NR-283 – Pathophysiology Examines disease processes, physiological alterations, body system dysfunctions, clinical manifestations, diagnostic findings, and healthcare implications.

NR-283 – Pathophysiology Examines disease
processes, physiological alterations, body system
dysfunctions, clinical manifestations, diagnostic
findings, and healthcare implications.

Question 1
A patient with chronic heart failure develops shortness of breath and crackles in
lung bases. Which pathophysiological mechanism is the primary cause?
A) Decreased left ventricular contractility leading to pulmonary congestion
B) Right ventricular failure causing systemic edema
C) Impaired renal perfusion leading to decreased renin release
D) Increased colloid osmotic pressure in pulmonary capillaries
Answer: A – Rationale: Left ventricular failure increases hydrostatic pressure in
pulmonary capillaries, causing transudate fluid into interstitium and alveoli
(pulmonary congestion). Crackles indicate fluid in airways.


Question 2
In Type 1 diabetes mellitus, which of the following best explains the etiology of
hyperglycemia?
A) Insulin resistance at the cellular receptor site
B) Autoimmune destruction of pancreatic beta cells
C) Excessive glucagon secretion from alpha cells
D) Increased hepatic glucose uptake
Answer: B – *Rationale: Type 1 DM results from autoimmune-mediated
destruction of pancreatic beta cells → absolute insulin deficiency → decreased
glucose uptake → hyperglycemia.*


Question 3
A patient with liver cirrhosis presents with asterixis, confusion, and elevated serum
ammonia. What is the primary mechanism of this neurological manifestation?

,A) Accumulation of bilirubin in brain tissue
B) Increased GABAergic tone from bacterial overgrowth
C) Failure of liver to convert ammonia to urea
D) Decreased cerebral blood flow from portal hypertension
Answer: C – Rationale: Liver failure impairs the urea cycle → ammonia
accumulates → crosses blood-brain barrier → astrocyte swelling and altered
neurotransmission → hepatic encephalopathy.


Question 4
Which laboratory finding is most consistent with acute pancreatitis?
A) Markedly elevated serum amylase and lipase
B) Elevated alkaline phosphatase with normal lipase
C) Decreased serum calcium and increased albumin
D) Elevated AST and ALT with normal amylase
Answer: A – Rationale: Amylase rises within 6–12 hours; lipase is more specific.
Both are released from damaged pancreatic acinar cells.


Question 5
A patient with chronic kidney disease has a GFR of 25 mL/min. Which of the
following electrolyte imbalances is expected?
A) Hypercalcemia and hypophosphatemia
B) Hypokalemia and hypernatremia
C) Hyperphosphatemia and hypocalcemia
D) Hypermagnesemia and hypercalcemia
Answer: C – Rationale: Reduced GFR → decreased phosphate excretion →
hyperphosphatemia → binds calcium → hypocalcemia. Also decreased renal
activation of vitamin D worsens hypocalcemia.


Question 6
In disseminated intravascular coagulation (DIC), the initial phase is characterized
by:

,A) Widespread thrombosis followed by bleeding
B) Isolated platelet destruction
C) Primary fibrinolysis without clotting
D) Isolated factor VIII deficiency
Answer: A – Rationale: DIC begins with systemic activation of coagulation →
microthrombi → consumption of platelets and clotting factors → later
hemorrhage.


Question 7
A patient with chronic obstructive pulmonary disease (COPD) has a PaCO2 of 68
mmHg. Which compensatory mechanism is most likely?
A) Increased respiratory rate
B) Increased renal bicarbonate reabsorption
C) Hyperventilation with decreased H+
D) Increased excretion of bicarbonate in urine
Answer: B – *Rationale: Chronic respiratory acidosis → kidneys compensate by
retaining HCO3- and excreting H+ → normalizing pH over days.*


Question 8
Which of the following best describes the pathophysiology of rheumatoid arthritis?
A) Uric acid crystal deposition in synovial fluid
B) Autoimmune-mediated synovial inflammation with pannus formation
C) Degenerative changes in articular cartilage from mechanical stress
D) Bacterial infection of the joint space
Answer: B – *Rationale: RA is systemic autoimmune disease → CD4+ T cells and
B cells attack synovium → pannus formation → cartilage/bone erosion.*


Question 9
A patient with a large anterior wall myocardial infarction is at highest risk for
which complication?
A) Ventricular septal rupture

, B) Acute mitral regurgitation
C) Left ventricular aneurysm
D) Right heart failure
Answer: A – Rationale: Large anterior MI → necrosis of septum → risk of VSD
within 3–7 days. Posterior MI more associated with mitral regurgitation.


Question 10
In asthma, the early-phase reaction (within 30 minutes of allergen exposure) is
mediated primarily by:
A) Eosinophil infiltration and leukotrienes
B) Mast cell degranulation and histamine release
C) T-cell mediated delayed hypersensitivity
D) Neutrophil chemotaxis to the airway
Answer: B – Rationale: IgE-mediated mast cell activation → histamine,
prostaglandins, leukotrienes → bronchospasm, edema, mucus.


Question 11
Which of the following is the primary mechanism of brain injury in a patient with
an epidural hematoma?
A) Tearing of bridging veins between cortex and venous sinuses
B) Rupture of middle meningeal artery from skull fracture
C) Diffuse axonal injury from rotational forces
D) Contusion of temporal lobe against skull base
Answer: B – Rationale: Epidural hematoma often from arterial bleed (middle
meningeal artery) secondary to temporal bone fracture → rapid expansion →
herniation risk.


Question 12
A patient with sepsis develops hypotension despite fluid resuscitation. Which
pathophysiological change is most likely occurring?
A) Increased systemic vascular resistance (SVR)