American Board of Internal Medicine (ABIM) Certification Practice Exam

For a solitary pulmonary nodule greater than 6 mm and less than or equal to 8 mm with low pretest probability, what is the recommended follow-up?

1. Initial follow-up CT every 6 months

2. Initial follow-up CT at 6 to 12 months

3. No follow-up needed

4. Immediate surgical intervention

The correct answer is: Initial follow-up CT at 6 to 12 months

The recommended follow-up for a solitary pulmonary nodule greater than 6 mm and less than or equal to 8 mm with low pretest probability is to conduct an initial follow-up CT at 6 to 12 months. This approach is aligned with established guidelines for the management of pulmonary nodules, such as those from the American College of Chest Physicians and the Fleischner Society. For nodules of this size, the rationale for follow-up imaging is to monitor for growth, which can indicate malignancy, especially in cases where there's a low probability of cancer based on clinical judgment and patient history. The initial follow-up at 6 to 12 months is appropriate, as it allows sufficient time for any potential change in the nodule's characteristics to be assessed. If there is no significant change in size at this initial follow-up, the frequency of subsequent imaging can often be decreased. The other options suggest either more aggressive follow-up or immediate intervention, which is not warranted in cases where the pretest probability of malignancy is low. Regular imaging allows for careful observation, striking a balance between vigilance for potential malignancy and avoiding unnecessary invasive procedures.