Aqueduct Radiology Core practice
questions and select Sonosim modules
A PA chest radiograph in a patient with suspected pneumonia shows a confluent opacity in the
right lung obscuring the right heart border. In which lobe is the pneumonia located? - ANSRight
middle lobe
In which of the following conditions can air bronchograms be seen? Select one or more.
A. Pneumonia
B. Emphysema
C. Pulmonary edema
D. Pulmonary hemorrhage
E. ARDS
F. Pulmonary fibrosis - ANSA. Pneumonia
C. Pulmonary edema
D. Pulmonary hemorrhage
E. ARDS
Spine sign - ANSThe spine sign is seen when there is a posterior lower lobe opacity on a lateral
chest radiograph. As the eye scans down the spine, it should get more lucent (or at least not
denser), aside from some linear vascular markings until the first hemidiaphragm is reached. If it
becomes more opaque, such as in the example above, there is a soft tissue or fluid density
abnormality there. It can be caused typically by pneumonia, but can also be seen in atelectasis
and masses. It will obscure the posterior portion of a hemidiaphragm depending on laterality.
Meniscus sign - ANScurved line seen from a pleural effusion as it abuts the posterior or lateral
pleura.
Rigler's sign - ANSsign of a pneumoperitoneum on a supine or decubitus abdominal radiograph
when air is seen on both sides of the bowel wall. Here is an example of Rigler's sign on a
decubitus study.
Deep Sulcus sign - ANSpneumothorax on a supine chest radiograph, where on costophrenic
sulcus appears much deeper and lucent than the other due to air collecting there.
Continuous hemidiaphragm sign - ANSis a sign of a pneumomediastinum on a chest radiograph
when there appears to be a lucent line connecting both hemidiaphragms due to air between the
pericardial sac and the diaphragm
,In which of the following clinical scenarios should a chest radiograph be performed according to
the ACR Appropriateness Criteria? Select all that apply.
A. 15 year old girl with a fever 39C and a cough for 4 days with inspiratory crackles in the right
lung base
B. 25 year old man with a fever 39.5C and a cough for a week with normal physical examination
C. 86 year old man with dementia and fever 38.5C and a cough for a week but no localizing
signs
D. 30 year old asthmatic woman with cough productive of clear sputum, runny nose, and diffuse
mild wheeze on examination
E. 59 year old woman with fever 39.5C, cough productive of yellow sputum, and focal left upper
lobe wheeze - ANS> A, C, E have been selected by the expert.
The correct answers are A, C, & E.
A, C, and E are all examples of appropriate scenarios for ordering a chest radiograph in an
immunocompetent patient. B and D are extremely unlikely to change management.
Put the following radiographic procedures in order of radiation exposure to the patient (low to
high).
A. Chest radiograph
B. Barium enema
C. CT chest, abdomen & pelvis
D. Extremity radiographs
E. Head CT - ANSE. D, A, E, B, C
Give the approximate effective radiation dose and comparable natural backgroud radiation
(time) of the following:
CT Abdomen and Pelvis
Barium enema
Intravenous Pyelogram (IVP)
CT Head
CT Chest
PA CXR
Mammography - ANSCT Abdomen and Pelvis/10 mSv/3 years
Barium enema/8 mSv/3 years
Intravenous Pyelogram (IVP)/2mSv/1year
, CT Head/2 mSv/8 months
CT Chest/7 mSv/2 years
PA CXR/0.1 mSv/10 days
Mammography/0.7 mSv/3 months
Which of the following is an indication using the ACR appropriateness criteria for obtaining a
pre-op chest radiograph? Select all that apply.
A. 37 year old woman with no cardiorespiratory symptoms currently but a history of asthma
pre-op breast implants
B. 73 year old asymptomatic man pre-op knee replacement
C. 49 year old diabetic man with no cardiorespiratory symptoms currently pre-op ACL repair with
crackles at the right lung base
D. 78 year old woman with COPD, normal CXR 5 months ago and no acute sypmtoms, pre-op
for a hip replacement
E. 71 year old man with COPD, normal CXR 12 months ago and no acute symptoms, pre-op
knee replacement - ANSC, E have been selected by the expert.
The correct answers are C and E.
Although frequently requested, preoperative chest radiographs are rarely indicated. The two
main indications are:
Acute cardiopulmonary findings by a history or physical.
Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6
months not available.
Signs of atelectasis of left upper lobe? - ANSVolume loss in the left hemithorax (smaller overall)
Tracheal deviation to the left
Left hemidiaphragm elevation (but can still be seen)
Hazy opacity over the mid and upper left hemithorax ('ground glass' - still can see the vascular
markings of the left lower lobe through it)
Loss of left heart border (which the left upper lobe abuts)
A 52 year old man with a 20 pack year history of smoking has an abdominal CT performed
when he presents with diverticulitis. He has no prior imaging. A 12 mm spiculated nodule is
seen in the peripheral right lower lobe. Which of the following would be an appropriate form of
management? Select all that apply.
A. CT guided needle biopsy
B. PET-FDG scan
C. Follow up CT in 6 months
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