Pathophysiology Focus in Respiratory Diseases - Respiratory Therapist Reviewer

The Pathophysiology section of the Respiratory Therapist Board Exam focuses on understanding the mechanisms, causes, and clinical manifestations of various respiratory diseases. This reviewer covers four major categories: Obstructive, Restrictive, Infectious, and Vascular Diseases, which are critical in diagnosing and managing respiratory conditions.

Obstructive Diseases

These conditions limit airflow due to airway narrowing or obstruction.

• Chronic Obstructive Pulmonary Disease (COPD): Progressive airflow limitation, commonly caused by smoking, with symptoms like chronic cough, sputum production, and dyspnea.
• Asthma: A reversible airway obstruction triggered by allergens or irritants, leading to wheezing, coughing, and shortness of breath.
• Bronchiectasis: Permanent airway dilation due to chronic infections or inflammation, characterized by persistent cough with copious sputum.

Restrictive Diseases

These conditions reduce lung expansion, leading to decreased lung volume.

• Pulmonary Fibrosis: Progressive scarring of lung tissue, causing dry cough and exertional dyspnea.
• Sarcoidosis: Granuloma formation in the lungs and other organs, presenting with cough and chest pain.
• Pneumoconiosis: Lung disease from inhaling dust particles (e.g., coal, silica), leading to chronic inflammation and fibrosis.

Infectious Diseases

Lung infections can cause inflammation, mucus production, and respiratory distress.

• Pneumonia: Infection of alveoli causing fever, cough, and difficulty breathing.
• Tuberculosis: Mycobacterium tuberculosis infection leading to chronic cough, hemoptysis, and weight loss.
• Bronchitis: Inflammation of bronchial tubes, often viral, with a persistent cough.

Vascular Diseases

These conditions affect lung blood flow and oxygenation.

• Pulmonary Embolism (PE): Blockage of pulmonary arteries, causing sudden dyspnea and chest pain.
• Pulmonary Hypertension: Increased pressure in pulmonary arteries, leading to right heart strain and fatigue.

Understanding these conditions is crucial for respiratory therapists to provide effective patient care and pass the board exam successfully.

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 Respiratory Diseases. 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.

Obstructive Lung Diseases

1. Which of the following is the primary cause of Chronic Obstructive Pulmonary Disease (COPD)?
A. Smoking
B. Occupational exposure to dust
C. Genetic mutations
D. Viral infections

2. Which test is most useful in distinguishing asthma from COPD?
A. Diffusion capacity (DLCO)
B. Methacholine challenge test
C. Chest X-ray
D. Arterial blood gas (ABG)

3. Bronchiectasis is characterized by:

A. Progressive alveolar destruction
B. Reversible airway obstruction
C. Permanent bronchial dilation
D. Decreased lung compliance

4. Which is a hallmark symptom of asthma?
A. Productive cough
B. Persistent wheezing
C. Digital clubbing
D. Weight loss

5. In COPD, which pulmonary function test result is most commonly decreased?

A. Total lung capacity (TLC)
B. Residual volume (RV)
C. Forced expiratory volume in 1 second (FEV₁)
D. Diffusing capacity of carbon monoxide (DLCO)

6. Which of the following is considered an irreversible component of COPD?
A. Airway inflammation
B. Mucus hypersecretion
C. Alveolar destruction
D. Bronchial hyperresponsiveness

7. Which statement about asthma is TRUE?

A. It is primarily a restrictive lung disease.
B. Airflow limitation is fully reversible.
C. It is characterized by chronic bronchial infection.
D. It does not respond to bronchodilators.

8. What is the typical FEV₁/FVC ratio in patients with obstructive lung disease?
A. >90%
B. 80–85%
C. 70–75%
D. <70%

Restrictive Lung Diseases

9. Which of the following is a restrictive lung disease?
A. Emphysema
B. Asthma
C. Pulmonary fibrosis
D. Chronic bronchitis

10. Pulmonary fibrosis primarily affects which part of the lungs?
A. Bronchi
B. Pleura
C. Alveolar interstitium
D. Large airways

11. Which environmental exposure is associated with pneumoconiosis?

A. Mold spores
B. Carbon monoxide
C. Tobacco smoke
D. Silica dust

12. Which restrictive lung disease is characterized by non-caseating granulomas?
A. Tuberculosis
B. Sarcoidosis
C. Pulmonary edema
D. Bronchiectasis

13. A patient with asbestosis is at increased risk of developing:
A. Mesothelioma
B. Asthma
C. Pulmonary embolism
D. Bronchiolitis

14. Which lung function parameter is most commonly reduced in restrictive lung diseases?

A. Forced expiratory volume in 1 second (FEV₁)
B. Total lung capacity (TLC)
C. Residual volume (RV)
D. Inspiratory reserve volume (IRV)

15. Which occupational exposure increases the risk of developing coal worker’s pneumoconiosis?
A. Asbestos
B. Silica
C. Coal dust
D. Cotton fibers

16. Which cytokine is most involved in the fibrosis of idiopathic pulmonary fibrosis (IPF)?
A. Tumor necrosis factor-alpha (TNF-α)
B. Interleukin-6 (IL-6)
C. Transforming growth factor-beta (TGF-β)
D. Interleukin-1 (IL-1)

Infectious Lung Diseases

17. The most common cause of bacterial pneumonia in adults is:
A. Mycoplasma pneumoniae
B. Haemophilus influenzae
C. Legionella pneumophila
D. Streptococcus pneumoniae

18. What is the classic radiographic finding in tuberculosis?
A. Ground-glass opacity
B. Honeycombing
C. Upper lobe cavitation
D. Pleural effusion

19. Which symptom is most commonly associated with acute bronchitis?

A. Hemoptysis
B. Dry, hacking cough
C. Night sweats
D. Weight loss

20. Pneumonia that develops after 48 hours of hospital admission is classified as:
A. Community-acquired pneumonia
B. Healthcare-associated pneumonia
C. Hospital-acquired pneumonia
D. Aspiration pneumonia

21. Which test is most commonly used to confirm tuberculosis?
A. Sputum culture
B. Chest X-ray
C. Mantoux (PPD) test
D. Bronchoscopy

22. Which of the following is a key symptom of pulmonary tuberculosis?
A. Sudden onset of pleuritic chest pain
B. Productive cough with hemoptysis
C. Acute respiratory distress
D. High fever with chills

23. What is the most appropriate first-line antibiotic regimen for community-acquired pneumonia?
A. Vancomycin + Clindamycin
B. Oseltamivir
C. Isoniazid + Rifampin
D. Azithromycin or Amoxicillin

Pulmonary Vascular Diseases

24. A pulmonary embolism is most commonly caused by a clot originating from:
A. The heart
B. The lungs
C. The deep veins of the legs
D. The carotid artery

25. Which imaging test is most sensitive for detecting pulmonary embolism?
A. Chest X-ray
B. CT Pulmonary Angiography (CTPA)
C. Ventilation-perfusion (V/Q) scan
D. Echocardiogram

26. Which is a major risk factor for pulmonary hypertension?

A. Smoking
B. Obstructive sleep apnea
C. Left heart disease
D. All of the above

27. What is the first-line treatment for acute pulmonary embolism?
A. Bronchodilators
B. Antibiotics
C. Anticoagulants
D. Diuretics

28. Which heart sound is commonly associated with pulmonary hypertension?
A. S1 accentuation
B. Loud P2 component of S2
C. S3 gallop
D. Diastolic murmur

29. Which clinical sign is most specific for a massive pulmonary embolism (PE)?
A. Sudden onset of dyspnea and chest pain
B. Slow progressive cough
C. Bilateral lung wheezing
D. Clubbing of the fingers

30. Which medication is used for long-term management of pulmonary arterial hypertension (PAH)?
A. Beta-blockers
B. Calcium channel blockers
C. Endothelin receptor antagonists (e.g., Bosentan)
D. Corticosteroids

ANSWER KEY HERE