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Biopsy and lymph node dissection
40%
2/5
CT scan in 6 months
20%
1/5
No further workup indicated
PET scan
Surgical excision
0%
0/5
Select Answer to see Preferred Response
This patient is presenting with a large pulmonary nodule (> 8 mm) discovered incidentally on imaging in a low-risk patient. He should be further worked up with a PET scan given the size of the lesion. The management of a pulmonary nodule depends on the lesion size, patient symptoms, and risk factors. In a low/intermediate-risk patient with a nodule > 8 mm, the best next step in management is to further characterize the lesion with a PET scan (though a biopsy can also be performed). If the PET scan shows a lesion concerning for malignancy, then surgical excision is indicated. If the lesion is not concerning for malignancy, it can be followed with serial CT scans. Incorrect Answers: Answer 1: Biopsy and lymph node dissection are incorrect as dissection of the lymph nodes would not be indicated at this time. It is true that a biopsy could be performed next in this low-risk patient with a large pulmonary nodule. Answer 2: CT scan in 6 months would be indicated if the PET scan was performed and was negative for a suspicious malignant lesion. At this point, serial CT scans could be performed. Answer 3: No further workup indicated would be indicated in a low-risk patient with a lesion 4 mm or smaller that was discovered incidentally. Answer 5: Surgical excision would be indicated if the lesion was suspicious on PET scan or if biopsy confirmed a malignancy. Bullet Summary: A low/intermediate-risk patient with a pulmonary nodule 8 mm or greater should have a PET scan or biopsy performed.
4.0
(6)
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