Granulomatous disease: primary tuberculosis: practice question

A Pathology 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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Pathology · Granulomatous disease: primary tuberculosis

Sample item

An 8-year-old child with household contact with a case of tuberculosis has a positive tuberculin test. Where is the parenchymal focus of primary pulmonary tuberculosis characteristically located?

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

The answer and the reasoning

A. Subpleural, in the lower part of the upper lobe or upper part of the lower lobe

In primary tuberculosis the inhaled bacilli lodge in well-aerated subpleural areas near the interlobar fissure, forming the Ghon focus. With caseous lymphadenitis of the draining hilar nodes this makes the Ghon complex. In most children cell-mediated immunity heals the lesion with fibrosis and calcification.

Option by option

  • A. Subpleural, in the lower part of the upper lobe or upper part of the lower lobe (correct)

    Correct. The Ghon focus is subpleural near the interlobar fissure.

  • B. The apex of the upper lobe, with cavitation

    Apical cavitation is the pattern of secondary (post-primary) tuberculosis.

  • C. The hilum only, without any parenchymal lesion

    A hilar-only picture would lack the characteristic parenchymal focus of the complex.

  • D. The basal segments of the lower lobe along the diaphragm

    The diaphragmatic basal segments are not the usual site of the primary focus.

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.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Subpleural, in the lower part of the upper lobe or upper part of the lower lobe. In primary tuberculosis the inhaled bacilli lodge in well-aerated subpleural areas near the interlobar fissure, forming the Ghon focus.

Why is "The apex of the upper lobe, with cavitation" not the answer?

Apical cavitation is the pattern of secondary (post-primary) tuberculosis.

Why is "The hilum only, without any parenchymal lesion" not the answer?

A hilar-only picture would lack the characteristic parenchymal focus of the complex.

Why is "The basal segments of the lower lobe along the diaphragm" not the answer?

The diaphragmatic basal segments are not the usual site of the primary focus.

What concept does this question test?

It tests Granulomatous disease: primary tuberculosis in Pathology. With caseous lymphadenitis of the draining hilar nodes this makes the Ghon complex. In most children cell-mediated immunity heals the lesion with fibrosis and calcification.

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 Granulomatous disease: primary tuberculosis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.