Surviving Pulmonology in Med School

So this blog post is a bit of an odd approach, because cardiology and pulmonology/respiratory are so delicately intertwined that they are almost always studied together as cardiopulmonary (also how my block was structured). However, as I mentioned in my Cardiology blog post, I wanted to provide specific tips for studying each subject so that I can give you good quality resources and advice. Combined, my tips for Cardio and Pulm should give you an awesome foundation of resources for your cardiopulmonary class.

I won’t repeat myself too much on my opinion of the class because a lot of my opinions about pulmonology are identical to cardiology. I absolutely love mechanism-based learning and applying a concept to various medical situations. Like cardio, that is what pulm is all about. And thus, it was one of my favorite subjects.

My best tips for studying pulm:

• Know your acid-base disorders backwards and forwards. Acid-base is so extremely important; not just for pulmonology but for metabolism, renal, and much more. It will pop up everywhere in medicine – on boards AND in your future practice.
• Here is a good acid-base tutorial to get started.
• Personally, I solve all acid-base problems using the formula CO₂ + H₂O ↔ H⁺ + HCO₃^– and the premise of Le Châtelier’s Principle. I do it in my head now, but when I was originally learning it I wrote it out and drew arrows every time until I became comfortable with it. For example, in respiratory acidosis, hypoventilation causes high CO₂; increased CO₂ shifts the equation to the right causing an increase in H⁺ and HCO₃^– (bicarbonate).
• When solving acid-base problems, get a system down that you apply every time. That way, you don’t have to think too much on each problem and confuse yourself.
• A quick acid-base rundown using my approach:
  • Acidosis = pH < 7.35
    • Respiratory Acidosis: Due to high CO₂ (i.e. hypoventilation). Equation shifts to the right, and thus, bicarb (HCO₃^–) will be high. Remember than renal compensation is much slower than respiratory compensation.
    • Metabolic Acidosis: Due to high H⁺ (i.e. diarrhea/loss of bicarb). Though the equation shifts to the left (increasing CO₂), CO₂ will be low because you’re breathing it off quickly to compensate.
  • Alkalosis = pH > 7.45
    • Respiratory Alkalosis: Due to low CO₂ (i.e. hyperventilation). Equation shifts to the left, and thus, bicarb (HCO₃^–) will be low. Remember than renal compensation is much slower than respiratory compensation.
    • Metabolic Alkalosis: Due to low H+ (i.e. vomiting). Though the equation shifts to the right (decreasing CO₂), CO₂ will be high because you’re breathing less/slower in order to compensate.
  • Mixed Acid-Base Disorder = pH 7.35-7.45 (normal). Due to compensation. Bicarb and CO2 will both be abnormal.
• Here are some acid-base practice questions.
• Müller’s and Valsalva maneuvers – become familiar with these.
• Armando’s hand-drawn tutorials are bomb. Here’s two links where you can find his respiratory tutorials: 1, 2
• Dr. Najeeb is also the bomb.
• First Aid for the USMLE – I always recommended this with each systems course, simply to follow along and use it as a supplement, because you may want to annotate your hard copy. This way, when it comes time to study for boards, you have a condensed version of high-yield notes.
• If you learn better talking things out, this is the class to do that in. Get a study group and run through various scenarios and pathology. Honestly, even if you don’t normally study in a group, you may want to give it a try for this class. Since pulmonology is such a conceptual-heavy system, it helps to talk through all of the down-stream effects of changing a variable. And your friends may have a different perspective than you, which will help you paint a complete picture. If you are in a cardiopulmonary class, connect the dots between the two physiological systems – it’s SO important to be comfortable with how they work together.
• PRACTICE QUESTIONS. Do the questions in the back of your textbook… make up questions and quiz your friends… do whatever you gotta do, just do not go into a pulm test without practicing first.