American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is an indication for diagnostic bronchoscopy?

1. Chronic cough

2. Hemoptysis

3. Fever

4. Nasal congestion

The correct answer is: Hemoptysis

Diagnostic bronchoscopy is a minimally invasive procedure used to visualize the airways and lungs, collect samples, and diagnose various respiratory conditions. Hemoptysis, which refers to coughing up blood, is a significant symptom that may indicate serious underlying conditions such as lung cancer, infection (like tuberculosis), or pulmonary embolism. The goal of performing a bronchoscopy in the presence of hemoptysis is to identify the source of the bleeding, determine the cause, and guide appropriate management. While chronic cough, fever, and nasal congestion can be indicative of respiratory issues, they do not usually warrant immediate bronchoscopy. Chronic cough may have many benign causes and is typically managed through less invasive approaches. Fever may suggest an infection that could sometimes warrant bronchoscopy, but it is more commonly investigated through other means such as imaging or sputum analysis. Nasal congestion is generally associated with upper respiratory conditions and is not an indication for bronchoscopy, which focuses on the lower airways. In summary, hemoptysis stands out as an urgent indication for diagnostic bronchoscopy, allowing direct evaluation of the airways and obtaining necessary diagnostic information in a potentially life-threatening situation.