NSG 3850 Exam 3 Pathophysiology 2026 Ultimate Bundle: 150 High-Yield
Practice Questions with Answers & Detailed Rationales — Complete Study
Guide for Cardio, Pulmonary, Renal, GI, Endocrine, Neuro &
Musculoskeletal Pathophysiology
SECTION 1: Cardiovascular Pathophysiology (Questions 1–30)
Question 1
A 62-year-old male with a history of hypertension presents with crushing substernal chest
pain radiating to the left arm. ECG shows ST-segment elevation in leads V1–V4. Which of
the following is the most likely diagnosis?
A) Unstable angina
B) NSTEMI
C) STEMI (anterior wall)
D) Pericarditis
E) Aortic dissection
Answer: C) STEMI (anterior wall)
Rationale: ST elevation in V1–V4 indicates an anterior wall myocardial infarction, most
commonly caused by occlusion of the left anterior descending (LAD) artery. This is a
STEMI, which requires immediate reperfusion therapy. Unstable angina and NSTEMI do not
have ST elevations. Pericarditis causes diffuse ST elevations, not localized.
,Question 2
A 68-year-old female presents with dyspnea, orthopnea, and paroxysmal nocturnal
dyspnea. On exam, she has jugular venous distention, peripheral edema, and crackles in
the lung bases. Which pathophysiological mechanism best explains her symptoms?
A) Decreased cardiac output with increased systemic vascular resistance
B) Increased left ventricular end-diastolic pressure with pulmonary congestion
C) Right ventricular failure with systemic venous congestion
D) Decreased renal perfusion with sodium and water retention
E) All of the above
Answer: E) All of the above
Rationale: Heart failure involves a complex interplay of mechanisms. Left-sided heart
failure increases left ventricular end-diastolic pressure, causing pulmonary congestion
(dyspnea, orthopnea, crackles). Decreased cardiac output activates the RAAS, causing
sodium and water retention. Right-sided heart failure causes systemic venous congestion
(JVD, peripheral edema). All mechanisms are present in heart failure.
,Question 3
A 72-year-old male presents with sudden-onset severe "tearing" chest pain radiating to the
back. Blood pressure is 180/100 in the right arm and 120/80 in the left arm. Which
pathophysiological process is most likely occurring?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Cardiac tamponade
E) Esophageal rupture
Answer: B) Aortic dissection
Rationale: Aortic dissection presents with sudden-onset tearing chest pain radiating to the
back, with pulse deficits and blood pressure differences between arms. It results from a tear
in the intimal layer of the aorta, allowing blood to enter the media and create a false lumen.
Risk factors include hypertension and connective tissue disorders.
Question 4
A 55-year-old male with a history of myocardial infarction now has a holosystolic murmur at
the apex radiating to the axilla. Which complication of MI is most likely?
, A) Ventricular septal defect
B) Papillary muscle rupture
C) Left ventricular aneurysm
D) Pericarditis
E) Dressler syndrome
Answer: B) Papillary muscle rupture
Rationale: Papillary muscle rupture is a complication of MI, causing acute mitral
regurgitation. The holosystolic murmur at the apex radiating to the axilla is classic for mitral
regurgitation. Ventricular septal defect would have a harsh holosystolic murmur at the left
sternal border. Dressler syndrome is pericarditis weeks after MI.
Question 5
A 45-year-old female with a history of mitral valve prolapse presents with palpitations and a
mid-systolic click. What is the underlying pathophysiological abnormality?
A) Fusion of mitral valve leaflets
B) Myxomatous degeneration of the mitral valve
C) Calcification of the mitral valve annulus
Practice Questions with Answers & Detailed Rationales — Complete Study
Guide for Cardio, Pulmonary, Renal, GI, Endocrine, Neuro &
Musculoskeletal Pathophysiology
SECTION 1: Cardiovascular Pathophysiology (Questions 1–30)
Question 1
A 62-year-old male with a history of hypertension presents with crushing substernal chest
pain radiating to the left arm. ECG shows ST-segment elevation in leads V1–V4. Which of
the following is the most likely diagnosis?
A) Unstable angina
B) NSTEMI
C) STEMI (anterior wall)
D) Pericarditis
E) Aortic dissection
Answer: C) STEMI (anterior wall)
Rationale: ST elevation in V1–V4 indicates an anterior wall myocardial infarction, most
commonly caused by occlusion of the left anterior descending (LAD) artery. This is a
STEMI, which requires immediate reperfusion therapy. Unstable angina and NSTEMI do not
have ST elevations. Pericarditis causes diffuse ST elevations, not localized.
,Question 2
A 68-year-old female presents with dyspnea, orthopnea, and paroxysmal nocturnal
dyspnea. On exam, she has jugular venous distention, peripheral edema, and crackles in
the lung bases. Which pathophysiological mechanism best explains her symptoms?
A) Decreased cardiac output with increased systemic vascular resistance
B) Increased left ventricular end-diastolic pressure with pulmonary congestion
C) Right ventricular failure with systemic venous congestion
D) Decreased renal perfusion with sodium and water retention
E) All of the above
Answer: E) All of the above
Rationale: Heart failure involves a complex interplay of mechanisms. Left-sided heart
failure increases left ventricular end-diastolic pressure, causing pulmonary congestion
(dyspnea, orthopnea, crackles). Decreased cardiac output activates the RAAS, causing
sodium and water retention. Right-sided heart failure causes systemic venous congestion
(JVD, peripheral edema). All mechanisms are present in heart failure.
,Question 3
A 72-year-old male presents with sudden-onset severe "tearing" chest pain radiating to the
back. Blood pressure is 180/100 in the right arm and 120/80 in the left arm. Which
pathophysiological process is most likely occurring?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Cardiac tamponade
E) Esophageal rupture
Answer: B) Aortic dissection
Rationale: Aortic dissection presents with sudden-onset tearing chest pain radiating to the
back, with pulse deficits and blood pressure differences between arms. It results from a tear
in the intimal layer of the aorta, allowing blood to enter the media and create a false lumen.
Risk factors include hypertension and connective tissue disorders.
Question 4
A 55-year-old male with a history of myocardial infarction now has a holosystolic murmur at
the apex radiating to the axilla. Which complication of MI is most likely?
, A) Ventricular septal defect
B) Papillary muscle rupture
C) Left ventricular aneurysm
D) Pericarditis
E) Dressler syndrome
Answer: B) Papillary muscle rupture
Rationale: Papillary muscle rupture is a complication of MI, causing acute mitral
regurgitation. The holosystolic murmur at the apex radiating to the axilla is classic for mitral
regurgitation. Ventricular septal defect would have a harsh holosystolic murmur at the left
sternal border. Dressler syndrome is pericarditis weeks after MI.
Question 5
A 45-year-old female with a history of mitral valve prolapse presents with palpitations and a
mid-systolic click. What is the underlying pathophysiological abnormality?
A) Fusion of mitral valve leaflets
B) Myxomatous degeneration of the mitral valve
C) Calcification of the mitral valve annulus
