American Board of Internal Medicine (ABIM) Certification Practice Exam

Which procedure is routinely used to obtain biopsy samples for histologic diagnosis?

1. Bronchoscopy

2. Mediastinoscopy

3. Endoscopy

4. Chest X-ray

The correct answer is: Mediastinoscopy

Mediastinoscopy is routinely used to obtain biopsy samples for histologic diagnosis, particularly when dealing with conditions that affect the mediastinum, such as lymphadenopathy or suspected malignancies. This minimally invasive surgical procedure allows the physician to access the mediastinal space through a small incision above the sternum. By using a mediastinoscope, which is a thin, lighted tube, the physician can visualize and biopsy lymph nodes or other structures in the mediastinum. The samples obtained can then be sent for histopathological analysis, which is critical for establishing a definitive diagnosis. While bronchoscopy is also a common procedure for obtaining airway and lung tissue samples, it specifically targets the bronchial tree and lung parenchyma rather than the mediastinum. Endoscopy typically refers to procedures that examine the gastrointestinal tract and would not be suitable for obtaining mediastinal biopsies. Chest X-ray is an imaging modality that helps identify abnormalities but does not allow for direct biopsy and histologic examination. Therefore, mediastinoscopy is the most appropriate choice for obtaining biopsy samples in the context described.