skip to main content

Pulmonary nodule — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardInternal Medicine (Chronic Management)Pulmonary noduleUSMLE Step 3

A 65-year-old former smoker with a 32-pack-year history has a 7-mm solid right-upper-lobe pulmonary nodule found on abdominal CT. There is no prior imaging, spiculation, lymphadenopathy, or known cancer. He is otherwise well and would be eligible for curative treatment. Which next step is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Obtain thin-section chest CT, then use nodule risk to plan surveillance

The best answer is “Obtain thin-section chest CT, then use nodule risk to plan surveillance”. The abdominal study incompletely characterizes the thorax. A dedicated thin-section chest CT establishes morphology and searches for additional lesions; a 6–8-mm solid nodule then receives risk-based CT surveillance, commonly at 6–12 months with a later scan depending on risk and stability. PET has limited resolution at this size, antibiotics are not diagnostic, and neither immediate resection nor dismissal is justified.

Reference: ACR Appropriateness Criteria: Incidentally Detected Pulmonary Nodule: https://acsearch.acr.org/list/TopicNarrativePdf?topicId=113