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Preoperative lung cancer assessment — SCE Respiratory MCQ

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HardLung CancerPreoperative lung cancer assessmentSCE Respiratory

A 71-year-old man with stage I NSCLC is being assessed for lobectomy. FEV1 is 52% predicted and TLCO is 38% predicted; he desaturates on shuttle walk testing. What is the most appropriate investigation?

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

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Correct answer: D — Cardiopulmonary exercise testing

The best answer is “Cardiopulmonary exercise testing”. Cardiopulmonary exercise testing 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—“Serum ACE level”, “Pleural fluid cytology”, “Peak-flow diary, after safety review”, “Overnight oximetry as sole operative assessment”—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: NICE NG122 lung cancer: diagnosis and management: https://www.nice.org.uk/guidance/ng122/chapter/Recommendations