Exam 3: NURS 5315 (Latest 2025/2026
Update) Advanced Pathophysiology
Questions with Verified Answers | 100%
Correct |Graded A- UTA.
1. A patient with chronic venous insufficiency develops a non-healing ulcer on
the medial malleolus. Histological examination shows abundant granulation
tissue with newly formed capillaries, but endothelial cells exhibit abnormal
pericyte coverage and increased VEGF expression. Which best explains the
impaired healing?
A. Excessive collagen deposition from TGF-β overactivity
B. Impaired angiogenesis from reduced HIF-1α stabilization
C. Defective maturation of new vessels leading to increased permeability and
edema
D. Overexpression of MMPs causing basement membrane destruction
Correct Answer: C
Rationale: In chronic venous insufficiency, venous hypertension leads to persistent
edema. Newly formed capillaries lack adequate pericyte coverage, resulting in
leaky vessels that perpetuate edema and impair healing. VEGF is elevated, but
vessels are immature and dysfunctional .
2. A researcher studies mitochondrial permeability transition pore (mPTP) in
ischemia-reperfusion injury. Cyclosporin A (an mPTP inhibitor) reduces cell
,death in early ischemia but loses protective effect after 60 minutes of
prolonged ischemia. Which best explains this observation?
A. Cyclosporin A becomes cytotoxic after prolonged hypoxia
B. Prolonged ischemia leads to irreversible mPTP opening and cytochrome c
release, independent of cyclosporin A
C. Cyclosporin A inhibits calcineurin, required for protective autophagy
D. The mPTP closes spontaneously after 60 minutes
Correct Answer: B
Rationale: During ischemia-reperfusion, mPTP opening leads to mitochondrial
dysfunction and cell death. Cyclosporin A inhibits mPTP opening and is protective
when administered early. However, after prolonged ischemia, mPTP opens
irreversibly, leading to cytochrome c release and apoptosis that cannot be
reversed by mPTP inhibition .
3. A 45-year-old with hypertension and type 2 diabetes presents with sudden
right flank pain radiating to the groin. Urinalysis shows hematuria and pH
6.5. CT reveals a 5 mm calculus in the proximal ureter composed of calcium
oxalate monohydrate. Which urinary abnormality most likely contributes to
stone formation?
A. Low urinary citrate concentration
B. High urinary magnesium concentration
C. High urinary pH above 7.0
D. Low urinary uric acid concentration
Correct Answer: A
,Rationale: Calcium oxalate stones form when urine is supersaturated with calcium
and oxalate. Citrate is a natural inhibitor of stone formation because it binds
calcium, reducing supersaturation. Low urinary citrate (hypocitraturia) is a
common risk factor, especially in patients with metabolic acidosis from diabetes or
hypertension .
4. A 60-year-old with a 30-pack-year smoking history presents with
hemoptysis and weight loss. CT shows a 3 cm mass in the right upper lobe.
Biopsy reveals small cell lung carcinoma. Genetic analysis shows RB1
mutation and loss of heterozygosity on chromosome 3p. Which additional
molecular alteration is most likely present?
A. EGFR activating mutation
B. ALK gene rearrangement
C. MYC amplification
D. KRAS mutation
Correct Answer: C
*Rationale: Small cell lung carcinoma (SCLC) is strongly associated with RB1
loss and 3p deletion. MYC amplification is a common event in SCLC, contributing
to its aggressive growth. EGFR mutations and ALK rearrangements are typical of
non-small cell lung cancer (NSCLC), especially adenocarcinoma .*
5. In decompensated cirrhosis with ascites, which pathophysiological
mechanism best explains the development of hyponatremia?
, A. Increased renal sodium excretion from elevated ANP due to portal hypertension
B. Impaired renal water excretion from non-osmotic AVP release due to reduced
effective arterial blood volume
C. Primary adrenal insufficiency causing decreased aldosterone secretion
D. Excessive sodium loss in ascitic fluid from increased peritoneal permeability
Correct Answer: B
Rationale: In cirrhosis, splanchnic vasodilation reduces effective arterial blood
volume, stimulating non-osmotic arginine vasopressin (AVP) release via
baroreceptors. AVP increases water reabsorption in the collecting duct, leading to
dilutional hyponatremia .
6. A 45-year-old with recurrent calcium oxalate kidney stones has
hypercalciuria. Which renal transport abnormality most likely contributes to
stone formation?
A. Decreased expression of NHE3 in the proximal tubule
B. Increased activity of ROMK in the thick ascending limb
C. Increased expression of CaSR in the thick ascending limb leading to reduced
paracellular calcium reabsorption
D. Increased activity of NKCC2 in the thick ascending limb
Correct Answer: C
Rationale: Hypercalciuria in idiopathic calcium stone formers is often due to
increased calcium-sensing receptor (CaSR) activation in the thick ascending limb,
which inhibits paracellular calcium reabsorption, leading to more calcium in the
urine .
Update) Advanced Pathophysiology
Questions with Verified Answers | 100%
Correct |Graded A- UTA.
1. A patient with chronic venous insufficiency develops a non-healing ulcer on
the medial malleolus. Histological examination shows abundant granulation
tissue with newly formed capillaries, but endothelial cells exhibit abnormal
pericyte coverage and increased VEGF expression. Which best explains the
impaired healing?
A. Excessive collagen deposition from TGF-β overactivity
B. Impaired angiogenesis from reduced HIF-1α stabilization
C. Defective maturation of new vessels leading to increased permeability and
edema
D. Overexpression of MMPs causing basement membrane destruction
Correct Answer: C
Rationale: In chronic venous insufficiency, venous hypertension leads to persistent
edema. Newly formed capillaries lack adequate pericyte coverage, resulting in
leaky vessels that perpetuate edema and impair healing. VEGF is elevated, but
vessels are immature and dysfunctional .
2. A researcher studies mitochondrial permeability transition pore (mPTP) in
ischemia-reperfusion injury. Cyclosporin A (an mPTP inhibitor) reduces cell
,death in early ischemia but loses protective effect after 60 minutes of
prolonged ischemia. Which best explains this observation?
A. Cyclosporin A becomes cytotoxic after prolonged hypoxia
B. Prolonged ischemia leads to irreversible mPTP opening and cytochrome c
release, independent of cyclosporin A
C. Cyclosporin A inhibits calcineurin, required for protective autophagy
D. The mPTP closes spontaneously after 60 minutes
Correct Answer: B
Rationale: During ischemia-reperfusion, mPTP opening leads to mitochondrial
dysfunction and cell death. Cyclosporin A inhibits mPTP opening and is protective
when administered early. However, after prolonged ischemia, mPTP opens
irreversibly, leading to cytochrome c release and apoptosis that cannot be
reversed by mPTP inhibition .
3. A 45-year-old with hypertension and type 2 diabetes presents with sudden
right flank pain radiating to the groin. Urinalysis shows hematuria and pH
6.5. CT reveals a 5 mm calculus in the proximal ureter composed of calcium
oxalate monohydrate. Which urinary abnormality most likely contributes to
stone formation?
A. Low urinary citrate concentration
B. High urinary magnesium concentration
C. High urinary pH above 7.0
D. Low urinary uric acid concentration
Correct Answer: A
,Rationale: Calcium oxalate stones form when urine is supersaturated with calcium
and oxalate. Citrate is a natural inhibitor of stone formation because it binds
calcium, reducing supersaturation. Low urinary citrate (hypocitraturia) is a
common risk factor, especially in patients with metabolic acidosis from diabetes or
hypertension .
4. A 60-year-old with a 30-pack-year smoking history presents with
hemoptysis and weight loss. CT shows a 3 cm mass in the right upper lobe.
Biopsy reveals small cell lung carcinoma. Genetic analysis shows RB1
mutation and loss of heterozygosity on chromosome 3p. Which additional
molecular alteration is most likely present?
A. EGFR activating mutation
B. ALK gene rearrangement
C. MYC amplification
D. KRAS mutation
Correct Answer: C
*Rationale: Small cell lung carcinoma (SCLC) is strongly associated with RB1
loss and 3p deletion. MYC amplification is a common event in SCLC, contributing
to its aggressive growth. EGFR mutations and ALK rearrangements are typical of
non-small cell lung cancer (NSCLC), especially adenocarcinoma .*
5. In decompensated cirrhosis with ascites, which pathophysiological
mechanism best explains the development of hyponatremia?
, A. Increased renal sodium excretion from elevated ANP due to portal hypertension
B. Impaired renal water excretion from non-osmotic AVP release due to reduced
effective arterial blood volume
C. Primary adrenal insufficiency causing decreased aldosterone secretion
D. Excessive sodium loss in ascitic fluid from increased peritoneal permeability
Correct Answer: B
Rationale: In cirrhosis, splanchnic vasodilation reduces effective arterial blood
volume, stimulating non-osmotic arginine vasopressin (AVP) release via
baroreceptors. AVP increases water reabsorption in the collecting duct, leading to
dilutional hyponatremia .
6. A 45-year-old with recurrent calcium oxalate kidney stones has
hypercalciuria. Which renal transport abnormality most likely contributes to
stone formation?
A. Decreased expression of NHE3 in the proximal tubule
B. Increased activity of ROMK in the thick ascending limb
C. Increased expression of CaSR in the thick ascending limb leading to reduced
paracellular calcium reabsorption
D. Increased activity of NKCC2 in the thick ascending limb
Correct Answer: C
Rationale: Hypercalciuria in idiopathic calcium stone formers is often due to
increased calcium-sensing receptor (CaSR) activation in the thick ascending limb,
which inhibits paracellular calcium reabsorption, leading to more calcium in the
urine .
