Keiser University
Course Code: NUR 650
Course Title: Advanced Pathophysiology
Credit Hours:3.0
Exam: Final Exam
Date:2026
A 58-year-old male with long-standing hypertension presents with left ventricular
hypertrophy on echocardiogram. The most likely underlying pathophysiologic
mechanism is:
A. Volume overload causing eccentric hypertrophy
B. Pressure overload causing concentric hypertrophy
C. Myocardial ischemia causing dilation
D. Neurogenic atrophy
Answer: B
Rationale: Chronic hypertension increases afterload, leading to concentric hypertrophy
due to pressure overload.
True or False: In heart failure with preserved ejection fraction (HFpEF), systolic
function is impaired while diastolic function remains normal.
Answer: False
Rationale: HFpEF involves impaired diastolic relaxation with preserved systolic
ejection fraction.
A patient with septic shock demonstrates hypotension despite adequate fluid
resuscitation. The primary pathophysiologic mechanism is:
A. Decreased preload from hemorrhage
B. Increased systemic vascular resistance
1
,C. Widespread vasodilation from inflammatory mediators
D. Cardiac tamponade
Answer: C
Rationale: Sepsis causes distributive shock via cytokine-mediated vasodilation and
capillary leak.
Fill in the blank: The movement of fluid from the intravascular to interstitial space due
to increased hydrostatic pressure is called __________.
Answer: Edema
Rationale: Elevated hydrostatic pressure drives fluid outward, causing edema.
A patient with uncontrolled type 2 diabetes develops microalbuminuria. The earliest
renal pathologic change is:
A. Glomerular basement membrane thickening
B. Tubular necrosis
C. Renal artery stenosis
D. Interstitial fibrosis
Answer: A
Rationale: Diabetic nephropathy begins with basement membrane thickening and
mesangial expansion.
True or False: In diabetic ketoacidosis (DKA), insulin deficiency leads to increased
lipolysis and ketone production.
Answer: True
Rationale: Lack of insulin promotes fat breakdown and hepatic ketogenesis.
A 24-year-old presents with acute asthma exacerbation. The bronchoconstriction is
primarily mediated by:
A. Beta-2 receptor activation
B. Histamine and leukotriene release
C. Surfactant deficiency
D. Decreased vagal tone
2
,Answer: B
Rationale: Inflammatory mediators cause airway constriction and edema.
Fill in the blank: The primary defect in cystic fibrosis involves mutation of the
__________ gene affecting chloride transport.
Answer: CFTR
Rationale: CFTR mutation disrupts chloride and water transport across epithelial cells.
A patient with chronic GERD develops Barrett’s esophagus. This represents:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Neoplasia
Answer: C
Rationale: Barrett’s involves replacement of squamous epithelium with columnar
epithelium (metaplasia).
True or False: An elevated anion gap metabolic acidosis may result from lactic acidosis.
Answer: True
Rationale: Lactate accumulation increases unmeasured anions, raising the anion gap.
A trauma patient presents with respiratory distress and absent breath sounds on one side.
Tension pneumothorax causes hypoxia primarily due to:
A. Increased alveolar perfusion
B. Decreased intrathoracic pressure
C. Lung collapse and mediastinal shift
D. Pulmonary fibrosis
Answer: C
Rationale: Air trapping increases pressure, collapsing lung and impairing venous
return.
3
, Fill in the blank: The Frank-Starling mechanism describes the relationship between
myocardial fiber stretch and __________.
Answer: Contractile force
Rationale: Increased preload enhances stroke volume up to physiologic limits.
A patient with SIADH presents with hyponatremia. The underlying mechanism involves
excessive secretion of:
A. Aldosterone
B. Renin
C. Antidiuretic hormone
D. Cortisol
Answer: C
Rationale: Excess ADH promotes water retention and dilutional hyponatremia.
True or False: Hyperkalemia increases the risk of cardiac arrhythmias due to altered
membrane excitability.
Answer: True
Rationale: Elevated potassium disrupts resting membrane potential.
A 65-year-old smoker develops chronic bronchitis. The primary pathologic feature is:
A. Alveolar wall destruction
B. Mucus gland enlargement and airway inflammation
C. Surfactant depletion
D. Pleural fibrosis
Answer: B
Rationale: Chronic bronchitis involves mucus hypersecretion and airway narrowing.
Fill in the blank: In iron deficiency anemia, red blood cells are typically __________
and hypochromic.
Answer: Microcytic
Rationale: Iron deficiency reduces hemoglobin synthesis.
4
Course Code: NUR 650
Course Title: Advanced Pathophysiology
Credit Hours:3.0
Exam: Final Exam
Date:2026
A 58-year-old male with long-standing hypertension presents with left ventricular
hypertrophy on echocardiogram. The most likely underlying pathophysiologic
mechanism is:
A. Volume overload causing eccentric hypertrophy
B. Pressure overload causing concentric hypertrophy
C. Myocardial ischemia causing dilation
D. Neurogenic atrophy
Answer: B
Rationale: Chronic hypertension increases afterload, leading to concentric hypertrophy
due to pressure overload.
True or False: In heart failure with preserved ejection fraction (HFpEF), systolic
function is impaired while diastolic function remains normal.
Answer: False
Rationale: HFpEF involves impaired diastolic relaxation with preserved systolic
ejection fraction.
A patient with septic shock demonstrates hypotension despite adequate fluid
resuscitation. The primary pathophysiologic mechanism is:
A. Decreased preload from hemorrhage
B. Increased systemic vascular resistance
1
,C. Widespread vasodilation from inflammatory mediators
D. Cardiac tamponade
Answer: C
Rationale: Sepsis causes distributive shock via cytokine-mediated vasodilation and
capillary leak.
Fill in the blank: The movement of fluid from the intravascular to interstitial space due
to increased hydrostatic pressure is called __________.
Answer: Edema
Rationale: Elevated hydrostatic pressure drives fluid outward, causing edema.
A patient with uncontrolled type 2 diabetes develops microalbuminuria. The earliest
renal pathologic change is:
A. Glomerular basement membrane thickening
B. Tubular necrosis
C. Renal artery stenosis
D. Interstitial fibrosis
Answer: A
Rationale: Diabetic nephropathy begins with basement membrane thickening and
mesangial expansion.
True or False: In diabetic ketoacidosis (DKA), insulin deficiency leads to increased
lipolysis and ketone production.
Answer: True
Rationale: Lack of insulin promotes fat breakdown and hepatic ketogenesis.
A 24-year-old presents with acute asthma exacerbation. The bronchoconstriction is
primarily mediated by:
A. Beta-2 receptor activation
B. Histamine and leukotriene release
C. Surfactant deficiency
D. Decreased vagal tone
2
,Answer: B
Rationale: Inflammatory mediators cause airway constriction and edema.
Fill in the blank: The primary defect in cystic fibrosis involves mutation of the
__________ gene affecting chloride transport.
Answer: CFTR
Rationale: CFTR mutation disrupts chloride and water transport across epithelial cells.
A patient with chronic GERD develops Barrett’s esophagus. This represents:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Neoplasia
Answer: C
Rationale: Barrett’s involves replacement of squamous epithelium with columnar
epithelium (metaplasia).
True or False: An elevated anion gap metabolic acidosis may result from lactic acidosis.
Answer: True
Rationale: Lactate accumulation increases unmeasured anions, raising the anion gap.
A trauma patient presents with respiratory distress and absent breath sounds on one side.
Tension pneumothorax causes hypoxia primarily due to:
A. Increased alveolar perfusion
B. Decreased intrathoracic pressure
C. Lung collapse and mediastinal shift
D. Pulmonary fibrosis
Answer: C
Rationale: Air trapping increases pressure, collapsing lung and impairing venous
return.
3
, Fill in the blank: The Frank-Starling mechanism describes the relationship between
myocardial fiber stretch and __________.
Answer: Contractile force
Rationale: Increased preload enhances stroke volume up to physiologic limits.
A patient with SIADH presents with hyponatremia. The underlying mechanism involves
excessive secretion of:
A. Aldosterone
B. Renin
C. Antidiuretic hormone
D. Cortisol
Answer: C
Rationale: Excess ADH promotes water retention and dilutional hyponatremia.
True or False: Hyperkalemia increases the risk of cardiac arrhythmias due to altered
membrane excitability.
Answer: True
Rationale: Elevated potassium disrupts resting membrane potential.
A 65-year-old smoker develops chronic bronchitis. The primary pathologic feature is:
A. Alveolar wall destruction
B. Mucus gland enlargement and airway inflammation
C. Surfactant depletion
D. Pleural fibrosis
Answer: B
Rationale: Chronic bronchitis involves mucus hypersecretion and airway narrowing.
Fill in the blank: In iron deficiency anemia, red blood cells are typically __________
and hypochromic.
Answer: Microcytic
Rationale: Iron deficiency reduces hemoglobin synthesis.
4
