Post-test: Pathophysiology

Question 1

Which of the following is the primary cause of right ventricular hypertrophy in pulmonary hypertension?
a. Chronic hypoxemia
b. Increased venous return
c. Left-to-right shunting
d. Decreased pulmonary capillary recruitment

Answer 1

Correct answer: a — Rationale: Chronic hypoxemia increases pulmonary vascular resistance, causing RV strain and hypertrophy.

Question 2

Which condition is most likely to cause a decrease in lung compliance?
a. Emphysema
b. Acute respiratory distress syndrome
c. Bronchospasm
d. Pneumothorax

Answer 2

Correct answer: b — Rationale: ARDS stiffens the lungs due to alveolar fluid and inflammation, reducing compliance.

Question 3

A patient with chronic bronchitis typically demonstrates which of the following?
a. Decreased RBC count
b. Increased DLCO
c. Blue bloater appearance
d. Digital clubbing is uncommon

Answer 3

Correct answer: c — Rationale: Chronic bronchitis causes hypoxemia, cyanosis, and edema—classic ‘blue bloater’.

Question 4

Which ABG result is MOST consistent with acute ventilatory failure?
a. pH 7.48, PaCO₂ 30
b. pH 7.36, PaCO₂ 50
c. pH 7.27, PaCO₂ 60
d. pH 7.38, PaCO₂ 45

Answer 4

Correct answer: c — Rationale: Acute ventilatory failure shows high PaCO₂ with acidemia (pH < 7.30).

Question 5

Which clinical finding is characteristic of emphysema?
a. Decreased A–P diameter
b. Elevated hemoglobin
c. Diminished breath sounds
d. Increased tactile fremitus

Answer 5

Correct answer: c — Rationale: Air trapping and hyperinflation reduce breath sound intensity.

Question 6

In asthma, airway obstruction is primarily due to:
a. Loss of surfactant
b. Decreased mucus production
c. Smooth muscle constriction
d. Alveolar wall destruction

Answer 6

Correct answer: c — Rationale: Asthma is defined by reversible bronchoconstriction from hyperreactive smooth muscle.

Question 7

A hallmark sign of left-sided heart failure is:
a. Peripheral edema
b. Hepatomegaly
c. Pulmonary congestion
d. Jugular vein distention

Answer 7

Correct answer: c — Rationale: Left heart failure causes fluid backup into the lungs → crackles and dyspnea.

Question 8

Which of the following increases airway resistance?
a. Decreased flow rate
b. Increased airway diameter
c. Bronchospasm
d. Removal of secretions

Answer 8

Correct answer: c — Rationale: Bronchospasm narrows the airway lumen, increasing resistance.

Question 9

Which pathology results in decreased diffusion capacity (DLCO)?
a. Emphysema
b. Chronic bronchitis
c. Asthma
d. Pulmonary edema

Answer 9

Correct answer: a — Rationale: Emphysema destroys alveolar walls, reducing surface area for diffusion → ↓DLCO.

Question 10

Which condition produces a ‘pink puffer’ appearance?
a. Chronic bronchitis
b. Pulmonary fibrosis
c. Emphysema
d. Asthma

Answer 10

Correct answer: c — Rationale: Emphysema patients hyperventilate to compensate, remaining well-oxygenated but dyspneic.

Question 11

In pneumonia, what is the primary cause of hypoxemia?
a. V/Q mismatch
b. Pure hypoventilation
c. Decreased barometric pressure
d. Low hemoglobin

Answer 11

Correct answer: a — Rationale: Consolidated alveoli cause V/Q mismatch and shunt leading to hypoxemia.

Question 12

Which breath sound is most associated with airway secretions?
a. Stridor
b. Crackles
c. Wheezes
d. Pleural friction rub

Answer 12

Correct answer: b — Rationale: Crackles occur when air moves through fluid or secretions in alveoli.

Question 13

Which of the following is a major risk factor for pulmonary embolism?
a. Chronic cough
b. Immobility
c. Upper airway obstruction
d. Pleural effusion

Answer 13

Correct answer: b — Rationale: Immobility leads to venous stasis, increasing clot formation.

Question 14

Which condition is characterized by a decreased A–P chest diameter?
a. Emphysema
b. Chronic bronchitis
c. Pulmonary fibrosis
d. Asthma

Answer 14

Correct answer: c — Rationale: Fibrosis restricts lung expansion, producing a narrow, stiff chest.

Question 15

A hallmark symptom of pulmonary edema is:
a. Dry cough
b. Pink frothy sputum
c. Barking cough
d. Purulent sputum

Answer 15

Correct answer: b — Rationale: Fluid in alveoli produces pink frothy sputum—classic for pulmonary edema.

Question 16

Which of the following breath sounds is MOST associated with pulmonary fibrosis?
a. Coarse crackles
b. Fine inspiratory crackles
c. Wheezes
d. Stridor

Answer 16

Correct answer: b — Rationale: Pulmonary fibrosis produces fine, Velcro-like crackles from stiff, fibrotic alveoli.

Question 17

A patient with COPD presents with polycythemia. What is the underlying cause?
a. Chronic metabolic alkalosis
b. Chronic hypoxemia
c. Reduced deadspace ventilation
d. Increased lung compliance

Answer 17

Correct answer: b — Rationale: Chronic hypoxemia stimulates erythropoiesis → increased RBC count.

Question 18

Which finding is MOST associated with bronchiectasis?
a. Digital clubbing
b. Barrel chest
c. Hyperresonance
d. Polycythemia

Answer 18

Correct answer: a — Rationale: Chronic infection and hypoxemia in bronchiectasis cause digital clubbing.

Question 19

What is the primary cause of pulsus paradoxus in severe asthma?
a. Left heart failure
b. Dynamic hyperinflation
c. Pleural effusion
d. Pulmonary fibrosis

Answer 19

Correct answer: b — Rationale: Severe asthma traps air → intrathoracic pressure swings → exaggerated drop in systolic BP.

Question 20

Which disorder leads to honeycombing on chest radiograph?
a. Emphysema
b. Pulmonary fibrosis
c. Chronic bronchitis
d. Asthma

Answer 20

Correct answer: b — Rationale: End-stage fibrosis forms cystic, ‘honeycomb’ structures.

Question 21

In chronic bronchitis, which parameter is typically INCREASED?
a. DLCO
b. Hemoglobin
c. Lung compliance
d. Inspiratory capacity

Answer 21

Correct answer: b — Rationale: Chronic hypoxemia triggers polycythemia → increased Hgb.

Question 22

Which disease is associated with decreased surfactant production?
a. ARDS
b. COPD
c. Asthma
d. Pleural effusion

Answer 22

Correct answer: a — Rationale: Type II pneumocytes are damaged in ARDS → loss of surfactant → alveolar collapse.

Question 23

Which clinical sign MOST suggests a pulmonary embolism?
a. Productive cough
b. Sudden dyspnea with clear lungs
c. Inspiratory stridor
d. Purulent sputum

Answer 23

Correct answer: b — Rationale: PE presents with sudden hypoxemia and dyspnea, usually with clear breath sounds.

Question 24

A patient with pneumonia MOST likely demonstrates which breath sound?
a. Pleural friction rub
b. Crackles
c. Wheezes
d. Rhonchi

Answer 24

Correct answer: b — Rationale: Fluid-filled alveoli produce crackles in pneumonia.

Question 25

Which ABG finding is commonly seen in early pulmonary embolism? a. Respiratory acidosis b. Hypercapnia c. Respiratory alkalosis d. Metabolic acidosis

Answer 25

Correct answer: c — Rationale: PE causes tachypnea → low PaCO₂ → respiratory alkalosis.

Question 26

Which sign is most indicative of tension pneumothorax? a. Dull percussion b. Tracheal deviation away from affected side c. Bilateral crackles d. Midline trachea

Answer 26

Correct answer: b — Rationale: Air under pressure pushes mediastinum away from the affected lung.

Question 27

In left heart failure, crackles occur due to: a. Airway inflammation b. Alveolar fluid accumulation c. Air trapping d. Pleural friction

Answer 27

Correct answer: b — Rationale: Pulmonary edema due to LHF fills alveoli with fluid → crackles.

Question 28

Which of the following is a hallmark of chronic bronchitis? a. Decreased mucus b. Reduced goblet cells c. Chronic sputum production d. Loss of elastic recoil

Answer 28

Correct answer: c — Rationale: Chronic productive cough for ≥3 months for 2 years defines chronic bronchitis.

Question 29

Hyperresonance to percussion is associated with: a. Consolidation b. Pleural effusion c. Pneumothorax d. Atelectasis

Answer 29

Correct answer: c — Rationale: Air in the pleural space increases resonance.

Question 30

Which of the following is a major risk factor for aspiration pneumonia? a. Hypertension b. Dysphagia c. Asthma d. COPD

Answer 30

Correct answer: b — Rationale: Swallowing dysfunction increases aspiration risk.

Question 31

Which condition is MOST associated with decreased DLCO? a. Chronic bronchitis b. Emphysema c. Asthma d. Pleural effusion

Answer 31

Correct answer: b — Rationale: Emphysema destroys alveolar-capillary membrane → markedly reduced DLCO.

Question 32

A patient with chronic bronchitis MOST likely presents with which ABG? a. pH 7.49, PaCO₂ 30 b. pH 7.36, PaCO₂ 55, HCO₃⁻ 32 c. pH 7.28, PaCO₂ 60 d. pH 7.52, PaCO₂ 22

Answer 32

Correct answer: b — Rationale: Chronic CO₂ retention with metabolic compensation is typical in chronic bronchitis.

Question 33

Which lung pattern is MOST typical for emphysema on chest X-ray? a. Consolidation b. Hyperinflation with flattened diaphragms c. Ground-glass opacities d. Massive pleural fluid

Answer 33

Correct answer: b — Rationale: Emphysema causes air trapping and diaphragm flattening.

Question 34

A hallmark sign of asthma on physical exam is: a. Dull percussion b. Expiratory wheeze c. Egophony d. Pleural rub

Answer 34

Correct answer: b — Rationale: Asthma causes airway narrowing → expiratory wheezing.

Question 35

Which disease typically presents with digital clubbing? a. Asthma b. Emphysema c. Bronchiectasis d. Pneumothorax

Answer 35

Correct answer: c — Rationale: Chronic inflammation and hypoxemia in bronchiectasis cause clubbing.

Question 36

Which pulmonary disease shows decreased lung compliance? a. Emphysema b. ARDS c. Chronic bronchitis d. Asthma

Answer 36

Correct answer: b — Rationale: ARDS results in stiff, non-compliant lungs due to alveolar flooding and inflammation.

Question 37

Which condition MOST commonly causes orthopnea? a. COPD b. Left ventricular failure c. Pneumothorax d. Pulmonary fibrosis

Answer 37

Correct answer: b — Rationale: LHF increases pulmonary venous pressure → patient cannot breathe lying flat.

Question 38

Which finding is MOST consistent with pneumonia? a. Hyperresonance b. Decreased fremitus c. Whispered pectoriloquy d. Prolonged expiration

Answer 38

Correct answer: c — Rationale: Consolidated lung transmits high-frequency sounds → positive pectoriloquy.

Question 39

Which sign is MOST indicative of pleural effusion? a. Tympanic percussion b. Dullness to percussion c. Hyperresonance d. Increased breath sounds

Answer 39

Correct answer: b — Rationale: Fluid in pleural space causes dull percussion.

Question 40

What is the best indicator of air trapping in COPD on X-ray? a. Kerley B lines b. Blunted costophrenic angles c. Flattened diaphragm d. Silhouette sign

Answer 40

Correct answer: c — Rationale: Air trapping pushes diaphragm downward.

Question 41

Which condition increases RV (residual volume)? a. ARDS b. Emphysema c. Pulmonary fibrosis d. Pleural effusion

Answer 41

Correct answer: b — Rationale: Loss of elastic recoil traps air → increased RV.

Question 42

Which condition leads to a shift of the mediastinum TOWARD the affected side? a. Large pleural effusion b. Tension pneumothorax c. Atelectasis d. Pneumonia

Answer 42

Correct answer: c — Rationale: Lung collapse pulls structures toward the affected side.

Question 43

Which disorder is associated with ground-glass opacities? a. Emphysema b. ARDS c. Pneumothorax d. Chronic bronchitis

Answer 43

Correct answer: b — Rationale: ARDS shows diffuse alveolar injury → ground glass pattern.

Question 44

A common clinical manifestation of pulmonary fibrosis is: a. Prolonged expiration b. Accessory muscle hypertrophy c. Dry inspiratory crackles d. Rhonchi

Answer 44

Correct answer: c — Rationale: Fibrosis produces fine “Velcro” crackles from stiff lungs.

Question 45

Which pulmonary disorder is MOST associated with chronic productive cough? a. Emphysema b. Chronic bronchitis c. Asthma d. Pneumothorax

Answer 45

Correct answer: b — Rationale: Chronic bronchitis requires productive cough ≥3 months/year for 2 consecutive years.

Question 46

Which condition is MOST associated with honeycombing on CT scan? a. ARDS b. Pulmonary fibrosis c. Chronic bronchitis d. Asthma

Answer 46

Correct answer: b — Rationale: Honeycombing is classic for end-stage interstitial lung disease, especially pulmonary fibrosis.

Question 47

Which breath sound is typically heard in pulmonary edema? a. Wheezes b. Fine crackles c. Pleural rub d. Stridor

Answer 47

Correct answer: b — Rationale: Fluid in alveoli causes fine inspiratory crackles, especially at lung bases.

Question 48

Which condition produces hyperresonant percussion with absent breath sounds? a. Pulmonary fibrosis b. Pneumothorax c. Pneumonia d. Pleural effusion

Answer 48

Correct answer: b — Rationale: Pneumothorax increases air volume → hyperresonance + absent breath sounds.

Question 49

Which disorder classically presents with barrel chest? a. Asthma (mild intermittent) b. Emphysema c. ARDS d. Pulmonary embolism

Answer 49

Correct answer: b — Rationale: Lung hyperinflation in emphysema increases AP diameter → barrel chest.

Question 50

Which condition is MOST consistent with dull percussion + ↓ fremitus + tracheal shift away? a. Atelectasis b. Pleural effusion c. Pneumothorax d. Chronic bronchitis

Answer 50

Correct answer: b — Rationale: Large effusion pushes mediastinum away and causes dullness from fluid.

Question 51

Which pulmonary condition commonly demonstrates tactile fremitus INCREASED? a. Pleural effusion b. Pneumothorax c. Consolidation (pneumonia) d. COPD

Answer 51

Correct answer: c — Rationale: Consolidation conducts low-frequency vibrations → increased fremitus.

Question 52

Which condition is MOST associated with sudden unilateral chest pain + dyspnea + hyperresonance? a. Asthma attack b. Spontaneous pneumothorax c. Bronchiectasis d. Pulmonary edema

Answer 52

Correct answer: b — Rationale: Pneumothorax presents with sudden pleuritic pain and hyperresonant chest.

Question 53

Which symptom BEST differentiates chronic bronchitis from asthma? a. Wheezing b. Chronic sputum production c. Dyspnea d. Cough

Answer 53

Correct answer: b — Rationale: Daily sputum production is the hallmark of chronic bronchitis.

Question 54

Which disease MOST typically exhibits decreased lung volumes with increased A–a gradient? a. Emphysema b. Interstitial lung disease c. Asthma d. Chronic bronchitis

Answer 54

Correct answer: b — Rationale: ILD causes restrictive physiology with impaired gas exchange → high A–a gradient.

Question 55

Which sign strongly suggests pleural friction rub? a. Continuous low-pitched rumble b. High-pitched musical sound c. Creaking/grating sound synchronous with breathing d. Disappears after coughing

Answer 55

Correct answer: c — Rationale: Pleural rub produces a leather-like grating sound that does not clear with cough.

Question 56

Which disorder MOST commonly presents with orthopnea and paroxysmal nocturnal dyspnea? a. Pulmonary embolism b. CHF c. COPD d. Pneumonia

Answer 56

Correct answer: b — Rationale: Left heart failure causes positional dyspnea and nocturnal attacks.

Question 57

Which finding suggests fluid-filled alveoli? a. Hyperresonance b. Dullness with bronchial breath sounds c. Increased AP diameter d. Decreased tactile fremitus

Answer 57

Correct answer: b — Rationale: Consolidation transmits bronchial sounds to periphery.

Question 58

Which condition MOST often shows pulsus paradoxus? a. Pulmonary fibrosis b. Severe asthma c. Pneumothorax d. Chronic bronchitis

Answer 58

Correct answer: b — Rationale: Severe asthma causes dynamic hyperinflation and large intrathoracic pressure swings.

Question 59

Which condition results in decreased DLCO with normal lung volumes? a. Emphysema b. Pulmonary fibrosis c. Pneumonia d. CHF

Answer 59

Correct answer: a — Rationale: Emphysema destroys alveolar-capillary surface area → low DLCO but often preserved or increased lung volumes.

Question 60

Which disorder MOST commonly produces inspiratory stridor? a. Upper airway obstruction b. Asthma c. COPD d. Pleural disease

Answer 60

Correct answer: a — Rationale: Stridor represents upper airway narrowing, not lower airway disease.

Question 61

Which condition is MOST associated with diffuse alveolar infiltrates and severe hypoxemia? a. Chronic bronchitis b. ARDS c. COPD d. Pleural effusion

Answer 61

Correct answer: b — Rationale: ARDS causes non-cardiogenic pulmonary edema with diffuse bilateral infiltrates and refractory hypoxemia.

Question 62

Which pulmonary condition classically shows Kerley B lines? a. Pneumonia b. Pulmonary edema c. COPD d. ARDS

Answer 62

Correct answer: b — Rationale: Kerley B lines reflect interstitial fluid from left heart failure or pulmonary edema.

Question 63

Which lung pathology shows hyperinflation + decreased vascular markings? a. ARDS b. Pneumonia c. Emphysema d. Pleural effusion

Answer 63

Correct answer: c — Rationale: Emphysema causes destruction of alveoli, reducing vasculature and increasing air volume.

Question 64

Which condition produces a large shift of mediastinum AWAY from the affected side? a. Pneumonia b. Atelectasis c. Large pleural effusion d. Pulmonary fibrosis

Answer 64

Correct answer: c — Rationale: Massive effusion pushes mediastinal structures away from the fluid-filled lung.

Question 65

Which finding indicates a tension pneumothorax? a. Dull percussion, absent fremitus b. Hyperresonance + tracheal shift away c. Bronchial breath sounds d. Egophony

Answer 65

Correct answer: b — Rationale: Tension pneumo causes severe hyperresonance and mediastinal shift.

Question 66

Which breathing pattern is MOST associated with metabolic acidosis? a. Biot's breathing b. Cheyne–Stokes c. Kussmaul respirations d. Apneustic breathing

Answer 66

Correct answer: c — Rationale: Kussmaul respirations are deep, rapid breaths compensating for metabolic acidosis.

Question 67

Which condition MOST commonly produces hemoptysis? a. Asthma b. Bronchiectasis c. Pneumothorax d. Pleural effusion

Answer 67

Correct answer: b — Rationale: Bronchiectasis causes chronic airway dilation → recurrent infection → blood-streaked sputum.

Question 68

Which disorder is characterized by coarse crackles that do NOT clear with coughing? a. Chronic bronchitis b. Pulmonary fibrosis c. Pneumonia d. Simple atelectasis

Answer 68

Correct answer: c — Rationale: Consolidated alveoli in pneumonia produce persistent crackles.

Question 69

Which condition MOST commonly leads to cor pulmonale? a. ARDS b. Chronic hypoxemia from COPD c. Pleural effusion d. Pulmonary embolism

Answer 69

Correct answer: b — Rationale: Long-term pulmonary vasoconstriction from COPD leads to right-sided heart failure.

Question 70

Which condition produces pink, frothy sputum? a. Bronchitis b. ARDS c. Left heart failure d. COPD

Answer 70

Correct answer: c — Rationale: Pulmonary edema from left heart failure causes pink, frothy sputum.

Question 71

Which disorder is MOST associated with wheezing unresponsive to bronchodilators? a. Asthma attack b. Pneumothorax c. Pulmonary edema d. Cardiac tamponade

Answer 71

Correct answer: c — Rationale: 'Cardiac asthma' due to pulmonary edema can mimic wheezing but will not respond to bronchodilators.

Question 72

Which lung condition decreases both compliance and lung volumes? a. Emphysema b. Pulmonary fibrosis c. Asthma d. Chronic bronchitis

Answer 72

Correct answer: b — Rationale: Fibrosis stiffens lung tissue → decreased compliance and restricted volumes.

Question 73

Which condition causes fremitus to DECREASE? a. Pneumonia b. Consolidation c. Pleural effusion d. Atelectasis with patent airway

Answer 73

Correct answer: c — Rationale: Fluid blocks transmission of vibrations → decreased fremitus.

Question 74

Which pathology increases the A–a gradient? a. Hypoventilation b. V/Q mismatch c. Anxiety attack d. Opioid overdose

Answer 74

Correct answer: b — Rationale: V/Q mismatch reduces oxygen transfer → increased A–a gradient.

Question 75

Which condition is MOST associated with a unilateral pleural rub? a. ARDS b. Pleural inflammation c. COPD d. CHF

Answer 75

Correct answer: b — Rationale: Inflamed pleural surfaces grate against each other causing a rub.