ABIM Pulmonology

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?

Accepted Answer

GOLD 2 (moderate)

Answer

GOLD 1 (mild)

Answer

GOLD 3 (severe)

Answer

GOLD 4 (very severe)

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?

Accepted Answer

Anticoagulation with unfractionated heparin or LMWH

Answer

Thrombolytic therapy immediately

Answer

IVC filter placement

Answer

Embolectomy

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?

Accepted Answer

Step 2: Mild persistent asthma

Answer

Step 1: Intermittent asthma

Answer

Step 3: Moderate persistent asthma

Answer

Step 4: Severe persistent asthma

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?

Accepted Answer

Nintedanib or pirfenidone

Answer

Prednisone

Answer

Azathioprine

Answer

N-acetylcysteine

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?

Accepted Answer

Sarcoidosis

Answer

Lymphoma

Answer

Tuberculosis

Answer

Histoplasmosis

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?

Accepted Answer

Non-invasive positive pressure ventilation (BiPAP)

Answer

Increase FiO2 to 100%

Answer

Immediate intubation

Answer

IV methylprednisolone only