An intern reports the chest X-ray of a healthy 25-year-old blood donor as abnormal because the left hilum lies higher than the right. The radiologist says the film is normal. Which anatomical fact explains the normal finding?

The left pulmonary artery arches over the left main bronchus

The left lung has a horizontal fissure that lifts the hilum

The heart pushes the left hilum upwards

The left main bronchus is shorter than the right

A 30-year-old man is admitted with fever, neck stiffness and photophobia, and the medical resident prepares to do a lumbar puncture. He draws a line joining the highest points of both iliac crests to choose the space. Why is the needle safe from injuring the spinal cord at the L3-L4 space in this adult?

The cord normally ends at about the L1-L2 level

The cord is protected by the ligamentum flavum at this level

The cord normally ends at about the S2 level

The cord is displaced forwards by the needle

A 50-year-old man with suspected infiltrative liver disease has a percutaneous liver biopsy in the right mid-axillary line, through the ninth intercostal space at the end of expiration. Which structures does the needle traverse between the intercostal muscles and the liver?

Costodiaphragmatic recess, then diaphragm

Costomediastinal recess, then diaphragm

Lower lobe of the lung, then diaphragm

Diaphragm alone, below the pleura

Radiological and surface anatomy

8 NEET-PG practice questions on Radiological and surface anatomy, 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 · Hard
Before teaching chest and abdominal examination to interns, a physician lists four surface markings: 1. The transpyloric plane lies at the level of the L1 vertebra. 2. The apex beat in adults lies in the left fifth intercostal space just medial to the midclavicular line. 3. The horizontal fissure of the right lung follows the fourth costal cartilage. 4. The oblique fissure ends anteriorly at the sixth costal cartilage. Which statements are correct?
1. A1, 2 and 3 only
2. B2 and 4 only
3. C1 and 3 only
4. D1, 2, 3 and 4
Show answerHide answer
Answer: D · 1, 2, 3 and 4
All four statements are correct. The transpyloric plane, midway between the jugular notch and the pubic symphysis, lies at L1 and passes near the pylorus, the neck of the pancreas and the renal hila. The apex beat, from the left ventricle, is in the left fifth space about 9 cm from the midline, just inside the midclavicular line. The horizontal fissure runs along the fourth costal cartilage to meet the oblique fissure in the mid-axillary line, and the oblique fissure ends in front at the sixth costal cartilage.
- A: Leaves out statement 4: the oblique fissure does end at the sixth costal cartilage.
- B: Leaves out statements 1 and 3: the transpyloric plane is at L1 and the horizontal fissure follows the fourth cartilage.
- C: Leaves out statements 2 and 4, both of which are correct.
Question 2 · Medium
An intern reports the chest X-ray of a healthy 25-year-old blood donor as abnormal because the left hilum lies higher than the right. The radiologist says the film is normal. Which anatomical fact explains the normal finding?
1. AThe left pulmonary artery arches over the left main bronchus
2. BThe left lung has a horizontal fissure that lifts the hilum
3. CThe heart pushes the left hilum upwards
4. DThe left main bronchus is shorter than the right
Show answerHide answer
Answer: A · The left pulmonary artery arches over the left main bronchus
On a normal PA chest film the left hilum is level with or slightly higher than the right in almost everyone. The hilar shadow is mostly the pulmonary artery, and the left pulmonary artery passes over the left main bronchus, while the right pulmonary artery lies in front of and below the right bronchus. A right hilum higher than the left suggests upper lobe volume loss, for example from fibrosis or collapse. Recognising the normal relationship avoids false alarms.
- B: Only the right lung has a horizontal fissure.
- C: The heart lies below the hila and does not lift the left hilum.
- D: The left main bronchus is longer, not shorter, than the right.
Question 3 · Medium
A 30-year-old man is admitted with fever, neck stiffness and photophobia, and the medical resident prepares to do a lumbar puncture. He draws a line joining the highest points of both iliac crests to choose the space. Why is the needle safe from injuring the spinal cord at the L3-L4 space in this adult?
1. AThe cord is protected by the ligamentum flavum at this level
2. BThe cord normally ends at about the S2 level
3. CThe cord is displaced forwards by the needle
4. DThe cord normally ends at about the L1-L2 level
Show answerHide answer
Answer: D · The cord normally ends at about the L1-L2 level
The line joining the highest points of the iliac crests usually crosses the L4 spinous process or the L4-L5 space, so the spaces at and just above it can be identified. In adults the spinal cord ends at the conus medullaris, at about the lower border of L1 or the L1-L2 disc, while the dural sac continues to S2. Below the conus the needle enters the lumbar cistern, where the floating roots of the cauda equina move aside. In newborns the cord ends lower, at about L3, so lower spaces are chosen.
- A: The ligamentum flavum is pierced by the needle and gives no protection to the cord.
- B: S2 is where the dural sac (subarachnoid space) ends, not the cord.
- C: A needle does not push the cord aside; safety comes from entering below its end.
Question 4 · Medium
A 55-year-old woman with heartburn has a CT scan of the chest and abdomen. The radiologist follows the oesophagus down to where it passes through the diaphragm and notes a small sliding hiatus hernia. At which vertebral level does the oesophagus normally pass through the diaphragm?
1. AT8
2. BT10
3. CT12
4. DL1
Show answerHide answer
Answer: B · T10
The oesophageal hiatus lies at the level of T10, in the muscular part of the right crus, and transmits the oesophagus, the vagal trunks and oesophageal branches of the left gastric vessels. The caval opening is at T8 in the central tendon, and the aortic hiatus is at T12 behind the median arcuate ligament. A sliding hiatus hernia occurs when the gastro-oesophageal junction rises through a widened hiatus. Muscle fibres of the right crus around the hiatus add to the lower oesophageal sphincter.
- A: T8 is the level of the caval opening in the central tendon.
- C: T12 is the level of the aortic hiatus.
- D: L1 is the transpyloric plane, below all three openings.
Question 5 · Hard
A 50-year-old man with suspected infiltrative liver disease has a percutaneous liver biopsy in the right mid-axillary line, through the ninth intercostal space at the end of expiration. Which structures does the needle traverse between the intercostal muscles and the liver?
1. ACostomediastinal recess, then diaphragm
2. BLower lobe of the lung, then diaphragm
3. CCostodiaphragmatic recess, then diaphragm
4. DDiaphragm alone, below the pleura
Show answerHide answer
Answer: C · Costodiaphragmatic recess, then diaphragm
In the mid-axillary line the lower border of the lung lies at about the eighth rib in quiet breathing, while the pleural reflection reaches the tenth rib. Between them is the costodiaphragmatic recess, where costal and diaphragmatic parietal pleura lie in contact with no lung. A needle through the ninth space therefore crosses two layers of pleura and the diaphragm before reaching the liver, which is why pneumothorax and pleural pain are recognised complications. Doing the biopsy in expiration keeps the lung edge above the needle track.
- A: The costomediastinal recess lies anteriorly behind the sternum, not in the axilla.
- B: At the end of expiration the lung edge lies above the ninth space in this line.
- D: The pleural reflection extends below the ninth space in the mid-axillary line, so pleura is crossed.
Question 6 · Easy
A 42-year-old woman in the surgical OPD has pain in the right upper abdomen after fatty meals. The surgeon presses at the point where the lateral border of the right rectus abdominis meets the costal margin, and she catches her breath on deep inspiration. Which structure lies deep to this point?
1. APylorus of the stomach
2. BNeck of the pancreas
3. CFundus of the gallbladder
4. DHilum of the right kidney
Answer and explanation in LearnFree account
Question 7 · Easy
A 60-year-old diabetic man has fever and a productive cough for five days. On his PA chest X-ray there is an ill-defined opacity, and the right heart border can no longer be seen, while the right hemidiaphragm is clearly outlined. Which part of the lung is most likely consolidated?
1. ARight middle lobe
2. BRight upper lobe
3. CPosterior segment of the right upper lobe
4. DRight lower lobe
Answer and explanation in LearnFree account
Question 8 · Medium
A 38-year-old woman in Pune has progressive breathlessness on exertion, a loud pulmonary component of the second heart sound and a left parasternal heave. Echocardiography confirms pulmonary arterial hypertension. On her PA chest X-ray, the left border of the cardiac silhouette shows a prominent convexity immediately below the aortic knuckle. Which structure forms this part of the border?
1. APulmonary trunk
2. BLeft auricle
3. CArch of the aorta
4. DLeft ventricle
Answer and explanation in LearnFree account

Radiological and surface anatomy

An intern reports the chest X-ray of a healthy 25-year-old blood donor as abnormal because the left hilum lies higher than the right. The radiologist says the film is normal. Which anatomical fact explains the normal finding?

A 55-year-old woman with heartburn has a CT scan of the chest and abdomen. The radiologist follows the oesophagus down to where it passes through the diaphragm and notes a small sliding hiatus hernia. At which vertebral level does the oesophagus normally pass through the diaphragm?

A 50-year-old man with suspected infiltrative liver disease has a percutaneous liver biopsy in the right mid-axillary line, through the ninth intercostal space at the end of expiration. Which structures does the needle traverse between the intercostal muscles and the liver?

A 42-year-old woman in the surgical OPD has pain in the right upper abdomen after fatty meals. The surgeon presses at the point where the lateral border of the right rectus abdominis meets the costal margin, and she catches her breath on deep inspiration. Which structure lies deep to this point?

A 60-year-old diabetic man has fever and a productive cough for five days. On his PA chest X-ray there is an ill-defined opacity, and the right heart border can no longer be seen, while the right hemidiaphragm is clearly outlined. Which part of the lung is most likely consolidated?