American Board of Internal Medicine (ABIM) Certification Practice Exam

What indicates the need for lung volume reduction surgery (LVRS)?

1. Favorable response to pharmacologic therapy

2. Evidence of bilateral upper-lobe emphysema on CT

3. Patient preference for surgical intervention

4. Age of the patient

The correct answer is: Evidence of bilateral upper-lobe emphysema on CT

Lung volume reduction surgery (LVRS) is primarily indicated for patients with severe emphysema, particularly those who demonstrate certain anatomical and clinical characteristics. Evidence of bilateral upper-lobe emphysema on CT scans is a key indicator for LVRS because patients with this specific pattern often experience considerable functional impairment and may greatly benefit from the procedure. The rationale behind LVRS is that by removing diseased lung tissue, patients can improve their overall lung mechanics, enhance exercise capacity, and potentially improve their quality of life. The presence of upper-lobe predominance suggests that the lower lobes are often more functional and can take over some of the respiratory duties, making the resection of the less functional upper lobes more advantageous. Therefore, the identification of this imaging finding supports the candidacy of a patient for LVRS, as these patients are more likely to experience a meaningful improvement in their pulmonary function and symptoms. While pharmacologic therapy can be beneficial in managing symptoms, a favorable response does not independently justify LVRS. Similarly, patient preference is important but must be aligned with clinical indications; it is not a sole criterion for selecting surgical intervention. Lastly, age can influence treatment decisions but is not a definitive indicator for LVRS eligibility on its own. Thus,