American Board of Internal Medicine (ABIM) Certification Practice Exam

What clinical finding is primarily associated with immediate treatment needs in SVC syndrome?

1. Fatigue

2. Hemoptysis

3. Laryngeal edema

4. Chest pain

The correct answer is: Laryngeal edema

In the context of superior vena cava (SVC) syndrome, laryngeal edema is particularly concerning and indicates an immediate treatment need. This condition arises when there is swelling in the throat due to obstruction from the engorgement of blood vessels, leading to potential airway compromise. Patients experiencing laryngeal edema may have difficulty breathing, a hoarse voice, or stridor, which signifies that the airway is at risk of becoming obstructed. The presence of laryngeal edema necessitates prompt intervention, as it can quickly progress to a life-threatening situation if the airway becomes completely obstructed. Immediate treatment may include securing the airway, which can involve intubation or tracheostomy, and addressing the underlying cause of the SVC syndrome, such as tumor compression or thrombosis. While the other symptoms such as fatigue, hemoptysis, and chest pain can be associated with SVC syndrome, they do not pose the same urgent threat to the airway. Fatigue is often a nonspecific symptom indicative of underlying pathology but does not require immediate intervention. Hemoptysis may indicate pulmonary complications but is not inherently life-threatening in the same way laryngeal edema is. Chest pain might suggest a wide variety of differential diagnoses