Respiratory medicine: Pancoast tumour: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: Pancoast tumour

Sample item

A 62-year-old heavy smoker has right shoulder pain radiating down the medial forearm to the ring and little fingers, wasting of the hand muscles, and right-sided ptosis, miosis and reduced facial sweating. A chest radiograph shows an apical opacity. Which structure invasion explains the arm pain and hand weakness?

AThe right stellate ganglionBThe right phrenic nerveCThe C8 and T1 roots (lower trunk of the brachial plexus)DThe right recurrent laryngeal nerve

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. The C8 and T1 roots (lower trunk of the brachial plexus)

A superior sulcus (Pancoast) tumour invades the apical chest wall, the lower brachial plexus (C8, T1) and the sympathetic chain. Plexus involvement produces ulnar-distribution pain and intrinsic hand weakness, while sympathetic chain or stellate ganglion involvement gives Horner syndrome. Treatment is usually induction chemoradiotherapy followed by surgery when resectable.

Option by option

A. The right stellate ganglion
The stellate ganglion explains the Horner syndrome, but it carries no motor or sensory supply to the arm.
B. The right phrenic nerve
The phrenic nerve paralyses the hemidiaphragm, which would cause breathlessness and an elevated diaphragm instead.
C. The C8 and T1 roots (lower trunk of the brachial plexus) (correct)
Correct. The lower trunk carries C8-T1 fibres to the ulnar side of the forearm and hand.
D. The right recurrent laryngeal nerve
The recurrent laryngeal nerve involvement gives hoarseness from vocal cord palsy, not arm pain.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, The C8 and T1 roots (lower trunk of the brachial plexus). A superior sulcus (Pancoast) tumour invades the apical chest wall, the lower brachial plexus (C8, T1) and the sympathetic chain.

Why is "The right stellate ganglion" not the answer?

The stellate ganglion explains the Horner syndrome, but it carries no motor or sensory supply to the arm.

Why is "The right phrenic nerve" not the answer?

The phrenic nerve paralyses the hemidiaphragm, which would cause breathlessness and an elevated diaphragm instead.

Why is "The right recurrent laryngeal nerve" not the answer?

The recurrent laryngeal nerve involvement gives hoarseness from vocal cord palsy, not arm pain.

What concept does this question test?

It tests Respiratory medicine: Pancoast tumour in General Medicine. Plexus involvement produces ulnar-distribution pain and intrinsic hand weakness, while sympathetic chain or stellate ganglion involvement gives Horner syndrome. Treatment is usually induction chemoradiotherapy followed by surgery when resectable.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: Pancoast tumour?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.