Kacmarek: Egan's Fundamentals of Respiratory Care, 10th 

Edition ​Chapter 20: Review of Thoracic Imaging  

Test Bank  

MULTIPLE CHOICE  
1. What lung problem is  ventilation/perfusion ( ) scanning used to 
detect?  
a. asthma  
b. pulmonary embolism  
c. pneumonia  
d. lung cancer  

2. Which of the following structures will result in the most radiopaque shadow on the chest 
radiograph?  
a. aorta  
b. heart  
c. lungs  
d. ribs  

3. The right heart shadow is NOT visible on the chest radiograph. Which of the following 
pathologies may explain this?  
a. right middle lobe pneumonia  
b. right lung pneumothorax  
c. bilateral emphysema  
d. bleb in the right lower lobe  

4. In which of the following situations is obtaining a chest radiograph least useful? 

a. following intubation  
b. following placement of a central venous pressure line  
c. when the static pressure drops by 2 cm H​2​O during CMV  
d. when the patient’s oxygenation status deteriorates for no known reason  

5. In what pulmonary condition does the chest radiograph often “lag behind” the clinical status 
of the patient?  
a. pulmonary embolism  
b. emphysema  
c. pneumonia  
d. congestive heart failure  

6. Which radiographic view of the chest allows the physician to read the best quality film? 
a. anteroposterior  
b. posteroanterior  
c. lateral  
d. lordotic  
 
7. Your patient just had an anteroposterior chest film taken. When you view the film, what may 
be a consideration?  
a. The lungs may appear smaller than they really are.  
b. The heart may appear less dense then it really is. 
c. The ribs may appear more horizontal than normal.  
d. The heart may appear larger than it really is.  

8. What abnormality may appear to be present on the chest x-ray but is simply due to abnormal 
rotation of the patient during production of the film?  
a. enlarged lungs  
b. enlarged heart  
c. widened mediastinum  
d. thickened pleura  

9. What problem exists when interpreting an overexposed chest film?  

a. There is difficulty in seeing the peripheral blood vessels.  
b. The ribs appear wider than normal.  
c. The heart shadow is blurred.  
d. The lymph nodes in the mediastinum cannot be seen.  

10. In the standard posteroanterior chest film, what proportion of the chest width should the heart 
shadow not exceed?  
a. 33%  
b. 40%  
c. 50%  
d. 65%  
 

11. Computed tomography (CT) scanning of the chest would be LEAST useful for which of the 
following?  
a. to evaluate the large vessels of the mediastinum  
b. to evaluate the pleura  
c. to evaluate lung masses  
d. to evaluate patients with asthma  

12. Which of the following diseases is NOT typically evaluated using high-resolution CT? 
a. emphysema  
b. asthma  
c. bronchiectasis  
d. interstitial lung disease  

13. CT angiography is most often used to evaluate the patient for which of the following 
conditions?  
a. pulmonary emboli  
b. chronic obstructive pulmonary disease  
c. congestive heart failure  
d. bilateral pneumonia  
 
14. Which of the following is a major limitation of magnetic resonance imaging (MRI) of the 
chest?  
a. cannot visualize large vessels  
b. cannot be used in patients with pacemakers  
c. cannot be used to examine hilar structures  
d. interpretation difficult  

15. Which of the following structures in the chest is NOT typically examined using MRI? 
a. lung parenchyma  
b. hilar structures  
c. large vessels in the lung  
d. structures in the mediastinum  

16. Which of the following statements is NOT true regarding the use of ultrasound to image the 
chest?  
a. It is useful to image the heart.  
b. It is useful to image pleural abnormalities.  
c. It is useful to image lung tissue.  
d. It uses sound waves that echo back to the sensor.  

17. What is indicated by rounding of the costophrenic angles seen on the posteroanterior or lateral 
chest film?  
a. emphysema  
b. excess pleural fluid  
c. obesity  
d. rib fractures  

18. What chest x-ray view is best used to identify excess pleural fluid?  
a. posteroanterior 
b. anteroposterior  
c. lateral decubitus  
d. apical lordotic  

19. What is the earliest sign of a left-sided pleural effusion on an upright chest radiograph? 
a. an increased distance between the inferior margin of the left lung and the stomach 
gas bubble  
b. inability to see small pulmonary blood vessels over the left lower lung  
c. a widened mediastinum  
d. elevation of the right hemidiaphragm  

20. What is indicated by an air-fluid level in the pleural space?  

a. tension pneumothorax  
b. hydropneumothorax  
c. pleural effusion  
d. an aerobic infection  

 
21. In which of the following would loculation of pleural fluid NOT be as likely to occur? 
a. empyema  
b. exudative fluid  
c. hemothorax  
d. congestive heart failure  

22. What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery 
or needle insertion?  
a. hemothorax  
b. pneumothorax  
c. empyema  
d. CHF  

23. Which of the following statements is NOT true regarding the use of the chest x-ray to detect a 
pneumothorax?  
a. An expiratory film may be best for a small pneumothorax.  
b. The standard chest film is of limited use in detecting a pneumothorax.  
c. The film will show a lack of vascular markings in the affected region.  
d. The lung margin is often visible with a pneumothorax.  

24. Which of the following statements is NOT true regarding the recognition and treatment of a 
tension pneumothorax as seen on the chest radiograph?  
a. The hemidiaphragm on the affected side will be pushed downward.  
b. The mediastinum will be pushed towards the unaffected side.  
c. It requires immediate insertion of a chest tube.  
d. The patient should be intubated.  

25. What term is used to describe the shadows seen on the chest film when the alveoli fill with 
pus, fluid, or blood?  
a. consolidates  
b. infiltrates  
c. alveolar lesions 
d. densities  

26. Which of the following is NOT true regarding the visualization of air bronchograms on the 
chest film?  
a. They indicate fluid in the pleura.  
b. They are caused by air-filled airways surrounded by consolidation.  
c. They are the hallmark of alveolar consolidation.  
d. They signify air space disease.  

27. Which of the following is NOT a typical cause of pulmonary edema as seen on the chest 
radiograph?  
a. left heart failure  
b. renal failure  
c. cor pulmonale  
d. fluid overload  
28. What is the most common cause of cephalization as seen on the upright chest film? 
a. renal failure  
b. left heart failure  
c. hypoxemia  
d. empyema  

29.  What  term  is  used  to  describe  the  predominance  of  edema  in  the hilar regions of both lungs 
with  progressively  less  edema in the more peripheral areas of the lungs as seen on the chest 
film?  
a. bat’s wing  
b. hilar wings  
c. butterfly wings  
d. heart wings  

30. Which of the following statements best describe the typical findings on a chest radiograph for 
a patient with interstitial lung disease?  
a. unilateral upper lobe infiltrates  
b. diffuse bilateral infiltrates  
c. diffuse pulmonary hyperinflation  
d. diffuse pleural inflammation  

31. Which of the following is the most common type of interstitial lung disease? 
a. asbestosis  
b. silicosis  
c. sarcoidosis  
d. scleroderma  

32. What is the cause of idiopathic pulmonary fibrosis?  

a. a virus  
b. inhaled dusts  
c. drug reaction  
d. unknown 

33. What type of imaging is most useful for diagnosing idiopathic pulmonary fibrosis? 
a. conventional chest radiography  
b. CT angiography  
c. HRCT  
d. MRI  

34. Which of the following is NOT a typical cause of atelectasis?  

a. abdominal surgery  
b. rib fracture  
c. hepatomegaly  
d. pleurisy  

 
35. What is the most common cause of lobar atelectasis?  
a. bronchial obstruction  
b. loss of surfactant  
c. viral pneumonia  
d. pleurisy  
 
36. Which of the following is NOT a common radiographic finding seen in patients with volume 
loss due to atelectasis?  
a. elevation of the hemidiaphragm  
b. narrowing of the space between the ribs  
c. increase in the retrosternal airspace  
d. shift of the mediastinum 

37. Which of the following findings on the chest radiograph is considered a secondary sign of 
emphysema?  
a. flattening of the diaphragm  
b. widening of the cardiac shadow  
c. narrowing of the space between the ribs  
d. blunting of the costophrenic angle  

38. What imaging technique would be most useful to determine which patients with emphysema 
may benefit from lung volume reduction surgery?  
a. chest HRCT  
b. CT angiography  
c. MRI  
d. ultrasound  

39. How many solitary pulmonary nodules (SPNs) would be encountered for every 1000 routine 
chest radiographs?  
a. 1 or 2  
b. 10 to 15  
c. 30 to 40  
d. 80 to 100  

40. Radiographically, into how many compartments is the mediastinum divided? 

a. two  
b. three  
c. four  
d. five  

41. What is the best imaging technique for examining mediastinal masses? 
a. conventional lateral chest radiography  
b. chest CT  
c. MRI  
d. ultrasound  
 

 
42. Which of the following is LEAST likely to cause pneumomediastinum? 
a. chest trauma  
b. esophageal rupture  
c. thyroid surgery  
d. pericarditis  

43. What is the optimal position of the endotracheal tube following intubation as seen on the chest 
radiograph?  
a. 1 to 2 cm above the carina  
b. 3 to 4 cm above the carina  
c. 5 to 7 cm above the carina  
d. in the upper third of the carina  

44. Why should a chest radiograph be obtained following placement of the central venous 
pressure catheter?  
a. to confirm proper placement  
b. to allow better interpretation of the results  
c. to identify when to change the line  
d. all the above  

45. What are the two most common reasons for placing a chest tube?  
a. pneumothorax and pleural effusion  
b. pneumothorax and empyema  
c. hemothorax and hydrothorax  
d. to place medicine in the pleural space and to withdraw excess fluid  

46. A 49 y/o COPD patient arrives to the ER complaining of SOB and difficulty breathing. The 
physical exam reveals bilateral coarse crackles throughout the lung fields, pedal edema and 
hepatomegaly. The chest X-ray shows bilateral fluffy infiltrates with a ‘bat’s wing’ 
configuration. What clinical condition you may suspect on this patient?  
a. acute coronary syndrome  
b. COPD exacerbation 
c. hypertensive crisis  
d. left heart failure  

47. A high resolution CAT scan of a 62 y/o smoker has revealed several nodules on the right lung. 
Which of the following procedures would you suggest to assess the ‘malignancy’ of these 
nodules?  
a. ultrasound tomography  
b. positron emission tomography  
c. magnetic resonance imaging  
d. CAT scan angiography