Suspicious Pulmonary Nodule — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateRespiratorySuspicious Pulmonary NoduleRACP Adult Medicine

A 60-year-old male smoker (40 pack-years) has an incidental 12 mm solid spiculated pulmonary nodule in the right upper lobe on CT. No prior imaging for comparison. He has no symptoms. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — PET-CT

A 12 mm spiculated nodule in a smoker is high-risk for malignancy (~15-30% pre-test probability). PET-CT is the recommended next step for solid nodules >8 mm to assess metabolic activity. If PET-avid (SUVmax >2.5), CT-guided biopsy or surgical excision is indicated. If PET-negative, short-interval CT follow-up (3 months). Multidisciplinary lung cancer MDT discussion is recommended for nodules ≥8 mm.

Reference: Fleischner Society – 2017; BTS 2024 Pulmonary Nodule; Cancer Council 2024