MCQ Spiculated Lung Lesion

L1 (Basic)

L1 Question 1: What is the most common cause of a spiculated lung nodule?

  • a) Tuberculosis
  • b) Adenocarcinoma
  • c) Sarcoidosis
  • d) Rheumatoid nodules

Answer: b) Adenocarcinoma

Comments

Adenocarcinoma is the most common cause of a spiculated lung nodule, as the irregular margins often result from malignant infiltration into adjacent lung parenchyma. “A spiculated nodule is highly suggestive of malignancy, with adenocarcinoma being the most common cause.” Radiopaedia

Incorrect Answers

  • a) Tuberculosis can cause granulomas but typically lacks spiculations. Radiopaedia
  • c) Sarcoidosis can present with nodules but often lacks significant spiculation. Radiopaedia
  • d) Rheumatoid nodules are often well-circumscribed without spiculations. Radiopaedia

L1 Question 2: Which imaging modality is the most sensitive for identifying spiculated lung nodules?

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

Answer: c) CT Scan

Comments

CT scans provide the most detailed evaluation of lung nodules and can identify spiculations clearly. “CT scanning is the modality of choice for evaluating lung nodules due to its high sensitivity and detail.” Radiographics

Incorrect Answers

  • a) Chest X-rays may miss small nodules or subtle spiculation. Radiopaedia
  • b) MRI is not commonly used for lung nodule evaluation. RadiologyKey
  • d) PET-CT evaluates metabolic activity but lacks detailed anatomic resolution for nodules. RadiologyKey

L1 Question 3: What microscopic features are seen in a spiculated lung nodule under pathology?

  • a) Fibroblast proliferation and collagen deposition
  • b) Necrotic tissue with no cellular detail
  • c) Normal alveolar architecture
  • d) Completely calcified nodules

Answer: a) Fibroblast proliferation and collagen deposition

Comments

Microscopically, spiculated lung nodules often show fibroblast proliferation, collagen deposition, and tumor infiltration into the lung interstitium, consistent with malignancy. “Spiculated nodules often demonstrate fibroblast proliferation, desmoplastic reaction, and collagen deposition, indicative of malignancy.” AJR

Incorrect Answers

  • b) Necrotic tissue is more typical of infections rather than spiculated malignancies. Radiopaedia
  • c) Normal alveolar architecture is inconsistent with spiculated lesions. Radiopaedia
  • d) Completely calcified nodules are more typical of benign granulomas. RadiologyKey

L1 Question 4: Does the size of a spiculated lung nodule influence the likelihood of malignancy?

  • a) No, size does not affect malignancy risk
  • b) Yes, nodules >8 mm have a higher risk
  • c) Only nodules larger than 3 cm are concerning
  • d) Nodules smaller than 6 mm have the highest risk

Answer: b) Yes, nodules >8 mm have a higher risk

Comments

Nodules greater than 8 mm are associated with an increased risk of malignancy. Smaller nodules, particularly those <6 mm, are less concerning but may still warrant follow-up. “Nodules >8 mm have a greater likelihood of malignancy and typically warrant further investigation or biopsy.” Fleischner Society Guidelines

Incorrect Answers

  • a) Size is a significant factor in risk stratification for malignancy. Fleischner Society Guidelines
  • c) Lesions larger than 3 cm are considered masses and evaluated differently. Radiopaedia
  • d) Nodules smaller than 6 mm are generally of lower concern but may require follow-up in high-risk patients. Radiopaedia

L1 Question 5: If a 4mm spiculated lung lesion is identified on chest CT, how does its malignancy risk compare to other 4mm nodules?

  • a) Higher malignancy risk than a solid 4mm nodule
  • b) Same risk as a solid 4mm nodule
  • c) Lower risk than a solid 4mm nodule
  • d) No malignancy risk

Answer: a) Higher malignancy risk than a solid 4mm nodule

Comments

A 4mm spiculated nodule carries a higher risk for malignancy compared to a solid nodule of the same size due to its irregular shape and possible infiltration into surrounding tissue. “Spiculated nodules, regardless of size, have an increased malignancy risk compared to smooth, solid nodules.” Fleischner Society Guidelines

Incorrect Answers

  • b) Solid nodules of similar size typically have lower risk without additional risk factors. Radiopaedia
  • c) Spiculated nodules generally imply a higher risk due to aggressive features. Radiographics
  • d) Even small spiculated nodules may warrant follow-up depending on patient risk factors. Radiopaedia

L2 (Advanced)

L2 Question 6: Which of the following features on a CT scan raises the suspicion of malignancy in a spiculated lung lesion? (Select all that apply)

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

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

Comments

Irregular margins, central necrosis, and size >10 mm are typical of malignant lesions. “Spiculated margins and central necrosis are highly indicative of malignancy in lung nodules.” AJR

Incorrect Answers

  • d) Homogeneous low density is more often seen in benign lesions like granulomas. Radiopaedia

  • L2 Question 7: What percentage of spiculated lung nodules are malignant?

    • a) 20%
    • b) 50%
    • c) 80%
    • d) 95%

    Answer: c) 80%

    Comments

    Approximately 80% of spiculated lung nodules are malignant, emphasizing the need for careful follow-up and potential biopsy. “Spiculated nodules carry an 80% probability of malignancy, warranting further investigation.” Fleischner Society Guidelines

    Incorrect Answers

    L2 Question 8: Which benign condition can present with a spiculated lung nodule?

    • a) Pulmonary Langerhans cell histiocytosis
    • b) Tuberculosis
    • c) Sarcoidosis
    • d) All of the above

    Answer: d) All of the above

    Comments

    Several benign conditions, including Pulmonary Langerhans cell histiocytosis, tuberculosis, and sarcoidosis, can present with spiculated nodules. “While spiculated nodules are often malignant, certain benign conditions can mimic this pattern.” Radiopaedia

    Incorrect Answers

    • a, b, c) Each of these conditions can independently present with spiculated features. Radiopaedia

    L2 Question 9: According to the Fleischner Society guidelines, how should a 5mm spiculated lung nodule be managed in a low-risk patient?

    • a) Immediate biopsy
    • b) Follow-up CT in 6-12 months
    • c) No follow-up needed
    • d) PET-CT immediately

    Answer: b) Follow-up CT in 6-12 months

    Comments

    For a low-risk patient with a 5mm spiculated lung nodule, the Fleischner Society recommends follow-up CT in 6-12 months rather than immediate intervention due to the size. “Nodules smaller than 6 mm typically warrant short-term follow-up rather than immediate biopsy.” Fleischner Society Guidelines

    Incorrect Answers

    • a) Immediate biopsy is generally not recommended for nodules <6mm without other risk factors. Radiopaedia
    • c) Even small spiculated nodules may warrant follow-up due to their concerning morphology. RadiologyKey
    • d) PET-CT is less reliable for nodules <8mm due to limited metabolic activity. Radiopaedia

    L2 Question 10: A patient with known sarcoidosis presents with a new 10mm spiculated lung nodule without other evidence of new activity in the remaining lung. What is the most appropriate next step?

    • a) Immediate biopsy
    • b) PET-CT to assess metabolic activity
    • c) Follow-up CT in 6-12 months
    • d) Assume benign due to sarcoidosis history

    Answer: b) PET-CT to assess metabolic activity

    Comments

    In a patient with a known history of sarcoidosis presenting with a new spiculated nodule, PET-CT is appropriate to differentiate benign inflammation from potential malignancy. “In cases with prior inflammatory disease, PET-CT can help assess metabolic activity to distinguish malignancy from benign changes.” Radiopaedia

    Incorrect Answers

    • a) Immediate biopsy is generally not the first step without metabolic data. Fleischner Society Guidelines
    • c) Follow-up CT alone may delay diagnosis if malignancy is present. Radiopaedia
    • d) Assuming benign without further evaluation is not recommended. Radiopaedia