Radiology Practice Test 1 Image Section Version A

A 72-year-old patient undergoes an upright chest X-ray.

Which radiographic finding is demonstrated in this image?

• Kerley B lines from interlobular septal thickening

• Pulmonary alveolar edema with bat-wing distribution

• Cephalization due to redistribution of pulmonary blood flow

• Peribronchial cuffing from fluid-thickened bronchial walls

Answer explanation

Correct Answer: C. Cephalization due to redistribution of pulmonary blood flow ✅
This image shows upper-lobe pulmonary vessels that are larger than the lower-lobe vessels, which matches the slide definition of cephalization. Your slides define cephalization as redistribution of pulmonary blood flow seen in congestive heart failure, and note that it is only meaningful on an upright chest X-ray.

Why the other answers are wrong:

A. Kerley B lines ❌
Kerley B lines are short, horizontal lines at the lung bases caused by interlobular septal thickening. The image instead shows prominent upper-lobe vessels, not basal linear markings.

B. Pulmonary alveolar edema with bat-wing distribution ❌
Alveolar edema appears as fluffy, patchy airspace opacities in a perihilar bat-wing pattern. This image demonstrates vascular redistribution, not airspace filling.

D. Peribronchial cuffing ❌
Peribronchial cuffing is caused by fluid-thickened bronchial walls seen end-on. The finding here involves pulmonary vessels, not bronchi.

Ultra-short memory tip 🧠:
Upper vessels bigger than lower = cephalization

The pattern seen on this chest X-ray represents:

• Interstitial lung disease

• Pulmonary contusion

• Bronchopneumonia

• Cardiogenic pulmonary alveolar edema

Answer explanation

Correct: B. Cardiogenic pulmonary alveolar edema ✅
The bat-wing (butterfly) pattern represents alveoli filled with fluid, typically from cardiogenic pulmonary edema, often with pleural effusions.

Why the others are wrong:

• A. Interstitial lung disease → reticular or nodular patterns, not fluffy airspace filling.

• C. Bronchopneumonia → patchy, segmental opacities, not symmetric perihilar spread.

• D. Pulmonary contusion → focal opacities at sites of trauma.

Tired-brain tip: Bat wings = alveoli full of fluid.

The findings in this image are best explained by:

• Loss of lung aeration causing volume loss

• Alveolar filling from pneumonia

• Pleural fluid accumulation

• Pulmonary edema

Answer explanation

Correct: B. Loss of lung aeration causing volume loss ✅
Atelectasis causes increased opacity PLUS volume loss, pulling mediastinal structures toward the affected side.

Why the others are wrong:

• A. Pneumonia → increases opacity without volume loss.

• C. Pleural effusion → pushes structures away, not toward.

• D. Pulmonary edema → bilateral, fluffy opacities without shift.

Tired-brain tip: Opacity + pull toward = atelectasis.

This radiographic appearance most likely represents:

• Pulmonary edema

• Left ventricular hypertrophy

• Pericardial effusion due to fluid accumulation in the pericardial sac

• Cardiomyopathy

Answer explanation

Correct: B. Pericardial effusion due to fluid accumulation in the pericardial sac ✅
A globular (“water bottle”) cardiac silhouette suggests fluid surrounding the heart.

Why the others are wrong:

• A. Cardiomyopathy → enlarged heart but not globular.

• C. LV hypertrophy → contour changes, not uniform enlargement.

• D. Pulmonary edema → lung findings, not heart shape.

Tired-brain tip: Big round heart = pericardial fluid.

This finding is classically associated with:

• Pulmonary contusion

• Atelectasis

• Lobar pneumonia

• Pulmonary infarction due to embolism

Answer explanation

Correct: A. Pulmonary infarction due to embolism ✅
A peripheral, wedge-shaped opacity represents pulmonary infarction from an occluded vessel.

Why the others are wrong:

• B. Lobar pneumonia → follows lobar anatomy, not wedge-shaped.

• C. Atelectasis → volume loss signs present.

• D. Pulmonary contusion → related to trauma.

Tired-brain tip: Wedge at edge = embolus.

Which feature most strongly supports an acute fracture rather than a normal variant?

• Smooth, well-corticated margins

• Abrupt disruption of the cortex with jagged edges

• Rounded margins consistent with ossicles

• Location near a tendon insertion

Answer explanation

Correct: B. Abrupt disruption of the cortex with jagged, non-corticated edges ✅
Acute fractures show sharp, irregular cortical disruption with non-smooth edges, reflecting recent bone failure.

Why the others are wrong:

• A. Smooth, rounded margins… ❌ → Well-corticated edges suggest a chronic or normal variant (ossicle).

• C. Linear structure tapering gradually ❌ → Typical of a nutrient canal, not a fracture.

• D. Small fragment near tendon insertion ❌ → Suggests an avulsion fracture, not the defining feature of an acute cortical break.

Tired-brain tip: Jagged + sharp = acute fracture.

This injury mechanism is most consistent with:

• Osteoporotic insufficiency

• Tendon or ligament pull on bone

• Repetitive microtrauma

• Direct axial loading

Answer explanation

Correct: C. Tendon or ligament pull resulting in a small fragment being pulled from bone ✅
Avulsion fractures occur when tendons or ligaments pull off a small piece of bone, often at predictable attachment sites.

Why the others are wrong:

• A. Axial compression ❌ → Causes compression or burst injuries.

• B. Repetitive loading ❌ → Leads to stress fractures.

• D. Osteoporosis ❌ → Causes insufficiency fractures, not avulsions.

Tired-brain tip: Small fragment + tendon pull = avulsion.

Tags

NGSS.HS-PS2-3

The presence of this sign indicates:

• Dislocation of the elbow joint with ligamentous disruption

• Joint effusion due to an occult radial head fracture

• Olecranon fracture with posterior cortical disruption

• Inflammatory arthritis causing chronic joint swelling

Answer explanation

Correct: B. Joint effusion due to an occult radial head fracture ✅
A visible posterior fat pad on lateral elbow X-ray indicates joint effusion, commonly from an occult radial head fracture in adults.

Why the others are wrong:

• A. Elbow dislocation ❌ → Produces alignment abnormalities.

• C. Olecranon fracture ❌ → Usually directly visible.

• D. Inflammatory arthritis ❌ → Chronic, not acute trauma finding.

Tired-brain tip: Posterior fat pad = hidden fracture.

This radiographic appearance suggests:

• An anterior dislocation with the humeral head displaced inferiorly

• A posterior dislocation often associated with seizures or electrical injury

• A proximal humeral fracture involving the surgical neck

• Glenohumeral arthritis with joint space narrowing

Answer explanation

Correct: B. A posterior dislocation often associated with seizures or electrical injury ✅
The “light-bulb sign” reflects a humeral head locked in internal rotation, classic for posterior dislocation.

Why the others are wrong:

• A. Anterior dislocation ❌ → Most common but has different appearance.

• C. Proximal humerus fracture ❌ → Cortical disruption would be visible.

• D. Arthritis ❌ → Joint space narrowing, chronic changes.

Tired-brain tip: Light bulb = posterior.

Which feature most strongly distinguishes this injury?

• Involvement limited to posterior elements without canal compromise

• Compression of only the anterior vertebral body

• Axial loading causing vertebral body collapse with retropulsion into the spinal canal

• Transverse fracture through the spinous process and pedicles

Answer explanation

Correct: B. Axial loading causing vertebral body collapse with retropulsion into the spinal canal ✅
Burst fractures result from high-energy axial compression and are dangerous due to retropulsed fragments.

Why the others are wrong:

• A. Posterior elements only ❌ → Different injury pattern.

• C. Anterior compression only ❌ → Compression fracture.

• D. Transverse through spinous process ❌ → Chance fracture.

Tired-brain tip: Burst = body explodes backward.