Chest and cardiac imaging: pulmonary alveolar microlithiasis: 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: pulmonary alveolar microlithiasis

Sample item

An asymptomatic young adult with a family history of similar findings has a chest radiograph showing innumerable tiny sand-grain calcific densities in both lungs, denser at the bases, obscuring the heart borders. What is the diagnosis?

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

The answer and the reasoning

C. Pulmonary alveolar microlithiasis

Pulmonary alveolar microlithiasis is an autosomal recessive condition with calcium phosphate microliths filling the alveoli, producing a sandstorm appearance. Symptoms are often mild compared with the striking radiograph. Miliary TB nodules are larger, non-calcified and the patient is unwell.

Option by option

  • A. Simple silicosis

    Silicosis gives small nodules in the upper zones and needs an exposure history.

  • B. Miliary tuberculosis

    Miliary TB gives uniform 1 to 3 mm non-calcified nodules in a febrile patient.

  • C. Pulmonary alveolar microlithiasis (correct)

    Correct. Diffuse, tiny, calcified densities in an asymptomatic person suggest microlithiasis.

  • D. Pulmonary sarcoidosis

    Sarcoidosis gives hilar adenopathy and perilymphatic nodules, not dense calcific sand.

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 C, Pulmonary alveolar microlithiasis. Pulmonary alveolar microlithiasis is an autosomal recessive condition with calcium phosphate microliths filling the alveoli, producing a sandstorm appearance.

Why is "Simple silicosis" not the answer?

Silicosis gives small nodules in the upper zones and needs an exposure history.

Why is "Miliary tuberculosis" not the answer?

Miliary TB gives uniform 1 to 3 mm non-calcified nodules in a febrile patient.

Why is "Pulmonary sarcoidosis" not the answer?

Sarcoidosis gives hilar adenopathy and perilymphatic nodules, not dense calcific sand.

What concept does this question test?

It tests Chest and cardiac imaging: pulmonary alveolar microlithiasis in Radiology. Symptoms are often mild compared with the striking radiograph. Miliary TB nodules are larger, non-calcified and the patient is unwell.

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 Chest and cardiac imaging: pulmonary alveolar microlithiasis?

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.