NR507 MIDTERM EXAM 2026 ADVA xl xl xl xl
NCED PATHOPHYSIOLOGY EXAM xl xl xl
QUESTIONS AND CORRECT ANSW xl xl xl
ERS WITH RATIONALES GRADED A xl xl xl xl
+ LATEST xl
1. A 62-year-
xl xl
old male presents with fatigue, weight loss, and a persistent cough. Imaging reve
xl xl xl xl xl xl xl xl xl xl xl xl
als a mass in the right lung. Biopsy shows malignant cells producing parathyroid
xl xl xl xl xl xl xl xl xl xl xl xl xl
hormone-
related peptide (PTHrP). Which paraneoplastic syndrome is most likely presen
xl xl xl xl xl xl x l xl xl
t?
A. SIADH
B. Hypercalcemia
C. Cushing syndrome xl
D. Lambert-Eaton syndrome xl
Answer: B xl
Rationale:PTHrP secretion causes increased bone resorption and hypercalcemia. SI
xl xl xl xl xl xl xl xl xl
ADH is associated with ectopic ADH secretion (often small cell lung cancer). Cushi
xl xl xl xl xl xl xl xl xl xl xl xl
ng syndrome results from ectopic ACTH production. Lambert-
xl xl x l xl xl xl xl
Eaton is associated with neuromuscular weakness due to autoantibodies affecting
x l xl xl xl x l xl xl xl x l xl
presynaptic calcium channels. xl xl
,2. A patient has chronic GERD. Which cellular adaptation is most likely to occur
xl xl xl xl xl xl xl xl xl xl xl xl xl xl
in the lower esophagus?
xl xl xl
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Hyperplasia
Answer: B xl
Rationale:Chronic acid exposure leads to replacement of squamous epithelium with c
xl xl xl xl xl xl xl xl xl xl xl
olumnar epithelium (Barrett esophagus), a classic example of metaplasia.
xl x l xl xl xl xl xl xl
3. A 35-year-
xl xl
oldwoman presents with sudden onset of shortness ofbreath and pleuritic chest p
xl xl xl xl xl xl xl xl xl xl xl xl xl
ain. She has a history of deep vein thrombosis. Which pathophysiologic mechani
xl xl xl xl xl xl xl xl xl xl xl
sm best explains her symptoms?
xl xl xl xl
A. Bronchoconstriction due to mast cell activation xl xl xl xl xl
B. Alveolar collapse due to surfactant deficiency xl xl xl xl xl
C. Pulmonary vascular obstruction leading to V/Q mismatch xl xl xl xl xl xl
D. Infection causing inflammation of the pleura xl xl xl xl xl
Answer: C xl
Rationale:Pulmonary embolism causes obstruction of pulmonary arteries, resulting
xl xl xl xl xl xl xl xl
in impaired perfusion of ventilated alveoli, causing a ventilation-
xl xl xl xl xl x l x l xl xl
perfusion (V/Q) mismatch and hypoxemia.
xl xl xl x l xl
4. A patient with untreated type 1 diabetes presents with nausea, abdominal pai
xl xl xl xl xl xl xl xl xl xl xl xl
n, fruity breath, and Kussmaul respirations. Which acid-
xl xl xl xl xl xl xl
base disturbance is most likely?
xl xl xl xl
A. Respiratory alkalosis xl
B. Metabolic alkalosis xl
C. Respiratory acidosis xl
D. Metabolic acidosis xl
,Answer: D xl
Rationale:DKA causes increased ketone production,leading to metabolic acidosis.
xl xl xl xl xl xl x l xl xl xl
Kussmaul respirations are a compensatory response. xl x l xl xl xl
5. A 48-year-
xl xl
oldmale presents with severe abdominal pain radiating to the back, elevated seru
xl xl xl xl xl xl xl xl xl xl xl xl
m amylase and lipase, and a history of alcohol abuse. Which mechanism is respo
xl xl xl xl xl xl xl xl xl xl xl xl xl
nsible for his condition? xl xl xl
A. Autoimmune destruction of pancreatic beta cells xl xl xl xl xl
B. Activation of pancreatic enzymes within the pancreas xl xl xl xl xl xl
C. Obstruction of the common bile duct xl xl xl xl xl
D. Viral infection of pancreatic tissue xl xl xl xl
Answer: B xl
Rationale:Acute pancreatitis is caused by premature activation of pancreatic enzym
xl xl xl xl xl xl xl xl xl xl
es, leading to autodigestion and inflammation.
xl xl xl xl xl
6. A patient develops sudden right-
xl xl xl xl xl
sided weakness and aphasia. CT scan reveals an ischemic stroke in the left middl
xl xl xl xl xl xl xl xl xl xl xl xl xl
e cerebralartery territory. Which mechanism best explains the neurologic defi
x l xl xl xl xl xl xl xl xl xl
cits?
A. Increased intracranial pressure xl x l
B. Ischemia leading to neuronal death xl xl xl xl
C. Demyelination of motor neurons x l xl xl
D. Autoimmune destruction of synapses x l xl xl
Answer: B xl
Rationale:Ischemic stroke causes decreased blood flow, leading to oxygen deprivation,
xl xl xl xl xl xl xl xl xl xl xl
ATP depletion, and neuronal cell death.
xl xl xl xl xl
, 7. A patient with chronic kidney disease develops anemia. Which mechanism be
xl xl xl xl xl xl xl xl xl xl xl
st explains the anemia?
xl xl xl
A. Reducederythropoietin production xl xl
B. Increased hemolysis xl
C. Iron overload xl
D. Increased platelet destruction xl x l
Answer: A xl
Rationale:Kidneys produceerythropoietin; chronic kidney disease reduces erythropoiet
xl xl xl xl xl xl xl xl
in, leading to decreased RBC production and anemia.
x l x l xl xl xl xl xl
8. A 27-year-
xl xl
old woman presents with fatigue, cold intolerance, constipation, and weightgain
xl xl xl xl xl xl xl xl xl xl
. Lab results show elevatedTSH and low T4. What is the most likely diagnosis?
xl xl xl xl xl xl xl xl xl xl x l xl xl xl
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome xl
D. Addison disease xl
Answer: B xl
Rationale:Elevated TSH with low T4 indicates primary hypothyroidism.
xl xl xl xl xl xl xl xl
9. A patient presents with chronic inflammation and tissue remodeling in the air
xl xl xl xl xl xl xl xl xl xl xl xl
ways, leading to airflow obstruction and hyperresponsiveness. Which disease
xl xl x l xl xl xl xl xl xl
process is most consistent with these findings?
xl xl xl xl xl xl
A. COPD
B. Asthma
C. Pulmonary fibrosis xl
D. Bronchiectasis
Answer: B xl
Rationale:Asthma is characterized bychronic airway inflammation, hyperresponsivenes
xl xl xl xl xl xl xl xl
s, and reversible airflow obstruction.
xl xl xl xl
NCED PATHOPHYSIOLOGY EXAM xl xl xl
QUESTIONS AND CORRECT ANSW xl xl xl
ERS WITH RATIONALES GRADED A xl xl xl xl
+ LATEST xl
1. A 62-year-
xl xl
old male presents with fatigue, weight loss, and a persistent cough. Imaging reve
xl xl xl xl xl xl xl xl xl xl xl xl
als a mass in the right lung. Biopsy shows malignant cells producing parathyroid
xl xl xl xl xl xl xl xl xl xl xl xl xl
hormone-
related peptide (PTHrP). Which paraneoplastic syndrome is most likely presen
xl xl xl xl xl xl x l xl xl
t?
A. SIADH
B. Hypercalcemia
C. Cushing syndrome xl
D. Lambert-Eaton syndrome xl
Answer: B xl
Rationale:PTHrP secretion causes increased bone resorption and hypercalcemia. SI
xl xl xl xl xl xl xl xl xl
ADH is associated with ectopic ADH secretion (often small cell lung cancer). Cushi
xl xl xl xl xl xl xl xl xl xl xl xl
ng syndrome results from ectopic ACTH production. Lambert-
xl xl x l xl xl xl xl
Eaton is associated with neuromuscular weakness due to autoantibodies affecting
x l xl xl xl x l xl xl xl x l xl
presynaptic calcium channels. xl xl
,2. A patient has chronic GERD. Which cellular adaptation is most likely to occur
xl xl xl xl xl xl xl xl xl xl xl xl xl xl
in the lower esophagus?
xl xl xl
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Hyperplasia
Answer: B xl
Rationale:Chronic acid exposure leads to replacement of squamous epithelium with c
xl xl xl xl xl xl xl xl xl xl xl
olumnar epithelium (Barrett esophagus), a classic example of metaplasia.
xl x l xl xl xl xl xl xl
3. A 35-year-
xl xl
oldwoman presents with sudden onset of shortness ofbreath and pleuritic chest p
xl xl xl xl xl xl xl xl xl xl xl xl xl
ain. She has a history of deep vein thrombosis. Which pathophysiologic mechani
xl xl xl xl xl xl xl xl xl xl xl
sm best explains her symptoms?
xl xl xl xl
A. Bronchoconstriction due to mast cell activation xl xl xl xl xl
B. Alveolar collapse due to surfactant deficiency xl xl xl xl xl
C. Pulmonary vascular obstruction leading to V/Q mismatch xl xl xl xl xl xl
D. Infection causing inflammation of the pleura xl xl xl xl xl
Answer: C xl
Rationale:Pulmonary embolism causes obstruction of pulmonary arteries, resulting
xl xl xl xl xl xl xl xl
in impaired perfusion of ventilated alveoli, causing a ventilation-
xl xl xl xl xl x l x l xl xl
perfusion (V/Q) mismatch and hypoxemia.
xl xl xl x l xl
4. A patient with untreated type 1 diabetes presents with nausea, abdominal pai
xl xl xl xl xl xl xl xl xl xl xl xl
n, fruity breath, and Kussmaul respirations. Which acid-
xl xl xl xl xl xl xl
base disturbance is most likely?
xl xl xl xl
A. Respiratory alkalosis xl
B. Metabolic alkalosis xl
C. Respiratory acidosis xl
D. Metabolic acidosis xl
,Answer: D xl
Rationale:DKA causes increased ketone production,leading to metabolic acidosis.
xl xl xl xl xl xl x l xl xl xl
Kussmaul respirations are a compensatory response. xl x l xl xl xl
5. A 48-year-
xl xl
oldmale presents with severe abdominal pain radiating to the back, elevated seru
xl xl xl xl xl xl xl xl xl xl xl xl
m amylase and lipase, and a history of alcohol abuse. Which mechanism is respo
xl xl xl xl xl xl xl xl xl xl xl xl xl
nsible for his condition? xl xl xl
A. Autoimmune destruction of pancreatic beta cells xl xl xl xl xl
B. Activation of pancreatic enzymes within the pancreas xl xl xl xl xl xl
C. Obstruction of the common bile duct xl xl xl xl xl
D. Viral infection of pancreatic tissue xl xl xl xl
Answer: B xl
Rationale:Acute pancreatitis is caused by premature activation of pancreatic enzym
xl xl xl xl xl xl xl xl xl xl
es, leading to autodigestion and inflammation.
xl xl xl xl xl
6. A patient develops sudden right-
xl xl xl xl xl
sided weakness and aphasia. CT scan reveals an ischemic stroke in the left middl
xl xl xl xl xl xl xl xl xl xl xl xl xl
e cerebralartery territory. Which mechanism best explains the neurologic defi
x l xl xl xl xl xl xl xl xl xl
cits?
A. Increased intracranial pressure xl x l
B. Ischemia leading to neuronal death xl xl xl xl
C. Demyelination of motor neurons x l xl xl
D. Autoimmune destruction of synapses x l xl xl
Answer: B xl
Rationale:Ischemic stroke causes decreased blood flow, leading to oxygen deprivation,
xl xl xl xl xl xl xl xl xl xl xl
ATP depletion, and neuronal cell death.
xl xl xl xl xl
, 7. A patient with chronic kidney disease develops anemia. Which mechanism be
xl xl xl xl xl xl xl xl xl xl xl
st explains the anemia?
xl xl xl
A. Reducederythropoietin production xl xl
B. Increased hemolysis xl
C. Iron overload xl
D. Increased platelet destruction xl x l
Answer: A xl
Rationale:Kidneys produceerythropoietin; chronic kidney disease reduces erythropoiet
xl xl xl xl xl xl xl xl
in, leading to decreased RBC production and anemia.
x l x l xl xl xl xl xl
8. A 27-year-
xl xl
old woman presents with fatigue, cold intolerance, constipation, and weightgain
xl xl xl xl xl xl xl xl xl xl
. Lab results show elevatedTSH and low T4. What is the most likely diagnosis?
xl xl xl xl xl xl xl xl xl xl x l xl xl xl
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome xl
D. Addison disease xl
Answer: B xl
Rationale:Elevated TSH with low T4 indicates primary hypothyroidism.
xl xl xl xl xl xl xl xl
9. A patient presents with chronic inflammation and tissue remodeling in the air
xl xl xl xl xl xl xl xl xl xl xl xl
ways, leading to airflow obstruction and hyperresponsiveness. Which disease
xl xl x l xl xl xl xl xl xl
process is most consistent with these findings?
xl xl xl xl xl xl
A. COPD
B. Asthma
C. Pulmonary fibrosis xl
D. Bronchiectasis
Answer: B xl
Rationale:Asthma is characterized bychronic airway inflammation, hyperresponsivenes
xl xl xl xl xl xl xl xl
s, and reversible airflow obstruction.
xl xl xl xl
