Chest and Respiratory Radiology (Plain X-ray, CT, ILD, Pneumonia, Lung Cancer) MCQs

Radiology · 47 free questions with answers & explanations.

1. A 55-year-old male smoker presents with progressive dyspnea. Chest CT shows centrilobular areas of low attenuation without definable walls, predominantly in the upper lobes, with no interstitial thickening. Which pattern best describes this finding?
2. A 62-year-old woman with no smoking history presents with exertional breathlessness. HRCT shows bilateral, basal-predominant, subpleural honeycombing with traction bronchiectasis and minimal ground-glass opacity. Which diagnosis does this CT pattern most strongly support?
3. On a PA chest radiograph of a patient with right-sided pleural effusion, the upper border of the opacity is highest in the axilla and concave medially. Which term describes this radiographic contour?
4. A 68-year-old man with a 40-pack-year history presents with hemoptysis and weight loss. CT chest shows a 3.2 cm spiculated right upper lobe mass with pleural puckering and ipsilateral mediastinal lymphadenopathy. The most likely histological type of lung cancer in this location and with these imaging characteristics is:
5. A chest radiograph shows opacification of the right lower zone with the right heart border still visible. An air bronchogram is seen within the opacity. Which lobe is most likely consolidated?
6. A 58-year-old male with progressive dyspnea has HRCT showing bilateral basal-predominant reticular opacities, traction bronchiectasis, and honeycombing in a subpleural distribution with no ground-glass opacity predominance. The pattern is MOST consistent with:
7. On a chest X-ray, which of the following signs indicates that a pleural effusion has a loculated (encapsulated) component rather than a freely flowing one?
8. A 62-year-old smoker has a CT chest showing a spiculated peripheral lung mass with pleural tags and notching of the pleural surface. The most likely histological type is:
9. Which of the following CT findings most reliably distinguishes an exudative from a transudative pleural effusion?
10. On HRCT chest, the 'crazy paving' pattern (ground-glass opacity with superimposed interlobular septal thickening) is classically associated with:
11. A 58-year-old male with progressive dyspnoea has HRCT showing areas of 'crazy-paving' pattern (ground-glass opacity superimposed on septal thickening). Which of the following diagnoses most characteristically produces this pattern?
12. On HRCT of a patient with suspected UIP/IPF, which combination of features confirms a 'typical UIP pattern' and allows diagnosis without surgical lung biopsy?
13. A 45-year-old woman with sarcoidosis has chest CT showing 'galaxy sign'. This refers to:
14. Which CT finding in lung adenocarcinoma in situ (previously bronchioloalveolar carcinoma) is considered the hallmark of lepidic growth pattern?
15. In a patient with chronic eosinophilic pneumonia, chest X-ray typically shows the 'photographic negative' of pulmonary oedema. This means:
16. On HRCT chest, a patient with progressive dyspnoea shows bilateral subpleural reticulation, honeycombing in the basal posterior zones, and traction bronchiectasis without ground-glass opacity predominance. The UIP (usual interstitial pneumonia) pattern is confirmed. Which feature, if present, would favour a diagnosis of hypersensitivity pneumonitis rather than IPF?
17. A chest CT pulmonary angiogram (CTPA) in a 50-year-old with acute dyspnoea shows a filling defect that straddles the bifurcation of the main pulmonary artery. What is this finding called and what is its immediate haemodynamic implication?
18. CT chest of a 65-year-old heavy smoker shows a 2.5 cm spiculated nodule in the right upper lobe with pleural tethering and a small satellite nodule. The PET-CT shows an SUVmax of 8.2. Which CT characteristic most independently predicts malignancy in a solitary pulmonary nodule?
19. A patient with known Eisenmenger syndrome undergoes chest X-ray. Which combination of findings is most characteristic?
20. On chest CT, a rounded, well-defined lung mass with an air-fluid level and thick irregular inner wall is identified in a patient with a prior cavitary lesion that has now changed character. What does development of an air crescent sign within a pre-existing cavity most specifically indicate?
21. On HRCT chest, a patient with interstitial lung disease shows diffuse ground-glass opacities with superimposed intralobular reticulation and subpleural honeycomb cysts bilaterally. The secondary pulmonary lobule demonstrates a 'crazy-paving' pattern in non-dependent zones. Which diagnosis is MOST consistent?
22. A 58-year-old smoker has a 3 cm peripheral lung mass with a CT density of +10 HU at baseline and +35 HU post-contrast. On PET-CT, the SUVmax is 2.2. Which statement BEST characterizes this lesion?
23. On HRCT chest, a 'tree-in-bud' pattern is observed in the right lower lobe. This pattern specifically indicates:
24. A CT chest of a patient with sarcoidosis shows micronodules distributed predominantly along bronchovascular bundles, interlobular septa, and subpleural regions. This distribution is called:
25. On lateral chest X-ray, which of the following findings MOST reliably localizes an opacity to the posterior basal segment of the right lower lobe?
26. A 62-year-old man with progressive dyspnoea undergoes HRCT thorax. Images show bilateral basal-predominant subpleural honeycombing with traction bronchiectasis and no ground-glass opacity predominance. The UIP pattern on HRCT in the absence of an identifiable cause is MOST consistent with which diagnosis?
27. On HRCT thorax, which of the following findings is MOST characteristic of lymphangitic carcinomatosis and helps distinguish it from pulmonary oedema?
28. A patient with superior vena cava obstruction undergoes CT chest with contrast. Which CT finding most reliably indicates SVC occlusion rather than stenosis?
29. On a plain chest radiograph, the 'silhouette sign' is used to localise intrathoracic pathology. A right lower lobe consolidation would obliterate which border?
30. A 55-year-old smoker has a 2 cm spiculated pulmonary nodule on CT. PET-CT shows SUVmax of 8.2 in the nodule. Which additional CT finding would MOST favour primary lung adenocarcinoma over a metastasis from a colon primary?
31. HRCT chest shows bilateral basal-predominant subpleural reticulation, honeycombing with traction bronchiectasis, and ground-glass opacity. Bronchoalveolar lavage shows lymphocytosis. The pattern corresponds to which ILD on UIP-pattern scoring?
32. A lung nodule 8 mm in diameter is detected incidentally on CT in a 62-year-old ex-smoker. According to Lung-RADS 2022, the nodule is solid with well-defined margins. The correct Lung-RADS category and recommended follow-up is:
33. On chest X-ray of a patient with right-sided pleural effusion, the fluid blunts the costophrenic angle but on lateral decubitus view, the fluid shifts freely. This indicates:
34. CT chest of a 45-year-old non-smoker female shows multiple bilateral cystic lesions with thin walls randomly distributed in the lung parenchyma, no associated nodules, and bilateral pleural effusions. Renal angiomyolipomas are detected on CT abdomen. The diagnosis is:
35. HRCT chest in a 60-year-old man shows bilateral basal-predominant, subpleural reticular opacities with honeycombing and traction bronchiectasis WITHOUT ground-glass opacity predominance. The UIP pattern on HRCT in the correct clinical context is diagnostic of:
36. A 55-year-old male smoker's CT chest shows a 28 mm spiculated mass in the right upper lobe with hilar lymphadenopathy and a pleural effusion. CT-guided biopsy is planned. Which lobe position on CT is the LEAST favourable for CT-guided percutaneous lung biopsy due to highest risk of pneumothorax?
37. A 35-year-old woman with known sarcoidosis has HRCT showing bilateral hilar and mediastinal lymphadenopathy with bilateral perihilar nodularity along bronchovascular bundles. Which CT description best characterizes pulmonary sarcoidosis?
38. On chest CT, a 2 cm pure ground-glass nodule (GGN) is identified in the right lower lobe. According to Lung-RADS 2022 guidelines, what is the appropriate management for a pure GGN measuring 2 cm detected at baseline screening CT?
39. A CT of the chest shows multiple bilateral cysts of variable size, thin-walled, without nodules or ground-glass change, in a 35-year-old woman with spontaneous pneumothorax and chylothorax. What is the most likely diagnosis?
40. A 60-year-old smoker has a spiculated 2.5 cm right upper lobe mass on CT with hilar and ipsilateral mediastinal lymph node enlargement but no contralateral nodes, pleural effusion, or distant metastases. According to TNM 8th edition, what is the stage?
41. On CT chest, 'crazy paving' pattern is described as ground-glass opacity superimposed on thickened interlobular septa and intralobular lines. Which of the following conditions can produce this pattern?
42. A 65-year-old smoker has HRCT chest showing bilateral basal subpleural honeycombing, traction bronchiectasis, and minimal ground-glass opacity. The pattern is consistent with usual interstitial pneumonia (UIP). Current guidelines (2022 ATS/ERS/JRS/ALAT) require which combination for a definitive diagnosis of IPF?
43. On CT chest, a solitary pulmonary nodule (SPN) 8 mm in diameter is found incidentally in a 60-year-old male ex-smoker. According to Fleischner Society 2017 guidelines for SPNs in high-risk patients, what is the recommended management for a solid 8 mm nodule?
44. A 70-year-old with massive left pleural effusion on CXR shows mediastinal shift to the RIGHT. This finding indicates:
45. CT chest shows a 'tree-in-bud' pattern (centrilobular nodules with branching linear opacities resembling a budding tree). This pattern specifically indicates:
46. The 'Westermark sign' on chest X-ray in pulmonary embolism refers to:
47. A 50-year-old asbestos-exposed worker has CT showing bilateral calcified pleural plaques, bilateral pleural thickening, and a new rounded opacity abutting the thickened pleura with a 'comet tail' sign extending into the parenchyma. What is the most likely diagnosis?