American Board of Internal Medicine (ABIM) Certification Practice Exam

What should patients suspected of having ventilator-associated pneumonia (VAP) undergo?

1. CT scan of the chest

2. Lower respiratory tract sampling

3. Bronchial lavage

4. Chest ultrasound

The correct answer is: Lower respiratory tract sampling

Patients suspected of having ventilator-associated pneumonia (VAP) should undergo lower respiratory tract sampling because this procedure allows for the direct collection of respiratory secretions from the lungs. This is crucial for diagnosing VAP, as it helps identify the specific pathogens causing the infection. The accurate diagnosis is vital to guide appropriate antibiotic therapy and improve patient outcomes. Lower respiratory tract sampling techniques, such as endotracheal suctioning or bronchoalveolar lavage, are commonly employed to obtain these samples. By analyzing the cultured samples, clinicians can discern the presence of bacterial pathogens and assess their susceptibility to antibiotics, which is essential for effective treatment. Other imaging studies, like a CT scan or chest ultrasound, primarily provide structural information and may not be as informative for confirming the diagnosis of VAP. While they might help to identify complications or assess lung fields, they do not provide the microbiological data needed to diagnose and manage the infection effectively. Bronchial lavage is a sampling technique often used within the broader context of lower respiratory tract sampling, but it specifically refers to the washing of the bronchial passages rather than a broader sampling of all lower respiratory secretions.