WITH IMAGES

X-RAY
1. Chest X-Ray in Ptn. with difficult swallowing
a- mediastinal mass
b- Bochdalic hernia
c- Zenker's diverticulum
d- Other option

DD.Internal & External Laryngeocele ( CT ) .

2. Lesion at Right cardio-phrenic angle , Bockd.H : + 4 B

Chest X-Ray , CT shows fat density and Big - Back – baby – bad prognosis
another Q about post. Mediastinal lesion : More at Lt.cardiophrenic angle .
‫ﺳﺆاﻟﯿﻦ ﻣﺨﺘﻠﻔﯿﻦ‬
a. Lipothymoma
b. Morgagni hernia.
c. Pericardial cyst.
d. Bockdalic hernia .

3. Chest PA & lateral ask about site of lesion :

a. Right upper lobe.
b. Right lower lobe.
c. Right middle.
d. Pleural. ( the lesion was nearly
elliptical, mostly encysted pleural
effusion ) .
14- chest x ray ap and lateral is showing
hyper dense lesion at middle and lower
right lobe and origin of the lesion .
a- Pleura ‫ﺻﺤﯿﺤﺔ‬
b- Intrcostal space
c- Lung parenchyma
d-Bone

4. AP & lat where is the lesion : acc to image

a. middle lobe lesion
b. lower
c. upper
d. lingual

-1-
5. Image lateral Chest X-Ray pointing to
IVC

6. Image CXR lateral view only with arrow

pointing towards :
a. aortic arch

7. Lateral chest and point to aorto-pulmonary

window
a. Right hilar vascularity.
b. Right superior pulmonary vein.
c. Left pulmonary artery

8. Lateral chest X-Ray pointing to :

( hilar shadow )
a. RT hilar vascular opacity
b. LT pulmonary vein

-2-
9. X-Ray AP & lat :
a. middle lobe

10. Image : X-Ray where tip of central line

a. SVC

-3-
11. Image : X-Ray where tip of CVP line
( it crosses to the opposite side ) – black arrows
a. Left SVC ‫اﺑﺮاھﯿﻢ ﻏﻠﻂ‬.‫ﺣﺴﺐ د‬
b. Aortic arch
c. Pericardial sinus

12. Image X-Ray chest ETT, chest tube

a. No need for chest tube
b. No need for ETT
c. ETT need to be pushed down
d. Chest tube needs adjustement

The end of the tube should not abut

‫ ﺗﺮﺗﻜﺰ ﻋﻠﻰ‬the mediastinum

13. X-Ray ICU with ETT tube in the right main

bronchus and subsequent total left lung collapse
Total Lt. lung collapse due to malposition
of ETT into Rt. main bronchus

14. Chest X-Ray of neonate shows two lines

(likely umbilical) one towards the umbilicus
( v.near from midline ) . The other towards the
left hypochondrium with bifid end (away from
the patient) . (I see no nasogastric tubes) :
a. abnormal umbilical arterial line
b. Abnormal umbilical venous line.
c. nasogastric tube abnormal position.

15. Chest X-Ray image in neonate showing

left mediastinal & tracheal shift with
Hyper Inflated Right Lung : NB. No ETT
a. left bronchial obstruction by foreign
body
b. Right congenital lobar
emphysema.
c. left bronchopneumonia
d. left lung collapse

-4-
16. Lucent RT lung , shift to left side ,
LT huge opacity : NB. No ETT
a. LT lung pneumonia
b. RT congenital emphysema (if
neonate)
c. RT tension pneumothorax .(if
adult )
[image] chest xray. adult, right lucent hemithorax with
flattened diaphragm and shift of the mediastinum to
the left  tension pneumothorax.
NB. Cystic Changes :
Honey Comb with interstitial P.should be more
than one raw more thick walled mostly basal .
Panacinar Emphysema : one subpleural raw
upper lobar bilateral
17. Image Infant left lung multiple
emphysematous bullae :
a- congenital lobar emphysema
( mostly in LUL )
b- emphysemtous malformation
c- ruptured bullae....
d- Cong.Cystic Adenomatoid Malformation

-5-
-6-
-7-
 18. 3 day old infant, premature 31 week, devlop
respiratory distress after 3 days (image)
a. IPE ( Interstitial Pulmonary
Emphysema ) . sure
b. Surfactant deficiency.
c. Pneumonia
d. Meconium aspiration.
‫ﺳﺆال ﻋﻠﯿﮫ ﺧﻼف و ﯾﺤﺘﺎج اﻟﻤﺮاﺟﻌﺔ‬
IPE occuring in NN treated with hight O2 tension
Meconium asp. occurs in post date NN
sufactant defe. occures early . post date think in aspiration
premature and early onset it is surfactant treated with
oxygen high tension it is IPE . Premature ; So there is
surfactant deficiency Then with ttt by conventional o2
He developed IPE ‫ ﺑﺲ‬So original diagnosis was
Surfactant deficiency

d
A.
19. Plain X-Ray for : Esophageal Atresia

20. X-Ray chest patient has bilateral emphysema

and complain from fever & cough
‫؟؟؟؟‬ a-carcinoma
b-metastasis
c-Asperagilloma = A symptomatic
cavitary lesion in Rt
d-emphysematous bullae
21. Old female chest X-Ray image (with CT image
with left diaphragmatic copula higher than the
right one) :
a. LT. upper lobe collapse
b. encysted effusion
c. LT. Diaphragmatic paralysis

22. X-Ray with left lung collapse and shift of

mediastinum to the left :
a. Foreign Body

23. X-Ray chest image of a child showing increased

opacity of the left hemithorax with ipsilateral
mediastinal shift and elevation of the left
diaphragmatic copula and crowding of ribs
with hyperinflation of the Right hemithorax
a- LT lung collapse due to foreign body
b- Rt congenital lober emphysema
b- Lt lung consolidation

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 24. AP and lateral films right Inverted Goldes S sign,
elevated horizontal fissure
Right Upper Lobe Collapse

25. Chest x-ray shows PA Luftsichel sign

Left upper lobe collapse.
‫اﻟﺼﻮرة ﻣﻘﻠﻮﺑﺔ‬

26. X-Ray chest AP, lat, ptn. young complain of not

remembre diagnosis
a-Lingular Atelectatic Band
b-aortic rupture

Plain X-Ray ( PA , lat. ) with right upper lobe

27. opacity not very clear but in lateral I think it
shows uplift of horizontal fissure , Diagnosis :
???????
a. Right Upper Lobe Collapse
b. right upper lobe
c. encysted effusion
d.other don’t remember and far.

28. Left lower cavitary lung lesion image

Abscess with pleural effusion .

Left lateral chest X-Ray , which is right

29. a. Right Rib Larger Than Left Rib
b. oesophagus anterior to the trachea.
c. pulmonary artery above aortic arch.
d. heart is larger than right lateral view
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30. Chest X-Ray lateral view show irregular ring of
calcifications .
a. Annular Mitral Calcification
b. Aortic.
c. Pericardial

31. Chest X-Ray PA-LAT ( patchy opacity of left

upper lobe ) , the outline of ascending aorta
not clearly seen) lateral view there is Effusion :
a. Left upper lobe collapse.
b. Left lower lobe collapse.
c. Pleural effusion.
d. Rupture Aortic Aneurysm

32. Chest X-Ray image showing :

a- Hydropneumothorax with pulmonary
Pathology
b- pleural effusion

33. X-Ray chest PA , lucent air at LT. cardiac

border :
a. pneumomediastinum

Up Extension

34. X-Ray Chest PA :

a. Pneumopericardium

Low Around Heart Extension

35. X-Ray adult grossly enlarged hilar vascular

shadows with peripheral prunning
a- Pulmonary Arterial HTN
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 b- primary venous hypertension
c- Lung disease with secondary venous HTN

36. Chest X-Ray posterior mediastinal mass .

CT abdomin . Symmetrical paravetebral
soft tissue masses :
a. Extramedulary Hematopioesis .
b. Thymoma.
c. Teratoma.

CT
37. CT chest , arrow towards bronchus asking According to the image , select the
about ( Left Lung ) : Q.83.Tracheal bronchus segment :
a. AnteroMedial basal . Rt.Upper Lobe https://radiopaedia.org/cases/bronc
b. Posterior basal. hopulmonary-segments-annotated-
c. Anterior basal. ct-1?lang=us

38. HRCT :
Bone Algorism

39. Axial CT Chest :

Pectus Excavatum
New

40. CT Lung Pulmonary Window :

a. Herniated lung
b. Horse Shoe Lung
c. Congenital lobar …‫ﻣﺶ ﻓﺎﻛﺮ‬

‫ ﺻﻮره زى دى اﻧﺎ ﺷﻮﻓﺖ‬posterior lungs ‫ﻗﺮﯾﺒﯿﻦ ﻣﻦ ﺑﻌﺾ زى‬

‫ دى ﺑﺎﻟﻀﺒﻂ وﻓﻰ ﺧﻂ ﻓﺎﺻﻞ ﺑﯿﻨﮭﻢ‬box

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41. CT Chest ( image of upper mediastinum )
shows aortic arch , SVC , trachea ,
lymph nodes …
( beside SVC ) >> Point at the lymph node.

( The structure is non enhancing )

42. CT Chest :
arrow at Right Aortic Arch .

43. Chest Axial CT :

a- dessecting aortic aneurysm

b- Double SVC
c- mediastinal hematoma

( The structure is enhancing )

44. Axial image of upper chest cuts , pointed to

the Azygos >> options :
a. lymph node.
b. Azygos Vein ( Azygos Lobe )

45. Patient after accident with chest trauma , ‫ﺑﺑﻘﻰ ﻟو ﺟﺎي ﺑﺻور ﻧرﻛز ﻋﻠﻰ‬
first did X-Ray chest ( 2 images ) CVL ‫وﻧﺷوﻓﮫ داﺧل ﻓﯾن‬
What is the information given by
CT not evaluated at CXR : ‫اﻣﺎ ﻟو ﻣن ﻏﯾر ﺻور وﺳؤال ﻋﺎم ﯾﺑﻘﻰ‬
a. Lung Contusion lung contusion
b. Rib fractures .
c. RT pneumothorax .
d. CVL need reposition

46. CT at level of Alveolar Margin and Pt. complain

of recurrent chest infection and fever
a- Septic Embolie
b- Fungal infection
c- Aspergillosis

47. Case with 1 cut CT Chest showing post. segment

RT. LL large consolidation & other axial CT
neck showing thrombus at the Lt.Carotid :
a. infective thrombus
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 b. pulmonary embolism
c. Carotid Thrombus With Pulm.
Embolism
d. two other options)
48.
Lemierre Syndrome : Images one in neck
shows left internal jugular thrombosis and
other in the lung shows septic emboli like this
images , He ask about what is in the CT Chest :
a. Septic Emboli

( Lemierre Syndrome is one of the causes of

septic pulmonary emboli )

49. CT image of
Pulmonary Embolism.

50. Pregnant female with pulmonary HPT. SFTP = ‫ﻓﻲ اﻵﺧﺮ ﺳﺆال‬
Investigations confirmed absence of Solitary Fibrous Tumor of Pleura
pulmonary embolism
CT chest >> dilated pulmonary arteries . Hypoglycemia in the context of SFTP
would be
a. Primary pulmonary hypertension
related to tumor secretion of insulin-like
b. Chronic thromboembolic pulmonary dis.
proteins . Complete emergency resection
c. ‫اﺑﺮاھﯿﻢ ﺑﯿﻘﻮل ان ﻓﯿﮫ إﺟﺎﺑﺔ ﻧﺎﻗﺼﺔ‬.‫د‬PDA is required to avoid the risk of life-
‫اﯾﻮه دا ﺳﺆاﻟﻮﺑﯿﻜﻮن ﻣﻌﺎه ﺻﻮرھﻮواﺿﺢ ﺟﺪا ﺟﺪا‬ threatening hypoglycemia.
PDA‫ﻓﻲ اﻟﺼﻮره‬ Pregnant Female :
‫ﻣﺎﺑﯿﻦ اﻻﻟﺸﺮﯾﺎن اﻟﺮﺋﻮي واﻻورطﻲ‬ Pitutary Apoplexy Shehan’s S.
‫واﺿﺤﮫ ﺟﺪا ﺟﺪا واي ﺣﺪ ﺣﯿﻼﺣﻈﮭﺎ ﻻ ﻣﺤﺎﻟﮫ‬ T.S.Thrombosis . PDA

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51. MOSAIC appearance of the chest (insp and
expiratory) lucent areas in inspiratory film with
less vessels and increase density in expiratory
film . What is the diagnosis :
a. air trapping
b. Chronic Pulmonary Embolism
c. IPF( interstitial pulmonary fibrosis ).

52. CT Chest : MOSAIC pattern of attenuation :

The two images: one image lung window shows
v.subtle if any mosaic appearance with central
few lucent areas with central dense dotes .
The Mediastinal window shows right sided
dense tubular structure extended from the
right hilum, with no filling defects ( may be
similar to this image ) . What is the diagnosis :
a. Chronic Pulmonary Embolism sure
b. pulm oedema
c. pneumonia.
Sometimes text without image
53. Halo sign :
Invasive Apergilloma

54. Image showing tree in bud appearance &

asking about Tree In Bud ) .
Is it CT chest ??
Causes of tree-in-bud sign :
Infective Bronchiolitis
pulmonary tuberculosis , Mycobacterium avium
Congenital : Cystic Fibrosis
Connective Tissue Disorders
Rheumatoid Arthritis (RA) , Sjogren syndrome
Bronchial
obliterative (constrictive) bronchiolitis
diffuse panbronchiolitis
follicular bronchiolitis
Neoplastic : Bronchioloalveolar Cell Carcinoma Q.154
Tree-in-bud in this case was
secondary endobronchial spread of tuberculosis .

55. Chest Axial CT Weight Loss And Night Fever

(Small Nodules Periphrally)
a. Milliary TB
- 14 -
 b. Tree En Bud
c. Pn
d. TB Rosen Marry

56. History TB cavity with life threating

complication
New Rasmussen Aneurysm

57. Post contrast CT ( Chest X-Ray )‫وﺣﺸﺔ ﻗﻮي و ﺻﻐﯿﺮة‬,

nodule parahilar very small ,
Otherwise clear chest :
a. solitary nodule (I THINK WRONG)
b. Sacroid
c. normal

58. Regarding middle lobe of the right lung

( CT axial image )
Cystic Bronchiectasis

59. CT lung :
Bronchiectasis

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 60. ?? Female Male ptn. with lung CT showing
innumerable cysts and small areas of
New honeycombing :
a. NSIP
b. Desquamative
c. Lymphangiomyomatosis :
Lymphangiolipomyomatosis If Female

61. Images CXR PA view ( ‫& ) ﺻﻮرة ﺻﻐﯿﺮة ﻣﺶ واﺿﺤﺔ‬ Williams-Campell S.: Congenital Cystic
CT axial ( have some Bronchiectasis ) : Bronchiectasis symmetrical bilateral
a. Kartagner syndrome : If Dextrocardia sparing trachea &main bronchi .
b. Sawyer James Syndrome: Unilat.Hyperlu. Q.188
c. Campell syndrome : Cystic Bronch. Area
62. CT and HRCT Chest showing :
basal reticulations ( lung window ) and
pleural calcifications ( med. window ) .
Normal cardiac enzymes
a. Asbestosis
b. Silicosis c. Lipoid pneumonia
d. Idiopathic pulmonary fibrosis

Asbestosis

63. CT showing heavy high densities within High-resolution CT shows ground-glass

the lungs : opacification and thickened intralobular
structures and septa in polygonal shapes
a. Silicosis
b. Sarcoidosis
c. Pneumoconiosis
d. Alveolar Proteinosis

("crazy-paving").

64. Sjogren disease and disease in the chest cause Sjogren disease :
multiple small pneumatocele ( with images Recurrent bronchitis , pneumonia &
shows small cysts ) : Interst.lung dise .
a. histocytosis If Lymphocytic IP present with choices
b. lymphangiomyomatosis LIP sure choose it .‫ﺗت‬
c. Idiopathic Non Specific
Interstitial Pneumonia‫ﺻﻮرة ﻓﻲ اﻻﺧﺮ‬
e. proteinases

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65. CT axial image of :

Usual Interstitial Pneumonia

Usual interstitial pneumonia (UIP) in rheumatoid arthritis. Axial

(CT) scan of the chest of a 47-year-old female patient with
pulmonary fibrosis ( scarring ) a honeycomb appearance in
places, with areas of bronchiectasis (enlargement of the
airways). UIP causes scarring in the supporting framework
(interstitium) of the lung, and results in progressive shortness of
breath and coughing.
UIP ground glass appearance : Basal Subpleural IP
fibrosis reticulation with bronchiectasis honey comb.

66. Characteristic radiologic finding in Idiopathic Idiopathic NIP :

Non Specific Interstitial Pneumonia :
Fibrotic Changes : lung architectural distortion
a. Pleural plaques. traction bronchiectasis and bronchiolectasis .
b. Subpleural sparing: traction bronchiectasis and volume loss honeycombing
bronchiolectasis . volume loss honeycombing distribution of disease : central
central peribronchiovascular . peripheral subpleural patchy . peribronchiovascular.
b. Centrilobular nodules: Hypersenistivity P. Diffuse Subpleural Sparing

c. Upper lobe predominance

67. CT image axial with bilateral lower lobe Chronic eosinophilic pneumonia :
pneumonia . Q. 142 , 143 , 144 Non-segmental air space consolidation .
Subpleural peripheral predilection .
a. Lipoid pneumonia mainly upper zone and
( Reverse Bat Wing Appearance )
b. Cryptogenic Organized pneumonia.
c. Chronic eosinophilic pneumonia.
(a or b according to image in the exam) Organizing pneumonia sign called
Both produce lower lobe condidation reverse halo sign in which central
hypodensity surrounded by opacity
Lipoid pneumonia
History of mental retarded pt with oil aspiration and
Lipoid density in CT

68. CT Chest Right pleural effusion with multiple

bilateral nodules :

Metastasis

69. CT abdomen chronic chest pain and

shortness of breath ;
( I saw pleural effusion+ enhancing nodules )
a. T.B
b. adenoma
c. aspergilloma
d. Mesothelioma

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70. CT image of classic fibrosing mediatinitis,
with history ‫اﻧﺎ ﻣﺶ ﻓﻜﺮاھﺎ‬

Fibrosing Mediatinitis

71. Image of upper chest axial CT with two small ‫ﻃﺎﳌﺎ ﻓﻮق ﻣﺴﺘﻮى اﻟﻘﻠﺐ ﻳﺒﻘﻰ‬
structure after contrast , one enhanced and Cyst of thymic origin
the other one not . Seen at midline beside
vertebra and ask :
a. Thymic Cyst
b. Thymic cyst is anterior
mediastinum cystPericardial cyst
‫اﻟﺼﻮرﻩ ﻣﺶ ﻇﺎهﺮ ﻓ��ﺎ اﻟﻘﻠﺐ‬
Thymic cyst is anterior mediastinum cyst
Esophageal duplicatiom cyst is posterior
72. CT mass in anterior mediastinium
Typical Lymphoma

73. Patient post cardiac operation , axial CT

chest : Layering fluid densities at right side ,
I saw the descended aorta dilated with
hyper-dense surrounding hematoma :
a. Hemo-thorax
b. Hydro-pneumothorax.
c. Post pulmonectomy syndrome

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 74. Suddenly comatosed patient in the home
with image like this choices are
a- aortic dissection
b-Ascending aortic dissection with
Hemopericardium

75. Axial CT lung base lung window + abdominal - (mcq) About round
X-Ray + angio show : like tumor blush at right atelectasis what is true:
supra renal boy 13 ys old with recurrent chest - Exerts mass effect.
infection there are two basal sub-pleural
nodules at lung window with - Can show air
no definite calcification bronchogram.(true)
a. Immotile cilia syndrome - Ill defined in all
b. Round atelectasis margins.
c. Neuroblastoma - Pleural plaques never
d. Hydatid present with it.

76. Image of V/Q scan of lung and degree of

probability of pulmonary embolism….
High Probability.
2 subsegmental V/Q missmatch‫ﺑدون ﺻورة ﻓﻘط ﻛﺎﺗب‬

TEXTS
77. Sternoclavicular joint :
AP with cephalic angulation 400

78. Acromioclavicular joint :

Stress View
AP with cephalic angulation 150 ( it is the correct answer if stress view not
included in choices )

79. view with minimal cardiac shadow :

New a. AP
b. PA
c. Lateral

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80. Most common Cause of sleep apnea in child :
a. Hypertrophy adenoid tonsils
b. Hypertrophy of palatine tonsil
c. Don’t exactly remember

81. For Epiglottitis, which statement is False :

a- Usually caused by bacterial infection.
b- Accompained by high fever and drooling.
c- Shows thickened any epiglottic fold.
d- Subglottic narrowing is more common than croup.
e- Fluoroscopy is better than plain lateral neck radiography.

82. The most common pattern of oesophageal atresia is associated with (tricky one).
a. Contrast study showing fistula between trachea and upper esophagus (F)
b. Gaseless abdomen (F)
c. Trachea is non aerated due to congenital canalization defect (f)
d. Lower lobe pneumonia is commonly found >> due to Aspiration

83. Tracheal Bronchus : Q.37. CT Lt.lung anteromedial basal

a- Left upper lobe
b- Right upper lobe
c- Left lower lobe
d- Right lower lobe
84. Most common lobe affected in congenital lobar emphysema :
Left upper lobe

85. Most common lobe affected in Sequestration :

Left lower lobe

86. Extra lobar sequestration all are true Except :

a. Common site Right .
b. Arterial supply from aorta
c. Venous drainage via portal vein
d. If connected with bronchial Tree...
87. Extra lobar sequestration "least":
a. More common in male
b. Venous drainage to portal vein
c. 5% clubbing
d. Presentation at 1st day of birth.
e. Causes respiratory distress.
Intra lobar sequestration :
a- Male and female equally.
b- The sequestration is usually in left lower lobe .
c- Majority of patient before 20 years .
d- May drain in P.V.
d- 20-30% with clubbing.

- 20 -
 Intralobar pulmonary sequestration.
A- The arterial supply is from the pulmonary artery… (Systemic artery, aorta or a bronchial a.)
B- The venous drainage is usually to IVC… (Pulmonary veins).
C- It is most commonly right sided… (Left side).
D- It may present with haemoptysis… (As it is not connected to the bronchial tree)
E- It may cavitate… True
Concerning extra lobar sequestration :
A. Male and female are equally affected
B. The majority of cases presented before 20years
C. The sequestration may drain into portal vein
D. 20-30% of patients present with clubbing
E. The sequestration is contained within the normal lung

88. What is separating medial segment of right lower lobe from others :
a- azygos fissure
b- hemiazygos fissure
c- transverse or oblique fissure
e- Inferior accessory fissure

89. Ligament separate pleural from peritoneal fluid :

Coronary ligament

90. Ligament separate peritoneal fluid from left pleura :

a. falciform
b. ligament teres
c. phrenico-colic
d. hepato-dudenal ligament

91. Internal mammary lymph nodes draining of :

Chest Wall

92. Normal chest of neonate :

a. thymus reach lat wall is abnormal
b. elevated left diaphragm more than rt is abnormal
c. PA is more diagnostic than AP
d. Cardiothoracic Ratio In Neonates Is Greater Than Adult
93. Haller index definitions :
Transverse diameter on the AP diameter

94. a.
95. Child X-Ray : history of preterm + distress + intubation + improvement then
deterioration then was left pneumothorax ……
a. TTN.
b. Respiratory distress syndrome. RDS
c. Pneumonia.
96. X-Ray chest neonate ( Tachypnea at 4th day after 3 days’ full relief ) :
Transient tachypnea of newborn

- 21 -
97. Most serious complication in child RTA ( road traffic accident ) :
a. pleural effusion
b. Traumatic diaphragmatic hernia
c. bronchial obstruction by mucous plug.

98. Child with previous operation for esophageal dysplasia has sudden respiratory distress
(X-Ray shows lucent area at the right cardiac border ) diagnosis :
a. Rupture esophagus with Pneumomediastinum. sure
b. Pleural effusion.
c. Pneumonia.

99. Cause of upper lobe lung vascularity diversion :

a) Mitral Stenosis (or any cause of cardiogenic pulm. Edema )
b) cushing syndrome
c) pneumothorax
d) pulmonary H

100. Most common cause of tracheal displacement in females :

a-Thyroid enlargement.
b-Thyroid inflammatory disease.
c-Marked pleural effusion

101. Chronic rejection of lung transplantation :

a. Bronchiolitis obliterans
b. Interstitial thickening

102. Very long question: child with Leukemia had bone marrow transplantation then
came with respiratory distress and pain , did CT chest multiple nodules (no image)
a. fungal pnemonia
b. GVHD Graft Versus Host Disease donar to host reaction ( pulmonary type )

103. The intial X-Ray findings on pulmonary embolism :

a. Normal X-Ray
b. pleural effusion
c. changes in vascularity

104. Patient suspected pulmonary embolism & will do V/ Q scan

what should be done before exam :
X-Ray before 12 hours

105. Pulmonary Embolism :

Can Be Diagnosed By V/Q Mis Match

106. Regarding diagnosis of pulmonary embolism by V/Q :

a. >2 ventilation-perfusion mismatch.
b. >2 ventilation-x-ray mismatch.

107. Regarding Pulmonary Embolism :

- 22 -
 a- plain x-ray showing majority of cases are abnormal
???? c- CTA is limited to show sub-segmental pulmonary embolism
d-
c- CTA is commonly showing pulmonary infaraction
f- CTA has the same accuracy as conventional angiography in the diagnosis of
sub-segmental pulmonary embolism

108. Elevated Right hemidiaphragm in a 40 years patient :

a- Eventration is most common cause.
b- If flouroscopy shows diaphragmatic paresis , CT mediastinum should be done.
c- Pleural effusion is excluded.
d- Ultrasound abdomen can help.

109. Pleural Effusion :

a) transudate indicate infection (x exudates)
b) Subpulmonary Effusion causing lateral displacement of diaphragmatic hump
c) Blunted posterior phrenic recess indicate at least 200 cc (right 250)
d) on lateral ray 20cc of fluid can be visualized.

110. Cystic Fibrosis :

a- calcification in pancreas 30%
b- Micro gallbladder ??
c- Fatty Pancreas d- chronic liver disease in 70%

111. 13. Regarding lung carcinoma :

a. Pancoast Tumor Is adenocarcinoma .
b. increase risk with pulmonary angiographic studies.

112. Basal area with soft tissue and air Which mass in the chest show air lucency within
a- Bochdalek Hernia
b- Fat
c- pericardial cyst
d- Fat necrosis
113. Regarding Bochdalek Hernia : all wrong Except
a- It is right sided.
B-not a known cause for respiratory distress.
C- It is a cause of Radio-Opaque Hemithorax

114. Congenital diaphragmatic hernia , its severity depends on :

a. Degree of lung hypoplasia sure
b. RT or LT
c. Other two options.

115. Question about Lemierre syndrome without images .

( Septic Thrombophlebitis of IJV With Septic Pumonary Embolie )

116. Sign of acute hypersensitivity pneumonia : Q.147

a. local node into upper lobe.
b. in lower lobe
c. Bilateral Diffuse. D. Centrolobular ground glass nodules . ‫ﻟوﻣوﺟودة ﺗﺑﻘﻰ أﺻﺢ‬

- 23 -
117. The most accurate sign of pulmonary edema :
a) septal lines
b) consolidiation
c) enlarged heart
d) Upper Lobe Diversion Vessels

118. Regarding cardiogenic pulmonary edema :

a- cannot be differentiated from non cardiogenic pulmonary edema in x ray
b- in 75% of cases it presents with perihilar consolidation
c- Associated with upper lobe diversion of pulmonary arteries ( Vessels ) .
d- I am not able to remember the 4th choice exactly but I think it was it represents 75
% of causes of pulmonary edema

119. Characteristic to Cryptogenic Organizing Pneumonia : Q. 67

a. Reverse Halo Sign. Central Hypodensity Surrounded By Opacity

120. Patient with multiple lower lobe pulmonary nodules with halo around cavitary lesion :
a. Aspiregilloma
b. Invasive Aspiregilloma
c. Semi aspiregilloma

121. Patient complain from fever & cough , X-Ray chest patient has bilateral emphysema
And , cavitary lesion in Rt. :
a. carcinoma
b. metastasis
c. Aspergilloma
d. emphysematous bullea
( bad quality small film with thin walled cavity in the right upper zone with
eccentric opacity inside, so I answered it asperigelloma)

- 24 -
 122. Image of bronchiactasis and the patient have fever and hypnosis :
New a. Fungal
b. Brochiactasis
c. Aspergilloma

123. Patient with hemoptysis and history of TB with apical cavitary lesion with nodule
fixed in supine & prone position :
a. Mycetoma (fungus ball) (aspergilloma) with abnormal lung , TB most common .
b. Bronchogenic cyst.

124. Middle aged African female with eye proplem , SOB ( Shortness Of Breath )
Image Bilateral Hilar Adenopathy
a. Sarcoid
b. TB
c. Cancer
125. What is suggestive sarcoid than T.B :
a- pleural effussion
b- calcified pulmonary lesion
c- Negative mantoux test

126. 70 years old female patient complaining cough, hemoptysis and weight loss . diagnosis :
a. TB
b. Sarcoid
c. Wagner granulomatosis

127. Pt With HIV + Fever + Cough :‫ﺻورة ﻓﻲ اﻻﺧر‬

a. Kaposi sarcoma
b. Lymphoma
c. TB d. Pneumonia
Patient with HIV chest lesion x-ray and CT
1-Kaposisarcom
2-Lymphoma ‫ﺻﺤﯿﺤﺔ‬
3-Peumnia cystic carnii
4-Tebrclus adenitis
128. Empyema characterized by :
a. fluid level on xray.
b. Malignant lesion may arise from its wall.
c. on CT surrounding fat is hyperechoic .

129. Empyema :
a- air fluid level is diagnostic
b- hilar lymphadenopathy is common
c- May predispose to mesothelioma in the wall
d- Right upper lobe collapse

130. Indian 30 years ♀ → manifestation showing RT.upper lobe consolidation which

support Primary TB Than 2ry TB
a- LN

- 25 -
 b- scarring
c- cavitaion
131. Most common sign of 1ry TB :
a- cavity in upper lobe
b- Hilar lymphadenopathy

132. Regardaring pulmonary TB :

a. commonly cavitary in primary
b. initial lesion in 10% present in apicoposterior segment of upper lobe and apical
segment of lower lobe in primary TB.
c. Effusion cannot be the only manifestation of primary Tb pleural
d. Millary TB occur in both the primary and post primary TB.

133. 1ry TB :
a. commonly cavitary in primary
b. intial lesion in 10% present in apicoposterior segment of upper lobe and apical
c. segment of lower lobe
d. effusion canot be the only manifestation of primary TB pleural
e. Miliary TB occur in primary more than post primary
1ry TB is commonly cavitary in primary
a- initial lesion in 10% present in apicoposterior segment of
upper lobe and apical segment of lower lobe
b- effusion cannot be the only manifestation of primary Tb
pleural
c- TB occur in primary more than post primary milary‫ﻓﻰ اﻟﻐﺎﻟﺐ‬

134. T.B cavity with hemoptysis & hypotension , what is the next step :
a. RF ablation of the cavity
b. catheter & emblolization of the PULM. A
c. Cath. & embol. Of bronchila a.
d. Cath & embol. Of phrenic a

135. Regarding Miliary TB :

a- TB spare apices
b- pleural effusion
c- septal lines
d- Randomly distributed nodules .

136. Least common cause of egg shell calcification in L.N :

a. Silicosis.
b. Coal worker Pneumoconiosis.
c. Sarcoidosis.
d. TB
Egg shell calcification seen in the following except:
A. TB
B. Amyliodosis
C. Silicosis
D. Coal workers pneumoconiosis
- 26 -
 Egg shell calcification in the.
A- 20% of coal miners with pneumoconiosis. (Only 3-6%).
B- Sarcoidosis…True… (The most)
C- AIDS x
D- Hodgkin's lymphoma after irradiation. True
E- Patients with parathyroid adenoma. x

- Least common cause of egg shell calcification in LN.

A- Silicosis… Silicosis. Sarcoidosis. Histoplasmosis. Lymphoma post rad. Blastomycosis. Amyloidosis.
Scleroderma.
B- Sarcoidosis.
C- Coal worker's pneumoconiosis.
D- Amyloidosis.
E- Scleroderma... (The least)
F- T.B… (Not at all)

Q30:The least lung cancer to associate marked lymphadenopathy :

a- Squamous cell carcinoma.
b- Small cell carcinoma.
c- Adenocarcinoma.
d- Lymphoma.
e- Metastases.

137. Lymph node calcifications commonly seen in :

a- lymphoma
b- Sarcoidosis
c- Sclerderma

138. Calcification in lung : Pleural calcifications in asbestosis & Mets ( Ovarian )

a- Occur in Chicken Box
b- occur in giant cell pneumonia
c- in untreated nonhodgkin lymphoma
d- in sarcoid pulmonary nodule
50 yr female chest xray bilateral lower pulmonary calcified nodule:
Breast
Cervical
Uterine
Ovariane tumer
Ichoose breat tumer
N.b no thyriid in chose

139. Amiodrone toxicity in chest radiograph :

- 27 -
 Peripheral areas of consolidation with Upper Lobe Predominance .

140. IPF :
Honeycombing

A. sclerderma( show same

picture but with dilatation of the
lower esophagus)
B. asbestosis
C. silicosis
D. IPF

141. Regarding IPF :

a. The most common findings in HRCT are ground glass appearance
b. Subpleural opacity at mid and upper lung lobes.
c. Decreased lung volume sure

142. Radiologic Findings In Chronic Eosinophilic Pneumonia : Q. 67

a. Subpleural.
b. Widely distributed patchy opacities
c. Pulmonary edema.
d. Lower lobes affection.

143. Chronic oesinophilic pneumonia : Q.119

Non-segmental air space consolidation ( Reverse Bat Wing Appearance )
peripheral predilection-mainly upper zone and subpleural
a. Non-segmental peripheral of airspace consolidation.
b. Pulmonary odema

144. Chronic eosinophic pneumonia :

Non-segmental peripheral of airspace consolidation
pulmonary odema

145. 25 years female patient with SLE ( Sclerodermia ) . Fever , cough and dyspnea since
25 days . symptoms increase from first day of illness . HRCT revealed bilateral ground
glass at lower lobes & thin walled cysts are seen . Diagnosis ?
a. Acute interstitial pneumonia
b. Acute lymphocytic pneumonitis ( Lymphocytic IP ) ‫ﻟﻮﻣﻮﺟﻮده ﺗﺒﻘﻰ أﺻﺢ‬
c. Nonspecific interstitial pneumonia : Subpl.Sparing
d. Desquamative interstitial pneumonia

146. A 67 yrs male with long years of Smoking and lung crepitation, what gives the Mosaic
Chest CT Appearance ??
a. cryptogenic organising pneumonia
b. hypersentivity pneumonia
c. Desqumative Interstitial Pneumonia
d. eosinophilic
- 28 -
 N.B: Two smoking-related ILD :
Respiratory bronchiolitis–interstitial lung disease (RB-ILD)
Desquamative interstitial pneumonia

147. Types of hypersensitivity pneumonias : Bilateral diffuse with Cenrolobular nodules

• farmer's lung (bird fancier's lung: pigeon fancier's lung )
• cheese worker’s lung
• bagassosis - mushroom worker’s lung
• malt worker’s lung
• maple bark disease
• hot tub lung
• organic chemicals such as isocyanates found in paint hardeners
• from immunosuppressant used in organ transplantation: e.g. sirolimus/everolimus

148. Pathognomonic for tension pneumothorax :

a. Bilateral Invert diaphragm
b. Invert hemidiaphragm
c. Cardiomegally
d. Prominent hilar shadow

149. Empyema :
a. air fluid level is diagnostic
b. hilar lymphadenopathy is common
c. May predispose to mesothelioma in the wall
d. Right upper lobe collapse

150. Regarding To Emphysema :

a-alpha1 antitrypsin are common with panacinar emphysema
b- emphysematous bullae are centrally located
c- lower lobe bullae are less symptomatic

151. Pleural mets with calcifications :

a. Ovarian
b. Colonic
c. Breast

152. In lung cancer :

a- 75 % is asymptomtic
b- pancoast tumor is adenocarcinoma
c- adenocarcimo is central
d- X-ray scans of lungs are apredisposing factor

153. What Type Of Lung Cancer That More To cavitate :

a- small cell
b- large cell
c- adeno
d- Squamous Cell Carcinoma

154. Regarding CT Of Bronchial Tree : Q.54

a- Elderly ptn. are common than children with FB obstruction specially those in ICU
b-Air bronchogram present in Bronchoalveolar Carcinoma Tree en budd Appear.

- 29 -
 155. What is the most likely primary tumor in patient with calcified lung metastasis on
chest X-Ray :
a- Thyroid papillary
b- leukemia
c- SCC of the neck
d- not remember the 4th

156. Source of pulmonary metastasis , If with calcification the answer is

New Thyroid papillary

157. Regarding Lymphoma :

a- Extra-nodal is more common in non-hodgkin than Hodgkin
b- LNs has homogenous enhancement with contrast CT
c- calcification on LNs is more before TTT

158. What Is The Most Likely 1ry tumor in patient with calcified lung metastssis
on chest X-Ray :
a- Thyroid
b- leukemia
c- SCC of the neck

159. Patient with chest pain and tearing pain in the throax migrating to Throat :
a- pulmonary embolism
b- pulmonary edema
c- mediastinitis
d- Aortic Syndrome

160. Most sensitive X-Ray position in Effusion :

a. AP b. PA
c. lateral
d. Decubitus portable

161. View for pleural effusion :

a. Lateral
b. Supine.
c. AP d. PA

162. In HRCT of the lung :

a- indicated in PE (chronic embolism)
b- Basal Atelectatic Artifact Done With CT; Corrected By Patient prone

163. According to the HRCT Chest :

a- to improve mediastinuim view; window level should be below zero
b- To Improve Lung View ; window level should be centered below zero
c- to improve the mediastinuim view increase the window width
tomography better than high resolution in detection of periphral pul lesion

164. Question about ttt of pulmonary cavity :

Not Percutaneous Ablation

- 30 -
165. Images CXR PA & Lat. show Right Posterior Lower Focal Lesion; Asking About Next Step
a. CT With Contrast

166. T.B cavity with hemoptysis & hypotension , what is the next step:
a. RF ablation of the cavity
b. Catheter & emblolization of the PULM. A (my answer)
c. Cath. & embol. Of bronchial a.
d. Cath. & embol. Of phrenic a.

167. PTN. with recent ortho operation developed dyspnea ,with impaired renal function
How to exclude embolic lung disease :
a. V/Q TEST
b. MRI
c. dialysis after iodinated contrast.
d. CT pulmonary angiography

168. Diabetic patient , long story… , suspect P.Embo.and go to CTA, renal function elevated :
A. go to V/Q Scan.
B. Hemodialysis can remove effect of contrast
C. contrast will cause minimal nephrotoxicity
D. metformin can taken after dialysis.

169. Neonate in ICU develop pulmonary interstitial emphysema, what should you do next :
a. Extubation.
b. Stop ventilation.
c. Shifting from high frequency ventilation to conventional ventilation.
d. Shifting from conventional frequency ventilation to high ventilation.
+resolve spontaneously.

170. Child in big accident , X-Ray image shows widened mediastinium , What to do :
a. CTA
b. surgery

171. ER patient with severe injury presented with widening of superior mediastinum in AP
chest X-Ray , presented also by interscapular pain & tachycardia, the next step is :
a- Conventional Or CT Aortic Angiography
b- perfusion- ventilation radionuclide scans for possible thromboemboli
c- Skeletal syurvey searching for fracture especially thoracic vertebrea
d- Radiographs to demonstrate ocult sternal fracture . Q73MSK for Thoracic V.#

172. Contraindication for intrathoracic biopsy :

a. huge lung lesions.
b. multiple lung lesions.
c. lymph node in mediastinum
d. Pulmonary Hypertension

173. Haller index indicated surgical intervention :

a. 2.5
b. 2.8
- 31 -
 c. 3.2
d. 3.6
normal index 2.5. Significant pectus excavatum
has an index greater than 3.25
174. Numbers of right lung segments
10 segments - 8 segments at Lt.Lobe

175. Pleural effusion least amount to obliterate the angle ( facts ) :

• in AP 200 cc
• in lateral 50 cc
• lateral decubitus 20 ml

176. Male smoker do HRCT chest.. Slice thickness should be :

a. 0.1mm
b. 1 mm
c. 3 mm
d. 5 mm

177. Recent guideline of lung cancer with CT about :

a. 1.5
b. 2
c. 3
d. 5

178. Left lung field mass (NSCL cancer) involving vascular structures , left main bronchus ,
ipsilateral enlarged LNS , not extending to right side or distant metastasis ,
What percentage survival for 5 years :
a. 3%
b. 7% ( T4N2 M0 ) Stage IIIB
c. 17%
D. 25%

179. Fat parentage in pulmonary hematoma

a. 05
b. 15
c . 35 d. 75

This is the term used in the question (Hematoma) , but we think he means
(Hamartoma) . so if question hematoma >> choose least parcentage . if hamartoma >> 35%

- 32 -
180. Percent of calcification in lung hematoma (‫ ﻣﺶ‬fat %)
a. 5 %
b. 20%
c. 50%
d. 70%
e. 80 %

181. Child 10 year do chest X-Ray , what the dose of radiation relative to adult dose :
a. 100%
b. 55%
c. 45%
d. 35% >>>>If CT

182. Patient with HIV complain from fever , cough (chest infection) make ESR high ,
amount of CD4 :
a. 50-100 cell/cm3
b.100-150
c. more 200 Choose it …..Mistake from our friend only
Actually less than 200 or around in exam The answers 200 – 400 - 600
183. Pre-vertebral soft tissue thickness in children
a. 1/ 4
b. 2/4
c. 3/ 4 of vertebral body

184. Lateral X-Ray , soft tissue measurement :

C1 < 7 mm.
C6 < 14 mm

185. Sweyre james $ :

Unilateral Hyper Lucency

186. Haller index definitions

Transverse diameter on the AP diameter
187. Lemierre syndrome : images one in neck shows left internal jugular thrombosis & other
in the lung shows septic emboli like this images , he ask about what is in the CT chest :
Septic emboli

188. Images X-Ray PA view (‫ & ) ﺻﻮرة ﺻﻐﯿﺮة ﻣﺶ واﺿﺤﺔ‬CT axial (have some Bronchiectasis) :
a. Kartagner syndrome ( if with dextrocardia )
b. sawyer James Syndrome ( Unilat.Hyperlucency ) .
c. Campell Syndrome Q. 61
d. Another 4th choice I don’t remember
Williams-Campell S.: Congenital Cystic Bronchiectasis symmetrical bilateral sparing trachea &main bronchi .

189. What is suggestive sarcoid than T.B :

a. pleural effussion
b. calcified pulmonary lesion
c. Negative mantoux test
- 33 -
 190. Most serious complication in child RTA (road traffic accident) :
a. pleural effusion
b. Traumatic Diaphragmatic Hernia
c. bronchial obstruction by mucous plug

191. Most common sign of pulmonary thromboembolism :

a. Hampton Hump
b. Fleishner
c. Wstermar
if pleural Effusion present in choices >> choose it

192. What is the most likely primary tumor in patient with calcified lung metastssis on
chest X-Ray :
a- Thyroid
b- leukemia
c- SCC of the neck
But; Calcified Pleural Mets : Ovarian
193. Most common cause of tracheal displacement in females :
a-Thyroid enlargement.
b-Thyroid inflammatory disease.
c-Marked pleural effusion

194. Least common cause of upper lobe fibrosis :

a. Bleomycin.
b. Ankylosing spondylitis.
c. Sarcoidosis.
d. Progressive massive fibrosis
But; In Amiodarone Toxicity >>> Peripheral areas of consolidation with
Upper Lobe Predominance
Apical pulmonary fibrosis is seen in the following EXCEPT.
A- Bleomycin toxicity… This… (Basal).
B- Pigeon breeder's disease… (Mid &upper zones).
C- Progressive massive fibrosis. … (Mid &upper zones).
D- Ankylosing sponylitis. … (Upper zones).
E- Sarcoidosis. … (Mid &upper zones)………. ……. NB: Asbestosis (Lower zones &pleural thickening and
calcify.)

Q-Upper zone pulmonary fibrosis is seen in EXCEPT.

A- Beryliosis.
B- Sarcoidosis.
C- Ankylosing spondylitis.
D- Farmer's lung.
E- Rheumatoid arthritis. This

* Amiodarone lung toxicity :

- Chylothorax – Pneumothorax – Hyperdense consolidation – Peribronchovascular nodules .

- 34 -
 1- [image] exactly like this:  I chose bronchogenic cyst.

2- [text] the initial finding in chest XR in pulmonary embolism  normal.

3- [image] very small bad chest xray. I saw right pneumothorax. There was ET tube, chest tube and NG
tube. Q what needs adjustment. I saw the chest tube low in the lower lung zone (should be higher to
drain the pneumothorax)  I chose adjustment of the chest tube.

4- [image] CT chest post contrast with mediastinal window. I saw dilated main pulmonary artery and left
pulmonary artery. But the right was not dilated. Q: what is the cause of this appearance. Choices that I
remember  Behcet disease, pulmonary hypertension. I chose pulmonary hypertension but don’t
know if it is true or not.

5- [image] chest CT axial mediastinal window (there was massive left pleural effusion, mild shift of the
mediastinum to the right, I saw multiple pleural thickening like plaques or nodules) the Q  mets,
mesothelioma , … I chose mesothelioma but not sure if true or not.

6- PCXR of Male pat.25Ys. complain of fever & cough :

Pneumicitis P. – Lymphoma – Kaposi sarcoma - TB.

mass of sarcoma‫ ﻟﻛن ﻣوﺟود ھﻧﺎ ﻣﻔﯾش‬reticulations OF Atypical pneumocystis Carnii pneumonia

7- ‫ اﻟﺳؤال ده ﯾﺟﻲ ﻋﻠﺷﺎن ﺗﻔرق ﺑﯾن‬Most two common chest lesions on AIDS patient WHICH ARE
KAPOSI SARCOMA VERSUS PNEUMOCYSTIS CARNII PNEUMONIA

Thymus
À. Normal irregular border
B. Smaller in supine than upside position
C. Should visualized at birth
D. Difficult to detect in first year of age

* Sign Of Empyma In CT Chest…. .‫ﻓﻲ ﺳؤال ﻋن‬

1.spilt pleura sign
2.pleural thickening
3.fluid level
4.enhacing visceral surface

* Features distinguish lung abscess from pleural empyma

- 35 -
1.split pleura sign ???
2.well defined lesion seen surronded by lung tissue
3.pleural thickening
4.enhancing visceral pleura

* Female pt complain of cough & dyspnea CT was done showing multiple nodules
with variable sized more in lower lobes with preseptal thickening and
decreased lung volumes :
Lympgangiolipomatosis ( T )
Silicosis – Sarcoidosis – Carcinoma

* Subacute Hypersensitivity Pneumonitis :

1. consolidation
2. Centrilobular Nodule ‫ودي اﻟﻠﻲ اﺧﺗرﺗﮭﺎ وﻣﺗﺄﻛده ﻣﻧﮭﺎ‬

1- Chest x ray AP view in neonate showing left mediastinal shift with hype inflated lucent right lung ( ‫ﺗﻣﺎﻣﺎ‬
‫)ﻣﺛل اﻟﺻورة ﻓﻲ اﻟﻣذﻛرة‬

- Left bronchial obstruction by FB

- Right congenital lobar emphysema
- Left bronchopneumonia
- Left lung collapse ]

2- Chest CT shows bilateral peripheral patchy consolations , (one of these consolidations of the right lung
shows inverted halo sign ) ,,

- Chronic eosinophilic pneumonia

- hypersensitivity pneumonia
- Cryptogenic pneumonia
- ,,,

3- Patient well go for pelvic operation, underwent routine preoperative chest x ray + image ,,,, what is
next

- 36 -
− Nothing
− CT chest
− ,,,,,
− ,,,,

4- Image X ray with CVL and ETT , (Central V line goo laterally likely in the SCV )

- Adjust ETT
- Reposition of CVL
- Do nothing
- //
5- Chest x ray (PA and LAT), ‫ ﻧﻔس اﻟﺳؤال ﻓﻲ اﻟﻣذﻛرة‬opacity of the left upper lobe , the outline of the outline of
the aorta is not clearly seen
- Left upper lobe collapse
- Left lower lobe collapse
- Pleural effusion
- Ruptured aortic aneurysm

‫ ﻛﺎن‬History ‫ﻟﻛن‬
patient middle age came to ER with chest pain , and finding was not matching with left upper lobe
collapse as the opacity take mostly the whole left mid and upper zones , and history not matching
with aortic rupture despite aorta is not clearly seen ??

6- Image x ray chest ETT , chest tube (patient has right apical pneumothorax and chest tube at the right
mid chest , and ETT relatively low near carina) ,,
- No need for chest tube
- No need for ETT
- ETT need to be pushed down
- Chest tube need adjustment

- 37 -
Q.64 , 66 . Nonspecific Interstitial Pneumonia . A 51-year-old female patient with ( SLE ) scleroderma. Axial
high-resolution computed tomography scan of the chest (A) and coronal reformatting (B). In A, ground-glass
attenuation , with linear reticular opacities (closed arrow) , traction bronchiectasis, and traction
bronchiolectasis. Note the discrete subpleural ( sparing ) preservation (open arrow). In B, predominantly
basal and symmetric pattern of distribution. Sjogren disease Q.64

- 38 -
Q.127. Kaposi sarcoma

- 39 -
- 40 -
- 41 -
- 42 -
‫واﻻﺧﺗﯾﺎرات‬
A) silicosis
B) sarcoidosis
C)pleural adenoma
D) malignant mesothelioma

59- fatty lesion in the chest 60- In HRCT of the lung a- indicated in
PE (chronic embolism) b- basal atelectated artifact done with CT;
patient prone ‫ ﺗﺄﻛﺪ ﺻﺤﺘﮭﺎ‬c- others

Q8: least likely to presents as respiratory distress in first day of life :

a- Cystic adenomatoid malformation .

b- Congenital lobar emphysema.

c- Broncho-pulmonary dysplasia . ( Gradual Change late manifestation )

d- Diaphragmatic hernia.

Q9: least likely to presents as respiratory distress in first day of life :

a- Mikity- Wilson syndrome. ( Part of spectrum of Bronchopulmonary Dysplasia )

b- Cystic adenomatoid malformation .

c- Congenital lobar emphysema.

d- Pulmonary hypoplasia .

e- Diaphragmatic hernia.

Q12: For Epiglottitis, which statement is false :

a- Usually caused by bacterial infection.

b- Accompained by high fever and drooling.

c- Shows thickened any epiglottic fold.

d- Subglottic narrowing is more common than croup.

e- Fluoroscopy is better than plain lateral neck radiography.

Q19: Which of the following will show pulmonary plethora with cyanosis :
- 43 -
a- Persistent fetal circulation.

b- P.D.A .

c- Aorta- pulmonary window.

d- Truncus arteriosus.

Q22:The most common radiology sign of pulm thrombo-embolic disease ?

a- Hamptons hump.

b- Westermark's sign.

c- X-ray chest normal in 80-90% of cases

d- Pleural effusion.

e- Segmental Atelectasis.

Q23:Common features of pulmonary thrombo- embolization except:

a- Normal chest in 80-90% .

b- Pleural effusion in some cases.

c- Atelectasis.

d- Pulmonary infraction (diaphragmatic hump).

e- Pulmonary infiltrates.

f- Mild elevation of hemi diaphragm.

Q28: Plethora with cyanosis occurs in all except:

a- Fallot,s tetralogy .

b- Persistent fetal circulation .

c- Transposition of the great vessels .

d- Truncus arteriosus.

e- Total anomalous pulmonary venous return.

- 44 -
Q31: What the most causes of 2nd Caushing syndrome:

a- Adrenal cell carcinoma.

b- Neuroblastoma.

c- Adrenal adenoma.

d- Adrenal hyperplasia.

1-80 years old male do ct chest what the incidental finding in trachea
A:tracheomalacia

B:wagner granulomatosis

C: Tracheobronchopathia Osteochondroplastica (sure,spot diagnosis)

14-Text ,Patient with SLE with chest infection ,ct shows

ground glass opacity
A:acute interstitial pneumonia

B:lymphocytic interstitial pneumonia

C:non specific interstitial pneumonia

D:desquamative interstitial pneumonia

- 45 -
 1) IPF 1- lung volume decrease progressively
2-ground glass appearance in HRCT .
2) Image CT chest (lower cuts ) with cystic like changes and reticulation 50y old
man .
a-Usual IP.
b-Desquamative IP .
c-Lymphocytic IP.
d-chronic esinophilic IP.

29- In pulmonary Sarcoidosis:

1- Pleural effusion is common.

2- The majority of cases presenting with parenchymal changes only.

3- An alveolar pattern of shadowing doesn't occur.

4- Approximately 20% of patients with parenchymal changes progress to fibrosis. ( T )

5- Paratrachial nodal alone is typical. ???

30- Rib destruction with an adjacent soft tissue mass is not seen in:

1- Multiple myeloma

2- Wegner's granuloma. ( T )

3- Tuberculosis osteitis.

4- Actinomycosis.

5- Mesothelioma.

31- Rib notching:

1- In aortic coarctation is usually symmetrical.

2- In aortic coarctation is left sided if the coarctation is proximal to the left subclavian artery.

3- Is not associated with aortic valvular lesion. ( T )

4- Is a feature of tuberous sclerosis

- 46 -
5- Is a feature of inferior vena caval obstruction.

33- The following is not a recognized cause of a unilateral hyper-transradient hemithorax in

chest radiograph:

1- Patient rotation.

2- Pulmonary embolus.

3- Congenital lobar emphysema.

4- Agenesis of the lung. ( T )

5- Poliomyelitis.

Pulmonary edema

- 47 -
 Lipoid pneumonia. Lipoid pneumonia organized
(different case) pneumonia
Exogenous lipoid
pneumonia is a condition There is bilateral low-
caused by the inhalation attenuation
of fat-like material of consolidations with 1-Multiple bilateral
animal, vegetable or greatest involvement of predominantly basal
mineral origin. the left lung. and peripheral
Opacification of the left subsegmental
mainstem bronchus consolidations with air
consistent with mucous bronchograms are
The patient in our case seen, 2-smaller
had a mild mental plugging or aspiration.
Small bilateral pleural consolidations are
retardation, disorders of seen within the mid
swallowing and her effusions, greater on
left with some lung zone as well as
relatives reported that both upper lobes
she had taken loculation. Volume loss
of the left hemithorax. anterior segments. The
unspecified drops opacification are
containing paraffin. Findings are typical for
lipoid pneumonia with predominantly
Acute exogenous lipoid chronic changes. bronchocentric.
pneumonia typically 3-Small patchy areas
manifests as cough, of ground glass
dyspnea, and low-grade attenuation as well as
fever. reticular pattern and
subpleural nodules.

The opacities, ground 4-Mild bronchial

glass and consolidative, dilatation with
are bilateral and bronchial wall
predominantly involve thickening is seen in
the middle and lower the right upper lobe
lobes. anterior segment as
well as the right
Exogenous lipoid middle lobe medial
pneumonia can also segment.
manifest as geographic

- 48 -
ground-glass attenuation 5-No pleural effusion.
associated with
interlobular septal 6-Small non-specific
thickening within areas mediastinal lymph
of ground-glass nodes.
attenuation: "crazy
paving" pattern.

Chronic eosinophilic Usual interstitial Amiodrone lung:

pneumonia pneumonia:
Numerous reticular
Peripheral areas of reticular opacities opacities, most
airspace consolidation marked in the right
throughout both lungs traction bronchiectasis , upper zone.
with a predominance for honeycombing and
the middle and upper architectural distortion,
lobs. which reflects lung
fibrosis.
Pathologic findings are
predominantly in the
lower lobes of both
lungs.

- 49 -
CT shows basal and peripheral reticular opacities with
honeycombing and traction bronchiectasis.

- 50 -
 Pleura

suboptimal position: Homogeneous opacification of the

left upper zone is noted.
The end of the endotracheal tube is
projected around 1cm above the carina. The tip of the endotracheal tube
This should be retracted approximately (ETT) is seen to lie in the right
3 cm. main stem bronchus.
The nasogastric tube is seen curling back The tip of the nasogastric tube is not
in the mid oesophagus and proceeding in the stomach.
superiorly, with the tip and side hole
not visualised. This should be replaced.
The left internal jugular central venous
catheter is seen to curl back with its tip
projected superiorly in the internal
jugular vein. This should be replaced.
There are two appropriately positioned
chest drains projected in the anterior
and superior mediastinum.

- 51 -
 Cystic bronchiectatic changes are noted involving the right upper and lower
lung lobes with relative sparing of the middle lobe which shows
compensatory hyperinflation. Some of the dilated bronchi shows air/fluid
level which is keeping with concurrent infection.

CHEST

Q- Lung carcinoma.

A. Overall 5Y survival in 35%... x (12%)

B. The majority of pleural effusions associated with lung carcinoma… True
C. The central tumor > 3cm, nodal metastasis are highest in adenocarcinoma… x
D. Inspite of hilar L.N. is usually contraindicated to surgical resection of the tumor… x
E. MRI is superior to CT in detection of subcarinal L.N. during staging… x

Q-Carcinoma of lung.

A. The oat cell variety commonly cavitates…x (Never)

B. Air bronchogram within the tumor mass are often shown by wide angle tomogram. x (high
resolution CT)
C. Tomography may demonstrate popcorn calcification within the tumor... x
D. Bone metastases are usually sclerotic. x (Osteolytic)
E. Hyponatraemia is associated with oat cell tumor… True

Q- Carcinoid tumor of the lung.

- 52 -
A- Is usually peripheral in location. xx (central 80%)
B- Usually affects the Rt. Ht. in carcinoid syndrome…x (Lt. Ht.)
C- Infrequently metastasis... x
D- Typical grows rapidly. x (Slow)
E- Is more common than adenoid cystic tumor…True

Q- Most likely to cavitate

A- Small cell carcinoma…(Central and 80% adenopathy)

B- Large cell carcinoma… (Peripheral and 2-10 % of cases cavitate).
C- Bronchoalveolar carcinoma.
D- Squamous cell carcinoma… True (Central, atelactasis and 30% of cases cavitate)
E- Metastases.

Q- In Wagener's granulomatosis.

A- There is 20% mortality rate if untreated.

B- The presence of anti-cytoplasm antibodies is pathognomonic.
C- Lobar consolidation occurs.
D- Steroids and cyclophosphamide are the treatment drug of choice… True
E- Limited Wagener's granulomatosis is predominant extra thoracic.

Q- Sarcoidosis presents with. (The most correct).

A- Presenting with midzonal multiple shadows.

B- Presents with basal multiple shadows.
C- Unilateral lymph hilar enlargement with discrete shadows.
D- Bilateral lymph hilar enlargement with midzonal opacities…
E- Bilateral lymph hilar enlargement… True

Q- Sarcoidosis. (The most correct).

A- Progression of the disease with parenchymal involvement occurs in approximately 10% of

patients presenting with hilar adenopathy. x (40%)
B- Bronchial stenosis is invariably relieved following resolution of hilar adenopathy. x
C- Recurrence of hilar adenopathy following treatment with steroids is seen in approximately
15% of cases. x
D- Necrotizing sarcoid granulomatosis may be distinguished from massive adenopathy
involving hilar + paratracheal lymph nodes. x

- 53 -
E- Conglomerate shadowing resembling progressive massive fibrosis is a recognized pattern
of lung involvement… True

Q- Sarcoidosis.

A- Erythema nodosum is associated with bilateral hilar lymphadenopathy. True

B- Pulmonary parenchymal involvement completely resolves in the majority of patients. x
C- Pleural effusion doesn't occur. x (Occur in 2%of cases.)
D- Pulmonary fibrosis typically occurs in the lower lobes. x (Upper lobes).
E- Anterior mediastinal lymph nodes are usually involved in the presence of hilar lymph
nodes enlargement. x (16% only)

Q- Pulmonary sarcoidosis. $$$

A- Pleural effusions are common. x (Occur in 2%of cases.)

B- The majority of cases present with parenchymal changes only. (50-70% not only)
C- An alveolar pattern of shadowing does not occur. x (15%)
D- Approximately 20% of patients with parenchymal involvement progress to fibrosis. x (33%)
E- Paratracheal nodal involvement alone is typical… True

Q- For epiglottitis, which statement is false. $$$

A- Usually caused by bacterial infection.

B- Accompanied by high fever and drooling. (Haemophilus influenzae)
C- Shows thickened aryepiglottic fold.
D- Subglottic narrowing is more common than croup. False (Supraglottitis)
E- Fluoroscopy is better than plain lateral neck radiograph.
Q- Rib notching. $$$

A- In aortic coarctation is usually symmetrical… x

B- In aortic coarctation is left sided if the coarctation is proximal to the left subclavian
artery.x
C- Is not associated with aortic valve lesion. True
D- Is a feature of tuberus sclerosis. x (Neurofibromatosis)
E- Is a feature of inferior vena cava obstruction… x (SVC)

Q- Rib destruction with an adjacent soft tissue mass is not seen in. $$$

A- Multiple myeloma.
B- Wegener's granulomatosis… This
C- Tuberculosis osteitis.
D- Actinomyocosis
- 54 -
E- Mesothelioma.

Q- The following statement is correct concerning pulmonary tuberculosis. $$

A- Patients on haemodialysis are at increased risk… True

B- The primary form most often affects the upper lobes. (Also in apical segment of lower lobes)
C- Miliary tuberculosis only occurs in the post primary form of the disease. (Also in 1ry)
D- Post primary disease is typically associated with hilar lymph node enlargement. (only in 1ry)
E- Primary disease is typically associated with cavitation. (only in post 1ry)

Q- Post 1ry TB.

A- 20% of patients will show no evidence of cavitations. True

B- Pleural effusion have a poor prognosis > that of 1ry TB. True
C- Air fluid levels are commonly found early in the course of the... False
D- Most tuberculomas are solitary. True
E- There is a higher incidence in patients suffering from silicosis. True

Q- Bochdalek hernia.

A- Is commoner than Morgagni.

B- Mainly on the left side.
C- Is through retrosternal defect. False… (Post. lat. part of hemidiaphragm).
D- Is a surgical emergency of newborn.
E- Can result in an abnormally high position of umbilical vascular eathes on plain radiograph.

Q- Bochdalek hernia.

A- It is found in 1:10000 fetuses. (Rare).

B- There is a slight Lt sided predominance. (Common 90%).
C- The mortality rate of these patients is approximately 50%. True
D- There is increase incidence of extralobar sequestration. True
E- The presence of H.H. in the patient worsens the prognosis. True

Q- The following is not a recognized cause of a unilateral hypertransradiant

hemithorax on a chest radiograph. $$$

- 55 -
A- Congenital lobar emphysema.
B- Agenesis of lung… This
C- Poliomyelitis.
D- Patient rotation.
E- Pulmonary embolus.

Q- Pulmonary embolic disease.

A- Over 90% of emboli are multiple.

B- 1/3 of patients have radiological evidence of acute pulmonary hypertension. (5-10%).
C- A pulmonary infarction is almost always associated with pleural effusion. True
D- Hemorrhagic infarction with necrosis of the lung occurs in less than 5% of patients.
E- Normal chest radiography is seen in 40-60% of the patients.

Q- Concerning Pulmonary Thromboembolism

A- Of the patients surviving for one hour following acute pulmonary embolism and in
whom the correct diagnosis has not been made, 30% will die. True
B- Haemoptysis occurs in more than 60% of patients with an acute pulmonary embolus.
(False only 17%)
C- Right-sided cardiac failure occurs when more than 50% of the pulmonary vasculature
has been occluded by embolus. True
D- Five to 10% of patients with acute pulmonary embolism may develop chronic
pulmonary hypertension. True
E- The classical ECG findings of pulmonary embolism include sinus tachycardia, right
axis deviation, S1Q3T3 and ST changes. True

Q- Radiological signs of thrombo-embolism include EXCEPT.

A- A normal chest radiograph in 80-90% of cases... False (Abnormal)

B- Westermark's sign…alteration of pulmonary vasculature distal to the embolism. True
C- Fleischner's sign…dilatation of the main pulmonary veins by back pressure or clot.
True
D- Hampton's hump…a shallow hump shaped lesion on the pleural surface due to a
pulmonary infarction. True
E- Demonstrable effusion in most cases. (50% of cases). True

56
 1. Long text Q; female wih hematuria and lion pain, IVP  hydronephrosis, multiple renal pelvic
stones, you notied fanning of contrast at renal papillae what is the cause.
a. Infilteration of ? tubules ( T )? calyces ? lymphatics.
2. CT chest in child (high cut).
a. Right aortic arch.
b. Left superior pulmonary vein.
c. Left SVC.
3. Most common intra-medullary spinal cord tumor in infant.
a. Epindymoma.
b. Astrocystoma.
c. Meningioma.

1- In pulmonary Sarciodosis:

A. Pleural effusions are common.

B. The majority of cases present with parenchymal changes only.
C. An alveolar pattern of shadowing does not occur.
D. Approximately 20% of patients with parenchymal involvement progress to fibrosis.
E. Paratracheal nodal involvement alone is typical.
2- Rib destruction with an adjacent soft tissue mass is not seen in:

A. Multiple myeloma.
B. Wegener's granulomatosis.
C. Tuberculosis Ostitis.
D. Actinomycosis.
E. Mesothelioma.

5- The following is not a recognized cause of unilateral hypertransradiant hemithorax on chest

radiograph:

A. Patient rotation.
B. Pulmonary embolus.
C. Congenital lobar emphysema.
D. Agenesis of lung.
E. Poliomyelitis.

6- The following statement is correct concerning pulmonary tuberculosis:

A. Patients on haemodialysis are at increased risk.

B. The primary form most often affects the upper lobes.
C. Military tubeculosis only occurs in the post primary form of the disease.
D. Post primary disease is typically associated with hilar lymph node enlargement.
E. Primary disease is typically associated with cavitation.

57
31- The following is most likely to be associated with lymphadenopathy:

A. Small cell carcinoma

B. Large cell carcinoma
C. Oat cell carcinoma
D. Adenoma
E. Parenchymal metastasis
62- Sarciodosis presents by:

A. Mid zonal multiple shadows

B. Basal multiple shadows
C. Unilateral hilar LNs with discreet shadows:
45-Sarciodosis:

A. Commonest feature is pleural effusion

B. Is pulmonary infiltrate without hilar lymphadenopathy
C. Is hilar lymphadenopathy only
D. CXR usually normal
E. May give density of acinar type

2. 2images (one lipoid pneumonia 1) (one hypersenstivity pneumonia)

Acute ans subacutehypersensitivity pneumonitis. chronic hypersensitivity pneumonitis.

10. The intial X-ray findings on pulmonary embolism:

a. normal x-ray 2

1
Images and comment at allinone notes
2
Radiographic signs are nonspecific and are present only if a significant infarction occurs (primer)

58
b. pleural effusion

c. changes in vascularity32. plain xray (PA, lat) with right upper lobe opacity
not very clear but in lateral I think it shows uplift of horizontal fissure, the
diagnosis:

a. right upper lobe collapse.(not classic golden s shape in PA) ???

b. right upper lobe pneum. (may be right, but I don’t notice air bronchogram) ( T )

c. encysted effusion

d.other don’t remember and far.

Rt upper lobe pneumonia (Air

bronchograms point to consolidation.)
Right UL collapse

12. post contrast CT (chest xray) ‫وﺣﺸﺔ ﻗﻮي و ﺻﻐﯿﺮة‬, nodule parahilar very
small, otherwise clear chest :

a. I choose solitary nodule (I THINK WRONG) According to images

b. sacroid

c.normal

pleural effusion (35% )https://radiopaedia.org/articles/pulmonary-embolism

59
17.Axial image of upper chest cuts, pointed to the azygous, options:

a. lymph node.

b. azygous vein

19. CT chest (image of upper mediastinum) shows aortic arch, svc, trachea,
lymph nodes(beside SVC) 3, point at the lymph node. 4

25. most common anomaly for pulmonary veins 5:

3
4R. Right Lower Paratracheal (Upper border: intersection of caudal margin of innominate (left brachiocephalic)
vein with the trachea. Lower border:lower border of azygos vein.) 4R nodes extend to the left lateral border of the
trachea.
4
http://www.radiologyassistant.nl/en/p4646f1278c26f/mediastinum-lymph-node-map.html
55
In normal conditions, the four pulmonary veins carry oxygenated blood from both lungs and drain into the left
atrium, as follows: (a) the right superior pulmonary vein drains the right upper and middle lobes; (b) the left

60
a. Middle lung lobe takes separate venous drainage (right )

Cystic bronchietasis

superior pulmonary vein drains the left upper lobe and lingula; and (c) the two inferior pulmonary veins drain the
lower lobes. https://pubs.rsna.org/doi/pdf/10.1148/rg.334125043
Variant anatomy (https://radiopaedia.org/articles/pulmonary-veins)
Typical anatomy described above is found in ~70% of patients 1-4. Variant configurations are more common on
the right and include:
common trunks
common draining trunk of left superior and inferior pulmonary veins
accessory (additional pulmonary veins)
single accessory right middle pulmonary vein (~10%)
two accessory right middle pulmonary veins
one accessory right middle pulmonary vein and one accessory right upper pulmonary vein
superior segment right lower lobe vein
basilar segment right lower lobe vein
right top pulmonary vein (drains right superior basal segment)

61
 1- Small to medium vessels vasculitis mainly at
coronary-young children.
a. Cardiac sarcoidosis
b. Viral pericarditis.
c. Kawasaki diseases.

N.B:
* Lipoid pneumonia: aspiration at the dominant part of
the lung. (Dependant portion of the lung, chch low
attenuation by CT -100).
*Cryptogenic organized pneumonia: Sub-pleural/ peri-
bronchial (peripheral) - unilateral or bilateral.
Inverted halo sign.
* Chronic oesinophilic pneumonia: Sub Pleural,
reversed bat wing. Upper & middle lobes.
*If bilateral basal lesion lipoid pneumonia.
& If upper lobes and peripheral chronic eosinophilic
pneumonia.

1-80 years old male do ct chest what the incidental finding in trachea
A:tracheomalacia

B:wagner granulomatosis

C:tracheobronchopathia osteochondroplastica(sure,spot diagnosis)

62
9-Patient with bronchogenic carcinoma mri inphase
&out of phase

a:myelolipoma

b:lipid rich adenoma

c:pheochromocytoma

d:adrenal carcinoma

14-Text ,Patient with SLE with chest infection ,ct shows

ground glass opacity
A:acute interstitial pneumonia

63
B:lymphocytic interstitial pneumonia

C:non specific interstitial pneumonia

D:desquamative interstitial pneumonia

A.

Chest X ray AP and Lat

A. treated epistain
B. rheumatic heart disease

bicuspid aortic valve

A.

E. sclerderma( show same

picture but with dilatation
of the lower esophagus)
F. asbestosis
G. silicosis
H. IPF

64
4- CT axial image of usual interstitial pneumonia: (
worst prognosis)
 Septal thickening, bronchiectasis, honey combing
(underlying CT disease: RH-S sclerosis).

5- CT image axial with bilateral lower lobe

pneumonia.
d. Lipoid.
e. Organized pneumonia.
f. Chronic eosinophilic pneumonia.
6- Lipoid pneumonia: middle & lower lobes.

Cxr pre and post biopsy from chest wall mass....

hemothorax

Other cxr 2 tubes..thoracotomy and endotracheal tube....

no need for endotracheal tube

7- Swyer james syndrome: is a rare lung condition that

manifest as unilateral hemi-thorax lucency as a result
of post-infectious obliterative bronchiolitis.

65
 8- X- ray & CT lat of child with lat. Neck soft tissue
mass with difficult swallowing & fever:
a. Retropharyngeal abscess.
9- The minimum time to chest tube drainage:
24 h.
3) IPF 1- lung volume decrease progressively
2-ground glass appearance in HRCT .
4) Image CT chest (lower cuts ) with cystic like changes and reticulation 50y old man .
a-Usual IP.
b-Desquamative IP .
c-Lymphocytic IP.
d-chronic esinophilic IP.

2. Child x ray image

a. malposition of nasogastric tube (i see it above diaphragm)

3. Other cxr 2 tubes..thoracotomy and endotracheal tube....

a. no need for endotracheal tube

21.If patient on dialysis by tube and you feel complain of suffocation

...suspicious of air embolism what is the true position of this patient
a. prone
b.supine
c. left lat decubitus 6
d. right lat decubitus

29. Most common lung segments show congenital lung emphysema 7:

6
https://emedicine.medscape.com/article/761367-treatment
Immediately place the patient in the left lateral decubitus and Trendelenburg position
7
Interestingly there is quite a pronounced predilection for some lobes: https://radiopaedia.org/articles/congenital-lobar-overinflation

• left upper lobe: most common, 40-45%

66
 a. right upper lobe
b. lt middle
c. basal segments

30. Plain X-ray chest, and tracheal tube and interviews tube, Image
endotracheal inside trachea .intercostal tube in marked effusion
a. No needs to tube

b. No need for intercostal tube

c. Adjust tracheal tube

d. Adjust intercostal tube(The tip of the tube should not abut the mediastinum)

31. image:cystic adenomatus malformations

10- Patient after accident with chest trauma, first

he did x-ray chest (2 images) what is the
information given by CT not evaluated at CXR:
a. Lung contusion.
• right middle lobe: 30%

• right upper lobe: 20%

• may involve more than a single lobe: 5%

• much rarer in the lower lobes

Therefore despite the left upper lobe is most commonly affected, the right hemithorax is the most common side to be affected 6.

67
 b. Rib fractures.
c. RT pneumothorax.
d. CVL need reposition (T).

11- Chest X-ray posterior mediastinal mass CT

abdomen = Symmetrical para-vertebral soft tissue
masses:
a. Extra-medullary hematopioesis.
b. Thymoma.
c. Teratoma.
b. The minimum time to chest tube drainage:
24 h.
c. X- ray & CT lat of child with lat. Neck soft tissue
mass with difficult swallowing & fever:
a. Retropharyngeal abscess.

5) IPF 1- lung volume decrease progressively

2-ground glass appearance in HRCT .

4. Child x ray image

b. malposition of nasogastric tube (i see it above diaphragm)

CXR pre and post biopsy from chest wall mass:

68
 a. hemothorax
Other cxr 2 tubes..thoracotomy
and endotracheal tube....
b. no need for endotracheal tube

27. Image of ventilation profusion scanning (‫ ﺻﻮر اﻟﺼﻮرﺻﻐﯿﺮه‬6x rays.isotope

‫)فﯾﮭﺎ‬: multiple segmentation defects ,x rays obscures ,effusion

a. high probability
b. low probalility
c.intermediate probalility
4. normal

21.If patient on dialysis by tube and you feel complain of suffocation

...suspicious of air embolism what is the true position of this patient
a. prone
b.supine
c. left lat decubitus 8
d. right lat decubitus

29. Most common lung segments show congenital lung emphysema 9:

8
https://emedicine.medscape.com/article/761367-treatment
Immediately place the patient in the left lateral decubitus and Trendelenburg position

9
Interestingly there is quite a pronounced predilection for some lobes: https://radiopaedia.org/articles/congenital-lobar-overinflation

• left upper lobe: most common, 40-45%

• right middle lobe: 30%

• right upper lobe: 20%

• may involve more than a single lobe: 5%

• much rarer in the lower lobes

69
 a. right upper lobe Such example: You can see that there is an extensive area of ventilation
b. lt middle perfusion mismatch in the left lower lobe. [ red arrows: perfusion
c. basal segments abnormality; blue arrows: normal ventilation] This is not a’ wedge shaped’
defect, which is the typical appearance of PE, but the extent of the
abnormality makes it ‘high probability’

* Old patient with suspected bowel perforation underwent ct with iv contrast after
injection developed tachycardia and ECG show arrhythmic changes
supraventricular tachycardia

What to give

Lidocaine

Adenosine

Amiodarone

Epinephrine

Adenosine for supra ventricular tachycardia. ...Amidorone for ventricular

tachycardia

* Male patient need ECG gated coronary angio with HR ranging from69 to 75

Therefore despite the left upper lobe is most commonly affected, the right hemithorax is the most common side to be affected 6.

70
The study needs lower HR to be below 65

What to do ?? ‫اﻻﺧﺘﯿﺎرات‬

Give B blocker metoprolol

Perform ECG matching after image acquisition.

Q41: Which of the following types of bronchoiectasis is most sever:

a- Cystic .

b- Cylinderal .

c- Irreversible .

d- Varicose .

e- Obstructive .

Q54: Regarding the inhalation of foreign bodies ?

a- The chest radiography is usually normal .

b- The majority of inhaled foreign bodies are radio-opaque .

c- Decubitus film are not helpful.

d- Coins are the foreign bodies most frequently inhaled .

e- CT scanning is useful in locating objects sited peripherally in the lung .

Q43: F.B aspiration all wrong except :

a- Mostly of them are radio-opaque.

b- Chest X-Ray usually normal.
c- Decubitus film is helpful .
d- C.T used for localization.

Q46:Features of sarcoidosis are the following except:

71
a- Parenchymal shadowing .
b- Resolution of the L.Ns in most of the cases.
c- Pleural effusion is rare.
d- Involvement of the Para tracheal L.N s only .
e- 20% progress into fibrosis.
Q58:Common features of pulmonary thrombo- embolization except:

a- Normal chest in 80-90% .

b- Pleural effusion in some cases.

c- Atelectasis.

d- Pulmonary infraction (diaphragmatic hump).

e- Pulmonary infiltrates.

f- Mild elevation of hemi diaphragm.

Q53:Pulmonary T.B. all wrong except:

a- Increase incidence in haemodialysis.

b- Miliary spread does not occur.

c- L.Ns is a feature.

Q37: Fetal distress at 1st day occur with all except :

a- Cystic fibrosis.

b- Diaphragmatic hernia.

c- Fallot,s tetralogy .

d- Transposition of the great vessels .

e- Hypo plastic LT or RT heart .

ADIL'S RADIOLOGY PEARL:-

========================

72
Idiopathic interstitial pneumonia's (IIPs) include seven entities: Idiopathic
pulmonary fibrosis, which is characterized by the morphologic pattern of usual
interstitial pneumonia (UIP). Nonspecific interstitial pneumonia (NSIP);
cryptogenic organizing pneumonia (COP); respiratory bronchiolitis–associated
interstitial lung disease (RB-ILD); desquamative

interstitial pneumonia (DIP); lymphoid interstitial pneumonia

(LIP); and acute interstitial pneumonia (AIP). The characteristic computed

tomographic findings in UIP are predominantly basal and peripheral reticular
opacities with honeycombing and traction bronchiectasis. In NSIP, basal ground-
glass opacities tend to predominate over reticular opacities, with traction
bronchiectasis only in advanced disease. COP is characterized by patchy peripheral
or peribronchovascular consolidation. RB-ILD and DIP are smoking-related
diseases characterized by centrilobular nodules and ground-glass opacities. LIP is
characterized by ground-glass opacities, often in combination with cystic

lesions. AIP manifests as diffuse lung consolidation with groundglass opacities,

which usually progress to fibrosis in patients who survive the acute phase of the
disease.

Q41: Which of the following types of bronchoiectasis is most sever:

a- Cystic .

b- Cylinderal .

c- Irreversible .

d- Varicose .

e- Obstructive .

10-copy past of this image congenital lobar malformation

f-

73
g-

Lesion at right cardiopherinic angle, chest X-ray, CT show fat density.

o Lipothymoma
o Mortgagni hernia.
o Pericardial cyst.
o Bockdalik hernia.
•
•

10 years child with repeated chest infection

X ray w ct ‫ﺑس ﻣﻔﯾش ﺻور ھو ﺑﯾﻘول اﻧﮫ ﻋﻣل و اﯾﮫ اﻟﻠﻲ ﻋﻧده‬
Diaphragmtic hernia
Lymphoma
Congenital pulmonary airway disease
Sequesteration

‫ ﻛﺎن ﻓﻲ‬hamartoma ‫ ﻓﻲ‬chest ct... Popcorn calcification ‫واﺿﺢ‬

74
 Q Patient with dull chest pain and cough . X ray and CT chest done. The
patient develop attacks of hypoglycemia !!!

A. Metastictumer
B. Lymphoma
C. pleural Fibroma ( Fibrous Tumor Of Pleura )
D. mesothelioma

( The lesion was not enhanced however it was

CE CT chest)

Fibrous tumour of the pleura Clinical presentation

Usually asymptomatic . Of those who are symptomatic, clinical presentation can be with either a
cough, chest pain or shortness of breath.

Associations
o hypoglycaemia (2-4%) :thought to be due to the production of insulin-like growth factor 2
o hypertrophic pulmonary osteoarthropathy (~20%) :thought to be due to abnormal
production of hyaluronic acid
Asbestos exposure is not an association

Asbestos exposure is not an association

A. sclerderma( show same

picture but with dilatation
of the lower esophagus)
B. asbestosis
C. silicosis

IPF

Artifact in coronal lung CT

a. Cardiac motion artifact.

75
 b. Respiratory artifact.
c. Beam hardening.
d. Volume averaging

Chest X ray AP and Lat

A. treated epistain
B. rheumatic heart disease
C. bicuspid aortic valve

9. During IR procedure, pulmonary air embolism is

occured ,what to do : Left lateral position (true).
10. If patient on dialysis by tube and you
feel complain of suffocation
...suspicious of air embolism what is the true position of this patient
a. Prone
b. Supine
c. Left lat decubitus
d. Rt.lat decubitus

Q10) Asymptomatic adult man CXR( PA & Lateral view) for employer
screening, there is a large right sided hemi thorax opacity with positive
silhouette sign:
A. Teratoma.
B.mediastinal neurogenic tumor.
C. Pleural effusion.
D. Lung tumor with pleural effusion

76
19 years old female, low grade fever and dysnea She left do chest X-ray what is possible finding

1) kliebsila

2)asperigloma

3)cavitating tumor

4)mucormucosis

Female patient with progressive Dysea

Chest X-ray show reticulonodular pattern

Hrct mid and lower lobe interlobular septa thickening and peribronchovascular nodularity

Sarcoid

Patient with fever CT brain normal

MRI bilateral temporal affection with restricted diffusion

CBC leucocytosis with neutrophilia

herpes

AIDS

Male patient young (CT image axial and coronal)

Left heterogeneous enhanced lesion intimitly related left thyroid

With lymph node

77
Papillary carcinoma

Medullary carcinoma

4 th bronchial cleft

Chest CT

‫ ﻏرﯾب ﺟدا ﻣش ﺑﺎﯾن ﺣﺎﺟﮫ اوي ﺑس ﺑﺎل‬exclusion

Aortic aneurysm (no very clear aorta)

Pneumothorax

Emphyema

Solitary nodule ( I choose)

Male patient chronic heavy smoker.

Did ECG and heart examination normal

VQ scan.

Matched upper lobe ventilation,perfusion defect

Normal

Mismatched defect

---Text toooo long ilia bone pain in young patient

You please understand it is osteonecrosis asking about name.

Bouchard

78
Hrct in children

35 % of adult milliampere

45%

55%

2.10 yr boy with respiratory distress.(without image):

a.diaphragmatic hernia ( T )

b.pulmonary sequestration

c.pulmoary venous malformation

4.congenital lobar ventilation

.chest xray of neonate (image small and bad) shows bilateral moderate
pneumothorax, chest tube (opposite the right 4th rib posteriorly), endotracheal
tube (non centralized patient, but tube sure v. near to carina):
a. no need for chest tube.
b. no need for endotracheal tube.
c. endotracheal tube have to place downwards.
d. chest tube have to be repositioned.(my answer.i think it is right) ( T )
e. abnormal position of nasogastric tube (idont see any nasogastric tube)

5. Child xray (bad small image) high elevated both diaphragmatic copulae.
Slightly more on right side. Both lung fields not clear. No air could be seen.
Cvl is seen entering the right internal jugular vein. Asking:

a. pneumothorax

b. pneumomedistinium.

C. abnormal CVL ( T )

d. cardiomegaly‫ﻣﺶ ﻣﺘﺎﻛﺪة‬

79
Abdominal radiograph
demonstrating normal positioned Normal positioned U. arterial
Normal positioned U. venous catheter
1. umbilical arterial catheter (midline)
catheter
2. umbilical venous catheter (right
side) M.C.Q.

2-

30- Rib destruction with an adjacent soft tissue mass is not seen in:

1- Multiple myeloma

2- Wegner's granuloma.

3- Tuberculosis osteitis.

4- Actinomycosis.

5- Mesothelioma.

31- Rib notching:

1- In aortic coarctation is usually symmetrical.

2- In aortic coarctation is left sided if the coarctation is proximal to the left subclavian artery.

3- Is not associated with aortic valvular lesion.

4- Is a feature of tuberous sclerosis

5- Is a feature of inferior vena caval obstruction.

80
33- The following is not a recognized cause of a unilateral
hyper-transradient hemithorax in chest radiograph:

1- Patient rotation.

2- Pulmonary embolus.

3- Congenital lobar emphysema.

4- Agenesis of the lung.

5- Poliomyelitis.

34- The following statement is correct concerning pulmonary tuberculosis:

1-Patient on haemodialysis is in great risk.

2- The primary form most often affects the upper lobes.

3- Miliary tuberculosis only occurs in the post primary form of the disease.

4- Post primary disease is typically associated with hilar L.N. enlargement.

5- Primary disease is typically associated with cavitation.

8. chest and abdomen xray for child: I suspect continuous diaphragm sign
(‫)ﻣﺶ واﺿﺤﺔ‬:

a. pneumo-peritoneum.

b. pneumo-medistinium 10. ( T )

10
Small amounts of gas appear as linear or curvilinear lucencies outlining mediastinal contours such as:
https://radiopaedia.org/articles/pneumomediastinum

• subcutaneous emphysema
• gas anterior to pericardium: pneumopericardium
• gas around pulmonary artery and main branches: ring around artery sign
• gas outlining major aortic branches: tubular artery sign
• gas outlining bronchial wall: double bronchial wall sign
• continuous diaphragm sign: due to gas trapped posterior to pericardium
• gas between parietal pleura and diaphragm: extrapleural sign
• gas in pulmonary ligament

81
9. CT axial shows very large mass below liver and above kidney (not involing
it):

a. wilms tumor.

b. neuroblastoma. 11 ( T )

C, GB adenocarcinoma (‫)ﺗﻘﺮﯾﺒﺎ‬.

21- (mcq) Regarding bronchiectasis.

- Can occur temporary with pneumonia.(true)

- signet ring is rarely seen in HRCT. (false)
- congenital bronchiectasis occur with swayer james syndrome.
- Mucoid impaction is seen in all cases of bronchaiectasis.

25- Regarding HRCT chest:

a) Sarcoidosis affects sub-pleural locations first (False).

- Pulmonary cystic changes are noted in lymphangiomyomatosis affecting
females.(true)
- Kerley B lines is the surest sign of acute left ventricular failure (False)
- Ankylosing spondylitis causes thickening pleural apical (False).

Most common lung segments show congenital lung emphysema..

11. Rt upper lobe
12. ET Middle
13. Basal segments
Two images CXR and CT
For emphysema
Choices

• Naclerios V sign

11
https://radiopaedia.org/articles/neuroblastoma

82
Types of emphysema
Para septal
Centrilobular
Alph 1 antitrypsin deficiency
Last choice not related to its type and I don't remember
Cenrolobular upper lobes smoking/lower lobes bilateral symmetrical alpha 1

(Text) … Pt. long history + with port wine facial stain … CT with
contrast reveal multiple dilated enhancing vascular channels (I don’t
remember site exactly from description)
 Sturge weber.
 Abnormal arterio-venous malformation

(text) regarding aortic dissection:

 Ascending aortic dissection conservative ttt.
 Descending aortic dissection surgical ttt.
 Complicated Stanford B needs surgical ttt and intervention.
 --- (not remember).

female abd pain anemic'diverticulea at right iliac fossa with diffuse

intestinal soft tissue thickening
Wipple....I chiose this
Ig deficiency
Malplackia
Lucoplakia
Amyliodosis

Pt postcontrast 5min develop chest pain.palpitation.swaeting.neusia

Amiidarone
Adenosine
Epiniphrine..ichose this
Atropine

Carotid doppler
Aliasing seen as continouds wave

83
 Frequancy shiftshowen as audible vioce ...ichose this

female abd pain anemic'diverticulea at right iliac fossa with diffuse

intestinal soft tissue thickening
Wipple....I chiose this
Ig deficiency
Malplackia
Lucoplakia
Amyliodosis

Pt postcontrast 5min develop chest pain.palpitation.swaeting.neusia

Amiidarone
Adenosine
Epiniphrine..ichose this
Atropine

50 yr female chest xray bilateral lower pulmonary cacified nodule:

Breast
Cervical
Uterine
Ovariane tumer
Ichoose breat tumer
N.b no thyriid in chose

view with minimal cardiac shadow :

 AP
 PA
 Lateral

Lymph nodes:
 Hilar vasclarity = normal
 Periphral vascularity = malignant
 Mixed vascularity = malignant
84
 Nephrogenic systemic sclerosis occur with:

1) female 30 y. will do MRI for suspected acquastic neuroma

2) male old age liver cirrhosis + renal impairment do MRI for liver
Liver cirrhosis conscious with: 3)
 HRCT
 Adenoma can pick contrast

male young age (I think 30) do .... Barium study

4) not remember but not MRI

‫ﺳﺆال ﺟﺪﯾﺪ‬

Long clinical data.. Women referred lastly for chest biopsy

‫و ﻣﻌﺎھﺎ ﺻﻮرﺗﯿﻦ واﺣﺪة ﻗﺒﻞ ال‬biopsy ‫ و و اﺣﺪة ﺑﻌﺪھﺎ‬right moderate effusion

‫اﻻﺟﺎﺑﺔ‬

Post procedure hemothorax

2-
•

NB: signs of thrombophlibitis includes: luminal thrombus, mural

thickening of the vessel wall & perivascular stranding of fat planes
together with vascular collaterals with or without perivascular fluid
/ hematoma.

30- Cystic fibrosis (CF) is an autosomal recessive genetic

disease that affects the exocrine function of the lungs, liver,
pancreas and small bowel resulting in progressive disability and
multi-system failure.
A) pulmonary manifestations of CF bronchiectasis.
pneumothorax. recurrent bacterial infection. pulmonary arterial
hypertension.

85
C) ABDOMINAL MANIFESTATIONS OF CF
Distal intestinal obstruction syndrome (DIOS)
meconium ileus: 10-20%
rectal prolapse
cirrhosis and hepatic steatosis
oesophageal dysfunction / gastro-oesophagheal
reflux pancreatic insufficiency Fatty replacement of
pancreas

86
Distension of appendix but reduced risk of appendicitis

87
D) Head and neck manifestations of CF
• Chronic sinusitis
• Nasal polyposis
Musculoskeletal manifestations of CF

for lung window the window level is -600 to -700, Window width is
1000-1500.for mediastinal window the window level is 40-
50.window width is 350-450.

N.B → if ther's a history of surgical interference as oesophageal

laparoscopy, mediasitinitis is the right answer. If not, the word tearing
is usuallly used as a term describing the pain of aortic dissection
(syndrome)
Mediastinitis is inflammation of the mediastinum.
Symptoms include severe chest pain, dyspnea, and fever. The diagnosis
is confirmed by chest x-ray or CT. Treatment is with antibiotics (eg,
clindamycin plus ceftriaxone) and sometimes surgery.

88
The 2 most common causes of acute mediastinitis are Esophageal

89
perforation,Median sternotomy
The term Acute Aortic Syndrome (AAS) is used to describe three
closely related emergency entities of the thoracic aorta: classic
Aortic Dissection (AD), Intramural Hematoma (IMH) and
Penetrating Atherosclerotic Ulcer (PAU).Clinically these conditions

90
are indistinguishable.CT is the most accurate imaging modality for

91
the initial diagnosis, differentiation and staging.

92
3 3-CXR with CVL at Left SVC

13 - Cut thickness in HRCT in early diagnosis of IPF

a-0-01mm‫اﺧﺘﺮت دى ﺑﺲ ﻣﺶ ﻣﺘﺎﻛﺪة‬
b-0.1mm
C-3mm

93
 D-5mm

4 CT mediastinum azygas

CT sagittal of chest what is the artifact:

• Cardiac According to image
• Blooming

94
• Beam hardening
•
5- Alveolar microlithis

5- Brain lesion T1; T2; gradient

A. Lymphoma
B. Mets
C. Cysticrcosis

7- CT angio ... Celiac stenosis

Hilar mixed cystic lésion in female 20 years:
A- idiopathic interstitial disease.
B - brinchiectasis.
C- pneumonia
‫ﺳﺆال ﺗﺎﻧﻲ‬
chest x ray Ap and lateral of (hilar lymph nodess)
MRI spine in pt complaining of weakness: sagital T2 hypointense oval
intradural extramedullary lesion, enhanced on T1 with contrast:
‫ اﻻﺧﺗﯾﺎرات‬shwanoma, heamangioma, menigioma (hypointense in T2), ‫اﻟراﺑﻊ‬
‫ﻣش ﻓﺎﻛرة‬

95