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COPD follow-up and lung cancer screening — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareCOPD follow-up and lung cancer screeningUSMLE Step 3

A 61-year-old man with COPD is seen after discharge for an exacerbation treated with prednisone and azithromycin. He now feels well. He smokes one pack daily and has a 44-pack-year history. Spirometry 1 year ago showed FEV1/FVC of 0.58. Oxygen saturation is 94% on room air. He quit smoking for 6 months once using varenicline but relapsed. Which of the following is the most appropriate next step in management?

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Correct answer: C — Annual low-dose CT and smoking-cessation pharmacotherapy

He meets criteria for annual low-dose CT lung cancer screening and should receive active smoking-cessation treatment. Long-term oxygen is indicated for severe resting hypoxemia, not this oxygen saturation.

Reference: USPSTF Lung Cancer Screening Recommendation 2021; GOLD COPD strategy