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Endobronchial obstruction — SCE Respiratory MCQ

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HardThoracic ImagingEndobronchial obstructionSCE Respiratory

A 61-year-old smoker has recurrent right upper lobe pneumonia. CT shows right upper lobe collapse with an abrupt cut-off of the upper lobe bronchus and distal mucus impaction. There is no pleural effusion. What is the most appropriate investigation?

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Correct answer: D — Flexible bronchoscopy to inspect and sample the airway

The best answer is “Flexible bronchoscopy to inspect and sample the airway”. Flexible bronchoscopy to inspect and sample the airway is the investigation that most directly resolves the remaining diagnostic or staging uncertainty at this point in the pathway. The alternatives address different questions, have lower expected yield, or would be premature before this result. The remaining choices—“Repeat chest radiograph in 6 months, after specialist assessment”, “Serum Aspergillus IgG principally, with clinical reassessment”, “V/Q scan for chronic thromboembolic disease, within a respiratory pathway”, “Trial of oral steroids for presumed organising pneumonia”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: British Thoracic Society guideline for pleural disease: https://thorax.bmj.com/content/78/Suppl_3/s1