American Board of Internal Medicine (ABIM) Certification Practice Exam

What is typically the first step in addressing malignant superior vena cava syndrome?

1. Immediate radiation therapy

2. Obtaining a histologic diagnosis

3. Setting up a palliative care plan

4. Administering anticoagulant therapy

The correct answer is: Obtaining a histologic diagnosis

Obtaining a histologic diagnosis is typically the first step in addressing malignant superior vena cava syndrome. This condition often arises from malignancies, such as lung cancer, lymphoma, or metastatic disease, leading to obstruction of the superior vena cava. Confirming the underlying cause through a histologic diagnosis is essential because the treatment approach can vary significantly based on the type of malignancy involved. Establishing a histologic diagnosis not only aids in identifying the specific cancer but also guides subsequent treatment decisions, such as the need for chemotherapy, radiation, or surgical interventions. In clinical practice, understanding the precise nature of the malignancy can facilitate a more tailored and effective approach to symptom management and patient care. On the other hand, immediate radiation therapy may not be appropriate without knowing the underlying malignancy, and a palliative care plan might be beneficial, but it typically follows the establishment of a diagnosis to provide the most effective supportive care. Administering anticoagulant therapy would be considered if there is a concurrent thrombotic event, but it is not a primary step in managing the obstruction associated with superior vena cava syndrome itself.