These free chest radiology samples come straight from the RadioQBank published set, complete with explanations, exam pearls, and references. They span HRCT airway disease, pulmonary infection, mediastinal masses, pulmonary embolism, and lymphoma response assessment — recurring high-yield areas in NEET SS and INI-SS. Attempt each before revealing the answer to train genuine exam recall.
Question 1 · Pulmonary Thromboembolism · easy
REGARDING PULMONARY EMBOLISM RISK STRATIFICATION — TRUE OR FALSE: Massive PTE is defined by the presence of haemodynamic instability (sustained hypotension SBP <90 mmHg or requirement for vasopressors), not solely by the anatomical extent of clot burden on CTPA.
- a. True
- b. False — massive PTE is defined by bilateral main pulmonary artery occlusion on CTPA
- c. False — massive PTE is defined by oxygen saturation <80% regardless of blood pressure
- d. False — massive PTE is defined by RV:LV ratio >1.5 on CT
Answer: A. This statement is TRUE. According to ESC (2019) and AHA guidelines, PTE risk stratification is based on haemodynamic status, not clot burden: Massive/high-risk PTE = haemodynamic instability (SBP <90 mmHg for ≥15 min, requirement for vasopressors, cardiac arrest, or signs of shock). Submassive/intermediate-risk PTE = haemodynamically stable but with evidence of right heart strain (RV dysfunction on CT/echo) and/or elevated troponin. Low-risk PTE = haemodynamically stable, no RV dysfunction. This distinction is critical because massive PTE mandates systemic thrombolysis or catheter-directed therapy.
Exam pearl: Massive PTE = haemodynamic instability (SBP <90 mmHg), NOT clot burden alone; systemic thrombolysis indicated.
ESC PE Guidelines 2019; Eur Heart J 2020;41(4):543
Question 2 · Aortic Trauma · easy
A trauma patient's CXR shows a widened mediastinum, first and second rib fractures, and depression of the left main bronchus. These are indirect signs of which injury?
- a. Pulmonary contusion
- b. Oesophageal rupture
- c. Traumatic aortic injury
- d. Traumatic pericardial effusion
Answer: C. These CXR findings are indirect signs of mediastinal haematoma from traumatic aortic injury (TAI). The classical plain radiograph signs of TAI include: widened mediastinum (>8 cm on AP supine), loss of the aortic knuckle contour, deviation of the trachea/NGT to the right, depression of the left main bronchus below 40°, left-sided haemothorax, apical pleural cap (extrapleural haematoma), and rib 1/2 fractures (suggesting high-energy mechanism). First and second rib fractures are important because their protection normally requires significant force, correlating with high-energy deceleration trauma.
Exam pearl: CXR signs of TAI: wide mediastinum + trachea deviation right + left bronchus depression + apical pleural cap + haemothorax.
AJR 2009;192:1–17
Question 3 · Pulmonary Infections · moderate
A 25-year-old shepherd from Rajasthan presents with a large, well-defined, homogeneous round opacity in the lower lobe of the right lung. HRCT shows a cystic mass with a 'water lily sign' and 'double wall sign'. Serology is positive. What is the diagnosis and the most appropriate investigation before treatment?
- a. Aspergilloma — BAL for fungal culture
- b. Hydatid cyst — percutaneous aspiration
- c. Hydatid cyst — surgical excision after albendazole
- d. Lung abscess — bronchoscopy and drainage
Answer: C. Pulmonary hydatid cyst (Echinococcus granulosus) presents as a well-defined round or oval cyst, often in the lower lobe. The 'water lily sign' (floating collapsed germinal layer after rupture into bronchus) and 'double wall sign' (pericyst + ectocyst) are pathognomonic CT findings. Positive serology confirms Echinococcus. Treatment is surgical excision (cystectomy/lobectomy) after pre-treatment with albendazole (3–4 weeks) to reduce risk of intraoperative spillage and anaphylaxis. Percutaneous aspiration (PAIR) is CONTRAINDICATED in pulmonary hydatid — risk of anaphylaxis and dissemination.
Exam pearl: Pulmonary hydatid = water lily + double wall sign. PAIR is CONTRAINDICATED. Albendazole → surgery.
Grainger & Allison 7th ed; AJR 2003 PMID 12646464
Question 4 · Airways Disease · moderate
A 35-year-old woman with asthma develops worsening dyspnoea and haemoptysis. HRCT shows bronchiectasis with mucoid impaction in central bronchi forming a 'finger-in-glove' pattern in both upper lobes. IgE is 2000 IU/mL, eosinophilia is present, and Aspergillus skin test is positive. What is the diagnosis?
- a. Invasive Pulmonary Aspergillosis
- b. Allergic Bronchopulmonary Aspergillosis (ABPA)
- c. Aspergilloma (simple mycetoma)
- d. Chronic Necrotising Aspergillosis
Answer: B. Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus colonising central bronchi, occurring in asthma or cystic fibrosis. HRCT hallmarks: central bronchiectasis (predominantly upper lobes), mucoid impaction ('finger-in-glove' = gloved finger opacity), and high-density mucus (>70 HU on CT, pathognomonic for ABPA-S/high attenuation mucus). Diagnostic criteria: asthma + elevated total IgE (>1000 IU/mL) + Aspergillus sensitisation + central bronchiectasis. Treatment is oral corticosteroids ± itraconazole.
Exam pearl: ABPA = central bronchiectasis + finger-in-glove + IgE >1000 in asthmatic. High-attenuation mucus (>70 HU) = HAM subtype.
Radiographics 2012 PMID 23065165; Grainger & Allison 7th ed
Question 5 · Mediastinum · hard
A 45-year-old man presents with chest heaviness. CT shows an anterior mediastinal mass with scattered calcifications, areas of low density, and a small component of fat. Serum AFP is 12 IU/mL (normal <10 IU/mL), and serum beta-hCG is 6 IU/L (normal <5 IU/L). What is the most appropriate interpretation of these mildly elevated tumour markers?
- a. Confirms diagnosis of non-seminomatous germ cell tumour
- b. May be non-specifically elevated — full histological assessment is required
- c. Consistent with seminoma and confirms no non-seminomatous component
- d. Confirms teratoma and requires no further workup
Answer: B. Mildly elevated AFP (12 vs normal <10 IU/mL) and mildly elevated beta-hCG (6 vs normal <5 IU/L) are just above the upper limit of normal and can be non-specifically elevated in conditions including hepatitis, marijuana use, or other tumours. In the context of an anterior mediastinal mass, mildly elevated markers do not confirm non-seminomatous GCT — markedly elevated AFP (>1000 IU/mL) or markedly elevated beta-hCG (>1000 IU/mL) would be diagnostic. The imaging (calcification + fat component) suggests a teratomatous lesion. Full histological assessment via resection or biopsy is required to determine the exact composition.
Exam pearl: AFP >1000 IU/mL = NSGCT (not seminoma); mildly elevated AFP (10–20 IU/mL) requires histological confirmation — never diagnose NSGCT on mildly elevated markers alone.
Grainger & Allison 7th ed; Radiographics 2015;35:1186
Question 6 · Lymphoma · hard
A 55-year-old man with complete remission from DLBCL after R-CHOP is on surveillance. End-of-treatment PET-CT shows a residual mediastinal mass (4 cm) with Deauville score 3 (uptake greater than mediastinal blood pool but ≤ liver). No new lesions. He is asymptomatic. The most appropriate management is:
- a. Mediastinal radiotherapy
- b. Biopsy of residual mass
- c. Observation with repeat PET-CT in 6–8 weeks
- d. Salvage chemotherapy (R-ICE)
Answer: C. A Deauville score of 3 (uptake > mediastinal blood pool but ≤ liver) at end-of-treatment PET-CT in DLBCL represents an equivocal response — in the Lugano Classification, D1–D2 = complete metabolic response (CMR); D3 can be interpreted as CMR in many clinical settings, especially if there is no new disease and it represents regression from baseline. The standard approach for an equivocal D3 finding in an asymptomatic patient is observation with repeat PET-CT in 6–8 weeks to assess stability — a rising uptake indicates residual disease and triggers biopsy, while stability or resolution confirms CMR.
Exam pearl: DLBCL end-of-treatment D3 PET = equivocal — observe + repeat PET-CT in 6–8 weeks; D1/D2 = CMR; D4/D5 = active disease requiring biopsy/salvage.
Cheson BD et al. JCO 2014;32:3059 (Lugano Classification); Radiographics 2014;34:1759