Respiratory: lung tumours: 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.

Try it

Pathology · Respiratory: lung tumours

Sample item

A 62-year-old smoker has shoulder pain radiating down the inner arm, weakness of the hand muscles, and a drooping eyelid with a constricted pupil on the right. A chest radiograph shows an apical opacity. What explains the eye findings?

AInvasion of the sympathetic chain by a superior sulcus tumourBCompression of the superior vena cavaCCompression of the phrenic nerveDInvasion of the recurrent laryngeal nerve

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

The answer and the reasoning

A. Invasion of the sympathetic chain by a superior sulcus tumour

A Pancoast tumour of the lung apex invades the brachial plexus (C8 to T1), causing arm pain and hand weakness, and the cervical sympathetic chain, causing Horner syndrome (ptosis, miosis and anhidrosis). Most are squamous or adenocarcinomas. Phrenic and recurrent laryngeal involvement cause diaphragm paralysis and hoarseness.

Option by option

A. Invasion of the sympathetic chain by a superior sulcus tumour (correct)
Correct. Sympathetic chain invasion produces Horner syndrome.
B. Compression of the superior vena cava
SVC obstruction causes facial plethora and venous distension.
C. Compression of the phrenic nerve
Phrenic nerve compression causes a raised hemidiaphragm, not ptosis and miosis.
D. Invasion of the recurrent laryngeal nerve
Recurrent laryngeal involvement causes hoarseness.

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 Pathology question

What is the answer to this Pathology question?

The best answer is A, Invasion of the sympathetic chain by a superior sulcus tumour. A Pancoast tumour of the lung apex invades the brachial plexus (C8 to T1), causing arm pain and hand weakness, and the cervical sympathetic chain, causing Horner syndrome (ptosis, miosis and anhidrosis).

Why is "Compression of the superior vena cava" not the answer?

SVC obstruction causes facial plethora and venous distension.

Why is "Compression of the phrenic nerve" not the answer?

Phrenic nerve compression causes a raised hemidiaphragm, not ptosis and miosis.

Why is "Invasion of the recurrent laryngeal nerve" not the answer?

Recurrent laryngeal involvement causes hoarseness.

What concept does this question test?

It tests Respiratory: lung tumours in Pathology. Most are squamous or adenocarcinomas. Phrenic and recurrent laryngeal involvement cause diaphragm paralysis and hoarseness.

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: lung tumours?

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.