NURS 5315 ADVANCED PATHOPHYSIOLOGY EXAMS 1-5
2026/2027 | UTA Latest Updated Verified & Complete | Pass
Guaranteed - A+ Graded
Exam 1: Cellular Function, Genetics & Fluid/Electrolyte Balance (Questions 1-50)
Q1: A 68-year-old male with a history of severe peripheral artery disease presents with
gangrenous changes in his left great toe. A biopsy of the surrounding tissue would most likely
demonstrate which of the following primary cellular morphologic changes?
A. Shrunken basophilic cells with nuclear fragmentation
B. Cellular swelling, organelle disruption, and nuclear pyknosis [CORRECT]
C. Coagulative necrosis with preserved cellular outlines
D. Caseating granulomas with giant cells
Correct Answer: C
Rationale: Ischemia caused by arterial occlusion typically leads to coagulative necrosis, where
the cellular architecture is preserved but the cells are dead due to protein denaturation;
pyknosis (B) is an early nuclear change but doesn't describe the classic morphologic tissue
pattern, while caseating granulomas (D) are pathognomonic for tuberculosis.
Q2: A 45-year-old female presents with a painless, firm mass in her breast. Genetic testing
reveals a mutation in the BRCA1 gene. At the cellular level, the BRCA1 protein normally
functions to:
A. Promote angiogenesis for tumor sustenance
B. Repair double-stranded DNA breaks via homologous recombination [CORRECT]
C. Inhibit apoptosis by upregulating Bcl-2
D. Activate the G1/S cell cycle checkpoint independently of p53
Correct Answer: B
Rationale: BRCA1 is a tumor suppressor gene critical for the repair of double-stranded DNA
breaks through homologous recombination; its mutation leads to genomic instability and
malignancy. Distractors A and C describe oncogene/pro-survival functions, while D misstates its
checkpoint role.
,Q3: A 24-year-old male is admitted with a severe crush injury to his lower extremities. His serum
potassium is 7.2 mEq/L, and he exhibits peaked T waves on ECG. The underlying
pathophysiologic mechanism for this hyperkalemia is:
A. Shift of potassium extracellularly due to ATP-dependent Na+/K+ pump failure and cellular
lysis [CORRECT]
B. Decreased renal excretion of potassium due to acute tubular necrosis
C. Increased gastrointestinal absorption of potassium from tissue ischemia
D. Metabolic alkalosis causing a shift of hydrogen ions into the cells
Correct Answer: A
Rationale: Crush injuries cause massive cellular trauma, releasing intracellular potassium
directly into the extracellular fluid, compounded by ischemia-induced failure of the
Na+/K+-ATPase pump, which normally pumps K+ back into cells. Decreased renal excretion (B)
takes hours to days to manifest, not acutely.
Q4: A patient with prolonged vomiting has the following arterial blood gas (ABG) results: pH
7.52, PaCO2 48 mm Hg, HCO3- 38 mEq/L. These findings indicate which of the following
acid-base disorders?
A. Uncompensated metabolic alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis [CORRECT]
D. Mixed respiratory and metabolic alkalosis
Correct Answer: C
Rationale: Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis (elevated
pH and HCO3-). The elevated PaCO2 represents respiratory compensation (hypoventilation to
retain CO2), and because the pH is at the upper limit of normal, it is considered fully
compensated. Option B is incorrect because the primary issue is metabolic, not respiratory.
Q5: A 55-year-old male with chronic alcoholism presents with confusion, ataxia, and
ophthalmoplegia. MRI shows mammillary body degeneration. This clinical presentation is
caused by a deficiency in a cofactor required for which cellular process?
A. Glycolysis
B. Pyruvate dehydrogenase activity and transketolase reactions [CORRECT]
C. Beta-oxidation of fatty acids
D. Urea cycle ammonia detoxification
Correct Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine (B1) deficiency, which acts as an
essential cofactor for pyruvate dehydrogenase (linking glycolysis to the TCA cycle) and
,transketolase (pentose phosphate pathway), leading to neuronal energy failure and localized
edema/necrosis.
Q6: A patient with a history of chronic heart failure develops ascites and dependent edema. At
the capillary level, the edema is primarily driven by:
A. Decreased interstitial hydrostatic pressure
B. Increased plasma oncotic pressure
C. Increased capillary hydrostatic pressure due to venous congestion [CORRECT]
D. Increased capillary permeability due to cytokine release
Correct Answer: C
Rationale: Heart failure causes fluid retention and increased venous pressure, which transmits
backward into the capillary bed, increasing capillary hydrostatic pressure and forcing fluid out
into the interstitial space (edema). Increased capillary permeability (D) occurs in inflammation,
not simple HF.
Q7: A 30-year-old female is diagnosed with systemic lupus erythematosus (SLE). Lab tests
reveal antinuclear antibodies (ANA). The tissue injury in SLE is primarily mediated through
which mechanism?
A. Type I hypersensitivity with mast cell degranulation
B. Type II hypersensitivity with complement-mediated cell lysis
C. Type III hypersensitivity with immune complex deposition in tissues [CORRECT]
D. Type IV hypersensitivity with cytotoxic T-cell destruction
Correct Answer: C
Rationale: SLE is a classic prototype of Type III hypersensitivity, where autoantibodies form
soluble immune complexes that deposit in small vessels, basement membranes, and joints,
activating complement and attracting neutrophils that release lysosomal enzymes causing
tissue damage.
Q8: A child is born with flat facial profile, slanted palpebral fissures, epicanthal folds, and a
simian crease. Karyotype analysis reveals trisomy 21. The pathophysiologic basis of this
chromosomal abnormality is:
A. Unbalanced translocation of genetic material
B. Nondisjunction during meiotic division [CORRECT]
C. Deletion of the short arm of chromosome 5
D. Mosaicism confined strictly to germ cells
Correct Answer: B
, Rationale: Down syndrome (Trisomy 21) is most commonly caused by meiotic nondisjunction,
where homologous chromosomes or sister chromatids fail to separate properly, resulting in an
egg or sperm with 24 chromosomes instead of 23. Unbalanced translocation (A) is a less
frequent cause.
Q9: A 60-year-old male presents with severe crushing chest pain. Lab results show elevated
troponin I. The release of troponin into the serum is a direct result of:
A. Increased cellular protein synthesis in response to hypoxia
B. Rupture of the cell membrane and leakage of intracellular contents [CORRECT]
C. Activation of the apoptotic cascade preventing protein degradation
D. Enhanced endocytosis of necrotic debris by macrophages
Correct Answer: B
Rationale: Troponin is a structural intracellular protein. Myocardial cell necrosis (irreversible
injury) involves loss of cell membrane integrity, allowing intracellular proteins like troponin to
leak into the interstitial space and subsequently into the bloodstream. Apoptosis (C) does not
typically cause significant membrane rupture or protein leakage.
Q10: A patient's lab results show a serum sodium of 120 mEq/L, serum osmolality of 250
mOsm/kg, and urine osmolality of 400 mOsm/kg. These findings are most consistent with:
A. Primary polydipsia
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) [CORRECT]
C. Diabetes insipidus
D. Severe dehydration
Correct Answer: B
Rationale: SIADH causes excessive water retention, leading to hyponatremia and
hypoosmolality. The kidneys continue to reabsorb water inappropriately, resulting in
concentrated urine (urine osmolality > 100 mOsm/kg) despite low serum osmolality. Diabetes
insipidus (C) presents with dilute urine.
Q11: Which of the following cellular adaptations is most likely to occur in the urinary bladder of a
patient with chronic, untreated benign prostatic hyperplasia (BPH)?
A. Hyperplasia
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
2026/2027 | UTA Latest Updated Verified & Complete | Pass
Guaranteed - A+ Graded
Exam 1: Cellular Function, Genetics & Fluid/Electrolyte Balance (Questions 1-50)
Q1: A 68-year-old male with a history of severe peripheral artery disease presents with
gangrenous changes in his left great toe. A biopsy of the surrounding tissue would most likely
demonstrate which of the following primary cellular morphologic changes?
A. Shrunken basophilic cells with nuclear fragmentation
B. Cellular swelling, organelle disruption, and nuclear pyknosis [CORRECT]
C. Coagulative necrosis with preserved cellular outlines
D. Caseating granulomas with giant cells
Correct Answer: C
Rationale: Ischemia caused by arterial occlusion typically leads to coagulative necrosis, where
the cellular architecture is preserved but the cells are dead due to protein denaturation;
pyknosis (B) is an early nuclear change but doesn't describe the classic morphologic tissue
pattern, while caseating granulomas (D) are pathognomonic for tuberculosis.
Q2: A 45-year-old female presents with a painless, firm mass in her breast. Genetic testing
reveals a mutation in the BRCA1 gene. At the cellular level, the BRCA1 protein normally
functions to:
A. Promote angiogenesis for tumor sustenance
B. Repair double-stranded DNA breaks via homologous recombination [CORRECT]
C. Inhibit apoptosis by upregulating Bcl-2
D. Activate the G1/S cell cycle checkpoint independently of p53
Correct Answer: B
Rationale: BRCA1 is a tumor suppressor gene critical for the repair of double-stranded DNA
breaks through homologous recombination; its mutation leads to genomic instability and
malignancy. Distractors A and C describe oncogene/pro-survival functions, while D misstates its
checkpoint role.
,Q3: A 24-year-old male is admitted with a severe crush injury to his lower extremities. His serum
potassium is 7.2 mEq/L, and he exhibits peaked T waves on ECG. The underlying
pathophysiologic mechanism for this hyperkalemia is:
A. Shift of potassium extracellularly due to ATP-dependent Na+/K+ pump failure and cellular
lysis [CORRECT]
B. Decreased renal excretion of potassium due to acute tubular necrosis
C. Increased gastrointestinal absorption of potassium from tissue ischemia
D. Metabolic alkalosis causing a shift of hydrogen ions into the cells
Correct Answer: A
Rationale: Crush injuries cause massive cellular trauma, releasing intracellular potassium
directly into the extracellular fluid, compounded by ischemia-induced failure of the
Na+/K+-ATPase pump, which normally pumps K+ back into cells. Decreased renal excretion (B)
takes hours to days to manifest, not acutely.
Q4: A patient with prolonged vomiting has the following arterial blood gas (ABG) results: pH
7.52, PaCO2 48 mm Hg, HCO3- 38 mEq/L. These findings indicate which of the following
acid-base disorders?
A. Uncompensated metabolic alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic alkalosis [CORRECT]
D. Mixed respiratory and metabolic alkalosis
Correct Answer: C
Rationale: Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis (elevated
pH and HCO3-). The elevated PaCO2 represents respiratory compensation (hypoventilation to
retain CO2), and because the pH is at the upper limit of normal, it is considered fully
compensated. Option B is incorrect because the primary issue is metabolic, not respiratory.
Q5: A 55-year-old male with chronic alcoholism presents with confusion, ataxia, and
ophthalmoplegia. MRI shows mammillary body degeneration. This clinical presentation is
caused by a deficiency in a cofactor required for which cellular process?
A. Glycolysis
B. Pyruvate dehydrogenase activity and transketolase reactions [CORRECT]
C. Beta-oxidation of fatty acids
D. Urea cycle ammonia detoxification
Correct Answer: B
Rationale: Wernicke encephalopathy is caused by thiamine (B1) deficiency, which acts as an
essential cofactor for pyruvate dehydrogenase (linking glycolysis to the TCA cycle) and
,transketolase (pentose phosphate pathway), leading to neuronal energy failure and localized
edema/necrosis.
Q6: A patient with a history of chronic heart failure develops ascites and dependent edema. At
the capillary level, the edema is primarily driven by:
A. Decreased interstitial hydrostatic pressure
B. Increased plasma oncotic pressure
C. Increased capillary hydrostatic pressure due to venous congestion [CORRECT]
D. Increased capillary permeability due to cytokine release
Correct Answer: C
Rationale: Heart failure causes fluid retention and increased venous pressure, which transmits
backward into the capillary bed, increasing capillary hydrostatic pressure and forcing fluid out
into the interstitial space (edema). Increased capillary permeability (D) occurs in inflammation,
not simple HF.
Q7: A 30-year-old female is diagnosed with systemic lupus erythematosus (SLE). Lab tests
reveal antinuclear antibodies (ANA). The tissue injury in SLE is primarily mediated through
which mechanism?
A. Type I hypersensitivity with mast cell degranulation
B. Type II hypersensitivity with complement-mediated cell lysis
C. Type III hypersensitivity with immune complex deposition in tissues [CORRECT]
D. Type IV hypersensitivity with cytotoxic T-cell destruction
Correct Answer: C
Rationale: SLE is a classic prototype of Type III hypersensitivity, where autoantibodies form
soluble immune complexes that deposit in small vessels, basement membranes, and joints,
activating complement and attracting neutrophils that release lysosomal enzymes causing
tissue damage.
Q8: A child is born with flat facial profile, slanted palpebral fissures, epicanthal folds, and a
simian crease. Karyotype analysis reveals trisomy 21. The pathophysiologic basis of this
chromosomal abnormality is:
A. Unbalanced translocation of genetic material
B. Nondisjunction during meiotic division [CORRECT]
C. Deletion of the short arm of chromosome 5
D. Mosaicism confined strictly to germ cells
Correct Answer: B
, Rationale: Down syndrome (Trisomy 21) is most commonly caused by meiotic nondisjunction,
where homologous chromosomes or sister chromatids fail to separate properly, resulting in an
egg or sperm with 24 chromosomes instead of 23. Unbalanced translocation (A) is a less
frequent cause.
Q9: A 60-year-old male presents with severe crushing chest pain. Lab results show elevated
troponin I. The release of troponin into the serum is a direct result of:
A. Increased cellular protein synthesis in response to hypoxia
B. Rupture of the cell membrane and leakage of intracellular contents [CORRECT]
C. Activation of the apoptotic cascade preventing protein degradation
D. Enhanced endocytosis of necrotic debris by macrophages
Correct Answer: B
Rationale: Troponin is a structural intracellular protein. Myocardial cell necrosis (irreversible
injury) involves loss of cell membrane integrity, allowing intracellular proteins like troponin to
leak into the interstitial space and subsequently into the bloodstream. Apoptosis (C) does not
typically cause significant membrane rupture or protein leakage.
Q10: A patient's lab results show a serum sodium of 120 mEq/L, serum osmolality of 250
mOsm/kg, and urine osmolality of 400 mOsm/kg. These findings are most consistent with:
A. Primary polydipsia
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) [CORRECT]
C. Diabetes insipidus
D. Severe dehydration
Correct Answer: B
Rationale: SIADH causes excessive water retention, leading to hyponatremia and
hypoosmolality. The kidneys continue to reabsorb water inappropriately, resulting in
concentrated urine (urine osmolality > 100 mOsm/kg) despite low serum osmolality. Diabetes
insipidus (C) presents with dilute urine.
Q11: Which of the following cellular adaptations is most likely to occur in the urinary bladder of a
patient with chronic, untreated benign prostatic hyperplasia (BPH)?
A. Hyperplasia
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
