Self-assessment questions

These questions test your ability to present a chest radiograph and recognise pathology.
They are presented in the same format as an objective structured clinical examination
(OSCE) or viva station, so to make it as real as possible there are no multiple-choice
questions (MCQs).
There are 18 questions, each based on one chest radiograph. Remember to use the
ABCDE approach when presenting and remember there may be more than one
pathology in a single radiograph.
Part (a) of each question tests your ability to correctly present the radiograph using the
ABCDE method and at the same time recognise pathology.
Parts (b) onward are typical questions you may get asked in an OSCE and do not
necessarily test facts learnt from this book. They are designed to test and teach you more
general knowledge relating to the patient’s pathology.
The answers can be found separately.
Note: Any initials, ages and dates used are purely fictitious and are not related to the patient’s radiograph in
question.

Question 1

Figure 1 Name: Ms LA, Age: 35. Date taken: 27 July. Presented with shortness of breath
(a). Present this radiograph.
(b). Where is the anterior part of the left 2nd rib?
(c). Where is the border of the right atrium?
(d). Why is the right ventricle not visible on this radiograph?

Chest X-rays for Medical Students, First Edition. Christopher Clarke, Anthony Dux.
© 2011 John Wiley & Sons, Ltd. Published 2011 by Blackwell Publishing Ltd.
Question 2

Figure 2 Name: Mr CC, Age: 32. Date taken: 30 September. Presented with acute shortness of breath
(a). Present this radiograph.
(b). What would you do next?

Question 3

Figure 3 Name: Ms HA, Age: 55. Date taken: 1 July. Admitted with a history of collapse. Complete heart
block was diagnosed, and a pacemaker inserted. This radiograph was taken prior to discharge.
(a). Present this radiograph.
(b). What is the likely cause of this patient’s pathology?
(c). What would be the next step in this patient’s management?
Question 4

Figure 4 Name: Ms NM, Age: 60. Date taken: 20 March. Presented with dyspnoea.
(a). Present this radiograph.
(b). What is the likely cause of the abnormality in the lower zone of the left lung?
(c). Other than a staging CT scan, what would be the next step in this patient’s management and what tests
would you specifically send for?

Question 5

Figure 5 Name: Ms VW, Age: 58. Date taken: 27 August. Post-op after major surgery.
(a). Present this radiograph.
(b). If the radiograph was repeated in one months’ time, what change(s) would you expect to see?
Question 6

Figure 6 Name: Ms NC, Age: 29. Date taken: 27 September. A patient with type 1 diabetes presents to the
emergency department with diabetic ketoacidosis.
(a). Present this radiograph.
(b). Which lobe of the lung is affected?

Question 7

Figure 7 Name: Ms DR, Age: 60. Date taken: 26 August. Presented with abdominal pain.
(a). Present this radiograph.
(b). The patient is complaining of severe abdominal pain. Given this radiograph, give three possible causes
for this patient’s pain.
(c). What are the causes for unilateral hilar lymphadenopathy?
Question 8

Figure 8 Name: Ms ES, Age: 56. Date taken: 3 April. Presented with chest pain.
(a). Present this radiograph.
(b). Give three causes for pleural effusions.
(c). How might you distinguish between them?

Question 9

Figure 9 Name: Ms RR, Age: 38. Date taken: 12 February. Presented with abdominal pain.
(a). Present this radiograph.
(b). What is the diagnosis?
(c). Give three possible causes of pneumoperitoneum?
Question 10

Figure 10 Name: Ms WC, Age: 52. Date taken: 23 July. Presented with a cough for 3 weeks.
(a). Present this radiograph.
(b). What is the diagnosis?
(c). What follow-up would you recommend?

Question 11

Figure 11 Name: Ms RP, Age: 38. Date taken: 31 January. Patient involved in a road traffic accident.
(a). Present this radiograph.
(b). In which lobe is the main lung abnormality?
Question 12

Figure 12 Name: Mr DC, Age: 62. Date taken: 11 December. Patient with hypercalcaemia.
(a). Present this radiograph.
(b). What is a common cause of this radiographic finding?

Question 13

Figure 13 Name: Ms HJ, Age: 46. Date taken: 18 April. Presented with a cough and fever.
(a). Present this radiograph.
(b). What is the diagnosis?
(c). What follow-up would you recommend?
Question 14

Figure 14 Name: Mr AC, Age: 62. Date taken: 30 August. Presented with shortness of breath.
(a). Present this radiograph.
(b). What is the diagnosis?
(c). What is the next appropriate imaging investigation?

Question 15

Figure 15 Name: Mr GB, Age: 43. Date taken: 2 August. Presented with cough and fever.
(a). Present this radiograph.
(b). What is the diagnosis?
(c). What follow-up/further investigations would you recommend?
Question 16

Figure 16 Name: Mr MF, Age: 67. Date taken: 6 March. Patient presenting with right sided ptosis.
(a). Present this radiograph.
(b). What is the likely diagnosis?
(c). What syndromes may be associated with this appearance?

Question 17

Figure 17 Name: Ms MA, Age: 49. Date taken: 14 March. Presented with chest pain.
(a). Present this radiograph.
(b). How may this patient have presented clinically?
(c). What medication will this patient need for life?
(d). Why is there widening of the carinal angle?
Question 18

Figure 18 Name: Mr BW, Age: 64. Date taken: 30 May. Presented with confusion.
(a). Present this radiograph.
(b). What is the diagnosis?
(c). What is the likely cause of the abnormality identified?