Internal Medicine: Miscellaneous

Question 1

What is the management approach to a Solid solitary nodule that has a low probability of being malignant?

Answer 1

Follow with serial CT scans

Question 2

What is the management approach to a Solid solitary nodule that is smaller than 1 cm and has an intermediate probability of being malignant?

Answer 2

Follow with serial CT scans

Question 3

What is the management approach to a Solid solitary nodule that is 8-10 mm or larger and has an intermediate probability of being malignant?

Answer 3

Evaluate with 18-fluorodeoxyglucose positron emission tomography (FDG-PET). Nodules that are negative on FDG-PET can be followed with serial CT scans, while nodules that are positive should be excised

Question 4

What is the management approach to a Solid solitary nodule that has a high probability of being malignant?

Answer 4

Excision

Question 5

How does 18-fluorodeoxyglucose positron emission tomography (FDG-PET) distinguish between malignant and benign lesions and when is it indicated in a patient with a solitary pulmonary nodule?

Answer 5

Cancers are metabolically active and take up FDG avidly. It is indicated for patients with a solid or part-solid SPN that is 8 to 10 mm or greater in size and has an intermediate probability of malignancy, especially if the patient has increased surgical risk.

Approximately 95 percent of patients with a malignant nodule will have an abnormal FDG-PET and 78 percent of patients with a benign lung nodule will have a normal FDG-PET. As a result, a negative FDG-PET will correctly exclude cancer in most cases, but a positive FDG-PET will incorrectly identify infectious, inflammatory, or granulomatous nodules as malignant with considerable frequency

Question 6

When is a fiberoptic bronchoscopy useful in evaluating a solitary pulmonary nodule?

Answer 6

Fiberoptic bronchoscopy is a reasonable approach for the diagnostic evaluation of large, central nodules and masses. It is much less useful for small or peripheral SPNs

Question 7

What are the 5 CHADS2 Score criteria?

Answer 7

1. Congestive heart failure (any history): 1 point
2. Hypertension (prior history): 1 point
3. Age ≥75 years: 1 point
4. Diabetes mellitus: 1 point
5. Secondary prevention in patients with a prior ischemic stroke or a transient ischemic attack; most experts also include patients with a systemic embolic event: 2 points

The CHADS2 score estimates the risk of stroke, which is defined as focal neurologic signs or symptoms that persist for more than 24 hours and that cannot be explained by hemorrhage, trauma, or other factors, or peripheral embolization, which is much less common. Transient ischemic attacks are not included.

Question 8

What is the approach to a patient that has been in atrial fibrillation for >48hrs

Answer 8

4 weeks of therapeutic oral anticoagulation prior to cardioversion

Question 9

What are the first line agents for rate control in a patient with A-fib?

Answer 9

Beta blockers and nondihydropyridine calcium channel blockers