A 38-year-old man with pulmonary nodule - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 12-15-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 617 Times in 234 Posts
Reputation: 627
Arrow A 38-year-old man with pulmonary nodule

A 38-year-old man is being seen in his physician’s office after being involved in a car accident. He now has a vague pain along his right sternal border, where he crashed into the steering wheel. On examination, his temperature is 36.6 °C (97.8°F), pulse is 80/min, bloodpressure is 123/75 mm Hg, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Physical examination is significant for point tenderness over the right sternal border. An x-ray of the chest shows no broken ribs but a single, well-circumscribed pulmonary nod-ule, 1.5 cm in diameter, located in the left lower lung field. A search through the patient’s electronic medical file reveals that he had an x-ray of the chest taken 2 years ago. The radiology report from that time reveals that the nod-ule was only 0.75 cm in diameter. To characterize the lesion, a CT scan of the chest is performed and shows “popcorn” calcification within the lesion. Which of the following risk factors most increases the chances of malignancy?

(A) Discrete border
(B) Doubling time
(C) Nodule diameter of 1.5 cm
(D) Patient age
(E) “Popcorn” calcification
Reply With Quote Quick reply to this message



  #2  
Old 12-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 623
Threads: 111
Thanked 424 Times in 264 Posts
Reputation: 434
Default

B) Doubling time
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (12-17-2012)
  #3  
Old 12-16-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS+3
Posts: 179
Threads: 16
Thanked 94 Times in 59 Posts
Default

(C) Nodule diameter of 1.5 cm
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (12-17-2012)
 
  #4  
Old 12-16-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 673 Times in 317 Posts
Reputation: 691
Default

i think doubling time......nodules less than 2 cm are fine.....
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (12-17-2012)
  #5  
Old 12-17-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 617 Times in 234 Posts
Reputation: 627
Default

The correct answer is B.
Review of old x-rays is crucial because they can give an indication of the nodule’s doubling time. A doubling time between 20 and 400 days is more concerning for malignancy. For example, small cell cancer doubles every 30 days, adenocarcinoma doubles every 180 days, and well differentiated cancers have an even longer doubling time. Benign processes generally have doubling times that are < 20 days (infection) or > 450 days (old granulomas). The doubling time for this patient is not 2 years. On x-ray of the chest, a pulmonary nodule appearsas a coin-shaped lesion, when in actuality it is best approximated as a three-dimensional sphere. Thus, if a calculation is performed for the volume of the nodule/sphere, we observe close to an eightfold increase in size. Thus, the lesion doubled in size three times during the 2-year period, meaning that the doubling time was 2 years divided by 3, or every two-thirds of a year (243.5 days).
Nodule size is directly
In one study, 80% of nodules > 3 cm were malignant compared with 20% in nodules < 2 cm.
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (12-18-2012), anomali (12-19-2012), fadi551 (12-27-2012), stepdoc1 (12-18-2012)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Solitary pulmonary nodule tyagee USMLE Step 2 CK Forum 10 01-10-2013 12:56 AM
Pulmonary Nodule: Risk factors for malignancy K06100 USMLE Step 2 CK Forum 4 09-30-2012 04:44 PM
Another solitary pulmonary nodule question tyagee USMLE Step 2 CK Forum 5 05-25-2012 08:00 AM
Solitary pulmonary nodule sonu.agarwall USMLE Step 2 CK Forum 6 11-14-2011 09:34 AM
1.5 CM Pulmonary Nodule in a smoker! ag2011n USMLE Step 2 CK Forum 4 09-13-2011 03:43 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)