NR 507 Advanced Pathophysiology
1. Which pathophysiologic mechanism BEST explains orthopnea in left-sided
heart failure?
A. Decreased pulmonary capillary pressure
B. Increased systemic venous return
C. Pulmonary venous congestion
D. Reduced myocardial oxygen demand
✅ Correct Answer: C
Rationale:
Left ventricular failure causes blood to back up into pulmonary circulation, leading to congestion
that worsens when lying flat.
2. A patient with chronic hypertension develops concentric left ventricular
hypertrophy. This is primarily due to:
A. Volume overload
B. Pressure overload
C. Ischemic injury
D. Neurohormonal depletion
✅ Correct Answer: B
Rationale:
Sustained pressure overload stimulates myocardial wall thickening to reduce wall stress.
3. Which cellular adaptation is REVERSIBLE with removal of stress?
A. Dysplasia
B. Metaplasia
C. Neoplasia
D. Apoptosis
✅ Correct Answer: B
Rationale:
Metaplasia is a reversible change where one mature cell type replaces another in response to
stress.
,4. In chronic obstructive pulmonary disease (COPD), hypoxemia primarily
results from:
A. Alveolar hypoventilation
B. Diffusion impairment
C. Ventilation–perfusion mismatch
D. Reduced respiratory drive
✅ Correct Answer: C
Rationale:
COPD causes uneven ventilation relative to perfusion, leading to hypoxemia.
5. Which acid–base disorder is expected in prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
✅ Correct Answer: C
Rationale:
Loss of gastric hydrochloric acid leads to metabolic alkalosis.
6. Which hormone primarily increases renal sodium reabsorption in heart
failure?
A. Atrial natriuretic peptide
B. Aldosterone
C. Antidiuretic hormone
D. Cortisol
✅ Correct Answer: B
Rationale:
Aldosterone promotes sodium and water retention, worsening volume overload.
7. Atherosclerosis development begins with:
,A. Foam cell rupture
B. Endothelial injury
C. Fibrous cap formation
D. Platelet aggregation
✅ Correct Answer: B
Rationale:
Endothelial dysfunction allows lipid infiltration and inflammatory cell migration.
8. Which cytokine plays a MAJOR role in systemic inflammation and sepsis?
A. Interleukin-2
B. Interleukin-6
C. Tumor necrosis factor–alpha
D. Interferon gamma
✅ Correct Answer: C
Rationale:
TNF-α drives vasodilation, capillary leak, and hypotension in sepsis.
9. Which condition results from decreased surfactant production?
A. Pulmonary embolism
B. Acute respiratory distress syndrome
C. Neonatal respiratory distress syndrome
D. Asthma
✅ Correct Answer: C
Rationale:
Insufficient surfactant causes alveolar collapse in premature infants.
10. Which mechanism BEST explains edema in nephrotic syndrome?
A. Increased capillary permeability
B. Sodium retention
C. Hypoalbuminemia
D. Reduced cardiac output
, ✅ Correct Answer: C
Rationale:
Loss of albumin decreases oncotic pressure, allowing fluid to shift into interstitial spaces.
11. Hyperkalemia is MOST likely caused by:
A. Loop diuretics
B. Metabolic alkalosis
C. Renal failure
D. Hyperaldosteronism
✅ Correct Answer: C
Rationale:
Impaired renal excretion leads to potassium accumulation.
12. Which condition results from chronic hyperglycemia–induced endothelial
damage?
A. Diabetic ketoacidosis
B. Macrovascular disease
C. Hypoglycemia unawareness
D. Insulin resistance
✅ Correct Answer: B
Rationale:
Chronic glucose toxicity accelerates atherosclerosis.
13. Which immune cell is responsible for antibody production?
A. T lymphocyte
B. Macrophage
C. B lymphocyte
D. Natural killer cell
✅ Correct Answer: C
Rationale:
B cells differentiate into plasma cells that produce antibodies.
1. Which pathophysiologic mechanism BEST explains orthopnea in left-sided
heart failure?
A. Decreased pulmonary capillary pressure
B. Increased systemic venous return
C. Pulmonary venous congestion
D. Reduced myocardial oxygen demand
✅ Correct Answer: C
Rationale:
Left ventricular failure causes blood to back up into pulmonary circulation, leading to congestion
that worsens when lying flat.
2. A patient with chronic hypertension develops concentric left ventricular
hypertrophy. This is primarily due to:
A. Volume overload
B. Pressure overload
C. Ischemic injury
D. Neurohormonal depletion
✅ Correct Answer: B
Rationale:
Sustained pressure overload stimulates myocardial wall thickening to reduce wall stress.
3. Which cellular adaptation is REVERSIBLE with removal of stress?
A. Dysplasia
B. Metaplasia
C. Neoplasia
D. Apoptosis
✅ Correct Answer: B
Rationale:
Metaplasia is a reversible change where one mature cell type replaces another in response to
stress.
,4. In chronic obstructive pulmonary disease (COPD), hypoxemia primarily
results from:
A. Alveolar hypoventilation
B. Diffusion impairment
C. Ventilation–perfusion mismatch
D. Reduced respiratory drive
✅ Correct Answer: C
Rationale:
COPD causes uneven ventilation relative to perfusion, leading to hypoxemia.
5. Which acid–base disorder is expected in prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
✅ Correct Answer: C
Rationale:
Loss of gastric hydrochloric acid leads to metabolic alkalosis.
6. Which hormone primarily increases renal sodium reabsorption in heart
failure?
A. Atrial natriuretic peptide
B. Aldosterone
C. Antidiuretic hormone
D. Cortisol
✅ Correct Answer: B
Rationale:
Aldosterone promotes sodium and water retention, worsening volume overload.
7. Atherosclerosis development begins with:
,A. Foam cell rupture
B. Endothelial injury
C. Fibrous cap formation
D. Platelet aggregation
✅ Correct Answer: B
Rationale:
Endothelial dysfunction allows lipid infiltration and inflammatory cell migration.
8. Which cytokine plays a MAJOR role in systemic inflammation and sepsis?
A. Interleukin-2
B. Interleukin-6
C. Tumor necrosis factor–alpha
D. Interferon gamma
✅ Correct Answer: C
Rationale:
TNF-α drives vasodilation, capillary leak, and hypotension in sepsis.
9. Which condition results from decreased surfactant production?
A. Pulmonary embolism
B. Acute respiratory distress syndrome
C. Neonatal respiratory distress syndrome
D. Asthma
✅ Correct Answer: C
Rationale:
Insufficient surfactant causes alveolar collapse in premature infants.
10. Which mechanism BEST explains edema in nephrotic syndrome?
A. Increased capillary permeability
B. Sodium retention
C. Hypoalbuminemia
D. Reduced cardiac output
, ✅ Correct Answer: C
Rationale:
Loss of albumin decreases oncotic pressure, allowing fluid to shift into interstitial spaces.
11. Hyperkalemia is MOST likely caused by:
A. Loop diuretics
B. Metabolic alkalosis
C. Renal failure
D. Hyperaldosteronism
✅ Correct Answer: C
Rationale:
Impaired renal excretion leads to potassium accumulation.
12. Which condition results from chronic hyperglycemia–induced endothelial
damage?
A. Diabetic ketoacidosis
B. Macrovascular disease
C. Hypoglycemia unawareness
D. Insulin resistance
✅ Correct Answer: B
Rationale:
Chronic glucose toxicity accelerates atherosclerosis.
13. Which immune cell is responsible for antibody production?
A. T lymphocyte
B. Macrophage
C. B lymphocyte
D. Natural killer cell
✅ Correct Answer: C
Rationale:
B cells differentiate into plasma cells that produce antibodies.
