NR507 MIDTERM EXAM 2026 ADVANCED
PATHOPHYSIOLOGY EXAM QUESTIONS
AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 62-year-old male presents with fatigue, weight loss, and a persistent
cough. Imaging reveals a mass in the right lung. Biopsy shows malignant cells
producing parathyroid hormone-related peptide (PTHrP). Which paraneoplastic
syndrome is most likely present?
A. SIADH
B. Hypercalcemia
C. Cushing syndrome
D. Lambert-Eaton syndrome
Answer: B
Rationale: PTHrP secretion causes increased bone resorption and
hypercalcemia. SIADH is associated with ectopic ADH secretion (often small
cell lung cancer). Cushing syndrome results from ectopic ACTH production.
Lambert-Eaton is associated with neuromuscular weakness due to
autoantibodies affecting presynaptic calcium channels.
1|Page
,2. A patient has chronic GERD. Which cellular adaptation is most likely to occur in the
lower esophagus?
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Hyperplasia
Answer: B
Rationale: Chronic acid exposure leads to replacement of squamous epithelium with
columnar epithelium (Barrett esophagus), a classic example of metaplasia.
3. A 35-year-old woman presents with sudden onset of shortness of breath and
pleuritic chest pain. She has a history of deep vein thrombosis. Which
pathophysiologic mechanism best explains her symptoms?
A. Bronchoconstriction due to mast cell activation
B. Alveolar collapse due to surfactant deficiency
C. Pulmonary vascular obstruction leading to V/Q mismatch
D. Infection causing inflammation of the pleura
Answer: C
Rationale: Pulmonary embolism causes obstruction of pulmonary arteries, resulting in
impaired perfusion of ventilated alveoli, causing a ventilation- perfusion (V/Q)
mismatch and hypoxemia.
4. A patient with untreated type 1 diabetes presents with nausea, abdominal pain,
fruity breath, and Kussmaul respirations. Which acid-base disturbance is most likely?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
2|Page
,Answer: D
Rationale: DKA causes increased ketone production, leading to metabolic acidosis.
Kussmaul respirations are a compensatory response.
5. A 48-year-old male presents with severe abdominal pain radiating to the back,
elevated serum amylase and lipase, and a history of alcohol abuse. Which mechanism
is responsible for his condition?
A. Autoimmune destruction of pancreatic beta cells
B. Activation of pancreatic enzymes within the pancreas
C. Obstruction of the common bile duct
D. Viral infection of pancreatic tissue
Answer: B
Rationale: Acute pancreatitis is caused by premature activation of pancreatic enzymes,
leading to autodigestion and inflammation.
6. A patient develops sudden right-sided weakness and aphasia. CT scan reveals an
ischemic stroke in the left middle cerebral artery territory. Which mechanism best
explains the neurologic deficits?
A. Increased intracranial pressure
B. Ischemia leading to neuronal death
C. Demyelination of motor neurons
D. Autoimmune destruction of synapses
Answer: B
Rationale: Ischemic stroke causes decreased blood flow, leading to oxygen deprivation,
ATP depletion, and neuronal cell death.
3|Page
, 7. A patient with chronic kidney disease develops anemia. Which mechanism best
explains the anemia?
A. Reduced erythropoietin production
B. Increased hemolysis
C. Iron overload
D. Increased platelet destruction
Answer: A
Rationale: Kidneys produce erythropoietin; chronic kidney disease reduces
erythropoietin, leading to decreased RBC production and anemia.
8. A 27-year-old woman presents with fatigue, cold intolerance, constipation, and
weight gain. Lab results show elevated TSH and low T4. What is the most likely
diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Addison disease
Answer: B
Rationale: Elevated TSH with low T4 indicates primary hypothyroidism.
9. A patient presents with chronic inflammation and tissue remodeling in the airways,
leading to airflow obstruction and hyperresponsiveness. Which disease process is
most consistent with these findings?
A. COPD
B. Asthma
C. Pulmonary fibrosis
D. Bronchiectasis
Answer: B
Rationale: Asthma is characterized by chronic airway inflammation, hyperresponsiveness,
and reversible airflow obstruction.
4|Page
PATHOPHYSIOLOGY EXAM QUESTIONS
AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST
1. A 62-year-old male presents with fatigue, weight loss, and a persistent
cough. Imaging reveals a mass in the right lung. Biopsy shows malignant cells
producing parathyroid hormone-related peptide (PTHrP). Which paraneoplastic
syndrome is most likely present?
A. SIADH
B. Hypercalcemia
C. Cushing syndrome
D. Lambert-Eaton syndrome
Answer: B
Rationale: PTHrP secretion causes increased bone resorption and
hypercalcemia. SIADH is associated with ectopic ADH secretion (often small
cell lung cancer). Cushing syndrome results from ectopic ACTH production.
Lambert-Eaton is associated with neuromuscular weakness due to
autoantibodies affecting presynaptic calcium channels.
1|Page
,2. A patient has chronic GERD. Which cellular adaptation is most likely to occur in the
lower esophagus?
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Hyperplasia
Answer: B
Rationale: Chronic acid exposure leads to replacement of squamous epithelium with
columnar epithelium (Barrett esophagus), a classic example of metaplasia.
3. A 35-year-old woman presents with sudden onset of shortness of breath and
pleuritic chest pain. She has a history of deep vein thrombosis. Which
pathophysiologic mechanism best explains her symptoms?
A. Bronchoconstriction due to mast cell activation
B. Alveolar collapse due to surfactant deficiency
C. Pulmonary vascular obstruction leading to V/Q mismatch
D. Infection causing inflammation of the pleura
Answer: C
Rationale: Pulmonary embolism causes obstruction of pulmonary arteries, resulting in
impaired perfusion of ventilated alveoli, causing a ventilation- perfusion (V/Q)
mismatch and hypoxemia.
4. A patient with untreated type 1 diabetes presents with nausea, abdominal pain,
fruity breath, and Kussmaul respirations. Which acid-base disturbance is most likely?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
2|Page
,Answer: D
Rationale: DKA causes increased ketone production, leading to metabolic acidosis.
Kussmaul respirations are a compensatory response.
5. A 48-year-old male presents with severe abdominal pain radiating to the back,
elevated serum amylase and lipase, and a history of alcohol abuse. Which mechanism
is responsible for his condition?
A. Autoimmune destruction of pancreatic beta cells
B. Activation of pancreatic enzymes within the pancreas
C. Obstruction of the common bile duct
D. Viral infection of pancreatic tissue
Answer: B
Rationale: Acute pancreatitis is caused by premature activation of pancreatic enzymes,
leading to autodigestion and inflammation.
6. A patient develops sudden right-sided weakness and aphasia. CT scan reveals an
ischemic stroke in the left middle cerebral artery territory. Which mechanism best
explains the neurologic deficits?
A. Increased intracranial pressure
B. Ischemia leading to neuronal death
C. Demyelination of motor neurons
D. Autoimmune destruction of synapses
Answer: B
Rationale: Ischemic stroke causes decreased blood flow, leading to oxygen deprivation,
ATP depletion, and neuronal cell death.
3|Page
, 7. A patient with chronic kidney disease develops anemia. Which mechanism best
explains the anemia?
A. Reduced erythropoietin production
B. Increased hemolysis
C. Iron overload
D. Increased platelet destruction
Answer: A
Rationale: Kidneys produce erythropoietin; chronic kidney disease reduces
erythropoietin, leading to decreased RBC production and anemia.
8. A 27-year-old woman presents with fatigue, cold intolerance, constipation, and
weight gain. Lab results show elevated TSH and low T4. What is the most likely
diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Addison disease
Answer: B
Rationale: Elevated TSH with low T4 indicates primary hypothyroidism.
9. A patient presents with chronic inflammation and tissue remodeling in the airways,
leading to airflow obstruction and hyperresponsiveness. Which disease process is
most consistent with these findings?
A. COPD
B. Asthma
C. Pulmonary fibrosis
D. Bronchiectasis
Answer: B
Rationale: Asthma is characterized by chronic airway inflammation, hyperresponsiveness,
and reversible airflow obstruction.
4|Page
