American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment approach for patients with limited mediastinal lymph node involvement?

1. Surgery only

2. Palliative chemotherapy

3. Chemotherapy or chemoradiation followed by surgery

4. Radiation therapy alone

The correct answer is: Chemotherapy or chemoradiation followed by surgery

The treatment approach for patients with limited mediastinal lymph node involvement involves a combination of chemotherapy or chemoradiation followed by surgery. This strategy is often employed in cases where there is a presence of localized malignancy, particularly in the context of lung cancer or similar thoracic tumors. Initiating treatment with chemotherapy or chemoradiation can help reduce the size of the primary tumor and any involved lymph nodes, which is crucial in enhancing the success rate of subsequent surgical intervention. This multimodal approach targets both the primary tumor site and the regional lymph nodes, thereby maximizing the chances of achieving a complete resection and minimizing the risk of recurrence. Surgery alone may not provide sufficient control for patients presenting with mediastinal lymph node involvement, as it does not adequately address the potential spread of the disease. Palliative chemotherapy primarily aims to relieve symptoms rather than cure the underlying disease and is not appropriate for limited involvement where curative intent is possible. Radiation therapy alone is typically reserved for localized disease with specific indications, but may not be adequate for comprehensive management in the presence of lymph node involvement. In summary, combining chemotherapy or chemoradiation with surgical resection offers the most promising outcome for patients with limited mediastinal lymph node involvement, aligning with current