,USMLE Step 3 Pulmonology | High-Yield Notes
& CCS Case Guidance (2024/2025)
Asthma and reactive airway disease
are confirmed with an...
increase in the FEV1 of > 12 % OR FVC; and an increase > 200ml from baseline with bronchodilator
FEV1/FVC < 0.7 usually indicates...
Airway obstruction (DDx: astham, COPD, bronchoectasis)
lung volumes review (image)
flow-volume loop patterns (image)
A young man comes to the clinic for evaluation of intermittent episodes of shortness of breath.
Currently he is not short of breath. What is the best test to determine a diagnosis of reactive airway
disease?
Methacholine stimulation testing
It looks for a decrease in FEV1 in response to synthetic acetylcholine. Methacholine will decrease FEV1 if
the patient has asthma.
What does diffusion capacity lung carbon monoxide (DLCO) evaluate?
DLCO evaluates gas transport across alveolar-capillary membranes
, DDx for:
- ↓DLCO and Normal lung volume
- ↓DLCO and ↓ lung volume
- ↑ DLCO
↓DLCO and Normal lung volume
- pulm. vascular disease
- anemia
↓DLCO and ↓ lung volume
- COPD
-bronchiectasis
↑ DLCO
- asthma
- pulm. hemorrhage
- L to R shunt
- HF
- polycythemia
DON'T BE TRICKED about the following regarding asthma
- Normal spirometry DOES NOT r/o asthma
- Normal bronchoprovacation test r/o asthma (sensitive); a "+" test DOES NOT rule it in (not specific)
- wheezing ≠ asthma (consider HF, COPD, vocal cord dysfunction, upper airway obstruction)
MCCs of chronic unexplained dyspnea
- COPD
- asthma
- interstitial lung disease
- HF
All patients with SOB should receive the following Rx and tests:
• Oxygen
• Continuous oximeter
• Chest x-ray
• Arterial blood gas (ABG)
The best initial therapies, which should be ordered with the first screen on CCS for an asthma Pt, are the
following:
& CCS Case Guidance (2024/2025)
Asthma and reactive airway disease
are confirmed with an...
increase in the FEV1 of > 12 % OR FVC; and an increase > 200ml from baseline with bronchodilator
FEV1/FVC < 0.7 usually indicates...
Airway obstruction (DDx: astham, COPD, bronchoectasis)
lung volumes review (image)
flow-volume loop patterns (image)
A young man comes to the clinic for evaluation of intermittent episodes of shortness of breath.
Currently he is not short of breath. What is the best test to determine a diagnosis of reactive airway
disease?
Methacholine stimulation testing
It looks for a decrease in FEV1 in response to synthetic acetylcholine. Methacholine will decrease FEV1 if
the patient has asthma.
What does diffusion capacity lung carbon monoxide (DLCO) evaluate?
DLCO evaluates gas transport across alveolar-capillary membranes
, DDx for:
- ↓DLCO and Normal lung volume
- ↓DLCO and ↓ lung volume
- ↑ DLCO
↓DLCO and Normal lung volume
- pulm. vascular disease
- anemia
↓DLCO and ↓ lung volume
- COPD
-bronchiectasis
↑ DLCO
- asthma
- pulm. hemorrhage
- L to R shunt
- HF
- polycythemia
DON'T BE TRICKED about the following regarding asthma
- Normal spirometry DOES NOT r/o asthma
- Normal bronchoprovacation test r/o asthma (sensitive); a "+" test DOES NOT rule it in (not specific)
- wheezing ≠ asthma (consider HF, COPD, vocal cord dysfunction, upper airway obstruction)
MCCs of chronic unexplained dyspnea
- COPD
- asthma
- interstitial lung disease
- HF
All patients with SOB should receive the following Rx and tests:
• Oxygen
• Continuous oximeter
• Chest x-ray
• Arterial blood gas (ABG)
The best initial therapies, which should be ordered with the first screen on CCS for an asthma Pt, are the
following:
