Pulmonology
Core framework
Organise respiratory questions around physiology and pattern: obstructive versus restrictive, hypoxaemic versus hypercapnic, acute versus chronic. Interpret spirometry with the FEV1/FVC ratio (below 0.7 supports obstruction; reduced FVC with preserved ratio suggests restriction, confirmed by lung volumes). Blood gas interpretation anchors severity: type 1 (hypoxaemia) versus type 2 (hypercapnia) failure, and the compensated chronic hypercapnic patient whose "normal" pH masks dangerous chronic retention.
Concepts examiners test
Asthma versus COPD overlap and reversibility testing; the stepwise asthma controller ladder and inhaler technique; community- versus hospital-acquired pneumonia severity scoring and when to admit; pulmonary embolism risk stratification (Wells, PERC, D-dimer, sPESI) and the role of thrombolysis in massive PE; pleural effusion Light's criteria; interstitial lung disease patterns on high-resolution CT; obstructive sleep apnoea diagnosis and driving implications; and tuberculosis diagnosis and isolation.
Traps
- Normal oxygen saturation does not exclude PE; use pretest probability.
- D-dimer is unhelpful in high pretest probability - go to imaging.
- In COPD, target oxygen saturation 88–92%; uncontrolled high-flow oxygen can worsen hypercapnia.
- Corticosteroids are not routine in uncomplicated CAP unless specific indications.
- Do not attribute clubbing to COPD; think lung cancer, bronchiectasis, fibrosis.
Worked rule of thumb
A tachycardic postoperative patient with pleuritic pain, hypoxia and a clear chest radiograph: calculate Wells score; if PE is "likely", proceed directly to CT pulmonary angiography, and if "unlikely" use a D-dimer to rule out. Escalate to thrombolysis only with haemodynamic instability.