American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be given if mediastinal lymph nodes are negative after surgery for stage III NSCLC?

1. Adjuvant chemotherapy

2. Immediate repeat surgery

3. Palliative care

4. Radiation therapy

The correct answer is: Adjuvant chemotherapy

Adjuvant chemotherapy is the recommended approach when mediastinal lymph nodes are negative after surgery for stage III non-small cell lung cancer (NSCLC). The rationale behind this recommendation lies in the goal of eradicating any potential residual microscopic disease that may not have been detected during surgery. Stage III NSCLC, characterized by the involvement of regional lymph nodes, poses a higher risk of recurrence, and the administration of adjuvant chemotherapy helps to improve overall survival rates and reduce the likelihood of cancer returning. In contrast, immediate repeat surgery isn't typically warranted in this context because, if the lymph nodes are confirmed to be negative following initial surgery, it suggests that there is no remaining disease in the mediastinum that would necessitate another surgical intervention. Palliative care is focused on quality of life and symptom management, which would not be the primary approach in a clinically negative lymph node situation where the intent is still curative. Radiation therapy can be considered for certain cases, especially when there’s a concern about local recurrence; however, it does not replace the first-line treatment of adjuvant chemotherapy when stage III disease is managed post-operatively and lymph nodes are free of cancer. Thus, adjuvant chemotherapy remains the most appropriate and beneficial next step in this