Chest imaging: practice question

A Radiology 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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Radiology · Chest imaging

Sample item

A chest radiograph of an elderly smoker shows right upper lobe collapse with a lateral concavity and a convex bulge at the hilum, giving a reversed S shape along the elevated horizontal fissure. What is the likely underlying cause?

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

The answer and the reasoning

D. A central obstructing hilar mass such as bronchogenic carcinoma

The Golden S sign is seen in right upper lobe collapse when a central mass at the hilum bulges the fissure's medial part while collapsed lung pulls the lateral part upward. It points to an obstructing proximal lesion, most often a bronchogenic carcinoma, so further evaluation by CT and bronchoscopy is needed.

Option by option

  • A. Left ventricular failure

    Left ventricular failure causes bilateral perihilar opacification and Kerley lines.

  • B. A simple pleural effusion

    A simple effusion causes a meniscus and basal opacity, not lobar collapse with a hilar bulge.

  • C. A tension pneumothorax

    Tension pneumothorax produces hyperlucency with mediastinal shift, not lobar collapse.

  • D. A central obstructing hilar mass such as bronchogenic carcinoma (correct)

    Correct. A hilar mass causes the convex medial bulge that forms the S shape with the collapsed lobe.

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.

More Radiology questions

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, A central obstructing hilar mass such as bronchogenic carcinoma. The Golden S sign is seen in right upper lobe collapse when a central mass at the hilum bulges the fissure's medial part while collapsed lung pulls the lateral part upward.

Why is "Left ventricular failure" not the answer?

Left ventricular failure causes bilateral perihilar opacification and Kerley lines.

Why is "A simple pleural effusion" not the answer?

A simple effusion causes a meniscus and basal opacity, not lobar collapse with a hilar bulge.

Why is "A tension pneumothorax" not the answer?

Tension pneumothorax produces hyperlucency with mediastinal shift, not lobar collapse.

What concept does this question test?

It tests Chest imaging in Radiology. It points to an obstructing proximal lesion, most often a bronchogenic carcinoma, so further evaluation by CT and bronchoscopy is needed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Chest imaging?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.