Nursing Pathophysiology Exam - Questions and Answers - Renal & Fluid Electrolyte Imbalances
Nursing Pathophysiology | Cellular Injury Inflammation | Systemic Disorders | High Yield
TABLE OF CONTENTS
1. I. Cellular Injury - Reversible vs Irreversible, Necrosis vs Apoptosis, Oxidative Stress Free Radicals
2. II. Inflammation - Acute Inflammation Vascular Permeability Neutrophils, Chronic Inflammation Macrophages Lymphocytes Granuloma,
Inflammatory Mediators Histamine Prostaglandins Leukotrienes Cytokines
3. III. Cardiovascular - Heart Failure Compensatory Sympathetic RAAS Vasoconstriction Sodium Water Retention Preload Afterload Ventricular
Remodeling Hypertrophy Dilation Maladaptive BNP, Ischemic Heart Disease, Shock Types Hypovolemic Cardiogenic Distributive Obstructive
4. IV. Respiratory - COPD Chronic Bronchitis Emphysema Chronic Inflammation Goblet Hyperplasia Mucus Hypersecretion Loss Alveolar Septa
Elastic Recoil Air Trapping Barrel Chest FEV1/FVC <0.70, Asthma Chronic Inflammation Th2 Eosinophils IgE Mast Cell Histamine
Bronchoconstriction Reversible, ARDS Diffuse Alveolar Damage Increased Permeability Protein-Rich Edema Hyaline Membrane V/Q Mismatch
Shunt Hypoxemia Refractory
5. V. Endocrine - Type 2 Diabetes Insulin Resistance Decreased Glucose Uptake Liver Increased Gluconeogenesis Beta Cell Dysfunction Relative
Deficiency Glucotoxicity Lipotoxicity, Type 1 Autoimmune Beta Cell Destruction Absolute Deficiency, DKA Absolute Deficiency Lipolysis
Ketogenesis Beta-Hydroxybutyrate Acidosis pH <7.3 Bicarbonate <18 Kussmaul Polyuria, HHNKS Relative Deficiency No Ketosis Osm >320
Glucose >600 Dehydration Altered Mental, Hyperthyroidism Graves TSI TSH Receptor Increased T4 T3 BMR Tremor Palpitations Exophthalmos,
Hypothyroidism Hashimoto Lymphocytic Infiltration Decreased T4 T3 BMR Fatigue Weight Gain Cold Intolerance
6. VI. Renal - Nephrotic Increased Glomerular Permeability Podocyte Injury Proteinuria >3.5 g/day Hypoalbuminemia Decreased Oncotic Edema
Hyperlipidemia Loss Antithrombin Hypercoagulable, Nephritic Glomerular Inflammation Immune Complex Decreased GFR Sodium Water
Retention HTN Oliguria RBC Casts Hematuria Proteinuria <3.5 g Post-Strep IgA, AKI vs CKD
7. VII. Gastrointestinal & Hepatic - Cirrhosis Chronic Injury Fibrosis Nodules Portal Hypertension Increased Resistance Decreased Synthetic
Albumin Clotting Factors PT/INR Up Impaired Bilirubin Jaundice Ascites Varices Splenomegaly Estrogen Spider Angiomas Palmar Erythema,
Acute Pancreatitis Premature Trypsin Activation Autodigestion Inflammation Edema Hemorrhage Alcohol Gallstones SIRS Lipase Amylase
Hypocalcemia, PUD Imbalance Aggressive Acid Pepsin H. pylori NSAID Decreased Protective Mucus Bicarbonate Prostaglandin Urease
Ammonia
8. VIII. Neurological - Ischemic Stroke Thrombotic Embolic Occlusion Decreased Cerebral Blood Flow <20 mL/100g/min Ischemia Penumbra
Salvageable Excitotoxicity Glutamate Calcium Cytotoxic Edema Infarction, Normal Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion
Incontinence Gait Disturbance Enlarged Ventricles VP Shunt
9. IX. Immune - SLE Autoimmune Type III Hypersensitivity Immune Complex ANA dsDNA Low C3 C4 Butterfly Rash Photosensitivity Joint Pain
Nephritis, RA Autoimmune Chronic Synovitis Pannus TNF IL-1 IL-6 Joint Destruction RF Anti-CCP Symmetric Small Joints Morning >30 min
Systemic, OA Degenerative Cartilage Loss Decreased Proteoglycan Chondrocyte Dysfunction Osteophyte Non-Inflammatory Pain Worse Activity
Morning <30 min Crepitus
10. X. Hematologic - Anemia Decreased Production Iron B12 Folate Erythropoietin Increased Destruction Hemolysis Blood Loss Hemorrhage
11. XI. Practice Questions - Each Asked Like Real Nursing Pathophysiology Exam
12. XII. Answer Key with Detailed Rationales
,NURSING PATHOPHYSIOLOGY EXAM - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on Nursing Pathophysiology Blueprint - Cellular Injury Inflammation Cardiovascular Respiratory Endocrine Renal GI Hepatic Neuro Immune Hematologic. High Yield.
1. A patient with cirrhosis presents with ascites, jaundice, spider angiomas, palmar erythema, low albumin, elevated PT/INR, portal hypertension,
esophageal varices. What is pathophysiology?
A. Only acute
B. No cirrhosis
C. Cirrhosis chronic liver injury fibrosis nodule formation portal hypertension increased resistance, decreased synthetic function albumin clotting factors low,
impaired bilirubin conjugation jaundice, portal hypertension ascites varices splenomegaly, estrogen not metabolized spider angiomas palmar erythema
D. No portal HTN
Answer: C
Rationale: Cirrhosis chronic injury fibrosis nodules portal hypertension increased resistance decreased synthetic albumin clotting factors low PT/INR up
impaired bilirubin conjugation jaundice portal HTN ascites varices splenomegaly estrogen not metabolized spider palmar erythema.
2. A patient with peptic ulcer disease epigastric pain, H. pylori positive, NSAID use. Pathophysiology?
A. PUD imbalance aggressive factors acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin, H. pylori urease ammonia
inflammation
B. Only stress
C. No H. pylori
D. No ulcer
Answer: A
Rationale: PUD imbalance aggressive acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin H. pylori urease ammonia
inflammation.
3. A patient with cirrhosis presents with ascites, jaundice, spider angiomas, palmar erythema, low albumin, elevated PT/INR, portal hypertension,
esophageal varices. What is pathophysiology?
A. Cirrhosis chronic liver injury fibrosis nodule formation portal hypertension increased resistance, decreased synthetic function albumin clotting factors low,
impaired bilirubin conjugation jaundice, portal hypertension ascites varices splenomegaly, estrogen not metabolized spider angiomas palmar erythema
B. No cirrhosis
C. No portal HTN
D. Only acute
Answer: A
Rationale: Cirrhosis chronic injury fibrosis nodules portal hypertension increased resistance decreased synthetic albumin clotting factors low PT/INR up
impaired bilirubin conjugation jaundice portal HTN ascites varices splenomegaly estrogen not metabolized spider palmar erythema.
4. A patient with acute pancreatitis presents with severe epigastric pain radiating back, nausea vomiting, elevated lipase 3x normal, alcohol use.
What is pathophysiology?
A. Acute pancreatitis premature activation trypsin within pancreas autodigestion inflammation edema hemorrhage, alcohol gallstones cause duct obstruction,
systemic inflammatory response SIRS, lipase amylase elevated, risk hypocalcemia
B. Only gastritis
C. No pancreatitis
D. No autodigestion
Answer: A
Rationale: Acute pancreatitis premature activation trypsin autodigestion inflammation edema hemorrhage alcohol gallstones duct obstruction SIRS lipase
amylase elevated hypocalcemia fat necrosis.
5. A patient with peptic ulcer disease epigastric pain, H. pylori positive, NSAID use. Pathophysiology?
A. No ulcer
B. PUD imbalance aggressive factors acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin, H. pylori urease ammonia
inflammation
C. Only stress
D. No H. pylori
Answer: B
Rationale: PUD imbalance aggressive acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin H. pylori urease ammonia
inflammation.
6. A 45-year-old with polyuria, polydipsia, polyphagia, fasting glucose 210 mg/dL, HbA1c 9.2%, obesity, insulin resistance. What is pathophysiology
of type 2 diabetes?
A. Type 1 autoimmune beta cell destruction
B. Only type 1
C. No diabetes
D. Type 2 insulin resistance peripheral tissues decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative insulin deficiency
glucotoxicity lipotoxicity obesity inflammation
Answer: D
Rationale: Type 2 diabetes insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative insulin
deficiency glucotoxicity lipotoxicity obesity inflammation.
7. A patient with acute pancreatitis presents with severe epigastric pain radiating back, nausea vomiting, elevated lipase 3x normal, alcohol use.
What is pathophysiology?
A. Only gastritis
B. No pancreatitis
,C. Acute pancreatitis premature activation trypsin within pancreas autodigestion inflammation edema hemorrhage, alcohol gallstones cause duct obstruction,
systemic inflammatory response SIRS, lipase amylase elevated, risk hypocalcemia
D. No autodigestion
Answer: C
Rationale: Acute pancreatitis premature activation trypsin autodigestion inflammation edema hemorrhage alcohol gallstones duct obstruction SIRS lipase
amylase elevated hypocalcemia fat necrosis.
8. A 25-year-old female with butterfly rash, joint pain, fatigue, positive ANA dsDNA, low C3 C4, proteinuria. What disease pathophysiology?
A. No autoimmune
B. Only osteoarthritis
C. RA
D. Systemic lupus erythematosus - autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive complement consumption low C3 C4,
inflammation multiple organs butterfly rash photosensitivity joint pain nephritis
Answer: D
Rationale: SLE autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive low C3 C4 inflammation butterfly rash photosensitivity
joint pain nephritis.
9. A patient with osteoarthritis knee pain worse activity morning <30 min crepitus no systemic. Pathophysiology?
A. RA
B. Only RA
C. No OA
D. OA degenerative wear tear cartilage loss decreased proteoglycan chondrocyte dysfunction osteophyte formation, non-inflammatory pain worse activity
morning <30 min crepitus no systemic
Answer: D
Rationale: OA degenerative cartilage loss decreased proteoglycan chondrocyte dysfunction osteophyte non-inflammatory pain worse activity morning <30 min
crepitus.
10. A 25-year-old female with butterfly rash, joint pain, fatigue, positive ANA dsDNA, low C3 C4, proteinuria. What disease pathophysiology?
A. Only osteoarthritis
B. No autoimmune
C. RA
D. Systemic lupus erythematosus - autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive complement consumption low C3 C4,
inflammation multiple organs butterfly rash photosensitivity joint pain nephritis
Answer: D
Rationale: SLE autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive low C3 C4 inflammation butterfly rash photosensitivity
joint pain nephritis.
11. A patient with hypothyroidism presents with fatigue, weight gain, cold intolerance, constipation, dry skin, elevated TSH low free T4. What is
pathophysiology?
A. No thyroid
B. Hypothyroidism Hashimoto autoimmune thyroiditis lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH feedback low free T4
C. Hyperthyroid
D. Only hyper
Answer: B
Rationale: Hypothyroidism Hashimoto autoimmune lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH low free T4.
12. A patient with acute pancreatitis presents with severe epigastric pain radiating back, nausea vomiting, elevated lipase 3x normal, alcohol use.
What is pathophysiology?
A. Only gastritis
B. Acute pancreatitis premature activation trypsin within pancreas autodigestion inflammation edema hemorrhage, alcohol gallstones cause duct obstruction,
systemic inflammatory response SIRS, lipase amylase elevated, risk hypocalcemia
C. No pancreatitis
D. No autodigestion
Answer: B
Rationale: Acute pancreatitis premature activation trypsin autodigestion inflammation edema hemorrhage alcohol gallstones duct obstruction SIRS lipase
amylase elevated hypocalcemia fat necrosis.
13. A 70-year-old with sudden unilateral weakness, facial droop, aphasia, CT shows ischemic stroke. What is pathophysiology?
A. Ischemic stroke thrombotic or embolic occlusion cerebral artery decreased cerebral blood flow <20 mL/100g/min ischemia, penumbra salvageable,
excitotoxicity glutamate calcium influx, cytotoxic edema, if >10 min infarction
B. No stroke
C. Hemorrhage only
D. Only hemorrhage
Answer: A
Rationale: Ischemic stroke thrombotic embolic occlusion decreased cerebral blood flow <20 mL/100g/min ischemia penumbra salvageable excitotoxicity
glutamate calcium influx cytotoxic edema infarction if >10 min.
14. A patient with nephritic syndrome presents with hematuria, proteinuria <3.5 g, hypertension, oliguria, RBC casts. What is pathophysiology?
A. Nephrotic only
, B. Only nephrotic
C. Nephritic - glomerular inflammation immune complex deposition decreased GFR sodium water retention HTN oliguria, RBC casts hematuria, proteinuria <3.5
g, example post-strep GN IgA nephropathy
D. No hematuria
Answer: C
Rationale: Nephritic glomerular inflammation immune complex decreased GFR Na water retention HTN oliguria RBC casts hematuria proteinuria <3.5 g
post-strep IgA.
15. A patient with hypothyroidism presents with fatigue, weight gain, cold intolerance, constipation, dry skin, elevated TSH low free T4. What is
pathophysiology?
A. No thyroid
B. Hyperthyroid
C. Only hyper
D. Hypothyroidism Hashimoto autoimmune thyroiditis lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH feedback low free T4
Answer: D
Rationale: Hypothyroidism Hashimoto autoimmune lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH low free T4.
16. A 25-year-old female with butterfly rash, joint pain, fatigue, positive ANA dsDNA, low C3 C4, proteinuria. What disease pathophysiology?
A. RA
B. No autoimmune
C. Systemic lupus erythematosus - autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive complement consumption low C3 C4,
inflammation multiple organs butterfly rash photosensitivity joint pain nephritis
D. Only osteoarthritis
Answer: C
Rationale: SLE autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive low C3 C4 inflammation butterfly rash photosensitivity
joint pain nephritis.
17. A patient with nephrotic syndrome presents with proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia. What is pathophysiology?
A. Only nephritic
B. No proteinuria
C. Nephritic hematuria HTN
D. Nephrotic - increased glomerular permeability loss negative charge podocyte injury proteinuria >3.5 g/day hypoalbuminemia decreased oncotic pressure
edema liver increased lipoprotein synthesis hyperlipidemia loss antithrombin III hypercoagulable
Answer: D
Rationale: Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia liver
lipoprotein synthesis loss antithrombin III hypercoagulable.
18. A patient with asthma presents with episodic wheezing, dyspnea, cough, reversible obstruction, eosinophils, IgE elevated. Pathophysiology?
A. COPD fixed
B. No asthma
C. Only COPD
D. Asthma chronic airway inflammation Th2 eosinophils IgE mast cell histamine leukotrienes bronchoconstriction mucus hypersecretion airway
hyperresponsiveness reversible obstruction
Answer: D
Rationale: Asthma chronic inflammation Th2 eosinophils IgE mast cell histamine leukotrienes bronchoconstriction mucus hyperresponsiveness reversible.
19. A 70-year-old with sudden unilateral weakness, facial droop, aphasia, CT shows ischemic stroke. What is pathophysiology?
A. No stroke
B. Hemorrhage only
C. Only hemorrhage
D. Ischemic stroke thrombotic or embolic occlusion cerebral artery decreased cerebral blood flow <20 mL/100g/min ischemia, penumbra salvageable,
excitotoxicity glutamate calcium influx, cytotoxic edema, if >10 min infarction
Answer: D
Rationale: Ischemic stroke thrombotic embolic occlusion decreased cerebral blood flow <20 mL/100g/min ischemia penumbra salvageable excitotoxicity
glutamate calcium influx cytotoxic edema infarction if >10 min.
20. A patient with DKA presents with polyuria, polydipsia, nausea vomiting, abdominal pain, Kussmaul breathing, glucose 450 mg/dL, pH 7.1,
bicarbonate 8, ketones positive. Pathophysiology?
A. No acidosis
B. DKA absolute insulin deficiency increased glucagon increased lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis pH low
bicarbonate low Kussmaul compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration
C. Only HHNKS
D. HHNKS
Answer: B
Rationale: DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis low pH low
bicarbonate Kussmaul compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration.
21. A 60-year-old male with long history smoking, chronic cough, increased sputum, barrel chest, prolonged expiration, wheezing, FEV1/FVC <0.70,
FEV1 55% predicted. What is pathophysiology?
Nursing Pathophysiology | Cellular Injury Inflammation | Systemic Disorders | High Yield
TABLE OF CONTENTS
1. I. Cellular Injury - Reversible vs Irreversible, Necrosis vs Apoptosis, Oxidative Stress Free Radicals
2. II. Inflammation - Acute Inflammation Vascular Permeability Neutrophils, Chronic Inflammation Macrophages Lymphocytes Granuloma,
Inflammatory Mediators Histamine Prostaglandins Leukotrienes Cytokines
3. III. Cardiovascular - Heart Failure Compensatory Sympathetic RAAS Vasoconstriction Sodium Water Retention Preload Afterload Ventricular
Remodeling Hypertrophy Dilation Maladaptive BNP, Ischemic Heart Disease, Shock Types Hypovolemic Cardiogenic Distributive Obstructive
4. IV. Respiratory - COPD Chronic Bronchitis Emphysema Chronic Inflammation Goblet Hyperplasia Mucus Hypersecretion Loss Alveolar Septa
Elastic Recoil Air Trapping Barrel Chest FEV1/FVC <0.70, Asthma Chronic Inflammation Th2 Eosinophils IgE Mast Cell Histamine
Bronchoconstriction Reversible, ARDS Diffuse Alveolar Damage Increased Permeability Protein-Rich Edema Hyaline Membrane V/Q Mismatch
Shunt Hypoxemia Refractory
5. V. Endocrine - Type 2 Diabetes Insulin Resistance Decreased Glucose Uptake Liver Increased Gluconeogenesis Beta Cell Dysfunction Relative
Deficiency Glucotoxicity Lipotoxicity, Type 1 Autoimmune Beta Cell Destruction Absolute Deficiency, DKA Absolute Deficiency Lipolysis
Ketogenesis Beta-Hydroxybutyrate Acidosis pH <7.3 Bicarbonate <18 Kussmaul Polyuria, HHNKS Relative Deficiency No Ketosis Osm >320
Glucose >600 Dehydration Altered Mental, Hyperthyroidism Graves TSI TSH Receptor Increased T4 T3 BMR Tremor Palpitations Exophthalmos,
Hypothyroidism Hashimoto Lymphocytic Infiltration Decreased T4 T3 BMR Fatigue Weight Gain Cold Intolerance
6. VI. Renal - Nephrotic Increased Glomerular Permeability Podocyte Injury Proteinuria >3.5 g/day Hypoalbuminemia Decreased Oncotic Edema
Hyperlipidemia Loss Antithrombin Hypercoagulable, Nephritic Glomerular Inflammation Immune Complex Decreased GFR Sodium Water
Retention HTN Oliguria RBC Casts Hematuria Proteinuria <3.5 g Post-Strep IgA, AKI vs CKD
7. VII. Gastrointestinal & Hepatic - Cirrhosis Chronic Injury Fibrosis Nodules Portal Hypertension Increased Resistance Decreased Synthetic
Albumin Clotting Factors PT/INR Up Impaired Bilirubin Jaundice Ascites Varices Splenomegaly Estrogen Spider Angiomas Palmar Erythema,
Acute Pancreatitis Premature Trypsin Activation Autodigestion Inflammation Edema Hemorrhage Alcohol Gallstones SIRS Lipase Amylase
Hypocalcemia, PUD Imbalance Aggressive Acid Pepsin H. pylori NSAID Decreased Protective Mucus Bicarbonate Prostaglandin Urease
Ammonia
8. VIII. Neurological - Ischemic Stroke Thrombotic Embolic Occlusion Decreased Cerebral Blood Flow <20 mL/100g/min Ischemia Penumbra
Salvageable Excitotoxicity Glutamate Calcium Cytotoxic Edema Infarction, Normal Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion
Incontinence Gait Disturbance Enlarged Ventricles VP Shunt
9. IX. Immune - SLE Autoimmune Type III Hypersensitivity Immune Complex ANA dsDNA Low C3 C4 Butterfly Rash Photosensitivity Joint Pain
Nephritis, RA Autoimmune Chronic Synovitis Pannus TNF IL-1 IL-6 Joint Destruction RF Anti-CCP Symmetric Small Joints Morning >30 min
Systemic, OA Degenerative Cartilage Loss Decreased Proteoglycan Chondrocyte Dysfunction Osteophyte Non-Inflammatory Pain Worse Activity
Morning <30 min Crepitus
10. X. Hematologic - Anemia Decreased Production Iron B12 Folate Erythropoietin Increased Destruction Hemolysis Blood Loss Hemorrhage
11. XI. Practice Questions - Each Asked Like Real Nursing Pathophysiology Exam
12. XII. Answer Key with Detailed Rationales
,NURSING PATHOPHYSIOLOGY EXAM - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on Nursing Pathophysiology Blueprint - Cellular Injury Inflammation Cardiovascular Respiratory Endocrine Renal GI Hepatic Neuro Immune Hematologic. High Yield.
1. A patient with cirrhosis presents with ascites, jaundice, spider angiomas, palmar erythema, low albumin, elevated PT/INR, portal hypertension,
esophageal varices. What is pathophysiology?
A. Only acute
B. No cirrhosis
C. Cirrhosis chronic liver injury fibrosis nodule formation portal hypertension increased resistance, decreased synthetic function albumin clotting factors low,
impaired bilirubin conjugation jaundice, portal hypertension ascites varices splenomegaly, estrogen not metabolized spider angiomas palmar erythema
D. No portal HTN
Answer: C
Rationale: Cirrhosis chronic injury fibrosis nodules portal hypertension increased resistance decreased synthetic albumin clotting factors low PT/INR up
impaired bilirubin conjugation jaundice portal HTN ascites varices splenomegaly estrogen not metabolized spider palmar erythema.
2. A patient with peptic ulcer disease epigastric pain, H. pylori positive, NSAID use. Pathophysiology?
A. PUD imbalance aggressive factors acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin, H. pylori urease ammonia
inflammation
B. Only stress
C. No H. pylori
D. No ulcer
Answer: A
Rationale: PUD imbalance aggressive acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin H. pylori urease ammonia
inflammation.
3. A patient with cirrhosis presents with ascites, jaundice, spider angiomas, palmar erythema, low albumin, elevated PT/INR, portal hypertension,
esophageal varices. What is pathophysiology?
A. Cirrhosis chronic liver injury fibrosis nodule formation portal hypertension increased resistance, decreased synthetic function albumin clotting factors low,
impaired bilirubin conjugation jaundice, portal hypertension ascites varices splenomegaly, estrogen not metabolized spider angiomas palmar erythema
B. No cirrhosis
C. No portal HTN
D. Only acute
Answer: A
Rationale: Cirrhosis chronic injury fibrosis nodules portal hypertension increased resistance decreased synthetic albumin clotting factors low PT/INR up
impaired bilirubin conjugation jaundice portal HTN ascites varices splenomegaly estrogen not metabolized spider palmar erythema.
4. A patient with acute pancreatitis presents with severe epigastric pain radiating back, nausea vomiting, elevated lipase 3x normal, alcohol use.
What is pathophysiology?
A. Acute pancreatitis premature activation trypsin within pancreas autodigestion inflammation edema hemorrhage, alcohol gallstones cause duct obstruction,
systemic inflammatory response SIRS, lipase amylase elevated, risk hypocalcemia
B. Only gastritis
C. No pancreatitis
D. No autodigestion
Answer: A
Rationale: Acute pancreatitis premature activation trypsin autodigestion inflammation edema hemorrhage alcohol gallstones duct obstruction SIRS lipase
amylase elevated hypocalcemia fat necrosis.
5. A patient with peptic ulcer disease epigastric pain, H. pylori positive, NSAID use. Pathophysiology?
A. No ulcer
B. PUD imbalance aggressive factors acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin, H. pylori urease ammonia
inflammation
C. Only stress
D. No H. pylori
Answer: B
Rationale: PUD imbalance aggressive acid pepsin H. pylori NSAID decreased protective mucus bicarbonate prostaglandin H. pylori urease ammonia
inflammation.
6. A 45-year-old with polyuria, polydipsia, polyphagia, fasting glucose 210 mg/dL, HbA1c 9.2%, obesity, insulin resistance. What is pathophysiology
of type 2 diabetes?
A. Type 1 autoimmune beta cell destruction
B. Only type 1
C. No diabetes
D. Type 2 insulin resistance peripheral tissues decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative insulin deficiency
glucotoxicity lipotoxicity obesity inflammation
Answer: D
Rationale: Type 2 diabetes insulin resistance peripheral decreased glucose uptake liver increased gluconeogenesis beta cell dysfunction relative insulin
deficiency glucotoxicity lipotoxicity obesity inflammation.
7. A patient with acute pancreatitis presents with severe epigastric pain radiating back, nausea vomiting, elevated lipase 3x normal, alcohol use.
What is pathophysiology?
A. Only gastritis
B. No pancreatitis
,C. Acute pancreatitis premature activation trypsin within pancreas autodigestion inflammation edema hemorrhage, alcohol gallstones cause duct obstruction,
systemic inflammatory response SIRS, lipase amylase elevated, risk hypocalcemia
D. No autodigestion
Answer: C
Rationale: Acute pancreatitis premature activation trypsin autodigestion inflammation edema hemorrhage alcohol gallstones duct obstruction SIRS lipase
amylase elevated hypocalcemia fat necrosis.
8. A 25-year-old female with butterfly rash, joint pain, fatigue, positive ANA dsDNA, low C3 C4, proteinuria. What disease pathophysiology?
A. No autoimmune
B. Only osteoarthritis
C. RA
D. Systemic lupus erythematosus - autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive complement consumption low C3 C4,
inflammation multiple organs butterfly rash photosensitivity joint pain nephritis
Answer: D
Rationale: SLE autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive low C3 C4 inflammation butterfly rash photosensitivity
joint pain nephritis.
9. A patient with osteoarthritis knee pain worse activity morning <30 min crepitus no systemic. Pathophysiology?
A. RA
B. Only RA
C. No OA
D. OA degenerative wear tear cartilage loss decreased proteoglycan chondrocyte dysfunction osteophyte formation, non-inflammatory pain worse activity
morning <30 min crepitus no systemic
Answer: D
Rationale: OA degenerative cartilage loss decreased proteoglycan chondrocyte dysfunction osteophyte non-inflammatory pain worse activity morning <30 min
crepitus.
10. A 25-year-old female with butterfly rash, joint pain, fatigue, positive ANA dsDNA, low C3 C4, proteinuria. What disease pathophysiology?
A. Only osteoarthritis
B. No autoimmune
C. RA
D. Systemic lupus erythematosus - autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive complement consumption low C3 C4,
inflammation multiple organs butterfly rash photosensitivity joint pain nephritis
Answer: D
Rationale: SLE autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive low C3 C4 inflammation butterfly rash photosensitivity
joint pain nephritis.
11. A patient with hypothyroidism presents with fatigue, weight gain, cold intolerance, constipation, dry skin, elevated TSH low free T4. What is
pathophysiology?
A. No thyroid
B. Hypothyroidism Hashimoto autoimmune thyroiditis lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH feedback low free T4
C. Hyperthyroid
D. Only hyper
Answer: B
Rationale: Hypothyroidism Hashimoto autoimmune lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH low free T4.
12. A patient with acute pancreatitis presents with severe epigastric pain radiating back, nausea vomiting, elevated lipase 3x normal, alcohol use.
What is pathophysiology?
A. Only gastritis
B. Acute pancreatitis premature activation trypsin within pancreas autodigestion inflammation edema hemorrhage, alcohol gallstones cause duct obstruction,
systemic inflammatory response SIRS, lipase amylase elevated, risk hypocalcemia
C. No pancreatitis
D. No autodigestion
Answer: B
Rationale: Acute pancreatitis premature activation trypsin autodigestion inflammation edema hemorrhage alcohol gallstones duct obstruction SIRS lipase
amylase elevated hypocalcemia fat necrosis.
13. A 70-year-old with sudden unilateral weakness, facial droop, aphasia, CT shows ischemic stroke. What is pathophysiology?
A. Ischemic stroke thrombotic or embolic occlusion cerebral artery decreased cerebral blood flow <20 mL/100g/min ischemia, penumbra salvageable,
excitotoxicity glutamate calcium influx, cytotoxic edema, if >10 min infarction
B. No stroke
C. Hemorrhage only
D. Only hemorrhage
Answer: A
Rationale: Ischemic stroke thrombotic embolic occlusion decreased cerebral blood flow <20 mL/100g/min ischemia penumbra salvageable excitotoxicity
glutamate calcium influx cytotoxic edema infarction if >10 min.
14. A patient with nephritic syndrome presents with hematuria, proteinuria <3.5 g, hypertension, oliguria, RBC casts. What is pathophysiology?
A. Nephrotic only
, B. Only nephrotic
C. Nephritic - glomerular inflammation immune complex deposition decreased GFR sodium water retention HTN oliguria, RBC casts hematuria, proteinuria <3.5
g, example post-strep GN IgA nephropathy
D. No hematuria
Answer: C
Rationale: Nephritic glomerular inflammation immune complex decreased GFR Na water retention HTN oliguria RBC casts hematuria proteinuria <3.5 g
post-strep IgA.
15. A patient with hypothyroidism presents with fatigue, weight gain, cold intolerance, constipation, dry skin, elevated TSH low free T4. What is
pathophysiology?
A. No thyroid
B. Hyperthyroid
C. Only hyper
D. Hypothyroidism Hashimoto autoimmune thyroiditis lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH feedback low free T4
Answer: D
Rationale: Hypothyroidism Hashimoto autoimmune lymphocytic infiltration decreased T4 T3 decreased BMR fatigue weight gain cold intolerance constipation
dry skin elevated TSH low free T4.
16. A 25-year-old female with butterfly rash, joint pain, fatigue, positive ANA dsDNA, low C3 C4, proteinuria. What disease pathophysiology?
A. RA
B. No autoimmune
C. Systemic lupus erythematosus - autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive complement consumption low C3 C4,
inflammation multiple organs butterfly rash photosensitivity joint pain nephritis
D. Only osteoarthritis
Answer: C
Rationale: SLE autoimmune type III hypersensitivity immune complex deposition ANA dsDNA positive low C3 C4 inflammation butterfly rash photosensitivity
joint pain nephritis.
17. A patient with nephrotic syndrome presents with proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia. What is pathophysiology?
A. Only nephritic
B. No proteinuria
C. Nephritic hematuria HTN
D. Nephrotic - increased glomerular permeability loss negative charge podocyte injury proteinuria >3.5 g/day hypoalbuminemia decreased oncotic pressure
edema liver increased lipoprotein synthesis hyperlipidemia loss antithrombin III hypercoagulable
Answer: D
Rationale: Nephrotic increased glomerular permeability podocyte injury proteinuria >3.5 g hypoalbuminemia decreased oncotic edema hyperlipidemia liver
lipoprotein synthesis loss antithrombin III hypercoagulable.
18. A patient with asthma presents with episodic wheezing, dyspnea, cough, reversible obstruction, eosinophils, IgE elevated. Pathophysiology?
A. COPD fixed
B. No asthma
C. Only COPD
D. Asthma chronic airway inflammation Th2 eosinophils IgE mast cell histamine leukotrienes bronchoconstriction mucus hypersecretion airway
hyperresponsiveness reversible obstruction
Answer: D
Rationale: Asthma chronic inflammation Th2 eosinophils IgE mast cell histamine leukotrienes bronchoconstriction mucus hyperresponsiveness reversible.
19. A 70-year-old with sudden unilateral weakness, facial droop, aphasia, CT shows ischemic stroke. What is pathophysiology?
A. No stroke
B. Hemorrhage only
C. Only hemorrhage
D. Ischemic stroke thrombotic or embolic occlusion cerebral artery decreased cerebral blood flow <20 mL/100g/min ischemia, penumbra salvageable,
excitotoxicity glutamate calcium influx, cytotoxic edema, if >10 min infarction
Answer: D
Rationale: Ischemic stroke thrombotic embolic occlusion decreased cerebral blood flow <20 mL/100g/min ischemia penumbra salvageable excitotoxicity
glutamate calcium influx cytotoxic edema infarction if >10 min.
20. A patient with DKA presents with polyuria, polydipsia, nausea vomiting, abdominal pain, Kussmaul breathing, glucose 450 mg/dL, pH 7.1,
bicarbonate 8, ketones positive. Pathophysiology?
A. No acidosis
B. DKA absolute insulin deficiency increased glucagon increased lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis pH low
bicarbonate low Kussmaul compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration
C. Only HHNKS
D. HHNKS
Answer: B
Rationale: DKA absolute insulin deficiency increased glucagon lipolysis ketogenesis beta-hydroxybutyrate acetoacetate metabolic acidosis low pH low
bicarbonate Kussmaul compensation hyperglycemia osmotic diuresis polyuria polydipsia dehydration.
21. A 60-year-old male with long history smoking, chronic cough, increased sputum, barrel chest, prolonged expiration, wheezing, FEV1/FVC <0.70,
FEV1 55% predicted. What is pathophysiology?
