Cardiac imaging: coarctation: 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 · Cardiac imaging: coarctation

Sample item

A 14-year-old with hypertension in the arms has a chest radiograph showing inferior rib notching of the posterior ribs 3 to 8 and a 'figure of 3' sign at the aortic knuckle. What is the diagnosis?

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

The answer and the reasoning

B. Coarctation of the aorta

Collateral intercostal arteries enlarge to bypass the narrowing and erode the inferior margins of the ribs. The aortic contour shows indentation at the coarctation with pre- and post-stenotic dilatation, the figure of 3 sign. Rib notching is not seen before about 6 years of age.

Option by option

  • A. Patent ductus arteriosus

    PDA gives increased pulmonary vascularity and a prominent aortic knuckle.

  • B. Coarctation of the aorta (correct)

    Correct. Rib notching with a figure of 3 aorta indicates coarctation.

  • C. Pulmonary stenosis

    Pulmonary stenosis shows post-stenotic pulmonary artery dilatation.

  • D. Aortic regurgitation

    Aortic regurgitation gives LV dilatation and a dilated aorta without rib notching.

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, Coarctation of the aorta. Collateral intercostal arteries enlarge to bypass the narrowing and erode the inferior margins of the ribs.

Why is "Patent ductus arteriosus" not the answer?

PDA gives increased pulmonary vascularity and a prominent aortic knuckle.

Why is "Pulmonary stenosis" not the answer?

Pulmonary stenosis shows post-stenotic pulmonary artery dilatation.

Why is "Aortic regurgitation" not the answer?

Aortic regurgitation gives LV dilatation and a dilated aorta without rib notching.

What concept does this question test?

It tests Cardiac imaging: coarctation in Radiology. The aortic contour shows indentation at the coarctation with pre- and post-stenotic dilatation, the figure of 3 sign. Rib notching is not seen before about 6 years of age.

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 Cardiac imaging: coarctation?

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.