USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

What is the first step in managing a solitary thyroid nodule?

1. Begin thyroid hormone replacement therapy

2. Schedule regular monitoring without intervention

3. Perform a fine-needle aspiration (FNA) biopsy

4. Prescribe corticosteroids

The correct answer is: Perform a fine-needle aspiration (FNA) biopsy

The first step in managing a solitary thyroid nodule is to perform a fine-needle aspiration (FNA) biopsy. This procedure is crucial because it allows for the evaluation of the nodule's cytological characteristics and helps to determine whether the nodule is benign or malignant. Thyroid nodules are common, and while most are benign, there is a significant risk for malignancy that necessitates a thorough investigation. An FNA biopsy is a minimally invasive technique that provides a sample of thyroid tissue for analysis and is considered the best initial diagnostic tool. The results of the FNA help guide further management, whether that is observation, surgery, or other interventions based on the findings. Other approaches to managing a solitary thyroid nodule, such as beginning hormone replacement therapy, would not address the need to determine the nature of the nodule. Scheduling regular monitoring without intervention may delay the diagnosis of a potential malignancy, and prescribing corticosteroids is not indicated without a diagnosis of autoimmune thyroiditis or another specific condition. Thus, performing an FNA biopsy is essential to provide the necessary information for appropriate treatment planning.