GALEN COLLEGE OF NURSING
NSG 3280 Pathophysiology
Exam 2
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% Annual
TABLE OF CONTENTS
Section 1: Neurological and Sensory Disorders ........ Q1-Q15
Section 2: Endocrine Disorders ........ Q16-Q30
Section 3: Hematologic and Immune Disorders ........ Q31-Q45
Section 4: Cardiovascular and Respiratory Disorders ........ Q46-Q60
Section 5: Renal, Gastrointestinal, and Hepatic Disorders ........ Q61-Q75
INSTRUCTIONS
Read each question carefully. Select the best answer from the four options provided. A rationale explaining the correct
answer and addressing a common misconception follows each question. You have 90 minutes to complete all 75
questions. A score of 80% or higher is required to pass. Review the answer key at the end of the document for quick
reference.
NSG 3280 Patho Exam 2 -- 2026/2027 | Passing Score: 80% | Page 1 of {TOTAL}
,Section 1: Neurological and Sensory Disorders -- 2026/2027
Q1 Question 1 of 75
Q1. A 68-year-old male awakens with right-sided hemiplegia and expressive aphasia. CT scan
reveals an ischemic infarct in the left middle cerebral artery territory. The most common cause of
ischemic stroke is which pathologic process?
A. Atherosclerosis with thrombus formation at the site of a ruptured plaque
B. Embolic occlusion from a left atrial thrombus secondary to atrial fibrillation
C. Lacunar infarction from lipohyalinosis of small penetrating arteries
D. Arterial dissection with intramural hematoma and vessel narrowing
Correct Answer: A
Rationale:
Atherosclerosis with in-situ thrombosis at a ruptured plaque is the most common mechanism of ischemic stroke,
accounting for the majority of large-artery atherothrombotic strokes. Embolic strokes from atrial fibrillation are the
second most common cause but are distinct from atherothrombotic disease.
Q2 Question 2 of 75
Q2. A 45-year-old female presents with bilateral vision loss, limb weakness, and paresthesias that
relapse and remit over months. MRI reveals periventricular white matter plaques of different ages.
The demyelination in multiple sclerosis is caused by which mechanism?
A. Ischemic injury to periventricular white matter from small vessel disease
B. Autoimmune T-cell and antibody-mediated attack on central nervous system myelin
C. Viral infection directly destroying oligodendrocytes and myelin sheaths
D. Genetic mutation causing failure of myelin basic protein synthesis
Correct Answer: B
Rationale:
Multiple sclerosis involves autoimmune attack by autoreactive T-cells and antibodies against CNS myelin,
producing inflammatory demyelination. Viral infection may trigger the autoimmune response but does not directly
cause the ongoing demyelination seen in MS.
,Q3 Question 3 of 75
Q3. A 62-year-old male with Parkinson disease presents with a resting pill-rolling tremor, cogwheel
rigidity, and bradykinesia. These motor symptoms result from degeneration of dopaminergic neurons
in which brain region?
A. Caudate nucleus leading to cholinergic excess and choreiform movements
B. Motor cortex pyramidal cells producing upper motor neuron signs
C. Substantia nigra pars compacta reducing dopaminergic input to the striatum
D. Cerebellar Purkinje cells causing loss of motor coordination and ataxia
Correct Answer: C
Rationale:
The classic parkinsonian triad results from loss of dopaminergic neurons in the substantia nigra pars compacta,
which disrupts basal ganglia circuitry by reducing dopamine in the striatum. Caudate degeneration is associated
with Huntington disease rather than Parkinson disease.
Q4 Question 4 of 75
Q4. A 55-year-old male presents with sudden severe headache described as the worst of his life,
followed by neck stiffness and decreased consciousness. CT shows blood in the subarachnoid space.
The most common cause of spontaneous subarachnoid hemorrhage is which condition?
A. Arteriovenous malformation with rupture of abnormal vascular connections
B. Hypertensive rupture of small penetrating arteries at the base of the brain
C. Cerebral amyloid angiopathy with deposition in leptomeningeal vessels
D. Ruptured saccular (berry) aneurysm at arterial bifurcations of the circle of Willis
Correct Answer: D
Rationale:
Saccular aneurysms at arterial bifurcations of the circle of Willis are the most common cause of spontaneous
subarachnoid hemorrhage. Hypertensive bleeds typically cause intraparenchymal hemorrhage in the basal
ganglia, not subarachnoid hemorrhage.
NSG 3280 Patho Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of {TOTAL}
, Q5 Question 5 of 75
Q5. A 30-year-old male presents with ascending flaccid paralysis and areflexia three weeks after a
Campylobacter jejuni gastrointestinal infection. CSF analysis reveals albuminocytologic dissociation.
The paralysis in Guillain-Barre syndrome results from which mechanism?
A. Autoimmune demyelination of peripheral nerves with macrophage-mediated myelin destruction
B. Viral invasion of anterior horn cells destroying lower motor neurons
C. Complement-mediated destruction of acetylcholine receptors at the neuromuscular junction
D. Ischemic injury to peripheral nerves from vasa nervorum vasculitis
Correct Answer: A
Rationale:
Guillain-Barre syndrome involves molecular mimicry where antibodies against Campylobber antigens cross-react
with peripheral nerve myelin, triggering macrophage-mediated demyelination. Anterior horn cell destruction
causes poliomyelitis, and AChR antibodies cause myasthenia gravis.
Q6 Question 6 of 75
Q6. A 40-year-old female presents with ptosis, diplopia, and difficulty swallowing that worsen toward
the end of the day. Edrophonium testing temporarily improves her strength. Myasthenia gravis is
caused by autoantibodies against which structure?
A. Skeletal muscle sarcolemma causing inflammatory myopathy
B. Acetylcholine receptors at the postsynaptic neuromuscular junction membrane
C. Voltage-gated calcium channels at the presynaptic motor nerve terminal
D. Myelin sheath of peripheral motor nerves and nerve roots
Correct Answer: B
Rationale:
Myasthenia gravis is caused by autoantibodies against acetylcholine receptors at the postsynaptic membrane,
reducing available receptors and impairing neuromuscular transmission. Antibodies against presynaptic calcium
channels cause Lambert-Eaton myasthenic syndrome.
NSG 3280 Patho Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of {TOTAL}
NSG 3280 Pathophysiology
Exam 2
Official Practice Exam -- 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% Annual
TABLE OF CONTENTS
Section 1: Neurological and Sensory Disorders ........ Q1-Q15
Section 2: Endocrine Disorders ........ Q16-Q30
Section 3: Hematologic and Immune Disorders ........ Q31-Q45
Section 4: Cardiovascular and Respiratory Disorders ........ Q46-Q60
Section 5: Renal, Gastrointestinal, and Hepatic Disorders ........ Q61-Q75
INSTRUCTIONS
Read each question carefully. Select the best answer from the four options provided. A rationale explaining the correct
answer and addressing a common misconception follows each question. You have 90 minutes to complete all 75
questions. A score of 80% or higher is required to pass. Review the answer key at the end of the document for quick
reference.
NSG 3280 Patho Exam 2 -- 2026/2027 | Passing Score: 80% | Page 1 of {TOTAL}
,Section 1: Neurological and Sensory Disorders -- 2026/2027
Q1 Question 1 of 75
Q1. A 68-year-old male awakens with right-sided hemiplegia and expressive aphasia. CT scan
reveals an ischemic infarct in the left middle cerebral artery territory. The most common cause of
ischemic stroke is which pathologic process?
A. Atherosclerosis with thrombus formation at the site of a ruptured plaque
B. Embolic occlusion from a left atrial thrombus secondary to atrial fibrillation
C. Lacunar infarction from lipohyalinosis of small penetrating arteries
D. Arterial dissection with intramural hematoma and vessel narrowing
Correct Answer: A
Rationale:
Atherosclerosis with in-situ thrombosis at a ruptured plaque is the most common mechanism of ischemic stroke,
accounting for the majority of large-artery atherothrombotic strokes. Embolic strokes from atrial fibrillation are the
second most common cause but are distinct from atherothrombotic disease.
Q2 Question 2 of 75
Q2. A 45-year-old female presents with bilateral vision loss, limb weakness, and paresthesias that
relapse and remit over months. MRI reveals periventricular white matter plaques of different ages.
The demyelination in multiple sclerosis is caused by which mechanism?
A. Ischemic injury to periventricular white matter from small vessel disease
B. Autoimmune T-cell and antibody-mediated attack on central nervous system myelin
C. Viral infection directly destroying oligodendrocytes and myelin sheaths
D. Genetic mutation causing failure of myelin basic protein synthesis
Correct Answer: B
Rationale:
Multiple sclerosis involves autoimmune attack by autoreactive T-cells and antibodies against CNS myelin,
producing inflammatory demyelination. Viral infection may trigger the autoimmune response but does not directly
cause the ongoing demyelination seen in MS.
,Q3 Question 3 of 75
Q3. A 62-year-old male with Parkinson disease presents with a resting pill-rolling tremor, cogwheel
rigidity, and bradykinesia. These motor symptoms result from degeneration of dopaminergic neurons
in which brain region?
A. Caudate nucleus leading to cholinergic excess and choreiform movements
B. Motor cortex pyramidal cells producing upper motor neuron signs
C. Substantia nigra pars compacta reducing dopaminergic input to the striatum
D. Cerebellar Purkinje cells causing loss of motor coordination and ataxia
Correct Answer: C
Rationale:
The classic parkinsonian triad results from loss of dopaminergic neurons in the substantia nigra pars compacta,
which disrupts basal ganglia circuitry by reducing dopamine in the striatum. Caudate degeneration is associated
with Huntington disease rather than Parkinson disease.
Q4 Question 4 of 75
Q4. A 55-year-old male presents with sudden severe headache described as the worst of his life,
followed by neck stiffness and decreased consciousness. CT shows blood in the subarachnoid space.
The most common cause of spontaneous subarachnoid hemorrhage is which condition?
A. Arteriovenous malformation with rupture of abnormal vascular connections
B. Hypertensive rupture of small penetrating arteries at the base of the brain
C. Cerebral amyloid angiopathy with deposition in leptomeningeal vessels
D. Ruptured saccular (berry) aneurysm at arterial bifurcations of the circle of Willis
Correct Answer: D
Rationale:
Saccular aneurysms at arterial bifurcations of the circle of Willis are the most common cause of spontaneous
subarachnoid hemorrhage. Hypertensive bleeds typically cause intraparenchymal hemorrhage in the basal
ganglia, not subarachnoid hemorrhage.
NSG 3280 Patho Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of {TOTAL}
, Q5 Question 5 of 75
Q5. A 30-year-old male presents with ascending flaccid paralysis and areflexia three weeks after a
Campylobacter jejuni gastrointestinal infection. CSF analysis reveals albuminocytologic dissociation.
The paralysis in Guillain-Barre syndrome results from which mechanism?
A. Autoimmune demyelination of peripheral nerves with macrophage-mediated myelin destruction
B. Viral invasion of anterior horn cells destroying lower motor neurons
C. Complement-mediated destruction of acetylcholine receptors at the neuromuscular junction
D. Ischemic injury to peripheral nerves from vasa nervorum vasculitis
Correct Answer: A
Rationale:
Guillain-Barre syndrome involves molecular mimicry where antibodies against Campylobber antigens cross-react
with peripheral nerve myelin, triggering macrophage-mediated demyelination. Anterior horn cell destruction
causes poliomyelitis, and AChR antibodies cause myasthenia gravis.
Q6 Question 6 of 75
Q6. A 40-year-old female presents with ptosis, diplopia, and difficulty swallowing that worsen toward
the end of the day. Edrophonium testing temporarily improves her strength. Myasthenia gravis is
caused by autoantibodies against which structure?
A. Skeletal muscle sarcolemma causing inflammatory myopathy
B. Acetylcholine receptors at the postsynaptic neuromuscular junction membrane
C. Voltage-gated calcium channels at the presynaptic motor nerve terminal
D. Myelin sheath of peripheral motor nerves and nerve roots
Correct Answer: B
Rationale:
Myasthenia gravis is caused by autoantibodies against acetylcholine receptors at the postsynaptic membrane,
reducing available receptors and impairing neuromuscular transmission. Antibodies against presynaptic calcium
channels cause Lambert-Eaton myasthenic syndrome.
NSG 3280 Patho Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of {TOTAL}
