Chest and cardiac imaging: nodal compression in primary TB: 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 and cardiac imaging: nodal compression in primary TB

Sample item

A 3-year-old with tuberculosis contact has persistent cough and chest film showing right middle lobe collapse with an enlarged right hilar shadow. What is the most likely mechanism?

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

The answer and the reasoning

A. Extrinsic compression of the middle lobe bronchus by enlarged tuberculous hilar nodes

Hilar and paratracheal lymphadenopathy is the hallmark of primary tuberculosis in children. The narrow middle lobe bronchus is easily compressed by nodes, causing lobar collapse (epituberculosis or middle lobe syndrome). Nodal disease is less typical in adults with post-primary disease.

Option by option

  • A. Extrinsic compression of the middle lobe bronchus by enlarged tuberculous hilar nodes (correct)

    Correct. Nodal compression of the bronchus explains the collapse.

  • B. Endobronchial foreign body

    Foreign body is possible but the tuberculous contact and hilar enlargement favour nodal compression.

  • C. Pulmonary embolism

    Pulmonary embolism is rare in children and does not cause lobar collapse with nodes.

  • D. Congenital lobar emphysema

    Congenital lobar emphysema causes hyperinflation, not collapse.

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 Radiology question

What is the answer to this Radiology question?

The best answer is A, Extrinsic compression of the middle lobe bronchus by enlarged tuberculous hilar nodes. Hilar and paratracheal lymphadenopathy is the hallmark of primary tuberculosis in children.

Why is "Endobronchial foreign body" not the answer?

Foreign body is possible but the tuberculous contact and hilar enlargement favour nodal compression.

Why is "Pulmonary embolism" not the answer?

Pulmonary embolism is rare in children and does not cause lobar collapse with nodes.

Why is "Congenital lobar emphysema" not the answer?

Congenital lobar emphysema causes hyperinflation, not collapse.

What concept does this question test?

It tests Chest and cardiac imaging: nodal compression in primary TB in Radiology. The narrow middle lobe bronchus is easily compressed by nodes, causing lobar collapse (epituberculosis or middle lobe syndrome). Nodal disease is less typical in adults with post-primary disease.

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 and cardiac imaging: nodal compression in primary TB?

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.