LE 1 (Pulmonary System) Flashcards
Type of Kerley Line which are long oblique lines that are < 1mm thick and course towards the hila:
A. Kerley A
B. Kerley B
C. Kerley C
D. Kerley D
A. Kerley A
Rationale: Kerley A lines are long, oblique lines in the lungs that extend from the periphery towards the hila and are typically less than 1mm thick. They represent distension of anastomotic channels between peripheral and central lymphatics.
Type of Kerley line which are thin lines seen in the periphery of the lung on a frontal radiograph:
A. Kerley A
B. Kerley B
C. Kerley C
D. Kerley D
B. Kerley B
Rationale: Kerley B lines are short, horizontal lines found at the lung periphery, usually at the lung bases. They are indicative of interstitial edema and result from fluid in the interlobular septa.
What is the pattern of pulmonary airspace/alveolar edema seen when the opacities are present in the central region of the lung and abruptly marginate before reaching the periphery?
A. Butterfly sign
B. Triangle sign
C. Sail sign
D. Hampton Hump
A. Butterfly sign
Rationale: The butterfly sign, or batwing appearance, describes a pattern of pulmonary alveolar edema where opacities spread centrally in a perihilar distribution and abruptly marginated before reaching the lung periphery, resembling the shape of a butterfly.
- Butterfly Sign (Bat Wing Sign)
Description: Central pulmonary edema with opacities in the central region of the lungs that abruptly marginate before reaching the periphery, resembling butterfly wings.
Clinical Association: Pulmonary edema, typically due to congestive heart failure. - Hampton Hump
Description: A wedge-shaped, pleural-based opacity on the periphery of the lung, with the base against the pleural surface.
Clinical Association: Pulmonary embolism and subsequent infarction.
Type of pulmonary edema associated with rapid re-expansion after lung collapse:
A. Hydrostatic pulmonary edema
B. Neurogenic pulmonary edema
C. Flash pulmonary edema
D. Re-expansion pulmonary edema
D. Re-expansion pulmonary edema
Rationale: Re-expansion pulmonary edema occurs after the rapid re-expansion of a collapsed lung, typically due to the rapid removal of air or fluid from the pleural space.
Type of pulmonary edema associated with head trauma, seizure, or increased ICP:
A. Hydrostatic pulmonary edema
B. Neurogenic pulmonary edema
C. Flash pulmonary edema
D. Re-expansion pulmonary edema
B. Neurogenic pulmonary edema
Rationale: Neurogenic pulmonary edema is associated with acute central nervous system insults such as head trauma, seizures, or increased intracranial pressure (ICP). It is thought to result from a massive sympathetic discharge.
The following are characteristics of alveolar opacities except:
A. Patchy
B. Confluent
C. Reticular
D. NOTA
C. Reticular
Rationale: Alveolar opacities are typically patchy, confluent, or both. Reticular patterns, however, are characteristic of interstitial rather than alveolar involvement and are composed of interlacing lines.
Sign of pulmonary embolism where there is localized peripheral oligemia with or without distended proximal vessels:
A. Hampton Hump
B. Westermark sign
C. Fleischner sign
D. NOTA
B. Westermark sign
Rationale: The Westermark sign is a radiologic sign of pulmonary embolism characterized by localized decreased blood volume (oligemia) in a portion of the lung, sometimes accompanied by distended vessels proximal to the area of oligemia.
What can you see in a CT pulmonary angiography that is definitive for a pulmonary embolism?
A. Evidence of bronchiectasis
B. Filling defect within the lumen of a pulmonary artery
C. Ground-glass opacity
D. Reticular densities
B. Filling defect within the lumen of a pulmonary artery
Rationale: A filling defect within the lumen of a pulmonary artery on CT pulmonary angiography is definitive for the diagnosis of a pulmonary embolism, indicating the presence of a thrombus.
Radiographic finding of pulmonary venous hypertension at more than 25 mmHg:
A. Normal chest x-ray
B. Constriction of lower lobe vessels and dilatation of upper lobe vessels
C. Alveolar edema
D. Interstitial pulmonary edema
C. Alveolar edema
Rationale: The table indicates that at a pulmonary capillary wedge pressure (PCWP) of greater than 25 mmHg, the radiographic finding is alveolar edema.
Radiographic finding of pulmonary venous hypertension at 8 to 12 mmHg:
A. Normal chest x-ray
B. Constriction of lower lobe vessels and dilatation of upper lobe vessels
C. Alveolar edema
D. Interstitial pulmonary edema
A. Normal chest x-ray
Rationale: At pulmonary venous pressures of 8 to 12 mmHg, the chest x-ray is usually normal. Changes such as vascular redistribution and interstitial edema become more apparent at higher pressures.
Which of the following characteristics suggests that a solitary pulmonary nodule on the CT scan is indeterminate and requires further work-up?
A. Presence of Fat
B. Lamellated calcification
C. Presence of feeding artery
D. Spiculated margin
D. Spiculated margin
Rationale: Spiculated margins are often associated with malignant lesions and suggest that a solitary pulmonary nodule may be indeterminate, requiring further diagnostic work-up.
The most important factor in distinguishing benign from indeterminate pulmonary nodules is:
A. Density
B. Growth pattern
C. Margin
D. Size
A. Density
Rationale: States that density is the most important factor in characterizing a nodule as benign or indeterminate. This includes the patterns of calcification and the presence of fat within the solitary pulmonary nodule (SPN), which can help identify benign conditions such as pulmonary hamartoma.
A pulmonary nodule that presents peripherally on the CT scan, with significant contrast enhancement and suspicious malignant features, will most likely be:
A. Adenocarcinoma
B. Large cell carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
A. Adenocarcinoma
Rationale: Adenocarcinoma is a type of lung cancer that often presents as a peripheral nodule with contrast enhancement and other suspicious malignant features.
The likely diagnosis in a 59-year-old male smoker with atelectasis on the chest X-ray is:
A. Adenocarcinoma
B. Bronchioalveolar cell carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
D. Squamous cell carcinoma
Rationale: Squamous cell carcinoma is commonly associated with smokers and often presents with central lesions that can lead to atelectasis.
CT scan findings of pseudocavitation, heterogeneous CT attenuation with small lucencies, and an open bronchus is most likely due to:
A. Adenocarcinoma
B. Bronchioalveolar cell carcinoma
C. Small cell carcinoma
D. Squamous cell carcinoma
B. Bronchioalveolar cell carcinoma
Rationale: Bronchioalveolar cell carcinoma can present with these CT findings, characterized by pseudocavitation and heterogeneous attenuation.
Concomitant tumor developing in or near a pulmonary tuberculosis lesion is suspected when:
A. Absence of hilar lymphadenopathy is noted
B. Increase in the size of the lesion is noted despite treatment
C. Multidrug-resistant TB is considered
D. Sputum examination or GeneXpert test is negative
B. Increase in the size of the lesion is noted despite treatment
Rationale: An increase in the size of a lesion despite appropriate TB treatment raises suspicion for a concomitant tumor.
Multifocal opacities with interspersed normal and diseased lobules, seen as a patchwork quilt pattern, is typically seen in:
A. COVID pneumonia
B. Mycoplasma pneumonia
C. Staphylococcal pneumonia
D. Streptococcal pneumonia
C. Staphylococcal pneumonia
Rationale: The description of multifocal opacities with interspersed normal and diseased lobules creating a “patchwork quilt” appearance is typical of bronchopneumonia, which is often associated with staphylococcal pneumonia. This pattern results from exudative fluid extending peripherally along the bronchi to involve the entire lobule.
Based on published studies, the most common feature of COVID pneumonia on the chest X-ray is:
A. Bilateral
B. Consolidation
C. Ground-glass opacities
D. Reticulonodular opacities
C. Ground-glass Opacities
Rationalization: Ground-glass opacities (GGOs) are areas of hazy lung opacity that do not obscure the underlying bronchial structures or pulmonary vessels. GGOs are a hallmark of COVID-19 pneumonia, especially in the early and progressive stages of the disease.
Clinical Evidence: Numerous studies and reports highlight GGOs as the most common radiographic finding in COVID-19 pneumonia. These opacities are typically bilateral and peripheral.
Conclusion: This is the correct answer as GGOs are consistently reported as the most common feature of COVID-19 pneumonia on chest X-rays.
Patients with sickle cell disease or post-splenectomy patients have a higher risk for developing:
A. Mycoplasma pneumonia
B. Pseudomonas pneumonia
C. Staphylococcal pneumonia
D. Streptococcal pneumonia
D. Streptococcal pneumonia
Rationale: Sickle cell disease and post-splenectomy patients are more susceptible to infections with encapsulated organisms like Streptococcus pneumoniae.
Chest X-ray and CT scan findings of patchy lung opacities with abscess formation in an intubated patient is most likely due to:
A. Mycoplasma pneumonia
B. Pseudomonas pneumonia
C. Staphylococcal pneumonia
D. Streptococcal pneumonia
B. Pseudomonas pneumonia
Rationale: Pseudomonas pneumonia is known for causing patchy lung opacities and abscess formation, especially in hospitalized or intubated patients.
Intravenous drug users or patients with indwelling catheters have a higher risk for developing:
A. Mycoplasma pneumoniae
B. Staphylococcal pneumoniae
C. Streptococcus pneumoniae
D. Tuberculous pneumoniae
B. Staphylococcal pneumoniae
Rationale: Intravenous drug users and patients with indwelling catheters are at higher risk for staphylococcal infections, which can lead to staphylococcal pneumonia.
Primary tuberculosis infection in children results from:
A. Erosion of a cavity into a pulmonary artery
B. Granulomatous response to mycobacterium
C. Reactivation of phagocytized mycobacterium
D. Transbronchial spread of multifocal tuberculous bronchopneumonia
B. Granulomatous response to mycobacterium
Rationale: Primary tuberculosis infection in children typically results from a granulomatous response to the Mycobacterium tuberculosis bacterium.
Hematogenous dissemination of the tubercle bacilli to the lungs will present on X-ray as:
A. Cavitation with air-fluid level
B. Diffuse tiny nodules
C. Ill-defined patchy and nodular opacities
D. Parenchymal disease with lymphadenopathies
B. Diffuse tiny nodules
Rationale: Hematogenous dissemination of tubercle bacilli results in miliary tuberculosis, which presents on X-ray as diffuse tiny nodules throughout the lungs.
_emphysema is the most common type that is predominantly seen in the upper lobes of smokers:
A. Alpha-1 Antitrypsin Deficiency (AATD)
B. Centrilobular
C. Paraseptal
D. Panlobular
B. Centrilobular
Rationale: Centrilobular emphysema is the most common type associated with smoking and predominantly affects the upper lobes.
Which imaging modality is a practical method for quantification of pleural effusion?
A. MRI
B. Radiograph in apicolordotic view
C. Radiograph in anteroposterior view
D. Ultrasound
D. Ultrasound
Rationale: Ultrasound is a practical and effective method for quantifying pleural effusion, allowing for real-time assessment and guidance for thoracentesis.
Why is a CT scan indicated for a patient with spontaneous pneumothorax?
A. To assess for presence of fluid in cases of pneumo-hydrothorax
B. To rule out secondary causes such as bullous diseases
C. To quantify the pneumothorax
D. To detect rib fractures in cases of trauma
B. To rule out secondary causes such as bullous diseases
Rationale: A CT scan is indicated to rule out secondary causes such as bullous diseases, which can be the underlying cause of a spontaneous pneumothorax.
Which film is appropriate to differentiate minimal right-sided pleural effusion with pleural thickening at the right costophrenic sulcus?
A. Cross table lateral
B. Apicolordotic view
C. Lateral decubitus film, left side down
D. Lateral decubitus film, right side down
D. Lateral decubitus film, right side down
Rationale: A lateral decubitus film with the right side down helps differentiate minimal pleural effusion from pleural thickening by allowing fluid to layer out and become more apparent.
There are () pulmonary veins which carry () blood, while () pulmonary arteries carry () blood:
A. (2) deoxygenated, (4) oxygenated
B. (4) deoxygenated, (2) oxygenated
C. (2) oxygenated, (4) deoxygenated
D. (4) oxygenated, (2) deoxygenated
D. (4) oxygenated, (2) deoxygenated
Rationale: There are four pulmonary veins that carry oxygenated blood to the heart, while two pulmonary arteries carry deoxygenated blood from the heart to the lungs.
What is the basic anatomic unit of pulmonary structure and function that can be assessed with a CT scan?
A. Alveoli
B. Secondary lobule
C. Bronchiole
D. Bronchial-alveolar complex
B. Secondary lobule
Rationale: The secondary lobule is the basic anatomic unit of pulmonary structure and function that can be assessed with a CT scan, consisting of a cluster of acini supplied by a terminal bronchiole.
What is the normal broncho-arterial ratio?
A. Greater than 1.0
B. 0.67 to 0.70
C. 0.8 to 1.2
D. 0.25 to 0.5
C. 0.8 to 1.2
Rationale: The normal broncho-arterial ratio ranges from 0.8 to 1.2, which indicates a balanced size between the bronchi and their accompanying arteries.
A B/A ratio of greater than one is indicative of:
A. Bronchiectasis
B. Pulmonary Congestion
C. Pneumonia
D. Pulmonary Tuberculosis
A. Bronchiectasis
Rationale: A broncho-arterial (B/A) ratio greater than one suggests bronchiectasis, where the bronchi are abnormally dilated compared to the accompanying pulmonary arteries.
Which of these is a direct sign of atelectasis?
A. Mediastinal shift
B. Narrowing of intercostal spaces
C. Increased opacification
D. Elevation of ipsilateral diaphragm
C. Increased opacification
Rationale: Increased opacification on a chest radiograph is a direct sign of atelectasis, indicating collapsed lung tissue.
Which of the following radiographic findings depicts a positive “silhouette sign”?
A. Obliteration of the cardiac border in right middle lobe pneumonia
B. Obliteration of the right cardiac border in lingular pneumonia
C. Obliteration of the right cardiac border in right lower lobe pneumonia
D. Obliteration of the right cardiac border in right perihilar pneumonia
A. Obliteration of the cardiac border in right middle lobe pneumonia
Rationale: The silhouette sign occurs when the normal borders between structures of different densities are obliterated. In right middle lobe pneumonia, the cardiac border is obscured.
Air appears as what on chest radiographs?
A. Anechoic
B. Hyperintense
C. Radiolucent
D. Radiopaque
C. Radiolucent
Rationale: On chest radiographs, air appears radiolucent (black) because it does not absorb X-rays, allowing them to pass through and reach the film or detector.
Fluid looks bright (“white”) on which weighted image?
A. T1
B. T2
C. Both
D. None
B. T2
Rationale: On T2-weighted MRI images, fluid appears bright (white) because it has a high signal intensity due to the long T2 relaxation time of water.
What is the radiologic diagnosis of the chest x-ray of a young student with dyspnea?
A. Emphysema
B. Pneumonia
C. Pneumothorax
D. Pulmonary tuberculosis
C. Pneumothorax
Rationale: A young student presenting with dyspnea and a chest X-ray showing a visible pleural line with no lung markings peripheral to this line is indicative of a pneumothorax.
Bones appear as what on X-rays?
A. Anechoic
B. Hyperintense
C. Radiolucent
D. Radiopaque
D. Radiopaque
Rationale: Bones appear radiopaque (white) on X-rays because they absorb a significant amount of X-rays, preventing them from reaching the film or detector.
