![]() This resistance is normally minimal because of the presence of pleural fluid. Tissue resistance is generated as the pleural surfaces slide over each other during respiration. Note that compliance work is reduced in obstructive lung disease and increased in restrictive lung disease. The work to overcome this resistance (compliance work) normally accounts for the largest proportion of the work of breathing. The total resistance (R T) of a specific number ( n) of resistors in series is equal to the sum of their individual resistances such thatīy contrast, the total resistance (R T) of a specific number ( n) of resistors in parallel is calculated asĬompliance resistance is generated as the lungs inflate and overcome the intrinsic elastic recoil of the lungs. Airway resistance is greater in the large airways because they are arranged in series, whereas the small airways are arranged in parallel. It is typically a small component of the work of breathing. ![]() You will notice that the key point is to constantly ask yourself “why?” when studying for this subject!Īirway resistance, compliance resistance, and tissue resistance are the forces of resistance for inspiration collectively, these forces determine the overall work of breathing.Īirway resistance is generated by the friction between rapidly moving air molecules and the walls of the airways. Instead, focus on reasoning through the pathophysiology of various conditions as they relate to the lung (e.g., why compliance increases with emphysema, why altitude changes alter pH, why certain diseases alter AaD O 2). In other words, avoid memorizing a ton of detailed information for this subject. In fact, many pulmonology questions on Step 1 will require you to apply conceptual knowledge of pathophysiology. However, this does not mean that USMLE test makers will forget to include questions regarding pulmonary physiology and pathology. ![]() Therefore, you should expect to find pulmonology questions on related subjects such as microbiology, cardiology, and clinical anatomy (we especially recommend spending some time with an anatomy atlas to refamiliarize yourself with chest x-ray films). Pulmonology is a favorite subject for Step 1 because it provides a lot of opportunity to integrate across disciplines. Insider’s Guide to Pulmonology for the USMLE Step 1 ![]()
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