American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with progressive idiopathic pulmonary fibrosis, what does the American Thoracic Society recommend instead of intubation?

1. Intensive care management

2. Replacing fluid balance

3. Palliation of symptoms

4. Long-term oxygen therapy

The correct answer is: Palliation of symptoms

In the context of progressive idiopathic pulmonary fibrosis, the American Thoracic Society recommends palliation of symptoms instead of intubation. This approach acknowledges the limited effectiveness of invasive mechanical ventilation in patients with advanced pulmonary fibrosis, where the underlying disease process has led to significant and often irreversible lung damage. Palliative care focuses on improving the quality of life for patients by managing symptoms like breathlessness, anxiety, and pain rather than attempting to prolong life through aggressive interventions. It provides a compassionate approach to care, ensuring that patients have their comfort prioritized during their illness, particularly in terminal phases where the focus might shift from treatment aimed at a cure to one that alleviates suffering. While intensive care management might be considered for other severe respiratory conditions, it is often not beneficial for patients with progressive idiopathic pulmonary fibrosis due to the failure of the underlying lung function to respond to such interventions. Similarly, replacing fluid balance and long-term oxygen therapy can be part of the management strategy but do not address the critical need for symptom relief during the progression of the disease. Therefore, the emphasis on palliation aligns with a more holistic approach to care in patients with severe respiratory compromise from idiopathic pulmonary fibrosis.