Regarding lung transplantation:

a. The chest radiograph is normal in acute rejection in up to 50% of cases.

b. Bronchial anastomotic complications are commonly owing to a difference between the size of donor and recipient bronchi.
c. Pneumonitis carinii is the most common cause of pneumonia in post-transplant patients.
d. The bronchiolitis obliterans syndrome is a recognized late complication.
e. In post-transplant lymphoproliferative disorder, most tumours are of T-cell origin.
Answer:
(a) True. Up to 50% have normal chest radiographs.
(b) False. Ischaemia and infection are the commonest causes of bronchial anastomotic failure. 145 Imaging, Volume 13 (2001)
Number 2
(c) False. Pneumocystis carinii pneumonia, which was previously seen in 90% of lung transplant recipients, has become uncommon
following the widespread use of chemoprophylaxis.
(d) True. The bronchiolitis obliterans syndrome is defined as a clinical syndrome of irreversible, progressive airway obstruction in the
pulmonary allograft caused by the presence of constrictive bronchiolitis. It is usually considered synonymous with chronic rejection.
(e) False. In post-transplant lymphoproliferative disorder, most tumours are of B-cell origin and positive for EpsteinVBarr virus.
Ward S, Muller NL. Pulmonary complications following lung transplantation. Clin Radiol 2000;55:332V9.

Regarding Round Pneumonia:
a. May be caused by Haemophilus influenzae
b. Is commoner in children than in adults
c. Usually involves the upper lobes
d. Characteristically has well defined margins
e. A posterior mediastinal tumor is often considered in the radiological differential diagnosis.
Answer:
a. True. Commonest causative organisms include H.influenzae, Streptococcus and Pnemococcus
b. True. Children>>Adults
c. False. Usually involves the lower lobes, posteriorly and subpleural in location.
d. False. Charachteristically round/spherical opacity, with poorly defined margins.
e. True. A solitary metastasis or a posterior mediastinal tumor is often considered in the radiological differential diagnosis.
Grainger and Allison (4th Ed. page 645); Dahnert (5th Ed.page 522)

The following are features consistent with pneumocystis pneumonia:
a. Mediastinal lymphadenopathy
b. Ground glass appearance
c. Segmental consolidation
d. Pleural effusions
e. Pneumothorax
Answer:
a. F
b. T
c. F
d. F
e. T

Regarding the PA CXR:
a. The main pulmonary artery appears prominent in uncorrected transposition of the great vessels
b. The cardiac size may decrease when a left-to-right shunt reverses in Eisenmenger VSD
c. Similar appearances are found with PDA and VSD
d. The cardiac silhouette usually significantly enlarges after papillary muscle rupture
e. The left and right pulmonary arteries are prominent in pulmonary valvular stenosis
Answer:
(a) FALSE: the pulmonary trunk is usually not seen as it lies posteriorly in the midline
(b) TRUE
(c) TRUE: both cause the non-specific appearances of a left-to-right shunt, ie, enlargement of both ventricles, left atriumand
proximal pulmonary arteries with prominent pulmonary vasculature
(d) FALSE: sudden, gross mitral incompetence causes rapid onset pulmonary oedema with little or no increase in cardiac size
(e) FALSE: the main and left pulmonary arteries are prominent due to post-stenotic dilatation (Grainger and Allison, 4th ed.)

Which of the following statements concerning pulmonary sarcoidosis are true:
a. 15-25% of patients presents without hilar lymphadenopathy.
b. Cavitation of large nodules occur.
c. Pleural exudate occur in less than 5% of cases.
d. Atelectasis is caused by endobronchial disease.
e. 20% of patients develop irreversible pulmonary changes.
Answer:
a. True sarcoidosis show 43% hilar lymphadenopathy only , 41% lymphadenopathy and parenchymal involvement and 16
% parenchymal involvement only.
b.True occur in occasional nodule.
c.True It occure in 2%
d.True Endotrachial granuloma also atelectasis caused by bronchial stenosis due to extrinsic compression by large lymph
node.
e. True Due to progressive lung fibrosis lead to end stage lung disease.

The following are causes of an enlarged right ventricle:
a. Mitral stenosis
b. IHD
c. VSD
d. PDA
e. ASD
Answer:
a. T b. T c. T d. F e. T

The following are true of a VSD:
a. 80% are isolated
b. The majority are the muscular type
c. In Maladie de Roger, RV pressures are typically very raised
d. Is associated with Downs syndrome
e. 80% close spontaneously by 2 years
Answer:
a. F 20%
b. F Membranous type
c. F Typically normal chamber pressures with small VSD
d. T
e. F 40% by 2 years and 60% by 5 years

Regarding egg shell calcification of hilar lymph nodes:
a. It occurs in 20% of patients with silicosis.
b. Asbestosis is a recognized cause.
c. It can occur in coal worker's pneumoconiosis.
d. Sarcoidosis is a common cause.
e. It can occur following treatment of leukaemia.
Answer:
A. False - Approximately 5% only.
B. False
C. True - In 1% of cases.
D. False - Only 5% of patients with sarcoidosis.
E. False - It occurs following radiotherapy for lymphoma not leukaemia. The changes are seen 1 year after treatment.

Regarding Thymoma:
a. It is the most common neoplasmof the anterior superior mediastinum
b. It is more common in the younger age group
c. Malignant Thymoma is more common
d. It may show calcification on CT
e. It may be associated with pure Red cell Aplasia
Answer:
a) It is the most common neoplasmof the anterior superior mediastinum - True
b) It is more common in the younger age group - (False 5th-6th decade)
c) Malignant Thymoma is more common (False - 30-35% of Thymomas)
d)It may show calcification on CT (True - in 5-25% of benign Thymomas - may be amorphous, flocculent / curvilinear)
e) It may be associated with pure Red cell Aplasia (True. about half of patients with pure red cell aplasia have Thymoma)
Reference: RRM 5th edition page 530-531

Regarding the solitary pulmonary nodule:
a. a density value of less than 200H in 10%of central pixal will suggest benign lesion.
b. an enhancement of less than 15H following iv contrast is virtually diagnostic of benign lesion.
c. sensitivity of pet scan is 95% with a for differentiating benign frommalignant lesion.
d. halo sign- groud glass opacity surrounding a nodule is seen in malignant nodules.
e. all lesions of less than 3cm will be treated as benign.
Answer:
a) F-a density of more than 200H in the central pixal or throughout the lesion is a reliable indicator of microcalcification and indicate
benignity.
b)T- rare falls positive seen in patients with central necrosis ofa malignant lesion or mucin producing bronchoalveolar cell carcinoma.
a value of more than 15H is non specific.
c)T- lesions of more than 10mm Pet has a sensityvity of 94%-96% and specificity of 87%-88%.
d)F- seen in patients with angio invasive opertunic infections esp, aspergillosis.
e)F- 80% lesions of less than 2cmare benign. 15% malignant nodules are less than 1cmand 42%are less than 2cm.
Immediately Post Pneumonectomy:
a. CXR usually shows a vacant hemi-thorax with little or no fluid
b. CXR usually shows a partially expanded contra lateral lung
c. CXR usually shows a fully expanded ipsilateral lung
d. The trachea should be in the midline
e. A clamped chest tube is contra indicated
Answer:
T.F.F.T.F
No significant mediastinal shift should occur. Therefore you should see a fully expanded contralateral lung , an approx. midline
trachea and a vacant hemithorax with little or no fluid.

Histiocytosis X of the lungs:
a. causes thin-walled cysts
b. ground glass attenuation is characteristic
c. affects the lower lobes
d. lymphangioleiomyomatosis can look the same on a plain radiograph
e. causes pneumothorax
Answer:
a) T nodule evolves into cavitated nodule then thin-walled cyst
b) F HRCT shows <5 mmcysts with even distribution centrally & peripherally
c) F bilat upper lobe mainly, CP angles spared
d) T also emphysema, bronchiectasis, idiopathic pulmonary fibrosis
e) T in 15%

An elderly patient presents with a several weeks history of cough. A plain radiograph shows patchy infiltrates. On CT there
are multiple areas of consolidation but no lymphadenopathy. The differential diagnosis includes:
a. heart failure
b. cryptogenic organizing pneumonia
c. eosinophilic pneumonia
d. alveolar cell carcinoma
e. pulmonary haemorrhage
Answer:
a) T
b) T bilat consolidation 90% all zones, 50-60% subpleural
c) T
d) T
e) T

Pulmonary AVMs:
a. are associated with TIAs
b. are present in 80% patients with hereditary haemorrhagic telangiectasia
c. plain radiographs may show only pulmonary hypervascularity
d. 90% are calcified on helical CT
Answer:
a) T 30-55%, cerebral abscess in 5-15%
b) F 30% patients with HHT have AVM, 70-95% AVMs occur in HHT
c) T or hazy increased opacity, or nodule with vessels
d) F

Azygous continuation of the IVC is associated with:
a. a normal intrahepatic IVC
b. bilateral bilobed lungs
c. polysplenia
d. total anomalous pulmonary venous drainage
Answer:
a) F
b) T
c) T and rarely with asplenia
d) F PARTIAL anomalous pulmonary venous drainage assoc with: persistent left SVC, dectrocardia, duplicated IVC

Regarding Angiography:
a. the testicular vein is easier to catheterise on the left than the right using a femoral approach
b. a non-covered stent in the iliac arteries is contraindicated at the bifurcation
c. iliac artery stent has double the patency rate of angioplasty at one year
d. iliac artery stent has a 2% infection rate at 2 years
e. iliac artery stents prevent neointimal hyperplasia
Answer:
Regarding Angiography
a) T
b) F
c) F
d) F infection is very rare
e) F

Regarding embolisation:
a. polyvinyl alcohol causes intimal sloughing
b. platinum coils are thrombogenic
c. the hepatic artery can only be embolised if the portal vein is patent
d. unintentional embolisation of the distal systemic arteries is more common at the beginning of the procedure than the end
Answer:
a) F absolute alcohol has a direct toxic effect on the endothelium
b) T
c) T
d) unintentional embolisation of the distal systemic arteries is more common at the beginning of the procedure than the end

Intrapulmonary bronchogenic cysts:
a. 10% calcify
b. are of water attenuation on CT
c. typically occur in the lower lobes
d. commonly present with infection
Answer:
a) F
b) T water attenuation in 50%
c) T 66% in lower lobes, in medial third
d) T 75% present with infection

The following are recognised findings in cystic fibrosis:
a. an association with situs inversus
b. gallstones
c. splenic artery aneurysm
d. cirrhosis of the liver
Answer:
a) F
b) T
c) T
d) T

Popliteal artery entrapment syndrome:
a. displaces the popliteal artery laterally
b. occurs over the age of 50 years
c. post-stenotic dilatation of the artery is seen
d. can cause distal embolisation
e. the artery lies posterior to the medial head of gastrocnemius
Answer:
a) F
b) F 68% patients under 35, peak at 17 and 47 years
c) T
d) T quite common, but not emphasised in literature
e) F anterior to medial head of gastrocnemius