American Board of Internal Medicine (ABIM) Certification Practice Exam

Which combination of symptoms indicates the need for antibiotics during a COPD exacerbation?

1. Increased dyspnea and reduced sputum volume

2. Increased dyspnea, sputum volume, and sputum purulence

3. Only increased sputum purulence

4. Increased sputum volume and decreased breath sound

The correct answer is: Increased dyspnea, sputum volume, and sputum purulence

The selection of symptoms indicating the need for antibiotics during a COPD exacerbation is particularly centered around the presence of increased dyspnea, increased sputum volume, and sputum purulence. This combination of factors suggests an increase in the severity of the exacerbation, potentially due to a bacterial infection. Increased dyspnea signifies that the patient is experiencing greater difficulty in breathing, which is a critical marker for worsening respiratory function. Increased sputum volume often points to a significant change in the patient’s condition, indicating that the airways are producing more mucus, which can obstruct airflow and exacerbate symptoms. Importantly, when sputum purulence is present, it suggests the presence of infection. Purulent sputum is usually a thick, yellowish or greenish slimy mucus that can indicate the need for antibiotic therapy to address a possible bacterial component of the exacerbation. This triad of symptoms is a well-accepted criterion in clinical practice for initiating antibiotic therapy, as it provides a stronger indication of an infectious exacerbation, which typically requires antimicrobials to prevent further complications and to improve the patient's condition. The other options do not fully capture the critical combination of severity and infection risk associated with COPD exacerbations. Therefore, the presence