Chest and cardiac imaging: tissue sampling of mediastinal nodes: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Chest and cardiac imaging: tissue sampling of mediastinal nodes

Sample item

A PET-CT in a patient with a resectable lung cancer shows FDG-avid subcarinal nodes. Which procedure is the preferred next step to confirm nodal metastasis before surgery?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Endobronchial ultrasound guided needle aspiration

FDG-avid nodes can be inflammatory, so tissue confirmation is needed because N2 disease changes management. EBUS-guided transbronchial needle aspiration is minimally invasive and reaches subcarinal and paratracheal stations. Surgery or radiotherapy without sampling risks wrong treatment.

Option by option

  • A. Endobronchial ultrasound guided needle aspiration (correct)

    Correct. EBUS needle aspiration confirms nodal disease with low morbidity.

  • B. Repeat PET-CT after three months

    Waiting three months delays treatment and does not give tissue.

  • C. Lobectomy and later nodal assessment

    Operating first would commit the patient to surgery that may be inappropriate for N2 disease.

  • D. Mediastinal radiotherapy without sampling

    Radiotherapy without a tissue diagnosis treats inflammatory nodes needlessly.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Endobronchial ultrasound guided needle aspiration. FDG-avid nodes can be inflammatory, so tissue confirmation is needed because N2 disease changes management.

Why is "Repeat PET-CT after three months" not the answer?

Waiting three months delays treatment and does not give tissue.

Why is "Lobectomy and later nodal assessment" not the answer?

Operating first would commit the patient to surgery that may be inappropriate for N2 disease.

Why is "Mediastinal radiotherapy without sampling" not the answer?

Radiotherapy without a tissue diagnosis treats inflammatory nodes needlessly.

What concept does this question test?

It tests Chest and cardiac imaging: tissue sampling of mediastinal nodes in Radiology. EBUS-guided transbronchial needle aspiration is minimally invasive and reaches subcarinal and paratracheal stations. Surgery or radiotherapy without sampling risks wrong treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Chest and cardiac imaging: tissue sampling of mediastinal nodes?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.