ABIM Pulmonary study guide
ABIM Pulmonary · Work through your exam, one topic at a time.
This page is an independent study overview for physicians preparing for the ABIM Pulmonary Disease Certification Exam. It is not affiliated with, endorsed by, or sponsored by the American Board of Internal Medicine. The ABIM Pulmonary study guide has 10 sections and about 3,063 words.
01Obstructive Lung Disease: Physiology, Phenotypes, and Treatment Levers
Airflow obstruction is defined by a reduced post-bronchodilator FEV1/FVC ratio. The GOLD fixed cutoff of 0.70 is simple but age-dependent: it over-calls obstruction in older adults and under-calls it in younger ones, whereas the lower limit of normal (fifth percentile) is age-adjusted.
339 words, about 2 min02Interstitial Lung Disease: Pattern Recognition Before Biopsy
The first is whether there is an identifiable cause: exposures (birds, mold, metal dusts, drugs such as amiodarone, methotrexate, nitrofurantoin), connective tissue disease, or sarcoidosis. The second is the HRCT pattern.
317 words, about 2 min03Pulmonary Vascular Disease: Grading, Grouping, and Risk
The current hemodynamic definition of precapillary pulmonary hypertension is mean pulmonary arterial pressure 20 mmHg with pulmonary vascular resistance 2 Wood units and pulmonary artery wedge pressure ≤15 mmHg. Group 1 (pulmonary arterial hypertension) is idiopathic, heritable, drug/toxin-associated, or related to connective tissue disease, congenital heart disease, portal hypertension, or HIV.
316 words, about 2 min04Respiratory Failure and Critical Care: Oxygenation, Ventilation, and Lung Protection
Type 1 (hypoxemic) failure has a normal or low PaCO2; type 2 (hypercapnic) has a PaCO2 45 mmHg. The alveolar gas equation (PAO2 = 150 − PaCO2/0.8) and the A-a gradient separate hypoventilation from a true gas-exchange defect: a hypoxemic patient with a normal gradient has hypoventilation, whereas a widened gradient means V/Q mismatch, shunt, or diffusion limitation.
321 words, about 2 min05Sleep Medicine: Defining Apnea, Choosing Therapy
Obstructive sleep apnea is defined by an apnea-hypopnea index (AHI) ≥5 with symptoms or comorbid conditions, or an AHI ≥15 with no symptoms at all. Hypopnea requires a ≥30% fall in airflow with desaturation or arousal, so differing scoring rules change the index - a common source of ambiguity.
321 words, about 2 min06Pulmonary Infections: Site of Care, Pathogen, and Isolation
Streptococcus pneumoniae remains the most common pathogen, with atypicals (Mycoplasma, Chlamydia, Legionella) and viruses filling out the list. Severity scoring drives the site of care: CURB-65 (confusion, urea 7 mmol/L, respiratory rate ≥30, blood pressure low, age ≥65) with ≥2 points supports admission.
270 words, about 1 min07Thoracic Neoplasms: Histology, Stage, and Biomarkers
Annual low-dose CT screening is recommended for adults 50–80 years with ≥20 pack-years who currently smoke or quit within 15 years. Screening reduces lung cancer mortality; it does not replace cessation counseling.
301 words, about 2 min08Pleural Disease: Fluid Analysis, Drainage, and Air
Light's criteria classify an exudate when any one of the following holds: pleural fluid protein/serum protein 0.5, pleural fluid LDH/serum LDH 0.6, or pleural fluid LDH two-thirds the upper limit of normal serum LDH. Transudates come from hydrostatic or oncotic forces (heart failure, cirrhosis, nephrotic syndrome); exudates come from infection, malignancy, pulmonary embolism, pancreatitis, and connective tissue disease.
287 words, about 1 min09Occupational and Environmental Lung Disease: Exposure, Latency, and Pattern
The occupational history must include specific job tasks, duration, protective equipment, symptom timing (better on weekends and holidays suggests work-related asthma), and coexposures such as smoking. Latency matters: pneumoconioses typically require 15–20 years or more, and hypersensitivity pneumonitis can present acutely, subacutely, or chronically.
277 words, about 1 min10Neuromuscular and Chest Wall Disorders: Failing the Bellows
Neuromuscular disease produces a restrictive defect: low TLC and vital capacity with a preserved or high FEV1/FVC ratio and normal DLCO. Respiratory muscle strength falls before routine spirometry is dramatic, so measure maximal inspiratory pressure, maximal expiratory pressure, and vital capacity in both upright and supine positions.
314 words, about 2 min