American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the follow-up imaging recommendation for solitary pulmonary nodules greater than 8 mm with high pretest probability of malignancy?

1. Initial follow-up CT at 12 months

2. Dynamic contrast-enhanced CT, PET, and/or biopsy at 3, 9, and 24 months

3. Immediate hospitalization

4. Only a routine CT every 2 years

The correct answer is: Dynamic contrast-enhanced CT, PET, and/or biopsy at 3, 9, and 24 months

For solitary pulmonary nodules greater than 8 mm that have a high pretest probability of malignancy, the recommendation for follow-up imaging is to use a combination of dynamic contrast-enhanced CT, PET scans, and/or biopsies at specific intervals, such as 3, 9, and 24 months. This approach is grounded in the need for a thorough assessment given the elevated risk of cancer associated with larger nodules. The intervals of 3 and 9 months are particularly important because they allow for early detection of any changes in the nodule’s characteristics that could suggest malignancy. A PET scan, which measures metabolic activity, can help distinguish benign from malignant nodules by highlighting areas of increased metabolic activity that are often indicative of cancer. Likewise, dynamic contrast-enhanced CT can provide further detailed imaging to assess the properties of the nodule. In contrast, routine imaging at longer intervals, such as every 2 years, does not align with the clinical urgency presented by nodules of this size and potential risk. Initial follow-up at 12 months would be considered insufficient for more aggressive monitoring. Immediate hospitalization is not warranted unless there are acute symptoms or complications arising from the nodule. Therefore, the multifaceted approach in option B is the