Chest X-Ray Quiz
Questions: 16 · 10 minutes
1. A patient deteriorates after central venous catheter placement. The chest radiograph shows a large right pneumothorax, leftward mediastinal displacement, and depression of the right hemidiaphragm. What is the most concerning interpretation?
Simple right pleural effusion
Right upper-lobe collapse
Chronic right-sided hyperinflation
A tension-pattern right pneumothorax requiring immediate clinical action
2. A portable chest radiograph shows the scapulae overlying the lungs, relatively horizontal clavicles, and an apparently enlarged cardiac silhouette. Which projection best explains this combination?
An anteroposterior (AP) projection
A standard posteroanterior (PA) projection
A lateral decubitus projection
An apical lordotic projection
3. An opacity in the right middle lobe touches and obscures the right heart border. Which principle explains the lost border?
The silhouette sign
The deep sulcus sign
The air crescent sign
The Golden S sign
4. A left-sided opacity is accompanied by elevation of the left hemidiaphragm, displacement of a fissure, and pull of the hilum toward the opacity. What process do these findings favor?
Pleural fluid accumulation
Contralateral tension pneumothorax
Pulmonary edema
Atelectasis with volume loss
5. A patient with fever and cough has a new segmental air-space opacity containing air bronchograms, without fissure displacement or other signs of volume loss. Which interpretation fits best?
Lobar atelectasis
Air-space consolidation, such as pneumonia
Pneumothorax
Pleural effusion
6. An endotracheal tube tip projects about 1 cm above the carina with the head in a neutral position. What is the best assessment?
It is too high and should be advanced into a main bronchus
It is in the esophagus because it lies above the carina
It is low and may enter a main bronchus with movement; prompt clinical reassessment is appropriate
Its position cannot be assessed on any frontal chest radiograph
7. Which textual description most strongly supports a pneumothorax on an upright chest radiograph?
A visceral pleural line with no lung markings peripheral to it
Fine peripheral lines extending all the way to the chest wall
Bilateral basal reticular markings with small pleural effusions
A dense peripheral opacity containing air bronchograms
8. On an upright chest radiograph, a smooth crescent of lucency is visible beneath the right hemidiaphragm, where the liver normally contacts the diaphragm. What does this most strongly suggest?
Right lower-lobe consolidation
A subpulmonic pleural effusion
Normal gastric gas
Free intraperitoneal gas
9. A patient has sudden pleuritic chest pain and shortness of breath, but the chest radiograph is reported as normal. Which conclusion is most accurate?
A normal radiograph excludes every urgent thoracic condition
Pulmonary embolism is excluded if there is no pleural effusion
No further clinical assessment is needed unless fever develops
A normal chest radiograph does not exclude pulmonary embolism or other serious causes of symptoms
10. A film obtained during shallow inspiration shows crowded basal vessels and apparent enlargement of the heart. What is the most appropriate interpretation step?
Conclude that emphysema is present
Recognize low lung volume and consider a better-inspired repeat if clinically appropriate
Assume the heart is enlarged regardless of technique
Diagnose pulmonary edema from the crowded vessels
11. The thoracic vertebrae are not faintly visible through the heart, and the left lung base looks diffusely opaque. Which technical problem should be considered before calling basal disease?
Overrotation
Overpenetration
Underpenetration
Excessive magnification from a PA view
12. Which finding most strongly suggests a moderate pleural effusion on an upright frontal chest radiograph?
A thin pleural line at the apex
Flattened diaphragms with narrow cardiac silhouette
Blunting of the costophrenic angle with a meniscus-shaped upper border
Air bronchograms extending through a lobar opacity
13. A chest radiograph shows increased lung volumes, flattened hemidiaphragms, increased overall lucency, and a relatively narrow cardiac silhouette. Which pattern is most consistent with these findings?
Low-volume film from poor inspiration
Bilateral pleural effusions
Hyperinflation, as may occur with obstructive lung disease
Acute lobar collapse
14. Which combination is most characteristic of cardiogenic pulmonary edema on a chest radiograph?
Bilateral perihilar air-space opacity, vascular congestion, and possible pleural effusions
Unilateral hyperlucency with a small hilum
An apical cavity with adjacent volume loss
A single peripheral wedge-shaped opacity with normal vessels
15. An enteric tube descends through the trachea, follows the left main bronchus, and ends over the left lower lung. What should happen before the tube is used?
Advance it because any tip below the clavicles is acceptable
Do not use it; report the airway placement and arrange repositioning and reassessment
Use it for medication but not feeding
Withdraw it only to the upper esophagus and begin feeding
16. On a frontal chest radiograph, the right medial clavicle is much closer to the thoracic spinous processes than the left. What is the main technical issue?
Insufficient penetration
Patient rotation
Excessive inspiration
Motion blur