American Board of Internal Medicine (ABIM) Certification Practice Exam

What test is recommended for patients with symptoms of bronchospastic disease but normal spirometry?

1. Chest X-ray

2. Bronchial challenge testing

3. CT angiography

4. Lung biopsy

The correct answer is: Bronchial challenge testing

Bronchial challenge testing is indicated for patients exhibiting symptoms of bronchospastic disease when spirometry results are normal. This type of testing helps to evaluate the airways' responsiveness to potential bronchoconstrictors, such as methacholine or histamine. In cases of conditions like asthma, the responsiveness can be diminished or absent when normal spirometry is achieved, but symptoms may persist. Thus, bronchial challenge testing allows healthcare providers to capture these subtle airway hyperresponsiveness findings, which may not manifest during routine spirometry. In contrast, chest X-ray and CT angiography primarily serve diagnostic purposes related to structural issues or vascular conditions but do not specifically evaluate airway reactivity. Lung biopsy is typically reserved for assessing parenchymal lung disease, such as interstitial lung disease, and is not relevant in the context of bronchospastic disease symptoms combined with normal spirometry. Therefore, bronchial challenge testing is the most appropriate choice for further evaluating the patient's condition.