ABIM Pulmonology 2

Question 1

A 62-year-old smoker presents with a 3.5 cm spiculated lung nodule on CT. PET scan shows hypermetabolic activity. What is the next step?

Accepted Answer

CT-guided biopsy or surgical resection

Answer

A spiculated >3 cm pulmonary nodule with PET hypermetabolic activity in a smoker is highly suspicious for malignancy and requires tissue diagnosis via biopsy or surgical resection.

Question 2

A patient presents with unilateral pleural effusion. Thoracentesis shows: protein 4.5 g/dL (serum protein 7.0 g/dL), LDH 280 U/L (serum LDH 200 U/L). What type of effusion is this?

Accepted Answer

Exudate

Answer

By Light's criteria, an exudate is diagnosed when pleural fluid/serum protein ratio >0.5, pleural fluid/serum LDH ratio >0.6, or pleural LDH >2/3 upper limit of normal serum LDH.

Question 3

A 50-year-old woman with obstructive sleep apnea (OSA) has an AHI of 28 events/hour. She is symptomatic with daytime sleepiness. What is the first-line treatment?

Accepted Answer

Continuous positive airway pressure (CPAP)

Answer

CPAP is the first-line treatment for moderate-to-severe OSA (AHI >15) and is the most effective therapy for reducing apnea events and improving symptoms.

Question 4

A 38-year-old woman with systemic sclerosis develops progressive dyspnea. Echocardiography shows RSVP of 55 mmHg. Right heart catheterization confirms mean PAP of 32 mmHg with normal PCWP. What is the diagnosis?

Accepted Answer

Pulmonary arterial hypertension (Group 1)

Answer

Pulmonary arterial hypertension (Group 1 WHO) is defined by mean PAP ≥25 mmHg with normal PCWP (≤15 mmHg) and pulmonary vascular resistance >3 WU, common in connective tissue diseases.

Question 5

A patient with community-acquired pneumonia (CAP) is admitted to the hospital (non-ICU). Blood cultures are negative. What is the preferred antibiotic regimen?

Accepted Answer

Beta-lactam plus macrolide, or respiratory fluoroquinolone

Answer

IDSA/ATS guidelines recommend a beta-lactam plus macrolide combination or a respiratory fluoroquinolone monotherapy for hospitalized non-ICU CAP.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Pulmonology 2