D115 NURS 5800
Advanced Pathophysiology
Final Assessment Review
(With Solutions)
2025
1
,1. A 56-year-old man with septic shock develops petechiae, oozing
from IV sites, and prolonged PT/aPTT. Which mechanism best
explains his coagulopathy?
a. Primary fibrinolysis
b. Depletion of clotting factors due to widespread microthrombi
c. Hepatic insufficiency leading to reduced synthesis of clotting
factors
d. Immune complex–mediated platelet destruction
ANS: b. Depletion of clotting factors due to widespread
microthrombi
Rationale: In sepsis-induced DIC, systemic activation of
coagulation consumes platelets and clotting factors, producing
bleeding despite microvascular thromboses.
2. A patient with ARDS on 100% FiO₂ remains hypoxemic. What
primary pathophysiologic change explains this refractory hypoxemia?
a. Increased shunt fraction
b. Elevated dead space ventilation
c. Alveolar hyperinflation
d. Reduced respiratory drive
ANS: a. Increased shunt fraction
Rationale: In ARDS, non-ventilated but perfused alveoli create a
right-to-left shunt that cannot be corrected by increasing FiO₂.
3. A diabetic patient in DKA has a serum bicarbonate of 8 mEq/L, pH
7.25. Which compensatory response would you expect?
a. Increased PaCO₂
b. Decreased respiratory rate
c. Kussmaul respirations
d. Renal retention of H⁺
2
, ANS: c. Kussmaul respirations
Rationale: Metabolic acidosis triggers hyperventilation (Kussmaul
breathing) to lower PaCO₂ and partially compensate for acidosis.
4. A cirrhotic patient develops hepatorenal syndrome. Which feature
predominates?
a. Intrinsic tubular necrosis
b. Hypovolemia
c. Splanchnic vasodilation with renal vasoconstriction
d. Immune-mediated glomerulonephritis
ANS: c. Splanchnic vasodilation with renal vasoconstriction
Rationale: Portal hypertension induces vasodilatory mediators in
splanchnic circulation, reducing effective renal perfusion and
causing functional renal failure.
5. A spinal cord injury at T6 triggers sudden hypertension,
bradycardia, and headache. What is the most likely cause?
a. Autonomic dysreflexia
b. Neurogenic shock
c. Orthostatic hypotension
d. Vasovagal syncope
ANS: a. Autonomic dysreflexia
Rationale: In SCI above T6, noxious stimuli below the injury
provoke unopposed sympathetic vasoconstriction, causing
hypertension and reflex bradycardia.
6. A patient with myasthenia gravis reports worsened muscle
weakness after receiving a flu vaccine. Which pathophysiologic
phenomenon explains this?
a. Immune complex deposition at the neuromuscular junction
b. Molecular mimicry augmenting anti-AChR antibody production
c. Direct viral invasion of motor neurons
3
Advanced Pathophysiology
Final Assessment Review
(With Solutions)
2025
1
,1. A 56-year-old man with septic shock develops petechiae, oozing
from IV sites, and prolonged PT/aPTT. Which mechanism best
explains his coagulopathy?
a. Primary fibrinolysis
b. Depletion of clotting factors due to widespread microthrombi
c. Hepatic insufficiency leading to reduced synthesis of clotting
factors
d. Immune complex–mediated platelet destruction
ANS: b. Depletion of clotting factors due to widespread
microthrombi
Rationale: In sepsis-induced DIC, systemic activation of
coagulation consumes platelets and clotting factors, producing
bleeding despite microvascular thromboses.
2. A patient with ARDS on 100% FiO₂ remains hypoxemic. What
primary pathophysiologic change explains this refractory hypoxemia?
a. Increased shunt fraction
b. Elevated dead space ventilation
c. Alveolar hyperinflation
d. Reduced respiratory drive
ANS: a. Increased shunt fraction
Rationale: In ARDS, non-ventilated but perfused alveoli create a
right-to-left shunt that cannot be corrected by increasing FiO₂.
3. A diabetic patient in DKA has a serum bicarbonate of 8 mEq/L, pH
7.25. Which compensatory response would you expect?
a. Increased PaCO₂
b. Decreased respiratory rate
c. Kussmaul respirations
d. Renal retention of H⁺
2
, ANS: c. Kussmaul respirations
Rationale: Metabolic acidosis triggers hyperventilation (Kussmaul
breathing) to lower PaCO₂ and partially compensate for acidosis.
4. A cirrhotic patient develops hepatorenal syndrome. Which feature
predominates?
a. Intrinsic tubular necrosis
b. Hypovolemia
c. Splanchnic vasodilation with renal vasoconstriction
d. Immune-mediated glomerulonephritis
ANS: c. Splanchnic vasodilation with renal vasoconstriction
Rationale: Portal hypertension induces vasodilatory mediators in
splanchnic circulation, reducing effective renal perfusion and
causing functional renal failure.
5. A spinal cord injury at T6 triggers sudden hypertension,
bradycardia, and headache. What is the most likely cause?
a. Autonomic dysreflexia
b. Neurogenic shock
c. Orthostatic hypotension
d. Vasovagal syncope
ANS: a. Autonomic dysreflexia
Rationale: In SCI above T6, noxious stimuli below the injury
provoke unopposed sympathetic vasoconstriction, causing
hypertension and reflex bradycardia.
6. A patient with myasthenia gravis reports worsened muscle
weakness after receiving a flu vaccine. Which pathophysiologic
phenomenon explains this?
a. Immune complex deposition at the neuromuscular junction
b. Molecular mimicry augmenting anti-AChR antibody production
c. Direct viral invasion of motor neurons
3
