Neuroimaging: hummingbird sign: 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 · Neuroimaging: hummingbird sign

Sample item

An elderly man has frequent backward falls and loss of vertical downgaze. Midline sagittal MRI shows a thin midbrain tegmentum with a relatively preserved pons, resembling a bird with its beak. What is the diagnosis?

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

The answer and the reasoning

B. Progressive supranuclear palsy

Midbrain atrophy with relative sparing of the pons gives the hummingbird (penguin) sign of progressive supranuclear palsy. Multiple system atrophy shows the hot cross bun sign in the pons. Parkinson disease has no distinctive structural change.

Option by option

  • A. Parkinson disease

    Parkinson disease does not produce marked midbrain atrophy.

  • B. Progressive supranuclear palsy (correct)

    Correct. Midbrain atrophy with a hummingbird profile suggests PSP.

  • C. Normal pressure hydrocephalus

    NPH shows enlarged ventricles with a gait disorder, not midbrain thinning.

  • D. Multiple system atrophy cerebellar type

    MSA-C shows pontine and cerebellar atrophy with a hot cross bun sign.

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 B, Progressive supranuclear palsy. Midbrain atrophy with relative sparing of the pons gives the hummingbird (penguin) sign of progressive supranuclear palsy.

Why is "Parkinson disease" not the answer?

Parkinson disease does not produce marked midbrain atrophy.

Why is "Normal pressure hydrocephalus" not the answer?

NPH shows enlarged ventricles with a gait disorder, not midbrain thinning.

Why is "Multiple system atrophy cerebellar type" not the answer?

MSA-C shows pontine and cerebellar atrophy with a hot cross bun sign.

What concept does this question test?

It tests Neuroimaging: hummingbird sign in Radiology. Multiple system atrophy shows the hot cross bun sign in the pons. Parkinson disease has no distinctive structural change.

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 Neuroimaging: hummingbird sign?

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.