American Board of Internal Medicine (ABIM) Certification Practice Exam

What imaging tests may be considered for solitary pulmonary nodules greater than 8 mm with low pretest probability?

1. BIOPSY and follow-up at 6 months

2. Dynamic contrast-enhanced CT, PET, and/or biopsy

3. No imaging is needed

4. Only chest X-ray

The correct answer is: Dynamic contrast-enhanced CT, PET, and/or biopsy

For solitary pulmonary nodules greater than 8 mm with low pretest probability, considering imaging tests such as dynamic contrast-enhanced CT, PET scans, and/or biopsy is appropriate due to several factors. Dynamic contrast-enhanced CT can provide a more detailed assessment of the nodules and help in differentiating between benign and malignant lesions. It involves the use of contrast material to highlight abnormalities in the lung tissues, thus facilitating the evaluation of the nodule's characteristics, such as size, shape, and vascularity. PET scans are useful because they provide functional imaging that can assess the metabolic activity of the nodule. Malignant nodules often exhibit higher metabolic activity compared to benign ones, making PET an effective tool in the evaluation process. Biopsy allows for histological examination, providing definitive information regarding the nature of the nodule. This step can be particularly crucial if imaging tests raise suspicion of malignancy. In cases where the nodule is greater than 8 mm, further investigation is warranted to ensure appropriate management and to rule out malignancy, especially for patients who may still exhibit some risk factors despite a low pretest probability. Imaging modalities and potential biopsy allow providers to gather more information that would inform treatment decisions and increase the likelihood of detecting malignancy