Radiology

Question 1

What does flattening of the hemidiaphragm suggest?

Answer 1

Increased intrathoracic pressure, e.g. from hyper expansion, or tension pneumothorax

Question 2

Where are central lines commonly inserted?

Answer 2

Internal jugular vein

Question 3

What are the features of pulmonary oedema and CCF?

Answer 3

Airspace and interstitial shadowing
Kelley B lines
Cardiomegaly
Pleural effusions
Fluid in the horizontal fissure

Question 4

What are the features of tension pneumothorax compared to simple pneumothorax?

Answer 4

Tracheal/mediastinal shift away from side

Flattening of the ipsilateral hemidiaphragm

Question 5

What are features of a lobe collapse?

Answer 5

Raised hemidiaphragm ipsilaterally
Trachea/mediastinal shift toward side
Displacement of hila
Rib space narrowing on side

Question 6

What sign is seen in left upper lobe collapse?

Answer 6

Veil sign

Question 7

What sign is seen in left lower lobe collapse?

Answer 7

Sail sign

Question 8

What is seen on XR in right upper lobe collapse?

Answer 8

Increased opacification in the right upper zone with raised (concave) horizontal fissure

Question 9

What is seen on XR in right middle lobe collapse?

Answer 9

Depression of horizontal fissure

Indistinct right heart border

Question 10

What is seen on XR in right lower lobe collapse?

Answer 10

Medial part of right hemidiaphragm will be indistinct

Question 11

What are risk factors for a primary (no cause identified) spontaneous pneumothorax?

Answer 11

Male gender

Smoking

Question 12

What is seen on examination of a simple pneumothorax?

Answer 12

Central trachea
Hyper-resonant percussion
Reduced air entry on that side

Question 13

What clinical features are associated with a tension pneumothorax?

Answer 13

Hypoxia
Tachycardia
Hypotension
Reduced consciousness

Question 14

What are possible causes of lobar collapse?

And what patients are they most common in?

Answer 14

Bronchial carcinoma - older smokers
Hilar lymph node enlargement
Mucus plugging - asthmatics
Inhaled foreign body - children

Question 15

What are features of an exudate on pleural fluid analysis?

Answer 15

pH 35g/L

Glucose

Question 16

What are some causes of an exudative pleural effusion?

Answer 16

Infection e.g. pneumonia
Inflammation e.g. pulmonary infarction
Malignancy e.g. lymphoma

Question 17

What are potential causes of bilateral hilar lymph node enlargement?

Answer 17

Sarcoidosis
TB
Lymphoma
Inorganic dust disease, e.g. silicosis

Question 18

What are causes of multiple pulmonary nodules/masses?

Answer 18

Pulmonary metastases
Abscesses
TB
Sarcoidosis
Granulomatosis with polyangiitis

Question 19

What does consolidation refer to?

Answer 19

Filling of alveoli with pathological products

Question 20

What are potential causes of pneumoperitoneum?

Answer 20

Diverticulitis, e.g. perforated colonic diverticulum
PUD, e.g. perforated ulcer
Appendicitis
Recent laparotomy

Question 21

What are the differentials for a posterior mediastinal mass?

Answer 21

Lymphadenopathy
Neurofibroma
Schwannoma
Extra-medullary haematopoiesis
Descending thoracic aortic aneurysm

Question 22

What are the differentials for an anterior mediastinal mass?

Answer 22

Thyroid e.g. thyroid goitre
Thymus e.g. thymoma
Teratoma
Lymphoma

Question 23

What are potential causes of a cavitating lung lesion?

Answer 23

Lung abscess
Tumour
Granulomatosis with polyangiitis
Thrombotic or septic emboli
Trauma e.g. pneumatocoele