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NR507 MIDTERM EXAM 2026 ADVANCED
PATHOPHYSIOLOGY REVIEW CHAMBERLAIN
ACTUAL EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES GRADED A+ LATEST
1. A 52-year-old male presents with fatigue, weight loss, and easy bruising. Laboratory results
reveal anemia, thrombocytopenia, and an elevated white blood cell count with 30% blasts.
Which of the following is the most likely diagnosis?
A. Aplastic anemia
B. Acute myeloid leukemia (AML)
C. Multiple myeloma
D. Myelodysplastic syndrome
✔✔ Correct Answer✔✔B. Acute myeloid leukemia (AML)
Rationale: AML is characterized by proliferation of immature myeloid precursors (blasts) in the
bone marrow, leading to cytopenias (anemia, thrombocytopenia) and systemic symptoms.
Aplastic anemia presents with pancytopenia but no blasts. Multiple myeloma typically presents
with lytic bone lesions, hypercalcemia, and M-protein. Myelodysplastic syndrome also presents
with cytopenias and may progress to AML, but the presence of 30% blasts defines AML.
2. A patient with type 2 diabetes mellitus is started on metformin. Which of the following is
the primary mechanism of action of metformin?
A. Stimulates insulin secretion from pancreatic beta cells
B. Decreases hepatic gluconeogenesis and increases peripheral glucose uptake
C. Delays carbohydrate absorption in the intestine
D. Increases insulin sensitivity in adipose tissue only
✔✔ Correct Answer✔✔B. Decreases hepatic gluconeogenesis and increases peripheral
glucose uptake
Rationale: Metformin is a biguanide that primarily works by activating AMP-activated protein
kinase (AMPK), which reduces hepatic glucose production and enhances insulin-mediated
,2
glucose uptake in skeletal muscle. It does not stimulate insulin secretion (sulfonylureas do) nor
delay carbohydrate absorption (acarbose does).
3. Which of the following best describes the pathophysiology of type 1 diabetes mellitus?
A. Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
B. Peripheral insulin resistance with compensatory hyperinsulinemia
C. Decreased insulin receptor sensitivity in adipose and muscle tissue
D. Impaired glucose uptake due to defective GLUT-4 transporters
✔✔ Correct Answer✔✔A. Autoimmune destruction of pancreatic beta cells leading to
absolute insulin deficiency
Rationale: Type 1 diabetes is an autoimmune disorder in which T-cell-mediated destruction of
beta cells in the islets of Langerhans results in absolute insulin deficiency. Options B, C, and D
describe features of type 2 diabetes.
4. A 68-year-old female with a history of hypertension presents with a sudden onset of severe
headache, nausea, and vomiting. Blood pressure is 210/120 mm Hg. Which of the following is
the most likely diagnosis?
A. Migraine headache
B. Hypertensive emergency with possible posterior reversible encephalopathy syndrome (PRES)
C. Subarachnoid hemorrhage
D. Transient ischemic attack
✔✔ Correct Answer✔✔B. Hypertensive emergency with possible posterior reversible
encephalopathy syndrome (PRES)
Rationale: Extremely elevated blood pressure with neurological symptoms (headache, nausea,
vomiting) indicates hypertensive emergency. PRES can occur with severe hypertension due to
failure of cerebral autoregulation, leading to vasogenic edema. Subarachnoid hemorrhage
presents with thunderclap headache but is not always accompanied by such extreme
hypertension. Migraine is less likely with this BP.
5. A patient with chronic kidney disease develops metabolic acidosis. Which of the following
is the most likely cause?
A. Increased bicarbonate reabsorption
B. Decreased excretion of hydrogen ions and impaired bicarbonate regeneration
C. Increased renal excretion of ammonium
D. Respiratory alkalosis secondary to hypoxemia
,3
✔✔ Correct Answer✔✔B. Decreased excretion of hydrogen ions and impaired
bicarbonate regeneration
Rationale: In chronic kidney disease, the kidneys lose the ability to excrete hydrogen ions and
regenerate bicarbonate, leading to a non-anion gap metabolic acidosis (uremic acidosis).
Increased bicarbonate reabsorption would cause alkalosis, not acidosis. Ammonium excretion is
impaired, not increased.
6. Which of the following laboratory findings is most consistent with a diagnosis of primary
hyperparathyroidism?
A. Low serum calcium, high serum phosphorus, high PTH
B. High serum calcium, low serum phosphorus, high PTH
C. High serum calcium, high serum phosphorus, low PTH
D. Low serum calcium, low serum phosphorus, low PTH
✔✔ Correct Answer✔✔B. High serum calcium, low serum phosphorus, high PTH
Rationale: Primary hyperparathyroidism is characterized by excessive PTH secretion from a
parathyroid adenoma, leading to hypercalcemia and hypophosphatemia (due to phosphaturia).
Secondary hyperparathyroidism presents with low calcium, high phosphorus, and high PTH.
Tertiary hyperparathyroidism occurs in CKD.
7. A 30-year-old male presents with recurrent episodes of abdominal pain, diarrhea, and
weight loss. Colonoscopy reveals skip lesions and cobblestone mucosa. Which of the
following is the most likely diagnosis?
A. Ulcerative colitis
B. Crohn’s disease
C. Irritable bowel syndrome
D. Celiac disease
✔✔ Correct Answer✔✔B. Crohn’s disease
Rationale: Crohn’s disease is a transmural inflammatory bowel disease characterized by skip
lesions, cobblestoning, and granulomas. Ulcerative colitis is continuous, superficial, and limited
to the colon. IBS has no inflammatory findings on colonoscopy. Celiac disease affects the small
intestine and is not typically associated with skip lesions in the colon.
8. Which of the following best describes the pathophysiology of heart failure with preserved
ejection fraction (HFpEF)?
, 4
A. Decreased left ventricular contractility with reduced ejection fraction
B. Impaired ventricular relaxation and increased filling pressures with normal ejection fraction
C. Severe valvular regurgitation leading to volume overload
D. Reduced cardiac output due to bradyarrhythmias
✔✔ Correct Answer✔✔B. Impaired ventricular relaxation and increased filling pressures
with normal ejection fraction
Rationale: HFpEF (diastolic heart failure) is characterized by abnormal ventricular relaxation
and stiffness, leading to elevated filling pressures but preserved systolic function (EF ≥50%).
Option A describes HFrEF. Valvular disease and bradyarrhythmias are specific causes but not
the underlying pathophysiology.
9. A 45-year-old male with a history of alcohol use disorder presents with jaundice, ascites,
and asterixis. Laboratory studies show elevated AST and ALT with AST:ALT ratio >2. Which of
the following is the most likely diagnosis?
A. Acute viral hepatitis
B. Alcoholic hepatitis
C. Primary biliary cholangitis
D. Wilson’s disease
✔✔ Correct Answer✔✔B. Alcoholic hepatitis
Rationale: Alcoholic hepatitis is characterized by an AST:ALT ratio >2 (often >2.5), jaundice,
ascites, and hepatic encephalopathy (asterixis). Acute viral hepatitis typically has ALT > AST.
Primary biliary cholangitis presents with elevated alkaline phosphatase and anti-mitochondrial
antibodies. Wilson’s disease presents with Kayser-Fleischer rings and low ceruloplasmin.
10. Which of the following is a hallmark of malignant neoplasms?
A. Encapsulated growth with well-defined borders
B. Lack of cellular differentiation (anaplasia)
C. Slow, progressive growth
D. Absence of metastasis
✔✔ Correct Answer✔✔B. Lack of cellular differentiation (anaplasia)
Rationale: Malignant tumors are characterized by anaplasia (loss of differentiation), invasive
growth, and metastasis. Benign tumors are encapsulated, well-differentiated, and do not
metastasize. Slow growth is more typical of benign tumors.
NR507 MIDTERM EXAM 2026 ADVANCED
PATHOPHYSIOLOGY REVIEW CHAMBERLAIN
ACTUAL EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES GRADED A+ LATEST
1. A 52-year-old male presents with fatigue, weight loss, and easy bruising. Laboratory results
reveal anemia, thrombocytopenia, and an elevated white blood cell count with 30% blasts.
Which of the following is the most likely diagnosis?
A. Aplastic anemia
B. Acute myeloid leukemia (AML)
C. Multiple myeloma
D. Myelodysplastic syndrome
✔✔ Correct Answer✔✔B. Acute myeloid leukemia (AML)
Rationale: AML is characterized by proliferation of immature myeloid precursors (blasts) in the
bone marrow, leading to cytopenias (anemia, thrombocytopenia) and systemic symptoms.
Aplastic anemia presents with pancytopenia but no blasts. Multiple myeloma typically presents
with lytic bone lesions, hypercalcemia, and M-protein. Myelodysplastic syndrome also presents
with cytopenias and may progress to AML, but the presence of 30% blasts defines AML.
2. A patient with type 2 diabetes mellitus is started on metformin. Which of the following is
the primary mechanism of action of metformin?
A. Stimulates insulin secretion from pancreatic beta cells
B. Decreases hepatic gluconeogenesis and increases peripheral glucose uptake
C. Delays carbohydrate absorption in the intestine
D. Increases insulin sensitivity in adipose tissue only
✔✔ Correct Answer✔✔B. Decreases hepatic gluconeogenesis and increases peripheral
glucose uptake
Rationale: Metformin is a biguanide that primarily works by activating AMP-activated protein
kinase (AMPK), which reduces hepatic glucose production and enhances insulin-mediated
,2
glucose uptake in skeletal muscle. It does not stimulate insulin secretion (sulfonylureas do) nor
delay carbohydrate absorption (acarbose does).
3. Which of the following best describes the pathophysiology of type 1 diabetes mellitus?
A. Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
B. Peripheral insulin resistance with compensatory hyperinsulinemia
C. Decreased insulin receptor sensitivity in adipose and muscle tissue
D. Impaired glucose uptake due to defective GLUT-4 transporters
✔✔ Correct Answer✔✔A. Autoimmune destruction of pancreatic beta cells leading to
absolute insulin deficiency
Rationale: Type 1 diabetes is an autoimmune disorder in which T-cell-mediated destruction of
beta cells in the islets of Langerhans results in absolute insulin deficiency. Options B, C, and D
describe features of type 2 diabetes.
4. A 68-year-old female with a history of hypertension presents with a sudden onset of severe
headache, nausea, and vomiting. Blood pressure is 210/120 mm Hg. Which of the following is
the most likely diagnosis?
A. Migraine headache
B. Hypertensive emergency with possible posterior reversible encephalopathy syndrome (PRES)
C. Subarachnoid hemorrhage
D. Transient ischemic attack
✔✔ Correct Answer✔✔B. Hypertensive emergency with possible posterior reversible
encephalopathy syndrome (PRES)
Rationale: Extremely elevated blood pressure with neurological symptoms (headache, nausea,
vomiting) indicates hypertensive emergency. PRES can occur with severe hypertension due to
failure of cerebral autoregulation, leading to vasogenic edema. Subarachnoid hemorrhage
presents with thunderclap headache but is not always accompanied by such extreme
hypertension. Migraine is less likely with this BP.
5. A patient with chronic kidney disease develops metabolic acidosis. Which of the following
is the most likely cause?
A. Increased bicarbonate reabsorption
B. Decreased excretion of hydrogen ions and impaired bicarbonate regeneration
C. Increased renal excretion of ammonium
D. Respiratory alkalosis secondary to hypoxemia
,3
✔✔ Correct Answer✔✔B. Decreased excretion of hydrogen ions and impaired
bicarbonate regeneration
Rationale: In chronic kidney disease, the kidneys lose the ability to excrete hydrogen ions and
regenerate bicarbonate, leading to a non-anion gap metabolic acidosis (uremic acidosis).
Increased bicarbonate reabsorption would cause alkalosis, not acidosis. Ammonium excretion is
impaired, not increased.
6. Which of the following laboratory findings is most consistent with a diagnosis of primary
hyperparathyroidism?
A. Low serum calcium, high serum phosphorus, high PTH
B. High serum calcium, low serum phosphorus, high PTH
C. High serum calcium, high serum phosphorus, low PTH
D. Low serum calcium, low serum phosphorus, low PTH
✔✔ Correct Answer✔✔B. High serum calcium, low serum phosphorus, high PTH
Rationale: Primary hyperparathyroidism is characterized by excessive PTH secretion from a
parathyroid adenoma, leading to hypercalcemia and hypophosphatemia (due to phosphaturia).
Secondary hyperparathyroidism presents with low calcium, high phosphorus, and high PTH.
Tertiary hyperparathyroidism occurs in CKD.
7. A 30-year-old male presents with recurrent episodes of abdominal pain, diarrhea, and
weight loss. Colonoscopy reveals skip lesions and cobblestone mucosa. Which of the
following is the most likely diagnosis?
A. Ulcerative colitis
B. Crohn’s disease
C. Irritable bowel syndrome
D. Celiac disease
✔✔ Correct Answer✔✔B. Crohn’s disease
Rationale: Crohn’s disease is a transmural inflammatory bowel disease characterized by skip
lesions, cobblestoning, and granulomas. Ulcerative colitis is continuous, superficial, and limited
to the colon. IBS has no inflammatory findings on colonoscopy. Celiac disease affects the small
intestine and is not typically associated with skip lesions in the colon.
8. Which of the following best describes the pathophysiology of heart failure with preserved
ejection fraction (HFpEF)?
, 4
A. Decreased left ventricular contractility with reduced ejection fraction
B. Impaired ventricular relaxation and increased filling pressures with normal ejection fraction
C. Severe valvular regurgitation leading to volume overload
D. Reduced cardiac output due to bradyarrhythmias
✔✔ Correct Answer✔✔B. Impaired ventricular relaxation and increased filling pressures
with normal ejection fraction
Rationale: HFpEF (diastolic heart failure) is characterized by abnormal ventricular relaxation
and stiffness, leading to elevated filling pressures but preserved systolic function (EF ≥50%).
Option A describes HFrEF. Valvular disease and bradyarrhythmias are specific causes but not
the underlying pathophysiology.
9. A 45-year-old male with a history of alcohol use disorder presents with jaundice, ascites,
and asterixis. Laboratory studies show elevated AST and ALT with AST:ALT ratio >2. Which of
the following is the most likely diagnosis?
A. Acute viral hepatitis
B. Alcoholic hepatitis
C. Primary biliary cholangitis
D. Wilson’s disease
✔✔ Correct Answer✔✔B. Alcoholic hepatitis
Rationale: Alcoholic hepatitis is characterized by an AST:ALT ratio >2 (often >2.5), jaundice,
ascites, and hepatic encephalopathy (asterixis). Acute viral hepatitis typically has ALT > AST.
Primary biliary cholangitis presents with elevated alkaline phosphatase and anti-mitochondrial
antibodies. Wilson’s disease presents with Kayser-Fleischer rings and low ceruloplasmin.
10. Which of the following is a hallmark of malignant neoplasms?
A. Encapsulated growth with well-defined borders
B. Lack of cellular differentiation (anaplasia)
C. Slow, progressive growth
D. Absence of metastasis
✔✔ Correct Answer✔✔B. Lack of cellular differentiation (anaplasia)
Rationale: Malignant tumors are characterized by anaplasia (loss of differentiation), invasive
growth, and metastasis. Benign tumors are encapsulated, well-differentiated, and do not
metastasize. Slow growth is more typical of benign tumors.
