American Board of Internal Medicine (ABIM) Certification Practice Exam

When patients with COPD experience a change in symptoms, what test should be obtained in clinic?

1. Chest X-ray

2. Spirometry

3. CT scan of the chest

4. Arterial blood gas analysis

The correct answer is: Spirometry

In the context of managing chronic obstructive pulmonary disease (COPD), spirometry is the preferred test when patients experience a change in their symptoms. Spirometry provides objective measurements of lung function, specifically the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC). This information is crucial for assessing the severity of airway obstruction and determining whether there has been an exacerbation or worsening of the underlying disease. Patients with COPD may present with increased shortness of breath, wheezing, or changes in sputum production, all of which may indicate a need for re-evaluation of their pulmonary status. Spirometry can help differentiate between exacerbations related to acute bronchoconstriction, chronic disease progression, or other complications, such as pneumonia. While other tests could provide valuable information, they do not directly address changes in lung function as effectively as spirometry. A chest X-ray may identify acute changes such as infections or pleural effusions, but it does not assess airway obstruction. A CT scan can provide more detailed images of the lungs but is generally not performed as a first-line test in routine evaluations of COPD exacerbations. Arterial blood gas analysis can be useful, particularly in severe cases or during respiratory distress,