NR 507 Pathophysiology Midterm Practice
Exam (2026) 150 Questions with Answers &
Rationales
Study Tips for NR 507 Midterm
Focus on mechanisms — Understand why pathophysiological
processes occur, not just memorization
Use case studies — Apply concepts to clinical scenarios (as in this
practice exam)
Know the atopic march — Atopic dermatitis → asthma → allergic
rhinitis progression
Understand spirometry interpretation — FEV1/FVC ratio,
reversibility, obstructive vs. restrictive
Review drug classes — SABA, LABA, ICS, biologics, and their
mechanisms
Practice clinical reasoning — Develop differential diagnoses
systematically
Section 1: Respiratory Pathophysiology (Questions 1–35)
1. A 15-year-old male presents with wheezing, chest tightness, and
dyspnea after basketball practice in cold weather. Spirometry
,shows an FEV1/FVC ratio of 69% pre-bronchodilator and 82% post-
bronchodilator. What is the most likely diagnosis?
A) Restrictive lung disease
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma with reversible airway obstruction
D) Pulmonary fibrosis
Answer: C) Asthma with reversible airway obstruction
Rationale: The significant improvement in FEV1 (>12% and
>200 mL) post-bronchodilator confirms reversible airway
obstruction, which is hallmark of asthma. The exercise and
cold air triggers further support this diagnosis.
2. Which of the following pathophysiological mechanisms is
primarily responsible for the expiratory wheezing heard in an acute
asthma exacerbation?
A) Upper airway edema
B) Bronchospasm and airway narrowing during expiration
C) Pulmonary artery vasoconstriction
D) Alveolar collapse
Answer: B) Bronchospasm and airway narrowing during
expiration
,Rationale: During expiration, intrathoracic pressure
increases, further narrowing already constricted airways,
producing the characteristic high-pitched wheezing sound.
3. A patient with asthma has an elevated fractional exhaled nitric
oxide (FeNO) level of 45 ppb. This finding indicates:
A) Fixed airway obstruction
B) Eosinophilic airway inflammation
C) Bacterial pneumonia
D) Vocal cord dysfunction
Answer: B) Eosinophilic airway inflammation
Rationale: FeNO is a biomarker of eosinophilic inflammation
in the airways, commonly elevated in allergic asthma.
4. Which of the following is the strongest risk factor for developing
asthma in an adolescent?
A) Obesity
B) Family history of asthma
C) Low birth weight
D) Urban residence
Answer: B) Family history of asthma
, Rationale: Family history of asthma, particularly in a first-
degree relative, is one of the strongest risk factors, with
heritability estimated at 35–95%.
5. A 15-year-old with new-onset asthma has a peak expiratory flow
rate (PEFR) of 320 L/min. His predicted PEFR is 550 L/min. What
percentage of predicted is this, and what does it indicate?
A) 58%; moderate obstruction
B) 42%; severe obstruction
C) 72%; mild obstruction
D) 85%; normal lung function
Answer: A) 58%; moderate obstruction
Rationale: 320/550 = 58%. PEFR <80% predicted indicates
airway obstruction; 50–80% represents moderate obstruction.
6. Which inflammatory cells are predominantly involved in the
early-phase response of an asthma exacerbation?
A) Neutrophils
B) Eosinophils
C) Mast cells
D) Macrophages
Answer: C) Mast cells
Exam (2026) 150 Questions with Answers &
Rationales
Study Tips for NR 507 Midterm
Focus on mechanisms — Understand why pathophysiological
processes occur, not just memorization
Use case studies — Apply concepts to clinical scenarios (as in this
practice exam)
Know the atopic march — Atopic dermatitis → asthma → allergic
rhinitis progression
Understand spirometry interpretation — FEV1/FVC ratio,
reversibility, obstructive vs. restrictive
Review drug classes — SABA, LABA, ICS, biologics, and their
mechanisms
Practice clinical reasoning — Develop differential diagnoses
systematically
Section 1: Respiratory Pathophysiology (Questions 1–35)
1. A 15-year-old male presents with wheezing, chest tightness, and
dyspnea after basketball practice in cold weather. Spirometry
,shows an FEV1/FVC ratio of 69% pre-bronchodilator and 82% post-
bronchodilator. What is the most likely diagnosis?
A) Restrictive lung disease
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma with reversible airway obstruction
D) Pulmonary fibrosis
Answer: C) Asthma with reversible airway obstruction
Rationale: The significant improvement in FEV1 (>12% and
>200 mL) post-bronchodilator confirms reversible airway
obstruction, which is hallmark of asthma. The exercise and
cold air triggers further support this diagnosis.
2. Which of the following pathophysiological mechanisms is
primarily responsible for the expiratory wheezing heard in an acute
asthma exacerbation?
A) Upper airway edema
B) Bronchospasm and airway narrowing during expiration
C) Pulmonary artery vasoconstriction
D) Alveolar collapse
Answer: B) Bronchospasm and airway narrowing during
expiration
,Rationale: During expiration, intrathoracic pressure
increases, further narrowing already constricted airways,
producing the characteristic high-pitched wheezing sound.
3. A patient with asthma has an elevated fractional exhaled nitric
oxide (FeNO) level of 45 ppb. This finding indicates:
A) Fixed airway obstruction
B) Eosinophilic airway inflammation
C) Bacterial pneumonia
D) Vocal cord dysfunction
Answer: B) Eosinophilic airway inflammation
Rationale: FeNO is a biomarker of eosinophilic inflammation
in the airways, commonly elevated in allergic asthma.
4. Which of the following is the strongest risk factor for developing
asthma in an adolescent?
A) Obesity
B) Family history of asthma
C) Low birth weight
D) Urban residence
Answer: B) Family history of asthma
, Rationale: Family history of asthma, particularly in a first-
degree relative, is one of the strongest risk factors, with
heritability estimated at 35–95%.
5. A 15-year-old with new-onset asthma has a peak expiratory flow
rate (PEFR) of 320 L/min. His predicted PEFR is 550 L/min. What
percentage of predicted is this, and what does it indicate?
A) 58%; moderate obstruction
B) 42%; severe obstruction
C) 72%; mild obstruction
D) 85%; normal lung function
Answer: A) 58%; moderate obstruction
Rationale: 320/550 = 58%. PEFR <80% predicted indicates
airway obstruction; 50–80% represents moderate obstruction.
6. Which inflammatory cells are predominantly involved in the
early-phase response of an asthma exacerbation?
A) Neutrophils
B) Eosinophils
C) Mast cells
D) Macrophages
Answer: C) Mast cells
