1 What is the MOST common congenital heart abnormality?

A Tetralogy of Fallot
B Atrial septal defect
C* Bicuspid aortic valve
D Ventricular septal defect
Rationale:
A. Of the listed options, Tetralogy of Fallot is the least common abnormality.
B. Atrial septal defect is not uncommon and the diagnosis can be delayed until adulthood. It is not the most
common congenital heart deformity.
C. Bicuspid aortic valve is the most common congenital heart deformity, occurring in 0.5 – 2% of the
population.
D. Ventricular septal defects are common but are not the most common congenital heart deformity.

4. What is the MOST common cause of an enlarged coronary sinus?

A. Unroofed coronary sinus
B. Bridging vein
C. Total anomalous pulmonary venous return
D.* Persistent left SVC
Rationale:
A: Unroofed coronary sinus is a rare congenital anomaly that causes a left-to-right shunt. Blood from the left
atrium or pulmonary veins flows through the defect into the coronary sinus, which drains into the right
atrium. This is not the most common cause of a dilated coronary sinus.
B: Rarely, a left-to-right shunt occurs due to a bridging vein between the left atrium and the coronary sinus.
This is not the most common cause of a dilated coronary sinus.
C: A small percentage of patients with total anomalous pulmonary venous return have drainage into the
coronary sinus. This is not the most common cause of a dilated coronary sinus.
D: In most cases, a persistent left superior vena cava (SVC) drains into the coronary sinus. The increased
volume of blood return results in enlargement of the coronary sinus. This is the most common cause of
enlargement of the coronary artery sinus.

8. Which pattern of interstitial lung disease is MOST commonly associated with Rheumatoid Arthritis?

A* Usual Interstitial Pneumonia

B Lymphocytic Interstitial Pneumonia
C Nonspecific Interstitial Pneumonia
D Respiratory Bronchiolitis Interstitial Lung Disease
Rationale:
A. Most common pattern of interstitial lung disease seen in patients with rheumatoid arthritis is usual
interstitial pneumonia which portends a poor prognosis.
B. Classically presents with perivascular cysts in patients with sjogren's syndrome.

C. Common pattern of interstitial lung disease encountered in many forms of collagen vascular disease such
as scleroderma but not in rheumatoid arthritis.

D. Most common presentation is upper-zone predominant vague centrilobular ground-glass nodules in

smokers.

1. Which of the following lateral supporting structures of the knee inserts on the tibia?

A Lateral collateral ligament (LCL)

B Biceps femoris tendon
C* Anterior oblique band LCL
D Popliteus tendon
Rationale: A. The lateral collateral ligament inserts on the fibula head with the biceps femoris as the
conjoined tendon. B. The biceps femoris tendon inserts with the lateral collateral ligament as the conjoined
tendon at the fibula head. C. The anterior oblique band of the lateral collateral ligament inserts with fibers
from the iliotibial band and the lateral joint capsule at the lateral proximal tibia. Varus stress may result in
avulsion fracture, the Segond fracture, most often associated with ACL rupture. D. The popliteus tendon
inserts at the popliteus fossa at the lateral femoral condyle.

3. What is the MOST common disorder of the plantar aponeurosis?

A* Fasciitis
B Fibromatosis
C Rheumatoid nodule
D Rupture
Rationale: Plantar fasciitis is the most common disorder of the plantar fascia. It is a low-grade inflammatory
condition which may be mechanical and/or degenerative in nature, i.e., overuse, foot deformities, obesity,
age related weakening/instability or be related to systemic disorders including rheumatoid arthritis,
seronegative spondyloarthropathies and gout.

9. Which of the following is associated with bone enlargement?

A Lytic Paget disease

B* Osteoid osteoma
C Type II neurofibromatosis
D Hyperparathyroidism
Rationale: Bone enlargement, secondary to the deposition of Pagetoid bone and subsequent cortical
thickening, is characteristic of the second and third stages of Pagets disease. The early or lytic phase of
Pagets disease involves bone resorption only. Neurofibromatosis Type I, a mesodermal and neuro-
ectodermal dysplasia, involves the musculoskeletal system. Bony deformity and malformation is typical.
There may be bone enlargement. Neurofibromatosis Type II does not result in bone enlargement.
Hyperparathyroidism results in bone resorption and therefore, less bone, not more bone. Osteoid osteoma
may result in localized cortical thickening about the lesion. In younger children, presumably due to the
marked hyperemia of the lesion, increased bone growth/bone length may result.

10. Tumor induced osteomalacia is MOST commonly associated with which of the following?

A* Hemangiopericytoma
B Non-ossifying fibroma
C Multiple myeloma
D Renal cell carcinoma
Rationale: A. Hemangiopericytoma is the tumor most associated with tumor-induced osteomalacia. This
syndrome has also been reported in association with non-ossifying fibroma, giant cell tumor, osteoblastoma
and fibrous dysplasia B. Hemangiopericytoma is the tumor most associated with tumor-induced
osteomalacia. This syndrome has also been reported in association with non-ossifying fibroma, giant cell
tumor, osteoblastoma and fibrous dysplasia. C. Multiple myeloma may result in diffuse osteopenia, without
discrete foci of bone lysis. Osteomalacia, however, is not associated. D. Hemangiopericytoma is the tumor
most associated with tumor-induced osteomalacia. This syndrome has also been reported in association with
non-ossifying fibroma, giant cell tumor, osteoblastoma and fibrous dysplasia. Although an association with
prostate and lung cancer has been described, there is no association

1.245. Concerning the morphologic right ventricle, which of the following is the MOST reliable indicator?
A. Anterior location of the ventricle
B. Trabeculation of the ventricular wall
C. Separation of the inflow and outflow valves by a muscular infundibulum
D. The ventricle receives blood from the right atrium

Rationales: C
2.246. Concerning the location of cardiac valves on a posteroanterior (PA) and lateral chest radiograph,
which one is TRUE?
A. The aortic valve is located superior to the other valves.
B. The tricuspid valve is the most anteriorly located valve.
C. The mitral valve lies inferior to the other valves.
D. The aortic valve lies closest to the pulmonary valve.

Rationales: B
3.247. Concerning the position of the interventricular septum on short axis images of the heart, which one
is TRUE?
A. It has a normal convexity toward the right ventricle.
B. It has a sinusoid shape.
C. It has a straight course separating the right and left ventricles.
D. Its convexity varies in position during the cardiac cycle.

Rationales: A
4.248. Concerning cardiac aneurysms, which one is TRUE?
A. True aneurysms of saphenous vein grafts are a manifestation of atherosclerosis.
B. Rupture of a sinus of Valsalva aneurysm occurs more commonly on the left.
C. Left ventricular pseudoaneurysms typically occur at the cardiac apex.
D. The neck of a left ventricular aneurysm is typically narrow.

Rationales: A
5.249. Concerning coronary artery atherosclerosis, which one is TRUE?
A. Coronary artery calcification is strongly associated with coronary atherosclerosis.
B. On angiography, a stenosis greater than 40 percent of the luminal diameter is considered to be significant.
C. On angiography, a stenosis greater than 60 percent of the luminal diameter is considered to be severe.
D. When present, coronary artery calcifications make up about 50 percent of the total plaque burden.

Rationales: A

6.250. Which one of the following congenital anomalies is MOST commonly associated with anomalous
pulmonary venous drainage?
A. Ostium primum atrial septal defect
B. Ostium secundum atrial septal defect
C. Ventricular septal defect
D. Sinus venosus atrial septal defect

Rationales: D
7.251. What is the greatest advantage of conventional CR imaging systems over DR imaging systems?
A. Better detective quantum efficiency with lower dose
B. Positioning flexibility
C. Instantaneous readout of the latent image
D. Better intrinsic spatial resolution

Rationales: B
8.252. Which one of the following structures directly communicates with the transverse sinus?
A. Oblique sinus
B. Postcaval recess
C. Superior aortic recess
D. Posterior pericardial recess

Rationales: C
9.253. Concerning coronary artery dominance, which one is TRUE?
A. It is determined by which coronary artery supplies the majority of the heart.
B. 85 percent of patients have a codominant system.
C. It is determined by which artery supplies the posterior descending artery.
D. 70 percent of patients have a left dominant system.
Rationales: C
10.254. Concerning a patient presenting with an acute myocardial infarction accompanied by severe
bradycardia, which coronary artery or branch is MOST LIKELY involved?
A. Diagonal branch
B. Left anterior descending coronary artery
C. Right coronary artery
D. Circumflex artery

Rationales: C
11.255. Concerning pulmonary vein ablation, which one is TRUE?
A. Accessory pulmonary veins are more common on the left.
B. Myocardial sleeves are longest and thickest in the inferior pulmonary veins.
C. The presence of left atrial thrombus is a contraindication.
D. A common pulmonary vein is more common on the right.
Rationales: C
12.256. Concerning the Ross procedure, which one is TRUE?
A. It is suitable for children because the pulmonary autograft grows with the child.
B. Patients undergoing the Ross procedure require lifelong anticoagulation.
C. It is preferred because it is technically easier to perform than standard valve replacement.
D. The procedure is performed to correct pulmonary valve stenosis.

Rationales: A
13.257. Concerning the Blalock-Taussig shunt, which one is TRUE?
A. It connects the subclavian artery to the pulmonary artery.
B. It creates a conduit between the right atrium and the pulmonary artery.
C. It creates an atrial switch using an intra-atrial baffle made of pericardium.
D. It connects the superior vena cava with the pulmonary artery.

Rationales: A
14.258. What is the MOST common congenital heart defect?
A. Tetralogy of Fallot
B. Atrial septal defect
C. Bicuspid aortic valve
D. Ventricular septal defect

Rationales: C
15.259. Regarding cardiac CT scans, keeping all scan parameters the same, the dose to the patient with
retrospective ECG gating when compared to prospective ECG triggering.
A. Increases
B. Decreases
C. Remains the same

Rationales: A
16.260. Concerning isolated aortic valve stenosis, what is the MOST likely cause in an adult?
A. Rheumatic heart disease
B. Calcific degeneration
C. Congenitally stenotic aortic valve
D. Infective endocarditis
Rationales: B
17.261. What is the MOST likely explanation for enlargement of the right atrium in a patient with mitral
valve stenosis?
A. Tricuspid valve regurgitation
B. Pulmonary valve stenosis
C. Tricuspid valve stenosis
D. Tricuspid valve prolapse

Rationales: A

18.262. Concerning differentiation of pseudoaneurysms from true aneurysms of the left ventricle, what is
the MOST reliable imaging finding?
A. Identification of the number of myocardial layers in the wall of the aneurysm
B. Involvement of the posterior or inferior walls of the left ventricle
C. Size of aneurysm neck or mouth
D. Thrombus lining the aneurysm.

Rationales: C
19.263. Concerning left atrial enlargement in a patient with dilated (congestive) cardiomyopathy, what
cause is MOST LIKELY?
A. Mitral valve regurgitation secondary to displacement of the papillary muscles
B. Mitral valve regurgitation secondary to fusion and shortening of the chordae tendineae
C. High left ventricular end-diastolic pressure resulting in left atrial hypertension
D. Mitral valve regurgitation secondary to ischemic papillary muscle dysfunction

Rationales: A
20.264. Concerning tricuspid valve regurgitation in adults, what is the MOST common etiology?
A. Infective endocarditis
B. Right ventricular hypertension
C. Ebstein’s’ anomaly of the tricuspid valve
D. Rheumatic heart disease

Rationales: B
ACR CARDAIC 2007
21.99. In regards to myocardial bridge, which one of the following statements is TRUE?
A. They occur in 5% of autopsy specimens.
B. They are better depicted by CT than by angiography.
C. They require surgical therapy.
D. They most frequently affect the right coronary artery.

RATIONALES: B
22.100. Enlargement of which one of the following structures is the MOST reliable radiographic sign of
pulmonary valve stenosis?
A. Enlargement of the pulmonary trunk
B. Enlargement of the right ventricle
C. Enlargement of the left main pulmonary artery
D. Enlargement of the right and left main pulmonary arteries
RATIONALES: C
23.101. Which of the following findings is the MOST reliable sign of elevated right ventricular pressure on a
contrast-enhanced CT scan of the chest?
A. Leftward bowing of the interventricular septum
B. Right ventricular hypertrophy
5|PageACRCARDIAC
C. Right ventricular enlargement
D. Reflux of contrast into the inferior vena cava

RATIONALES: A
24.102. Regarding cardiomyopathies, which one of the following statements is TRUE?
A. Patients with dilated cardiomyopathy have an increase in left ventricular mass.
B. The myocardium is diffusely affected by cardiac sarcoidosis.
C. Aortic stenosis is a cause of hypertrophic cardiomyopathy.
D. Systolic function is preserved in patients with restrictive cardiomyopathy secondary to amyloidosis.

RATIONALES (This Test Item Was Not Scored)

25.103. Regarding cardiac transplantation, which one of the following statements is TRUE?
A. Accelerated atherosclerosis is an early complication.
B. Postoperative screening for lymphoproliferative disease is the most common indication for imaging.
C. Cyclosporine results in left ventricular hypertrophy.
D. Cytomegalovirus and Aspergillus species are the most common cause of early postoperative infection.

RATIONALES: C
26.104. Concerning cardiac neoplasms, which of the following is TRUE?
A. Myxoma is the most common benign cardiac tumor.
B. Metastases to the heart are most commonly caused by renal cell carcinoma.
C. Primary cardiac malignancies are more common than metastases to the heart.
D. Malignant primary cardiac neoplasms are more common than benign neoplasms.

RATIONALES: A
27.105. Concerning the coronary circulation, which of the following statements is TRUE?
A. Dominance is determined by which vessel gives rise to the posterior descending artery and posterior left
ventricular branches.
B. Left dominant circulation is more common than right dominant circulation.
C. The left coronary artery supplies the sinoatrial node in most individuals.
D. The diagonal branches arise from the right coronary artery.

RATIONALES: A
28.106. A 3-D cardiac CT image data set is acquired at 0.5-mm slice thickness. If the reconstruction interval
is reduced from 0.5 mm to 0.3 mm, which of the following changes is MOST LIKELY to occur?
A. Increase patient dose
B. Decrease patient dose
C. Increase image size
D. Increase scan time

RATIONALES: C

29.107. Concerning prospective ECG gating in cardiac CT imaging, which of the following is TRUE?
A. Data is acquired throughout the cardiac cycle.
B. Data is acquired only at pre specified points throughout the cardiac cycle.
C. It allows for dynamic assessment of the heart and functional status.
D. It involves more radiation dose to the patient than retrospective gating.

RATIONALES: B
30.108. Concerning the use of B Blockers in cardiac CT imaging, which of the following statements is TRUE?
A. Heart rates of below 70 beats per minute are optimal.
B. They can be administered to patients with asthma.
C. Verapamil is not a useful alternative to beta-adrenergic blocking agents.
D. Atrial fibrillation is a contraindication to beta-blocker use.

RATIONALES: A
32.109. Which of the following digital detectors directly converts x-ray signals into an electrical charge?
A. Photostimulable storage phosphor
B. Structured cesium-iodine (CsI) scintillator
C. Amorphous selenium (aSe) semiconductor
D. Charge-coupled devices (CCD) photodiode

RATIONALES: C
33.110. In regards to constrictive pericarditis, which of the following statements is TRUE?
A. The normal pericardium measures up to 5mm in thickness.
B. Tuberculosis is the most common cause of constrictive pericarditis in the United States.
C. The degree of pericardial calcification correlates with the degree of constriction.
D. Pericardial thickening and calcification can occur in the absence of constrictive pericarditis.

RATIONALES: D
34.111. Concerning anomalous origins of the coronary arteries, which of the following is TRUE?
A. Coronary artery anomalies are usually hemodynamically significant.
B. Anomalous coronary arteries that pass between the right ventricular outflow tract / pulmonary artery and
the ascending aorta are characterized by abnormal myocardial perfusion.
C. With hemodynamically significant coronary artery anomalies, compression of the coronary artery occurs
during systole.
D. Coronary artery anomalies with a retroaortic course are associated with sudden death in young athletes.

RATIONALES: B
35.112. In regards to cyanotic congenital heart disease presenting in infancy, which one of the following is
MOST common?
A. Hypoplastic left heart syndrome
B. Tetralogy of Fallot
C. Truncus arteriosus
D. Ventricular septal defect
RATIONALES :B
36.113. Regarding atrial morphology, which one of the following is the MOST reliable indicator of the
morphologic right atrium?
A. Connection with the superior vena cava
B. Connection with the inferior vena cava
C. Presence of a thin appendage with a narrow neck
D. Presence of a tricuspid atrioventricular valve

RATIONALES: B
37.114. Regarding coronary artery aneurysms, which one of the following statements is CORRECT?
A. Aneurysmal dilatation is defined as an increase in vessel diameter twice that of the normal adjacent
artery.
B. Most coronary aneurysms are secondary to infection.
C. Small aneurysms (<4mm) seen in the setting of Kawasaki disease (mucocutaneous lymph node syndrome)
tend to regress.
D. Aneurysms due to atherosclerosis have a high frequency of rupture.

RATIONALES: C
38.115. Regarding hypertrophic cardiomyopathy, which one of the following is an associated valvular
abnormality?
A. Aortic valve stenosis
B. Mitral valve stenosis
C. Systolic anterior motion of the mitral valve
D. Mitral valve prolapse

RATIONALES: C
ACR CARDIAC 2009
39.8. Concerning coarctation of the aorta, which one of the following is TRUE?
A. The most common location of coarctation is pre-ductal
B. Aortic coarctation is associated with Turner syndrome.
C. There is a measurable pressure gradient in aortic pseudocoarctation.
D. Inferior rib notching affects the first through eighth ribs.

KEY: B
40.9. Concerning congenital absence of the pericardium, which one of the following is TRUE?
A. Complete absence is more common than partial absence.
B. Partial absence is more commonly right sided.
C. It can result in infarction of the left atrial appendage.
D. It can mimic adenopathy in the aorticopulmonary window.

KEY: C

41.10. In order to have a left dominant coronary artery system, which one of the following must be
supplied by the circumflex coronary artery?
A. Acute marginal artery
B. Posterior lateral artery
C. Posterior descending artery
D. Conus artery

KEY: C
42.11. Which digital detector material directly converts x-ray signals into electronic charge
when coupled to a thin-film transistor array?
A. Photostimulable storage phosphor
B. Structured cesium iodine (CsI) scintillator
C. Amorphous selenium semiconductor
D. Charge-coupled device (CCD) photodiode
KEY:C
43.12. Where is the crista terminalis located?
A. At the junction of the left atrial appendage and left superior pulmonary vein
B. Between the right ventricular free wall and the interventricular septum
C. Between the inflow and outflow portions of the right ventricle
D. In the right atrium extending from the superior vena cava to the inferior vena cava

KEY: D
44.13. What is the MOST common cause of tricuspid regurgitation in adults?
A. Rheumatic heart disease
B. Pulmonary arterial hypertension
C. Carcinoid disease
D. Endocarditis

KEY:B
45.14. Regarding myocardial bridging, which one of the following is TRUE?
A. It most frequently involves the right coronary artery.
B. It is most easily demonstrated during diastole on cardiac catheterization.
C. It refers to abnormal interconnections between major coronary arteries.
D. It may result in ischemia.

KEY: D
46.15. From which cardiac structure do papillary fibroelastomas typically arise?
A. Pericardium
B. Ventricular myocardium
C. Cardiac valves
D. Pulmonary vein ostia

KEY:C

47.16. Which of the following is TRUE about cardiac valvular disease secondary to carcinoid
syndrome?
A. Valve dysfunction occurs only when carcinoid tumor metastasizes to the heart.
B. The tricuspid valve is involved and the pulmonic valve if spared.
C. The aortic and mitral valves can be affected in the presence of a right-to-left shunt.
D. Right-sided cardiac chambers are generally normal in size.

KEY: C
48.17. Concerning complications of thoracic aortic dissection, which one of the following is TRUE?
A. The most common valvular complication is aortic regurgitation.
B. The most common coronary artery complication is occlusion or dissection of the left main coronary artery.
C. Stanford type B (DeBakey type III) dissections are frequently complicated by cardiac tamponade.
D. In the aortic arch, the false lumen typically follows the lesser curvature of the arch.

KEY: A
49.18. Which of the following pathologies result in delayed enhancement on perfusion MR
imaging using contrast-enhanced T1-weighted images?
A. Myocardial infarction
B. Myocardial stunning
C. Myocardial ischemia
D. Myocardial hibernation

KEY: A
50.19. Regarding coronary calcium CT assessment, which one of the following is TRUE?
A. The amount of coronary calcium is not related to the extent of atherosclerosis.
B. Retrospective ECG-gating is used.
C. The Agatson score incorporates lesion attenuation and size.
D. The amount of calcification is proportional to the degree of stenosis at that particular site.

KEY:C
51.20. Which of the following anomalous vascular structures results in posterior impression
upon the trachea and anterior impression upon the esophagus?
A. Double aortic arch
B. Right aortic arch with aberrant left subclavian artery
C. Left aortic arch with aberrant right subclavian artery
D. Left pulmonary artery arising from the right pulmonary artery

Key: D
52.21. Concerning cardiac failure, what is the primary cause of lung edema?
A. Increased hydrostatic pressure
B. Decreased oncotic pressure
C. Increased capillary permeability
D. Failure of lymphatic resorption

Key: A

53.22. Concerning lipomatous hypertrophy of the intra-atrial septum, which one of the following is TRUE?
A. It is associated with ventricular arrhythmias.
B. If large enough, it completely separates the atria.
C. It may contain brown fat.
D. It has malignant potential.

Key: C
54.23. Which of the following is the MOST LIKELY diagnosis for a newborn with cyanosis,
diminished pulmonary vascularity, and an enlarged cardiac silhouette?
A. Tetralogy of Fallot
B. Complete atrioventricular canal defect
C. Complete transposition of the great vessels
D. Pulmonary atresia with intact ventricular septum

Key: D
ACR CARDIAC 2008
55.232. Concerning obstructive hypertrophic cardiomyopathy, which one of the following
is TRUE?
A. Asymmetric thickening of the interventricular septum causes aortic valvular ,stenosis.
B. Systolic anterior motion of the anterior mitral leaflet contributes to obstruction.
C. It is a sporadic and not an inherited disease.
D. Cardiomegaly is a common feature on chest radiograph.

KEY: B
56.233. Which one of the following arteries typically supplies the sinoatrial node?
A. Right coronary artery
B. Proximal left anterior descending artery
C. Proximal circumflex artery
D. Posterior descending artery

KEY: A
57.234. What is the MOST common neoplasm to arise from the cardiac valves?
A. Fibroelastoma
B. Elastofibroma
C. Carcinoid
D. Myxoma

KEY: A
58.235. What is the MOST common malignant cardiac neoplasm in adults?
A. Metastasis
B. Myxoma
C. Lymphoma
D. Rhabdomyosarcoma

Key: A

59.236. Regarding the management of heart rate in cardiac CT, which one of the following
is TRUE?
A. Beta-blockers can be administered to patients with asthma.
B. The optimal heart rate is less than 70 beats per minute.
C. Atrial fibrillation is a contraindication to beta-blockers.
D. Verapamil is not a useful beta-blocker alternative.

Key: B
60.237. Which of the following is the MOST common cause of cyanotic congenital heart
disease?
A. Ventricular septal defect
B. Truncus arteriosus
C. Patent ductus arteriosus
D. Tetralogy of Fallot

Key: D
61.238. Concerning acute aortic intramural hematoma, which of the following is TRUE?
A. Conservative treatment is indicated regardless of the location within the aorta.
B. Penetrating atheromatous ulcers are a common cause.
C. The ascending aorta is most commonly involved.
D. It is best identified with contrast-enhanced multidetector CT.
Key: C
62.239. The two major factors that influence the in-plane spatial resolution in a CT scanner are which of
the following?
A. kVp and mA
B. Focal spot and acquisition field of view by the computer.
C. Scan time and acquisition pitch
D. Beam hardening and scatter

Key: B
63.240. In patients with mitral valve stenosis, what is the MOST LIKELY cause of right atrial enlargement?
A. Tricuspid valve prolapse
B. Tricuspid valve stenosis
C. Pulmonary valve stenosis
D. Tricuspid valve regurgitation

Key: D
64.241. Regarding congenital heart disease, which of the following congenital defects is MOST common?
A. Ventricular septal defect
B. Atrial septal defect
C. Tetralogy of Fallot
D. Bicuspid aortic valve

Key: D

65.242. Regarding aortic pseudocoarctation, which of the following statements is TRUE?

A. Pseudocoarctation begins proximal to the origin of the left subclavian artery.
B. Significant pressure gradient across the stenosis is characteristic.
C. Poststenotic aneurysmal dilation may progress over time.
D. Patients are symptomatic and typically present with chest pain.

Key: C
66.243. Polysplenia is characterized by which one of the following?
A. Bilateral atrial appendages with triangular morphology and wide ostia
B. More severe and complex cardiac anomalies than asplenia
C. An association with azygous continuation of the inferior vena cava
D. Bilateral eparterial mainstem bronchi

Key: C
67.244. Regarding congenital absence of the pericardium, which one of the following is TRUE?
A. Complete absence is more common than partial absence.
B. Partial absence occurs more commonly on the left.
C. Pulmonary arterial stenosis is the most common complication.
D. The left ventricle is the most commonly entrapped chamber.

Key: B
68.245. Which one of the following is characteristic of cardiac tamponade?
A. Decreased diastolic filling pressures
B. Dilatation of the vena cavae
C. Dilatation of the coronary sinus
D. Left ventricular dilatation

Key: B
69.246. What is the MOST consistent feature of Ebstein anomaly on chest radiography?
A. Aortic enlargement
B. Pulmonary trunk enlargement
C. Left atrial enlargement
D. Right atrial enlargement

Key: D
ACR CARDIAC 2009
70.99. For a 3D cardiac CT image dataset acquired at 0.5 mm slice thickness, which of the following is
MOST LIKELY to occur if the reconstruction interval is altered from 0.5 mm to 0.3 mm?
A. Increased patient dose
B. Decreased patient dose
C. Increased data set
D. Increased scan time

Rationale: C

71.100. Which one of the following conditions is MOST closely associated with aortic dissection?
A. Systemic hypertension
B. Bicuspid aortic valve
C. Marfan’s syndrome
D. Prior cardiac surgery

Rationale: A& C
72.101. Where is the crista supraventricularis located?
A. At the junction of the left atrial appendage and the left pulmonary vein
B. Between the right ventricular free wall and the interventricular septum
C. Between the inflow and outflow portions of the right ventricle
D. Between the right atrial appendage and the right atrium

Rationale: C
73.102. What is the MOST common cause of mitral valve stenosis?
A. Left atrial myxoma
B. Endocarditis
C. Mitral annular calcification
D. Rheumatic heart disease

Rationale: D
73.103. Regarding congenital absence of the pericardium, which of the following statements is TRUE?
A. Right pericardial involvement is more common than left.
B. Most patients have associated cardiopulmonary defects.
C. Total absence of the pericardium occurs most commonly.
D. Partial defects risk cardiac herniation and strangulation.
Rationale: D
74.104. Regarding myocardial bridges, which of the following statements is TRUE?
A. The circumflex artery is most commonly affected.
B. They require surgical treatment.
C. CT depicts them better than angiography.
D. They occur in less than 10% of autopsy specimens.

Rationale: C
75.105. Enlargement of which of the following structures is the MOST reliable radiographic sign of
pulmonary valve stenosis?
A. Left pulmonary artery
B. Bilateral pulmonary arteries
C. Right ventricle
D. Main pulmonary artery

Rationale: A

76.106. Which of the following structures contributes to the posterior border of the mediastinum on a
normal lateral chest radiograph?
A. Superior vena cava
B. Inferior vena cava
C. Main pulmonary artery
D. Right atrium

Rationale: B
77.107. Which one of the following findings is seen in the setting of constrictive pericarditis?
A. Atrial collapse
B. Globular configuration of the ventricles
C. Dilation of the inferior vena cava
D. Left ventricular hypertrophy

Rationale: C
78.108. Diffuse subendocardial enhancement of the left ventricle on delayed contrast-enhanced MRI of the
heart is MOST typical of what entity?
A. Myocardial ischemia
B. Myocardial infarction
C. Amyloidosis
D. Asymmetric septal hypertrophy

Rationale: C
79.109. Regarding sinus of Valsalva aneurysms, which one of the following statements is TRUE?
A. They rarely involve the left coronary sinus.
B. Hypertension is the most common acquired cause.
C. Rupture usually causes pericardial tamponade.
D. The majority are acquired.

Rationale: A
ACR CADIAC 2011
80.202. Which of the following is the MOST common cardiac neoplasm in adults?
A. Myxoma
B. Primary cardiac lymphoma
C. Rhabdomyoma
D. Metastasis

Rationale: D
81.203. Concerning an aneurysm of a sinus of Valsalva, which of the following is CORRECT?
A. Aortic regurgitation is uncommon.
B. The right sinus is most frequently affected.
C. It is usually an acquired lesion.
D. Rupture is usually fatal.

Rationale: B

82.204. Which of the following meets criteria for the diagnosis of myocardial infarction using contrast-
enhanced MR imaging?
A. Enhancement follows a vascular distribution and extends from the endocardium towards the epicardium.
B. Enhancement has a patchy distribution with endocardial involvement.
C. Enhancement follows a vascular distribution and extends from the epicardium to the endocardium.
D. Enhancement has a patchy distribution with epicardial involvement.

Rationale: A
83.205. Which of the following is the MOST common complication following surgical repair of tetralogy of
Fallot?
A. Pulmonary regurgitation
B. Residual ventricular septal defect
C. Branch pulmonary stenosis
D. Tricuspid regurgitation

Rationale: A
84.206. Which of the following statements regarding aortic aneurysms is TRUE?
A. Mycotic aneurysms are usually fusiform in shape.
B. The aortic root is spared in Marfan syndrome.
C. Bicuspid aortic valve is an independent risk factor.
D. It is the most common manifestation of Takayasu arteritis.

Rationale: C
85.207. Which of the following statements regarding coronary artery anatomy is CORRECT?
A. Obtuse marginal branches arise from the right coronary artery.
B. The circumflex coronary artery usually supplies the posterior descending coronary artery.
C. The sinoatrial nodal artery most commonly arises from the right coronary artery.
D. The ramus intermedius is a branch of the posterior descending coronary artery.

Rationale: C
86.208. Which of the following statements is TRUE regarding an ostium primum atrial septal defect?
A. It is the most common type of atrial septal defect.
B. It is typically smaller than an ostium secundum defect.
C. It is associated with Down syndrome (trisomy 21).
D. Partial anomalous pulmonary venous drainage most commonly occurs with an ostium primum atrial septal
defect.

Rationale: C
87.209. What is the MOST common pulmonary vein anatomic variation?
A. Separate vein draining the right middle lobe
B. Separate vein draining the lingula
C. Common pulmonary vein draining the right lung
D. Common pulmonary trunk draining an entire lung

Rationale: A

88.210. Which of the following congenital heart abnormalities is MOST frequently encountered in patients
with Down syndrome (trisomy 21)?
A. Total anomalous pulmonary venous return
B. Aortic coarctation
C. D-transposition of the great arteries
D. Atrioventricular canal defect

Rationale: D
89.211. In congenital pericardial defects, which cardiac structure is MOST LIKELY to become strangulated?
A. Right ventricle
B. Left ventricle
C. Right atrial appendage
D. Left atrial appendage

Rationale: D
ACR CARDIAC 2012
90.1. Concerning cardiac magnetic resonance imaging, which of the following are absolute
contraindications?
A. Coronary artery stents
B. Septal closure devices
C. Metallic bullet fragments in the chest wall
D. Patient with absolute pacemaker dependence

Rationale: D
91.2. Concerning endoleak of the aorta, which of the following statements is true?
A. Type I is the most common type of endoleak
B. Type II leaks are the most likely to rupture
C. Type III endoleak are due to graft porosity
D. Type I endoleak results from device failure

Rationale: D
92.3. Regarding total anomalous pulmonary venous return, which of the following is true?
A. Infracardiac venous return occurs through a persistent left SVC
B. Pulmonary edema is rare in the presence of obstruction of pulmonary venous return
C. The "snowman sign" indicates infracardiac venous return
D. Atrial septal defect or patent foramen ovale allow admixed blood to enter the left heart

Rationale: D
93.4. Concerning the morphologic right ventricle, which of the following is the MOST reliable indicator?
A. Anterior location of the ventricle
B. Trabeculation of the ventricular wall
C. Separation of the inflow and outflow valves by a muscular infundibulum
D. The ventricle receives blood from the right atrium

Rationale: C

94.5. Concerning the location of cardiac valves on a posteroanterior (PA) and lateral chest radiograph,
which one is TRUE?
A. The aortic valve is located superior to the other valves.
B. The tricuspid valve is the most anteriorly located valve.
C. The mitral valve lies inferior to the other valves.
D. The aortic valve lies closest to the pulmonary valve.

Rationale: B
95.6. Concerning coronary artery dominance, which one is TRUE?
A. It is determined by which coronary artery supplies the majority of the heart.
B. 85 percent of patients have a codominant system.
C. It is determined by which artery supplies the posterior descending artery.
D. 70 percent of patients have a left dominant system

Rationale: C
96.7. Concerning pulmonary vein ablation, which one is TRUE?
A. Accessory pulmonary veins are more common on the left.
B. Myocardial sleeves are longest and thickest in the inferior pulmonary veins.
C. The presence of left atrial thrombus is a contraindication.
D. A common pulmonary vein is more common on the right.

Rationale: C
97.8. Concerning the Blalock-Taussig shunt, which one is TRUE?
A. It connects the subclavian artery to the pulmonary artery.
B. It creates a conduit between the right atrium and the pulmonary artery.
C. It creates an atrial switch using an intra-atrial baffle made of pericardium.
D. It connects the superior vena cava with the pulmonary artery.

Rationale: A
98.9. Regarding cardiac transplantation, which one of the following statements is TRUE?
A. Accelerated atherosclerosis is an early complication.
B. Postoperative screening for lymphoproliferative disease is the most common indication for imaging.
C. Cyclosporine results in left ventricular hypertrophy.
D. Cytomegalovirus and Aspergillus species are the most common cause of early postoperative infection.

Rationale: C
99.10. Concerning prospective ECG gating in cardiac CT imaging, which of the following is TRUE?
A. Data is acquired throughout the cardiac cycle.
B. Data is acquired only at pre specified points throughout the cardiac cycle.
C. It allows for dynamic assessment of the heart and functional status.
D. It involves more radiation dose to the patient than retrospective gating.

Rationale: B

100.11. Concerning the use of B Blockers in cardiac CT imaging, which of the following statements is TRUE?
A. Heart rates of below 70 beats per minute are optimal.
B. They can be administered to patients with asthma.
C. Verapamil is not a useful alternative to beta-adrenergic blocking agents.
D. Atrial fibrillation is a contraindication to beta-blocker use.

Rationale: A
ACR CARDIAC 2013
101.1. Concerning valvular heart disease, which one of the following is TRUE?
A. Mitral stenosis is most commonly congenital.
B. Isolated aortic valve disease is common in rheumatic heart disease.
C. A primarily insufficient valve frequently calcifies.
D. Aortic stenosis is associated with a bicuspid aortic valve.

Rationales: D
102.2. Concerning the Ross procedure, which one is TRUE?
A. It is suitable for children because the pulmonary autograft grows with the child.
B. Patients undergoing the Ross procedure require lifelong anticoagulation.
C. It is preferred because it is technically easier to perform than standard valve replacement.
D. The procedure is performed to correct pulmonary valve stenosis.

Rationales: A
103.3. Concerning the coronary circulation, which of the following statements is TRUE?
A. Dominance is determined by which vessel gives rise to the posterior descending artery and posterior left
ventricular branches.
B. Left dominant circulation is more common than right dominant circulation.
C. The left coronary artery supplies the sinoatrial node in most individuals.
D. The diagonal branches arise from the right coronary artery.

Rationales: A
104.4. Regarding atrial morphology, which one of the following is the MOST reliable indicator of the
morphologic right atrium?
A. Connection with the superior vena cava
B. Connection with the inferior vena cava
C. Presence of a thin appendage with a narrow neck
D. Presence of a tricuspid atrioventricular valve

Rationales: B
105.5. Which of the following findings is associated with constrictive pericarditis?
A. Small ventricles
B. Small atria
C. Small superior vena cava

Rationales: A

ACR CARDIAC 2014

106.2. Following surgical repair of aortic coarctation, what is the MOST reliable MRI finding of significant
re-stenosis?
A. Turbulent flow across the repair site on gradient-echo images
B. Narrowing of the repair site on T1-weighted spin-echo images
C. Narrowing of the repair site on gradient-echo images
D. Presence of collateral vessels on flow-sensitive images

Rationales: A
107.3. Concerning valvular heart disease, which one of the following is TRUE?
A. Mitral stenosis is most commonly congenital.
B. Isolated aortic valve disease is common in rheumatic heart disease.
C. A primarily insufficient valve frequently calcifies.
D. Aortic stenosis is associated with a bicuspid aortic valve.

Rationales: D
108.Which one of the following structures directly communicates with the transverse sinus?
A. Oblique sinus
B. Postcaval recess
C. Superior aortic recess
D. Posterior pericardial recess

Rationales: C
109.7. Concerning cardiac neoplasms, which of the following is TRUE?
A. Myxoma is the most common benign cardiac tumor.
B. Metastases to the heart are most commonly caused by renal cell carcinoma.
C. Primary cardiac malignancies are more common than metastases to the heart.
D. Malignant primary cardiac neoplasms are more common than benign neoplasms.

RATIONALES: A
110.8. Concerning the coronary circulation, which of the following statements is TRUE?
A. Dominance is determined by which vessel gives rise to the posterior descending artery and posterior left
ventricular branches.
B. Left dominant circulation is more common than right dominant circulation.
C. The left coronary artery supplies the sinoatrial node in most individuals.
D. The diagonal branches arise from the right coronary artery.

RATIONALES: A
111.9. In regards to constrictive pericarditis, which of the following statements is TRUE?
A. The normal pericardium measures up to 5mm in thickness.
B. Tuberculosis is the most common cause of constrictive pericarditis in the United States.
C. The degree of pericardial calcification correlates with the degree of constriction.
D. Pericardial thickening and calcification can occur in the absence of constrictive
pericarditis.
RATIONALES: D

112.10. Regarding coronary artery aneurysms, which one of the following statements is
CORRECT?
A. Aneurysmal dilatation is defined as an increase in vessel diameter twice that of the normal adjacent
artery.
B. Most coronary aneurysms are secondary to infection.
C. Small aneurysms (<4mm) seen in the setting of Kawasaki disease (mucocutaneous lymph node syndrome)
tend to regress.
D. Aneurysms due to atherosclerosis have a high frequency of rupture.

RATIONALES: C
ACR CARDIAC 2015
113.4. Which of the following is a TRUE statement concerning acute aortic intramural hematoma?
A. It is best identified with contrast-enhanced CT.
B. The ascending thoracic aorta is most commonly involved.
C. Penetrating atheromatous ulcer is a common cause.
D. Involvement of the ascending thoracic aorta is treated conservatively.

Key: C
114.6. Concerning the position of the interventricular septum on short axis images of the heart, which one
is TRUE?
A. It has a normal convexity toward the right ventricle.
A. It has a sinusoid shape.
B. It has a straight course separating the right and left ventricles.
C. Its convexity varies in position during the cardiac cycle.

Key: A
115.7. What is the MOST likely explanation for enlargement of the right atrium in a patient with mitral
valve stenosis?
A. Tricuspid valve regurgitation
B. Pulmonary valve stenosis
C. Tricuspid valve stenosis
D. Tricuspid valve prolapse

Key: A
116.8. Enlargement of which one of the following structures is the MOST reliable radiographic sign of
pulmonary valve stenosis?
A. Pulmonary trunk
B. Right ventricle
C. Left main pulmonary artery
D. Right and left main pulmonary arteries

Key: C

117.9. Regarding hypertrophic cardiomyopathy, which one of the following is an associated valvular
abnormality?
a. Aortic valve stenosis
B. Mitral valve stenosis
C. Systolic anterior motion of the mitral valve
D. Mitral valve prolapse

Key: C
118.10. Which of the following statements is TRUE regarding myocardial bridges?
A. They occur in 5% of autopsy specimens.
B. They are better depicted by CT than by angiography.
C. They require surgical therapy.
D. They most frequently affect the right coronary artery.

Key: B
ACR CARDIAC 2016
119.Which one of the following septal defects is MOST commonly associated with partial anomalous
pulmonary venous drainage?
A. Ostium primum
B. Ostium secundum
C. Ventricular
D. Sinus venosus

Key: D
120.Concerning a patient presenting with an acute myocardial infarction accompanied by severe
bradycardia, which vessel is MOST likely involved?
A. Diagonal branch
B. Left anterior descending coronary artery
C. Right coronary artery
D. Circumflex artery

Key: C
121.Concerning tricuspid valve regurgitation in adults, what is the MOST common etiology?
A. Infective endocarditis
B. Right ventricular hypertension
C. Ebsteins’ anomaly of the tricuspid valve
D. Rheumatic heart disease

Key: B
122.Which of the following findings is the MOST reliable sign of elevated right ventricular pressure on a
contrast-enhanced CT scan of the chest?
A. Leftward bowing of the interventricular septum
B. Right ventricular hypertrophy
C. Right ventricular enlargement
D. Reflux of contrast into the inferior vena cava
Key: A
123.In regards to cyanotic congenital heart disease presenting in infancy, which one of the following is
MOST common?
A. Hypoplastic left heart syndrome
B. Tetralogy of Fallot
C. Truncus arteriosus
D. Ventricular septal defect

Key: B
124.What is the MOST common anomaly associated with partial anomalous pulmonary venous drainage of
the left lung?
A. A left superior vena cava draining to the coronary sinus
B. Ostium secundum atrial septal defect
C. A vertical vein draining to the left brachiocephalic vein
D. Hypoplasia of the left pulmonary artery and lung

Key: C
ACR CARDIAC 2017
125.1. Coronary artery aneurysms can be caused by which of the following?
A. Hypertension
B. Syphilis
C. Atherosclerosis
D. Neoplasm

Key: C
126.6. Coronary artery aneurysms are associated with which of the following?
A. Kawasaki disease
B. Giant cell arteritis
C. Sjögren syndrome
D. Hypertension

Key: A
127.7. What is a potential life threatening complication of congenital absence of the pericardium?
A. Herniation and strangulation of the heart
B. Acute pulmonary embolism
C. Pericardial effusion
D. Thrombosis of the superior vena cava

Key: A
128.8. What is the most common form of congenital pericardial absence?
A. Partial right sided
B. Complete right sided
C. Partial left sided
D. Complete left sided

Key: D

129.9. What is the MOST common cause of constrictive pericarditis in the United States?
A. Tuberculosis
B. Uremia
C. Idiopathic
D. Prior cardiac surgery
Key: C
130.10. Regarding the anomalous course of coronary arteries, which of the following types carries a risk for
sudden cardiac death?
A. Interatrial
B. Retroaortic
C. Pre pulmonic
D. Subpulmonic

Key: A

ACR THORACIC
2005
1.295. A false negative F-18 FDG PET study is MOST likely to occur in which one of the following lung
carcinomas?
A. Bronchioloalveolar
B. Small cell
C. Squamous
D. Large cell

Rationales: A
2.296. Which one of the following lung diseases is classified as a smoking related disorder?
A. Diffuse panbronchiolitis
B. Usual interstitial pneumonia
C. Lymphocytic interstitial pneumonia
D. Desquamative interstitial pneumonia

Rationales: D
3.297. ALL of the following are a cause of bronchiectasis EXCEPT:
A. Mycobacterium avium-intracellulare
B. Allergic bronchopulmonary aspergillosis
C. Dyskinetic cilia syndrome
D. Cryptogenic organizing pneumonia

Rationales: D
4.298. ALL of the following are thoracic manifestations of Wegener’s granulomatosis EXCEPT:
A. Pericardial effusion
B. Pulmonary hemorrhage
C. Tracheal thickening
D. Cavitary nodules

Rationales: A
5.299. ALL of the following manifest as the tree-in-bud pattern on high-resolution chest CT EXCEPT:
A. Endobronchial spread of infection
B. Perilymphatic opacities
C. Centrilobular opacities
D. Terminal bronchiolar impaction
Rationales: B
6.38. For which of the following is obtaining a definitive diagnosis with needle biopsy MOST DIFFICULT?
A. Hamartoma
B. Healed granuloma
C. Lymphoma
D. Metastatic carcinoma
Rationales: B
7.39. Which one of the following is MOST frequently involved in fibrosing mediastinitis?
A. Pulmonary artery
B. Aorta
C. Left common carotid artery
D. Bronchial artery

Rationales: A
8.40. Concerning inverse square law in chest fluoroscopy, if the patient’s entrance dose is 20 mGy/min
with the source-to-skin distance (SSD) of 65 cm and source-to-image distance (SID) of 90 cm. How much
does the entrance dose change if the SID is increased to 120 cm while maintaining similar SSD?
A. Increases by a factor of approximately 1.3
B. Remains unchanged
C. Decreases by a factor of approximately 2
D. Increases by a factor of approximately 1.8

Rationales: D
9.41. Which one of the following is MOST LIKELY to be associated with small cell carcinoma?
A. Brachial plexopathy
B. Hypoglycemia
C. Hyponatremia
D. Pupillary constriction

Rationales: C
10.42. Concerning pulmonary veno-occlusive disease, which of the following are characteristic CT findings?
A. Enlarged left atrium and diffuse interstitial edema
B. Enlarged left atrium and normal lung parenchyma
C. Normal-sized left atrium and normal lung parenchyma
D. Normal-sized left atrium and diffuse interstitial edema

Rationales: D
11.43. Kerley B lines represent which one of the following?
A. Dilated peripheral pulmonary veins
B. Distended capillaries
C. Distended lymphatics
D. Thickened interlobular septa

Rationales: D
12.44. Which one of the following injuries is indicated by the dependent viscera sign?
A. Bronchial fracture
B. Diaphragmatic rupture
C. Pulmonary laceration
D. Traumatic aortic tear
3|PageACRThoracic
Rationales: B
13.45. Which one of the following entities can be expected to cause a pneumothorax?
A. Boerhaave’s syndrome
B. Desquamative interstitial pneumonia
C. Metastatic osteogenic sarcoma
D. Ruptured bronchus within 1 cm of the carina

Rationales: C
14.46. Concerning cystic fibrosis, which one is TRUE?
A. Bronchiectasis is more severe in the lower lobes.
B. Sodium and chloride levels are elevated in the sweat.
C. It is heritable by dominant transmission.
D. The lung volumes are small.

Rationales: B
15.47. Concerning solitary pulmonary nodules, which one is TRUE?
A. Considered benign if stable for 1 year
B. Defined as a lesion that measures less than 2 cm
C. Metastasis is the most common cause
D. Presence of fat is indicative of benign etiology

Rationales: D
16.48. A film cassette spot film is taken of the chest of a supine patient with an under-table tube on a
fluoroscopic system. How does the spot film image taken with an under-table fluoroscopy system differ
from a typical properly exposed PA chest radiography film performed using an upright Bucky with similar
kVp and cassette?
A. The spot film will have significantly lower noise.
B. The longer exposure time will cause increased cardiac motion blurring for the spot film image.
C. A larger difference in image size is seen between anterior and posterior structures in spot film image.
D. The spot film yields lower entrance dose to patient.

Rationales: C
17.49. Which finding is characteristic of sarcoidosis?
A. Anterior mediastinal adenopathy
B. Basilar reticular opacities
C. Peri bronchovascular nodules
D. Random nodules

Rationales: C
18.50. Concerning the left superior vena cava, how does it communicate with the heart?
A. Enters the left atrium via the pulmonary veins
B. Enters the left atrium via the coronary sinus
C. Enters the right atrium via the sinus of Valsalva
D. Enters the right atrium via the coronary sinus
4|PageACRThoracic
Rationales: D
19.51. Concerning eosinophilic lung disease, which one is TRUE?
A. Blood eosinophilia is necessary to make the diagnosis.
B. It can be caused by drugs, such as sulfonamides.
C. Chronic eosinophilic pneumonia is characterized by central opacities.
D. Loffler’s syndrome is characterized by peripheral opacities.

Rationales: B & D ARE BOTH CORRECT

20.52. Which one of the following is characteristic of acute pulmonary emboli on CT angiography?
A. Thickened, narrowed pulmonary arteries
B. Pulmonary artery webs
C. Central filling defect within the pulmonary arteries
D. Mosaic perfusion of the lung parenchyma

Rationales: C
21.53. Which one of the following radiographic features is seen with allergic bronchopulmonary
aspergillosis?
A. Air crescent sign
B. Central bronchiectasis
C. Halo sign
D. Pleural thickening

Rationales: B
22.54. Which one of the following conditions demonstrates air-trapping on expiratory high resolution CT
scan?
A. Churg-Strauss syndrome
B. Goodpasture’s syndrome
C. Scimitar syndrome
D. Swyer-James syndrome

Rationales: D
23.55. Which one of the following mediastinal landmarks is likely to be obliterated by a bronchogenic cyst?
A. Anterior junction line
B. Posterior junction line
C. Azygoesophageal interface
D. Descending aortic interface

Rationales: C
24.56. Concerning asbestosis, which one of the following is an expected manifestation?
A. Increased lung volume
B. Upper lung nodules
C. Bronchiectasis
D. Pleural effusions

Rationales: D

5|PageACRThoracic
24.57. Which one is MOST likely to cause hoarseness?
A. Anterior mediastinal mass
B. Aorto-pulmonary window mass
C. Right hilar mass
D. Subcarinal mass

Rationales: B
ACR THORACIC 2007
25.208. Regarding pulmonary mycetoma, which one of the following is TRUE?
A. Patients are usually immunosuppressed.
B. Cavity results from severe central cystic bronchiectasis.
C. They are most often seen in the upper lobes.
D. Hemoptysis results from angioinvasion by the fungal elements.

RATIONALES: C
26.209. Which of the following structures is a core or centrilobular component of the secondary pulmonary
lobule?
A. Pulmonary vein
B. Septum
C. Bronchiole
D. Lymphatic

RATIONALES: C
27.210. Concerning the solitary pulmonary nodule, which CT appearance is MOST predictive of a primary
lung carcinoma?
A. Laminated calcification
B. Solid density
C. Pure ground glass attenuation
D. Mixed solid and ground glass opacity

RATIONALES: D
28.211. Eggshell calcification in hilar or mediastinal nodes occurs in which of the following diseases?
A. Tuberculosis
B. Metastatic mucinous adenocarcinoma
C. Histoplasmosis
D. Sarcoidosis

RATIONALES: D

6|PageACRThoracic
29.212. Which one of the following is MOST LIKELY to cause obliteration of a portion of the descending
aortic interface?
A. Pericardial cyst
B. Bronchogenic cyst
C. Lymphoma
D. Neurogenic tumor

RATIONALES: D
30.213. Which of the following statements about localized fibrous tumors of the pleura is TRUE?
A. They are associated with asbestos exposure.
B. They are associated with hypertrophic pulmonary osteoarthropathy.
C. They account for the majority of pleural tumors.
D. Most of these tumors arise from parietal pleura.

RATIONALES: B
31.214. Concerning radiation pneumonitis, which of the following is TRUE?
A. It usually occurs 6 months after completion of radiation therapy.
B. Chemotherapeutic agents potentiate the effects of radiation.
C. The acute phase of injury manifests as traction bronchiectasis.
D. Pre-existing lung disease has no effect on the development of radiation pneumonitis.

RATIONALES: B
32.215. Which one of the following diseases is MOST LIKELY to be a cause of pulmonary artery aneurysm
or pseudoaneurysm?
A. Pulmonary infection
B. Mediastinal fibrosis
C. Metastasis
D. Goodpasture’s syndrome

RATIONALES: A
33.216. Concerning pulmonary mycobacterium avium-intracellulare complex infection, which one of the
following is TRUE?
A. Cavitary lesions occur in patients with chronic obstructive pulmonary disease.
B. Centrilobular nodules occur in immunocompromised patients.
C. Mediastinal adenopathy occurs in elderly woman without underlying lung disease.
D. RML and lingular bronchiectasis occurs in patients with hypersensitivity pneumonitis.

RATIONALES: A
34.217. Concerning lung cancer staging, which one of the following is MOST indicative of unrespectability?
A. Size of the tumor
B. Pleural effusion
C. Scalene node
D. Ipsilateral hilar adenopathy

RATIONALES: C

7|PageACRThoracic
35.218. Concerning Morgagni hernia, which one of the following is the MOST common location for its
occurrence?
A. Left cardiophrenic
B. Right cardiophrenic
C. Left paraspinal
D. Right paraspinal

RATIONALES: B
36.219. Which one of the following radiographic signs represents chronic deep vein thrombosis at CT
venography?
A. Central low attenuation
B. Perivenous soft tissue edema
C. Venous dilatation
D. Central calcification

RATIONALES: D
37.220. Which one of the following is true regarding the ACR recommendation for chest radiographs in
patients requiring mechanical ventilation?
A. Daily
B. Twice a day
C. Every other day
D. Once a week

RATIONALES: A
38.221. A computed radiography image with a 10-bit pixel depth will have how many possible shades of
gray?
A. 256
B. 1024
C. 4094
D. 8192

RATIONALES: B
39.222. A patient undergoes a chest CT in a trauma center and later found to be pregnant. The radiation
exposure to fetus is mainly from:
A. primary x-ray radiation.
B. internal scatter radiation.
C. external scatter radiation.
D. leakage radiation.

RATIONALES:
40.223. Concerning idiopathic pulmonary fibrosis, which of the following is TRUE regarding the distribution
of disease?
A. Upper and central
B. Upper and peripheral
C. Lower and central
D. Lower and peripheral
8|PageACRThoracic
RATIONALES: D
41.224. Concerning cysts noted in the lung on High Resolution CT scan of the chest, which one of the
following is TRUE?
A. They are spherical and uniform in Langerhans cell histiocytosis.
B. They lack a well-defined wall in early centrilobular emphysema.
C. They are spherical and in the upper lobes in panlobular emphysema.
D. They are irregular and in the upper lobes in lymphangioleiomyomatosis.

RATIONALES: B
42.32. Concerning diffuse tracheal abnormality, which one of the following is TRUE?
A. There is circumferential thickening of the trachea in Wegner's granulomatosis.
B. Tachiobronchiopathia osteochondroblastica is a premalignant condition.
C. Relapsing polychondritis affects the posterior membrane of the trachea.
D. Widening of the transverse diameter of the trachea is seen in saber-sheath trachea.

Key: A
43.33. Which one of the following conditions is MOST associated with hypervascular adenopathy?
A. Small cell cancer
B. Histoplasmosis
C. Castleman's disease
D. Whipple's disease

Key: C
44.34. Concerning a solitary pulmonary nodule, which pattern of calcification is considered MOST
indeterminate?
A. Central
B. Eccentric
C. Laminar
D. Popcorn

Key: B
45.35. Which of the following is the major advantage of using a scintillator material for PET imaging that
emits light very promptly after each interaction?
A. Reduced random coincidences
B. Improved spatial resolution
C. Reduced effects of attenuation in the patient
D. Improved rejection of single-scatter coincidences

Key: A
46.36. Which one of the following sternal wire abnormalities is MOST characteristic of sternal dehiscence?
A. Shift of the wire
B. Resorption of the wire
C. Rotation of the wire
D. Fracture of the wire

Key: A

9|PageACRThoracic
47.37. Which one of the following complications is MOST LIKELY to occur in the first 30 days after
hematopoietic stem cell transplantation?
A. Bronchiolitis obliterans
B. Cytomegalovirus pneumonia
C. Diffuse alveolar hemorrhage
D. Cryptogenic organizing pneumonia

Key: C
48.38. Concerning "vanishing lung syndrome," which one of the following is TRUE?
A. It is predominantly seen in elderly men
B. There is no association with history of smoking
C. It is associated with panacinar emphysema
D. Bullae occupy one third of the hemithorax

Key: A, B, C, D
49.39. In which disease of the aorta is an initial noncontrast CT scan often helpful?
A. Aortic aneurysm
B. Coarctation of aorta
C. Traumatic aortic transaction
D. Aortic dissection

Key: D
50.40. Which one of the following is TRUE regarding silo filler's disease?
A. It is a hypersensitivity reaction.
B. It is caused by inhalation of nitrogen dioxide.
C. It occurs several months after exposure.
D. CT scan shows bibasilar reticular opacities.

Key: B
52.41. Which of the following is considered an absolute CONTRAINDICATION of percutaneous
transthoracic needle biopsy?
A. Severe emphysema
B. Pulmonary arterial hypertension
C. Puncture of only one functional lung
D. Hydatid cyst

Key: D
53.42. Which of the following is the EARLIEST identified thoracic abnormality associated with asbestos
exposure?
A. Pleural plaques
B. Benign pleural effusion
C. Asbestosis
D. Malignant mesothelioma

Key: B

10 | P a g e A C R T h o r a c i c
54.43. Concerning barotrauma, which one of the following is CORRECT?
A. Pulmonary fibrosis is a significant risk factor.
B. Interstitial emphysema is the first radiographic manifestation.
C. Only a minority of pneumothoraces in ventilation-assisted patients are under tension.
D. Tracheal tears are a recognized effect of barotrauma.

Key: B
56.44. Concerning percutaneous ablation of the pulmonary veins, which one of the following statements is
TRUE?
A. Pulmonary vein variation occurs in less than 10% of the patients.
B. The procedure is performed via the femoral artery approach.
C. High resolution CT scan of the chest is performed for preprocedural mapping.
D. Indication for procedure includes atrial fibrillation.
Key: D
57.45. For a chest radiograph of a typical adult, both primary and scattered x-rays exit patient and are
incident on the grid. How many scattered x-rays are there in comparison to primary x-rays?
A. Scatter is 25% of primary.
B. Scatter is 50% of primary.
C. Scatter is 4X primary.
D. Scatter is 2X primary.

Key: C
58.46. Which finding is MOST LIKELY seen in lymphangitic spread of cancer?
A. Random nodules
B. Centrilobular ground-glass opacity
C. Mosaic attenuation
D. Thickening of fissures

Key: D
59.256. Which one of the following is TRUE of cardiogenic pulmonary edema?
A. Acute onset and rapid resolution are characteristic on chest radiographs.
B. Interstitial edema first appears at pulmonary capillary wedge pressures above 25 mm Hg.
C. Radiographs show the presence of sharply defined perihilar vessels.
D. Pulmonary capillary wedge pressure is a measure of main pulmonary artery pressure.

KEY: A
60.257. Regarding small cell carcinoma, which of the following is MOST typical?
A. Usually presents as a peripheral nodule
B. Localized disease at time of diagnosis
C. Associated with paraneoplastic syndrome
D. Most common type of lung cancer

Key: C

11 | P a g e A C R T h o r a c i c
61.258. Regarding lymphangiomyomatosis, which one of the following is TRUE?
A. Irregularly shaped cysts are characteristic.
B. Chylous pleural effusions are expected.
C. It is typically associated with smoking.
D. It occurs predominantly in men.

Key: b
62.259. Regarding transthoracic needle biopsy, which one of the following is TRUE?
A. Core needle biopsy is preferred for definitive diagnosis of mediastinal masses.
B. Diagnostic yield for both benign and malignant lesions is similar.
C. Large chest tube insertion is the treatment of choice for post biopsy pneumothorax.
D. Solitary pulmonary nodules do not require biopsy if the PET scan is negative.

Key: A
63.260. Regarding cytomegalovirus pneumonia, which one of the following is TRUE?
A. Extrapulmonary manifestations include skin nodules.
B. The diagnosis is frequently made with a sputum culture.
C. CT scan shows hilar and mediastinal adenopathy.
D. It occurs following bone marrow transplantation.

Key: D
64.261. What is the etiology of “tree-in-bud” opacities identified on high-resolution CT scan of the chest?
A. Mucoid-impacted peripheral airways
B. Lymphangitic spread of disease
C. Hematogenous spread of cancer
D. Interstitial lung disease

Key: A
65.262. According to the ACR appropriateness criteria, which one of the following should be the initial
imaging test in a patient with suspected thoracic metastatic disease?
A. Chest radiograph
B. CT scan of the chest
C. FDG-PET of the whole body
D. MRI of the chest

Key: A
66.263. According to the Fleischner Society guidelines for management of small pulmonary nodules
detected on CT scan of the chest, when should a follow-up CT scan be performed for a 4-mm nodule in a
low-risk patient?
A. No follow-up needed
B. 6 months
C. 9 months
D. 12 months

Key: A

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67.264. Which one of the following connective tissue disorders is MOST LIKELY to be associated with
pericardial effusion?
A. Rheumatoid arthritis
B. Scleroderma
C. Polymyositis
D. Systemic lupus erythematosus

Key: D
68.265. Which of the following digital radiography detector systems involves direct conversion of x-rays
into an electrical charge?
A. Cesium-iodide scintillator flat panel detector
B. Gadolinium-based scintillator flat panel detector
C. Selenium-based photoconductor flat panel detector
D. Photostimulable storage phosphor image plate

Key: C
69.266. Which one of the following matches of work-related lung findings are CORRECT?
A. Asbestosis and hilar adenopathy
B. Berylliosis and upper-lung reticular opacities
C. Coal workers’ pneumoconiosis and small lower-lobe nodules
D. Silicosis and pleural effusions

Key: B
70.267. Which one of the following congenital anomalies is MOST common in the left upper lobe?
A. Bronchial atresia
B. Cardiac bronchus
C. Sequestration
D. Tracheal bronchus

Ke: A
71.268. Regarding aspiration pneumonia, which one of the following is TRUE?
A. Secondary infection is frequently caused by aerobic bacteria from the oropharyngeal secretions.
B. Predisposing factors are not usually found in patients with aspiration pneumonia.
C. Complications include lung injury that may progress to respiratory failure.
D. Radiographic findings of pure gastric acid aspiration resolve within 1 to 2 day.

Key: C
72.120. Which one of the following statements is TRUE regarding Langerhans cell histiocytosis?
A. Lower lobe nodules predominate.
B. There is proliferation of immature smooth muscle.
C. It has well-defined round cysts.
D. Most patients are cigarette smokers.

Rationale: D

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73.121.Which of the following organisms is MOST commonly implicated in fibrosing mediastinitis?
A. Histoplasma capsulatum
B. Actinomyces israelii
C. Treponema pallidum
D. Coccidioides immitis

Rationale: A
74.122.Which one of the following statements is TRUE regarding pleural effusions?
A. Split-pleura sign noted on contrast-enhanced CT scan is diagnostic of empyema.
B. Lung cancer with malignant pleural effusion implies stage IIIB disease.
C. Transudative pleural effusion is present in asbestos-related pleural disease.
D. Cirrhosis is associated with exudative pleural effusion.

Rationale: C
75.123.Which one of the following statements is TRUE regarding Kaposi’s sarcoma?
A. It is caused by the human papilloma virus infection.
B. Imaging of lesions shows Peri bronchovascular distribution.
C. It is seen exclusively in patients who are intravenous drug users.
D. There is an increased uptake of Ga-67 in lesions on imaging.

Rationale: B
76.124.What is the average energy of a 100-kVp x-ray beam?
A. 10 KeV
B. 20 KeV
C. 40 KeV
D. 80 KeV

Rationale: C
77.125. According to the ACR Appropriateness criteria, which one of the following is the MOST appropriate
first radiological examination in the evaluation of a patient with chest pain and suspicion of aortic
dissection?
A. Chest radiograph
B. Aortic angiogram
C. MRI of the chest
D. Chest CT with contrast

Rationale: A
78.126.Which one of the following statements is TRUE regarding fat embolism syndrome?
A. It occurs in 20% of patients with long bone fractures.
B. It appears radiographically as peripheral wedge-shaped opacities.
C. Patients present with hypoxia, altered mental status, and petechial rash.
D. It appears as central low-attenuation filling defects in the pulmonary artery branches.

Rationale: C

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79.127.A digital radiograph is excessively dark when presented on a properly calibrated PACS workstation.
What is the MOST LIKELY cause for this suboptimal image?
A. Overexposure of the imaging plate
B. Underexposure of the imaging plate
C. Incorrect kVp selected by the technologist
D. Image processing failure

Rationale: D
80.128.In which of the following conditions is hypertrophic pulmonary osteoarthropathy seen?
A. Septic emboli
B. Lung carcinoma
C. Cryptogenic organizing pneumonia
D. Rheumatoid arthritis

Rationale: B
81.129.Which one of the following statements is TRUE regarding a solitary pulmonary nodule?
A. The presence of calcification suggests benignity.
B. Transthoracic needle biopsy has shown greater than 90% diagnostic accuracy for all nodules.
C. Granulomas can show positive FDG uptake similar to that seen with malignant nodules.
D. A doubling time of less than 1 month for nodules is highly suggestive of malignancy.
Rationale: C
82.130.Which one of the following structures is present in the wall of the secondary lobule?
A. Pulmonary artery
B. Terminal bronchiole
C. Bronchial artery
D. Pulmonary vein

Rationale: D
83.131.Which one of the following statements is TRUE regarding a bronchogenic cyst?
A. It is a low-signal intensity lesion on T1- and T2-weighted MR images.
B. It is a well-defined spherical subcarinal mass.
C. It demonstrates enhancement after intravenous contrast administration.
D. It occurs most commonly in the left lower lobe.

Rationale: B
84.39. Which of the following is MOST commonly associated with Eaton-Lambert syndrome?
A. Small cell carcinoma
B. Carcinoid tumor
C. Pancoast tumor
D. Solitary fibrous tumor of the pleura

Rationale: A

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85.40. Which of the following is TRUE regarding acquired immune deficiency syndrome (AIDS)-related
disease?
A. Staphylococcus aureus is the most common cause of pneumonia.
B. Kaposi sarcoma occurs when the CD4 count is below 50 cells/uL.
C. Cysts are seen in the majority of cases of Pneumocystis jiroveci pneumonia.
D. The majority of the Aids-related lymphomas have extranodal disease.

Rationale: D
86.41. Which of the following statements is TRUE regarding arteriovenous malformation (AVM)?
A. No treatment is necessary unless the patient is symptomatic.
B. Clinical presentation may include transient ischemic attacks or stroke.
C. It is more common in the upper lobes.
D. The majority of malformations have two or more feeding arteries or draining veins.

Rationale: B
87.42. "Shrinking lung" syndrome is seen with which of the following entities?
A. Systemic lupus erythematosus
B. Panlobular emphysema
C. Swyer-James syndrome
D. Lymphangiomyomatosis

Rationale: A
88.43. Which of the following is the MOST common location of a bronchogenic cyst?
A. Right cardiophrenic angle
B. Left paraspinal region
C. Subcarinal space
D. Within lung parenchyma

Rationale: C
89.1. Regarding thoracic manifestations of scleroderma (progressive systemic sclerosis), which of the
following is true?
A. When present, fibrosis tends to be present within the upper lobes.
B. Esophageal involvement is less frequently seen than cardiac involvement.
C. The primary pattern of fibrosis is a usual interstitial pneumonitis (UIP) pattern.
D. Scleroderma is associated with an increased incidence of lung cancer.

Rationale: D
90.4. Concerning cystic fibrosis, which one is TRUE?
A. Bronchiectasis is more severe in the lower lobes.
B. Sodium and chloride levels are elevated in the sweat.
C. It is heritable by dominant transmission.
D. The lung volumes are small.

Rationale: B

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91.5. Concerning solitary pulmonary nodules, which one is TRUE?
A. Considered benign if stable for 1 year
B. Defined as a lesion that measures less than 2 cm
C. Metastasis is the most common cause
D. Presence of fat is indicative of benign etiology

Rationale: D
92.6. Which one is MOST likely to cause hoarseness?
A. Anterior mediastinal mass
B. Aorto-pulmonary window mass
C. Right hilar mass
D. Subcarinal mass

Rationale: B
93.9. Regarding pulmonary mycetoma, which one of the following is TRUE?
A. Patients are usually immunosuppressed.
B. Cavity results from severe central cystic bronchiectasis.
C. They are most often seen in the upper lobes.
D. Hemoptysis results from angioinvasion by the fungal elements.

Rationale: C
94.10. Which of the following structures is a core or centrilobular component of the secondary pulmonary
lobule?
A. Pulmonary vein
B. Septum
C. Bronchiole
D. Lymphatic

Rationale: C
95.65.1. Which statement is true regarding lung cancer?
A. Part-solid nodules are more likely to be malignant than solid or ground glass nodules.
B. Yearly chest x-rays in smokers and former smokers have been shown to decrease mortality.
C. Ground glass features are associated with invasive tumor.
D. Eccentric calcification is a reliable predictor of benignity in a nodule.

Rationales: A
96.4. Which of the following statements about localized fibrous tumors of the pleura is TRUE?
A. They are associated with asbestos exposure.
B. They are associated with hypertrophic pulmonary osteoarthropathy.
C. They account for the majority of pleural tumors.
D. Most of these tumors arise from parietal pleura.

Rationales: B
97.5. Which one of the following diseases is MOST LIKELY to be a cause of pulmonary artery aneurysm or
pseudoaneurysm?
A. Pulmonary infection
17 | P a g e A C R T h o r a c i c
B. Mediastinal fibrosis
C. Metastasis
D. Goodpasture’s syndrome

Rationales: A
98.6. Concerning lung cancer staging, which one of the following is MOST indicative of unrespectability?
A. Size of the tumor
B. Pleural effusion
C. Scalene node
D. Ipsilateral hilar adenopathy

Rationales: C
99.7. Which of the following is the MOST common location for a Morgagni hernia?
A. Left cardiophrenic
B. Right cardiophrenic
C. Left paraspinal
D. Right paraspinal

Rationales: B
100.8. Which one of the following radiographic signs represents chronic deep vein thrombosis at CT
venography?
A. Central low attenuation
B. Perivenous soft tissue edema
C. Venous dilatation
D. Central calcification
Rationales: D
101.3. For which of the following is obtaining a definitive diagnosis with needle biopsy MOST DIFFICULT?
A. Hamartoma
B. Healed granuloma
C. Lymphoma
D. Metastatic carcinoma

Rationales: B
103.4. Which one of the following injuries is indicated by the dependent viscera sign?
A. Bronchial fracture
B. Diaphragmatic rupture
C. Pulmonary laceration
D. Traumatic aortic tear

Rationales: B
104.5. Eggshell calcification in hilar or mediastinal nodes occurs in which of the following diseases?
A. Tuberculosis
B. Metastatic mucinous adenocarcinoma
C. Histoplasmosis
18 | P a g e A C R T h o r a c i c
D. Sarcoidosis

RATIONALES: D
105.6. Which of the following statements about localized fibrous tumors of the pleura is TRUE?
A. They are associated with asbestos exposure.
B. They are associated with hypertrophic pulmonary osteoarthropathy.
C. They account for the majority of pleural tumors.
D. Most of these tumors arise from parietal pleura.

Key: B
106.7. Which of the following is TRUE regarding radiation pneumonitis?
A. It usually occurs 6 months after completion of radiation therapy.
B. Chemotherapeutic agents potentiate the effects of radiation.
C. The acute phase of injury manifests as traction bronchiectasis.
D. Pre-existing lung disease has no effect on the development of radiation pneumonitis.

RATIONALES: B
107.9. Concerning pulmonary mycobacterium avium-intracellulare complex infection, which one of the
following is TRUE?
A. Cavitary lesions occur in patients with chronic obstructive pulmonary disease.
B. Centrilobular nodules occur in immunocompromised patients.
C. Mediastinal adenopathy occurs in elderly woman without underlying lung disease.
D. RML and lingular bronchiectasis occurs in patients with hypersensitivity pneumonitis.

Key: A
108.10. Which one of the following radiographic signs represents chronic deep vein thrombosis at CT
venography?
A. Central low attenuation
B. Perivenous soft tissue edema
C. Venous dilatation
D. Central calcification

RATIONALES: D
109.2. A false negative F-18 FDG PET study is MOST likely to occur in which one of the following lung
carcinomas?
A. Bronchioloalveolar
B. Small cell
C. Squamous cell
D. Large cell

Key: A
110.5. Which one of the following is MOST LIKELY to be associated with small cell carcinoma?
A. Brachial plexopathy
B. Hypoglycemia
C. Hyponatremia
D. Pupillary constriction
19 | P a g e A C R T h o r a c i c
Key: C
111.6. Concerning pulmonary veno-occlusive disease, which of the following are characteristic CT findings?
A. Enlarged left atrium and diffuse interstitial edema
B. Enlarged left atrium and normal lung parenchyma
C. Normal-sized left atrium and normal lung parenchyma
D. Normal-sized left atrium and diffuse interstitial edema

Key: D
112.7. Which finding is characteristic of sarcoidosis?
A. Anterior mediastinal adenopathy
B. Basilar reticular opacities
C. Peri bronchovascular nodules
D. Random nodules

Key: C
113.8. How does the left superior vena cava return blood to the heart ?
A. Pulmonary veins
B. Azygos vein
C. Sinus of Valsalva
D. Coronary sinus

Key: D
114.9. Which one of the following is characteristic of acute pulmonary emboli on CT angiography?
A. Thickened, narrowed pulmonary arteries
B. Pulmonary artery webs
C. Central filling defect within the pulmonary arteries
D. Mosaic perfusion of the lung parenchyma

Key: C
115.11. Which one of the following is MOST likely to cause obliteration of a portion of the descending
aortic interface?
A. Pericardial cyst
B. B: Bronchogenic cyst
C. Lymphoma
D. Neurogenic tumor

Key: D
116.12. Concerning idiopathic pulmonary fibrosis, which of the following is TRUE regarding the distribution
of disease?
A. Upper and central
B. Upper and peripheral
C. Lower and central
D. Lower and peripheral

Key: D

20 | P a g e A C R T h o r a c i c
117.Which one of the following lung diseases is classified as a smoking related disorder? Options:
A. Diffuse panbronchiolitis
B. Usual interstitial pneumonia
C. Lymphocytic interstitial pneumonia
D. Desquamative interstitial pneumonia

Key: D
118.Kerley B lines represent which one of the following?
A. Dilated peripheral pulmonary veins
B. Distended capillaries
C. Distended lymphatics
D. Thickened interlobular septa

Key: D
119.Which one of the following entities is MOST likely to cause a pneumothorax?
A. Boerhaave’s syndrome
B. Desquamative interstitial pneumonia
C. Metastatic osteogenic sarcoma
D. Ruptured bronchus within 1 cm of the carina

Key: C
120.Which one of the following radiographic features is seen with allergic bronchopulmonary
aspergillosis?
A. Air crescent sign
B. Central bronchiectasis
C. Halo sign
D. Pleural thickening

Key: B
121.Which of the following is the MOST common location for a Morgagni hernia?
A. Left cardiophrenic
B. Right cardiophrenic
C. Left paraspinal
D. Right paraspinal

Key: B
122.Which statement is TRUE with respect to Desquamative Interstitial Pneumonia (DIP)?
A. High-resolution CT characteristically shows diffuse ground glass opacities.
B. The majority of patients are non-smokers.
C. High-resolution CT characteristically shows peripheral honeycombing in the lower lobes.
D. If untreated, it often progresses to Usual Interstitial Pneumonia (UIP).

Key: A
123.Concerning lung screening, which of the following would be MOST suspicious for lung cancer?
A. 7 mm solid nodule
B. 10 mm ground glass nodule
21 | P a g e A C R T h o r a c i c
C. 9 mm mixed solid/ground glass nodule
D. 8 mm polygonal shaped ground glass nodule

Key: C
124.Which one of the following conditions is MOST likely associated with hypervascular adenopathy?
A. Small cell cancer
B. Histoplasmosis
C. Castleman disease
D. Whipple disease

Key: C
125.Which one of the following sternal wire abnormalities is MOST characteristic of sternal dehiscence?
A. Shift of the wire
B. Resorption of the wire
C. Rotation of the wire
D. Fracture of the wire

Key: A
126.Which statement is TRUE regarding small airway diseases?
A. Tree-in-bud is almost always secondary to a mycobacterial infection.
B. Tiny nodules from small airway diseases tend to be centrilobular.
C. Areas of decreased attenuation are associated with increased vessel caliber in these regions.
D. Obliterative (constrictive) bronchiolitis usually manifests as peripheral ground glass opacities.

Key: B
127.Which statement is TRUE regarding traumatic aortic injury (TAI)?
A. An eccentric thrombus can be a manifestation of minimal aortic intimal injury.
B. Aortic injuries seen on CT are most often detected within the ascending aorta.
C. Mediastinal hemorrhage isolated to the anterior mediastinum is often associated with TAI.
D. Pseudoaneurysms are rarely seen with TAI.
Key: A
128.Which one of the following statements is true regarding barotrauma?
A. Pulmonary fibrosis is a significant risk factor.
B. Interstitial emphysema is the first radiographic manifestation.
C. Only a minority of pneumothoraces in ventilation assisted patients are under tension.
D. Tracheal tears are a recognized effect of barotrauma.

Key: B

1. What is the MOST common radiographic manifestation of acute papillary muscle rupture?

A. Pulmonary edema
B. Left atrial enlargement
C. Left ventricular enlargement
D. Pericardial effusion
Key: A

6. Regarding MR imaging in the evaluation of myocardial infarction, which of the following is the MOST
important technique?

A. T2-weighted
B. First pass perfusion
C. Velocity-encoded phase-contrast
D. Delayed-enhancement
Key: D

7. Regarding pericardial cysts, what is the MOST common CT appearance?

A. High attenuation fluid

B. Low attenuation fluid
C. Thin wall calcifications
D. Thin walled septations
Key: B

8. What is the MOST common primary malignant pericardial neoplasm?

A. Angiosarcoma
B. Lymphoma
C. Mesothelioma
D. Neuroectodermal tumor
Key: C

9. Regarding implantable cardioverter-defibrillator devices, what is the proper anatomic position of the
proximal shock coil?

A. Right ventricle
B. Superior vena cava
C. Left ventricle
D. Inferior vena cava
Key: B
8. Which one of the following is the MOST common location of a bronchogenic cyst?
A. Right cardiophrenic angle
B. Left paraspinal region
C. Subcarinal space
D. Lung parenchyma
Key: C

9. Which one of the following conditions predisposes to pulmonary aspergilloma?

A. Cystic fibrosis
B. Asthma
C. Sarcoidosis
D. Chronic lymphocytic leukemia
Key: C

Which of the following structures is a core component of the secondary pulmonary lobule?

A. Bronchiole
B. Pulmonary vein
C. Lymphatic
D. Septum
Key: A