Pathophysiology is a crucial subject in the Respiratory Therapist Board Exam, particularly in managing acute respiratory conditions. These conditions require rapid assessment and intervention to prevent life-threatening complications. Below are three key topics frequently covered in the exam:
Acute Respiratory Distress Syndrome (ARDS)
ARDS is a severe inflammatory lung condition caused by infections (e.g., pneumonia, sepsis), trauma, or aspiration. It leads to non-cardiogenic pulmonary edema, decreased lung compliance, and refractory hypoxemia due to alveolar damage. The Berlin Criteria defines ARDS severity based on PaO₂/FiO₂ ratios. Exam topics may include mechanical ventilation strategies, such as low tidal volume (lung-protective ventilation), PEEP optimization, and prone positioning.
Acute Exacerbations of Chronic Respiratory Diseases
Exacerbations of COPD and asthma are common causes of hospitalization. COPD exacerbations are typically triggered by infections, pollutants, or noncompliance with therapy, leading to increased airflow limitation, hypercapnia, and respiratory acidosis. Asthma exacerbations involve bronchospasm, airway inflammation, and mucus plugging, causing wheezing, hypoxemia, and severe dyspnea. Board questions often cover ABG interpretation, bronchodilator therapy (SABAs, corticosteroids), and noninvasive ventilation (NIV) indications.
Respiratory Failure (Hypoxemic & Hypercapnic)
Hypoxemic respiratory failure (Type I) results from impaired oxygenation (e.g., ARDS, pneumonia, pulmonary embolism), while hypercapnic respiratory failure (Type II) is due to ventilatory failure (e.g., COPD, neuromuscular disorders). The exam focuses on oxygen therapy, mechanical ventilation, BiPAP/CPAP use, and ABG analysis.
RESPIRATORY THERAPIST REVIEWER
Welcome to our Respiratory Therapist Reviewer. In this session, you'll have the opportunity to test your understanding of key concepts in Acute Respiratory Conditions. The quiz consists of multiple-choice questions covering various topics. Pay close attention to each question and select the best answer. After completing the exam, check the video or the answer key and explanations at the last part.
Acute Respiratory Distress Syndrome (ARDS)
1. Which of the following is the hallmark feature of ARDS?
A. Pulmonary hypertension
B. Diffuse alveolar damage with noncardiogenic pulmonary edema
C. Obstructive airway disease
D. Pleural effusion
2. Which of the following is the most common cause of ARDS?
A. Sepsis
B. Aspiration pneumonia
C. Pulmonary embolism
D. Myasthenia gravis
3. Which of the following is a key criterion in diagnosing ARDS?
A. Elevated left atrial pressure
B. PaO₂/FiO₂ ratio < 300 mmHg
C. Increased lung compliance
D. Normal chest X-ray
4. Which ventilatory strategy is recommended for ARDS?
A. High tidal volume, low PEEP
B. Low tidal volume, high PEEP
C. Zero PEEP with high FiO₂
D. Inverse ratio ventilation
5. What is the primary goal of lung-protective ventilation in ARDS?
A. Maximize tidal volume
B. Prevent oxygen toxicity
C. Reduce ventilator-induced lung injury
D. Increase respiratory rate
6. Which of the following chest X-ray findings is characteristic of ARDS?
A. Hyperinflation with flattened diaphragms
B. Pleural effusion
C. Cavitary lesions in upper lobes
D. Bilateral diffuse infiltrates
7. What is the primary cause of refractory hypoxemia in ARDS?
A. Increased airway resistance
B. Ventilation-perfusion (V/Q) mismatch and shunting
C. Bronchospasm
D. Increased lung compliance
Acute Exacerbations of Chronic Respiratory Diseases
8. Which of the following is a common trigger for acute exacerbation of COPD?
A. Pulmonary embolism
B. Viral or bacterial infection
C. Pneumothorax
D. Lung cancer
9. Which arterial blood gas (ABG) pattern is expected in acute exacerbation of COPD?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
10. Which medication is the first-line treatment for acute COPD exacerbation?
A. Long-acting beta-agonist (LABA)
B. Inhaled corticosteroids
C. Short-acting beta-agonist (SABA)
D. Montelukast
11. Which of the following is a hallmark feature of an asthma exacerbation?
A. FEV₁/FVC > 80%
B. Decreased airway resistance
C. Pulsus paradoxus
D. Hypercapnia at onset
12. Which intervention is most appropriate in severe asthma exacerbation unresponsive to bronchodilators?
A. Magnesium sulfate IV
B. Nebulized anticholinergics
C. Montelukast
D. Long-acting beta-agonist (LABA)
13. Which of the following signs is a red flag in an acute COPD exacerbation?
A. Increased sputum production
B. Accessory muscle use and paradoxical breathing
C. Mild wheezing
D. Increased breath sounds
14. Which of the following medications is most effective in treating an acute asthma exacerbation?
A. Inhaled corticosteroids
B. Long-acting beta-agonists (LABA)
C. Short-acting beta-agonists (SABA)
D. Leukotriene receptor antagonists
15. Which of the following is NOT a common feature of a severe asthma attack?
A. Respiratory acidosis
B. Silent chest
C. Bradycardia
D. Hypercapnia
Respiratory Failure (Hypoxemic and Hypercapnic)
16. Which ABG finding is characteristic of Type 1 (hypoxemic) respiratory failure?
A. PaO₂ < 60 mmHg, PaCO₂ > 50 mmHg
B. PaO₂ < 60 mmHg, PaCO₂ normal or low
C. PaO₂ > 80 mmHg, PaCO₂ > 50 mmHg
D. PaO₂ < 80 mmHg, PaCO₂ < 40 mmHg
17. Which condition is a common cause of hypercapnic (Type 2) respiratory failure?
A. Pulmonary embolism
B. Asthma
C. Opioid overdose
D. Pneumonia
18. Which non-invasive intervention is preferred for a COPD patient in hypercapnic respiratory failure?
A. High-flow nasal cannula
B. Invasive mechanical ventilation
C. Non-invasive positive pressure ventilation (NIPPV)
D. Supplemental oxygen alone
19. What is the hallmark of impending respiratory failure in an asthmatic patient?
A. Wheezing
B. Tachycardia
C. Hyperventilation
D. Silent chest
20. What is the main cause of hypoxemia in ARDS?
A. Hypoventilation
B. Ventilation-perfusion mismatch
C. Airway obstruction
D. Hypercapnia
21. Which laboratory test helps distinguish between cardiogenic and noncardiogenic pulmonary edema?
A. Brain natriuretic peptide (BNP)
B. D-dimer
C. Troponin
D. C-reactive protein
22. What is the preferred method of oxygen therapy for a patient with COPD and mild hypoxemia?
A. High-flow nasal cannula
B. Venturi mask
C. Non-rebreather mask
D. Simple face mask
23. A patient in respiratory failure has a pH of 7.28, PaCO₂ of 65 mmHg, and HCO₃⁻ of 27 mEq/L. What is the diagnosis?
A. Metabolic acidosis
B. Acute respiratory alkalosis
C. Metabolic alkalosis
D. Acute respiratory acidosis
24. Which of the following is a sign of impending respiratory failure?
A. Tachycardia
B. Bradypnea and lethargy
C. Mild dyspnea
D. Normal oxygen saturation
Miscellaneous Acute Respiratory Conditions
25. Which of the following is an early sign of acute respiratory failure?
A. Bradycardia
B. Confusion and agitation
C. Cyanosis
D. Hypotension
26. Which of the following oxygen delivery methods provides the highest FiO₂?
A. Non-rebreather mask
B. Simple face mask
C. Nasal cannula
D. Venturi mask
27. Which of the following conditions causes an increased A-a gradient (alveolar-arterial oxygen difference)?
A. Hypoventilation
B. High altitude exposure
C. Pulmonary embolism
D. Opioid overdose
28. Which of the following signs suggests a tension pneumothorax?
A. Bilateral wheezing
B. Bilateral crackles
C. Increased tactile fremitus
D. Tracheal deviation away from the affected side
29. A patient with acute dyspnea and pleuritic chest pain has a PaO₂ of 55 mmHg on room air. Which condition is most likely?
A. Asthma
B. Pulmonary embolism
C. Bronchiectasis
D. Pleural effusion
30. Which test confirms the diagnosis of a pulmonary embolism?
A. Chest X-ray
B. Electrocardiogram (ECG)
C. Spirometry
D. CT pulmonary angiography
ANSWER KEY HERE