SOUTH COLLEGE
NSG 5544 Exam 2
Official Practice Exam | 2026/2027 Edition
75 Questions 90 Minutes 80% Passing Recertification
Table of Contents
Section 1: Cellular & Molecular Pathophysiology (Questions 1-15)
Section 2: Cardiovascular & Hematologic Disorders (Questions 16-30)
Section 3: Pulmonary & Renal Disorders (Questions 31-45)
Section 4: Neurologic & Endocrine Disorders (Questions 46-60)
Section 5: Gastrointestinal & Musculoskeletal Disorders (Questions 61-75)
Answer Key (Final Page)
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections.
You have 90 minutes to complete the entire exam. Pace yourself accordingly.
Each question has four answer choices (A, B, C, D). Select the single best answer.
A passing score of 80% requires at least 60 correct answers out of 75 questions.
Read each scenario carefully before selecting your response.
The correct answer and rationale are provided after each question for study purposes.
This exam reflects the 2026/2027 curriculum update for South College NSG 5544.
,Section 1 of 5: Cellular & Molecular Pathophysiology
Q1 Question 1 of 75
A 52-year-old male with a 30-pack-year smoking history presents with persistent cough and
unilateral wheezing. Chest imaging reveals a 3-cm central lung mass. Biopsy confirms small cell
lung carcinoma. Which molecular pathway is most commonly dysregulated in this type of neoplasm?
A. RAS/RAF/MEK/ERK pathway mutation
B. TP53 and RB1 tumor suppressor gene loss
C. BCR-ABL fusion protein overexpression
D. HER2 receptor amplification
Correct Answer: B
Rationale:
Small cell lung carcinoma is almost universally characterized by loss-of-function mutations in both TP53
and RB1 tumor suppressor genes, which drive uncontrolled cellular proliferation. While RAS mutations
occur in non-small cell lung cancer, they are not the hallmark of small cell histology. BCR-ABL is specific
to chronic myeloid leukemia, and HER2 amplification is associated with breast cancer.
Q2 Question 2 of 75
A 34-year-old female presents with chronic fatigue, recurrent oral ulcers, and a malar rash worsened
by sun exposure. Laboratory findings include positive ANA and anti-dsDNA antibodies. Which
pathophysiologic mechanism is primarily responsible for tissue damage in this condition?
A. Type I hypersensitivity with IgE-mediated mast cell degranulation
B. Type II hypersensitivity with complement-mediated cell lysis
C. Type III hypersensitivity with immune complex deposition
D. Type IV hypersensitivity with cytotoxic T-cell infiltration
Correct Answer: C
Rationale:
Systemic lupus erythematosus primarily causes tissue damage through type III hypersensitivity, in which
autoantibodies form circulating immune complexes that deposit in vessels, glomeruli, and serosal
surfaces, activating complement and attracting neutrophils. Type I hypersensitivity is associated with
allergic reactions, type II involves antibody-directed cell destruction, and type IV is T-cell mediated and
does not involve immune complexes.
NSG 5544 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of Y
,Q3 Question 3 of 75
A 68-year-old male with a history of Barrett esophagus undergoes endoscopic surveillance. Biopsy
reveals high-grade dysplasia with cells demonstrating loss of cell polarity, nuclear hyperchromasia,
and increased nuclear-to-cytoplasmic ratio. Which cellular adaptation process preceded these
malignant changes?
A. Metaplasia of squamous epithelium to columnar epithelium
B. Hyperplasia of the squamous epithelial layer
C. Hypertrophy of the smooth muscle layer
D. Atrophy of the esophageal mucosal glands
Correct Answer: A
Rationale:
Barrett esophagus represents metaplasia, in which chronic acid reflux causes the normal squamous
epithelium to be replaced by intestinal-type columnar epithelium as an adaptive response. This
metaplastic change is the precursor that can progress through dysplasia to adenocarcinoma.
Hyperplasia involves increased cell number in the same tissue type, hypertrophy involves increased cell
size, and atrophy involves tissue shrinkage.
Q4 Question 4 of 75
A 45-year-old male with chronic hepatitis C infection presents with abdominal distension and
jaundice. Laboratory studies show elevated ALT and AST. Hepatocyte biopsy demonstrates
ballooning degeneration, Councilman bodies, and inflammatory cell infiltrates. Which mechanism
best explains the hepatocyte injury pattern in this patient?
A. Direct viral cytopathic destruction of hepatocytes
B. CD8+ cytotoxic T-lymphocyte-mediated apoptosis
C. Ischemic necrosis from hepatic artery thrombosis
D. Drug-induced oxidative stress and mitochondrial injury
Correct Answer: B
Rationale:
In chronic hepatitis C, the majority of hepatocyte injury results from the host immune response,
specifically CD8+ cytotoxic T lymphocytes that recognize viral antigens on hepatocyte surfaces and
induce apoptosis, producing Councilman bodies. Direct viral cytopathic effect is minimal in hepatitis C.
Ischemic necrosis and drug-induced injury would present with different histologic patterns.
NSG 5544 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of Y
, Q5 Question 5 of 75
A 3-year-old boy is brought to the clinic by his parents due to recurrent bacterial sinopulmonary
infections and failure to thrive. Serum immunoglobulin levels reveal profoundly decreased IgG,
absent IgA, and low IgM. Genetic testing confirms a mutation in the BTK gene. Which cellular
developmental stage is most directly affected by this defect?
A. Pro-B cell to pre-B cell maturation
B. Thymocyte positive selection in the thymus
C. Naive T cell activation by antigen-presenting cells
D. Plasma cell differentiation from memory B cells
Correct Answer: A
Rationale:
X-linked agammaglobulinemia results from a mutation in the BTK gene, which is essential for B-cell
receptor signaling during the transition from the pro-B cell to the pre-B cell stage. This arrest prevents
mature B cells from forming, leading to absent immunoglobulins. Thymocyte selection involves T cells, T
cell activation is intact in this disorder, and plasma cell differentiation cannot occur without mature B
cells.
Q6 Question 6 of 75
A 60-year-old female with rheumatoid arthritis on long-term methotrexate therapy presents with
progressive dyspnea and a nonproductive cough. High-resolution CT shows bilateral ground-glass
opacities. Pulmonary function tests reveal a restrictive pattern with reduced DLCO. Which
pathophysiologic process best explains these findings?
A. Bronchiectasis from chronic airway colonization
B. Interstitial pneumonitis with fibrotic remodeling
C. Pulmonary embolism with infarction
D. Pleural effusion with lung compression
Correct Answer: B
Rationale:
Methotrexate-induced pulmonary toxicity manifests as interstitial pneumonitis, characterized by
ground-glass opacities on CT and a restrictive pattern on pulmonary function testing. Chronic
inflammation leads to fibrotic remodeling of the interstitium. Bronchiectasis would cause an obstructive
pattern, pulmonary embolism would present acutely, and pleural effusion would show fluid on imaging
rather than ground-glass opacities.
NSG 5544 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of Y
NSG 5544 Exam 2
Official Practice Exam | 2026/2027 Edition
75 Questions 90 Minutes 80% Passing Recertification
Table of Contents
Section 1: Cellular & Molecular Pathophysiology (Questions 1-15)
Section 2: Cardiovascular & Hematologic Disorders (Questions 16-30)
Section 3: Pulmonary & Renal Disorders (Questions 31-45)
Section 4: Neurologic & Endocrine Disorders (Questions 46-60)
Section 5: Gastrointestinal & Musculoskeletal Disorders (Questions 61-75)
Answer Key (Final Page)
Instructions
This practice exam contains 75 multiple-choice questions divided into 5 sections.
You have 90 minutes to complete the entire exam. Pace yourself accordingly.
Each question has four answer choices (A, B, C, D). Select the single best answer.
A passing score of 80% requires at least 60 correct answers out of 75 questions.
Read each scenario carefully before selecting your response.
The correct answer and rationale are provided after each question for study purposes.
This exam reflects the 2026/2027 curriculum update for South College NSG 5544.
,Section 1 of 5: Cellular & Molecular Pathophysiology
Q1 Question 1 of 75
A 52-year-old male with a 30-pack-year smoking history presents with persistent cough and
unilateral wheezing. Chest imaging reveals a 3-cm central lung mass. Biopsy confirms small cell
lung carcinoma. Which molecular pathway is most commonly dysregulated in this type of neoplasm?
A. RAS/RAF/MEK/ERK pathway mutation
B. TP53 and RB1 tumor suppressor gene loss
C. BCR-ABL fusion protein overexpression
D. HER2 receptor amplification
Correct Answer: B
Rationale:
Small cell lung carcinoma is almost universally characterized by loss-of-function mutations in both TP53
and RB1 tumor suppressor genes, which drive uncontrolled cellular proliferation. While RAS mutations
occur in non-small cell lung cancer, they are not the hallmark of small cell histology. BCR-ABL is specific
to chronic myeloid leukemia, and HER2 amplification is associated with breast cancer.
Q2 Question 2 of 75
A 34-year-old female presents with chronic fatigue, recurrent oral ulcers, and a malar rash worsened
by sun exposure. Laboratory findings include positive ANA and anti-dsDNA antibodies. Which
pathophysiologic mechanism is primarily responsible for tissue damage in this condition?
A. Type I hypersensitivity with IgE-mediated mast cell degranulation
B. Type II hypersensitivity with complement-mediated cell lysis
C. Type III hypersensitivity with immune complex deposition
D. Type IV hypersensitivity with cytotoxic T-cell infiltration
Correct Answer: C
Rationale:
Systemic lupus erythematosus primarily causes tissue damage through type III hypersensitivity, in which
autoantibodies form circulating immune complexes that deposit in vessels, glomeruli, and serosal
surfaces, activating complement and attracting neutrophils. Type I hypersensitivity is associated with
allergic reactions, type II involves antibody-directed cell destruction, and type IV is T-cell mediated and
does not involve immune complexes.
NSG 5544 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of Y
,Q3 Question 3 of 75
A 68-year-old male with a history of Barrett esophagus undergoes endoscopic surveillance. Biopsy
reveals high-grade dysplasia with cells demonstrating loss of cell polarity, nuclear hyperchromasia,
and increased nuclear-to-cytoplasmic ratio. Which cellular adaptation process preceded these
malignant changes?
A. Metaplasia of squamous epithelium to columnar epithelium
B. Hyperplasia of the squamous epithelial layer
C. Hypertrophy of the smooth muscle layer
D. Atrophy of the esophageal mucosal glands
Correct Answer: A
Rationale:
Barrett esophagus represents metaplasia, in which chronic acid reflux causes the normal squamous
epithelium to be replaced by intestinal-type columnar epithelium as an adaptive response. This
metaplastic change is the precursor that can progress through dysplasia to adenocarcinoma.
Hyperplasia involves increased cell number in the same tissue type, hypertrophy involves increased cell
size, and atrophy involves tissue shrinkage.
Q4 Question 4 of 75
A 45-year-old male with chronic hepatitis C infection presents with abdominal distension and
jaundice. Laboratory studies show elevated ALT and AST. Hepatocyte biopsy demonstrates
ballooning degeneration, Councilman bodies, and inflammatory cell infiltrates. Which mechanism
best explains the hepatocyte injury pattern in this patient?
A. Direct viral cytopathic destruction of hepatocytes
B. CD8+ cytotoxic T-lymphocyte-mediated apoptosis
C. Ischemic necrosis from hepatic artery thrombosis
D. Drug-induced oxidative stress and mitochondrial injury
Correct Answer: B
Rationale:
In chronic hepatitis C, the majority of hepatocyte injury results from the host immune response,
specifically CD8+ cytotoxic T lymphocytes that recognize viral antigens on hepatocyte surfaces and
induce apoptosis, producing Councilman bodies. Direct viral cytopathic effect is minimal in hepatitis C.
Ischemic necrosis and drug-induced injury would present with different histologic patterns.
NSG 5544 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of Y
, Q5 Question 5 of 75
A 3-year-old boy is brought to the clinic by his parents due to recurrent bacterial sinopulmonary
infections and failure to thrive. Serum immunoglobulin levels reveal profoundly decreased IgG,
absent IgA, and low IgM. Genetic testing confirms a mutation in the BTK gene. Which cellular
developmental stage is most directly affected by this defect?
A. Pro-B cell to pre-B cell maturation
B. Thymocyte positive selection in the thymus
C. Naive T cell activation by antigen-presenting cells
D. Plasma cell differentiation from memory B cells
Correct Answer: A
Rationale:
X-linked agammaglobulinemia results from a mutation in the BTK gene, which is essential for B-cell
receptor signaling during the transition from the pro-B cell to the pre-B cell stage. This arrest prevents
mature B cells from forming, leading to absent immunoglobulins. Thymocyte selection involves T cells, T
cell activation is intact in this disorder, and plasma cell differentiation cannot occur without mature B
cells.
Q6 Question 6 of 75
A 60-year-old female with rheumatoid arthritis on long-term methotrexate therapy presents with
progressive dyspnea and a nonproductive cough. High-resolution CT shows bilateral ground-glass
opacities. Pulmonary function tests reveal a restrictive pattern with reduced DLCO. Which
pathophysiologic process best explains these findings?
A. Bronchiectasis from chronic airway colonization
B. Interstitial pneumonitis with fibrotic remodeling
C. Pulmonary embolism with infarction
D. Pleural effusion with lung compression
Correct Answer: B
Rationale:
Methotrexate-induced pulmonary toxicity manifests as interstitial pneumonitis, characterized by
ground-glass opacities on CT and a restrictive pattern on pulmonary function testing. Chronic
inflammation leads to fibrotic remodeling of the interstitium. Bronchiectasis would cause an obstructive
pattern, pulmonary embolism would present acutely, and pleural effusion would show fluid on imaging
rather than ground-glass opacities.
NSG 5544 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of Y
