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NR507 – Advanced Pathophysiology
Exam Study Guide – Final Study Guide
Exam Format: Cumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The final exam will only be available starting on Wednesday Week 8 at
12:01 am MT until Saturday Week 8 at 11:59 pm MT.
1. Exam CoverageContent
Areas:
• Week 5: Gastrointestinal and Neurobiological Pathologies
• Week 6: Endocrine Pathologies
• Week 7: CNS Sensory and Motor Pathologies
• Week 8: Brain and Dermatological Pathologies
2. Key Concepts to
StudyGastrointestinal
pathologies:
• Pathophysiology of GERD
involves several mechanisms that allow the contents of the stomach especially acid
and digestive enzymes like pepsin) to reflux into the esophagus leading to
mucosal injury and symptoms like heartburn and regurgitation.
• Signs and symptoms of GERD
Heartburn
Burning sensation in the chest (retrosternal)
Often worse after meals or when lying down
Improves with antacids
Regurgitation
Sour or bitter-tasting fluid in the throat or mouth
Especially when bending over or lying flat
Dysphagia (difficulty swallowing)
May indicate esophageal inflammation or stricture formation
Chest pain
Non-cardiac in nature
Burning or squeezing, often mistaken for angina
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Atypical s/s
Chronic cough
Hoarseness or voice changes
Sore throat or frequent throat clearing
Asthma-like symptoms or worsening of asthma Laryngitis
Dental erosion (due to acid exposure)
Globus sensation (feeling of a lump in the throat)
Pharmacologic management of GERD
PPI – 1st Line -omeprazole
Inhibit H⁺/K⁺-ATPase in gastric parietal cells → suppress gastric acid secretion.
Taken 30–60 min before meals (best before breakfast)
Superior to H2 blockers for healing erosive esophagitis
Typically used for 4–8 weeks; long-term use if symptoms persist or in severe
cases
H2 Receptor Agonists – famotidine
Block H2 receptors on parietal cells → ↓ acid secretion
For mild or intermittent symptoms
Less effective than PPIs for healing esophagitis
Can be used at bedtime for nocturnal symptoms (often in combination with
daytime PPI)
Antacids
Neutralizes gastric acid -Calcium carbonate (tums)
Short acting
Alginates (gavison) use with antacids
Forms gel raft – helps prevent reflux
Prokinetic Agents
Increases tone and improves gastric emptying
Used with PPIs in some cases
• Risk factors for esophageal stricture
Chronic GERD (most common)
Esophagitis
Esophageal surgery or radiation
Ingestion of corrosive substances -caustic ingestion – alkali and acid burns
Prolonged NG tube
Hiatal hernia
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Medications -pill induced esophagitis (potassium chloride, NSAIDs)
Smoking and alcohol
• Hiatal hernia treatment depends on the type, severity of symptoms, and the
presence of complications sliding hernia
most common
stomach and JE junction slide into esophagus
commonly associated with GERD paraoesophageal
hernia part of stomach herniates beside esophagus risk
of strangulation or obstruction
Treatment
Control symptoms/prevent complications
Lifestyle modifications
Weight loss
Smaller meals
Avoid lying down after meals
Elevate HOB
Avoid trigger foods -spicy, fatty, caffeine, chocolate, alcohol
Smoking cessation
Pharmacological Therapy – PPI, H2 antagonists, antacids, prokinetics
Surgical Interventions
Laparoscopic paraoesophageal fundoplication – most common
Pathophysiology of appendicitis inflammation of the vermiform appendix, usually
caused by obstruction of the appendiceal lumen. It is a surgical emergency and one
of the most common causes of acute abdominal pain.
Luminal obstruction – primary trigger
Caused by:
Fecalith (hard stool)
Lymphoid hyperplasia
Foreign body
Worms
tumors
Mucus secretion continues behind obstruction
Leads to increased luminal pressure
Causes obstruction
Bacterial overgrowth and inflammation
Most common – e coli
Ischemia and wall necrosis
Impairs arterial blood flow, leading to ischemia
Perforation
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Localized or general peritonitis
Possible complications
Perforations
Abscess
Sepsis
Appendiceal mass
Portal pylephlebitis (rare)
Symptoms of appendicitis progressive abdominal pain with associated gastrointestinal
and
systemic symptoms. The classic presentation can vary depending on age, sex, and the stage of
the disease (early vs. perforated).
Classic symptoms
Abdominal pain – dull, poorly localized in periumbilical area- becomes
sharp localized pain in RLQ
Worsens with movement, coughing and palpation
Anorexia
Nausea/Vomiting
Fever
Constipation/Diarrhea
Malaise
• Diagnosing appendicitis via lab work
CBC
CRP
Serum electrolytes and renal function
UA/pregnancy test – appendicitis can mimic ectopic pregnancy
LFT Lactate – if perforation is
suspected
• Risks for appendectomy in adults
These risks depend on factors such as the patient's overall health, timing of
surgery (early vs. after perforation), and whether the surgery is open or
laparoscopic.
Risks include:
Bleeding
Damage to surrounding organs
Anesthesia related risks
Hernia at incision site
Bowel obstruction
Prolonged ileus
Scarring and adhesions
NR507 – Advanced Pathophysiology
Exam Study Guide – Final Study Guide
Exam Format: Cumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The final exam will only be available starting on Wednesday Week 8 at
12:01 am MT until Saturday Week 8 at 11:59 pm MT.
1. Exam CoverageContent
Areas:
• Week 5: Gastrointestinal and Neurobiological Pathologies
• Week 6: Endocrine Pathologies
• Week 7: CNS Sensory and Motor Pathologies
• Week 8: Brain and Dermatological Pathologies
2. Key Concepts to
StudyGastrointestinal
pathologies:
• Pathophysiology of GERD
involves several mechanisms that allow the contents of the stomach especially acid
and digestive enzymes like pepsin) to reflux into the esophagus leading to
mucosal injury and symptoms like heartburn and regurgitation.
• Signs and symptoms of GERD
Heartburn
Burning sensation in the chest (retrosternal)
Often worse after meals or when lying down
Improves with antacids
Regurgitation
Sour or bitter-tasting fluid in the throat or mouth
Especially when bending over or lying flat
Dysphagia (difficulty swallowing)
May indicate esophageal inflammation or stricture formation
Chest pain
Non-cardiac in nature
Burning or squeezing, often mistaken for angina
, lOMoARcPSD| 63525276
Atypical s/s
Chronic cough
Hoarseness or voice changes
Sore throat or frequent throat clearing
Asthma-like symptoms or worsening of asthma Laryngitis
Dental erosion (due to acid exposure)
Globus sensation (feeling of a lump in the throat)
Pharmacologic management of GERD
PPI – 1st Line -omeprazole
Inhibit H⁺/K⁺-ATPase in gastric parietal cells → suppress gastric acid secretion.
Taken 30–60 min before meals (best before breakfast)
Superior to H2 blockers for healing erosive esophagitis
Typically used for 4–8 weeks; long-term use if symptoms persist or in severe
cases
H2 Receptor Agonists – famotidine
Block H2 receptors on parietal cells → ↓ acid secretion
For mild or intermittent symptoms
Less effective than PPIs for healing esophagitis
Can be used at bedtime for nocturnal symptoms (often in combination with
daytime PPI)
Antacids
Neutralizes gastric acid -Calcium carbonate (tums)
Short acting
Alginates (gavison) use with antacids
Forms gel raft – helps prevent reflux
Prokinetic Agents
Increases tone and improves gastric emptying
Used with PPIs in some cases
• Risk factors for esophageal stricture
Chronic GERD (most common)
Esophagitis
Esophageal surgery or radiation
Ingestion of corrosive substances -caustic ingestion – alkali and acid burns
Prolonged NG tube
Hiatal hernia
, lOMoARcPSD| 63525276
Medications -pill induced esophagitis (potassium chloride, NSAIDs)
Smoking and alcohol
• Hiatal hernia treatment depends on the type, severity of symptoms, and the
presence of complications sliding hernia
most common
stomach and JE junction slide into esophagus
commonly associated with GERD paraoesophageal
hernia part of stomach herniates beside esophagus risk
of strangulation or obstruction
Treatment
Control symptoms/prevent complications
Lifestyle modifications
Weight loss
Smaller meals
Avoid lying down after meals
Elevate HOB
Avoid trigger foods -spicy, fatty, caffeine, chocolate, alcohol
Smoking cessation
Pharmacological Therapy – PPI, H2 antagonists, antacids, prokinetics
Surgical Interventions
Laparoscopic paraoesophageal fundoplication – most common
Pathophysiology of appendicitis inflammation of the vermiform appendix, usually
caused by obstruction of the appendiceal lumen. It is a surgical emergency and one
of the most common causes of acute abdominal pain.
Luminal obstruction – primary trigger
Caused by:
Fecalith (hard stool)
Lymphoid hyperplasia
Foreign body
Worms
tumors
Mucus secretion continues behind obstruction
Leads to increased luminal pressure
Causes obstruction
Bacterial overgrowth and inflammation
Most common – e coli
Ischemia and wall necrosis
Impairs arterial blood flow, leading to ischemia
Perforation
, lOMoARcPSD| 63525276
Localized or general peritonitis
Possible complications
Perforations
Abscess
Sepsis
Appendiceal mass
Portal pylephlebitis (rare)
Symptoms of appendicitis progressive abdominal pain with associated gastrointestinal
and
systemic symptoms. The classic presentation can vary depending on age, sex, and the stage of
the disease (early vs. perforated).
Classic symptoms
Abdominal pain – dull, poorly localized in periumbilical area- becomes
sharp localized pain in RLQ
Worsens with movement, coughing and palpation
Anorexia
Nausea/Vomiting
Fever
Constipation/Diarrhea
Malaise
• Diagnosing appendicitis via lab work
CBC
CRP
Serum electrolytes and renal function
UA/pregnancy test – appendicitis can mimic ectopic pregnancy
LFT Lactate – if perforation is
suspected
• Risks for appendectomy in adults
These risks depend on factors such as the patient's overall health, timing of
surgery (early vs. after perforation), and whether the surgery is open or
laparoscopic.
Risks include:
Bleeding
Damage to surrounding organs
Anesthesia related risks
Hernia at incision site
Bowel obstruction
Prolonged ileus
Scarring and adhesions
