NURS 6501 ADVANCED PATHOPHYSIOLOGY
MIDTERM EXAMINATION 250 QUESTIONS
WITH 100% CORRECT ANSWERS AND
RATIONALES
1. A patient with heart failure develops peripheral edema. This is primarily due to:
A) Decreased capillary oncotic pressure
B) Increased capillary hydrostatic pressure ✔
C) Decreased interstitial oncotic pressure
D) Increased lymphatic flow
Rationale: Heart failure → increased venous pressure → increased capillary
hydrostatic pressure → net filtration exceeds reabsorption. Decreased oncotic
pressure (e.g., cirrhosis) would worsen edema but is not the primary mechanism in
heart failure.
2. Which cellular change is most characteristic of reversible cell injury?
A) Lysosomal rupture
B) Nuclear pyknosis
C) Mitochondrial swelling ✔
D) Karyorrhexis
Rationale: Reversible injury → mitochondrial swelling, ER dilation. Pyknosis,
karyorrhexis, and lysosomal rupture indicate irreversible injury.
3. A patient with chronic bronchitis has increased mucus production due to an
increase in the number of goblet cells. This is an example of:
A) Dysplasia
B) Hypertrophy
C) Metaplasia
,D) Hyperplasia ✔
Rationale: Hyperplasia = increased cell number. Metaplasia = change from one cell
type to another; hypertrophy = increased cell size; dysplasia = disordered growth.
4. Which lab finding is most specific for hepatocellular injury?
A) Elevated bilirubin
B) Elevated GGT
C) Elevated ALP
D) Elevated ALT ✔
Rationale: ALT is cytosolic in hepatocytes; more specific than AST. ALP/GGT rise in
cholestasis. Bilirubin elevation is not specific for hepatocellular injury (can be post-
hepatic).
5. A patient with unstable angina has ST-segment depression on ECG. This
indicates:
A) Pericarditis
B) Subendocardial ischemia ✔
C) Transmural infarction
D) Left ventricular aneurysm
Rationale: Subendocardial ischemia (e.g., unstable angina) → ST depression.
Transmural MI → ST elevation. Pericarditis → diffuse ST elevation. LV aneurysm →
persistent ST elevation.
6. In type 2 diabetes, insulin resistance is most closely associated with:
A) Increased hepatic glucose output only
B) Autoimmune beta-cell destruction
C) Decreased GLUT4 translocation in adipose and muscle ✔
D) Absolute insulin deficiency
*Rationale: Insulin resistance → impaired GLUT4 translocation → decreased
glucose uptake. Autoimmune beta-cell destruction is type 1. Absolute deficiency is
type 1.*
7. A patient with liver cirrhosis develops ascites. The primary mechanism is:
A) Increased plasma aldosterone due to heart failure
,B) Increased lymphatic drainage
C) Reduced portal pressure
D) Decreased plasma oncotic pressure from hypoalbuminemia ✔
Rationale: Cirrhosis → hypoalbuminemia → decreased plasma oncotic pressure →
fluid shifts to interstitium. Portal hypertension also contributes, but primary
mechanism in advanced cirrhosis is low albumin.
8. A patient with chronic kidney disease has anemia. The most likely mechanism
is:
A) Iron deficiency from poor intake
B) Vitamin B12 malabsorption
C) Decreased erythropoietin production ✔
D) Hemolysis from uremia
Rationale: Kidneys produce EPO; CKD → EPO deficiency → normocytic
normochromic anemia. Iron deficiency can occur but is not the primary
mechanism.
9. Which finding is most characteristic of irreversible cell injury?
A) Glycogen depletion
B) Fatty change
C) Loss of nuclear basophilia (karyolysis) ✔
D) Cell swelling
Rationale: Karyolysis = irreversible. Swelling, glycogen depletion, fatty change can
be reversible.
10. A patient with asthma has an acute exacerbation triggered by an allergen.
Which mediator is most responsible for early bronchospasm?
A) Leukotrienes
B) Histamine ✔
C) IL-5
D) TNF-alpha
*Rationale: Histamine from mast cells causes immediate bronchospasm.
Leukotrienes cause late-phase reaction. IL-5 activates eosinophils.*
, 11. A patient with septic shock develops hypotension despite adequate fluid
resuscitation. The primary mechanism is:
A) Decreased cardiac output
B) Massive vasodilation due to NO and cytokines ✔
C) Increased systemic vascular resistance
D) Adrenal insufficiency
Rationale: Septic shock → cytokines and NO → vasodilation → distributive shock.
Early sepsis may have increased or normal CO. Adrenal insufficiency is a secondary
consideration.
12. A patient with chronic alcohol use presents with ataxia and confusion. A
thiamine deficiency is suspected. Which brain region is most affected?
A) Basal ganglia
B) Cerebellum
C) Mammillary bodies ✔
D) Hippocampus
Rationale: Wernicke encephalopathy (thiamine deficiency) affects mammillary
bodies, periaqueductal gray. Cerebellar involvement also occurs but mammillary
bodies are classic.
13. A patient with left ventricular failure develops pulmonary edema. The primary
hemodynamic abnormality is:
A) Increased pulmonary capillary hydrostatic pressure ✔
B) Decreased pulmonary capillary oncotic pressure
C) Increased left atrial compliance
D) Decreased pulmonary venous pressure
Rationale: LV failure → increased LVEDP → increased left atrial pressure →
increased pulmonary capillary hydrostatic pressure → pulmonary edema.
14. A patient with a deep vein thrombosis develops sudden dyspnea and hypoxia.
Which pathophysiological process is most likely?
A) Pulmonary infarction
B) Ventilation-perfusion mismatch ✔
C) Decreased diffusion capacity
MIDTERM EXAMINATION 250 QUESTIONS
WITH 100% CORRECT ANSWERS AND
RATIONALES
1. A patient with heart failure develops peripheral edema. This is primarily due to:
A) Decreased capillary oncotic pressure
B) Increased capillary hydrostatic pressure ✔
C) Decreased interstitial oncotic pressure
D) Increased lymphatic flow
Rationale: Heart failure → increased venous pressure → increased capillary
hydrostatic pressure → net filtration exceeds reabsorption. Decreased oncotic
pressure (e.g., cirrhosis) would worsen edema but is not the primary mechanism in
heart failure.
2. Which cellular change is most characteristic of reversible cell injury?
A) Lysosomal rupture
B) Nuclear pyknosis
C) Mitochondrial swelling ✔
D) Karyorrhexis
Rationale: Reversible injury → mitochondrial swelling, ER dilation. Pyknosis,
karyorrhexis, and lysosomal rupture indicate irreversible injury.
3. A patient with chronic bronchitis has increased mucus production due to an
increase in the number of goblet cells. This is an example of:
A) Dysplasia
B) Hypertrophy
C) Metaplasia
,D) Hyperplasia ✔
Rationale: Hyperplasia = increased cell number. Metaplasia = change from one cell
type to another; hypertrophy = increased cell size; dysplasia = disordered growth.
4. Which lab finding is most specific for hepatocellular injury?
A) Elevated bilirubin
B) Elevated GGT
C) Elevated ALP
D) Elevated ALT ✔
Rationale: ALT is cytosolic in hepatocytes; more specific than AST. ALP/GGT rise in
cholestasis. Bilirubin elevation is not specific for hepatocellular injury (can be post-
hepatic).
5. A patient with unstable angina has ST-segment depression on ECG. This
indicates:
A) Pericarditis
B) Subendocardial ischemia ✔
C) Transmural infarction
D) Left ventricular aneurysm
Rationale: Subendocardial ischemia (e.g., unstable angina) → ST depression.
Transmural MI → ST elevation. Pericarditis → diffuse ST elevation. LV aneurysm →
persistent ST elevation.
6. In type 2 diabetes, insulin resistance is most closely associated with:
A) Increased hepatic glucose output only
B) Autoimmune beta-cell destruction
C) Decreased GLUT4 translocation in adipose and muscle ✔
D) Absolute insulin deficiency
*Rationale: Insulin resistance → impaired GLUT4 translocation → decreased
glucose uptake. Autoimmune beta-cell destruction is type 1. Absolute deficiency is
type 1.*
7. A patient with liver cirrhosis develops ascites. The primary mechanism is:
A) Increased plasma aldosterone due to heart failure
,B) Increased lymphatic drainage
C) Reduced portal pressure
D) Decreased plasma oncotic pressure from hypoalbuminemia ✔
Rationale: Cirrhosis → hypoalbuminemia → decreased plasma oncotic pressure →
fluid shifts to interstitium. Portal hypertension also contributes, but primary
mechanism in advanced cirrhosis is low albumin.
8. A patient with chronic kidney disease has anemia. The most likely mechanism
is:
A) Iron deficiency from poor intake
B) Vitamin B12 malabsorption
C) Decreased erythropoietin production ✔
D) Hemolysis from uremia
Rationale: Kidneys produce EPO; CKD → EPO deficiency → normocytic
normochromic anemia. Iron deficiency can occur but is not the primary
mechanism.
9. Which finding is most characteristic of irreversible cell injury?
A) Glycogen depletion
B) Fatty change
C) Loss of nuclear basophilia (karyolysis) ✔
D) Cell swelling
Rationale: Karyolysis = irreversible. Swelling, glycogen depletion, fatty change can
be reversible.
10. A patient with asthma has an acute exacerbation triggered by an allergen.
Which mediator is most responsible for early bronchospasm?
A) Leukotrienes
B) Histamine ✔
C) IL-5
D) TNF-alpha
*Rationale: Histamine from mast cells causes immediate bronchospasm.
Leukotrienes cause late-phase reaction. IL-5 activates eosinophils.*
, 11. A patient with septic shock develops hypotension despite adequate fluid
resuscitation. The primary mechanism is:
A) Decreased cardiac output
B) Massive vasodilation due to NO and cytokines ✔
C) Increased systemic vascular resistance
D) Adrenal insufficiency
Rationale: Septic shock → cytokines and NO → vasodilation → distributive shock.
Early sepsis may have increased or normal CO. Adrenal insufficiency is a secondary
consideration.
12. A patient with chronic alcohol use presents with ataxia and confusion. A
thiamine deficiency is suspected. Which brain region is most affected?
A) Basal ganglia
B) Cerebellum
C) Mammillary bodies ✔
D) Hippocampus
Rationale: Wernicke encephalopathy (thiamine deficiency) affects mammillary
bodies, periaqueductal gray. Cerebellar involvement also occurs but mammillary
bodies are classic.
13. A patient with left ventricular failure develops pulmonary edema. The primary
hemodynamic abnormality is:
A) Increased pulmonary capillary hydrostatic pressure ✔
B) Decreased pulmonary capillary oncotic pressure
C) Increased left atrial compliance
D) Decreased pulmonary venous pressure
Rationale: LV failure → increased LVEDP → increased left atrial pressure →
increased pulmonary capillary hydrostatic pressure → pulmonary edema.
14. A patient with a deep vein thrombosis develops sudden dyspnea and hypoxia.
Which pathophysiological process is most likely?
A) Pulmonary infarction
B) Ventilation-perfusion mismatch ✔
C) Decreased diffusion capacity
