Rosh Emergency Medicine Practice Test 2025 – 400 Free Practice Questions to Pass the Exam

The hallmark sign of congestive heart failure (CHF) on a chest X-ray is the presence of cardiomegaly and pulmonary edema. This is because, in CHF, the heart is unable to pump blood effectively, which leads to an increase in pressure in the heart and ultimately results in fluid buildup in the lungs and surrounding tissues.

Cardiomegaly, or an enlarged heart, indicates that the heart is working harder than normal, often due to underlying conditions such as hypertension or valvular heart disease. This enlargement can be observed on the chest X-ray, where the silhouette of the heart is wider than usual.

Pulmonary edema appears as increased vascular markings or horizontal lines (kerley B lines) in the lung fields, indicating fluid accumulation in the interstitial spaces and alveoli. This fluid in the lungs is a direct consequence of increased pressure in the pulmonary capillaries due to the compromised pumping ability of the heart.

While other options may indicate various conditions related to the lungs or cardiopulmonary issues, none encompass the characteristic combination of cardiomegaly and pulmonary edema that specifically points to congestive heart failure on a chest X-ray.