American Board of Internal Medicine (ABIM) Certification Practice Exam

What action is advised when a solitary pulmonary nodule is identified without changes over a follow-up period, as per the Fleischner criteria?

1. Increased surveillance for all patients

2. Discharge from follow-up care

3. Consideration for surgical removal

4. Immediate advanced imaging

The correct answer is: Discharge from follow-up care

When a solitary pulmonary nodule is identified and remains stable over an established follow-up period, the Fleischner Society guidelines recommend the patient can be discharged from follow-up care. The rationale behind this recommendation is centered on the assessment of risk associated with the nodule. If imaging studies over time show no significant growth or change in characteristics of the nodule, the likelihood of it being malignant is significantly reduced. This stability suggests that the nodule may be benign. Therefore, continuing to monitor such nodules may not provide additional benefit to the patient while possibly subjecting them to unnecessary stress and healthcare costs. Discharging patients from follow-up care when no changes are detected allows for a more efficient use of medical resources and helps reduce patient anxiety about the nodule's potential risks. This strategy aligns with the principles of evidence-based medicine, where the focus is on providing care that has been proven to be effective and necessary.