NR507 Final Exam –
Comprehensive Advanced
Pathophysiology Review
with Answers
(Chamberlain
1. Which patient is most likely to develop left-sided heart failure first?
A. A patient with chronic pulmonary hypertension
B. A patient with long-standing systemic hypertension
C. A patient with tricuspid regurgitation
D. A patient with cor pulmonale
Answer: B. A patient with long-standing systemic hypertension
Rationale: Systemic hypertension increases afterload on the left ventricle, leading to
LV hypertrophy and eventual left-sided heart failure.
2. A patient with left-sided heart failure most commonly presents with:
A. Peripheral edema and hepatomegaly
B. Jugular venous distention
C. Pulmonary congestion and dyspnea
D. Ascites
Answer: C. Pulmonary congestion and dyspnea
,Rationale: Left-sided heart failure causes blood to back up into the lungs, leading to
crackles, orthopnea, and dyspnea.
3. The primary pathophysiologic defect in type 1 diabetes mellitus is:
A. Peripheral insulin resistance
B. Autoimmune destruction of pancreatic beta cells
C. Excess glucagon secretion
D. Impaired incretin response
Answer: B. Autoimmune destruction of pancreatic beta cells
Rationale: Type 1 DM results from autoimmune destruction of beta cells, causing
absolute insulin deficiency.
4. The “dawn phenomenon” in diabetes refers to:
A. Nocturnal hypoglycemia followed by rebound hyperglycemia
B. Early morning hyperglycemia caused by increased counterregulatory hormones
C. Sudden onset of diabetic ketoacidosis
D. Hyperglycemia after breakfast
Answer: B. Early morning hyperglycemia caused by increased counterregulatory
hormones
Rationale: Cortisol and growth hormone rise in early morning, increasing glucose
production.
5. Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Severe hyperglycemia without ketosis
B. Metabolic alkalosis
C. Kussmaul respirations
D. Profound bradycardia
,Answer: C. Kussmaul respirations
Rationale: DKA causes metabolic acidosis; the body compensates with deep, rapid
respirations.
6. Hyperosmolar hyperglycemic state (HHS) differs from DKA because HHS usually
has:
A. More severe ketosis
B. Lower serum osmolality
C. Minimal or absent ketoacidosis
D. Earlier onset
Answer: C. Minimal or absent ketoacidosis
Rationale: In HHS, enough insulin is present to prevent lipolysis and significant
ketone formation.
7. The most common cause of primary hypothyroidism is:
A. Pituitary adenoma
B. Hashimoto thyroiditis
C. Graves disease
D. Iodine excess
Answer: B. Hashimoto thyroiditis
Rationale: Hashimoto is an autoimmune destruction of the thyroid gland and is the
leading cause of hypothyroidism.
8. Which lab pattern is expected in primary hypothyroidism?
A. Low TSH, low free T4
B. High TSH, low free T4
, C. High TSH, high free T4
D. Low TSH, high free T4
Answer: B. High TSH, low free T4
Rationale: The pituitary increases TSH in response to low thyroid hormone.
9. Graves disease causes hyperthyroidism through:
A. Destruction of thyroid follicles
B. TSH-secreting pituitary tumor
C. Autoantibodies stimulating the TSH receptor
D. Iodine deficiency
Answer: C. Autoantibodies stimulating the TSH receptor
Rationale: Thyroid-stimulating immunoglobulins mimic TSH and increase hormone
production.
10. Exophthalmos is most specifically associated with:
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid storm
D. Myxedema coma
Answer: B. Graves disease
Rationale: Autoimmune inflammation of orbital tissues leads to eye protrusion.
11. Which electrolyte abnormality is most associated with Addison disease?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia
C. Hypercalcemia and hypophosphatemia
Comprehensive Advanced
Pathophysiology Review
with Answers
(Chamberlain
1. Which patient is most likely to develop left-sided heart failure first?
A. A patient with chronic pulmonary hypertension
B. A patient with long-standing systemic hypertension
C. A patient with tricuspid regurgitation
D. A patient with cor pulmonale
Answer: B. A patient with long-standing systemic hypertension
Rationale: Systemic hypertension increases afterload on the left ventricle, leading to
LV hypertrophy and eventual left-sided heart failure.
2. A patient with left-sided heart failure most commonly presents with:
A. Peripheral edema and hepatomegaly
B. Jugular venous distention
C. Pulmonary congestion and dyspnea
D. Ascites
Answer: C. Pulmonary congestion and dyspnea
,Rationale: Left-sided heart failure causes blood to back up into the lungs, leading to
crackles, orthopnea, and dyspnea.
3. The primary pathophysiologic defect in type 1 diabetes mellitus is:
A. Peripheral insulin resistance
B. Autoimmune destruction of pancreatic beta cells
C. Excess glucagon secretion
D. Impaired incretin response
Answer: B. Autoimmune destruction of pancreatic beta cells
Rationale: Type 1 DM results from autoimmune destruction of beta cells, causing
absolute insulin deficiency.
4. The “dawn phenomenon” in diabetes refers to:
A. Nocturnal hypoglycemia followed by rebound hyperglycemia
B. Early morning hyperglycemia caused by increased counterregulatory hormones
C. Sudden onset of diabetic ketoacidosis
D. Hyperglycemia after breakfast
Answer: B. Early morning hyperglycemia caused by increased counterregulatory
hormones
Rationale: Cortisol and growth hormone rise in early morning, increasing glucose
production.
5. Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Severe hyperglycemia without ketosis
B. Metabolic alkalosis
C. Kussmaul respirations
D. Profound bradycardia
,Answer: C. Kussmaul respirations
Rationale: DKA causes metabolic acidosis; the body compensates with deep, rapid
respirations.
6. Hyperosmolar hyperglycemic state (HHS) differs from DKA because HHS usually
has:
A. More severe ketosis
B. Lower serum osmolality
C. Minimal or absent ketoacidosis
D. Earlier onset
Answer: C. Minimal or absent ketoacidosis
Rationale: In HHS, enough insulin is present to prevent lipolysis and significant
ketone formation.
7. The most common cause of primary hypothyroidism is:
A. Pituitary adenoma
B. Hashimoto thyroiditis
C. Graves disease
D. Iodine excess
Answer: B. Hashimoto thyroiditis
Rationale: Hashimoto is an autoimmune destruction of the thyroid gland and is the
leading cause of hypothyroidism.
8. Which lab pattern is expected in primary hypothyroidism?
A. Low TSH, low free T4
B. High TSH, low free T4
, C. High TSH, high free T4
D. Low TSH, high free T4
Answer: B. High TSH, low free T4
Rationale: The pituitary increases TSH in response to low thyroid hormone.
9. Graves disease causes hyperthyroidism through:
A. Destruction of thyroid follicles
B. TSH-secreting pituitary tumor
C. Autoantibodies stimulating the TSH receptor
D. Iodine deficiency
Answer: C. Autoantibodies stimulating the TSH receptor
Rationale: Thyroid-stimulating immunoglobulins mimic TSH and increase hormone
production.
10. Exophthalmos is most specifically associated with:
A. Hashimoto thyroiditis
B. Graves disease
C. Thyroid storm
D. Myxedema coma
Answer: B. Graves disease
Rationale: Autoimmune inflammation of orbital tissues leads to eye protrusion.
11. Which electrolyte abnormality is most associated with Addison disease?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia
C. Hypercalcemia and hypophosphatemia
