NSG 5003 – Advanced Pathophysiology Comprehensive
Exam Questions and Correct Answers (1–200)
1. What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage,
and coma in hypernatremia?
a) High sodium in the blood vessels pulls water out of the brain cells into the blood
vessels, causing brain cells to shrink
b) High sodium in the brain cells pulls water out of the blood vessels into the brain cells,
causing them to swell
c) High sodium in the blood vessels pulls potassium out of the brain cells, slowing
synaptic transmission
d) High sodium in the blood vessels draws chloride into the brain cells followed by water,
causing swelling
ANSWER-a)
Hypernatremia increases plasma osmolarity, causing water to move out of brain cells.
Cellular dehydration leads to neuronal shrinkage. This can tear cerebral vessels, resulting
in hemorrhage and severe neurologic symptoms.
2. A major determinant of the resting membrane potential necessary for nerve impulse
transmission is the ratio between:
a) Intracellular and extracellular sodium
b) Intracellular and extracellular potassium
c) Intracellular sodium and extracellular potassium
d) Intracellular potassium and extracellular sodium
ANSWER-b)
Potassium concentration gradients primarily determine resting membrane potential.
Potassium diffuses out of the cell more readily than sodium enters. This creates a
negative intracellular environment necessary for excitability.
3. In hyperkalemia, what change occurs to the cell’s resting membrane potential?
a) Hyperpolarization
b) Repolarization
c) Depolarization
d) Stabilization
ANSWER-c)
Elevated extracellular potassium reduces the potassium gradient. The resting membrane
potential becomes less negative. Persistent depolarization can impair conduction and
cause dysrhythmias.
4. Physiologic pH is maintained at approximately 7.4 because bicarbonate and carbonic acid
exist in a ratio of:
a) 20:1
b) 1:20
c) 10:2
d) 10:5
ANSWER-a)
, The bicarbonate buffer system regulates blood pH. A 20:1 ratio maintains physiologic
balance. The lungs regulate CO₂ while kidneys regulate bicarbonate.
5. Increased capillary hydrostatic pressure results in edema because of:
a) Decreased plasma albumin
b) Immune-mediated inflammation
c) Lymphatic obstruction
d) Sodium and water retention
ANSWER-d)
Sodium and water retention increase intravascular volume. This raises capillary
hydrostatic pressure. Fluid is forced into the interstitial space, producing edema.
6. Hypomethylation of oncogenes results in:
a) Decreased oncogene expression
b) Enhanced DNA repair
c) Increased tumor progression
d) Tumor suppression
ANSWER-c)
Hypomethylation increases gene transcription. When oncogenes are overexpressed, cell
proliferation becomes uncontrolled. This promotes malignant transformation.
7. The functions of MHC and CD1 molecules are alike because both:
a) Are antigen-presenting molecules
b) Bind antigens to antibodies
c) Secrete cytokines
d) Activate B lymphocytes
ANSWER-a)
Both MHC and CD1 present antigens to T cells. MHC presents peptide antigens, while
CD1 presents lipid antigens. Antigen presentation is essential for adaptive immunity.
8. The B-cell receptor complex functions uniquely by:
a) Activating cytotoxic T cells
b) Producing antibodies
c) Recognizing antigen on the B-cell surface
d) Secreting cytokines
ANSWER-c)
The B-cell receptor is a membrane-bound immunoglobulin. Its primary role is antigen
recognition. This interaction initiates B-cell activation and clonal expansion.
9. The generation of clonal diversity includes a process that:
a) Occurs in secondary lymphoid organs
b) Requires antigen exposure
c) Takes place in primary lymphoid organs
d) Causes antigen mutation
ANSWER-c)
Clonal diversity is generated during lymphocyte development. This occurs before antigen
exposure. Random gene rearrangement produces receptor variability.
10. Vaccinations provide long-term protection primarily through:
a) IgM production
b) IgG memory response
c) IgE activation
, d) IgA secretion
ANSWER-b)
Vaccines stimulate memory B cells. Upon re-exposure, IgG is rapidly produced. This
creates long-lasting immunity.
11. Type II hypersensitivity reactions occur when:
a) IgE binds mast cells
b) Immune complexes deposit in tissue
c) T cells attack host cells
d) Antibodies bind antigens on cell surfaces
ANSWER-d)
Type II reactions are antibody-mediated. Antibodies bind cell-surface antigens.
Complement activation or immune destruction follows.
12. Tissue damage from circulating immune complexes results primarily from:
a) Complement lysis
b) Macrophage phagocytosis
c) Splenic filtration
d) Neutrophil enzymes and oxidative products
ANSWER-d)
Immune complexes activate neutrophils. Degranulation releases enzymes and free
radicals. These substances damage surrounding tissues.
13. Which electrolyte imbalance is most likely to cause tetany?
a) Hyperkalemia
b) Hypernatremia
c) Hypocalcemia
d) Hypermagnesemia
ANSWER-c)
Low calcium increases neuromuscular excitability. This results in muscle spasms and
tetany. Chvostek and Trousseau signs are classic.
14. Respiratory acidosis is caused by:
a) Excess bicarbonate loss
b) Increased carbon dioxide retention
c) Excess acid intake
d) Hyperventilation
ANSWER-b)
Respiratory acidosis occurs when ventilation is inadequate. CO₂ retention increases
carbonic acid. Blood pH decreases.
15. Which organ is responsible for T-cell maturation?
a) Bone marrow
b) Spleen
c) Thymus
d) Lymph nodes
ANSWER-c)
T cells mature in the thymus. Self-reactive cells are eliminated. This ensures immune
tolerance.
16. Edema in nephrotic syndrome primarily results from:
a) Increased capillary permeability
, b) Decreased oncotic pressure
c) Lymphatic obstruction
d) Increased arterial pressure
ANSWER-b)
Protein loss in urine lowers plasma oncotic pressure. Fluid shifts into interstitial spaces.
Generalized edema results.
17. Which immunoglobulin crosses the placenta?
a) IgA
b) IgE
c) IgG
d) IgM
ANSWER-c)
IgG crosses the placenta to protect the fetus. It provides passive immunity. Protection
persists after birth.
18. Delayed-type hypersensitivity reactions are mediated by:
a) IgE
b) Immune complexes
c) T lymphocytes
d) Complement proteins
ANSWER-c)
These reactions are cell-mediated. T cells release cytokines that recruit macrophages.
Symptoms appear hours to days later.
19. Which condition commonly causes metabolic alkalosis?
a) Diarrhea
b) Renal failure
c) Prolonged vomiting
d) Hypoventilation
ANSWER-c)
Vomiting causes loss of gastric acid. Bicarbonate levels increase. This leads to metabolic
alkalosis.
20. Albumin contributes to fluid balance by:
a) Transporting oxygen
b) Activating platelets
c) Maintaining oncotic pressure
d) Regulating electrolytes
ANSWER-c)
Albumin retains fluid in the vascular compartment. Low levels cause fluid leakage.
Edema develops.
21. Which buffer system is most important in extracellular fluid?
a) Phosphate
b) Protein
c) Bicarbonate
d) Hemoglobin
ANSWER-c)
The bicarbonate buffer system maintains blood pH. It works with lungs and kidneys. This
system provides rapid regulation.
Exam Questions and Correct Answers (1–200)
1. What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage,
and coma in hypernatremia?
a) High sodium in the blood vessels pulls water out of the brain cells into the blood
vessels, causing brain cells to shrink
b) High sodium in the brain cells pulls water out of the blood vessels into the brain cells,
causing them to swell
c) High sodium in the blood vessels pulls potassium out of the brain cells, slowing
synaptic transmission
d) High sodium in the blood vessels draws chloride into the brain cells followed by water,
causing swelling
ANSWER-a)
Hypernatremia increases plasma osmolarity, causing water to move out of brain cells.
Cellular dehydration leads to neuronal shrinkage. This can tear cerebral vessels, resulting
in hemorrhage and severe neurologic symptoms.
2. A major determinant of the resting membrane potential necessary for nerve impulse
transmission is the ratio between:
a) Intracellular and extracellular sodium
b) Intracellular and extracellular potassium
c) Intracellular sodium and extracellular potassium
d) Intracellular potassium and extracellular sodium
ANSWER-b)
Potassium concentration gradients primarily determine resting membrane potential.
Potassium diffuses out of the cell more readily than sodium enters. This creates a
negative intracellular environment necessary for excitability.
3. In hyperkalemia, what change occurs to the cell’s resting membrane potential?
a) Hyperpolarization
b) Repolarization
c) Depolarization
d) Stabilization
ANSWER-c)
Elevated extracellular potassium reduces the potassium gradient. The resting membrane
potential becomes less negative. Persistent depolarization can impair conduction and
cause dysrhythmias.
4. Physiologic pH is maintained at approximately 7.4 because bicarbonate and carbonic acid
exist in a ratio of:
a) 20:1
b) 1:20
c) 10:2
d) 10:5
ANSWER-a)
, The bicarbonate buffer system regulates blood pH. A 20:1 ratio maintains physiologic
balance. The lungs regulate CO₂ while kidneys regulate bicarbonate.
5. Increased capillary hydrostatic pressure results in edema because of:
a) Decreased plasma albumin
b) Immune-mediated inflammation
c) Lymphatic obstruction
d) Sodium and water retention
ANSWER-d)
Sodium and water retention increase intravascular volume. This raises capillary
hydrostatic pressure. Fluid is forced into the interstitial space, producing edema.
6. Hypomethylation of oncogenes results in:
a) Decreased oncogene expression
b) Enhanced DNA repair
c) Increased tumor progression
d) Tumor suppression
ANSWER-c)
Hypomethylation increases gene transcription. When oncogenes are overexpressed, cell
proliferation becomes uncontrolled. This promotes malignant transformation.
7. The functions of MHC and CD1 molecules are alike because both:
a) Are antigen-presenting molecules
b) Bind antigens to antibodies
c) Secrete cytokines
d) Activate B lymphocytes
ANSWER-a)
Both MHC and CD1 present antigens to T cells. MHC presents peptide antigens, while
CD1 presents lipid antigens. Antigen presentation is essential for adaptive immunity.
8. The B-cell receptor complex functions uniquely by:
a) Activating cytotoxic T cells
b) Producing antibodies
c) Recognizing antigen on the B-cell surface
d) Secreting cytokines
ANSWER-c)
The B-cell receptor is a membrane-bound immunoglobulin. Its primary role is antigen
recognition. This interaction initiates B-cell activation and clonal expansion.
9. The generation of clonal diversity includes a process that:
a) Occurs in secondary lymphoid organs
b) Requires antigen exposure
c) Takes place in primary lymphoid organs
d) Causes antigen mutation
ANSWER-c)
Clonal diversity is generated during lymphocyte development. This occurs before antigen
exposure. Random gene rearrangement produces receptor variability.
10. Vaccinations provide long-term protection primarily through:
a) IgM production
b) IgG memory response
c) IgE activation
, d) IgA secretion
ANSWER-b)
Vaccines stimulate memory B cells. Upon re-exposure, IgG is rapidly produced. This
creates long-lasting immunity.
11. Type II hypersensitivity reactions occur when:
a) IgE binds mast cells
b) Immune complexes deposit in tissue
c) T cells attack host cells
d) Antibodies bind antigens on cell surfaces
ANSWER-d)
Type II reactions are antibody-mediated. Antibodies bind cell-surface antigens.
Complement activation or immune destruction follows.
12. Tissue damage from circulating immune complexes results primarily from:
a) Complement lysis
b) Macrophage phagocytosis
c) Splenic filtration
d) Neutrophil enzymes and oxidative products
ANSWER-d)
Immune complexes activate neutrophils. Degranulation releases enzymes and free
radicals. These substances damage surrounding tissues.
13. Which electrolyte imbalance is most likely to cause tetany?
a) Hyperkalemia
b) Hypernatremia
c) Hypocalcemia
d) Hypermagnesemia
ANSWER-c)
Low calcium increases neuromuscular excitability. This results in muscle spasms and
tetany. Chvostek and Trousseau signs are classic.
14. Respiratory acidosis is caused by:
a) Excess bicarbonate loss
b) Increased carbon dioxide retention
c) Excess acid intake
d) Hyperventilation
ANSWER-b)
Respiratory acidosis occurs when ventilation is inadequate. CO₂ retention increases
carbonic acid. Blood pH decreases.
15. Which organ is responsible for T-cell maturation?
a) Bone marrow
b) Spleen
c) Thymus
d) Lymph nodes
ANSWER-c)
T cells mature in the thymus. Self-reactive cells are eliminated. This ensures immune
tolerance.
16. Edema in nephrotic syndrome primarily results from:
a) Increased capillary permeability
, b) Decreased oncotic pressure
c) Lymphatic obstruction
d) Increased arterial pressure
ANSWER-b)
Protein loss in urine lowers plasma oncotic pressure. Fluid shifts into interstitial spaces.
Generalized edema results.
17. Which immunoglobulin crosses the placenta?
a) IgA
b) IgE
c) IgG
d) IgM
ANSWER-c)
IgG crosses the placenta to protect the fetus. It provides passive immunity. Protection
persists after birth.
18. Delayed-type hypersensitivity reactions are mediated by:
a) IgE
b) Immune complexes
c) T lymphocytes
d) Complement proteins
ANSWER-c)
These reactions are cell-mediated. T cells release cytokines that recruit macrophages.
Symptoms appear hours to days later.
19. Which condition commonly causes metabolic alkalosis?
a) Diarrhea
b) Renal failure
c) Prolonged vomiting
d) Hypoventilation
ANSWER-c)
Vomiting causes loss of gastric acid. Bicarbonate levels increase. This leads to metabolic
alkalosis.
20. Albumin contributes to fluid balance by:
a) Transporting oxygen
b) Activating platelets
c) Maintaining oncotic pressure
d) Regulating electrolytes
ANSWER-c)
Albumin retains fluid in the vascular compartment. Low levels cause fluid leakage.
Edema develops.
21. Which buffer system is most important in extracellular fluid?
a) Phosphate
b) Protein
c) Bicarbonate
d) Hemoglobin
ANSWER-c)
The bicarbonate buffer system maintains blood pH. It works with lungs and kidneys. This
system provides rapid regulation.
