American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common characteristic of SPN in a current smoker with a history of smoking cessation less than 5 years?

1. Size less than 0.8 cm

2. Size between 0.8-2.0 cm

3. Size greater than or equal to 2.0 cm

4. Size between 1.5-2.0 cm is indeterminate

The correct answer is: Size greater than or equal to 2.0 cm

A common characteristic of a solitary pulmonary nodule (SPN) in a current smoker, especially one with a history of smoking cessation of less than 5 years, is that it is likely to be larger in size, particularly when categorized as greater than or equal to 2.0 cm. The risk of malignancy in pulmonary nodules increases with size, and larger nodules have a higher probability of being cancerous. In smokers and former smokers, the association is even stronger, as the risk of lung cancer is significantly elevated in these individuals due to the carcinogenic effects of tobacco smoke. Nodules of this size warrant further evaluation, such as imaging studies or biopsies, as they require careful consideration in the context of the patient's smoking history and risk factors. In contrast, smaller nodules—particularly those less than 0.8 cm—are often considered to have a lower risk of malignancy and are frequently managed with a more conservative follow-up approach. Similarly, nodules between 0.8 and 2.0 cm, while still necessitating careful evaluation, do not carry the same level of concern as those that are larger. Therefore, recognizing that larger sizes in the context of a patient with significant risk factors, such