American Board of Internal Medicine (ABIM) Certification Practice Exam

For a solitary pulmonary nodule greater than 8 mm with high pretest probability, what follow-up procedures are suggested?

1. Follow-up CT at 1 month and MRI

2. Follow-up CT at around 3, 9, and 24 months with additional imaging

3. Only surgical excision

4. No follow-up actions are recommended

The correct answer is: Follow-up CT at around 3, 9, and 24 months with additional imaging

When dealing with a solitary pulmonary nodule greater than 8 mm with a high pretest probability of malignancy, the approach to follow-up is critical. The recommended follow-up procedures generally involve a structured imaging strategy to assess for any signs of growth or progression over time. Following up with a CT scan at around 3 months, 9 months, and 24 months is important in this context. This method allows clinicians to monitor the nodule closely while balancing the need to avoid unnecessary interventions. The 3-month follow-up is particularly crucial, as it helps to rule out early growth, which can indicate malignancy. Observing the nodule at these intervals, rather than opting for immediate surgical intervention or no follow-up, helps to ensure that any changes in the nodule's characteristics can be closely observed, allowing for a more informed clinical decision regarding further management. The strategy of rigorous imaging over time helps to either confirm the nodule's benign nature or identify any malignant changes that may necessitate surgical excision or other treatments. This systematic approach is aligned with guidelines that advocate for active surveillance before pursuing more invasive procedures, particularly in cases where there is a relatively high suspicion for cancer but still uncertainty about the diagnosis. In contrast, immediate surgical