Pulmonology
Pulmonary reasoning centers on pattern recognition of dyspnea, cough, and sputum, plus spirometry interpretation. Candidates must distinguish obstructive (reduced FEV1/FVC ratio) from restrictive (reduced FVC with preserved or increased ratio) patterns, and know when to order chest imaging versus spirometry first. Master asthma versus COPD: reversibility, age of onset, smoking history, and treatment priorities. Understand community-acquired pneumonia severity assessment to decide inpatient versus outpatient care, and the red flags for respiratory failure. Know the approach to pleural effusion (transudate vs exudate) and to suspected pulmonary embolism (pretest probability then D-dimer or imaging).
Traps: treating suspected pneumonia without assessing severity; missing hypoxia because pulse oximetry is normal in anemia; confusing cardiac asthma with bronchial asthma; ordering D-dimer in high-probability pulmonary embolism where imaging is needed directly.
Worked example: a patient with acute dyspnea, pleuritic chest pain, and tachycardia after immobilization. Step one is pretest probability (Wells score). If high probability, go straight to CT pulmonary angiography; if low probability, a negative D-dimer excludes embolism. Do not use D-dimer to rule out disease in high-probability patients.
Key concepts: spirometry patterns, asthma-COPD distinction, pneumonia severity, effusion analysis, and pulmonary embolism pathways.