Updated for 2026-2027
NR 507 ADVANCED PATHOPHYSIOLOGY FINAL EXAM ,100%
CORRECT QUESTIONS (CARDIAC, PULMONARY, RENAL &
HEMATOLOGY) [2026-2027, ALREADY GRADED A+
1. Cardiac
A 58-year-old man with hypertension and long-standing coronary artery disease
presents with exertional chest pain. His ECG shows ST depression during exercise
that resolves with rest. Which pathophysiologic mechanism best explains his
symptoms?
A) Coronary artery spasm reducing blood flow at rest
B) Fixed atherosclerotic narrowing preventing adequate blood flow during exertion
C) Myocardial oxygen demand decreased by sympathetic activation
D) Sudden thrombus formation causing complete coronary occlusion
Answer: B.
Stable angina is caused by fixed atherosclerotic narrowing that limits blood flow
during exertion but improves at rest.
2. Pulmonary
A patient with COPD has chronic hypoxemia, elevated hematocrit, and digital
clubbing. Which mechanism best explains the increased red blood cell count?
A) Destruction of alveolar walls increasing carbon dioxide retention
B) Stimulation of erythropoietin by the kidneys due to chronic hypoxia
C) Direct stimulation of bone marrow by carbon dioxide
D) Inflammatory cytokines increasing megakaryocyte activity
Answer: B.
Chronic hypoxia stimulates the kidney to release erythropoietin, leading to
secondary polycythemia.
,Updated for 2026-2027
3. Hematology
A 35-year-old woman presents with fatigue and pallor. Labs show: Hgb 8.9 g/dL,
MCV 72 fL, ferritin low, TIBC high. Which pathophysiology explains her
condition?
A) Impaired heme synthesis due to iron deficiency
B) Failure of intrinsic factor production leading to B12 deficiency
C) Suppressed erythropoietin production from chronic kidney disease
D) Autoimmune hemolysis destroying mature red blood cells
Answer: A.
Low ferritin and microcytosis are classic for iron deficiency anemia due to
impaired heme synthesis.
4. Renal
A patient with advanced chronic kidney disease presents with pruritus, fatigue, and
metabolic acidosis. Which mechanism best explains the acidosis?
A) Increased renal bicarbonate reabsorption
B) Failure to excrete hydrogen ions and reabsorb bicarbonate
C) Increased aldosterone secretion leading to acid loss
D) Decreased carbon dioxide excretion by the lungs
Answer: B.
Kidneys fail to excrete H+ and regenerate bicarbonate, leading to metabolic
acidosis.
5. Cardiac
A 65-year-old woman presents with shortness of breath, orthopnea, and bilateral
crackles. Echocardiography reveals reduced ejection fraction. Which physiologic
change occurs in systolic heart failure?
A) Increased contractility with reduced preload
B) Reduced contractility and increased left ventricular end-diastolic volume
C) Normal stroke volume but impaired filling
D) Hyperdynamic ejection due to outflow obstruction
,Updated for 2026-2027
Answer: B.
Systolic HF is characterized by impaired contractility, decreased EF, and increased
LVEDV.
6. Pulmonary
A 30-year-old man presents with sudden-onset pleuritic chest pain and dyspnea
after a long flight. V/Q scan shows mismatch. What is the underlying
pathophysiology?
A) Decreased surfactant production impairing alveolar expansion
B) Embolus obstructing pulmonary artery blood flow
C) Increased bronchoconstriction narrowing airways
D) Diffuse alveolar damage leading to impaired diffusion
Answer: B.
Pulmonary embolism blocks perfusion, causing ventilation–perfusion mismatch.
7. Hematology
A 72-year-old male with atrial fibrillation is on warfarin and presents with
bleeding gums. INR is elevated. Which pathophysiologic mechanism explains his
bleeding?
A) Platelet dysfunction due to decreased prostaglandin production
B) Reduced vitamin K–dependent clotting factor synthesis in the liver
C) Increased fibrinolysis by plasmin activation
D) Autoimmune destruction of clotting factors
Answer: B.
Warfarin inhibits vitamin K–dependent clotting factor synthesis, prolonging INR.
8. Renal
A patient with diabetic nephropathy presents with proteinuria and peripheral
edema. Which structural change in the kidney explains the proteinuria?
A) Loss of tubular secretion of proteins
, Updated for 2026-2027
B) Thickening and increased permeability of the glomerular basement membrane
C) Hyperactivity of podocytes blocking filtration
D) Increased absorption of protein in the proximal tubule
Answer: B.
Diabetic nephropathy damages the GBM, increasing permeability and causing
proteinuria.
9. Cardiac
A 44-year-old woman with untreated hypertension develops concentric left
ventricular hypertrophy. Which mechanism causes this hypertrophy?
A) Volume overload increasing ventricular filling
B) Pressure overload increasing afterload
C) Sympathetic blockade decreasing myocardial demand
D) Decreased preload reducing wall stress
Answer: B.
Hypertension increases afterload, leading to concentric hypertrophy.
10. Pulmonary
A neonate born prematurely at 28 weeks develops respiratory distress syndrome.
Which deficiency is the primary cause?
A) Hemoglobin F
B) Surfactant
C) Type I pneumocytes
D) Mucus-secreting goblet cells
Answer: B.
Premature infants have insufficient surfactant, leading to alveolar collapse.
11. Hematology
A 60-year-old woman undergoing chemotherapy develops pancytopenia. Which
mechanism best explains the low blood counts?
NR 507 ADVANCED PATHOPHYSIOLOGY FINAL EXAM ,100%
CORRECT QUESTIONS (CARDIAC, PULMONARY, RENAL &
HEMATOLOGY) [2026-2027, ALREADY GRADED A+
1. Cardiac
A 58-year-old man with hypertension and long-standing coronary artery disease
presents with exertional chest pain. His ECG shows ST depression during exercise
that resolves with rest. Which pathophysiologic mechanism best explains his
symptoms?
A) Coronary artery spasm reducing blood flow at rest
B) Fixed atherosclerotic narrowing preventing adequate blood flow during exertion
C) Myocardial oxygen demand decreased by sympathetic activation
D) Sudden thrombus formation causing complete coronary occlusion
Answer: B.
Stable angina is caused by fixed atherosclerotic narrowing that limits blood flow
during exertion but improves at rest.
2. Pulmonary
A patient with COPD has chronic hypoxemia, elevated hematocrit, and digital
clubbing. Which mechanism best explains the increased red blood cell count?
A) Destruction of alveolar walls increasing carbon dioxide retention
B) Stimulation of erythropoietin by the kidneys due to chronic hypoxia
C) Direct stimulation of bone marrow by carbon dioxide
D) Inflammatory cytokines increasing megakaryocyte activity
Answer: B.
Chronic hypoxia stimulates the kidney to release erythropoietin, leading to
secondary polycythemia.
,Updated for 2026-2027
3. Hematology
A 35-year-old woman presents with fatigue and pallor. Labs show: Hgb 8.9 g/dL,
MCV 72 fL, ferritin low, TIBC high. Which pathophysiology explains her
condition?
A) Impaired heme synthesis due to iron deficiency
B) Failure of intrinsic factor production leading to B12 deficiency
C) Suppressed erythropoietin production from chronic kidney disease
D) Autoimmune hemolysis destroying mature red blood cells
Answer: A.
Low ferritin and microcytosis are classic for iron deficiency anemia due to
impaired heme synthesis.
4. Renal
A patient with advanced chronic kidney disease presents with pruritus, fatigue, and
metabolic acidosis. Which mechanism best explains the acidosis?
A) Increased renal bicarbonate reabsorption
B) Failure to excrete hydrogen ions and reabsorb bicarbonate
C) Increased aldosterone secretion leading to acid loss
D) Decreased carbon dioxide excretion by the lungs
Answer: B.
Kidneys fail to excrete H+ and regenerate bicarbonate, leading to metabolic
acidosis.
5. Cardiac
A 65-year-old woman presents with shortness of breath, orthopnea, and bilateral
crackles. Echocardiography reveals reduced ejection fraction. Which physiologic
change occurs in systolic heart failure?
A) Increased contractility with reduced preload
B) Reduced contractility and increased left ventricular end-diastolic volume
C) Normal stroke volume but impaired filling
D) Hyperdynamic ejection due to outflow obstruction
,Updated for 2026-2027
Answer: B.
Systolic HF is characterized by impaired contractility, decreased EF, and increased
LVEDV.
6. Pulmonary
A 30-year-old man presents with sudden-onset pleuritic chest pain and dyspnea
after a long flight. V/Q scan shows mismatch. What is the underlying
pathophysiology?
A) Decreased surfactant production impairing alveolar expansion
B) Embolus obstructing pulmonary artery blood flow
C) Increased bronchoconstriction narrowing airways
D) Diffuse alveolar damage leading to impaired diffusion
Answer: B.
Pulmonary embolism blocks perfusion, causing ventilation–perfusion mismatch.
7. Hematology
A 72-year-old male with atrial fibrillation is on warfarin and presents with
bleeding gums. INR is elevated. Which pathophysiologic mechanism explains his
bleeding?
A) Platelet dysfunction due to decreased prostaglandin production
B) Reduced vitamin K–dependent clotting factor synthesis in the liver
C) Increased fibrinolysis by plasmin activation
D) Autoimmune destruction of clotting factors
Answer: B.
Warfarin inhibits vitamin K–dependent clotting factor synthesis, prolonging INR.
8. Renal
A patient with diabetic nephropathy presents with proteinuria and peripheral
edema. Which structural change in the kidney explains the proteinuria?
A) Loss of tubular secretion of proteins
, Updated for 2026-2027
B) Thickening and increased permeability of the glomerular basement membrane
C) Hyperactivity of podocytes blocking filtration
D) Increased absorption of protein in the proximal tubule
Answer: B.
Diabetic nephropathy damages the GBM, increasing permeability and causing
proteinuria.
9. Cardiac
A 44-year-old woman with untreated hypertension develops concentric left
ventricular hypertrophy. Which mechanism causes this hypertrophy?
A) Volume overload increasing ventricular filling
B) Pressure overload increasing afterload
C) Sympathetic blockade decreasing myocardial demand
D) Decreased preload reducing wall stress
Answer: B.
Hypertension increases afterload, leading to concentric hypertrophy.
10. Pulmonary
A neonate born prematurely at 28 weeks develops respiratory distress syndrome.
Which deficiency is the primary cause?
A) Hemoglobin F
B) Surfactant
C) Type I pneumocytes
D) Mucus-secreting goblet cells
Answer: B.
Premature infants have insufficient surfactant, leading to alveolar collapse.
11. Hematology
A 60-year-old woman undergoing chemotherapy develops pancytopenia. Which
mechanism best explains the low blood counts?
