A term newborn in the labour room has severe breathing difficulty from birth. The abdomen is scaphoid, breath sounds are absent on the left, heart sounds are heard on the right, and the X-ray shows bowel loops in the left hemithorax. Which developmental failure is most likely?

Pleuroperitoneal membrane failing to close

Septum transversum failing to fuse anteriorly

Diaphragm muscle failing to develop in the central tendon

Oesophageal hiatus forming too wide

An intercostal chest drain is to be inserted in a 26-year-old man with a traumatic haemopneumothorax, using the 'safe triangle' in the axilla. Which structure forms the posterior border of this triangle?

Anterior border of latissimus dorsi

Lateral border of pectoralis major

A 38-year-old woman has fever and cough. On the frontal chest X-ray there is consolidation next to the heart, the left heart border cannot be seen, and the left hemidiaphragm is clearly outlined. Which part of the lung is involved?

Anterior basal segment of the left lower lobe

Superior segment of the left lower lobe

Apicoposterior segment of the left upper lobe

Lungs, pleura and diaphragm

8 NEET-PG practice questions on Lungs, pleura and diaphragm, part of Anatomy. The first 8 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A term newborn in the labour room has severe breathing difficulty from birth. The abdomen is scaphoid, breath sounds are absent on the left, heart sounds are heard on the right, and the X-ray shows bowel loops in the left hemithorax. Which developmental failure is most likely?
1. ASeptum transversum failing to fuse anteriorly
2. BPleuroperitoneal membrane failing to close
3. CDiaphragm muscle failing to develop in the central tendon
4. DOesophageal hiatus forming too wide
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Answer: B · Pleuroperitoneal membrane failing to close
This is a congenital diaphragmatic hernia of the Bochdalek type, a posterolateral defect, usually on the left. It results from failure of the pleuroperitoneal membrane to close the pericardioperitoneal canal, so gut herniates into the chest and compresses the developing lung, leading to pulmonary hypoplasia and pulmonary hypertension. The baby is intubated rather than ventilated by bag and mask, and a nasogastric tube decompresses the gut.
- A: An anterior defect beside the sternum from the septum transversum region is a Morgagni hernia.
- C: The central tendon is not muscular; absent muscle causes eventration, not a posterolateral defect.
- D: A wide oesophageal hiatus gives a hiatus hernia, not bowel filling the chest at birth.
Question 2 · Easy
An intercostal chest drain is to be inserted in a 26-year-old man with a traumatic haemopneumothorax, using the 'safe triangle' in the axilla. Which structure forms the posterior border of this triangle?
1. AAnterior border of latissimus dorsi
2. BLateral border of pectoralis major
3. CMedial border of the scapula
4. DMidclavicular line
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Answer: A · Anterior border of latissimus dorsi
The safe triangle is bounded in front by the lateral border of pectoralis major, behind by the anterior border of latissimus dorsi, below by a horizontal line at the level of the nipple (about the fifth intercostal space), with the apex just below the axilla. A drain placed here avoids the internal thoracic artery, the heart and great muscles, and stays above the diaphragm. The tube is passed over the upper border of the rib below to avoid the intercostal vessels.
- B: Pectoralis major forms the anterior, not posterior, border.
- C: The scapula lies far behind the triangle.
- D: The midclavicular line is the site for needle decompression in some guidance, not a border of the triangle.
Question 3 · Medium
A 38-year-old woman has fever and cough. On the frontal chest X-ray there is consolidation next to the heart, the left heart border cannot be seen, and the left hemidiaphragm is clearly outlined. Which part of the lung is involved?
1. AAnterior basal segment of the left lower lobe
2. BSuperior segment of the left lower lobe
3. CLingula of the left upper lobe
4. DApicoposterior segment of the left upper lobe
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Answer: C · Lingula of the left upper lobe
Consolidation in contact with the left heart border removes the normal air-soft tissue interface, the silhouette sign. The lingula (superior and inferior lingular segments of the left upper lobe) lies against the left border of the heart and corresponds to the middle lobe on the right, so lingular pneumonia hides the left heart border. Lower lobe consolidation lies behind the heart and obscures the hemidiaphragm instead, while the heart border stays visible.
- A: Basal lower lobe disease hides the hemidiaphragm, which is clear here.
- B: The superior segment of the lower lobe lies posteriorly and does not touch the heart border.
- D: The apicoposterior segment lies at the apex, far from the heart border.
Question 4 · Hard
Before repair of a large hiatus hernia in a 60-year-old woman, a surgical resident reviews the openings of the diaphragm: 1. The caval opening, at about T8, transmits the IVC and branches of the right phrenic nerve. 2. The oesophageal opening lies in the central tendon, so it does not narrow when the diaphragm contracts. 3. The oesophageal opening, at about T10, transmits the vagal trunks. 4. The aortic opening, at about T12, transmits the aorta, thoracic duct and azygos vein. Which statements are correct?
1. A2 and 3 only
2. B1 and 4 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
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Answer: D · 1, 3 and 4 only
Statements 1, 3 and 4 are correct. The caval opening lies in the central tendon at about T8, so it is held open, and transmits the IVC and branches of the right phrenic nerve. The oesophageal opening at about T10 transmits the oesophagus, both vagal trunks and the oesophageal branches of the left gastric vessels. The aortic opening at about T12 lies behind the median arcuate ligament and transmits the aorta, thoracic duct and azygos vein. Statement 2 is wrong: the oesophageal opening lies in the muscular part, where fibres of the right crus loop around it and act as a sphincter that narrows it on inspiration, which matters in hiatal repair.
- A: Includes statement 2 and leaves out the caval and aortic openings.
- B: Leaves out statement 3: the vagal trunks do pass through the oesophageal opening.
- C: Includes statement 2, which is false, and leaves out the aortic opening.
Question 5 · Easy
A 30-year-old man with tuberculous pleural effusion has an erect chest X-ray. The only abnormality is blunting of the right costophrenic angle. In which part of the pleural cavity has the fluid collected first?
1. ACostomediastinal recess
2. BPulmonary ligament
3. CCostodiaphragmatic recess
4. DHorizontal fissure
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Answer: C · Costodiaphragmatic recess
The costodiaphragmatic recess is the lowest part of the pleural cavity in the upright position, where the costal and diaphragmatic parietal pleura meet below the lower border of the lung. Free fluid gravitates there first, so a small effusion shows only as blunting of the costophrenic angle on an erect film. A lateral decubitus film or ultrasound detects even smaller amounts. Pleural taps are done below the upper level of the fluid but above the lowest limit of the recess, to avoid the diaphragm and abdominal organs.
- A: The costomediastinal recess lies in front, behind the sternum, and is not the most dependent part.
- B: The pulmonary ligament is a fold of pleura below the lung root, not a space.
- D: A fissure lies within the lung and is not a pleural recess where free fluid first collects.
Question 6 · Medium
A 45-year-old woman has a pleural tap in the eighth intercostal space in the posterior axillary line. The resident inserts the needle just above the upper border of the ninth rib rather than below the eighth. Why?
1. AThe internal thoracic artery runs along the lower border of each rib
2. BThe parietal pleura is thickest just above each rib
3. CThe intercostal vessels and nerve run under the lower border of each rib
4. DThe lung edge lies opposite the lower border of each rib
Answer and explanation in LearnFree account
Question 7 · Hard
A 49-year-old man has an open left nephrectomy through a loin incision along the 12th rib. In recovery he becomes breathless, with absent breath sounds over the left lower chest, and the X-ray shows a pneumothorax. The lung itself was not touched. What anatomical fact explains this complication?
1. AThe lower border of the lung reaches the 12th rib in expiration
2. BThe costomediastinal recess extends down to the loin
3. CThe kidney lies above the diaphragm posteriorly
4. DThe pleura extends below the medial part of the 12th rib
Answer and explanation in LearnFree account
Question 8 · Medium
A 74-year-old man recovering from a stroke on the ward is fed while propped upright in bed. Two days later he has fever and crackles at the right base, and a lateral chest X-ray shows consolidation in the lowest, most posterior part of the right lung. Which bronchopulmonary segment is involved?
1. APosterior segment of the right upper lobe
2. BSuperior segment of the right lower lobe
3. CPosterior basal segment of the right lower lobe
4. DMedial segment of the right middle lobe
Answer and explanation in LearnFree account

Lungs, pleura and diaphragm

A term newborn in the labour room has severe breathing difficulty from birth. The abdomen is scaphoid, breath sounds are absent on the left, heart sounds are heard on the right, and the X-ray shows bowel loops in the left hemithorax. Which developmental failure is most likely?

An intercostal chest drain is to be inserted in a 26-year-old man with a traumatic haemopneumothorax, using the 'safe triangle' in the axilla. Which structure forms the posterior border of this triangle?

A 38-year-old woman has fever and cough. On the frontal chest X-ray there is consolidation next to the heart, the left heart border cannot be seen, and the left hemidiaphragm is clearly outlined. Which part of the lung is involved?

A 30-year-old man with tuberculous pleural effusion has an erect chest X-ray. The only abnormality is blunting of the right costophrenic angle. In which part of the pleural cavity has the fluid collected first?

A 45-year-old woman has a pleural tap in the eighth intercostal space in the posterior axillary line. The resident inserts the needle just above the upper border of the ninth rib rather than below the eighth. Why?

A 49-year-old man has an open left nephrectomy through a loin incision along the 12th rib. In recovery he becomes breathless, with absent breath sounds over the left lower chest, and the X-ray shows a pneumothorax. The lung itself was not touched. What anatomical fact explains this complication?

A 74-year-old man recovering from a stroke on the ward is fed while propped upright in bed. Two days later he has fever and crackles at the right base, and a lateral chest X-ray shows consolidation in the lowest, most posterior part of the right lung. Which bronchopulmonary segment is involved?