,NSG3850/NSG 3850 Exam 3 | Pathophysiology for
1. A patient with nephrotic syndrome presents with generalized edema and a 24-hour urine protein of
5.2 grams. Which pathophysiological mechanism is primarily responsible for the edema?
A) Increased capillary hydrostatic pressure from sodium retention
B) Decreased plasma oncotic pressure from hypoalbuminemia
C) Increased capillary permeability from immune complex deposition
D) Lymphatic obstruction from interstitial fibrosis
Correct Answer: Decreased plasma oncotic pressure from hypoalbuminemia
Rationale: In nephrotic syndrome, massive proteinuria causes hypoalbuminemia, reducing plasma
oncotic pressure and leading to fluid shifting into the interstitial space, resulting in edema. Sodium
retention contributes but is secondary. Immune complex deposition causes glomerulonephritis, not
nephrotic syndrome. Lymphatic obstruction is not a mechanism.
2. A patient with acute glomerulonephritis has cola-colored urine, hypertension, and periorbital
edema. Which finding on urinalysis is most characteristic of this condition?
A) White blood cell casts
B) Red blood cell casts
C) Fatty casts
D) Broad waxy casts
Correct Answer: Red blood cell casts
Rationale: Red blood cell casts are pathognomonic for glomerular bleeding and are a hallmark of
acute glomerulonephritis. White blood cell casts suggest pyelonephritis or interstitial nephritis. Fatty
casts and broad waxy casts are associated with nephrotic syndrome and chronic kidney disease,
respectively.
3. A patient with cirrhosis develops esophageal varices. Which pathophysiological mechanism directly
leads to the formation of these varices?
A) Increased systemic arterial pressure
B) Portal hypertension with collateral vessel formation
,C) Decreased hepatic synthesis of clotting factors
D) Increased splenic sequestration of platelets
Correct Answer: Portal hypertension with collateral vessel formation
Rationale: Cirrhosis causes fibrosis and increased intrahepatic resistance, leading to portal
hypertension. This forces blood to find alternative pathways through collateral vessels, including the
esophageal and gastric veins, resulting in varices. Systemic pressure, clotting factors, and platelet
sequestration are not direct causes.
4. A patient with ulcerative colitis has severe diarrhea and abdominal cramping. Which
pathophysiological process is responsible for the diarrhea?
A) Impaired sodium absorption in the inflamed colonic mucosa
B) Increased colonic motility from parasympathetic overactivity
C) Decreased secretion of intestinal fluids
D) Malabsorption of fats due to bile salt deficiency
Correct Answer: Impaired sodium absorption in the inflamed colonic mucosa
Rationale: In ulcerative colitis, inflammation of the colonic mucosa disrupts the normal absorptive
function of the epithelium, leading to reduced sodium and water absorption and subsequent diarrhea.
Increased motility is a secondary effect. Fluid secretion is typically increased, not decreased. Fat
malabsorption is more characteristic of Crohn's disease or pancreatic insufficiency.
5. A patient with a history of peptic ulcer disease reports severe epigastric pain radiating to the back,
which is partially relieved by leaning forward. Which complication is most likely?
A) Gastric outlet obstruction
B) Perforation of the ulcer
C) Penetration into the pancreas
D) Upper gastrointestinal bleeding
Correct Answer: Penetration into the pancreas
Rationale: Penetration occurs when an ulcer erodes through the wall of the stomach or duodenum
into an adjacent organ, most commonly the pancreas. Pain radiating to the back that is relieved by
, leaning forward is a classic sign. Perforation causes acute, severe, diffuse abdominal pain. Obstruction
causes vomiting. Bleeding presents with hematemesis or melena.
6. A patient with Crohn's disease has a history of chronic diarrhea and abdominal pain. Which
pathophysiological feature distinguishes Crohn's disease from ulcerative colitis?
A) Continuous mucosal inflammation limited to the rectum
B) Transmural inflammation with skip lesions and fistula formation
C) Inflammation confined to the mucosa and submucosa
D) Presence of crypt abscesses and pseudopolyps
Correct Answer: Transmural inflammation with skip lesions and fistula formation
Rationale: Crohn's disease is characterized by transmural (full-thickness) inflammation, which can
occur in skip lesions anywhere in the GI tract and commonly leads to fistula formation. Ulcerative
colitis is limited to the mucosa and submucosa of the colon and rectum, is continuous, and features
crypt abscesses and pseudopolyps.
7. A patient with acute kidney injury (AKI) is in the oliguric phase with a urine output of 200 mL/day.
Which electrolyte imbalance is the patient at highest risk for?
A) Hypokalemia
B) Hyperkalemia
C) Hypophosphatemia
D) Hypomagnesemia
Correct Answer: Hyperkalemia
Rationale: In the oliguric phase of AKI, the kidneys are unable to excrete potassium, leading to
hyperkalemia. This is a life-threatening complication. Hypokalemia is more common in the diuretic
phase. Hypophosphatemia and hypomagnesemia are not typical of the oliguric phase.
8. A patient with end-stage renal disease (ESRD) has a serum calcium of 7.5 mg/dL and a serum
phosphate of 6.8 mg/dL. Which hormonal change is the body's compensatory response to these
imbalances?
A) Decreased parathyroid hormone (PTH) secretion
1. A patient with nephrotic syndrome presents with generalized edema and a 24-hour urine protein of
5.2 grams. Which pathophysiological mechanism is primarily responsible for the edema?
A) Increased capillary hydrostatic pressure from sodium retention
B) Decreased plasma oncotic pressure from hypoalbuminemia
C) Increased capillary permeability from immune complex deposition
D) Lymphatic obstruction from interstitial fibrosis
Correct Answer: Decreased plasma oncotic pressure from hypoalbuminemia
Rationale: In nephrotic syndrome, massive proteinuria causes hypoalbuminemia, reducing plasma
oncotic pressure and leading to fluid shifting into the interstitial space, resulting in edema. Sodium
retention contributes but is secondary. Immune complex deposition causes glomerulonephritis, not
nephrotic syndrome. Lymphatic obstruction is not a mechanism.
2. A patient with acute glomerulonephritis has cola-colored urine, hypertension, and periorbital
edema. Which finding on urinalysis is most characteristic of this condition?
A) White blood cell casts
B) Red blood cell casts
C) Fatty casts
D) Broad waxy casts
Correct Answer: Red blood cell casts
Rationale: Red blood cell casts are pathognomonic for glomerular bleeding and are a hallmark of
acute glomerulonephritis. White blood cell casts suggest pyelonephritis or interstitial nephritis. Fatty
casts and broad waxy casts are associated with nephrotic syndrome and chronic kidney disease,
respectively.
3. A patient with cirrhosis develops esophageal varices. Which pathophysiological mechanism directly
leads to the formation of these varices?
A) Increased systemic arterial pressure
B) Portal hypertension with collateral vessel formation
,C) Decreased hepatic synthesis of clotting factors
D) Increased splenic sequestration of platelets
Correct Answer: Portal hypertension with collateral vessel formation
Rationale: Cirrhosis causes fibrosis and increased intrahepatic resistance, leading to portal
hypertension. This forces blood to find alternative pathways through collateral vessels, including the
esophageal and gastric veins, resulting in varices. Systemic pressure, clotting factors, and platelet
sequestration are not direct causes.
4. A patient with ulcerative colitis has severe diarrhea and abdominal cramping. Which
pathophysiological process is responsible for the diarrhea?
A) Impaired sodium absorption in the inflamed colonic mucosa
B) Increased colonic motility from parasympathetic overactivity
C) Decreased secretion of intestinal fluids
D) Malabsorption of fats due to bile salt deficiency
Correct Answer: Impaired sodium absorption in the inflamed colonic mucosa
Rationale: In ulcerative colitis, inflammation of the colonic mucosa disrupts the normal absorptive
function of the epithelium, leading to reduced sodium and water absorption and subsequent diarrhea.
Increased motility is a secondary effect. Fluid secretion is typically increased, not decreased. Fat
malabsorption is more characteristic of Crohn's disease or pancreatic insufficiency.
5. A patient with a history of peptic ulcer disease reports severe epigastric pain radiating to the back,
which is partially relieved by leaning forward. Which complication is most likely?
A) Gastric outlet obstruction
B) Perforation of the ulcer
C) Penetration into the pancreas
D) Upper gastrointestinal bleeding
Correct Answer: Penetration into the pancreas
Rationale: Penetration occurs when an ulcer erodes through the wall of the stomach or duodenum
into an adjacent organ, most commonly the pancreas. Pain radiating to the back that is relieved by
, leaning forward is a classic sign. Perforation causes acute, severe, diffuse abdominal pain. Obstruction
causes vomiting. Bleeding presents with hematemesis or melena.
6. A patient with Crohn's disease has a history of chronic diarrhea and abdominal pain. Which
pathophysiological feature distinguishes Crohn's disease from ulcerative colitis?
A) Continuous mucosal inflammation limited to the rectum
B) Transmural inflammation with skip lesions and fistula formation
C) Inflammation confined to the mucosa and submucosa
D) Presence of crypt abscesses and pseudopolyps
Correct Answer: Transmural inflammation with skip lesions and fistula formation
Rationale: Crohn's disease is characterized by transmural (full-thickness) inflammation, which can
occur in skip lesions anywhere in the GI tract and commonly leads to fistula formation. Ulcerative
colitis is limited to the mucosa and submucosa of the colon and rectum, is continuous, and features
crypt abscesses and pseudopolyps.
7. A patient with acute kidney injury (AKI) is in the oliguric phase with a urine output of 200 mL/day.
Which electrolyte imbalance is the patient at highest risk for?
A) Hypokalemia
B) Hyperkalemia
C) Hypophosphatemia
D) Hypomagnesemia
Correct Answer: Hyperkalemia
Rationale: In the oliguric phase of AKI, the kidneys are unable to excrete potassium, leading to
hyperkalemia. This is a life-threatening complication. Hypokalemia is more common in the diuretic
phase. Hypophosphatemia and hypomagnesemia are not typical of the oliguric phase.
8. A patient with end-stage renal disease (ESRD) has a serum calcium of 7.5 mg/dL and a serum
phosphate of 6.8 mg/dL. Which hormonal change is the body's compensatory response to these
imbalances?
A) Decreased parathyroid hormone (PTH) secretion
