothorax

Answer 43

43.
a) False - 7th rib
b) False - centrilobular emphysema is related to cigarette smoking
c) False - panlobular emphysema is related to alpha-1 antitrypsin deficiency
d) False - centrilobular emphysema has an upper lobe predominance
e) True

Question 44

44. Causes of an apical pleural cap include: (T/F)

a) Traumatic aortic rupture

b) Pancoast tumour

c) Upper lobe collapse

d) Fibrosing mediastinitis

e) Mediastinal lipomatosis

Answer 44

44. a) True
    b) True
    c) True
    d) False
    e) True

Question 45

45. The following pulmonary tumours are benign: (T/F)

a) Leiomyoma

b) Plasma cell granuloma

c) Askin tumour

d) Kaposi sarcoma

e) Squamous papilloma

Answer 45

45.
a) True
b) True
c) False - Askin tumor is an uncommon malignant neoplasm of a neuroectodermic origin that arises from the soft tissues of the thoracopulmonary wall
d) False
e) True

Question 46

@# 46. Features of Wegener’s granulomatosis include: (T/F)

a) Focal glomerulonephritis

b) Migratory polyarthropathy

c) Marked lymphadenopathy

d) Multiple pulmonary nodules with upper lobe predominance

e) Pleural effusion in 3-5%

Answer 46

46.
Churchill Livingstone, 2001: 476-9.
a) True
b) True
c) False - lymphadenopathy is rare
d) False - multiple pulmonary nodules with lower lobe predominance
e) False - pleural effusion in 25%

Question 47

47. Causes of inferior rib notching include: (T/F)

a) Coarctation of the aorta

b) Systemic sclerosis

c) Blalock-Taussig shunt

d) Neurofibromatosis Type 1

e) Superior vena caval obstruction

Answer 47

47.
a) True
b) False
c) True
d) True
e) True

Question 48

48. Causes of a posterior mediastinal mass include: (T/F)

a) Aneurysm of the ascending aorta

b) Neuro-enteric cyst

c) Neurofibroma

d) Phaeochromocytoma

e) Teratoma

Answer 48

48.
a) False - aneurysm of the descending aorta
b) True
c) True
d) True
e) False - anterior mediastinal mass

Question 49

49. Concerning lymphoma: (T/F)

a) Hodgkin’s disease is more common in the chest than non-Hodgkin’s disease

b) Lymph node calcification occurs

c) Posterior mediastinal lymph nodes favour lymphoma rather than sarcoidosis

d) Intrapulmonary lymphoma can present with massive pneumonia-like lobar infiltrates

e) Miliary nodules can be the presenting appearance on chest X-ray

Answer 49

49.
a) True
b) True-post-radio/chemotherapy
c) False - anterior mediastinal lymph nodes favour lymphoma
d) True
e) True

Question 50

50. The following statements concerning adult respiratory distress syndrome (ARDS) are true: (T/F)

a) Characteristically, there is a 12-hour delay between clinical onset and chest X-ray abnormalities

b) It is associated with large pleural effusions

c) Pancreatitis is a recognized cause

d) Change is usually unilateral

e) Air bronchograms are more commonly seen in cardiogenic pulmonary oedema than ARDS, allowing differentiation from left heart failure

Answer 50

50.
a) True
b) False - no pleural effusion
c) True
d) False - bilateral but asymmetrical
e) False - air bronchograms are more commoner in ARDS