How chest and cardiac is examined
Phase 2 of the RANZCR clinical radiology training program is assessed with examinations that test image interpretation, pathology knowledge and clinical reasoning across body systems. Formats and weightings change, so check the current RANZCR examination information and Phase 2 learning outcomes.
High-yield topics
| Topic | Key imaging points |
|---|---|
| Pulmonary nodules | Size, morphology and Fleischner-based follow-up |
| ILD | UIP versus NSIP patterns on HRCT |
| PE | CTPA signs of right heart strain |
| Mediastinal masses | Compartment-based differentials |
| Cardiac MRI | Late gadolinium enhancement patterns |
Worked questions
Worked question · ILD
Which HRCT feature most supports a UIP pattern?
- A Basal subpleural honeycombing
- B Upper zone nodules
- C Ground-glass with subpleural sparing
- D Centrilobular nodules
- E Mosaic attenuation
Show the reasoning
Answer A. UIP shows basal, subpleural predominant reticulation with honeycombing and traction bronchiectasis. Subpleural sparing suggests NSIP.
A search pattern for reporting
- Check lines and tubes first
- Airway, trachea and mediastinal contours
- Hila and lungs zone by zone, comparing sides
- Pleura, costophrenic angles and diaphragm
- Heart size and borders
- Bones and soft tissues
- Review areas: apices, behind the heart, below the diaphragm
Use the same order every time so that nothing is missed under exam conditions, then finish with a concise conclusion and recommendation.
Signs and differentials to know
| Imaging sign or finding | Think of |
|---|---|
| Upper zone fibrosis | TB, sarcoidosis, silicosis, ankylosing spondylitis, radiation |
| Lower zone fibrosis | UIP/IPF, asbestosis, connective tissue disease, drugs |
| Anterior mediastinal mass | Thymoma, teratoma, lymphoma, thyroid |
| Cavitating nodule | Squamous cell carcinoma, TB, abscess, granulomatosis with polyangiitis |
| Late gadolinium enhancement, subendocardial | Myocardial infarction |
| Late gadolinium enhancement, mid-wall | Myocarditis, dilated cardiomyopathy, sarcoid |
A 4-week revision block
| Week | Focus |
|---|---|
| 1 | Radiograph patterns |
| 2 | Nodules and cancer staging |
| 3 | ILD and airways |
| 4 | PE, mediastinum and cardiac |
Pair reading with daily timed questions and image review on teaching files, and log every missed structure or sign.
Common traps
- Missing subtle nodules.
- Confusing UIP and NSIP.
- Ignoring right heart strain on CTPA.
Free sample chest and cardiac questions
Questions from our Radiology Phase 2 bank. Choose your answer, then open the explanation.
Which CXR sign suggests tension pneumothorax?
- AMediastinal shift towards the collapsed lung
- BMediastinal shift away from the side
- CBilateral perihilar haziness
- DElevated ipsilateral hemidiaphragm
- EKerley B lines at both bases
Show answer and explanation
Answer B. Tension causes contralateral mediastinal shift, depressed hemidiaphragm and widened rib spaces. It is a clinical diagnosis; do not delay decompression for imaging.
Learning point: Tension: shift away, flattened diaphragm.
Which finding makes lung cancer T4?
- ASeparate nodule in the same lobe as the primary
- BVisceral pleural invasion only
- CTumour 2.5 cm without invasion
- DHilar nodal spread
- ENodule in another ipsilateral lobe
Show answer and explanation
Answer E. T4: over 7 cm, invasion of mediastinum, heart, great vessels, carina, trachea, vertebra, or separate nodule in a different ipsilateral lobe.
Learning point: T4 includes ipsilateral different-lobe nodule.
Which CT feature favours empyema over lung abscess?
- AThick irregular wall within the lung
- BVessels ending abruptly at the lesion
- CRound shape with acute angles to wall
- DSplit pleura sign
- EAir-fluid level of equal length on both views
Show answer and explanation
Answer D. Empyema: lenticular shape, obtuse angles, split pleura sign, compresses lung. Abscess: round, thick wall, acute angles, vessels end at the lesion.
Learning point: Empyema: split pleura sign.
Practise more chest and cardiac questions free
Every chest and cardiac subtopic in our bank
The bank holds 18 chest and cardiac questions across 16 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Aortic dissection2
- Asbestos1
- Deep sulcus sign1
- Fleischner nodule1
- Golden S sign1
- Lobar collapse1
- Lung abscess vs empyema1
- Lung cancer staging1
- Mesothelioma1
- Pneumothorax signs1
- Pulmonary embolism CT1
- Pulmonary embolism severity1
- Pulmonary oedema1
- Sarcoidosis2
- Tension pneumothorax1
- UIP pattern1
Common questions
What does Phase 2 assess?
Image interpretation, pathology and clinical reasoning across body systems. Check RANZCR for current formats.
How should I practise?
Daily timed questions with image review, and structured reporting practice.
Which nodule guideline is used?
Fleischner Society recommendations are widely used for incidental nodules.
How many chest and cardiac questions are in the Radiology Phase 2 bank?
There are 18 chest and cardiac questions across 16 subtopics, and the bank grows as new questions pass review.
Can I practise only chest and cardiac questions?
Yes. Filter by area or by any subtopic to build a custom block, in tutor mode with explanations after each question or in timed mode.
How are chest and cardiac questions explained?
Every question explains why the answer is right and why each other option is wrong, with a learning point and the Australian source behind it.
How much of the Radiology Phase 2 mock is chest and cardiac?
About 13 questions in each 100-question mock come from chest and cardiac, following our mock blueprint.
Which sources is this chest and cardiac page based on?
It summarises current Australian guidance, including RANZCR Clinical Radiology examinations; Radiopaedia. Guidelines change, so always check the latest edition.
When was this chest and cardiac guide last updated?
It was last reviewed on 9 November 2026. We update topic pages when the exam or Australian guidance changes.
How do I unlock all Radiology Phase 2 questions?
Choose a Radiology Phase 2 plan: 3 or 6 months of access, from A$569.99, one payment with no auto-renew. It opens every area, not just chest and cardiac.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.