American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the role of periodic IVIG or plasmapheresis in the treatment of chronic inflammatory demyelinating polyradiculoneuropathy?

1. Maintenance therapy

2. Rescue therapy

3. Initial therapy

4. Symptom management only

The correct answer is: Rescue therapy

The role of periodic intravenous immunoglobulin (IVIG) or plasmapheresis in the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is best described as rescue therapy. Both IVIG and plasmapheresis are used in patients when there is an acute exacerbation of symptoms or when the disease is particularly active and the patient is experiencing severe symptoms that may not be adequately managed with other treatments. Rescue therapy is aimed at rapidly alleviating symptoms and stabilizing the patient's condition during a flare-up of the disease. In CIDP, where there can be periods of exacerbation and remission, these interventions help to quickly reduce the inflammatory response that is causing the demyelination of peripheral nerves. Maintenance therapy, on the other hand, typically refers to long-term treatment strategies aimed at preventing future flares and maintaining neurological function over time. Initial therapy would generally denote the first line of treatment when a diagnosis is first made. Symptom management focuses solely on alleviating symptoms without addressing the underlying inflammatory process, which is not the primary goal of using IVIG or plasmapheresis during active disease. Thus, the characterization of these therapies as rescue treatments during acute episodes aligns with their intended use in the management