ABIM Pulmonary Disease Initial Certification Examination Practice Test
Pulmonary medicine combines respiratory physiology with evaluation and treatment of airway, parenchymal, pleural, vascular, and sleep-related disorders. The available practice cases touch on asthma and COPD, hypoventilation, pulmonary embolism, tuberculosis, hypersensitivity pneumonitis, and pleural effusion. They emphasize interpreting clinical findings and selecting appropriate diagnostic or treatment steps.
Exam overview
About the ABIM Pulmonary Disease Initial Certification Examination Exam
Pulmonary clinical reasoning involves matching symptoms and examination findings to tests such as spirometry, arterial blood gases, high-resolution CT, and pleural fluid analysis. Key decisions include recognizing severe airflow obstruction and ventilatory failure, distinguishing acute from chronic hypercapnia, and assessing oxygen needs after a COPD exacerbation. Other cases call for choosing nocturnal support for obesity hypoventilation, considering phenotype-directed therapy for eosinophilic asthma, and evaluating suspected pulmonary embolism or tuberculosis. Pleural disease questions may test what to do when cytology is negative but suspicion of malignancy remains. These tasks draw on respiratory physiology, microbiologic evaluation, imaging interpretation, and risk-sensitive treatment selection.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A patient has an acute asthma exacerbation with poor air movement and a markedly reduced peak expiratory flow. Which finding is most concerning for impending ventilatory failure?
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Correct answer: APatients with an early severe asthma attack often hyperventilate and have a low PaCO2. A normalizing or rising PaCO2 in a patient who remains distressed can indicate fatigue and failing ventilation, requiring urgent escalation and close monitoring.
A patient with obesity hypoventilation syndrome has stable daytime hypercapnia and severe obstructive sleep apnea documented on testing. Which initial nocturnal treatment is generally preferred?
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Correct answer: AFor stable obesity hypoventilation syndrome with coexisting severe obstructive sleep apnea, CPAP is generally the initial positive-airway-pressure approach. Oxygen alone does not correct upper-airway obstruction or hypoventilation and may worsen carbon dioxide retention in some patients.
A patient with COPD has chronic stable daytime hypercapnia and recurrent exacerbations. After an acute episode is treated, which intervention is appropriate to assess whether long-term supplemental oxygen is indicated?
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Correct answer: ALong-term oxygen therapy is considered for patients meeting defined criteria for chronic resting hypoxemia, assessed when clinically stable. COPD diagnosis or hypercapnia alone does not establish eligibility, and measurements obtained during an acute exacerbation may not reflect the stable baseline.
A patient with severe asthma remains symptomatic despite optimized inhaled therapy and has recurrent exacerbations. Blood eosinophils are repeatedly elevated. Which treatment approach is most specifically suited to this inflammatory phenotype?
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Correct answer: AFor selected patients with severe asthma and an eosinophilic phenotype despite optimized standard treatment, biologics targeting IL-5 or its receptor can reduce exacerbations. Treatment selection requires assessment of phenotype, adherence, comorbidities, and eligibility.
A patient with suspected hypersensitivity pneumonitis has an exposure history and compatible high-resolution CT findings. Which bronchoalveolar lavage result can support this diagnosis, while remaining nonspecific?
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Correct answer: ABronchoalveolar lavage lymphocytosis may support hypersensitivity pneumonitis in the appropriate clinical and radiographic context, but it is not specific and can vary with disease stage, smoking, and treatment. Diagnosis integrates exposure assessment, imaging, and sometimes pathology.
A patient with advanced COPD develops a gradual increase in somnolence and asterixis. Arterial blood gas shows pH 7.28 and PaCO₂ 72 mm Hg. Which acid-base process best explains the acidemia?
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Correct answer: AA low pH with elevated PaCO₂ indicates respiratory acidosis. Inadequate alveolar ventilation causes carbon dioxide retention; the degree of renal bicarbonate compensation depends on whether hypercapnia is acute or chronic.
A patient develops acute dyspnea several days after a prolonged hospitalization and immobilization. CT pulmonary angiography shows a segmental pulmonary embolus. The patient is hemodynamically stable, has no active bleeding, and has preserved renal function. Which treatment is generally appropriate?
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Correct answer: ATherapeutic anticoagulation is standard treatment for acute pulmonary embolism in a patient without a contraindication. Systemic thrombolysis is generally reserved for selected patients with hemodynamic instability or other high-risk circumstances, while an inferior vena cava filter is considered when anticoagulation cannot be given or in specific treatment-failure situations.
How to use this practice test
Access is free. A practice session presents up to 20 random questions from the 50-question bank, and results appear after the session. Use each case to identify the clinical clue driving the decision, then review any missed reasoning around test interpretation, respiratory support, or treatment selection.
Preparation tips
- Practice reading spirometry for reversible airflow obstruction, and connect peak-flow reduction and poor air movement with signs of impending respiratory failure.
- Compare arterial blood gas patterns in acute and chronic hypercapnia, including how pH and PaCO₂ clarify the cause of acidemia.
- Review how oxygenation assessment after a COPD exacerbation informs evaluation for long-term supplemental oxygen.
- For pulmonary embolism, tuberculosis, and recurrent pleural effusion cases, distinguish the next diagnostic step from treatment selection and account for hemodynamic stability, persistent suspicion, and whether a tissue diagnosis would change care.
- Connect exposure history and high-resolution CT findings in suspected hypersensitivity pneumonitis with the supportive—but nonspecific—role of bronchoalveolar lavage.