Keiser University
Course Code: BSC2085C
Course Title: Human Anatomy & Physiology I
Credit Hours:4.0
Exam: Final Exam
Date:2026
Case: A 45-year-old male patient is admitted with severe dehydration following three days of
vomiting and diarrhea. His serum sodium is 158 mEq/L. On assessment, his cells appear shrunken
under microscopy.
Which transport mechanism is responsible for the movement of water out of his cells in this
clinical scenario?
A) Facilitated diffusion B) Active transport C) Osmosis D) Endocytosis
Correct Answer: C) Osmosis
Rationale: When extracellular sodium is elevated (hypernatremia), the extracellular fluid becomes
hypertonic relative to the intracellular fluid. Water moves passively down its concentration gradient
from an area of lower solute concentration (inside the cell) to higher solute concentration (outside
the cell) via osmosis, through aquaporin channels. This does not require ATP and explains the
observed cell crenation (shrinkage).
Case: A 28-year-old woman presents to the clinic after sustaining a deep laceration on her forearm.
During wound assessment, the nurse observes that the wound has penetrated through the epidermis
and into the dermis. Profuse bleeding is present.
Why does the epidermis alone not contain blood vessels, yet the dermis bleeds profusely?
A) The epidermis contains lymphatic vessels instead of blood vessels B) The epidermis is
avascular and relies on diffusion from the dermis for nutrition C) The epidermis contains only
nerve endings, which supply oxygen directly D) Melanocytes in the epidermis actively pump
nutrients from surrounding tissue
Correct Answer: B) The epidermis is avascular and relies on diffusion from the dermis for
nutrition
Rationale: The epidermis is completely avascular. Keratinocytes in the stratum basale receive
oxygen and nutrients via diffusion from the capillary loops located in the dermal papillae of the
dermis. The dermis, being a connective tissue layer, is richly vascularized, which explains profuse
bleeding when it is breached. This structural arrangement is a fundamental concept in wound care
nursing.
Case: A 72-year-old female patient with a long-standing history of osteoporosis sustains a
1
,compression fracture of the L2 vertebra after a minor fall. A DEXA scan confirms severely
reduced bone mineral density.
Which cells are primarily responsible for the pathological bone resorption seen in osteoporosis?
A) Osteoblasts B) Osteocytes C) Osteoclasts D) Chondroblasts
Correct Answer: C) Osteoclasts
Rationale: Osteoclasts are large, multinucleated cells derived from monocyte precursors that are
responsible for bone resorption. They secrete hydrochloric acid and lysosomal enzymes (such as
cathepsin K) onto the bone surface, dissolving the mineral matrix and degrading collagen. In
osteoporosis, particularly postmenopausal osteoporosis, decreased estrogen levels lead to increased
osteoclast activity relative to osteoblast activity, tipping the remodeling balance toward net bone
loss. Bisphosphonate drugs work by inhibiting osteoclast activity.
Case: A 19-year-old male athlete presents to the emergency department after a knee injury
sustained during a football match. MRI reveals a complete tear of the anterior cruciate ligament
(ACL).
The ACL is composed primarily of which type of connective tissue?
A) Hyaline cartilage B) Dense irregular connective tissue C) Dense regular connective tissue D)
Elastic connective tissue
Correct Answer: C) Dense regular connective tissue
Rationale: Ligaments and tendons are composed of dense regular connective tissue, characterized
by parallel bundles of type I collagen fibers arranged in the same direction as the lines of force
applied to them. This arrangement provides exceptional tensile strength along one axis. The
regular, parallel arrangement distinguishes it from dense irregular connective tissue (found in the
dermis and joint capsules), which resists multidirectional forces. Understanding tissue composition
helps nurses anticipate healing timelines, as dense regular connective tissue has a poor blood
supply and heals slowly.
Case: A 55-year-old male with type 2 diabetes develops a non-healing plantar ulcer. Biopsy
reveals accumulation of glycation end-products within the basement membrane of dermal
capillaries, causing significant thickening.
The basement membrane is secreted and maintained by which two cell types?
A) Fibroblasts and macrophages B) Epithelial cells and endothelial cells C) Mast cells and plasma
cells D) Osteoblasts and osteoclasts
Correct Answer: B) Epithelial cells and endothelial cells
Rationale: The basement membrane (basal lamina) is a specialized extracellular matrix structure
composed primarily of type IV collagen, laminin, fibronectin, and heparan sulfate proteoglycans. It
is secreted and maintained by the epithelial cells sitting on top of it and the endothelial cells lining
the vasculature. In diabetes, chronic hyperglycemia leads to non-enzymatic glycation of proteins,
causing basement membrane thickening in capillaries (diabetic microangiopathy), which impairs
diffusion of oxygen and nutrients, contributing to poor wound healing.
Case: A 60-year-old male patient is diagnosed with Duchenne muscular dystrophy late in life
(atypical presentation). Muscle biopsy shows absence of dystrophin protein and replacement of
muscle fibers with adipose and connective tissue.
Dystrophin connects the intracellular cytoskeleton of the muscle fiber to which extracellular
structure?
A) The sarcoplasmic reticulum B) The neuromuscular junction receptor complex C) The
extracellular matrix via the dystrophin-associated protein complex D) The T-tubule membrane
Correct Answer: C) The extracellular matrix via the dystrophin-associated protein complex
Rationale: Dystrophin is a large rod-shaped protein located on the cytoplasmic face of the
2
, sarcolemma. It links the intracellular actin cytoskeleton to the dystrophin-associated protein
complex (DAPC), which spans the sarcolemma and connects to laminin in the extracellular matrix.
This linkage stabilizes the sarcolemma during repeated cycles of muscle contraction and relaxation.
Without dystrophin, membrane fragility leads to calcium influx, protease activation, and ultimately
necrosis of muscle fibers, which are replaced by fibrofatty tissue, causing progressive weakness.
Case: A 34-year-old female nurse presents with tingling and numbness in the lateral forearm and
thumb following a humeral shaft fracture sustained in a motor vehicle accident.
Which nerve is most likely injured, and through which foramen does this nerve pass distally?
A) Ulnar nerve; cubital tunnel B) Median nerve; carpal tunnel C) Radial nerve; no specific foramen
at this level D) Musculocutaneous nerve; coracobrachialis muscle
Correct Answer: C) Radial nerve; no specific foramen at this level
Rationale: The radial nerve runs in the spiral groove (radial groove) of the humerus and is the
most commonly injured nerve in humeral shaft fractures. Injury here causes wrist drop (inability to
extend the wrist and fingers) due to loss of innervation to the posterior forearm extensor muscles,
along with sensory loss over the dorsolateral hand and lateral forearm. The nerve does not pass
through a foramen at this level but is vulnerable due to its close proximity to the bone in the spiral
groove. This is high-yield clinical anatomy for nursing practice.
Case: A premature infant (32 weeks gestation) is admitted to the NICU with respiratory distress
syndrome (RDS). Chest X-ray shows bilateral "ground-glass" opacities. Blood gas analysis reveals
hypoxemia and hypercapnia.
The deficiency of which substance secreted by which specific cell type is responsible for this
presentation?
A) Mucus, secreted by goblet cells B) Surfactant, secreted by type II pneumocytes C)
Immunoglobulin A, secreted by plasma cells in the lamina propria D) Angiotensin-converting
enzyme, secreted by type I pneumocytes
Correct Answer: B) Surfactant, secreted by type II pneumocytes
Rationale: Pulmonary surfactant is a complex mixture of phospholipids (primarily
dipalmitoylphosphatidylcholine, DPPC) and proteins (SP-A, SP-B, SP-C, SP-D) produced by type
II alveolar cells (granular pneumocytes). Surfactant reduces surface tension at the air-liquid
interface within alveoli, preventing alveolar collapse at end-expiration (atelectasis). Production is
not sufficient until approximately 34 to 36 weeks gestation. In premature infants, surfactant
deficiency leads to diffuse atelectasis, decreased lung compliance, and the clinical picture of RDS.
Treatment includes exogenous surfactant administration and assisted ventilation.
Case: A 48-year-old construction worker presents with a crush injury to his right hand.
Radiographs reveal fractures of the 2nd and 3rd metacarpals. The orthopedic surgeon notes injury
to the intrinsic muscles of the hand.
The interossei muscles of the hand are innervated by which nerve, and what is the primary action
of the palmar interossei?
A) Median nerve; abduction of fingers B) Radial nerve; extension of the MCP joints C) Ulnar
nerve; adduction of fingers toward the middle finger D) Musculocutaneous nerve; flexion of the
PIP joints
Correct Answer: C) Ulnar nerve; adduction of fingers toward the middle finger
Rationale: All interossei (both dorsal and palmar) are innervated by the deep branch of the ulnar
nerve (C8, T1). The palmar interossei (three muscles) adduct the index, ring, and little fingers
toward the middle finger (DAB for Dorsal = ABduct; PAD for Palmar = ADduct is the classic
mnemonic). The dorsal interossei abduct fingers away from the middle finger. Ulnar nerve injury
results in loss of interossei function, contributing to "ulnar claw" deformity and significant loss of
3
Course Code: BSC2085C
Course Title: Human Anatomy & Physiology I
Credit Hours:4.0
Exam: Final Exam
Date:2026
Case: A 45-year-old male patient is admitted with severe dehydration following three days of
vomiting and diarrhea. His serum sodium is 158 mEq/L. On assessment, his cells appear shrunken
under microscopy.
Which transport mechanism is responsible for the movement of water out of his cells in this
clinical scenario?
A) Facilitated diffusion B) Active transport C) Osmosis D) Endocytosis
Correct Answer: C) Osmosis
Rationale: When extracellular sodium is elevated (hypernatremia), the extracellular fluid becomes
hypertonic relative to the intracellular fluid. Water moves passively down its concentration gradient
from an area of lower solute concentration (inside the cell) to higher solute concentration (outside
the cell) via osmosis, through aquaporin channels. This does not require ATP and explains the
observed cell crenation (shrinkage).
Case: A 28-year-old woman presents to the clinic after sustaining a deep laceration on her forearm.
During wound assessment, the nurse observes that the wound has penetrated through the epidermis
and into the dermis. Profuse bleeding is present.
Why does the epidermis alone not contain blood vessels, yet the dermis bleeds profusely?
A) The epidermis contains lymphatic vessels instead of blood vessels B) The epidermis is
avascular and relies on diffusion from the dermis for nutrition C) The epidermis contains only
nerve endings, which supply oxygen directly D) Melanocytes in the epidermis actively pump
nutrients from surrounding tissue
Correct Answer: B) The epidermis is avascular and relies on diffusion from the dermis for
nutrition
Rationale: The epidermis is completely avascular. Keratinocytes in the stratum basale receive
oxygen and nutrients via diffusion from the capillary loops located in the dermal papillae of the
dermis. The dermis, being a connective tissue layer, is richly vascularized, which explains profuse
bleeding when it is breached. This structural arrangement is a fundamental concept in wound care
nursing.
Case: A 72-year-old female patient with a long-standing history of osteoporosis sustains a
1
,compression fracture of the L2 vertebra after a minor fall. A DEXA scan confirms severely
reduced bone mineral density.
Which cells are primarily responsible for the pathological bone resorption seen in osteoporosis?
A) Osteoblasts B) Osteocytes C) Osteoclasts D) Chondroblasts
Correct Answer: C) Osteoclasts
Rationale: Osteoclasts are large, multinucleated cells derived from monocyte precursors that are
responsible for bone resorption. They secrete hydrochloric acid and lysosomal enzymes (such as
cathepsin K) onto the bone surface, dissolving the mineral matrix and degrading collagen. In
osteoporosis, particularly postmenopausal osteoporosis, decreased estrogen levels lead to increased
osteoclast activity relative to osteoblast activity, tipping the remodeling balance toward net bone
loss. Bisphosphonate drugs work by inhibiting osteoclast activity.
Case: A 19-year-old male athlete presents to the emergency department after a knee injury
sustained during a football match. MRI reveals a complete tear of the anterior cruciate ligament
(ACL).
The ACL is composed primarily of which type of connective tissue?
A) Hyaline cartilage B) Dense irregular connective tissue C) Dense regular connective tissue D)
Elastic connective tissue
Correct Answer: C) Dense regular connective tissue
Rationale: Ligaments and tendons are composed of dense regular connective tissue, characterized
by parallel bundles of type I collagen fibers arranged in the same direction as the lines of force
applied to them. This arrangement provides exceptional tensile strength along one axis. The
regular, parallel arrangement distinguishes it from dense irregular connective tissue (found in the
dermis and joint capsules), which resists multidirectional forces. Understanding tissue composition
helps nurses anticipate healing timelines, as dense regular connective tissue has a poor blood
supply and heals slowly.
Case: A 55-year-old male with type 2 diabetes develops a non-healing plantar ulcer. Biopsy
reveals accumulation of glycation end-products within the basement membrane of dermal
capillaries, causing significant thickening.
The basement membrane is secreted and maintained by which two cell types?
A) Fibroblasts and macrophages B) Epithelial cells and endothelial cells C) Mast cells and plasma
cells D) Osteoblasts and osteoclasts
Correct Answer: B) Epithelial cells and endothelial cells
Rationale: The basement membrane (basal lamina) is a specialized extracellular matrix structure
composed primarily of type IV collagen, laminin, fibronectin, and heparan sulfate proteoglycans. It
is secreted and maintained by the epithelial cells sitting on top of it and the endothelial cells lining
the vasculature. In diabetes, chronic hyperglycemia leads to non-enzymatic glycation of proteins,
causing basement membrane thickening in capillaries (diabetic microangiopathy), which impairs
diffusion of oxygen and nutrients, contributing to poor wound healing.
Case: A 60-year-old male patient is diagnosed with Duchenne muscular dystrophy late in life
(atypical presentation). Muscle biopsy shows absence of dystrophin protein and replacement of
muscle fibers with adipose and connective tissue.
Dystrophin connects the intracellular cytoskeleton of the muscle fiber to which extracellular
structure?
A) The sarcoplasmic reticulum B) The neuromuscular junction receptor complex C) The
extracellular matrix via the dystrophin-associated protein complex D) The T-tubule membrane
Correct Answer: C) The extracellular matrix via the dystrophin-associated protein complex
Rationale: Dystrophin is a large rod-shaped protein located on the cytoplasmic face of the
2
, sarcolemma. It links the intracellular actin cytoskeleton to the dystrophin-associated protein
complex (DAPC), which spans the sarcolemma and connects to laminin in the extracellular matrix.
This linkage stabilizes the sarcolemma during repeated cycles of muscle contraction and relaxation.
Without dystrophin, membrane fragility leads to calcium influx, protease activation, and ultimately
necrosis of muscle fibers, which are replaced by fibrofatty tissue, causing progressive weakness.
Case: A 34-year-old female nurse presents with tingling and numbness in the lateral forearm and
thumb following a humeral shaft fracture sustained in a motor vehicle accident.
Which nerve is most likely injured, and through which foramen does this nerve pass distally?
A) Ulnar nerve; cubital tunnel B) Median nerve; carpal tunnel C) Radial nerve; no specific foramen
at this level D) Musculocutaneous nerve; coracobrachialis muscle
Correct Answer: C) Radial nerve; no specific foramen at this level
Rationale: The radial nerve runs in the spiral groove (radial groove) of the humerus and is the
most commonly injured nerve in humeral shaft fractures. Injury here causes wrist drop (inability to
extend the wrist and fingers) due to loss of innervation to the posterior forearm extensor muscles,
along with sensory loss over the dorsolateral hand and lateral forearm. The nerve does not pass
through a foramen at this level but is vulnerable due to its close proximity to the bone in the spiral
groove. This is high-yield clinical anatomy for nursing practice.
Case: A premature infant (32 weeks gestation) is admitted to the NICU with respiratory distress
syndrome (RDS). Chest X-ray shows bilateral "ground-glass" opacities. Blood gas analysis reveals
hypoxemia and hypercapnia.
The deficiency of which substance secreted by which specific cell type is responsible for this
presentation?
A) Mucus, secreted by goblet cells B) Surfactant, secreted by type II pneumocytes C)
Immunoglobulin A, secreted by plasma cells in the lamina propria D) Angiotensin-converting
enzyme, secreted by type I pneumocytes
Correct Answer: B) Surfactant, secreted by type II pneumocytes
Rationale: Pulmonary surfactant is a complex mixture of phospholipids (primarily
dipalmitoylphosphatidylcholine, DPPC) and proteins (SP-A, SP-B, SP-C, SP-D) produced by type
II alveolar cells (granular pneumocytes). Surfactant reduces surface tension at the air-liquid
interface within alveoli, preventing alveolar collapse at end-expiration (atelectasis). Production is
not sufficient until approximately 34 to 36 weeks gestation. In premature infants, surfactant
deficiency leads to diffuse atelectasis, decreased lung compliance, and the clinical picture of RDS.
Treatment includes exogenous surfactant administration and assisted ventilation.
Case: A 48-year-old construction worker presents with a crush injury to his right hand.
Radiographs reveal fractures of the 2nd and 3rd metacarpals. The orthopedic surgeon notes injury
to the intrinsic muscles of the hand.
The interossei muscles of the hand are innervated by which nerve, and what is the primary action
of the palmar interossei?
A) Median nerve; abduction of fingers B) Radial nerve; extension of the MCP joints C) Ulnar
nerve; adduction of fingers toward the middle finger D) Musculocutaneous nerve; flexion of the
PIP joints
Correct Answer: C) Ulnar nerve; adduction of fingers toward the middle finger
Rationale: All interossei (both dorsal and palmar) are innervated by the deep branch of the ulnar
nerve (C8, T1). The palmar interossei (three muscles) adduct the index, ring, and little fingers
toward the middle finger (DAB for Dorsal = ABduct; PAD for Palmar = ADduct is the classic
mnemonic). The dorsal interossei abduct fingers away from the middle finger. Ulnar nerve injury
results in loss of interossei function, contributing to "ulnar claw" deformity and significant loss of
3
