New Series of Interactive Cardiology MCQs 27: X-Rays and Fluoroscopy
⚡ Advanced Cardiology Series – Part 27
Interactive Cardiology MCQs #27
Post-Graduate Level Masterclass: Cardiac X-Ray and Fluoroscopy
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Q1
On a standard posteroanterior (PA) chest radiograph, severe left atrial enlargement can elevate the left main bronchus. At what carinal angle is left atrial enlargement strongly suspected?
Q2
A patient with Coarctation of the Aorta demonstrates inferior rib notching on a chest X-ray due to dilated intercostal collateral arteries. Which ribs are characteristically SPARED from this notching?
Q3
On a PA chest radiograph, an infant presents with a narrow superior mediastinum and a globular heart shape, classically described as an ‘Egg on a String’. Which congenital heart defect does this pattern suggest?
Q4
When examining a Lateral Chest X-ray, the Hoffman-Rigler sign is used to detect Left Ventricular Enlargement. The posterior border of the left ventricle should not extend more than how many centimeters posterior to the inferior vena cava (IVC) at a level 2 cm above their crossing?
Q5
On fluoroscopy of a patient with a Cardiac Resynchronization Therapy (CRT) device, three leads are identified. In a standard Right Anterior Oblique (RAO) view, which anatomical path indicates correct placement of the Left Ventricular (LV) pacing lead?
Q6
A patient presents to the ER with chest pain. Their chest X-ray shows a widened mediastinum. The radiologist notes the ‘Calcium Sign’. What specifically does this sign indicate in the context of an acute Aortic Dissection?
Q7
On a PA chest radiograph, assessing Pulmonary Venous Hypertension involves grading the redistribution of blood flow. ‘Cephalization’ (Grade 1 Pulmonary Edema) suggests that Pulmonary Capillary Wedge Pressure (PCWP) has risen to approximately what range?
Q8
You are reviewing the fluoroscopy of a patient with three mechanical prosthetic heart valves. You observe a valve with a distinct ‘ball-in-cage’ radiopaque structure. Which historic valve model is this?
Q9
On a PA chest radiograph, Right Atrial Enlargement is characterized by an increased convexity of the right heart border. This border is considered abnormal if it extends more than how many centimeters to the right of the midline (spinous processes)?
Q10
How can you reliably differentiate Mitral Annular Calcification (MAC) from Aortic Valve Calcification on a standard lateral chest radiograph?
Q11
A patient has severe Pulmonary Arterial Hypertension (e.g., primary PAH). What is the classic expected finding on a PA chest radiograph regarding the pulmonary vasculature?
Q12
On a standard lateral chest radiograph, Right Ventricular Enlargement is most accurately identified by which specific anatomical change?
Q13
You are reviewing the chest X-ray of a patient with an implanted Transvenous Implantable Cardioverter-Defibrillator (ICD). How can you visually differentiate the ICD lead from a standard permanent pacemaker lead?
Q14
The ‘Water Bottle Sign’ on a PA chest radiograph is a classic finding for a massive Pericardial Effusion. Which secondary radiographic finding helps differentiate a massive pericardial effusion from severe cardiomegaly (e.g., dilated cardiomyopathy) on a plain film?
Q15
You review a PA chest radiograph of a 30-year-old male from a developing nation presenting with dyspnea. The X-ray demonstrates a ‘straightening of the left heart border’. What specific anatomical structure enlarges to fill the normal concave pulmonary bay to create this straight edge?
Q16
During fluoroscopy of the coronary arteries (coronary angiography), the Right Anterior Oblique (RAO) cranial projection is famously utilized to best visualize which specific segment of the left coronary system?
Q17
A patient with a history of Tuberculosis presents with right heart failure. A lateral chest X-ray reveals a thick, dense shell of calcification predominantly over the anterior and diaphragmatic surfaces of the heart. This radiographic pattern is diagnostic for:
Q18
On an AP chest X-ray, it can be challenging to differentiate dextrocardia with situs inversus from a technically mislabeled film (flipped left-to-right by the technologist). What internal anatomical landmark confirms true Situs Inversus?
Q19
A patient with long-standing severe Aortic Stenosis undergoes a chest X-ray. Which of the following is a classic secondary radiographic sign of this specific valvular pathology?
Q20
During right heart catheterization, fluoroscopy is used to guide a Swan-Ganz catheter into the pulmonary artery. The catheter enters via the right Internal Jugular vein. Through which cardiac structure must the catheter pass IMMEDIATELY after exiting the Right Atrium?
Q21
On a lateral chest radiograph, observing dense ‘tram-track’ calcifications running anteriorly and inferiorly down the anterior margin of the heart is highly indicative of calcification within which specific coronary artery?
Q22
An infant’s chest X-ray reveals a massive, globular ‘Snowman’ (or ‘Figure of 8’) heart shape alongside severe pulmonary venous congestion. What specific anatomical structure forms the ‘head’ of the snowman in this classic congenital presentation?
Q23
During transcatheter aortic valve replacement (TAVR), fluoroscopic positioning relies heavily on the ‘Coplanar View’. What is the geometric goal of achieving a true coplanar fluoroscopic angle?
Q24
On a PA chest radiograph, Kerley B lines are indicative of interstitial pulmonary edema. Which description best defines the classical anatomical appearance and location of Kerley B lines?
Q25
An adult patient who underwent cardiac surgery during early childhood has a routine chest X-ray. You observe classic inferior rib notching (ribs 4 through 8) on the RIGHT side only. The left ribs are completely normal. What specific historical surgical intervention perfectly explains this unilateral finding?
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About The Author
Johnson Francis
Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal