The following statements are true:

a. bronchogenic cysts are most common in the posterior mediastinum.

b. following radiation damage to the lung, the ventilation-perfusion radionuclide studies are unaffected.
c. cytomegalovirus is the most common cause of pneumonia in bone marrow transplant patients.
d. lung involvement is more common in acute graft versus host disease.
e. aortic rupture most commonly occurs at the aortic root level.
Answer:
a. F, these are more common in the middle mediastinum. But rarely found in the posterior or anterior mediastinum.
b. F, there are perfusion defects due to vascular sclerosis.
c. T, overall infections due to cytomegalovirus occur in 23% of this patient group.
d. F, in acute graft versus host disease lung involvement is rare. In the chronic form lung involvement is more common,
usually with obstructive features.
e. F, aortic rupture most commonly occurs at the level of the isthmus.
Verified DJB 3/4/05
Ref: Dahnert, 5th ed, 2003 pp462; eMedicine: Graft versus Host Disease 2002;
Fat embolism is associated with
a. Pleural effusion
b. Pneumothorax
c. Multiple pulmonary opacities
d. Petechiae
e. Arterial hypoxia
Answer:
a. T, uncommon
b. F, not seen
c. T, may lead onto ARDS
d. T, 50% due to coagulopathy
e. T, often profound and with a normal CXR
Verfied DJB 3/4/05 Ref: Dahnert 5th ed 2003 pp487-488; Chapman & Nakielny 4th ed 2003 pp124
Histiocytosis X of the lungs
a. Causes thin-walled cysts
b. Ground-glass attenuation is characteristic
c. Affects the lower lobes
d. Lymphangioleiomyomatosis can look the same on a plain radiograph
e. Causes pneumothorax
Answer:
a. T Thick and thin
b. F
c. F Usually upper lobe
d. T
e. T Recurrent pneumothorax in 25% Verified DJB 3/4/05 Ref: Dahnert 5th ed 2003 pp498
Pulmonary AVMs
a. Are associated with TIAs
b. Are present in 80% patients with hereditary haemorrhagic telangiectasia
c. Plain radiographs may show only pulmonary hypervascularity
d. 90% are calcified on helical CT
e. Are associated with haemoptysis in 10% cases
Answer:
a. T Occur in 37%; strokes in 18%
b. F 15-50% with HHT have pulmonary AVMs, although 30-88% of patients with pulmonary AVMs have HHT
c. T Usually show a sharply defined, lobulated oval/round mass up to several cm across
d. F Almost always non-calcified
e. T Verified DJB 3/4/05 Ref: Dahnert 5th ed 2003 pp 513-514
Azygous continuation of the IVC is usually associated with
a. A normal intrahepatic IVC
b. Bilateral bilobed lungs
c. Polysplenia
d. Total anomalous pulmonary venous drainage
e. Intestinal malrotation
Answer:
a. F, drainage of hepatic veins into right atrium via supra-/post-hepatic segment of IVC
b. T
c. T, and, rarely, asplenia
d. F
e. T, part of the polysplenia spectrum Verified DJB 3/4/05 Ref: Dahnert 5th ed 2003 pp615-616

Angiography
a. The testicular vein is easier to catheterise on the left than the right using a femoral approach
b. A non-covered stent in the iliac arteries is contraindicated at the bifurcation
c. Iliac artery stent has double the patency rate of angioplasty at one year
d. Iliac artery stents prevent neointimal hyperplasia
e. Following iliac artery stenting the patient should be heparinised for 24 hours
Answer:
a. T, on the right a jugular approach is usual
b. F, usually kissing stents are employed
c. T
d. F, the converse is true
e. T, most clinicians would, although not all Verified DJB 3/4/05
This question has appeared on several past papers
Popliteal artery entrapment syndrome
a. Displaces the popliteal artery laterally
b. Occurs over the age of 50 years
c. Post-stenotic dilatation of the artery is seen
d. Can cause distal embolisation
e. The artery lies posterior to the medial head of gastrocnemius
Answer:
a. F, medially. This is a rare syndrome
b. F, <35yrs in 68%; M:F=9:1; Bilateral= 66%
c. T
d. T
e. F Popliteal artery winds medially, then inferiorly, to the tendinous insertion of the medial head of gatrocnemius
This is a past FRCR question
Verified DJB 3/4/05 Ref: Dahnert 5th ed 2003 pp643
Regarding the course of the thoracic duct:
a. It arises from the cisterna chyli
b. It ascends in the thorax between the azygous vein and the aorta.
c. It lies just to the left of the mid line as it ascends in the thorax
d. It crosses to the left and lies anteriorly at the level of the aortic arch
e. It terminates at the root of the neck by emptying into the junction of the subclavian and internal jugular veins.
Answer:
a. T, and is 2-8 mm in diameter, often up to 8 separate channels, it cannot be seen on CXR or CT unless
lymphangiographic contrast is present
b. T
c. F, it lies just to the right of the midline
d. T
e. T, drains into a large central vein at or within 1cm of this junction Verified DJB 3/4/05
Ref: Applied Radiological Anatomy, Butler et al, 1999 pp141
Regarding Cardiac CT:
a. Can be performed using Electron Beam CT (EBCT).
b. A coronary calcium score (Agatston score) of 50 is highly predictive for coronary stenoses.
c. Coronary calcium deposition usually occurs adjacent to or within a significant stenosis.
d. Coronary calcium estimation cannot be calculated from the data set of a CT coronary angiogram.
e. Of the three main proximal vessels, the right coronary artery is usually the most difficult to image using CT coronary
angiography.
Answer:
a. T, although mostly performed using MSCT.
b. F, an Agatston score of >160 has a high sensitivity and specificity for predicting a >80% stenosis within the
coronary tree.
c. F, calcium is only an independent risk factor for stenoses and usually does not correspond to their location.
d. T, because an unenhanced CT is required for calcium measurements.
e. T, because is it the fastest moving (70mm/s vs. 22-48 mm/s for the left coronary system).
Regarding Smoking-related Interstitial Lung Diseases - Histopathological and Imaging Perspectives:
a. Presently, one in every fifteen deaths in Britain can be attributed to smoking
b. Over 90% of patients with pulmonary Langerhans cell histiocytosis are smokers
c. The appearances on plain chest radiography are generally non-specific
d. Respiratory bronchiolitis is a common but incidental abnormality in otherwise healthy young smokers
e. Lung involvement in DIP is generally more uniform and widespread
Answer:
a. F.Presently, one in every five deaths in Britain can be attributed to smoking: bronchogenic carcinoma, chronic
obstructive pulmonary disease and ischaemic heart disease accounting proportionately for the greatest smoking-

related mortality
b. T.
c. T.
d. T.Respiratory bronchiolitis (sometimes called "smoker's bronchiolitis") is a common but incidental abnormality in
otherwise healthy young smokers
e. T. Reference: S. R. Desaia, S. M. Ryana and T. V. Colbyb. Smoking-related Interstitial Lung Diseases:
Histopathological and Imaging Perspectives Clinical Radiology (2003). 58, 259268
Non-neoplastic lung disorders related to cigarette smoking include:
a. Emphysema
b. Respiratory bronchiolitis
c. Desquamative interstitial pneumonitis
d. Langerhans cell histiocytosis
e. Cryptogenic fibrosing alveolitis
Answer:
All are correct. Other disorders include - Chronic bronchitis, Eosinophilic pneumonia
Reference:S. R. Desaia, S. M. Ryana and T. V. Colbyb. Smoking-related Interstitial Lung Diseases: Histopathological
and Imaging Perspectives Clinical Radiology (2003). 58, 259268
Coarctation of aorta:
a. Has equal incidence in males and females
b. Rib notching is typically bilateral and symmetrical
c. In adults and older children, PA chest radiograph is always abnormal
d. Commonly associated with Fallot's tetralogy
e. There is an increased incidence of cerebral aneurysms
Answer:
a. F, more than 80% affect males
b. F, rib notching is typically bilateral and asymmetrical
c. F
d. F, the commonest association is bicuspid aortic valve (~50%); other associations include aortic stenosis and other
left heart obstructive lesions
e. T, death may occur due to intracranial bleed
Ref: Grainger & Allison's Diagnostic Radiology, 4th edition pp 948-951. Verified DJB 5/4/05
Concerning CT of the pericardium:
a. normal thickness on non-ECG gated studies should not exceed 4mm
b. absence of the left hemipericardium can be demonstrated
c. benign and malignant pericardial effusions can be distinguished by the attenuation values of the fluid
d. small effusions are typically seen as curvilinear collections anterior to the right ventricle
e. constrictive pericarditis characteristically causes diffuse pericardial thickening
Answer:
a) normal thickness on non-ECG gated studies should not exceed 4mm -T
b) absence of the left hemipericardium can be demonstrated - T
c) benign and malignant pericardial effusions can be distinguished by the attenuation values of the fluid - F
d) small effusions are typically seen as curvilinear collections anterior to the right ventricle _F
e) constrictive pericarditis characteristically causes diffuse pericardial thickening - T
Explanation
A. The pericardium can be identified on CT because of the presence of fat in the epicardial space and mediastinum. It
can be identified in 95% of adults, usually anterior to the ventricles and less commonly inferolaterally. The normal
pericardium may appear thickened if imaged tangentially, especially around the anterior sternopericardial ligaments.
Also, the pre- and retroaortic pericardial recesses may be seen at the level of the carina since they commonly contain
a small amount of fluid B. Congenital pericardial defects may be classified as partial (almost always on the left),
absence of the left hemipericardium (the commonest type) or total absence of the pericardium. The characteristic CT
signs of absent left hemipericardium include inability to identify the fibrous layer of the parietal pericardium along the
left heart border, displacement of the main pulmonary artery toward the left lung and direct contact of the lung with the
heart C. Most pericardial effusions appear as near-water-density collections between the niediastinal and epicardial
fat. Exudative or haemorrhagic effusions may have soft tissue densities but benign and malignant effusions cannot
reliably be differentiated by their CT numbers. Small soft-tissue-density effusions can be differentiated from pericardial
thickening since they change shape with position and do not enhance D. Pericardial thickening tends to occur over the
anterolateral surface of the heart, whereas small effusions typically collect behind the- left ventricle and to the left of
the left atrium. Pericardial effusions may occasionally be loculated due to adhesions, usually as a result of surgery or
pericarditis. These loculated effusions are commoner in a posterior or right anterolateral location E. Pericardial
thickening in constrictive pericarditis is typically diffuse but not necessarily regular. The pericardium may measure
from O.5cm to 2cm in thickness. CT will also demonstrate associated dilatation of the SVC and IVC, ascites and
pleural effusions and dilatation of the atria with small ventricles. Radiation, pericarditis and trauma are other causes of
pericardial thickening. Ref: mcqs.com web site

This is true of thoracic sarcoidosis:

a. pleural effusion in 20 % cases
b. Egg shell calcification of mediastinal nodes in 5 % cases
c. Raised ACE in 70 % cases
d. Predominently involving the basal segments of lungs
e. Miliary nodules in lungs
Answer:
a)False .Pleural effusion in 2 % cases
b)True
c)True
d)False.Involving upper and mid zones
e)True
Regarding Severe Acute Respiratory Syndrome (SARS):
a. The virus responsible is an adenovirus.
b. The commonest chest x-ray (CXR) pattern is bilateral interstitial shadowing.
c. A normal HRCT effectively excludes the diagnosis.
d. Pleural effusion is common.
e. The initial CXR is normal in <5% of adults.
Answer:
a. F, coronavirus: CoV.
b. F, air space shadowing is commonest. Features are similar to other atypical pneumonias eg. mycoplasma,
legionella.
c. T, according to one series.
d. F, effusion, cavitation and lymphadenopathy do not occur.
e. F, as high as 25%. (Reference: Clin Rad Nov 2003)
Regarding pulmonary complications of HIV infection:
a. fine symmetric reticular shadowing without lymphadenopaty or pleural effusion is the characteristic feature of Kaposi's sarcoma
(KS).
b. Pneumatoceles is a recognoside feature in Pneumocystis carinii pneumonia (PCP)
c. Gallium-67 uptake will differentaiate PCP from Lymphocytic interstitial pneumonia (LIP).
d. Intra thoracic lymphadenopathy is commonly due to Lymphoma.
e. CMV infection frequently coexists with other infections.
Answer:
a. F. This is a feature of PCP. Coarse reticulonodular shadowing can ocuur in TB, Histoplasmosis,
Coccidiodomycosis. Presence of hilar / mediastinal adenopathy distinguish them from PCP. KS shows poorly defineg
1 to 2 cm. peribronchovascular nodules +/- effusions and +/- lyphadenopathy.
b. T. seen in 10% of patients.
c. F. Both PCP and LIP show Ga-67 uptake.
d. F. Mediastinal or Hilar adenopathy are not part of generalised lymphadenopathy syndrome. They arec usually due
to TB, Mycomacterium avium complex, Kaposi's sarcoma and less commonly due to lymphoma.
e. T. CMV can be isolated from lung tissue in 1/4 to 1/3 ot patients with AIDs related lung disease. Its contribution to
clincal or radilogical features in such patients is uncertain.
Regarding Lobar Collapse:
a. The more collapsed a lobe is, the more opaque it appears on the chest radiograph
b. Apparent reduction in the size of the hilum occurs in lower-lobe collapse
c. In compensatory hyperinflation, the affected hyperinflated lung fails to deflate normally on expiration
d. Rounded atelectasis is most common in the lower lobes
e. In left upper-lobe collapse the lower lobe may expand to reach the level of the apex of the hemithorax
Answer:
a-F
b-T
c-F
d-T
e-T
Regarding the imaging modalities of the chest:
a. High resolution computed tomography (HRCT) uses a slice thickness of 4-6 mm to identify mass lesions in the lung.
b. Spiral CT ensures that no portion of the chest is missed due to variable inspiratory effort.
c. MRI shows excellent detail of the lung anatomy.
d. Bronchography is the technique of choice to visualize the bronchial tree
e. CT pulmonary angiography (CTPA) is performed using catheters placed in a femoral vein.
Answer:
a. F, HRCT uses 1-2 mm slice thickness and a high resolution computer algorithm to show fine detail of the lung
parenchyma, pleura and tracheobronchial tree.

b. T
c. F, MRI is a poor technique for showing lung detail.
d. F, this invasive technique has largely been superseded by HRCT.
e. F, CTPA is performed to diagnose major pulmonary emboli using a cannula placed in any peripheral vein and is
relatively non-invasive compated to conventional pulmonary angiography.
Allergic Bronchopulmonary Aspergillosis:
a. It most typically occurs in acute asthma.
b. It is characterized by pulmonary infiltration with eosinophils, mucoid impaction and central bronchiectasis.
c. Radiological hallmark is peripheral bronchiectasis.
d. Bronchiectasis tends to predominate in the upper lobes.
e. Mucoid impaction is often a prominent radiological finding in patients with ABPA, causing the "gloved-finger appearance.
Answer:
F, T, F, T, T Ref: Grainger p428-429
Regarding pulmonary thromboembolism:
a. more than 90% of all PEs arise from thrombi within the large deep veins of the legs, typically the popliteal vein and the larger
veins above it.
b. conditions associated with an increased risk of thrombosis include DIC, nephrotic syndrome and hemophilia B.
c. treatment reduces the mortality rate from 87% to less than 10%
d. overall, age- and sex-adjusted annual incidence of DVT is approx. 50 cases per 100,000, and for PE 70 cases per 100,000.
e. advise your ED attendings that if the chest radiograph is abnormal, V/Q findings may be diagnostic; if the chest radiograph is
normal, helical CT should be performed
Answer:
a. True
b. False: hemophilia B, a bleeding disorder, is not associated with PE.
c. False: initial mortality is approx. 30% not 87% which would be way too high.
d. True
e. False: Opposite is true- if the chest radiograph is normal, V/Q findings may be diagnostic; if the chest radiograph is
abnormal, helical CT should be performed
Regarding sinus peicranii:
a. A vascular anomalie involving an abnormal communication between intra&extracranial circulation through dilated diploic
veins .
b. either congenital or post-tramatic .
c. presented as painfull soft tissue mass especially at the pediateric age group .
d. In CT & MRI there is thickening of the calavarium .
Answer:
a.True
b.True.
c.False .sinus pericranii presented as painless soft tissue mass
d.False .there is thinning of the calavarium .
Regarding CO2 angiography:
a. CO2 is nephrotoxic
b. air contamination is a potential hazard
c. image quality is superior to contrast angiography
d. COPD is a relative contraindication
e. Bolus segmentation artfact is recognized
Answer:
a) F, is used in renal failure
b) T
c) F
d) F, but pulmonary hypertension is
e) T Reference: http://www.emedicine.com/radio/topic870.htm
Regarding Bronchial Carcinoma:
a. adenocarcinoma are the most common
b. sqamous cell carcinoma are located peripherally
c. adenocarcinomas cavitates most often
d. large cell caecinomas have the fastest rate of growth
e. central lesions are more likely to cause lung collapse than peripheral lesions.
Answer:
a. F. squamous cell carcinomas are the most common accounting for 30-50% of cases
b.F. Suamous cell carcinomas are centrally located, while adenocarcinomas are peripheraly located.
c.F. squamous cell carcinomas cavitates most often
d.F. small cell carcinomas have the fastest rate of growth.

e.T. central lesions are more likely to cause collapse than peripheral lesions
Source. testbook of radiological imaging David Sutton page 399-401 6th edition
Concerning pulmonary haemorrhage:
a. haemoptysis is a common presentation
b. air-space shadowing tend to clear in 5-10 days
c. increase in KCO2
d. in goodpasture associated with antiglomeruler basement membrane antibodies
e. cardiac enlargment is an important sign when deciding the etiology
Answer:
a. F
b. T Pulmonary edema clears in 24-48 hrs.
c. F
d. T
e. F
Causes of calcified mediastinal lymhadenopathy include:
a. sarcoidosis
b. lymphoma
c. tuberculosis
d. pneumocysis carinii in AIDS patient
e. silicosis
Answer:
TFTTT
The left phrenic nerve:
a. Lies anterior to the left scalenus anterior
b. Lies posterior to the subclavian artery
c. Lies posterior to the brachial plexus
d. Traverses the diaphragm through the oesophageal hiatus
e. Passes posterior to the left hilum
Answer:
A. T
B. F
C. F
D. T
E. F
Regarding Pulmonary embolism:
a. CTPA should be performed in all cases as confirmation
b. V/Q scan has no role in diagnosis
c. Alteplase can be given as thrombolysis when suspected cardac arrest is due to PE during resuscitaion.
d. Recurrent PE reduces transfer factor
e. Some PE diagnosis confirmation needs conventional pulmonary angiogram
Answer:
a. F, V/Q can be confirmatory in a given case
b. F
c. T
d. T
e. F, CTPA has superceded conventional pulmonary angiogram now.
Regarding bronchpulmonary sequestration:
a. the intralobar type is commoner in males than females
b. the extralobar form presents in the neonatal period
c. the intralobar type is associated with other anomalies in 60%
d. is commoner on the right than the left
e. the extralobar form does not connect with the bronchial tree
Answer:
a. F
b. T
c. F
d. F
e. T
In Extrinsic Alergic Alveolitis
a. More than half are asymptomatic
b. Symptomatic after 6-8 hrs of exposure
c. Sudden onset of dyspnoea

d. Decreased vital capacity, diffusing capacity and arterial pO2

e. BAL- T-lymphocytes and neutrophils
Answer:
a. F, (10-40%)
b. T
c. F, Insidious with progressive dyspnoea
d. T
e. T, Neutrophils acute stage and T lymphocytes chronic stage.
Inferior rib notching is a recognized finding in:
a. Rheumatoid arthritis
b. Coarctation of the aorta
c. Long standing obstruction of the superior venacava
d. Pulmonary atresia
e. Neurofibromatosis
Answer:
a. F, rheumatoid arthritis is however a recognized cause of superior marginal rib defects
b. T, the notching is due to enlarged tortous intercostal arteries which provide a collateral supply to the aorta distill to
the coarctation
c. T, enlarged venous collaterals may cause inferior rib notching
d. T, enlarged intercostal arteries may participate in the collateral cirulation to the lungs
e. T, the notches due to neurofibromas are offen wide and may occur anywhere in the rib
Regarding asbestos related pleral disease:
a. Apical involvement is a common finding with pleural plaques
b. Calcification is an unusual feature of diffuse pleural thickening
c. Involvement of the mediastinal pleura is more suggestive of mesothelioma rather than diffuse pleural thickening
d. Round atelectasis should not normally abut a pleural plaque
e. When unilateral pleural plaques occur, they are usually right-sided
Answer:
a. F, pleural plaques do not usually involve apices or costophrenic angles
b. T, think of previous TB, haemothorax, empyema
c. T
d. F, should abut pleural plaque
e. F, usually on left
Histiocytosis X of the lungs:
a. causes thin-walled cysts
b. ground glass attenuation is characteristic
c. affects predominantly the lower lobes
d. lymphangioleiomyomatosis can look the same on a plain radiograph
e. causes pneumothorax
Answer:
a. T
b. F
c. F, upper lobes.
d. T
e. T Ref: G&A Page 498
The following is not a recognized cause of unilateral hyper-transradiant hemithorax of chest radiolgraph:
a. Patient rotation.
b. Pulmonary embolus.
c. Congenital lobar empyema.
d. Agenesis of lung.
e. Poliomyelitis
Answer:
a. F
b. F
c. F
d. T
e. F
Large pulmonary fibrotic masses are seen in:
a. silicosis
b. talcosis
c. progressive massive fibrosis
d. alveolar proteinosis
e. pneumoconiosis

Answer:
a. T
b. T
c. T
d. F
e. T
Regarding bronchogenic cysts:
a. They may be subpleural in location.
b. They may cause air trapping.
c. They are always symptomatic.
d. They can be found in the neck.
e. They are the most common type of fore gut duplication cyst.
Answer:
TTFTT
The Following are true of Angiodysplasia:
a. Commonly occurs in caecum
b. An association with Osler Weber Rendu syndrome
c. Associated with Tetralogy of Fallot
d. Is associated with cutaneous lesions in 40%
e. Diagnosis commonly made in 2nd and 3rd decades.
Answer:
a. T, Rt sided including ascending colon
b. T
c. F
d. F
e. F Ref Dahnert
False negatives on CT Pulmonary Angiogram may be caused by:
a. Hilar lymph nodes
b. Motion artefact
c. Partial voluming
d. PE nofined to subsegmental vessels
e. Low signal to noise ratio
Answer:
a. F, False positive maybe caused by lymph nodes.
b. T
c. T
d. T
e. T