American Board of Internal Medicine (ABIM) Certification Practice Exam

What is necessary in the preoperative workup for NSCLC?

1. Baseline pulmonary function with DLCO and spirometry

2. Only imaging studies

3. Genetic testing

4. Blood transfusions

The correct answer is: Baseline pulmonary function with DLCO and spirometry

In the preoperative workup for non-small cell lung cancer (NSCLC), obtaining baseline pulmonary function tests, including diffusion capacity of the lungs for carbon monoxide (DLCO) and spirometry, is essential. This is because assessing a patient's lung function helps to evaluate their respiratory reserve and fitness for surgery. Surgery for NSCLC can significantly impact lung function, and understanding a patient’s baseline pulmonary status is critical for anticipating postoperative complications such as respiratory failure. In patients with compromised lung function, the risk of adverse outcomes during and after lung surgery increases, often necessitating further interventions or careful planning of the surgical approach. While imaging studies are indeed important in the management of NSCLC to determine the extent of disease and to aid in surgical decision-making, they do not assess the physiological capability of the lungs. Genetic testing may be valuable for targeted therapies in specific situations but is not a routine component of preoperative evaluation. Blood transfusions are also not a standard part of the preoperative workup for lung cancer, as they are only indicated in specific scenarios related to anemia or significant blood loss. Thus, the assessment of pulmonary function is vital for determining the suitability of a patient for surgical interventions in NSCLC.