Respiratory Disease Recognition Guide for RT Students

How to Use This Guide

Recognize the Pattern First

Each disease includes what to think first, common symptoms, ABG clues, PFT clues, imaging clues, and a board-style recognition clue. This is a recognition tool, not a full diagnostic or treatment protocol.

🫁 Obstructive 🫁 Restrictive 🦠 Infectious 🫀 Vascular 🫁 Pleural 🚨 Acute Failure 😴 Sleep 👶 Neonatal

🫁 Obstructive Diseases

Obstructive Diseases

Asthma

Reversible airway obstruction

Symptoms
Wheezing, chest tightness, cough, dyspnea

ABG clues
Early respiratory alkalosis; late respiratory acidosis

PFT clues
Obstructive pattern; decreased FEV1/FVC; bronchodilator response

Imaging clues
Often normal; hyperinflation during severe attacks

NBRC recognition clue: Young patient with episodic wheezing.

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COPD

Permanent airflow limitation

Symptoms
Dyspnea, chronic cough, sputum, smoking history

ABG clues
Chronic respiratory acidosis with metabolic compensation

PFT clues
Obstructive pattern; decreased FEV1/FVC

Imaging clues
Hyperinflation, flattened diaphragm

NBRC recognition clue: Older smoker with chronic symptoms.

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Chronic Bronchitis

Blue bloater; mucus-dominant COPD phenotype

Symptoms
Productive cough, frequent infections, dyspnea

ABG clues
Chronic respiratory acidosis may be present

PFT clues
Obstructive pattern

Imaging clues
Increased bronchovascular markings may be seen

NBRC recognition clue: Chronic productive cough for years.

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Emphysema

Pink puffer; alveolar wall destruction

Symptoms
Progressive dyspnea, minimal sputum, pursed-lip breathing

ABG clues
May be near normal early; chronic respiratory acidosis later

PFT clues
Obstructive pattern; reduced DLCO often seen

Imaging clues
Hyperinflation, flattened diaphragm, barrel chest

NBRC recognition clue: Thin smoker with dyspnea and hyperinflation.

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Bronchiectasis

Permanent airway dilation and destruction

Symptoms
Copious purulent sputum, recurrent infections, chronic cough

ABG clues
Hypoxemia or chronic CO2 retention in advanced disease

PFT clues
Often obstructive; may be mixed

Imaging clues
Tram-track or signet-ring findings on imaging

NBRC recognition clue: Large amounts of purulent secretions.

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Cystic Fibrosis

Thick secretions throughout the body

Symptoms
Chronic lung infections, malabsorption, poor weight gain

ABG clues
Hypoxemia or chronic hypercapnia in advanced disease

PFT clues
Obstructive pattern common as disease progresses

Imaging clues
Bronchiectatic changes, hyperinflation

NBRC recognition clue: Young patient with recurrent Pseudomonas infections.

🔒 Unlock Full Cystic Fibrosis Module

Go Beyond Recognition

This guide helps you identify diseases. PulmoLearn teaches the full clinical reasoning.

Unlock pathophysiology, diagnostics, management, ventilator implications, and board-style review across the full RT curriculum.

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🫁 Restrictive Diseases

Restrictive Diseases

Pulmonary Fibrosis

Stiff lungs and impaired diffusion

Symptoms
Progressive dyspnea, dry cough, fatigue

ABG clues
Hypoxemia; respiratory alkalosis may occur early

PFT clues
Restrictive pattern; reduced TLC; reduced DLCO

Imaging clues
Reticular changes, honeycombing

NBRC recognition clue: Fine crackles, clubbing, and progressive dyspnea.

🔒 Unlock Full Pulmonary Fibrosis Module

Sarcoidosis

Granulomatous disease

Symptoms
Cough, dyspnea, fatigue; may have systemic findings

ABG clues
Often normal early; hypoxemia if advanced

PFT clues
Restrictive, obstructive, or mixed pattern possible

Imaging clues
Bilateral hilar adenopathy is classic

NBRC recognition clue: Young adult with hilar lymphadenopathy.

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Pneumoconiosis

Occupational exposure lung disease

Symptoms
Progressive dyspnea, cough, exposure history

ABG clues
Hypoxemia in advanced disease

PFT clues
Restrictive pattern common; mixed patterns possible

Imaging clues
Nodular or fibrotic changes depending on exposure

NBRC recognition clue: Exposure history is the key clue.

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🦠 Infectious Diseases

Infectious Diseases

Pneumonia

Infection with consolidation

Symptoms
Fever, productive cough, chills, dyspnea

ABG clues
Hypoxemia; respiratory alkalosis may occur early

PFT clues
Not usually diagnosed by PFTs acutely

Imaging clues
Localized or multifocal infiltrates/consolidation

NBRC recognition clue: Fever plus infiltrate.

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Tuberculosis

Chronic infection, often upper-lobe predominant

Symptoms
Chronic cough, weight loss, night sweats, hemoptysis

ABG clues
Usually normal early; hypoxemia if extensive

PFT clues
Variable depending on chronic damage

Imaging clues
Upper-lobe infiltrates or cavitary lesions

NBRC recognition clue: Chronic cough, weight loss, night sweats, hemoptysis.

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🫀 Vascular Disorders

Vascular Disorders

Pulmonary Embolism

Dead space problem from blocked perfusion

Symptoms
Sudden dyspnea, pleuritic chest pain, tachycardia

ABG clues
Respiratory alkalosis and hypoxemia are common clues

PFT clues
Not a primary diagnostic tool

Imaging clues
Chest x-ray may be normal; CT angiography often used

NBRC recognition clue: Sudden dyspnea with a normal or near-normal CXR.

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Pulmonary Hypertension

High pulmonary vascular pressure and right heart strain

Symptoms
Dyspnea, fatigue, syncope, edema in advanced disease

ABG clues
May show hypoxemia depending on cause

PFT clues
Depends on underlying disease

Imaging clues
Enlarged pulmonary arteries or right heart findings may appear

NBRC recognition clue: Dyspnea, syncope, loud P2, right-heart strain clues.

🔒 Unlock Full Pulmonary Hypertension Module

🫁 Pleural Disorders

Pleural Disorders

Pneumothorax

Air in the pleural space

Symptoms
Sudden unilateral chest pain, dyspnea, decreased breath sounds

ABG clues
Hypoxemia if large or tension physiology develops

PFT clues
Not used acutely

Imaging clues
Absent lung markings beyond pleural line

NBRC recognition clue: Sudden unilateral chest pain with absent lung markings.

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Pleural Effusion

Fluid in the pleural space

Symptoms
Dyspnea, pleuritic pain, decreased breath sounds

ABG clues
Hypoxemia if large enough to impair ventilation

PFT clues
Restrictive effect if large/chronic

Imaging clues
Blunted costophrenic angle; meniscus sign

NBRC recognition clue: Decreased breath sounds plus blunted costophrenic angle.

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🚨 Acute Respiratory Failure

Acute Respiratory Failure

ARDS

Noncardiogenic pulmonary edema and severe inflammatory lung injury

Symptoms
Acute dyspnea, severe hypoxemia, high oxygen needs

ABG clues
Severe hypoxemia; low P/F ratio

PFT clues
Not an acute diagnostic test

Imaging clues
Diffuse bilateral infiltrates

NBRC recognition clue: Refractory hypoxemia after sepsis, trauma, aspiration, or major insult.

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Acute Pulmonary Edema

Cardiogenic flooding of the lungs

Symptoms
Severe dyspnea, crackles, orthopnea, pink frothy sputum

ABG clues
Hypoxemia; respiratory alkalosis early, acidosis if failing

PFT clues
Not used acutely

Imaging clues
Bat-wing infiltrates, vascular congestion, possible cardiomegaly

NBRC recognition clue: Pink frothy sputum and cardiogenic fluid overload clues.

🔒 Unlock Full Pulmonary Edema Module

😴 Sleep Disorders

Sleep Disorders

Obstructive Sleep Apnea

Upper airway collapse during sleep

Symptoms
Snoring, witnessed apneas, daytime sleepiness, morning headaches

ABG clues
May show chronic hypercapnia if overlap/OHS present

PFT clues
Usually not diagnostic

Imaging clues
Not usually diagnosed by chest imaging

NBRC recognition clue: Obese patient with snoring and witnessed apneas.

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👶 Neonatal Disorders

Neonatal Disorders

Neonatal RDS

Surfactant deficiency

Symptoms
Premature infant, grunting, retractions, nasal flaring

ABG clues
Hypoxemia; respiratory acidosis if ventilation worsens

PFT clues
Not used like adult PFTs

Imaging clues
Ground-glass appearance, low lung volumes

NBRC recognition clue: Premature infant with ground-glass CXR.

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Meconium Aspiration Syndrome

Air trapping plus chemical inflammation

Symptoms
Post-term infant, respiratory distress, meconium-stained fluid

ABG clues
Hypoxemia; respiratory acidosis may occur

PFT clues
Not applicable acutely

Imaging clues
Patchy infiltrates and hyperinflation

NBRC recognition clue: Post-term infant with meconium staining and distress.

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PPHN

Persistent fetal circulation with right-to-left shunting

Symptoms
Severe hypoxemia, cyanosis, respiratory distress

ABG clues
Severe hypoxemia; may be disproportionate to lung findings

PFT clues
Not applicable acutely

Imaging clues
May vary depending on underlying lung disease

NBRC recognition clue: Pre/post-ductal saturation difference.

🔒 Unlock Full PPHN Module

Board Prep

10 Common NBRC Disease Recognition Clues

These are the kinds of clues that help students quickly narrow the differential during board-style questions.

If You See...	Think...
Reversible wheezing	Asthma
Smoker + hyperinflation	COPD / Emphysema
Copious purulent sputum	Bronchiectasis
Clubbing + honeycombing	Pulmonary Fibrosis
Sudden dyspnea + normal CXR	Pulmonary Embolism
Bilateral infiltrates + refractory hypoxemia	ARDS
Pink frothy sputum	Acute Pulmonary Edema
Blunted costophrenic angle	Pleural Effusion
Premature infant + ground-glass CXR	Neonatal RDS
Pre/post-ductal saturation difference	PPHN

Differential Diagnosis

Quick Comparison Table

Use this table to quickly compare obstructive patterns, restrictive patterns, imaging clues, and board-style recognition details.

Disease	Obstructive	Restrictive	Hyperinflation	Infiltrates / Imaging	Key Clue
Asthma	Yes		Sometimes		Reversible wheezing
COPD	Yes		Yes		Smoking history
Bronchiectasis	Often			Sometimes	Copious purulent sputum
Cystic Fibrosis	Often		Sometimes	Recurrent	Young patient + Pseudomonas
Pulmonary Fibrosis		Yes		Reticular/honeycomb	Clubbing + crackles
Pneumonia				Yes	Fever + infiltrate
ARDS		Stiff lungs		Diffuse bilateral	Refractory hypoxemia
Pulmonary Embolism				Usually normal	Sudden dyspnea
Pneumothorax				Absent markings	Sudden unilateral pain
Pleural Effusion		Restrictive effect		Blunted CP angle	Dullness/decreased sounds
Neonatal RDS		Low compliance		Ground glass	Premature infant
MAS	Air trapping		Yes	Patchy infiltrates	Meconium staining

Continue Learning

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