ABIM Pulmonology 1 — Questions and Answers
Question 1: A 65-year-old man with a 50-pack-year smoking history has FEV1/FVC ratio of 0.60 (post-bronchodilator). FEV1 is 55% predicted. What GOLD stage of COPD does he have?
- GOLD 1 (mild)
- GOLD 2 (moderate) (Correct answer)
- GOLD 3 (severe)
- GOLD 4 (very severe)
Correct answer: GOLD 2 (moderate)
GOLD stage 2 (moderate COPD) is defined by FEV1 50–79% predicted with FEV1/FVC <0.70 post-bronchodilator.
Question 2: A 70-year-old woman presents with acute dyspnea, pleuritic chest pain, and tachycardia after hip replacement surgery. CT pulmonary angiography shows filling defects in the right pulmonary artery. What is the immediate treatment?
- Thrombolytic therapy immediately
- Anticoagulation with unfractionated heparin or LMWH (Correct answer)
- IVC filter placement
- Embolectomy
Correct answer: Anticoagulation with unfractionated heparin or LMWH
Anticoagulation with heparin (unfractionated or LMWH) is the immediate treatment for hemodynamically stable pulmonary embolism to prevent clot propagation.
Question 3: A patient with asthma requires daily short-acting beta-agonist use and has nighttime symptoms 3–4 times per month. FEV1 is 78% predicted. What step of asthma therapy does this represent?
- Step 1: Intermittent asthma
- Step 2: Mild persistent asthma (Correct answer)
- Step 3: Moderate persistent asthma
- Step 4: Severe persistent asthma
Correct answer: Step 2: Mild persistent asthma
Mild persistent asthma (Step 2) is defined by symptoms >2 days/week but not daily, nighttime symptoms 3–4 times/month, and FEV1 ≥80% predicted.
Question 4: A 55-year-old woman with idiopathic pulmonary fibrosis (IPF) has progressive dyspnea with a UIP pattern on HRCT. FVC is 68% predicted. Which medication is approved to slow disease progression?
- Prednisone
- Azathioprine
- Nintedanib or pirfenidone (Correct answer)
- N-acetylcysteine
Correct answer: Nintedanib or pirfenidone
Nintedanib and pirfenidone are the only FDA-approved antifibrotic agents for IPF and have been shown to slow the rate of FVC decline.
Question 5: A 40-year-old African American woman presents with bilateral hilar lymphadenopathy, erythema nodosum, and polyarthritis. Serum ACE is elevated. What is the most likely diagnosis?
- Lymphoma
- Sarcoidosis (Correct answer)
- Tuberculosis
- Histoplasmosis
Correct answer: Sarcoidosis
Löfgren syndrome (bilateral hilar lymphadenopathy, erythema nodosum, and periarthritis/arthritis) is an acute presentation of sarcoidosis with a favorable prognosis.
Question 6: A patient with COPD exacerbation is on 2L/min O2 and has arterial blood gas: pH 7.29, PaCO2 62 mmHg, PaO2 58 mmHg. He is drowsy but cooperative. What is the next intervention?
- Increase FiO2 to 100%
- Non-invasive positive pressure ventilation (BiPAP) (Correct answer)
- Immediate intubation
- IV methylprednisolone only
Correct answer: Non-invasive positive pressure ventilation (BiPAP)
Non-invasive positive pressure ventilation (BiPAP) is the preferred initial intervention for acute hypercapnic respiratory failure in COPD before resorting to intubation.
ABIM Pulmonology 1
A 65-year-old man with a 50-pack-year smoking history has FEV1/FVC ratio of 0.60 (post-bronchodilator).
FEV1 is 55% predicted.
What GOLD stage of COPD does he have?