Question Kaplan Step 2 videos vs UW

[dangit]

Hi there,

I had a question about lung nodules found on CXR.

Kaplan Videos states that if pt is high risk (>50 and smoking hx), you should bx as next step. CT is not the first choice.

But UW states that you should do a CT before bx....

Can you clarify this for me? Thanks I greatly appreciate it.

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[OveractiveBrain]

Hi there,

I had a question about lung nodules found on CXR.

Kaplan Videos states that if pt is high risk (>50 and smoking hx), you should bx as next step. CT is not the first choice.

But UW states that you should do a CT before bx....

Can you clarify this for me? Thanks I greatly appreciate it.

How can you biopsy a nodule if you dont know where it is? CT first tells you its a Bronch (if its close to the mainstem) or a Percutaneous Needle (if its close to the pleura) or a VATS (if its in between)

onlinemeded.org/pulm
watch these videos. they are free, new, and legal

 

[AndyRSC]

Which Kaplan video suggests biopsy first? I'm guessing pulm, since I haven't gotten to it yet.

The surgery videos suggest this approach:

- Once lesion cinfirmed by CXR, first step is to compare to an older CXR (if available). As lung cancer grows in a predictable way and at predictable rate, if the same lesion was present on an old CXR, it's unlikely to be cancer; if the lesion was not present, cancer becomes much more likely.
- The next step is to perform a CT scan and sputum cytology. These are both good starting points as they are noninvasive.
- The main points of diagnosis will come from bronchoscopy + biopsy for central lesion, or transthoracic needle biopsy for peripheral lesion. If this step fails, you go to thoracotomy or thoracoscopy.

 

[bigyihoroi]

Hi there,

I had a question about lung nodules found on CXR.

Kaplan Videos states that if pt is high risk (>50 and smoking hx), you should bx as next step. CT is not the first choice.

But UW states that you should do a CT before bx....

Can you clarify this for me? Thanks I greatly appreciate it.

I just did that question on Uworld and pick scope+biopsy. I recalled one of kaplan dudes said something about <50 yo without smoking hx should repeat CXR in 3 months vs. >50yo with smoking hx should go directly to biopsy, but i think he assumed we remembered to get CT first as mentioned in most of the other videos.