Thoracic duct: termination and Virchow node: practice question

A Anatomy 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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Anatomy · Thoracic duct: termination and Virchow node

Sample item

A 64-year-old man with weight loss and an upper abdominal mass has a hard, enlarged lymph node in the left supraclavicular fossa. Biopsy shows metastatic adenocarcinoma, consistent with a gastric primary. Which anatomical feature best explains this metastatic route?

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

The answer and the reasoning

B. The thoracic duct ends at the left venous angle, so abdominal lymph reaches nodes in the left supraclavicular fossa

Lymph from the abdomen collects in the cisterna chyli and ascends in the thoracic duct, which opens at the junction of the left internal jugular and left subclavian veins. Tumour cells can lodge in the left supraclavicular (Virchow) nodes close to this termination. A palpable node of this kind is called the Troisier sign.

Option by option

  • A. The internal thoracic lymphatics carry gastric lymph upward to the left supraclavicular fossa

    The internal thoracic lymphatics drain the anterior chest wall and breast, not the stomach.

  • B. The thoracic duct ends at the left venous angle, so abdominal lymph reaches nodes in the left supraclavicular fossa (correct)

    Correct. The thoracic duct terminates at the left venous angle next to these nodes.

  • C. The azygos vein drains the stomach directly into the left supraclavicular nodes

    The azygos vein is a venous channel in the thorax and does not drain stomach lymph to nodes.

  • D. The right lymphatic duct drains the abdomen and ends at the right venous angle

    The right lymphatic duct drains only the right upper body and not the abdomen.

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 Anatomy question

What is the answer to this Anatomy question?

The best answer is B, The thoracic duct ends at the left venous angle, so abdominal lymph reaches nodes in the left supraclavicular fossa. Lymph from the abdomen collects in the cisterna chyli and ascends in the thoracic duct, which opens at the junction of the left internal jugular and left subclavian veins.

Why is "The internal thoracic lymphatics carry gastric lymph upward to the le…" not the answer?

The internal thoracic lymphatics drain the anterior chest wall and breast, not the stomach.

Why is "The azygos vein drains the stomach directly into the left supraclavic…" not the answer?

The azygos vein is a venous channel in the thorax and does not drain stomach lymph to nodes.

Why is "The right lymphatic duct drains the abdomen and ends at the right ven…" not the answer?

The right lymphatic duct drains only the right upper body and not the abdomen.

What concept does this question test?

It tests Thoracic duct: termination and Virchow node in Anatomy. Tumour cells can lodge in the left supraclavicular (Virchow) nodes close to this termination. A palpable node of this kind is called the Troisier sign.

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 Thoracic duct: termination and Virchow node?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy 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.