ABIM Exam Review Practice Question of the Week: A helpful review of pulmonary function tests

You are given a set of pulmonary function test (PFT) readings that show:

  • FEV1 is low
  • FEV1/FVC ratio is elevated
  • TLC is decreased
  • DLCO is normal
  • Residual volume is increased


Which of the following conditions does this patient likely have?




B. Asthma


C. Sarcoidosis


D. Obesity


E. Interstitial fibrosis





PFTs can be interpreted into obstructive and restrictive lung diseases.
  • Obstructive lung disease (characterized by airway obstruction) could be conditions such as COPD and asthma.
  • Restrictive lung disease (characterized by reduced lung volume) can be further broken down into intrathoracic and extrathroacic diseases.


The first way to differentiate between obstructive and restrictive disease is to look at the TLC (Total Lung Capacity). With obstructive diseases, TLC would be increased. The way to understand this concept is the following:
  • With obstructive diseases, there is bronchoconstriction or air trapping that occurs. As a result there is so much air in the lungs that total lung capacity and residual volume are increased.
  • Restrictive diseases are just like the name sounds….they “restrict” the amount of air in the lungs which means TLC would be decreased.


This example shows that the TLC is decreased so we can eliminate Choice A (COPD) and Choice B (Asthma) since both are obstructive diseases. Now we have to choose among the other 3 choices. This is where we see if the condition is an extrathoraic or intrathoracic restrictive disease.
  • Intrathoracic restrictive diseases consist of sarcoidosis, interstitial fibrosis, or pulmonary fibrosis. With these diseases, the DLCO and residual volume levels are decreased.
  • Extrathoracic restrictive diseases consists of disorders such as: kyphosis, obesity, Guillain-Barre syndrome, Myasthenia Gravis, and muscular dystrophy. This would show a normal DLCO and increased residual volume levels.


Of the above, only Choice D (Obesity) could match the criteria for this patient.


You can see all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can find also additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.

1 Comment
June 2, 2013

When studying for board exams, there are some things that are just high yield topics. Guaranteed you will be asked about PFTs on your boards. Big areas to be able to distinguish are obstructive versus restrictive disease. More importantly reversible versus non-reversible obstructive disease and extrathoracic vs intrathoracic restrictive disease. HIGH YIELD….Make sure to know this topic cold.


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