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Chapter 10: Chest Imaging
Test Bank

MULTIPLE CHOICE

1. Electrons coming off the cathode in an x-ray machine are focused to hit a small area of the
anode called the:
a. tube.
b. target.
c. transformer.
d. focusing plate.
ANS: B
Electrons coming off the cathode wire are focused to hit a small area on the anode. This area
is called the target.

REF: pg. 208 OBJ: 1

2. The ability of x-rays to penetrate matter is inversely proportional to which of the following
physical properties of matter?
a. Viscosity
b. Density
c. Weight
d. Diffusion
ANS: B
X-rays are not reflected as light rays are, but they penetrate most matter. Their ability to
penetrate matter is dependent on the density of the matter. Dense objects such as bone absorb
more x-rays (allow less penetration) than do air-filled objects such as lung tissue.

REF: pg. 209 OBJ: 1

3. Which of the following tissues will look radiolucent on a chest radiograph?

a. Blood
b. Bone
c. Lungs
d. Liver
ANS: C
X-rays that pass through low-density (air-filled) tissue strike the film in great numbers and
turn it black (radiolucent).

REF: pg. 209 OBJ: 3

4. Which of the following terms defines high-density tissues on the x-ray film?
a. Radiolucent
b. Radiopaque
c. Radiographic
d. Tomographic
ANS: B
 Radiolucent areas on the chest radiograph are seen as dark shadows. X-rays that strike bone
are partially absorbed; therefore, fewer x-rays strike the film and less darkening of
corresponding areas on the x-ray film is seen (radiopaque). Radiopaque areas are seen as
white shadows on the film.

REF: pg. 209 OBJ: 2

5. Which of the following tissues represent the four distinct densities recognized in the x-ray
(from higher to lower density)?
a. Bone, water, air, fat
b. Fat, bone, water, air
c. Bone, water, fat, air
d. Air, fat, water, bone
ANS: C
Four distinct densities recognized on x-ray include bone (which is very dense), water (which
is less dense), fat (which is mildly radiolucent), and air (which is very radiolucent). Most
tissues in the body have a characteristic density based on the mixture within these materials.

REF: pg. 210 OBJ: 3

6. As a patient who is being positioned for a chest x-ray is moved closer to the source of the
x-rays, what happens to the shadows of anatomic structures seen on the chest film?
a. They get larger.
b. They get smaller.
c. They get clearer.
d. They stay the same.
ANS: A
X-rays leave the x-ray tube from a single point and scatter, so that they cover the whole x-ray
film. This leads to enhanced magnification of shadows on the x-ray film if the patient is close
to the x-ray tube, and less magnification if the patient is not close to the x-ray source.

REF: pg. 209 OBJ: 4

7. To minimize the magnification associated with portable films, how far should the patient and
the film be from the source of the x-rays in a conventional chest x-ray?
a. 6 feet
b. 8 feet
c. 10 feet
d. 12 feet
ANS: A
The patient and the film are positioned approximately 6 feet from the x-ray source for the
conventional chest x-ray examination. At this distance, the magnification effect is minimized.
Portable films are positioned approximately 4 feet from the x-ray source. This results in
enhanced magnification, especially for structures in the body farthest from the x-ray film.

REF: pg. 210 OBJ: 4

8. Which of the following statements is not considered an indication for obtaining a radiograph?
a. Determine the appropriate therapy.
 b. Evaluate the effectiveness of treatment.
c. Detect alterations of the lung caused by pathologic processes.
d. Diagnose specific diseases.
ANS: D
Production of the chest radiograph has become one of the most popular and important
procedures performed in the hospital. It can be used in the following ways: detecting
alterations of the lung caused by pathologic processes; determining appropriate therapy;
evaluating the effectiveness of treatment; determining the positioning of tubes and catheters;
and observing the progression of lung disease.

REF: pg. 210 OBJ: 4

9. What breathing instruction is a patient given immediately before an anteroposterior (AP) or

posteroanterior (PA) chest radiograph?
a. Breathe normally.
b. Exhale completely.
c. Take a deep breath.
d. Do not worry about breathing; it will not affect this x-ray.
ANS: C
The patient is instructed to take a deep breath and hold it just before the x-ray is taken.

REF: pg. 210 OBJ: 6

10. A male patient who is standing upright with his back to the x-ray tube, his anterior thorax
pressed against a metal cassette containing the film, and his arms positioned out of the way is
positioned for what x-ray view?
a. PA view
b. AP view
c. Apical lordotic view
d. Lateral decubitus view
ANS: A
Standard chest radiographs are taken in two directions. First, with the patient standing upright
with his or her back to the x-ray tube, the anterior thorax is pressed against a metal cassette
containing the film, and his or her arms are positioned out of the way. The patient is instructed
to take a deep breath and hold it just before the x-ray is taken. The x-ray beam leaves the
source, strikes the patient’s posterior chest, moves through the chest, exits through the front
(anterior), and then strikes the film. Because the beam moves from posterior to anterior, this is
called a posteroanterior (PA) view.

REF: pg. 210 OBJ: 5

11. Which of the following views provides less cardiac magnification and a sharper view of the
left lower lobe?
a. PA view
b. AP view
c. Left lateral view
d. Lateral decubitus view
ANS: C
 Generally, a left lateral view (left side against the cassette) is preferred. The left lateral view
provides less cardiac magnification than the right lateral view.

REF: pg. 210 OBJ: 5

12. Which of the following views is used to see whether free fluid (pleural effusion or blood) is
present in the chest in the left pleural region?
a. AP view
b. Left lateral view
c. Right lateral view
d. Lateral decubitus view
ANS: D
Other views are sometimes obtained to elucidate special problems. A lateral decubitus view is
taken with the patient lying on the right or left side, to see whether free fluid (pleural fluid) is
present in the chest.

REF: pgs. 210-211 OBJ: 5

13. A lateral decubitus view is able to detect as little as _____ mL of the pleural fluid.
a. 200 to 300
b. 100 to 200
c. 50 to 100
d. 25 to 50
ANS: D
As little as 25 to 50 mL of pleural fluid can be detected with the lateral decubitus view.

REF: pg. 211 OBJ: 5

14. Which of the following views is most helpful in identifying a pneumothorax?

a. Expiratory view
b. AP view
c. Left lateral view
d. Lateral decubitus view
ANS: A
The expiratory view can be helpful in the identification of a small pneumothorax.

REF: pg. 211 OBJ: 5

15. AP portable films are obtained to evaluate all of the following except:
a. Lung status.
b. Lung tumor growth.
c. Line and tubing positions.
d. Results of invasive therapeutic procedures.
ANS: B
AP portable films are obtained to evaluate lung status, to gain information on how well lines
and tubing are positioned, and to see the results of invasive therapeutic maneuvers.

REF: pg. 212 OBJ: 5

16. A portable film is ordered immediately after a patient is intubated in the emergency
department. Which of the following distances confirms proper placement of the endotracheal
tube?
a. 1 to 2 cm below the cricoid cartilage
b. 5 to 7 cm above the carina
c. 3 cm below the thyroid cartilage
d. 3 to 5 cm above the carina
ANS: D
The AP chest film often is used to evaluate the position of the endotracheal tube, to ensure
that the inferior tip comes to rest appropriately 3 to 5 cm above the carina after intubation.

REF: pg. 222 OBJ: 10

17. A portable film is ordered immediately after a central venous pressure (CVP) catheter is
placed via the subclavian vein. Which of the following is the correct placement site for the
catheter?
a. 1 to 2 cm above the right atrium
b. Between the left and right ventricles
c. At the confluence of the superior vena cava and the right atrium
d. Anywhere in the superior vena cava
ANS: C
The catheter is placed into the right or left subclavian or jugular vein and should come to rest
just above the confluence of the superior vena cava and the right atrium of the heart.

REF: pg. 222 OBJ: 11

18. The presence of the characteristic “signet sign” in a computed tomography (CT) scan is
consistent with which of the following diseases?
a. Asthma
b. Lung tumor
c. Emphysema
d. Bronchiectasis
ANS: D
Bronchiectasis shows up on a CT scan as a very characteristic “signet ring” pattern, with the
blood vessel appearing to be a small stone set against the much larger ring of bronchial tissue.

REF: pg. 227 OBJ: 9

19. In which of the following areas has magnetic resonance imaging (MRI) demonstrated
superiority over CT scanning?
a. Evaluation of the hila
b. Evaluation of diffuse, interstitial lung disease
c. Evaluation of chest wall invasion by lung cancer
d. Both a and b
ANS: A
The only area in which MRI may be a little better than CT scanning is in the evaluation of
mediastinal and hilar masses.
 REF: pg. 226 OBJ: 13 | 14

20. Which of the following forms of radiologic assessment is most useful for studying the
distribution of ventilation and perfusion and the effects that diseases may have on these two
important functions?
a. MRI
b. CT scanning
c. Lung scanning
d. Pulmonary angiography
ANS: C
Lung scans are obtained by measuring gamma radiation emitted from the chest after
radiopharmaceuticals are injected into the bloodstream and inhaled into the lung. Lung
scanning is useful for studying the distribution of ventilation and perfusion and the effects that
disease may have on these two important functions.

REF: pg. 228 OBJ: 15

21. Which of the following studies is gradually replacing scanning for the diagnosis of
pulmonary embolus?
a. MRI
b. CT scanning
c. Lung scanning
d. CT angiography
ANS: D
CT angiography is gradually replacing scanning for the diagnosis of pulmonary
embolus.

REF: pg. 230 OBJ: 15

22. The presence of “hot spots” in a positron emission tomography (PET) scan is indicative of:
a. metabolically active tumor or infection.
b. pneumothorax.
c. pulmonary embolism.
d. atelectasis.
ANS: A
Tumors and areas of infection increase the local rate of metabolic activity and cause “hot”
spots. This allows the clinician to determine whether a lung mass is metabolically active.

REF: pg. 229 OBJ: 15

23. On a PA film, what number of posterior ribs visible above the diaphragm indicates a good
inspiratory effort?
a. 10
b. 8
c. 6
d. 5
ANS: A
 Finally, the degree of the patient’s inspiratory effort is evaluated by counting the posterior ribs
visible above the diaphragm. On a PA film, 10 ribs indicates a good inspiratory effort.

REF: pg. 213 OBJ: 5

24. The casting of a white shadow on a film is consistent with which of the following situations?
a. Less exposed film
b. More exposed film
c. More radiolucent film
d. More penetrated film
ANS: A
The greater the density, the less the penetration. X-rays that do not penetrate fully are
absorbed, resulting in less exposure of the film and the casting of a white shadow on the film.

REF: pg. 212 OBJ: 2

25. What is the significance of the silhouette sign?

a. It allows differentiation between alveolar and interstitial infiltrates.
b. It can aid in detection of pleural effusion.
c. It helps determine whether an infiltrate is in contact with a heart border.
d. It allows differentiation between alveolar and interstitial opacities.
ANS: C
The silhouette sign is useful primarily in determining whether a pulmonary infiltrate is in
anatomic contact with a heart border or the diaphragm.

REF: pg. 214 OBJ: 2

26. Which of the following radiologic terms confirm the presence of intrapulmonary disease?
a. Sulcus sign
b. Compression atelectasis
c. Air bronchogram
d. Platelike atelectasis
ANS: C
The presence of an air bronchogram confirms intrapulmonary disease, and the absence of an
air bronchogram does not rule out intrapulmonary disease.

REF: pg. 214 OBJ: 7

27. Which of the following radiologic findings is not consistent with lobar atelectasis?
a. Collapse of lung tissue
b. Shift in hilar structures toward the area of atelectasis
c. Hemidiaphragm elevation
d. Shift in hilar structures away from the area of atelectasis
ANS: D
The chest radiograph in most cases demonstrates the loss of lung volume caused by
atelectasis. Collapse of entire segments or lobes produces characteristic densities that show on
the chest x-ray. Shift of the trachea, heart, and major thoracic vessels toward the affected side
may be seen with lobar atelectasis.
 REF: pg. 216 OBJ: 9

28. Which of the following clinical or chest x-ray findings is consistent with hyperinflation
caused by obstructive lung disease?
a. Large retrosternal space
b. Prolonged inspiratory phase
c. Decreased resonance to percussion
d. Decreased functional residual capacity (FRC)
ANS: A
The most common cause of hyperinflation is obstructive lung disease. This is seen on chest
x-rays as an increased AP diameter, a large retrosternal air space, and flattening of the
diaphragm.

REF: pg. 217 OBJ: 9

29. Which of the following would suggest that a patient has congestive heart failure (CHF)?
a. Low and flat diaphragm
b. Increased cardiothoracic ratio
c. Tracheal deviation
d. Increased retrosternal air space on a lateral film
ANS: B
The ratio of the width of the heart at its greatest span to the width of the thorax is the
cardiothoracic (C/T) ratio. Normally, this ratio does not exceed 0.5. In CHF, the heart enlarges
and its width exceeds one half the width of the thoracic cage.

REF: pg. 219 OBJ: 9

30. All of the following are typical findings of a small pleural effusion except:
a. blunting of the costophrenic angle.
b. a small meniscus sign.
c. a partially obscured diaphragm.
d. complete whiteout of the affected side.
ANS: D
Small-volume findings include (1) blunting of the otherwise sharp angle between the chest
wall and the point at which the diaphragm touches the chest wall laterally (the costophrenic
[CP] angle) and (2) a small meniscus sign, a sign seen whenever fluid starts to fill the space
between the lung and the chest wall, forming an opaque white crescent (meniscus) next to the
chest wall.

REF: pg. 221 OBJ: 9

31. Radiographic signs of consolidation include all of the following except:

a. lobar distribution.
b. minimal loss of volume.
c. homogenous density late in the process.
d. a low shift of the diaphragm.
ANS: D
Radiographic signs of consolidation include the following: minimal loss of volume; lobar or
segmental distribution (usually); homogenous density; and an air bronchogram if the airway
leading to the consolidated area is open.

REF: pg. 222 OBJ: 9

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