NR-507 Advanced Pathophysiology – Week
8 Final Practice Exam actual exam 100%
latest 2026!!!!
Questions 1–10
Question 1
A 45-year-old male with alcohol use disorder presents with jaundice, ascites, and confusion. Labs show
elevated ammonia. Which mechanism best explains his confusion?
A) Accumulation of aromatic amino acids leading to false neurotransmitters
B) Direct hepatocyte necrosis causing decreased albumin synthesis
C) Increased conjugated bilirubin crossing the blood-brain barrier
D) Portal hypertension causing splenic sequestration of platelets
Correct Answer: A
• A (correct): In liver failure, ammonia enters the brain → converted to glutamine in astrocytes →
osmotic changes. Aromatic amino acids accumulate and form false neurotransmitters
(octopamine), contributing to hepatic encephalopathy.
• B (wrong): Decreased albumin causes ascites and edema but not confusion.
• C (wrong): Unconjugated bilirubin is neurotoxic (neonates); conjugated bilirubin does not cross
BBB.
• D (wrong): Portal hypertension causes splenomegaly/thrombocytopenia, not confusion.
Question 2
A 60-year-old female with rheumatoid arthritis has fatigue, pallor, and mild jaundice. Labs: Hgb 8.5,
elevated indirect bilirubin, elevated LDH, low haptoglobin. Which anemia?
A) Iron deficiency anemia
B) Anemia of chronic disease
C) Autoimmune hemolytic anemia
D) Megaloblastic anemia
,Correct Answer: C
• C (correct): Autoimmune hemolytic anemia is associated with RA. Hemolysis labs: indirect
hyperbilirubinemia, high LDH, low haptoglobin.
• A (wrong): Iron deficiency: low ferritin, high TIBC, no hemolysis.
• B (wrong): Anemia of chronic disease: low iron, low TIBC, normal bilirubin.
• D (wrong): Megaloblastic anemia: macrocytes, normal hemolysis labs.
Question 3
A 55-year-old male with CKD stage 4 has calcium 7.2 mg/dL, phosphorus 6.5 mg/dL, PTH 450 pg/mL.
Primary driver of elevated PTH?
A) Decreased renal 1-alpha-hydroxylase activity → low calcitriol
B) Primary hyperparathyroidism from adenoma
C) Vitamin D toxicity
D) Increased intestinal calcium absorption
Correct Answer: A
• A (correct): CKD → decreased 1-alpha-hydroxylase → low calcitriol → low intestinal Ca
absorption → hypocalcemia → secondary hyperparathyroidism.
• B (wrong): Primary hyperparathyroidism causes high calcium.
• C (wrong): Vitamin D toxicity causes hypercalcemia.
• D (wrong): Intestinal calcium absorption is decreased, not increased.
Question 4
Pathophysiology of type 1 diabetes mellitus?
A) Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency
B) Insulin resistance with compensatory hyperinsulinemia
C) Genetic mutation in insulin receptor gene
D) Autoantibodies against insulin itself
Correct Answer: A
• A (correct): Type 1 DM is autoimmune beta-cell destruction → absolute insulin deficiency.
• B (wrong): Describes type 2 DM.
• C (wrong): Insulin receptor mutations are rare (type A insulin resistance).
• D (wrong): Anti-insulin antibodies are markers, not primary cause.
,Question 5
A 72-year-old male smoker with dyspnea, barrel-shaped chest. PFT: FEV1/FVC <0.70, low DLCO,
hyperinflation. Which explains low DLCO?
A) Loss of alveolar-capillary surface area from emphysema
B) Mucus plugging of small airways
C) Hypertrophy of bronchial smooth muscle
D) Fibrosis of interstitium
Correct Answer: A
• A (correct): Emphysema destroys alveolar walls → loss of capillary bed → reduced DLCO.
• B (wrong): Mucus plugging causes obstruction, not low DLCO.
• C (wrong): Smooth muscle hypertrophy occurs in asthma.
• D (wrong): Interstitial fibrosis also lowers DLCO but describes ILD, not emphysema.
Question 6
A 30-year-old female with fatigue, weight gain, cold intolerance. TSH 12.5, free T4 0.6, anti-TPO positive.
Diagnosis?
A) Hashimoto thyroiditis
B) Graves’ disease
C) Subacute thyroiditis
D) Euthyroid sick syndrome
Correct Answer: A
• A (correct): Hashimoto: autoimmune hypothyroidism, high TSH, low T4, positive anti-TPO.
• B (wrong): Graves causes hyperthyroidism (low TSH, high T4).
• C (wrong): Subacute thyroiditis: transient hyper then hypo, often neck pain.
• D (wrong): Euthyroid sick syndrome: acute illness, low T3, normal/low TSH, no anti-TPO.
Question 7
A 65-year-old male with HTN and DM has sudden severe tearing chest pain radiating to back. BP
180/100 (R arm), 100/60 (L arm). Most likely?
A) Acute MI
B) Pulmonary embolism
, C) Aortic dissection
D) Pericarditis
Correct Answer: C
• C (correct): Aortic dissection: tearing pain, pulse deficits, BP differential.
• A (wrong): MI pain is pressure-like, no pulse deficit.
• B (wrong): PE: sudden dyspnea, pleuritic pain, hypoxia.
• D (wrong): Pericarditis: sharp positional pain, improves leaning forward.
Question 8
A 25-year-old male with sickle cell disease has acute chest pain, fever, hypoxemia, new infiltrate on CXR.
Primary pathophysiology?
A) Vaso-occlusion of pulmonary microvasculature by sickled RBCs
B) Fat embolism from bone marrow necrosis
C) Iron overload causing restrictive lung disease
D) Autoimmune pulmonary capillaritis
Correct Answer: A
• A (correct): Acute chest syndrome = vaso-occlusion in pulmonary vessels → infarction,
inflammation, secondary infection.
• B (wrong): Fat embolism can occur but is not primary.
• C (wrong): Iron overload causes chronic damage, not acute.
• D (wrong): Not autoimmune.
Question 9
A 40-year-old female with episodic headache, palpitations, sweating, severe hypertension. Elevated
plasma metanephrines. CT: 4 cm adrenal mass. Diagnosis?
A) Pheochromocytoma
B) Adrenocortical carcinoma
C) Aldosteronoma
D) Myelolipoma
Correct Answer: A
• A (correct): Pheochromocytoma secretes catecholamines → episodic HTN, headache,
palpitations, diaphoresis. Elevated metanephrines confirm.
• B (wrong): Adrenocortical carcinoma secretes cortisol/androgens, not episodic symptoms.
8 Final Practice Exam actual exam 100%
latest 2026!!!!
Questions 1–10
Question 1
A 45-year-old male with alcohol use disorder presents with jaundice, ascites, and confusion. Labs show
elevated ammonia. Which mechanism best explains his confusion?
A) Accumulation of aromatic amino acids leading to false neurotransmitters
B) Direct hepatocyte necrosis causing decreased albumin synthesis
C) Increased conjugated bilirubin crossing the blood-brain barrier
D) Portal hypertension causing splenic sequestration of platelets
Correct Answer: A
• A (correct): In liver failure, ammonia enters the brain → converted to glutamine in astrocytes →
osmotic changes. Aromatic amino acids accumulate and form false neurotransmitters
(octopamine), contributing to hepatic encephalopathy.
• B (wrong): Decreased albumin causes ascites and edema but not confusion.
• C (wrong): Unconjugated bilirubin is neurotoxic (neonates); conjugated bilirubin does not cross
BBB.
• D (wrong): Portal hypertension causes splenomegaly/thrombocytopenia, not confusion.
Question 2
A 60-year-old female with rheumatoid arthritis has fatigue, pallor, and mild jaundice. Labs: Hgb 8.5,
elevated indirect bilirubin, elevated LDH, low haptoglobin. Which anemia?
A) Iron deficiency anemia
B) Anemia of chronic disease
C) Autoimmune hemolytic anemia
D) Megaloblastic anemia
,Correct Answer: C
• C (correct): Autoimmune hemolytic anemia is associated with RA. Hemolysis labs: indirect
hyperbilirubinemia, high LDH, low haptoglobin.
• A (wrong): Iron deficiency: low ferritin, high TIBC, no hemolysis.
• B (wrong): Anemia of chronic disease: low iron, low TIBC, normal bilirubin.
• D (wrong): Megaloblastic anemia: macrocytes, normal hemolysis labs.
Question 3
A 55-year-old male with CKD stage 4 has calcium 7.2 mg/dL, phosphorus 6.5 mg/dL, PTH 450 pg/mL.
Primary driver of elevated PTH?
A) Decreased renal 1-alpha-hydroxylase activity → low calcitriol
B) Primary hyperparathyroidism from adenoma
C) Vitamin D toxicity
D) Increased intestinal calcium absorption
Correct Answer: A
• A (correct): CKD → decreased 1-alpha-hydroxylase → low calcitriol → low intestinal Ca
absorption → hypocalcemia → secondary hyperparathyroidism.
• B (wrong): Primary hyperparathyroidism causes high calcium.
• C (wrong): Vitamin D toxicity causes hypercalcemia.
• D (wrong): Intestinal calcium absorption is decreased, not increased.
Question 4
Pathophysiology of type 1 diabetes mellitus?
A) Autoimmune destruction of pancreatic beta cells → absolute insulin deficiency
B) Insulin resistance with compensatory hyperinsulinemia
C) Genetic mutation in insulin receptor gene
D) Autoantibodies against insulin itself
Correct Answer: A
• A (correct): Type 1 DM is autoimmune beta-cell destruction → absolute insulin deficiency.
• B (wrong): Describes type 2 DM.
• C (wrong): Insulin receptor mutations are rare (type A insulin resistance).
• D (wrong): Anti-insulin antibodies are markers, not primary cause.
,Question 5
A 72-year-old male smoker with dyspnea, barrel-shaped chest. PFT: FEV1/FVC <0.70, low DLCO,
hyperinflation. Which explains low DLCO?
A) Loss of alveolar-capillary surface area from emphysema
B) Mucus plugging of small airways
C) Hypertrophy of bronchial smooth muscle
D) Fibrosis of interstitium
Correct Answer: A
• A (correct): Emphysema destroys alveolar walls → loss of capillary bed → reduced DLCO.
• B (wrong): Mucus plugging causes obstruction, not low DLCO.
• C (wrong): Smooth muscle hypertrophy occurs in asthma.
• D (wrong): Interstitial fibrosis also lowers DLCO but describes ILD, not emphysema.
Question 6
A 30-year-old female with fatigue, weight gain, cold intolerance. TSH 12.5, free T4 0.6, anti-TPO positive.
Diagnosis?
A) Hashimoto thyroiditis
B) Graves’ disease
C) Subacute thyroiditis
D) Euthyroid sick syndrome
Correct Answer: A
• A (correct): Hashimoto: autoimmune hypothyroidism, high TSH, low T4, positive anti-TPO.
• B (wrong): Graves causes hyperthyroidism (low TSH, high T4).
• C (wrong): Subacute thyroiditis: transient hyper then hypo, often neck pain.
• D (wrong): Euthyroid sick syndrome: acute illness, low T3, normal/low TSH, no anti-TPO.
Question 7
A 65-year-old male with HTN and DM has sudden severe tearing chest pain radiating to back. BP
180/100 (R arm), 100/60 (L arm). Most likely?
A) Acute MI
B) Pulmonary embolism
, C) Aortic dissection
D) Pericarditis
Correct Answer: C
• C (correct): Aortic dissection: tearing pain, pulse deficits, BP differential.
• A (wrong): MI pain is pressure-like, no pulse deficit.
• B (wrong): PE: sudden dyspnea, pleuritic pain, hypoxia.
• D (wrong): Pericarditis: sharp positional pain, improves leaning forward.
Question 8
A 25-year-old male with sickle cell disease has acute chest pain, fever, hypoxemia, new infiltrate on CXR.
Primary pathophysiology?
A) Vaso-occlusion of pulmonary microvasculature by sickled RBCs
B) Fat embolism from bone marrow necrosis
C) Iron overload causing restrictive lung disease
D) Autoimmune pulmonary capillaritis
Correct Answer: A
• A (correct): Acute chest syndrome = vaso-occlusion in pulmonary vessels → infarction,
inflammation, secondary infection.
• B (wrong): Fat embolism can occur but is not primary.
• C (wrong): Iron overload causes chronic damage, not acute.
• D (wrong): Not autoimmune.
Question 9
A 40-year-old female with episodic headache, palpitations, sweating, severe hypertension. Elevated
plasma metanephrines. CT: 4 cm adrenal mass. Diagnosis?
A) Pheochromocytoma
B) Adrenocortical carcinoma
C) Aldosteronoma
D) Myelolipoma
Correct Answer: A
• A (correct): Pheochromocytoma secretes catecholamines → episodic HTN, headache,
palpitations, diaphoresis. Elevated metanephrines confirm.
• B (wrong): Adrenocortical carcinoma secretes cortisol/androgens, not episodic symptoms.
