NSG 520 (HU) Pathophysiology & Pharmacology
Final Exam 2025 CORRECT AND VERIFIED
ANSWERS.
Section 1: Cellular Function & Inflammation (Questions 1–30)
1. A patient has sustained a severe burn. Which cellular change would you expect due to ATP
depletion?
A. Increased Na+/K+ pump activity
B. Cellular swelling
C. Decreased intracellular calcium
D. Increased protein synthesis
Answer: B
Rationale: ATP depletion impairs the Na+/K+ pump, causing sodium accumulation
intracellularly, followed by water, leading to cellular swelling.
2. Which mediator of inflammation is primarily responsible for vasodilation and increased
vascular permeability during the immediate phase?
A. Leukotrienes
B. Histamine
C. Interleukin-10
D. Tumor necrosis factor-alpha
Answer: B
Rationale: Histamine, released from mast cells, acts on H1 receptors to cause arteriolar
dilation and venular endothelial gap formation.
3. A patient with rheumatoid arthritis has elevated levels of which cytokine that promotes
joint destruction?
A. Interleukin-4
B. Interleukin-10
C. Tumor necrosis factor-alpha (TNF-α)
D. Transforming growth factor-beta
Answer: C
Rationale: TNF-α activates osteoclasts and synovial fibroblasts, leading to cartilage and bone
erosion in RA.
4. Which type of necrosis is most commonly seen in the lungs of a patient with tuberculosis?
A. Coagulative necrosis
,B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: C
Rationale: Caseous necrosis (cheese-like appearance) is characteristic of TB due to combined
immune and microbial factors.
5. A drug that blocks cyclooxygenase-2 (COX-2) would most directly reduce production of:
A. Leukotrienes
B. Prostaglandins
C. Platelet-activating factor
D. Histamine
Answer: B
Rationale: COX-2 converts arachidonic acid to prostaglandins. Blocking it reduces pain and
inflammation but not leukotrienes (lipoxygenase pathway).
6. In ischemia-reperfusion injury, reactive oxygen species (ROS) cause damage primarily by:
A. Activating complement
B. Lipid peroxidation of cell membranes
C. Replenishing ATP stores
D. Increasing heat shock proteins
Answer: B
Rationale: ROS attack polyunsaturated fatty acids in membranes, causing lipid peroxidation,
loss of integrity, and cell death.
7. Which laboratory finding indicates a systemic inflammatory response (SIRS) in a patient
with sepsis?
A. WBC 2,000/mm³
B. PaCO2 55 mm Hg
C. Heart rate 55 bpm
D. Temperature 35.5°C (95.9°F)
Answer: D
Rationale: SIRS criteria include temp <36°C or >38°C, HR >90, RR >20 or PaCO2 <32, WBC
<4,000 or >12,000.
8. A 45-year-old with chronic alcoholism develops painful, swollen right great toe. Serum uric
acid is 9.5 mg/dL. The pathophysiology involves:
A. Defect in pyrimidine metabolism
B. Overproduction or underexcretion of uric acid
,C. Autoimmune destruction of joint cartilage
D. Deficiency of adenosine deaminase
Answer: B
Rationale: Gout results from monosodium urate crystal deposition due to hyperuricemia
from overproduction or renal underexcretion.
9. The primary mechanism of action of allopurinol in gout is:
A. Inhibiting urate transporter 1 (URAT1)
B. Blocking xanthine oxidase
C. Increasing urinary pH
D. Enhancing renal uric acid excretion
Answer: B
Rationale: Allopurinol is a xanthine oxidase inhibitor, reducing uric acid synthesis.
10. A patient with heart failure has pitting edema and hepatomegaly. Which hemodynamic
change is the direct cause?
A. Decreased capillary hydrostatic pressure
B. Increased capillary oncotic pressure
C. Increased capillary hydrostatic pressure
D. Decreased venous pressure
Answer: C
Rationale: Elevated venous pressure from heart failure increases capillary hydrostatic
pressure, forcing fluid into interstitium.
11. A wound that heals with granulation tissue, wound contraction, and scar formation is an
example of:
A. Primary intention
B. Secondary intention
C. Tertiary intention
D. Regeneration
Answer: B
Rationale: Secondary intention healing occurs when wound edges are not approximated,
requiring granulation and contraction.
12. Which drug class is most effective at preventing long-term complications of type 2
diabetes by reducing advanced glycation end-products (AGEs)?
A. Sulfonylureas
B. Metformin
C. Insulin
, D. Thiazolidinediones
Answer: B
Rationale: Metformin improves insulin sensitivity and reduces hyperglycemia, thereby
decreasing AGE formation; also has cardiovascular benefits.
13. A patient with anaphylaxis is given epinephrine. Which receptor activation is most
important for reversing hypotension?
A. Beta-1 cardiac
B. Alpha-1 vasoconstriction
C. Beta-2 bronchodilation
D. Dopamine-1 renal
Answer: B
Rationale: Alpha-1-mediated vasoconstriction increases peripheral vascular resistance and
blood pressure.
14. In disseminated intravascular coagulation (DIC), the initial pathophysiologic event is:
A. Massive platelet destruction
B. Uncontrolled activation of coagulation cascade
C. Vitamin K deficiency
D. Heparin overdose
Answer: B
Rationale: DIC begins with systemic activation of thrombin, leading to microthrombi then
consumption of factors and bleeding.
15. A patient with chronic kidney disease has anemia. The primary cause is:
A. Iron malabsorption
B. Decreased erythropoietin production
C. Folate deficiency
D. Hemolysis
Answer: B
Rationale: Erythropoietin from peritubular interstitial cells is reduced in CKD, decreasing RBC
production.
16. Which medication is used to treat anemia of CKD and works by mimicking
erythropoietin?
A. Ferrous sulfate
B. Epoetin alfa
C. Folic acid
Final Exam 2025 CORRECT AND VERIFIED
ANSWERS.
Section 1: Cellular Function & Inflammation (Questions 1–30)
1. A patient has sustained a severe burn. Which cellular change would you expect due to ATP
depletion?
A. Increased Na+/K+ pump activity
B. Cellular swelling
C. Decreased intracellular calcium
D. Increased protein synthesis
Answer: B
Rationale: ATP depletion impairs the Na+/K+ pump, causing sodium accumulation
intracellularly, followed by water, leading to cellular swelling.
2. Which mediator of inflammation is primarily responsible for vasodilation and increased
vascular permeability during the immediate phase?
A. Leukotrienes
B. Histamine
C. Interleukin-10
D. Tumor necrosis factor-alpha
Answer: B
Rationale: Histamine, released from mast cells, acts on H1 receptors to cause arteriolar
dilation and venular endothelial gap formation.
3. A patient with rheumatoid arthritis has elevated levels of which cytokine that promotes
joint destruction?
A. Interleukin-4
B. Interleukin-10
C. Tumor necrosis factor-alpha (TNF-α)
D. Transforming growth factor-beta
Answer: C
Rationale: TNF-α activates osteoclasts and synovial fibroblasts, leading to cartilage and bone
erosion in RA.
4. Which type of necrosis is most commonly seen in the lungs of a patient with tuberculosis?
A. Coagulative necrosis
,B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: C
Rationale: Caseous necrosis (cheese-like appearance) is characteristic of TB due to combined
immune and microbial factors.
5. A drug that blocks cyclooxygenase-2 (COX-2) would most directly reduce production of:
A. Leukotrienes
B. Prostaglandins
C. Platelet-activating factor
D. Histamine
Answer: B
Rationale: COX-2 converts arachidonic acid to prostaglandins. Blocking it reduces pain and
inflammation but not leukotrienes (lipoxygenase pathway).
6. In ischemia-reperfusion injury, reactive oxygen species (ROS) cause damage primarily by:
A. Activating complement
B. Lipid peroxidation of cell membranes
C. Replenishing ATP stores
D. Increasing heat shock proteins
Answer: B
Rationale: ROS attack polyunsaturated fatty acids in membranes, causing lipid peroxidation,
loss of integrity, and cell death.
7. Which laboratory finding indicates a systemic inflammatory response (SIRS) in a patient
with sepsis?
A. WBC 2,000/mm³
B. PaCO2 55 mm Hg
C. Heart rate 55 bpm
D. Temperature 35.5°C (95.9°F)
Answer: D
Rationale: SIRS criteria include temp <36°C or >38°C, HR >90, RR >20 or PaCO2 <32, WBC
<4,000 or >12,000.
8. A 45-year-old with chronic alcoholism develops painful, swollen right great toe. Serum uric
acid is 9.5 mg/dL. The pathophysiology involves:
A. Defect in pyrimidine metabolism
B. Overproduction or underexcretion of uric acid
,C. Autoimmune destruction of joint cartilage
D. Deficiency of adenosine deaminase
Answer: B
Rationale: Gout results from monosodium urate crystal deposition due to hyperuricemia
from overproduction or renal underexcretion.
9. The primary mechanism of action of allopurinol in gout is:
A. Inhibiting urate transporter 1 (URAT1)
B. Blocking xanthine oxidase
C. Increasing urinary pH
D. Enhancing renal uric acid excretion
Answer: B
Rationale: Allopurinol is a xanthine oxidase inhibitor, reducing uric acid synthesis.
10. A patient with heart failure has pitting edema and hepatomegaly. Which hemodynamic
change is the direct cause?
A. Decreased capillary hydrostatic pressure
B. Increased capillary oncotic pressure
C. Increased capillary hydrostatic pressure
D. Decreased venous pressure
Answer: C
Rationale: Elevated venous pressure from heart failure increases capillary hydrostatic
pressure, forcing fluid into interstitium.
11. A wound that heals with granulation tissue, wound contraction, and scar formation is an
example of:
A. Primary intention
B. Secondary intention
C. Tertiary intention
D. Regeneration
Answer: B
Rationale: Secondary intention healing occurs when wound edges are not approximated,
requiring granulation and contraction.
12. Which drug class is most effective at preventing long-term complications of type 2
diabetes by reducing advanced glycation end-products (AGEs)?
A. Sulfonylureas
B. Metformin
C. Insulin
, D. Thiazolidinediones
Answer: B
Rationale: Metformin improves insulin sensitivity and reduces hyperglycemia, thereby
decreasing AGE formation; also has cardiovascular benefits.
13. A patient with anaphylaxis is given epinephrine. Which receptor activation is most
important for reversing hypotension?
A. Beta-1 cardiac
B. Alpha-1 vasoconstriction
C. Beta-2 bronchodilation
D. Dopamine-1 renal
Answer: B
Rationale: Alpha-1-mediated vasoconstriction increases peripheral vascular resistance and
blood pressure.
14. In disseminated intravascular coagulation (DIC), the initial pathophysiologic event is:
A. Massive platelet destruction
B. Uncontrolled activation of coagulation cascade
C. Vitamin K deficiency
D. Heparin overdose
Answer: B
Rationale: DIC begins with systemic activation of thrombin, leading to microthrombi then
consumption of factors and bleeding.
15. A patient with chronic kidney disease has anemia. The primary cause is:
A. Iron malabsorption
B. Decreased erythropoietin production
C. Folate deficiency
D. Hemolysis
Answer: B
Rationale: Erythropoietin from peritubular interstitial cells is reduced in CKD, decreasing RBC
production.
16. Which medication is used to treat anemia of CKD and works by mimicking
erythropoietin?
A. Ferrous sulfate
B. Epoetin alfa
C. Folic acid
