NR 546 Advanced Pathophysiology Midterm & Final Exam Review |
Complete Question Bank questions and detailed answers 2026/2027
Question 1 Which primary cellular event occurs first during severe,
acute hypoxia leading to reversible cellular injury?
• A. Activation of lysosomal enzymes and cellular autodigestion.
• B. Depletion of intracellular ATP due to cessation of oxidative
phosphorylation.
• C. Massive influx of extracellular calcium ions through ruptured
membranes.
• D. Complete structural fragmentation of nuclear chromatin
(karyorrhexis).
Correct Answer: B. Depletion of intracellular ATP due to cessation of
oxidative phosphorylation.
Detailed Rationale: Hypoxia halts mitochondrial aerobic respiration,
abruptly cutting off ATP production. This energy failure disrupts the
Na+/K+ ATPase pump, triggering early cellular and organelle swelling.
Question 2 Which histological type of necrosis is uniquely characteristic
of tuberculosis infections within the lung parenchyma?
• A. Coagulative necrosis
• B. Liquefactive necrosis
• C. Caseous necrosis
• D. Fat necrosis
,Correct Answer: C. Caseous necrosis
Detailed Rationale: Caseous necrosis ("cheese-like") is a distinct form of
cell death combining features of coagulative and liquefactive necrosis,
typically seen in granulomatous inflammation caused by
Mycobacterium tuberculosis.
Question 3 During the cellular phase of acute inflammation, what
process directs leukocytes from the central blood stream toward the
vascular endothelial wall?
• A. Margination
• B. Diapedesis
• C. Opsonization
• D. Phagocytosis
Correct Answer: A. Margination
Detailed Rationale: As fluid leaves the capillaries during inflammation,
blood viscosity increases and blood flow slows, causing white blood
cells to move from the center of the lumen toward the endothelial
lining (margination).
Question 4 What is the characteristic recurrence risk for offspring when
both parents are carriers of an autosomal recessive genetic disorder?
• A. 0% chance of being affected, 50% chance of being carriers.
• B. 25% chance of being affected, 50% chance of being carriers,
25% chance of being completely unaffected.
• C. 50% chance of being affected and showing severe clinical
manifestations.
, • D. 100% chance of inheriting the mutated allele configuration.
Correct Answer: B. 25% chance of being affected, 50% chance of being
carriers, 25% chance of being completely unaffected.
Detailed Rationale: In autosomal recessive inheritance, two carrier
parents (heterozygotes) each have a 50% chance of passing the
defective allele, yielding a 25% statistical probability per pregnancy for
an affected child.
Question 5 An excess accumulation of fluid within the interstitial
spaces, characterized by pitting upon physical examination, is primarily
driven by:
• A. Decreased capillary hydrostatic pressure combined with
lymphatic obstruction.
• B. Increased capillary hydrostatic pressure or decreased plasma
oncotic pressure.
• C. Massive intracellular potassium shift into the extracellular fluid
matrix.
• D. Elevated serum sodium excretion paired with direct renal
tubular failure.
Correct Answer: B. Increased capillary hydrostatic pressure or
decreased plasma oncotic pressure.
Detailed Rationale: Edema formation stems from Starling forces
favoring fluid filtration out of capillaries into the interstitium, typically
driven by high hydrostatic pressure (e.g., heart failure) or low oncotic
pressure (e.g., hypoalbuminemia).
, Question 6 What compensatory mechanism is initially activated by the
sympathetic nervous system in response to acute heart failure?
• A. Vasodilation of peripheral arterioles and profound diuresis.
• B. Increased heart rate and myocardial contractility to maintain
cardiac output.
• C. Complete suppression of antidiuretic hormone release from the
posterior pituitary.
• D. Immediate reduction of renal renin secretion.
Correct Answer: B. Increased heart rate and myocardial contractility to
maintain cardiac output.
Detailed Rationale: When cardiac output drops, baroreceptors trigger
sympathetic activation, increasing heart rate and contractility to
preserve tissue perfusion, though chronic activation eventually worsens
myocardial workload.
Question 7 What is the primary pathophysiological hallmark of Acute
Respiratory Distress Syndrome (ARDS)?
• A. Permanent overinflation and destruction of terminal
bronchioles due to elastase excess.
• B. Increased permeability of the alveolar-capillary membrane
leading to non-cardiogenic pulmonary edema and hyaline
membrane formation.
• C. Primary bronchospasm mediated by massive IgE mast cell
degranulation.
Complete Question Bank questions and detailed answers 2026/2027
Question 1 Which primary cellular event occurs first during severe,
acute hypoxia leading to reversible cellular injury?
• A. Activation of lysosomal enzymes and cellular autodigestion.
• B. Depletion of intracellular ATP due to cessation of oxidative
phosphorylation.
• C. Massive influx of extracellular calcium ions through ruptured
membranes.
• D. Complete structural fragmentation of nuclear chromatin
(karyorrhexis).
Correct Answer: B. Depletion of intracellular ATP due to cessation of
oxidative phosphorylation.
Detailed Rationale: Hypoxia halts mitochondrial aerobic respiration,
abruptly cutting off ATP production. This energy failure disrupts the
Na+/K+ ATPase pump, triggering early cellular and organelle swelling.
Question 2 Which histological type of necrosis is uniquely characteristic
of tuberculosis infections within the lung parenchyma?
• A. Coagulative necrosis
• B. Liquefactive necrosis
• C. Caseous necrosis
• D. Fat necrosis
,Correct Answer: C. Caseous necrosis
Detailed Rationale: Caseous necrosis ("cheese-like") is a distinct form of
cell death combining features of coagulative and liquefactive necrosis,
typically seen in granulomatous inflammation caused by
Mycobacterium tuberculosis.
Question 3 During the cellular phase of acute inflammation, what
process directs leukocytes from the central blood stream toward the
vascular endothelial wall?
• A. Margination
• B. Diapedesis
• C. Opsonization
• D. Phagocytosis
Correct Answer: A. Margination
Detailed Rationale: As fluid leaves the capillaries during inflammation,
blood viscosity increases and blood flow slows, causing white blood
cells to move from the center of the lumen toward the endothelial
lining (margination).
Question 4 What is the characteristic recurrence risk for offspring when
both parents are carriers of an autosomal recessive genetic disorder?
• A. 0% chance of being affected, 50% chance of being carriers.
• B. 25% chance of being affected, 50% chance of being carriers,
25% chance of being completely unaffected.
• C. 50% chance of being affected and showing severe clinical
manifestations.
, • D. 100% chance of inheriting the mutated allele configuration.
Correct Answer: B. 25% chance of being affected, 50% chance of being
carriers, 25% chance of being completely unaffected.
Detailed Rationale: In autosomal recessive inheritance, two carrier
parents (heterozygotes) each have a 50% chance of passing the
defective allele, yielding a 25% statistical probability per pregnancy for
an affected child.
Question 5 An excess accumulation of fluid within the interstitial
spaces, characterized by pitting upon physical examination, is primarily
driven by:
• A. Decreased capillary hydrostatic pressure combined with
lymphatic obstruction.
• B. Increased capillary hydrostatic pressure or decreased plasma
oncotic pressure.
• C. Massive intracellular potassium shift into the extracellular fluid
matrix.
• D. Elevated serum sodium excretion paired with direct renal
tubular failure.
Correct Answer: B. Increased capillary hydrostatic pressure or
decreased plasma oncotic pressure.
Detailed Rationale: Edema formation stems from Starling forces
favoring fluid filtration out of capillaries into the interstitium, typically
driven by high hydrostatic pressure (e.g., heart failure) or low oncotic
pressure (e.g., hypoalbuminemia).
, Question 6 What compensatory mechanism is initially activated by the
sympathetic nervous system in response to acute heart failure?
• A. Vasodilation of peripheral arterioles and profound diuresis.
• B. Increased heart rate and myocardial contractility to maintain
cardiac output.
• C. Complete suppression of antidiuretic hormone release from the
posterior pituitary.
• D. Immediate reduction of renal renin secretion.
Correct Answer: B. Increased heart rate and myocardial contractility to
maintain cardiac output.
Detailed Rationale: When cardiac output drops, baroreceptors trigger
sympathetic activation, increasing heart rate and contractility to
preserve tissue perfusion, though chronic activation eventually worsens
myocardial workload.
Question 7 What is the primary pathophysiological hallmark of Acute
Respiratory Distress Syndrome (ARDS)?
• A. Permanent overinflation and destruction of terminal
bronchioles due to elastase excess.
• B. Increased permeability of the alveolar-capillary membrane
leading to non-cardiogenic pulmonary edema and hyaline
membrane formation.
• C. Primary bronchospasm mediated by massive IgE mast cell
degranulation.
