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PET-CT

Practice targeted AMC-style multiple-choice questions on PET-CT.

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A 68-year-old man with a 40 pack-year smoking history presents with a 3-month history of persistent cough, occasional haemoptysis, and a 5 kg weight loss. A chest X-ray shows a left upper lobe opacity. A subsequent CT scan of the chest, abdomen, and pelvis confirms a 4 cm mass in the left upper lobe and identifies several enlarged mediastinal lymph nodes (largest 1.5 cm). There is no clear evidence of distant metastatic disease on the CT scan. He has no neurological symptoms or bone pain. Pulmonary function tests are pending. What is the most appropriate next investigation for staging this patient's non-small cell lung cancer?

A. Brain MRI
B. Bone scan
C. Mediastinoscopy
D. PET-CT scan
E. Repeat CT scan in 3 months
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 45-year-old male presents with a 3-month history of cough and unintentional weight loss. He is a former smoker. Physical examination is unremarkable. A chest X-ray showed a nodule, and a PET-CT was performed for further characterisation, an axial view is shown. Considering the imaging findings and clinical presentation, what is the MOST appropriate next diagnostic step?

A. Initiate empirical anti-tuberculous therapy
B. Repeat sputum studies for acid-fast bacilli
C. Thoracic surgical referral for wedge resection
D. CT-guided percutaneous biopsy
E. Follow-up PET-CT in 3 months
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 65-year-old patient with a history of smoking presents with a chronic cough and mild weight loss over three months. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray revealed a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging was performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided, which of the following is the most appropriate next step in the management of this patient?

A. Refer for surgical resection
B. Bronchoscopy with biopsy or fine needle aspiration
C. Prescribe a course of inhaled corticosteroids
D. Initiate empirical broad-spectrum antibiotics
E. Repeat PET-CT scan in three months
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 68-year-old former smoker with a 30 pack-year history presents to their GP with a 2-month history of persistent cough and increasing fatigue, noting a 3kg unintentional weight loss. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray reveals a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging is performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?

A. Repeat PET-CT scan in 3 months
B. Tissue biopsy via bronchoscopy or CT guidance
C. Initiate empirical chemotherapy
D. Initiate empirical anti-tuberculosis therapy
E. Perform pulmonary function tests
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 3-year-old child presents with a 2-month history of increasing abdominal distension and intermittent pain. On examination, a firm, non-tender mass is palpable in the upper abdomen. Initial blood tests reveal mild anaemia. Vital signs are stable. The provided image was obtained as part of the diagnostic evaluation. Based on the findings in the image and the clinical context, which of the following imaging modalities is most likely to provide critical information regarding potential metastatic disease, which is essential for accurate staging and treatment planning in this paediatric patient?

A. Bone scan with Technetium-99m
B. Contrast-enhanced ultrasound of the abdomen
C. PET-CT with 18F-FDG
D. 123I-MIBG scintigraphy
E. Whole-body MRI
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 58-year-old non-smoker presents with a 4-month history of intermittent fever, night sweats, and a persistent cough productive of small amounts of sputum. He recently emigrated from a region with a high prevalence of tuberculosis. Physical examination is unremarkable. Chest X-ray reveals a solitary nodule in the right upper lobe. A PET-CT scan is performed as part of the investigation. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?

A. Manage conservatively with serial chest X-rays
B. Repeat the PET-CT scan in three months
C. Obtain tissue diagnosis via bronchoscopy or CT-guided biopsy
D. Arrange for surgical resection of the nodule
E. Initiate empirical treatment for pulmonary tuberculosis
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 65-year-old patient with a history of smoking presents with a chronic cough and mild weight loss over three months. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray revealed a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging was performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?

A. Refer for surgical consultation for lobectomy
B. Obtain tissue diagnosis via biopsy
C. Initiate empirical anti-tuberculosis therapy
D. Schedule follow-up CT scan in three months
E. Perform sputum microscopy and culture for acid-fast bacilli
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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino CC BY-SA 2.0 · Source

A 72-year-old woman presents with a persistent, slowly expanding skin lesion on her right chest wall, present for several months. She underwent a right mastectomy for invasive ductal carcinoma 12 years ago. She denies pain, discharge, or systemic symptoms. Physical examination reveals the appearance shown. Considering the patient's history and the clinical finding, which of the following investigations is most appropriate to assess for potential underlying malignancy or systemic involvement?

A. Bone scan
B. Serum tumour markers (CA 15-3, CEA)
C. Mammography of the contralateral breast
D. CT scan of chest, abdomen, and pelvis
E. PET scan
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