Pulmonary and Critical Care Medicine Q35

A 72-year-old woman is evaluated during a routine visit. She has a 30-pack-year smoking history and quit 5 years ago. She has a history of mild COPD and breast cancer diagnosed 15 years ago, currently in remission. A chest radiograph from 5 years ago showed no signs of disease recurrence. Medications are albuterol and tiotropium inhalers. On physical examination, vital signs are normal. Lung examination reveals prolonged expiration and diminished breath sounds throughout. The breast examination is unremarkable. A screening low-dose chest CT scan shows a peripheral 9-mm solid pulmonary nodule in the left upper lobe and emphysema but no mediastinal or hilar lymphadenopathy and no pleural effusion. A PET/CT scan using fluorodeoxyglucose (FDG) is performed and the nodule is intensely hypermetabolic. There is no evidence of distant uptake.

Which of the following is the most appropriate management?

A Bronchoscopy with biopsy

B Serial chest CT scans

C Surgical wedge resection

D Transthoracic needle aspiration

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