American Board of Internal Medicine (ABIM) Certification Practice Exam

Disable ads (and more) with a membership for a one time $2.99 payment

Study for the ABIM Certification Exam. Use flashcards and multiple choice questions, with hints and explanations for each. Get ready to succeed!

Each practice test/flash card set has 50 randomly selected questions from a bank of over 500. You'll get a new set of questions each time!

Practice this question and more.


In patients with T3N1 disease, which initial therapy is recommended?

  1. Combined chemoradiation therapy

  2. Surgery including mediastinal lymph node dissection

  3. Palliative care

  4. Observation without treatment

The correct answer is: Surgery including mediastinal lymph node dissection

In patients with T3N1 disease, the recommended initial therapy is surgery, particularly including mediastinal lymph node dissection. This is due to the nature of T3N1 disease, which indicates a locally advanced tumor (T3) with regional lymph node involvement (N1). The management of this stage typically aims for a curative approach when possible. Surgery allows for the direct removal of the primary tumor and involved lymph nodes, which can potentially lead to better outcomes. By excising the tumor along with any affected lymph nodes, the risks of recurrence can be reduced significantly, especially important in cases of T3 disease where the tumor may involve nearby structures. Combined chemoradiation therapy, while effective in certain cases, is usually reserved for more advanced stages, such as when the tumor is unresectable or in the presence of substantial comorbidities. Palliative care and observation without treatment do not address the need for definitive management in this context, as they are more appropriate for patients with advanced disease where curative options are not feasible.