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Acute Exacerbation of COPD with Type 2 Respiratory Failure — MRCP Part 1 MCQ

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HardRespiratory MedicineAcute Exacerbation of COPD with Type 2 Respiratory FailureMRCP Part 1MRCEM SBAUKMLAPARA

CT shows a 5.2-cm enhancing renal mass. Imaging is not diagnostic of benign disease; the patient is fit and has chosen partial nephrectomy as first treatment. There is no suspicion of lymphoma, metastasis or infection. What does NG256 indicate about biopsy?

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Correct answer: CProceed to surgery without routine preoperative biopsy

The best answer is “Proceed to surgery without routine preoperative biopsy”. For a mass over 4 cm, biopsy is considered only in specified circumstances, including benign-appearing imaging, planned ablation/SABR or a patient request to avoid surgery. When surgery is clearly the first treatment and none applies, routine biopsy is not required.

Reference: NICE NG256, Renal cell carcinoma: diagnosis and management: https://www.nice.org.uk/guidance/ng256/chapter/Diagnosis