HSC 4558 Exam 2 V2 | HSC 4558 Pathophysiology II | Actual Q&A with
Rationale (HSC4558 Exam 2) | University of Central Florida
1. Which phase of acute kidney injury (AKI) is characterized by a significant decrease in urine
output, often less than 400 mL per day, and an increase in serum creatinine?
A. Diuretic phase
B. Initiation phase
C. Recovery phase
D. Oliguric phase
Answer: D
Explanation: The oliguric phase is the most common clinical manifestation of AKI and
involves a reduction in GFR and urine volume. During this stage, nitrogenous waste
products like urea and creatinine accumulate in the blood, leading to azotemia. It usually
lasts for 1 to 2 weeks and is followed by the diuretic phase if the kidneys begin to heal.
2. A patient with chronic kidney disease (CKD) presents with severe anemia. Which of the
following is the primary pathophysiological reason for this condition?
A. Excessive loss of blood in the urine
B. Reduced production of erythropoietin
C. Iron deficiency due to poor absorption
D. Destruction of red blood cells by urea
Answer: B
Explanation: The kidneys are responsible for producing erythropoietin, a hormone that
stimulates the bone marrow to produce red blood cells. In chronic kidney disease, the
damaged renal tissue cannot produce sufficient amounts of this hormone, leading to
normocytic, normochromic anemia. This condition is typically treated with synthetic
erythropoiesis-stimulating agents to maintain hemoglobin levels.
3. Which clinical syndrome is characterized by the massive loss of protein in the urine,
hypoalbuminemia, and generalized edema?
A. Nephrotic syndrome
B. Nephritic syndrome
C. Acute pyelonephritis
D. Cystitis
,Answer: A
Explanation: Nephrotic syndrome occurs when the glomerular filtration barrier is
damaged, allowing more than 3.5 grams of protein to be lost in the urine daily. The
resulting low serum albumin levels decrease plasma oncotic pressure, leading to fluid shifts
into the interstitial space and systemic edema. Patients also frequently exhibit
hyperlipidemia and an increased risk for thromboembolic events.
4. A patient exhibits high serum levels of antidiuretic hormone (ADH) despite low serum
osmolality and hyponatremia. Which condition is most likely?
A. Diabetes insipidus
B. Addison’s disease
C. Cushing syndrome
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: D
Explanation: SIADH involves the excessive secretion of ADH, which causes the kidneys to
reabsorb too much water, diluting the blood. This results in dilutional hyponatremia and a
highly concentrated urine despite the body being fluid-overloaded. Management typically
includes fluid restriction and addressing the underlying cause, such as a tumor or CNS
disorder.
5. Which of the following describes the mechanism of Type 1 Diabetes Mellitus?
A. Autoimmune destruction of pancreatic beta cells
B. Insulin resistance in peripheral tissues
C. Excessive glucagon secretion by alpha cells
D. Decreased glucose absorption in the gut
Answer: A
Explanation: Type 1 Diabetes Mellitus is primarily an autoimmune disease where T-cells
attack and destroy the insulin-producing beta cells in the Islets of Langerhans. This leads to
an absolute insulin deficiency, requiring life-long exogenous insulin therapy. It is often
diagnosed in childhood or adolescence but can occur at any age.
6. A patient presents with polydipsia, polyuria, and a very low urine specific gravity. Serum
osmolality is high. What is the most probable diagnosis?
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
, D. Conn syndrome
Answer: B
Explanation: Diabetes insipidus is characterized by a deficiency of or resistance to ADH,
preventing the kidneys from concentrating urine. This leads to the excretion of large
volumes of dilute urine and significant dehydration if fluid intake is insufficient. It can be
classified as neurogenic (central) or nephrogenic based on the site of the defect.
7. What is the primary cause of the fruity odor on the breath of a patient in diabetic
ketoacidosis (DKA)?
A. Excessive glucose in the saliva
B. Accumulation of acetoacetic acid and acetone
C. High levels of lactic acid
D. Dehydration and dry mucous membranes
Answer: B
Explanation: In DKA, the lack of insulin causes the body to break down fats for energy,
producing acidic ketone bodies. One of these ketones, acetone, is volatile and excreted
through the lungs, creating a characteristic sweet or fruity odor. This condition is a medical
emergency that requires immediate insulin and fluid resuscitation.
8. Which hormone is excessively produced in Cushing syndrome, leading to symptoms like a
‘buffalo hump’ and ‘moon face’?
A. Aldosterone
B. Epinephrine
C. Cortisol
D. Growth hormone
Answer: C
Explanation: Cushing syndrome results from chronic exposure to excessive levels of
cortisol, whether from an endogenous tumor or exogenous steroid use. Cortisol promotes
fat redistribution to the trunk and face while causing muscle wasting in the extremities. It
also leads to skin thinning, hypertension, and glucose intolerance.
9. Which of the following is a classic sign of Grave’s disease (Hyperthyroidism)?
A. Weight gain and bradycardia
B. Cold intolerance
C. Exophthalmos (bulging eyes)
D. Constipation
Rationale (HSC4558 Exam 2) | University of Central Florida
1. Which phase of acute kidney injury (AKI) is characterized by a significant decrease in urine
output, often less than 400 mL per day, and an increase in serum creatinine?
A. Diuretic phase
B. Initiation phase
C. Recovery phase
D. Oliguric phase
Answer: D
Explanation: The oliguric phase is the most common clinical manifestation of AKI and
involves a reduction in GFR and urine volume. During this stage, nitrogenous waste
products like urea and creatinine accumulate in the blood, leading to azotemia. It usually
lasts for 1 to 2 weeks and is followed by the diuretic phase if the kidneys begin to heal.
2. A patient with chronic kidney disease (CKD) presents with severe anemia. Which of the
following is the primary pathophysiological reason for this condition?
A. Excessive loss of blood in the urine
B. Reduced production of erythropoietin
C. Iron deficiency due to poor absorption
D. Destruction of red blood cells by urea
Answer: B
Explanation: The kidneys are responsible for producing erythropoietin, a hormone that
stimulates the bone marrow to produce red blood cells. In chronic kidney disease, the
damaged renal tissue cannot produce sufficient amounts of this hormone, leading to
normocytic, normochromic anemia. This condition is typically treated with synthetic
erythropoiesis-stimulating agents to maintain hemoglobin levels.
3. Which clinical syndrome is characterized by the massive loss of protein in the urine,
hypoalbuminemia, and generalized edema?
A. Nephrotic syndrome
B. Nephritic syndrome
C. Acute pyelonephritis
D. Cystitis
,Answer: A
Explanation: Nephrotic syndrome occurs when the glomerular filtration barrier is
damaged, allowing more than 3.5 grams of protein to be lost in the urine daily. The
resulting low serum albumin levels decrease plasma oncotic pressure, leading to fluid shifts
into the interstitial space and systemic edema. Patients also frequently exhibit
hyperlipidemia and an increased risk for thromboembolic events.
4. A patient exhibits high serum levels of antidiuretic hormone (ADH) despite low serum
osmolality and hyponatremia. Which condition is most likely?
A. Diabetes insipidus
B. Addison’s disease
C. Cushing syndrome
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: D
Explanation: SIADH involves the excessive secretion of ADH, which causes the kidneys to
reabsorb too much water, diluting the blood. This results in dilutional hyponatremia and a
highly concentrated urine despite the body being fluid-overloaded. Management typically
includes fluid restriction and addressing the underlying cause, such as a tumor or CNS
disorder.
5. Which of the following describes the mechanism of Type 1 Diabetes Mellitus?
A. Autoimmune destruction of pancreatic beta cells
B. Insulin resistance in peripheral tissues
C. Excessive glucagon secretion by alpha cells
D. Decreased glucose absorption in the gut
Answer: A
Explanation: Type 1 Diabetes Mellitus is primarily an autoimmune disease where T-cells
attack and destroy the insulin-producing beta cells in the Islets of Langerhans. This leads to
an absolute insulin deficiency, requiring life-long exogenous insulin therapy. It is often
diagnosed in childhood or adolescence but can occur at any age.
6. A patient presents with polydipsia, polyuria, and a very low urine specific gravity. Serum
osmolality is high. What is the most probable diagnosis?
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
, D. Conn syndrome
Answer: B
Explanation: Diabetes insipidus is characterized by a deficiency of or resistance to ADH,
preventing the kidneys from concentrating urine. This leads to the excretion of large
volumes of dilute urine and significant dehydration if fluid intake is insufficient. It can be
classified as neurogenic (central) or nephrogenic based on the site of the defect.
7. What is the primary cause of the fruity odor on the breath of a patient in diabetic
ketoacidosis (DKA)?
A. Excessive glucose in the saliva
B. Accumulation of acetoacetic acid and acetone
C. High levels of lactic acid
D. Dehydration and dry mucous membranes
Answer: B
Explanation: In DKA, the lack of insulin causes the body to break down fats for energy,
producing acidic ketone bodies. One of these ketones, acetone, is volatile and excreted
through the lungs, creating a characteristic sweet or fruity odor. This condition is a medical
emergency that requires immediate insulin and fluid resuscitation.
8. Which hormone is excessively produced in Cushing syndrome, leading to symptoms like a
‘buffalo hump’ and ‘moon face’?
A. Aldosterone
B. Epinephrine
C. Cortisol
D. Growth hormone
Answer: C
Explanation: Cushing syndrome results from chronic exposure to excessive levels of
cortisol, whether from an endogenous tumor or exogenous steroid use. Cortisol promotes
fat redistribution to the trunk and face while causing muscle wasting in the extremities. It
also leads to skin thinning, hypertension, and glucose intolerance.
9. Which of the following is a classic sign of Grave’s disease (Hyperthyroidism)?
A. Weight gain and bradycardia
B. Cold intolerance
C. Exophthalmos (bulging eyes)
D. Constipation
