Pathophysiology Focus in Systemic Diseases in Respiratory System - Respiratory Therapist Reviewer

A critical component of the Respiratory Therapist Board Exam is understanding how systemic diseases affect respiratory function. Pathophysiological changes resulting from heart failure, renal failure, and neuromuscular disorders often have profound implications on pulmonary health. A thorough review of these interrelated conditions is essential for exam preparation and clinical practice.

Heart Failure and Respiratory Function

Heart failure, particularly left-sided heart failure, often leads to pulmonary congestion and edema due to increased pulmonary capillary pressure. Candidates must understand how fluid accumulation affects gas exchange, leading to symptoms like dyspnea and orthopnea. Familiarity with diagnostic tools such as chest X-rays and arterial blood gas (ABG) analysis, as well as treatments like diuretics and non-invasive ventilation (NIV), is essential for effective patient management.

Renal Failure and Pulmonary Complications

Renal failure significantly impacts respiratory function due to fluid overload, metabolic acidosis, and uremic lung conditions. Respiratory therapists should recognize how electrolyte imbalances, particularly hyperkalemia and metabolic acidosis, can impair respiratory drive and muscle function. Management includes hemodialysis and maintaining proper fluid-electrolyte balance.

Neuromuscular Disorders and Respiratory Impairment

Neuromuscular disorders such as amyotrophic lateral sclerosis (ALS), myasthenia gravis, and muscular dystrophy can lead to respiratory muscle weakness. Understanding the progression from respiratory insufficiency to failure is crucial. Candidates should focus on the assessment of vital capacities and other pulmonary function tests, as well as the use of non-invasive positive-pressure ventilation (NIPPV) and airway clearance strategies.

Mastering the pathophysiology and clinical management of systemic diseases affecting respiratory function, candidates are better equipped to provide effective care and excel in their board examinations. The reviewer should emphasize diagnostic strategies, therapeutic interventions, and patient monitoring for these complex conditions.

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 Systemic Diseases in Respiratory System. 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.

Cardiovascular Conditions and Respiratory Function

1. Which respiratory complication is most commonly associated with left-sided heart failure?

A. Pleural effusion

B. Pulmonary edema

C. Pneumothorax

D. Pulmonary embolism

2. A patient with congestive heart failure (CHF) is experiencing dyspnea when lying flat but improves when sitting up. What is this symptom called?

A. Orthopnea

B. Platypnea

C. Trepopnea

D. Hyperpnea

3. Which of the following is a hallmark sign of pulmonary congestion in heart failure?

A. Hyperinflated lungs on chest X-ray

B. Kerley B lines on chest X-ray

C. Decreased lung compliance

D. Alveolar consolidation

4. Which of the following is the primary cause of dyspnea in heart failure?

A. Airway obstruction

B. Fluid overload in the lungs

C. Increased lung compliance

D. Hyperventilation

5. Which of the following findings is expected in a patient with cardiogenic pulmonary edema?

A. Decreased PCWP (Pulmonary Capillary Wedge Pressure)

B. Frothy pink sputum

C. Decreased venous return

D. Decreased systemic vascular resistance

Renal Failure and Pulmonary Function

6. Which acid-base disorder is most commonly seen in chronic kidney disease (CKD)?

A. Metabolic alkalosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Respiratory acidosis

7. Patients with renal failure are at increased risk of pulmonary edema due to:

A. Increased sodium and water retention

B. Decreased pulmonary vascular resistance

C. Increased alveolar surfactant production

D. Hypovolemia

8. What is Kussmaul breathing, which is commonly seen in metabolic acidosis due to renal failure?

A. Rapid, deep breathing

B. Periodic cessation of breathing

C. Shallow, slow breathing

D. Labored breathing

9. Which pulmonary complication is commonly associated with end-stage renal disease (ESRD)?

A. Pleural effusion

B. Bronchiectasis

C. Pulmonary embolism

D. Pulmonary fibrosis

10. Why do patients with uremia experience dyspnea?

A. Bronchial obstruction

B. Increased lung compliance

C. Uremic toxins affect respiratory drive

D. Increased alveolar perfusion

Neuromuscular Disorders and Respiratory Function

11. Which of the following neuromuscular diseases is most likely to cause respiratory failure?

A. Myasthenia gravis

B. Multiple sclerosis

C. Guillain-Barré syndrome

D. All of the above

12. In patients with neuromuscular disease, which respiratory function is usually affected first?

A. Tidal volume

B. Inspiratory muscle strength

C. Oxygen saturation

D. Diffusing capacity

13. Which test is used to assess respiratory muscle weakness in neuromuscular disorders?

A. Peak expiratory flow rate (PEFR)

B. Maximum inspiratory pressure (MIP)

C. DLCO test

D. Arterial blood gas (ABG)

14. Which neuromuscular disorder is most associated with diaphragmatic paralysis?

A. Guillain-Barré syndrome

B. Parkinson’s disease

C. Huntington’s disease

D. Amyotrophic lateral sclerosis (ALS)

15. What is the most common cause of death in patients with advanced neuromuscular diseases?

A. Cardiac arrhythmias

B. Respiratory failure

C. Liver failure

D. Renal failure

More Questions

16. Which test helps differentiate cardiac from non-cardiac pulmonary edema?

A. D-dimer

B. B-type natriuretic peptide (BNP)

C. C-reactive protein (CRP)

D. Troponin

17. Which electrolyte imbalance in renal failure worsens muscle weakness and respiratory function?

A. Hyperkalemia

B. Hypocalcemia

C. Hyponatremia

D. Hypermagnesemia

18. Which of the following is a sign of diaphragmatic weakness in neuromuscular disease?

A. Paradoxical breathing

B. Kussmaul respiration

C. Cheyne-Stokes breathing

D. Biot’s breathing

19. Why does renal failure increase the risk of pleural effusion?

A. Increased vascular resistance

B. Fluid overload and uremic inflammation

C. Increased cardiac output

D. Increased lung compliance

20. Which neuromuscular disorder is most likely to cause chronic respiratory insufficiency?

A. Guillain-Barré syndrome

B. Myasthenia gravis

C. Amyotrophic lateral sclerosis (ALS)

D. Multiple sclerosis

21. Which respiratory support is recommended for advanced neuromuscular diseases with nocturnal hypoventilation?

A. High-flow nasal cannula (HFNC)

B. Invasive mechanical ventilation

C. Bilevel positive airway pressure (BiPAP)

D. Simple oxygen therapy

22. What is the primary cause of hypoxemia in pulmonary edema due to heart failure?

A. Decreased diffusion capacity

B. Ventilation-perfusion mismatch

C. Airway obstruction

D. Bronchoconstriction

23. Which of the following symptoms is a hallmark of respiratory failure in myasthenia gravis?

A. Sudden onset of fever and chills

B. Progressive dyspnea and reduced tidal volume

C. Wheezing and stridor

D. Chronic cough and sputum production

24. Which pulmonary function test (PFT) finding is expected in a patient with ALS?

A. Increased FEV1/FVC ratio

B. Decreased total lung capacity (TLC)

C. Increased residual volume (RV)

D. Decreased FEV1/FVC ratio

25. Which sleep-related breathing disorder is most common in patients with neuromuscular disease?

A. Central sleep apnea

B. Obstructive sleep apnea

C. Cheyne-Stokes respiration

D. Nocturnal hypoventilation

26. Which diagnostic test is most useful for evaluating chronic respiratory failure in neuromuscular disorders?

A. Chest X-ray

B. Pulmonary function tests (PFTs)

C. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP)

D. D-dimer

27. Which oxygen therapy strategy should be avoided in chronic CO₂ retainers, such as neuromuscular patients?

A. Low-flow oxygen therapy

B. High-flow nasal cannula (HFNC)

C. Non-invasive ventilation (NIV)

D. 100% oxygen via non-rebreather mask

28. What is the most common cause of pulmonary hypertension in patients with chronic renal failure?

A. Left ventricular dysfunction

B. Pulmonary embolism

C. Hypoxemia-induced vasoconstriction

D. Increased alveolar compliance

29. Which condition is associated with diaphragmatic fatigue and paradoxical breathing?

A. Chronic bronchitis

B. Spinal cord injury

C. Pulmonary fibrosis

D. Bronchiectasis

30. Which of the following is the most serious complication of respiratory muscle weakness in neuromuscular disorders?

A. Aspiration pneumonia

B. Atelectasis

C. Respiratory failure

D. Pulmonary hypertension

ANSWER KEY HERE