NR 507 Advanced Pathophysiology Practice Test | 100
Questions And Answers With Rationale | 2025-2026
Updated Study Solutions
1. A patient has chronic hypoxia due to COPD. Which cellular adaptation is most likely to occur in tissues
exposed to prolonged low oxygen?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Atrophy
Answer: D
Rationale: Prolonged decreased oxygen delivery causes cells to downsize metabolic demand and reduce cell
size (atrophy). Metaplasia can occur in epithelium exposed to chronic irritation; hyperplasia is increased cell
number; dysplasia is disordered growth.
2. Reperfusion injury after myocardial ischemia is mediated primarily by:
A. Bacterial toxins
B. Reactive oxygen species (ROS)
C. Autoantibodies
D. Decreased intracellular calcium
Answer: B
Rationale: Restoration of blood flow generates ROS that cause additional membrane and mitochondrial
damage, contributing to reperfusion injury.
3. Which intracellular change is a common feature of irreversible cell injury?
A. Mild chromatin clumping
B. Cellular swelling reversible with oxygen
C. Rupture of lysosomes releasing hydrolytic enzymes
D. Restoration of ATP levels
Answer: C
Rationale: Lysosomal membrane rupture and enzyme release lead to autodigestion — a hallmark of
irreversible injury. Mild chromatin clumping and swelling can be reversible.
,4. A 24-year-old male has sickle cell trait (heterozygous). Which statement is true?
A. He will have severe vaso-occlusive crises like homozygotes.
B. He does not carry the mutation.
C. He may have complications under extreme hypoxic stress.
D. He is immune to all malaria species.
Answer: C
Rationale: Heterozygotes usually are asymptomatic but can develop sickling complications during severe
hypoxia, dehydration, or high altitude.
5. Which cytokine primarily induces fever by acting on the hypothalamus?
A. Interleukin-10 (IL-10)
B. Tumor necrosis factor-alpha (TNF-α)
C. Interleukin-1 (IL-1)
D. Transforming growth factor-beta (TGF-β)
Answer: C
Rationale: IL-1 (and IL-6) act on the hypothalamus to elevate the thermoregulatory set point, producing fever;
TNF-α also contributes but IL-1 is key.
6. In acute inflammation, which cell type is earliest to transmigrate to the site of injury?
A. Lymphocytes
B. Eosinophils
C. Neutrophils
D. Monocytes
Answer: C
Rationale: Neutrophils are the first responders in acute inflammation; monocytes/macrophages arrive later;
lymphocytes are prominent in chronic inflammation.
7. A patient has prolonged neutropenia and recurrent bacterial infections. Which immune function is most
affected?
A. Antibody class switching
B. Phagocytosis of extracellular bacteria
,C. Complement synthesis by the liver
D. T-cell mediated cytotoxicity
Answer: B
Rationale: Neutrophils are crucial for phagocytosis of bacteria; neutropenia predisposes to bacterial infections.
8. A genetic mutation that changes one amino acid in the protein product is called:
A. Nonsense mutation
B. Frameshift mutation
C. Missense mutation
D. Silent mutation
Answer: C
Rationale: Missense mutations substitute one amino acid for another. Nonsense creates stop codon; frameshift
alters reading frame; silent causes no amino acid change.
9. Syndrome caused by antibody-mediated destruction of acetylcholine receptors at the neuromuscular
junction:
A. Lambert-Eaton syndrome
B. Myasthenia gravis
C. Guillain-Barré syndrome
D. Multiple sclerosis
Answer: B
Rationale: Myasthenia gravis is antibody-mediated against nicotinic ACh receptors, causing fatigable muscle
weakness. Lambert-Eaton involves presynaptic calcium channel antibodies.
10. Which acid–base disturbance is expected with prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: C
Rationale: Loss of gastric HCl leads to metabolic alkalosis with increased bicarbonate.
, 11. A patient with DKA (diabetic ketoacidosis) typically presents with:
A. Metabolic alkalosis with low anion gap
B. High anion gap metabolic acidosis with increased ketones
C. Normal anion gap metabolic acidosis from diarrhea
D. Respiratory alkalosis due to hyperventilation
Answer: B
Rationale: DKA produces ketone acids, causing high anion gap metabolic acidosis; respiratory compensation
causes Kussmaul respirations.
12. In nephrotic syndrome, which change is characteristic?
A. Hematuria and RBC casts
B. Significant proteinuria and hypoalbuminemia
C. Hypernatremia and volume depletion
D. Decreased lipid levels in blood
Answer: B
Rationale: Nephrotic syndrome features heavy proteinuria (>3.5 g/day), hypoalbuminemia, edema, and
hyperlipidemia.
13. Elevated troponin I indicates:
A. Pulmonary embolism always
B. Myocardial cell injury/necrosis
C. Dehydration
D. Hemolytic anemia
Answer: B
Rationale: Troponin I is a sensitive and specific marker of myocardial injury (e.g., MI).
14. Which pathogen-associated molecular pattern (PAMP) receptor is located on endosomal membranes and
recognizes viral RNA?
A. TLR4 (Toll-like receptor 4)
B. NOD2
C. TLR3
D. Mannose receptor
Questions And Answers With Rationale | 2025-2026
Updated Study Solutions
1. A patient has chronic hypoxia due to COPD. Which cellular adaptation is most likely to occur in tissues
exposed to prolonged low oxygen?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Atrophy
Answer: D
Rationale: Prolonged decreased oxygen delivery causes cells to downsize metabolic demand and reduce cell
size (atrophy). Metaplasia can occur in epithelium exposed to chronic irritation; hyperplasia is increased cell
number; dysplasia is disordered growth.
2. Reperfusion injury after myocardial ischemia is mediated primarily by:
A. Bacterial toxins
B. Reactive oxygen species (ROS)
C. Autoantibodies
D. Decreased intracellular calcium
Answer: B
Rationale: Restoration of blood flow generates ROS that cause additional membrane and mitochondrial
damage, contributing to reperfusion injury.
3. Which intracellular change is a common feature of irreversible cell injury?
A. Mild chromatin clumping
B. Cellular swelling reversible with oxygen
C. Rupture of lysosomes releasing hydrolytic enzymes
D. Restoration of ATP levels
Answer: C
Rationale: Lysosomal membrane rupture and enzyme release lead to autodigestion — a hallmark of
irreversible injury. Mild chromatin clumping and swelling can be reversible.
,4. A 24-year-old male has sickle cell trait (heterozygous). Which statement is true?
A. He will have severe vaso-occlusive crises like homozygotes.
B. He does not carry the mutation.
C. He may have complications under extreme hypoxic stress.
D. He is immune to all malaria species.
Answer: C
Rationale: Heterozygotes usually are asymptomatic but can develop sickling complications during severe
hypoxia, dehydration, or high altitude.
5. Which cytokine primarily induces fever by acting on the hypothalamus?
A. Interleukin-10 (IL-10)
B. Tumor necrosis factor-alpha (TNF-α)
C. Interleukin-1 (IL-1)
D. Transforming growth factor-beta (TGF-β)
Answer: C
Rationale: IL-1 (and IL-6) act on the hypothalamus to elevate the thermoregulatory set point, producing fever;
TNF-α also contributes but IL-1 is key.
6. In acute inflammation, which cell type is earliest to transmigrate to the site of injury?
A. Lymphocytes
B. Eosinophils
C. Neutrophils
D. Monocytes
Answer: C
Rationale: Neutrophils are the first responders in acute inflammation; monocytes/macrophages arrive later;
lymphocytes are prominent in chronic inflammation.
7. A patient has prolonged neutropenia and recurrent bacterial infections. Which immune function is most
affected?
A. Antibody class switching
B. Phagocytosis of extracellular bacteria
,C. Complement synthesis by the liver
D. T-cell mediated cytotoxicity
Answer: B
Rationale: Neutrophils are crucial for phagocytosis of bacteria; neutropenia predisposes to bacterial infections.
8. A genetic mutation that changes one amino acid in the protein product is called:
A. Nonsense mutation
B. Frameshift mutation
C. Missense mutation
D. Silent mutation
Answer: C
Rationale: Missense mutations substitute one amino acid for another. Nonsense creates stop codon; frameshift
alters reading frame; silent causes no amino acid change.
9. Syndrome caused by antibody-mediated destruction of acetylcholine receptors at the neuromuscular
junction:
A. Lambert-Eaton syndrome
B. Myasthenia gravis
C. Guillain-Barré syndrome
D. Multiple sclerosis
Answer: B
Rationale: Myasthenia gravis is antibody-mediated against nicotinic ACh receptors, causing fatigable muscle
weakness. Lambert-Eaton involves presynaptic calcium channel antibodies.
10. Which acid–base disturbance is expected with prolonged vomiting?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: C
Rationale: Loss of gastric HCl leads to metabolic alkalosis with increased bicarbonate.
, 11. A patient with DKA (diabetic ketoacidosis) typically presents with:
A. Metabolic alkalosis with low anion gap
B. High anion gap metabolic acidosis with increased ketones
C. Normal anion gap metabolic acidosis from diarrhea
D. Respiratory alkalosis due to hyperventilation
Answer: B
Rationale: DKA produces ketone acids, causing high anion gap metabolic acidosis; respiratory compensation
causes Kussmaul respirations.
12. In nephrotic syndrome, which change is characteristic?
A. Hematuria and RBC casts
B. Significant proteinuria and hypoalbuminemia
C. Hypernatremia and volume depletion
D. Decreased lipid levels in blood
Answer: B
Rationale: Nephrotic syndrome features heavy proteinuria (>3.5 g/day), hypoalbuminemia, edema, and
hyperlipidemia.
13. Elevated troponin I indicates:
A. Pulmonary embolism always
B. Myocardial cell injury/necrosis
C. Dehydration
D. Hemolytic anemia
Answer: B
Rationale: Troponin I is a sensitive and specific marker of myocardial injury (e.g., MI).
14. Which pathogen-associated molecular pattern (PAMP) receptor is located on endosomal membranes and
recognizes viral RNA?
A. TLR4 (Toll-like receptor 4)
B. NOD2
C. TLR3
D. Mannose receptor
