Clarkson College
Course Number: NRS 205
Course Title: Pathophysiology & Pharmacology
Exam: Midterm Exam
Date:2026
- Multiple Choice: A 68‑year‑old patient with long‑standing hypertension presents
with sudden left‑sided weakness and aphasia. CT shows an ischemic infarct in the
right middle cerebral artery territory. Which pathophysiologic mechanism most likely
produced the focal neurologic deficit?
Answer: Thromboembolic occlusion of a cortical branch of the MCA.
Rationale: Focal deficits in an MCA distribution are classically due to arterial
occlusion from thrombus or embolus; hypertension predisposes to atherosclerotic
plaque formation and thromboembolism causing ischemia in cortical territories.
- True/False: In septic shock, peripheral vasodilation and increased capillary
permeability are primarily mediated by excessive nitric oxide production and
inflammatory cytokines. True .
Rationale: Sepsis triggers inducible nitric oxide synthase and cytokines (TNF‑α,
IL‑1, IL‑6) causing vasodilation, endothelial dysfunction, and capillary leak leading
to distributive shock physiology.
- Fill in the Blank: In diabetic ketoacidosis (DKA), the primary acid‑base
disturbance is _________ metabolic acidosis with an increased anion gap.
Answer: high‑anion‑gap
Rationale: DKA produces accumulation of ketoacids (β‑hydroxybutyrate,
acetoacetate), causing a high‑anion‑gap metabolic acidosis.
- Multiple Choice: A patient with chronic obstructive pulmonary disease (COPD)
has chronic CO₂ retention and compensatory metabolic changes. Which arterial
blood gas pattern is most consistent with compensated chronic respiratory
acidosis?
A. Low PaCO₂, low HCO₃⁻
B. High PaCO₂, high HCO₃⁻
C. High PaCO₂, low HCO₃⁻
D. Normal PaCO₂, normal HCO₃⁻
Answer: B. High PaCO₂, high HCO₃⁻.
Rationale: Chronic CO₂ retention raises PaCO₂; renal compensation increases
HCO₃⁻ over days to weeks, producing elevated bicarbonate with hypercapnia.
,- True/False: Acute respiratory distress syndrome (ARDS) is characterized by
noncardiogenic pulmonary edema due to increased alveolar‑capillary permeability.
True .
Rationale: ARDS results from diffuse alveolar injury, increased permeability,
protein‑rich edema, and impaired gas exchange without primary left heart failure.
- Fill in the Blank: The hallmark histologic lesion of chronic hypertension in small
renal arteries and arterioles is _________ arteriolosclerosis (hyaline or
hyperplastic).
Answer: hyaline
Rationale: Longstanding benign hypertension causes hyaline arteriolosclerosis
with homogeneous pink hyaline thickening and luminal narrowing; malignant
hypertension causes hyperplastic changes.
- Multiple Choice: Which mechanism best explains hyperkalemia in acute kidney
injury (AKI)?
A. Increased aldosterone secretion
B. Decreased renal excretion of potassium
C. Increased cellular uptake of potassium
D. Enhanced gastrointestinal loss of potassium
Answer: B. Decreased renal excretion of potassium.
Rationale: AKI reduces glomerular filtration and tubular secretion of K⁺, causing
retention and hyperkalemia.
- True/False: In congestive heart failure with reduced ejection fraction, activation
of the renin‑angiotensin‑aldosterone system (RAAS) is an adaptive response that
ultimately worsens remodeling and fluid overload. True .
Rationale: RAAS increases preload and afterload via sodium/water retention
and vasoconstriction; chronic activation promotes adverse remodeling and
progression of HF.
- Fill in the Blank: The primary pathophysiologic process in atherosclerotic
plaque rupture leading to myocardial infarction is _________ (thrombus
formation / vasospasm / embolism).
Answer: thrombus formation
Rationale: Plaque rupture exposes subendothelial collagen and tissue factor,
triggering platelet aggregation and thrombus formation that occludes coronary
arteries.
- Multiple Choice: A patient with systemic lupus erythematosus develops immune
complex deposition in glomeruli causing nephritic syndrome. Which hypersensitivity
type best describes this mechanism?
A. Type I
B. Type II
C. Type III
D. Type IV
Answer: C. Type III.
, Rationale: Immune complex (antigen–antibody) deposition in tissues with
complement activation is characteristic of Type III hypersensitivity.
- True/False: Disseminated intravascular coagulation (DIC) is always associated
with a hypercoagulable state only and never with bleeding. False .
Rationale: DIC involves widespread microthrombi consuming clotting factors
and platelets, leading paradoxically to bleeding due to consumption coagulopathy.
- Fill in the Blank: In sickle cell disease, vaso‑occlusive crises are precipitated by
polymerization of _________ hemoglobin under deoxygenated conditions.
Answer: hemoglobin S
Rationale: HbS polymerizes when deoxygenated, distorting RBCs into sickle
shapes that occlude microvasculature and cause ischemia.
- Multiple Choice: Which electrolyte disturbance is most likely to cause peaked T
waves and widened QRS on ECG and can progress to ventricular fibrillation?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Answer: B. Hyperkalemia.
Rationale: Elevated serum K⁺ alters cardiac membrane potentials, producing
peaked T waves, PR prolongation, QRS widening, and arrhythmias.
- True/False: In hyperosmolar hyperglycemic state (HHS), patients typically
present with significant ketosis similar to DKA. False .
Rationale: HHS (type 2 diabetes) features extreme hyperglycemia and
hyperosmolarity with minimal or absent ketosis due to residual insulin activity.
- Fill in the Blank: The earliest cellular event in ischemic cell injury is failure of the
_________ pump leading to intracellular sodium and water accumulation.
Answer: Na⁺/K⁺‑ATPase
Rationale: ATP depletion impairs Na⁺/K⁺‑ATPase, causing ionic imbalance,
cellular swelling, and progression to necrosis if prolonged.
- Multiple Choice: A patient with acute pancreatitis develops hypocalcemia.
Which mechanism best explains this finding?
A. Increased renal excretion of calcium
B. Fat saponification binding calcium in necrotic fat
C. Parathyroid hormone suppression by cytokines
D. Increased bone resorption
Answer: B. Fat saponification binding calcium in necrotic fat.
Rationale: Lipase‑mediated fat necrosis produces free fatty acids that bind
Ca²⁺, forming soaps and lowering serum calcium.
- True/False: In chronic liver disease, decreased synthesis of albumin contributes
to ascites formation by lowering plasma oncotic pressure. True .
, Rationale: Hypoalbuminemia reduces plasma oncotic pressure, favoring fluid
transudation into the peritoneal cavity; portal hypertension also contributes.
- Fill in the Blank: The classic triad of increased intracranial pressure includes
headache, vomiting, and _________ (altered consciousness / fever /
bradycardia).
Answer: altered consciousness
Rationale: Elevated ICP causes headache, vomiting, and altered mental status;
Cushing reflex (hypertension, bradycardia) may appear later.
- Multiple Choice: Which best describes the pathophysiology of type 2 diabetes
mellitus?
A. Autoimmune destruction of β‑cells
B. Insulin resistance with relative insulin deficiency
C. Excessive insulin secretion causing hypoglycemia
D. Pancreatic exocrine insufficiency
Answer: B. Insulin resistance with relative insulin deficiency.
Rationale: T2DM arises from peripheral insulin resistance and β‑cell
dysfunction leading to hyperglycemia.
- True/False: A pulmonary embolus large enough to obstruct >50% of pulmonary
vasculature typically causes acute right ventricular strain and hypotension. True .
Rationale: Massive PE increases pulmonary vascular resistance, causing RV
overload, decreased LV preload, and systemic hypotension.
- Fill in the Blank: In acute tubular necrosis (ATN) due to ischemia, the most
vulnerable nephron segment is the _________ (proximal tubule / distal tubule /
collecting duct).
Answer: proximal tubule
Rationale: Proximal tubular epithelial cells have high metabolic demand and are
most susceptible to ischemic injury leading to ATN.
- Multiple Choice: Which mechanism underlies the development of cachexia in
advanced cancer?
A. Increased anabolic signaling and muscle synthesis
B. Tumor‑derived cytokines causing systemic inflammation and muscle proteolysis
C. Exclusive malabsorption of dietary protein
D. Hypothyroidism induced by tumor hormones
Answer: B. Tumor‑derived cytokines causing systemic inflammation and
muscle proteolysis.
Rationale: Cytokines (TNF‑α, IL‑6) and tumor factors drive catabolism,
anorexia, and muscle wasting in cancer cachexia.
- True/False: In anaphylactic shock, bronchospasm, urticaria, and hypotension
are mediated by IgE‑dependent mast cell degranulation releasing histamine and
other mediators. True .
Rationale: Type I hypersensitivity via IgE crosslinking causes mast cell/basophil
Course Number: NRS 205
Course Title: Pathophysiology & Pharmacology
Exam: Midterm Exam
Date:2026
- Multiple Choice: A 68‑year‑old patient with long‑standing hypertension presents
with sudden left‑sided weakness and aphasia. CT shows an ischemic infarct in the
right middle cerebral artery territory. Which pathophysiologic mechanism most likely
produced the focal neurologic deficit?
Answer: Thromboembolic occlusion of a cortical branch of the MCA.
Rationale: Focal deficits in an MCA distribution are classically due to arterial
occlusion from thrombus or embolus; hypertension predisposes to atherosclerotic
plaque formation and thromboembolism causing ischemia in cortical territories.
- True/False: In septic shock, peripheral vasodilation and increased capillary
permeability are primarily mediated by excessive nitric oxide production and
inflammatory cytokines. True .
Rationale: Sepsis triggers inducible nitric oxide synthase and cytokines (TNF‑α,
IL‑1, IL‑6) causing vasodilation, endothelial dysfunction, and capillary leak leading
to distributive shock physiology.
- Fill in the Blank: In diabetic ketoacidosis (DKA), the primary acid‑base
disturbance is _________ metabolic acidosis with an increased anion gap.
Answer: high‑anion‑gap
Rationale: DKA produces accumulation of ketoacids (β‑hydroxybutyrate,
acetoacetate), causing a high‑anion‑gap metabolic acidosis.
- Multiple Choice: A patient with chronic obstructive pulmonary disease (COPD)
has chronic CO₂ retention and compensatory metabolic changes. Which arterial
blood gas pattern is most consistent with compensated chronic respiratory
acidosis?
A. Low PaCO₂, low HCO₃⁻
B. High PaCO₂, high HCO₃⁻
C. High PaCO₂, low HCO₃⁻
D. Normal PaCO₂, normal HCO₃⁻
Answer: B. High PaCO₂, high HCO₃⁻.
Rationale: Chronic CO₂ retention raises PaCO₂; renal compensation increases
HCO₃⁻ over days to weeks, producing elevated bicarbonate with hypercapnia.
,- True/False: Acute respiratory distress syndrome (ARDS) is characterized by
noncardiogenic pulmonary edema due to increased alveolar‑capillary permeability.
True .
Rationale: ARDS results from diffuse alveolar injury, increased permeability,
protein‑rich edema, and impaired gas exchange without primary left heart failure.
- Fill in the Blank: The hallmark histologic lesion of chronic hypertension in small
renal arteries and arterioles is _________ arteriolosclerosis (hyaline or
hyperplastic).
Answer: hyaline
Rationale: Longstanding benign hypertension causes hyaline arteriolosclerosis
with homogeneous pink hyaline thickening and luminal narrowing; malignant
hypertension causes hyperplastic changes.
- Multiple Choice: Which mechanism best explains hyperkalemia in acute kidney
injury (AKI)?
A. Increased aldosterone secretion
B. Decreased renal excretion of potassium
C. Increased cellular uptake of potassium
D. Enhanced gastrointestinal loss of potassium
Answer: B. Decreased renal excretion of potassium.
Rationale: AKI reduces glomerular filtration and tubular secretion of K⁺, causing
retention and hyperkalemia.
- True/False: In congestive heart failure with reduced ejection fraction, activation
of the renin‑angiotensin‑aldosterone system (RAAS) is an adaptive response that
ultimately worsens remodeling and fluid overload. True .
Rationale: RAAS increases preload and afterload via sodium/water retention
and vasoconstriction; chronic activation promotes adverse remodeling and
progression of HF.
- Fill in the Blank: The primary pathophysiologic process in atherosclerotic
plaque rupture leading to myocardial infarction is _________ (thrombus
formation / vasospasm / embolism).
Answer: thrombus formation
Rationale: Plaque rupture exposes subendothelial collagen and tissue factor,
triggering platelet aggregation and thrombus formation that occludes coronary
arteries.
- Multiple Choice: A patient with systemic lupus erythematosus develops immune
complex deposition in glomeruli causing nephritic syndrome. Which hypersensitivity
type best describes this mechanism?
A. Type I
B. Type II
C. Type III
D. Type IV
Answer: C. Type III.
, Rationale: Immune complex (antigen–antibody) deposition in tissues with
complement activation is characteristic of Type III hypersensitivity.
- True/False: Disseminated intravascular coagulation (DIC) is always associated
with a hypercoagulable state only and never with bleeding. False .
Rationale: DIC involves widespread microthrombi consuming clotting factors
and platelets, leading paradoxically to bleeding due to consumption coagulopathy.
- Fill in the Blank: In sickle cell disease, vaso‑occlusive crises are precipitated by
polymerization of _________ hemoglobin under deoxygenated conditions.
Answer: hemoglobin S
Rationale: HbS polymerizes when deoxygenated, distorting RBCs into sickle
shapes that occlude microvasculature and cause ischemia.
- Multiple Choice: Which electrolyte disturbance is most likely to cause peaked T
waves and widened QRS on ECG and can progress to ventricular fibrillation?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypermagnesemia
Answer: B. Hyperkalemia.
Rationale: Elevated serum K⁺ alters cardiac membrane potentials, producing
peaked T waves, PR prolongation, QRS widening, and arrhythmias.
- True/False: In hyperosmolar hyperglycemic state (HHS), patients typically
present with significant ketosis similar to DKA. False .
Rationale: HHS (type 2 diabetes) features extreme hyperglycemia and
hyperosmolarity with minimal or absent ketosis due to residual insulin activity.
- Fill in the Blank: The earliest cellular event in ischemic cell injury is failure of the
_________ pump leading to intracellular sodium and water accumulation.
Answer: Na⁺/K⁺‑ATPase
Rationale: ATP depletion impairs Na⁺/K⁺‑ATPase, causing ionic imbalance,
cellular swelling, and progression to necrosis if prolonged.
- Multiple Choice: A patient with acute pancreatitis develops hypocalcemia.
Which mechanism best explains this finding?
A. Increased renal excretion of calcium
B. Fat saponification binding calcium in necrotic fat
C. Parathyroid hormone suppression by cytokines
D. Increased bone resorption
Answer: B. Fat saponification binding calcium in necrotic fat.
Rationale: Lipase‑mediated fat necrosis produces free fatty acids that bind
Ca²⁺, forming soaps and lowering serum calcium.
- True/False: In chronic liver disease, decreased synthesis of albumin contributes
to ascites formation by lowering plasma oncotic pressure. True .
, Rationale: Hypoalbuminemia reduces plasma oncotic pressure, favoring fluid
transudation into the peritoneal cavity; portal hypertension also contributes.
- Fill in the Blank: The classic triad of increased intracranial pressure includes
headache, vomiting, and _________ (altered consciousness / fever /
bradycardia).
Answer: altered consciousness
Rationale: Elevated ICP causes headache, vomiting, and altered mental status;
Cushing reflex (hypertension, bradycardia) may appear later.
- Multiple Choice: Which best describes the pathophysiology of type 2 diabetes
mellitus?
A. Autoimmune destruction of β‑cells
B. Insulin resistance with relative insulin deficiency
C. Excessive insulin secretion causing hypoglycemia
D. Pancreatic exocrine insufficiency
Answer: B. Insulin resistance with relative insulin deficiency.
Rationale: T2DM arises from peripheral insulin resistance and β‑cell
dysfunction leading to hyperglycemia.
- True/False: A pulmonary embolus large enough to obstruct >50% of pulmonary
vasculature typically causes acute right ventricular strain and hypotension. True .
Rationale: Massive PE increases pulmonary vascular resistance, causing RV
overload, decreased LV preload, and systemic hypotension.
- Fill in the Blank: In acute tubular necrosis (ATN) due to ischemia, the most
vulnerable nephron segment is the _________ (proximal tubule / distal tubule /
collecting duct).
Answer: proximal tubule
Rationale: Proximal tubular epithelial cells have high metabolic demand and are
most susceptible to ischemic injury leading to ATN.
- Multiple Choice: Which mechanism underlies the development of cachexia in
advanced cancer?
A. Increased anabolic signaling and muscle synthesis
B. Tumor‑derived cytokines causing systemic inflammation and muscle proteolysis
C. Exclusive malabsorption of dietary protein
D. Hypothyroidism induced by tumor hormones
Answer: B. Tumor‑derived cytokines causing systemic inflammation and
muscle proteolysis.
Rationale: Cytokines (TNF‑α, IL‑6) and tumor factors drive catabolism,
anorexia, and muscle wasting in cancer cachexia.
- True/False: In anaphylactic shock, bronchospasm, urticaria, and hypotension
are mediated by IgE‑dependent mast cell degranulation releasing histamine and
other mediators. True .
Rationale: Type I hypersensitivity via IgE crosslinking causes mast cell/basophil
