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 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?

Accepted Answer

Anticoagulation with unfractionated heparin or LMWH

Answer

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?

Accepted Answer

Step 2: Mild persistent asthma

Answer

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?

Accepted Answer

Nintedanib or pirfenidone

Answer

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?

Accepted Answer

Sarcoidosis

Answer

Löfgren syndrome (bilateral hilar lymphadenopathy, erythema nodosum, and periarthritis/arthritis) is an acute presentation of sarcoidosis with a favorable prognosis.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Pulmonology