Chest and cardiac imaging: valvular pulmonary stenosis: 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: valvular pulmonary stenosis

Sample item

A 12-year-old has an ejection systolic murmur in the left second intercostal space with a thrill. The chest radiograph shows normal lung vascularity and a prominent bulge in the left upper heart border. What explains this bulge?

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

The answer and the reasoning

C. Post-stenotic dilatation of the main pulmonary artery

In valvular pulmonary stenosis the jet strikes the pulmonary trunk wall, causing post-stenotic dilatation that forms a bulge on the left upper heart border. Pulmonary vascularity stays normal or reduced. A prominent left atrial appendage would suggest mitral disease instead.

Option by option

  • A. Enlarged aortic knuckle

    The aortic knuckle is on the left upper border but is not enlarged by pulmonary valve disease.

  • B. Right atrial dilatation

    Right atrial dilatation bulges the right heart border, not the left.

  • C. Post-stenotic dilatation of the main pulmonary artery (correct)

    Correct. The jet beyond the stenotic valve dilates the pulmonary trunk.

  • D. Left atrial appendage enlargement

    Left atrial appendage enlargement occurs with mitral stenosis, not with this lesion.

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, Post-stenotic dilatation of the main pulmonary artery. In valvular pulmonary stenosis the jet strikes the pulmonary trunk wall, causing post-stenotic dilatation that forms a bulge on the left upper heart border.

Why is "Enlarged aortic knuckle" not the answer?

The aortic knuckle is on the left upper border but is not enlarged by pulmonary valve disease.

Why is "Right atrial dilatation" not the answer?

Right atrial dilatation bulges the right heart border, not the left.

Why is "Left atrial appendage enlargement" not the answer?

Left atrial appendage enlargement occurs with mitral stenosis, not with this lesion.

What concept does this question test?

It tests Chest and cardiac imaging: valvular pulmonary stenosis in Radiology. Pulmonary vascularity stays normal or reduced. A prominent left atrial appendage would suggest mitral disease instead.

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: valvular pulmonary stenosis?

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.