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Actual QUESTIONS WITH ANSWERS AND
RATIONALES
Kinds of topics NR607 (Advanced Pathophysiology / differential diagnosis & clinical
reasoning) typically emphasizes:
Core pathophysiology mechanisms
Cardiopulmonary, renal, GI, endocrine, neuro, hematology, immunology
Common primary care presentations and red flags
Interpretation of basic labs and diagnostics
Application of disease processes to case vignettes
Format: single best answer, with the correct option in bold and a brief rationale. Use this
as a study aid only, not as the real exam.
Foundational Pathophysiology & General Concepts (Q1–20)
1. A patient with chronic hypoxia from COPD is found to have an elevated
hemoglobin level. Which adaptive mechanism best explains this finding?
A. Increased erythropoietin production by the kidney
B. Increased erythropoietin production by the kidney stimulating erythropoiesis
C. Decreased plasma volume causing relative polycythemia only
D. Bone marrow neoplastic transformation
Chronic hypoxia increases renal EPO, driving RBC production.
,2. Which of the following best describes the primary injury in ischemic cell
damage?
A. Excess oxygen delivery to tissues
B. ATP depletion leading to failure of ion pumps and cellular swelling
C. Immediate apoptosis without inflammation
D. Increased protein synthesis
Ischemia reduces oxidative phosphorylation → ATP depletion → Na⁺/K⁺ pump
failure → swelling.
3. A patient has a systemic inflammatory response with fever, tachycardia, and
leukocytosis. Which mediator is most directly responsible for resetting the
hypothalamic set point?
A. Histamine
B. Prostaglandin E₂ (PGE₂)
C. Bradykinin
D. Serotonin
PGE₂ acts on the hypothalamus to raise the temperature set point.
4. Which of the following best distinguishes apoptosis from necrosis?
A. Apoptosis always triggers significant inflammation
B. Apoptosis is programmed cell death with cell shrinkage and minimal
,inflammation
C. Necrosis is always physiologic and controlled
D. Necrosis involves caspase activation only
Apoptosis is controlled, non-inflammatory; necrosis is pathologic and
inflammatory.
5. A patient has chronic exposure to high levels of gastric acid due to a
gastrin-secreting tumor. Which type of cellular adaptation is most likely in the
gastric mucosa?
A. Atrophy
B. Hyperplasia
C. Metaplasia only
D. Dysplasia only
Increased stimulation can cause hyperplasia of acid-secreting cells.
6. A patient with long-standing hypertension develops left ventricular
hypertrophy. Which type of adaptation is this?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Cardiac myocytes enlarge (hypertrophy) in response to increased workload.
, 7. A chronic smoker’s bronchial epithelium changes from ciliated columnar to
stratified squamous. Which adaptation is this?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Reversible change to a more resistant cell type is metaplasia.
8. Which of the following best describes the role of free radicals in cell injury?
A. They stabilize cell membranes
B. They damage lipids, proteins, and DNA via oxidative stress
C. They enhance ATP production
D. They reduce inflammation
Free radicals cause lipid peroxidation and macromolecular damage.
9. A patient has a deep vein thrombosis. Which of Virchow’s triad components
is most implicated when the patient has been immobilized after surgery?
A. Endothelial injury only
B. Stasis of blood flow
C. Hypercoagulability only
D. Increased fibrinolysis