American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the role of surgery in the management of impending pathologic fractures in metastatic breast cancer?

1. To improve survival rates

2. To prevent further metastases

3. To stabilize bone structure

4. To eliminate the tumor

The correct answer is: To stabilize bone structure

Surgery plays a crucial role in the management of impending pathologic fractures in patients with metastatic breast cancer, primarily by stabilizing the bone structure. When a bone is compromised due to metastatic lesions, it becomes more susceptible to fractures, which can severely impact a patient's mobility and quality of life. By performing surgical procedures, such as internal fixation or intramedullary nailing, the integrity of the affected bone can be reinforced, preventing fracturing under stress and allowing the patient to maintain function. The other options, while potentially relevant in different contexts, do not specifically pertain to the primary goal of surgery for impending fractures. For instance, improving survival rates generally requires systemic treatment approaches rather than localized surgical intervention. Similarly, preventing further metastases is not a direct outcome of surgical stabilization; surgery targets the mechanical strength of the bone rather than the underlying cancer. Lastly, eliminating the tumor is not achievable through surgery in most cases of metastatic disease, as these lesions are often multiple and can involve significant portions of skeletal anatomy, making complete resection impractical. Thus, the primary purpose of surgery in this context is indeed to stabilize bone structure and prevent the complications that arise from pathologic fractures.