NSG 530 ACTUAL EXAM 2026/2027 | Advanced Pathophysiology –
Wilkes University | Exams 1-4 Comprehensive Test Bank | 100% Verified
Q&A with Detailed Rationales | Pass Guaranteed - A+ Graded
EXAM 1: CELLULAR FOUNDATIONS, FLUIDS AND GENETICS
Section 1. Cellular Adaptation, Injury, and Death
1. A 58-year-old with chronic alcoholism presents with painful swelling of the right knee after minimal trauma.
Aspiration reveals negatively birefringent crystals. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Pseudogout
D) Gout
Answer: C Calcium pyrophosphate crystals (pseudogout) are negatively birefringent under polarized light; gout
shows positively birefringent urate crystals.
2. A patient with heart failure develops worsening dyspnea and crackles in all lung fields. Jugular veins are
distended. Which pathophysiologic mechanism is dominant?
A) Decreased cardiac output
B) Increased afterload
C) Increased pulmonary capillary hydrostatic pressure
D) Reduced plasma oncotic pressure
Answer: C Left-sided heart failure raises pulmonary venous pressure, increasing hydrostatic pressure and
causing pulmonary edema.
3. A 72-year-old with hypertension reports episodes of unilateral vision loss lasting 10 minutes. Carotid ultrasound
shows 80% stenosis. This symptom is best termed:
A) Amaurosis fugax
Page | 1 SUCCESS!!!
,B) Retinal migraine
C) Optic neuritis
D) Transient global amnesia
Answer: A Amaurosis fugax is transient monocular vision loss from retinal ischemia due to carotid
emboli/stenosis.
4. A child with recurrent sinopulmonary infections and low IgG, IgA, and IgM but normal B-cell count likely has:
A) Selective IgA deficiency
B) X-linked agammaglobulinemia
C) Common variable immunodeficiency
D) DiGeorge syndrome
Answer: C Common variable immunodeficiency presents with low all major immunoglobulins, recurrent
infections, and normal B cells.
5. A 45-year-old female has fatigue, proximal muscle weakness, and a heliotrope rash. Serum aldolase and CK are
elevated. What autoantibody is most specific?
A) Anti-Jo-1
B) Anti-dsDNA
C) Anti-Scl-70
D) Anti-Ro
Answer: A Anti-Jo-1 is associated with dermatomyositis/polymyositis, especially when interstitial lung disease is
present.
6. A patient with cirrhosis develops asterixis and confusion. Ammonia level is 180 µmol/L. The primary mechanism
of neurological dysfunction involves:
A) Accumulation of manganese
Page | 2 SUCCESS!!!
,B) Direct neurotoxicity of ammonia
C) Hepatic encephalopathy from GABAergic activation
D) Increased aromatic amino acids
Answer: B Ammonia crosses blood-brain barrier, causing astrocyte swelling and impaired neurotransmission
leading to encephalopathy.
7. A 60-year-old smoker has slowly worsening exertional dyspnea, prolonged expiration, and hyperresonance to
percussion. Spirometry shows FEV1/FVC 0.65. Most likely pathology:
A) Alveolar fibrosis
B) Destruction of alveolar walls without fibrosis
C) Thickened basement membranes
D) Granulomatous inflammation
Answer: B Emphysema causes irreversible loss of alveolar septa without fibrosis, reducing elastic recoil and gas
exchange.
8. A 30-year-old presents with episodic headache, palpitations, and profuse sweating. BP 210/110 mmHg. MRI
shows a 4-cm adrenal mass. Urine metanephrines are elevated. This tumor most likely arises from:
A) Adrenal cortex zona glomerulosa
B) Adrenal cortex zona fasciculata
C) Adrenal medulla chromaffin cells
D) Extra-adrenal paraganglia
Answer: C Pheochromocytoma originates from chromaffin cells of adrenal medulla, releasing catecholamines
episodically.
9. A newborn with respiratory distress, poor feeding, and a scaphoid abdomen. Chest X-ray shows left-sided
mediastinal shift with bowel loops in the chest. Most likely diagnosis:
Page | 3 SUCCESS!!!
, A) Congenital diaphragmatic hernia
B) Eventration of diaphragm
C) Esophageal atresia
D) Congenital pulmonary airway malformation
Answer: A Bochdalek hernia (posterolateral defect) allows abdominal contents into thorax, causing mediastinal
shift and respiratory distress.
10. A 24-year-old male develops severe abdominal pain after a heavy meal. Serum lipase is 1200 U/L. CT shows
pancreatic necrosis. A common genetic risk factor involves:
A) CFTR mutation
B) PRSS1 mutation
C) SPINK1 mutation
D) HFE mutation
Answer: B PRSS1 (cationic trypsinogen) mutation causes hereditary pancreatitis via premature trypsin activation
within the pancreas.
11. A 55-year-old with type 2 diabetes has a non-healing ulcer over the first metatarsal head. No palpable pedal
pulses. ABI is 0.4. The primary cause of impaired healing is:
A) Venous insufficiency
B) Peripheral arterial disease
C) Sensory neuropathy
D) Autonomic dysfunction
Answer: B ABI <0.9 indicates peripheral artery disease; 0.4 suggests severe ischemia, impairing oxygen delivery
and wound healing.
Page | 4 SUCCESS!!!
Wilkes University | Exams 1-4 Comprehensive Test Bank | 100% Verified
Q&A with Detailed Rationales | Pass Guaranteed - A+ Graded
EXAM 1: CELLULAR FOUNDATIONS, FLUIDS AND GENETICS
Section 1. Cellular Adaptation, Injury, and Death
1. A 58-year-old with chronic alcoholism presents with painful swelling of the right knee after minimal trauma.
Aspiration reveals negatively birefringent crystals. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Pseudogout
D) Gout
Answer: C Calcium pyrophosphate crystals (pseudogout) are negatively birefringent under polarized light; gout
shows positively birefringent urate crystals.
2. A patient with heart failure develops worsening dyspnea and crackles in all lung fields. Jugular veins are
distended. Which pathophysiologic mechanism is dominant?
A) Decreased cardiac output
B) Increased afterload
C) Increased pulmonary capillary hydrostatic pressure
D) Reduced plasma oncotic pressure
Answer: C Left-sided heart failure raises pulmonary venous pressure, increasing hydrostatic pressure and
causing pulmonary edema.
3. A 72-year-old with hypertension reports episodes of unilateral vision loss lasting 10 minutes. Carotid ultrasound
shows 80% stenosis. This symptom is best termed:
A) Amaurosis fugax
Page | 1 SUCCESS!!!
,B) Retinal migraine
C) Optic neuritis
D) Transient global amnesia
Answer: A Amaurosis fugax is transient monocular vision loss from retinal ischemia due to carotid
emboli/stenosis.
4. A child with recurrent sinopulmonary infections and low IgG, IgA, and IgM but normal B-cell count likely has:
A) Selective IgA deficiency
B) X-linked agammaglobulinemia
C) Common variable immunodeficiency
D) DiGeorge syndrome
Answer: C Common variable immunodeficiency presents with low all major immunoglobulins, recurrent
infections, and normal B cells.
5. A 45-year-old female has fatigue, proximal muscle weakness, and a heliotrope rash. Serum aldolase and CK are
elevated. What autoantibody is most specific?
A) Anti-Jo-1
B) Anti-dsDNA
C) Anti-Scl-70
D) Anti-Ro
Answer: A Anti-Jo-1 is associated with dermatomyositis/polymyositis, especially when interstitial lung disease is
present.
6. A patient with cirrhosis develops asterixis and confusion. Ammonia level is 180 µmol/L. The primary mechanism
of neurological dysfunction involves:
A) Accumulation of manganese
Page | 2 SUCCESS!!!
,B) Direct neurotoxicity of ammonia
C) Hepatic encephalopathy from GABAergic activation
D) Increased aromatic amino acids
Answer: B Ammonia crosses blood-brain barrier, causing astrocyte swelling and impaired neurotransmission
leading to encephalopathy.
7. A 60-year-old smoker has slowly worsening exertional dyspnea, prolonged expiration, and hyperresonance to
percussion. Spirometry shows FEV1/FVC 0.65. Most likely pathology:
A) Alveolar fibrosis
B) Destruction of alveolar walls without fibrosis
C) Thickened basement membranes
D) Granulomatous inflammation
Answer: B Emphysema causes irreversible loss of alveolar septa without fibrosis, reducing elastic recoil and gas
exchange.
8. A 30-year-old presents with episodic headache, palpitations, and profuse sweating. BP 210/110 mmHg. MRI
shows a 4-cm adrenal mass. Urine metanephrines are elevated. This tumor most likely arises from:
A) Adrenal cortex zona glomerulosa
B) Adrenal cortex zona fasciculata
C) Adrenal medulla chromaffin cells
D) Extra-adrenal paraganglia
Answer: C Pheochromocytoma originates from chromaffin cells of adrenal medulla, releasing catecholamines
episodically.
9. A newborn with respiratory distress, poor feeding, and a scaphoid abdomen. Chest X-ray shows left-sided
mediastinal shift with bowel loops in the chest. Most likely diagnosis:
Page | 3 SUCCESS!!!
, A) Congenital diaphragmatic hernia
B) Eventration of diaphragm
C) Esophageal atresia
D) Congenital pulmonary airway malformation
Answer: A Bochdalek hernia (posterolateral defect) allows abdominal contents into thorax, causing mediastinal
shift and respiratory distress.
10. A 24-year-old male develops severe abdominal pain after a heavy meal. Serum lipase is 1200 U/L. CT shows
pancreatic necrosis. A common genetic risk factor involves:
A) CFTR mutation
B) PRSS1 mutation
C) SPINK1 mutation
D) HFE mutation
Answer: B PRSS1 (cationic trypsinogen) mutation causes hereditary pancreatitis via premature trypsin activation
within the pancreas.
11. A 55-year-old with type 2 diabetes has a non-healing ulcer over the first metatarsal head. No palpable pedal
pulses. ABI is 0.4. The primary cause of impaired healing is:
A) Venous insufficiency
B) Peripheral arterial disease
C) Sensory neuropathy
D) Autonomic dysfunction
Answer: B ABI <0.9 indicates peripheral artery disease; 0.4 suggests severe ischemia, impairing oxygen delivery
and wound healing.
Page | 4 SUCCESS!!!
