American Board of Internal Medicine (ABIM) Certification Practice Exam

What characteristic feature won’t be observed in a patient with COPD?

1. Reproducible spirometry readings

2. Normal FEV1/FVC ratio

3. Presence of chronic cough

4. Airflow obstruction

The correct answer is: Normal FEV1/FVC ratio

In patients with Chronic Obstructive Pulmonary Disease (COPD), one of the hallmark characteristics is the presence of airflow obstruction, which is typically assessed through spirometry. In this testing, the FEV1 (Forced Expiratory Volume in one second) is reduced, while the FVC (Forced Vital Capacity) may be reduced as well but not to the same extent, leading to a decreased FEV1/FVC ratio. This is contrary to what is observed in healthy individuals, who generally have a normal or even increased FEV1/FVC ratio. The other features associated with COPD, such as reproducible spirometry readings and the presence of a chronic cough, are common in these patients. COPD patients consistently demonstrate a pattern in their spirometry results that confirms airflow limitation, which is indeed reproducible upon repeated tests. Additionally, a chronic productive cough is a frequent symptom, reflecting the airway inflammation and mucus production associated with this disease. Therefore, the characteristic feature that will not be observed in a patient with COPD is a normal FEV1/FVC ratio, as the defining characteristic of COPD is the presence of an obstructive pattern reflected by a reduced ratio.