MCQ Endobronchial Nodules

L1 (Basic Questions)

L1 Question 1: What is an endobronchial nodule?

  • a) A solitary nodule located within the lung parenchyma
  • b) A solitary nodule located within the bronchial tree
  • c) A calcified nodule within the pleura
  • d) A subpleural nodule

Answer: b) A solitary nodule located within the bronchial tree

Comments

Endobronchial nodules are characterized by their location within the bronchial tree, often associated with infectious, inflammatory, or neoplastic processes. “Endobronchial nodules refer to multiple nodules confined within the bronchial tree, typically secondary to infection, inflammation, or metastases.” Radiopaedia

Incorrect Answers:

  • a) A solitary nodule within the lung parenchyma is not considered an endobronchial nodule. Radiopaedia
  • c) Calcified pleural nodules are more typical of chronic infections or granulomatous disease. Radiographics
  • d) Subpleural nodules are usually seen in interstitial lung disease and not endobronchial pathology. Radiopaedia

L1 Question 2: Which imaging modality is most effective for identifying endobronchial nodules?

  • a) Chest X-ray
  • b) CT Chest with contrast
  • c) PET-CT
  • d) MRI Chest

Answer: b) CT Chest with contrast

Comments

CT Chest with contrast provides the best visualization of endobronchial nodules and their relationship with the airway lumen. “CT imaging is the modality of choice for detecting endobronchial nodules, assessing size, distribution, and airway involvement.” Radiopaedia

Incorrect Answers:

  • a) Chest X-ray may show indirect signs but lacks sensitivity for small endobronchial nodules. Radiopaedia
  • c) PET-CT assesses metabolic activity but is not ideal for primary detection of endobronchial nodules. Radiopaedia
  • d) MRI is rarely used for airway assessment due to lower spatial resolution. Radiopaedia

L2 (Advanced Questions)

L2 Question 3: A 52-year-old female with a history of breast cancer presents with multiple endobronchial nodules on CT. Which of the following is the most likely etiology?

  • a) Endobronchial metastases
  • b) Allergic bronchopulmonary aspergillosis (ABPA)
  • c) Granulomatosis with polyangiitis (GPA)
  • d) Bronchial atresia
  • e) Hypersensitivity reaction to chemotherapeutic agents

Answer: a) Endobronchial metastases

Comments

Endobronchial metastases are common in patients with a history of malignancies such as breast, renal, or melanoma. “Endobronchial metastases often arise from primary malignancies such as breast, renal, and melanoma, presenting as multiple nodules in the bronchial tree.” Radiopaedia

Incorrect Answers:

  • b) ABPA is associated with mucus plugging rather than nodular patterns. Radiopaedia
  • c) GPA can cause endobronchial involvement but more often presents with cavitation and diffuse nodularity. Radiopaedia
  • d) Bronchial atresia is congenital and does not typically present as multiple nodules. Radiopaedia
  • e) Hypersensitivity reactions to chemotherapeutic agents can cause pulmonary opacities but are not typically associated with multiple endobronchial nodules. Radiographics

L2 Question 4: Which infection most commonly presents with multiple endobronchial nodules?

  • a) Mycobacterium tuberculosis
  • b) Pneumocystis jirovecii pneumonia (PJP)
  • c) Histoplasmosis
  • d) Cytomegalovirus (CMV)

Answer: a) Mycobacterium tuberculosis

Comments

Endobronchial spread of tuberculosis can lead to multiple nodules within the bronchial tree, particularly in post-primary TB. “Endobronchial tuberculosis commonly presents with multiple nodules, often due to post-primary infection and airway involvement.” Radiopaedia

Incorrect Answers:

  • b) PJP typically presents with diffuse ground-glass opacities, not nodules. Radiopaedia
  • c) Histoplasmosis can cause nodules but more commonly presents with calcified granulomas. Radiographics
  • d) CMV more often presents with diffuse interstitial patterns rather than nodular disease. Radiopaedia

L2 Question 5: A 60-year-old male presents with hemoptysis and a CT showing a solitary endobronchial nodule in the right mainstem bronchus. What is the next best step?

  • a) Observation and repeat CT in 3 months
  • b) Bronchoscopy with biopsy
  • c) Empiric antibiotics
  • d) PET-CT only

Answer: b) Bronchoscopy with biopsy

Comments

Bronchoscopy with biopsy is necessary to evaluate a solitary endobronchial nodule for malignancy, especially in a high-risk patient with hemoptysis. “Solitary endobronchial nodules, particularly in smokers or those presenting with hemoptysis, warrant bronchoscopy for direct visualization and biopsy.” Radiographics

Incorrect Answers:

  • a) Observation is inappropriate when malignancy is a strong consideration. Radiopaedia
  • c) Antibiotics would not be indicated without infection signs. Radiopaedia
  • d) PET-CT can assist in staging but would not replace biopsy for tissue confirmation. Radiopaedia