Answers (Chest X-ray Radiology MCQs)

Q1. A 50-year-old woman presents with shortness of breath. CXR shows silhouette sign on the left side, with fluffy, indistinct borders. What is the diagnosis?

• The silhouette sign on the left side with fluffy, indistinct borders points to consolidation in the left lower lobe (LLL)
• LLL pneumonia obliterates the left hemidiaphragm silhouette, producing exactly this pattern
• LUL pneumonia would obliterate the left heart border instead
• Atelectasis typically produces a denser, sharper opacity with volume loss (not fluffy borders)
• The handwritten annotation "ج" (option C) in the image confirms this answer

Q2. In AP Chest X-ray compared to PA CXR, which statement is correct?

• In AP (Anteroposterior) films, the heart is farther from the film cassette, so X-ray beam divergence magnifies the cardiac silhouette - making it appear larger than on a PA film
• Option الف (Right diaphragm shadow disappears): Incorrect - AP vs PA doesn't eliminate the diaphragm shadow
• Option ب (Clavicles appear S-shaped): Incorrect
• Option د (Fewer posterior ribs visible): In AP, you may see slightly fewer posterior ribs due to positioning, but the most classic/important difference is cardiac magnification

Q3. Which statement is correct?

• Right lung has 3 lobes separated by 2 fissures: the oblique (major) fissure and the horizontal (minor) fissure
• Left lung has 2 lobes separated by 1 fissure: only the oblique (major) fissure
• Wait - re-reading the option: "Right side 3 fissures, left side 2 fissures" - this is incorrect anatomically
• Correct answer: د) 200-300 cc of fluid can cause blunting of the Posterior CPA (costophrenic angle)
• The posterior costophrenic angle is the deepest, most dependent recess. As little as 200-300 mL of pleural fluid can blunt the posterior CPA (seen on lateral view), while the lateral CPA on PA view requires ~300-500 mL to blunt
• Option ب (Only minor fissure is visible on lateral CXR): Incorrect - both major and minor fissures can be seen on lateral
• Option ج (Pulmonary hilum is formed mainly from veins): Incorrect - the hilum is formed mainly from pulmonary arteries, not veins
• Answer: د)

Q4. Which of the following is NOT a cause of Air Space Disease?

• Air space (alveolar) disease causes: Pneumonia (الف), Pulmonary edema (ب), Sarcoidosis (د - can cause air space consolidation)
• UIP (Usual Interstitial Pneumonia) is an interstitial pattern (honeycombing, reticular), NOT an air space disease
• UIP is the pathological pattern underlying IPF (Idiopathic Pulmonary Fibrosis) and produces interstitial, not alveolar filling, opacities
• Answer: ج) UIP

Q5. Which is NOT usually seen in Primary TB?

• Primary TB typically presents with:
  • الف) Mediastinal lymphadenopathy (adenopathy) - very common, classic feature
  • ب) Tuberculoma - can occur in primary TB
  • ج) Lobar pneumonia - Ghon complex / primary complex with consolidation
• Bronchiectasis is a feature of post-primary (reactivation) TB due to chronic cavitation and scarring, not typically seen in primary TB
• Answer: د) Bronchiectasis

Q6. Which is NOT a cause of unilateral right-sided pleural effusion?

• Liver disease (cirrhosis, hypoalbuminemia) typically causes bilateral pleural effusions, or when unilateral, it tends to be right-sided due to diaphragmatic defects (hepatic hydrothorax) - so actually liver disease CAN cause right-sided effusion
• Common causes of right-sided effusion: hepatic hydrothorax, right heart failure, right-sided malignancy, subphrenic abscess
• The question asks what is NOT a cause - this needs the remaining options visible (the image is cut off at option الف)

Summary Table