NR 507 Advanced
Pathophysiology
Week 4 Midterm Exam
ACTUAL 2026
Question 1
A patient presents with an acute onset of severe joint pain, swelling, and erythema in the great toe.
Which of the following is the most likely underlying pathophysiologic mechanism?
A. Autoimmune destruction of synovial tissue
B. Deposition of monosodium urate crystals due to purine metabolism dysfunction
C. Degradation of articular cartilage by proteolytic enzymes
D. Immune complex deposition in the synovial membrane
,ANSWER: B. Gout is caused by hyperuricemia leading to monosodium urate crystal deposition in joints.
Option A is rheumatoid arthritis, C is osteoarthritis, D is associated with other inflammatory arthritides
like lupus.
Question 2
A 65-year-old male with a history of heavy alcohol use presents with ascites and jaundice. His serum AST
is 120 U/L, ALT is 80 U/L, with an AST/ALT ratio >1.5. Which stage of liver disease is most consistent with
these findings?
A. Acute viral hepatitis
B. Alcoholic steatohepatitis
C. Primary biliary cholangitis
D. Hepatocellular carcinoma
ANSWER: B. An AST/ALT ratio >1.5 is characteristic of alcoholic liver disease. The presentation with
ascites indicates advanced fibrosis or cirrhosis.
Question 3
In the pathophysiology of type 2 diabetes mellitus, which of the following is the primary defect
preceding hyperglycemia?
A. Autoimmune destruction of beta cells
B. Insulin resistance in peripheral tissues and inadequate compensatory insulin secretion
C. Defective proinsulin synthesis
D. Viral-induced pancreatic necrosis
ANSWER: B. Type 2 diabetes is characterized by insulin resistance (muscle, liver, fat) and relative insulin
deficiency (beta-cell dysfunction).
Question 4
A patient with chronic kidney disease has a glomerular filtration rate (GFR) of 25 mL/min. Which of the
following electrolyte imbalances is most expected?
A. Hypercalcemia
B. Hypophosphatemia
C. Hyperkalemia
D. Hyponatremia
ANSWER: C. As GFR falls below 30 mL/min, potassium excretion decreases, leading to hyperkalemia.
Hypercalcemia is rare in CKD; hypocalcemia is more common.
Question 5
, Which of the following best describes the pathophysiology of primary hypertension?
A. Sustained increase in systemic vascular resistance due to complex genetic and environmental factors
B. Isolated increase in cardiac output due to hyperthyroidism
C. Decreased renal perfusion leading to renin-angiotensin-aldosterone system activation
D. Autosomal dominant disorder of sodium channels in the collecting duct
ANSWER: A. Primary (essential) hypertension is multifactorial, involving genetics, endothelial
dysfunction, increased sympathetic tone, and altered sodium handling, resulting in increased systemic
vascular resistance.
Question 6
A 50-year-old female presents with fatigue, joint pain, and a butterfly rash on her face. Antinuclear
antibody (ANA) test is positive. The presence of anti-dsDNA antibodies would confirm which condition?
A. Rheumatoid arthritis
B. Scleroderma
C. Systemic lupus erythematosus (SLE)
D. Sjögren’s syndrome
ANSWER: C. Anti-dsDNA antibodies are highly specific for SLE. The butterfly rash and ANA positivity
further support the diagnosis.
Question 7
Which of the following is a hallmark of the irreversible stage of shock?
A. Increased cardiac output
B. Anaerobic metabolism with lactic acidosis leading to cellular death
C. Compensatory vasoconstriction
D. Activation of the renin-angiotensin-aldosterone system
ANSWER: B. In the irreversible stage, cellular injury is so severe that organ failure occurs, and survival is
not possible despite intervention. Lactic acidosis from anaerobic metabolism is profound.
Question 8
A patient with heart failure is administered a loop diuretic. What is the primary mechanism of action of
this drug class?
A. Inhibition of sodium-chloride symporter in the distal convoluted tubule
B. Antagonism of aldosterone in the collecting duct
C. Inhibition of the Na-K-2Cl transporter in the thick ascending loop of Henle
D. Osmotic retention of water in the proximal tubule
ANSWER: C. Loop diuretics (e.g., furosemide) inhibit the Na-K-2Cl cotransporter in the thick ascending
limb, causing profound diuresis.
Pathophysiology
Week 4 Midterm Exam
ACTUAL 2026
Question 1
A patient presents with an acute onset of severe joint pain, swelling, and erythema in the great toe.
Which of the following is the most likely underlying pathophysiologic mechanism?
A. Autoimmune destruction of synovial tissue
B. Deposition of monosodium urate crystals due to purine metabolism dysfunction
C. Degradation of articular cartilage by proteolytic enzymes
D. Immune complex deposition in the synovial membrane
,ANSWER: B. Gout is caused by hyperuricemia leading to monosodium urate crystal deposition in joints.
Option A is rheumatoid arthritis, C is osteoarthritis, D is associated with other inflammatory arthritides
like lupus.
Question 2
A 65-year-old male with a history of heavy alcohol use presents with ascites and jaundice. His serum AST
is 120 U/L, ALT is 80 U/L, with an AST/ALT ratio >1.5. Which stage of liver disease is most consistent with
these findings?
A. Acute viral hepatitis
B. Alcoholic steatohepatitis
C. Primary biliary cholangitis
D. Hepatocellular carcinoma
ANSWER: B. An AST/ALT ratio >1.5 is characteristic of alcoholic liver disease. The presentation with
ascites indicates advanced fibrosis or cirrhosis.
Question 3
In the pathophysiology of type 2 diabetes mellitus, which of the following is the primary defect
preceding hyperglycemia?
A. Autoimmune destruction of beta cells
B. Insulin resistance in peripheral tissues and inadequate compensatory insulin secretion
C. Defective proinsulin synthesis
D. Viral-induced pancreatic necrosis
ANSWER: B. Type 2 diabetes is characterized by insulin resistance (muscle, liver, fat) and relative insulin
deficiency (beta-cell dysfunction).
Question 4
A patient with chronic kidney disease has a glomerular filtration rate (GFR) of 25 mL/min. Which of the
following electrolyte imbalances is most expected?
A. Hypercalcemia
B. Hypophosphatemia
C. Hyperkalemia
D. Hyponatremia
ANSWER: C. As GFR falls below 30 mL/min, potassium excretion decreases, leading to hyperkalemia.
Hypercalcemia is rare in CKD; hypocalcemia is more common.
Question 5
, Which of the following best describes the pathophysiology of primary hypertension?
A. Sustained increase in systemic vascular resistance due to complex genetic and environmental factors
B. Isolated increase in cardiac output due to hyperthyroidism
C. Decreased renal perfusion leading to renin-angiotensin-aldosterone system activation
D. Autosomal dominant disorder of sodium channels in the collecting duct
ANSWER: A. Primary (essential) hypertension is multifactorial, involving genetics, endothelial
dysfunction, increased sympathetic tone, and altered sodium handling, resulting in increased systemic
vascular resistance.
Question 6
A 50-year-old female presents with fatigue, joint pain, and a butterfly rash on her face. Antinuclear
antibody (ANA) test is positive. The presence of anti-dsDNA antibodies would confirm which condition?
A. Rheumatoid arthritis
B. Scleroderma
C. Systemic lupus erythematosus (SLE)
D. Sjögren’s syndrome
ANSWER: C. Anti-dsDNA antibodies are highly specific for SLE. The butterfly rash and ANA positivity
further support the diagnosis.
Question 7
Which of the following is a hallmark of the irreversible stage of shock?
A. Increased cardiac output
B. Anaerobic metabolism with lactic acidosis leading to cellular death
C. Compensatory vasoconstriction
D. Activation of the renin-angiotensin-aldosterone system
ANSWER: B. In the irreversible stage, cellular injury is so severe that organ failure occurs, and survival is
not possible despite intervention. Lactic acidosis from anaerobic metabolism is profound.
Question 8
A patient with heart failure is administered a loop diuretic. What is the primary mechanism of action of
this drug class?
A. Inhibition of sodium-chloride symporter in the distal convoluted tubule
B. Antagonism of aldosterone in the collecting duct
C. Inhibition of the Na-K-2Cl transporter in the thick ascending loop of Henle
D. Osmotic retention of water in the proximal tubule
ANSWER: C. Loop diuretics (e.g., furosemide) inhibit the Na-K-2Cl cotransporter in the thick ascending
limb, causing profound diuresis.
