MCQ Lymphadenopathy in the Chest – Non Calcified

L1 (Basic)

L1 Question 1: What is the most common cause of non-calcified lymphadenopathy in the chest?

a) Tuberculosis
b) Sarcoidosis
c) Metastatic cancer
d) Reactive lymphadenopathy

Answer: d) Reactive lymphadenopathy

Comments

Reactive lymphadenopathy is the most common cause due to infection or inflammation. “Reactive lymphadenopathy commonly results from infections and inflammatory conditions.” Radiopaedia

Incorrect Answers

a) Tuberculosis: “Tuberculosis can lead to necrotic lymphadenopathy but reactive lymphadenopathy is more frequently seen.” Radiopaedia
b) Sarcoidosis: “Sarcoidosis often presents with symmetrical hilar lymphadenopathy, making it a less common generalized cause.” Radiopaedia
c) Metastatic cancer: “Metastatic cancer can cause lymphadenopathy, but it is less commonly the primary cause compared to reactive lymphadenopathy.” Radiopaedia

L1 Question 2: Which imaging modality is the most sensitive for detecting non-calcified lymphadenopathy?

a) Chest X-ray
b) Ultrasound
c) CT Scan
d) PET-CT

Answer: c) CT Scan

Comments

CT scans provide detailed anatomical information and are the gold standard for detecting mediastinal lymphadenopathy. “CT scanning is the imaging modality of choice for evaluating mediastinal lymphadenopathy due to its high sensitivity.” Radiographics

Incorrect Answers

a) Chest X-ray: “Chest X-rays are less sensitive than CT scans in detecting thoracic lymphadenopathy.” RadiologyKey
b) Ultrasound: “Ultrasound has limited utility for deep thoracic lymph nodes due to its restricted field of view.” RadiologyKey
d) PET-CT: “PET-CT is primarily used for metabolic activity assessment rather than anatomical detail compared to CT.” Radiopaedia

L1 (Basic)

L1 Question 3: What is the size threshold for defining abnormal lymphadenopathy in the chest on CT?

a) >5 mm
b) >10 mm
c) >15 mm
d) >20 mm

Answer: b) >10 mm

Comments

The size threshold for abnormal mediastinal lymphadenopathy is generally considered >10 mm in the short axis. “A short-axis diameter greater than 10 mm is widely used as the cut-off for abnormal mediastinal lymph nodes.” Radiographics

Incorrect Answers

a) “Nodes smaller than 10 mm are often considered within normal limits.” Radiopaedia
c) “15 mm is above the commonly accepted threshold for normal size.” RadiologyKey
d) “20 mm is significantly above the threshold of concern for mediastinal lymphadenopathy.” Radiopaedia

L1 Question 4: Which mediastinal lymph node station is most commonly involved in malignancy?

a) Right paratracheal (station 4R)
b) Subcarinal (station 7)
c) Prevascular (station 3A)
d) Left hilar (station 10L)

Answer: b) Subcarinal (station 7)

Comments

The subcarinal lymph node station (station 7) is a common site for metastatic involvement due to its central location. “Station 7, the subcarinal node group, is frequently involved in malignancies like lung cancer.” AJR

Incorrect Answers

a) “Station 4R can be involved but less frequently than subcarinal nodes.” Radiopaedia
c) “Station 3A is more commonly reactive than involved with malignancy.” RadiologyKey
d) “Station 10L is typically involved when there is direct spread from a left-sided lesion.” Radiographics

L1 Question 5: How is the size of a mediastinal lymph node measured on CT?

a) Long-axis diameter
b) Short-axis diameter
c) Volume
d) Density

Answer: b) Short-axis diameter

Comments

The short-axis diameter is the standard measurement for assessing lymph node size on CT. “Short-axis measurement is the preferred method for assessing lymph node enlargement on CT.” Radiopaedia

Incorrect Answers

a) “Long-axis diameter is less reliable for determining abnormality.” Radiopaedia
c) “Volume is rarely used clinically for lymph node assessment.” RadiologyKey
d) “Density is used for characterizing, not sizing lymph nodes.” Radiographics

L2 (Advanced)

L2 Question 6: Which of the following features suggest malignancy in non-calcified lymphadenopathy on CT? (Select all that apply)

a) Size >10 mm
b) Irregular margins
c) Central necrosis
d) Homogeneous low density

Answer: a) Size >10 mm, b) Irregular margins, c) Central necrosis

Comments

Features such as enlarged size, irregular margins, and central necrosis are suggestive of malignancy due to invasive and necrotic tumor processes. “Irregular margins and central necrosis are classic imaging findings in malignant lymphadenopathy.” Radiographics

Incorrect Answers

d) Homogeneous low density: “Low-density lymph nodes without necrosis are more often associated with benign reactive lymphadenopathy.” RadiologyKey

L2 Question 7: Which clinical scenario is most concerning for malignant lymphadenopathy?

a) A 35-year-old with bilateral hilar lymphadenopathy and no symptoms
b) A 60-year-old with unilateral large mediastinal mass and weight loss
c) A 25-year-old with symmetric hilar lymphadenopathy and erythema nodosum
d) A 50-year-old with small bilateral mediastinal nodes on routine chest CT

Answer: b) A 60-year-old with unilateral large mediastinal mass and weight loss

Comments

Unilateral large mediastinal masses associated with systemic symptoms raise suspicion for malignancy. “Unilateral lymphadenopathy with systemic symptoms such as weight loss can suggest malignancy.” AJR

Incorrect Answers

a) “Bilateral hilar lymphadenopathy without symptoms is often seen in sarcoidosis.” Radiopaedia
c) “Symmetric hilar lymphadenopathy with erythema nodosum is characteristic of sarcoidosis, not malignancy.” Radiopaedia
d) “Small bilateral mediastinal nodes are often reactive or benign.” Radiopaedia

L2 Question 8: Which pattern of lymphadenopathy is most suggestive of lymphoma?

a) Bulky mediastinal mass
b) Multiple small peripheral lung nodes
c) Isolated right hilar node
d) Unilateral subcarinal node

Answer: a) Bulky mediastinal mass

Comments

A bulky mediastinal mass is a common presentation of lymphoma, particularly Hodgkin lymphoma. “Bulky mediastinal masses are often associated with lymphoma, especially Hodgkin’s disease.” AJR

Incorrect Answers

b) “Peripheral lung nodes are more typical of metastatic disease than lymphoma.” RadiologyKey
c) “An isolated right hilar node can be reactive or due to infection.” Radiopaedia
d) “A unilateral subcarinal node is not a specific indicator for lymphoma.” Radiopaedia

L2 Question 9: Which of the following conditions is most commonly associated with non-calcified lymphadenopathy and night sweats?

a) Sarcoidosis
b) Hodgkin’s lymphoma
c) Histoplasmosis
d) Silicosis

Answer: b) Hodgkin’s lymphoma

Comments

Hodgkin’s lymphoma frequently presents with systemic symptoms, including night sweats and non-calcified lymphadenopathy. “Night sweats and non-calcified lymphadenopathy are classic symptoms in Hodgkin’s lymphoma.” ATS

Incorrect Answers

a) Sarcoidosis: “Sarcoidosis can present with lymphadenopathy but typically lacks systemic symptoms like night sweats.” Radiopaedia
c) Histoplasmosis: “Histoplasmosis often causes calcified lymphadenopathy rather than non-calcified.” Radiopaedia
d) Silicosis: “Silicosis usually presents with calcified lymphadenopathy rather than non-calcified forms.” Radiopaedia

L2 Question 10: What imaging feature would most warrant a biopsy in non-calcified lymphadenopathy?

a) Smooth margins and small size
b) Central necrosis and irregular margins
c) Symmetrical hilar enlargement
d) Isolated right hilar node

Answer: b) Central necrosis and irregular margins

Comments

Central necrosis and irregular margins raise suspicion for malignancy and often necessitate further histopathological evaluation. “Lymph nodes with central necrosis and irregular margins often warrant biopsy due to a higher likelihood of malignancy.” Radiographics

Incorrect Answers

a) “Small, smoothly marginated lymph nodes are more commonly benign.” Radiopaedia
c) “Symmetrical hilar enlargement is more typical of benign conditions such as sarcoidosis.” RadiologyKey
d) “An isolated right hilar node can be reactive rather than indicating malignancy.” Radiopaedia
a) Sarcoidosis
b) Hodgkin’s lymphoma
c) Histoplasmosis
d) Silicosis