CHD with ↑/↓ Pulmonary Blood Flow – X-ray Clues MCQ Quiz | Radiology

Welcome, future medical professionals! This quiz is designed to test your knowledge of radiological findings in Congenital Heart Diseases (CHDs), focusing on the crucial distinction between conditions causing increased or decreased pulmonary blood flow. Understanding these X-ray clues is essential for differential diagnosis in pediatric cardiology. This quiz contains 25 multiple-choice questions tailored to the MBBS curriculum, covering classic signs like the “boot-shaped heart,” “snowman sign,” and “egg on a string.” Challenge yourself to interpret these radiographic patterns accurately. After submitting your answers, you will receive your score and a detailed review of the correct responses. You can also download a PDF copy of all questions and their correct answers for your revision. Good luck!

1. A chest X-ray of a cyanotic infant reveals a “boot-shaped” heart (coeur en sabot) and pulmonary oligemia. What is the most likely diagnosis?

2. Which congenital heart disease is classically associated with increased pulmonary blood flow and a “snowman” or “figure of 8” sign on chest X-ray?

3. The “egg on a string” appearance on a neonatal chest radiograph is a characteristic finding in which condition?

4. A chest X-ray demonstrating cardiomegaly, a prominent main pulmonary artery, and shunt vascularity (plethora) is most consistent with which type of congenital heart defect?

5. In a patient with suspected Coarctation of the Aorta, what associated X-ray finding might be seen in older children or adults due to collateral circulation?

6. A chest X-ray shows marked cardiomegaly, specifically right atrial enlargement, giving a “box-shaped” or “wall-to-wall” heart appearance, along with decreased pulmonary vascularity. This is most characteristic of:

7. The term “pulmonary oligemia” on a chest X-ray refers to:

8. A “figure of 3” sign on the aortic knob and rib notching are pathognomonic for which condition?

9. Which of the following conditions is a cyanotic CHD with DECREASED pulmonary blood flow?

10. In Transposition of the Great Arteries (TGA), the chest X-ray typically shows a narrow superior mediastinum because:

11. Which of the following is an acyanotic CHD with INCREASED pulmonary blood flow?

12. A “scimitar sign” on a chest X-ray, which is a curved vascular shadow in the right lower lung, is associated with:

13. In Eisenmenger syndrome, the initial radiographic finding of pulmonary plethora due to a large left-to-right shunt changes to:

14. A right-sided aortic arch is most commonly associated with which cyanotic congenital heart disease?

15. What is the typical status of pulmonary blood flow in isolated, severe Pulmonary Stenosis?

16. The presence of Kerley B lines on a chest X-ray in a patient with CHD indicates:

17. In a large, uncorrected Ventricular Septal Defect (VSD), the chest X-ray will most likely show:

18. The cardiac apex in Tetralogy of Fallot is typically upturned and elevated due to:

19. In which condition might you see a “water-bottle” or “globular” shaped heart with signs of pulmonary venous congestion, mimicking pericardial effusion?

20. What is the most common radiographic finding in a hemodynamically significant Patent Ductus Arteriosus (PDA)?

21. A neonate presents with severe cyanosis. The chest X-ray shows a normal-sized heart but severely decreased pulmonary vascularity. Which diagnosis is high on the differential?

22. Truncus arteriosus is a cyanotic CHD. What is the expected finding regarding pulmonary blood flow on a chest X-ray?

23. In a patient with Tricuspid Atresia, the chest X-ray often shows decreased pulmonary vascularity and which other characteristic finding?

24. Cephalization of pulmonary blood vessels (upper lobe diversion) is a sign of:

25. Which of these findings would NOT be expected in a typical chest X-ray of Tetralogy of Fallot?