NUR2063 Essentials of Pathophysiology
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, Question 1:
A 68-year-old male with a history of dilated cardiomyopathy presents
with worsening dyspnea and peripheral edema. Laboratory tests reveal
an elevated level of a natriuretic peptide. Which biomarker is most
sensitive and specific for the diagnosis and monitoring of chronic heart
failure in this patient?
A. Creatine kinase-MB
B. Troponin I
C. B-type natriuretic peptide (BNP)
D. C-reactive protein (CRP)
Correct ANS: C. B-type natriuretic peptide (BNP)
Rationale: BNP is secreted by ventricular myocytes in response to
increased wall stress, making it an important and sensitive marker for
diagnosing and monitoring heart failure.
---
Question 2:
A 45-year-old female with a known history of chronic obstructive
pulmonary disease (COPD) presents with an acute exacerbation. Her
arterial blood gas (ABG) shows a pH of 7.32, PaCO₂ of 50 mm Hg, and
HCO₃⁻ of 25 mEq/L. Which acid-base disorder does this pattern
represent?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
Correct ANS: B. Respiratory acidosis
Rationale: An elevated PaCO₂ with a pH below 7.35 indicates
respiratory acidosis. This is common in COPD exacerbations where
©2025
,hypoventilation leads to CO₂ retention.
---
Question 3:
A 30-year-old patient is newly diagnosed with Type 1 diabetes mellitus.
What is the primary immunopathological mechanism responsible for the
destruction of pancreatic beta-cells in this condition?
A. Autoimmune-mediated destruction by T lymphocytes
B. Beta-cell dysfunction due to chronic hyperglycemia
C. Insulin resistance in peripheral tissues
D. Viral infection of the pancreatic islets
Correct ANS: A. Autoimmune-mediated destruction by T lymphocytes
Rationale: Type 1 diabetes mellitus results from a cell-mediated
autoimmune process where T lymphocytes specifically target pancreatic
beta-cells.
---
Question 4:
An elderly patient presents with a sudden, severe headache and altered
mental status. A CT scan reveals subarachnoid hemorrhage. Which
underlying pathophysiological process is most frequently responsible for
this condition?
A. Atherosclerotic plaque rupture
B. Berry aneurysm rupture
C. Embolic occlusion
D. Vasculitis-induced vessel wall damage
Correct ANS: B. Berry aneurysm rupture
Rationale: Berry aneurysms, common in older populations, can rupture
and cause subarachnoid hemorrhage. Their saccular shape predisposes
them to rupture under increased pressure.
©2025
, ---
Question 5:
A 50-year-old patient with acute chest pain and clinical features of
myocardial infarction is evaluated. Early cellular changes indicate
reversible injury. Which of the following is the earliest indicator of
reversible myocardial injury?
A. Mitochondrial swelling
B. Myofibrillar lysis
C. Loss of membrane integrity
D. Calcium overload
Correct ANS: A. Mitochondrial swelling
Rationale: Mitochondrial swelling is a sensitive early cellular change
that indicates reversible myocardial injury before permanent damage
develops.
---
Question 6:
A 55-year-old patient with a long history of smoking presents with
symptoms of emphysema. Which enzyme imbalance is primarily
responsible for the destruction of alveolar walls in this condition?
A. Increased elastase activity
B. Decreased cortisol secretion
C. Augmented superoxide dismutase activity
D. Elevated collagenase activity
Correct ANS: A. Increased elastase activity
Rationale: Emphysema is largely due to an imbalance between
proteases and antiproteases (notably increased elastase activity vs.
alpha-1 antitrypsin), leading to the destruction of alveolar walls.
---
©2025
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, Question 1:
A 68-year-old male with a history of dilated cardiomyopathy presents
with worsening dyspnea and peripheral edema. Laboratory tests reveal
an elevated level of a natriuretic peptide. Which biomarker is most
sensitive and specific for the diagnosis and monitoring of chronic heart
failure in this patient?
A. Creatine kinase-MB
B. Troponin I
C. B-type natriuretic peptide (BNP)
D. C-reactive protein (CRP)
Correct ANS: C. B-type natriuretic peptide (BNP)
Rationale: BNP is secreted by ventricular myocytes in response to
increased wall stress, making it an important and sensitive marker for
diagnosing and monitoring heart failure.
---
Question 2:
A 45-year-old female with a known history of chronic obstructive
pulmonary disease (COPD) presents with an acute exacerbation. Her
arterial blood gas (ABG) shows a pH of 7.32, PaCO₂ of 50 mm Hg, and
HCO₃⁻ of 25 mEq/L. Which acid-base disorder does this pattern
represent?
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
Correct ANS: B. Respiratory acidosis
Rationale: An elevated PaCO₂ with a pH below 7.35 indicates
respiratory acidosis. This is common in COPD exacerbations where
©2025
,hypoventilation leads to CO₂ retention.
---
Question 3:
A 30-year-old patient is newly diagnosed with Type 1 diabetes mellitus.
What is the primary immunopathological mechanism responsible for the
destruction of pancreatic beta-cells in this condition?
A. Autoimmune-mediated destruction by T lymphocytes
B. Beta-cell dysfunction due to chronic hyperglycemia
C. Insulin resistance in peripheral tissues
D. Viral infection of the pancreatic islets
Correct ANS: A. Autoimmune-mediated destruction by T lymphocytes
Rationale: Type 1 diabetes mellitus results from a cell-mediated
autoimmune process where T lymphocytes specifically target pancreatic
beta-cells.
---
Question 4:
An elderly patient presents with a sudden, severe headache and altered
mental status. A CT scan reveals subarachnoid hemorrhage. Which
underlying pathophysiological process is most frequently responsible for
this condition?
A. Atherosclerotic plaque rupture
B. Berry aneurysm rupture
C. Embolic occlusion
D. Vasculitis-induced vessel wall damage
Correct ANS: B. Berry aneurysm rupture
Rationale: Berry aneurysms, common in older populations, can rupture
and cause subarachnoid hemorrhage. Their saccular shape predisposes
them to rupture under increased pressure.
©2025
, ---
Question 5:
A 50-year-old patient with acute chest pain and clinical features of
myocardial infarction is evaluated. Early cellular changes indicate
reversible injury. Which of the following is the earliest indicator of
reversible myocardial injury?
A. Mitochondrial swelling
B. Myofibrillar lysis
C. Loss of membrane integrity
D. Calcium overload
Correct ANS: A. Mitochondrial swelling
Rationale: Mitochondrial swelling is a sensitive early cellular change
that indicates reversible myocardial injury before permanent damage
develops.
---
Question 6:
A 55-year-old patient with a long history of smoking presents with
symptoms of emphysema. Which enzyme imbalance is primarily
responsible for the destruction of alveolar walls in this condition?
A. Increased elastase activity
B. Decreased cortisol secretion
C. Augmented superoxide dismutase activity
D. Elevated collagenase activity
Correct ANS: A. Increased elastase activity
Rationale: Emphysema is largely due to an imbalance between
proteases and antiproteases (notably increased elastase activity vs.
alpha-1 antitrypsin), leading to the destruction of alveolar walls.
---
©2025
