American Board of Internal Medicine (ABIM) Certification Practice Exam

When is lung volume reduction surgery indicated in COPD patients?

1. In patients with low exercise capacity and predominantly lower-lobe emphysema

2. In patients with severe COPD and predominantly upper-lobe emphysema

3. In all patients with COPD regardless of lung function

4. Only in patients who have not responded to medication

The correct answer is: In patients with severe COPD and predominantly upper-lobe emphysema

Lung volume reduction surgery (LVRS) is indicated in specific cases of chronic obstructive pulmonary disease (COPD) patients, particularly those with severe emphysema. The primary rationale for selecting candidates for LVRS is to target those who have predominantly upper-lobe emphysema. In patients with upper-lobe disease, hyperinflation occurs because the lower lobes are often more functional. By removing diseased lung tissue in the upper lobes, the remaining functional lung tissue can expand more effectively, improving airflow and exercise capacity. These patients typically experience a significant improvement in quality of life and exercise tolerance after the surgery. The other scenarios presented lack the specific characteristics that justify performing LVRS. For instance, patients with low exercise capacity and predominantly lower-lobe emphysema are generally not ideal candidates for this surgery because their remaining lung function is not maximized by volume reduction. Offering LVRS to all COPD patients regardless of their lung function does not align with current treatment guidelines, as LVRS is a specialized intervention reserved for a select group. Additionally, recommending LVRS only for patients who have not responded to medication overlooks the importance of anatomical considerations and disease severity in determining surgical candidacy.