American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended follow-up for a solitary pulmonary nodule greater than 8 mm with low pretest probability?

1. Follow-up CT at 3, 9, and 24 months

2. Immediate surgical evaluation

3. No follow-up needed

4. Only PET imaging is necessary

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

The recommended follow-up for a solitary pulmonary nodule greater than 8 mm with low pretest probability involves a structured approach to monitor potential changes in the nodule over time without immediate invasive procedures. A solitary pulmonary nodule larger than 8 mm is clinically significant and may warrant further investigation; however, given the low pretest probability suggests a reduced likelihood of malignancy, immediate surgical intervention is not indicated. Instead, following a protocol of surveillance with follow-up CT imaging at specified intervals (typically at 3, 9, and 24 months) allows for careful monitoring of the nodule's characteristics. This approach helps assess whether there are any changes in size, shape, or density that may indicate growth and a potential diagnosis of lung cancer. Immediate surgical evaluation is more appropriate in cases where malignancy is highly suspected based on features observed on imaging or other clinical indicators. Therefore, it wouldn't be suitable in this context. Likewise, while PET imaging can be helpful in some scenarios, it is not the sole necessary follow-up for this type of nodule without clear indications from earlier imaging studies. Lastly, completely forgoing follow-up is not advisable for nodules of this size, as it could potentially overlook a significant pathology. By adhering to