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NR 507 Advanced Pathophysiology Final Exam Practice Questions with Answers
& Detailed Rationales New UPDATED!!
Question 1
A 45-year-old woman presents with fatigue, weight gain, and
cold intolerance. Her TSH is elevated and free T4 is low. Which
of the following is the most likely pathophysiologic mechanism?
A. Autoimmune destruction of thyroid follicular cells
B. Excessive iodine intake
C. Pituitary adenoma secreting TSH
D. Thyroid hormone resistance
Answer: A
Rationale: The presentation is primary hypothyroidism, most
commonly caused by Hashimoto thyroiditis—an autoimmune
destruction of thyroid follicular cells. Elevated TSH with low free
T4 indicates primary thyroid failure. Iodine excess can cause
hypothyroidism but is not the most likely mechanism. A TSH-
secreting adenoma would cause hyperthyroidism. Thyroid
hormone resistance is rare and would show elevated T4 with
elevated TSH.
Question 2
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Which of the following best describes the pathophysiology of
type 2 diabetes mellitus?
A. Autoimmune destruction of beta cells leading to absolute
insulin deficiency
B. Insulin resistance with progressive beta-cell dysfunction
C. Excessive glucagon secretion without insulin resistance
D. Genetic defect causing complete absence of insulin receptors
Answer: B
Rationale: Type 2 DM is characterized by insulin resistance in
peripheral tissues and progressive beta-cell dysfunction leading
to relative insulin deficiency. Type 1 DM involves autoimmune
beta-cell destruction. Glucagon excess is secondary, not the
primary defect. Complete absence of insulin receptors is a rare
genetic syndrome.
Question 3
A patient with chronic kidney disease develops anemia. Which
factor is the most important cause of this anemia?
A. Increased red blood cell destruction
B. Decreased erythropoietin production
C. Iron overload
D. Folate deficiency
Answer: B
Rationale: The kidneys produce erythropoietin (EPO) in
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response to hypoxia. In CKD, damaged renal tissue produces
less EPO, leading to decreased erythropoiesis and anemia.
Hemolysis, iron overload, and folate deficiency may contribute
but are not the primary mechanism.
Question 4
In acute respiratory distress syndrome (ARDS), the primary
pathophysiologic event is:
A. Bronchoconstriction causing airflow obstruction
B. Diffuse alveolar-capillary membrane damage leading to
increased permeability
C. Pulmonary embolism obstructing blood flow
D. Pleural effusion compressing the lung
Answer: B
Rationale: ARDS is characterized by diffuse injury to the
alveolar-capillary membrane from inflammatory mediators,
causing increased permeability, pulmonary edema, and
impaired gas exchange. Bronchoconstriction is more typical of
asthma; embolism and effusion are different conditions.
Question 5
Which gene is most commonly mutated in familial
adenomatous polyposis (FAP)?
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A. BRCA1
B. APC
C. p53
D. RET
Answer: B
Rationale: FAP is caused by mutations in the APC (adenomatous
polyposis coli) gene, a tumor suppressor. BRCA1 is associated
with breast/ovarian cancer, p53 with Li-Fraumeni, and RET with
multiple endocrine neoplasia type 2.
Question 6
A patient with systemic lupus erythematosus (SLE) is likely to
have which type of hypersensitivity reaction?
A. Type I
B. Type II
C. Type III
D. Type IV
Answer: C
Rationale: SLE is a classic example of type III hypersensitivity,
mediated by immune complex deposition (DNA–anti-DNA
complexes) in tissues, leading to inflammation and organ
damage. Type I is IgE-mediated allergy; type II is antibody-
mediated cytotoxicity; type IV is T-cell–mediated delayed
hypersensitivity.
NR 507 Advanced Pathophysiology Final Exam Practice Questions with Answers
& Detailed Rationales New UPDATED!!
Question 1
A 45-year-old woman presents with fatigue, weight gain, and
cold intolerance. Her TSH is elevated and free T4 is low. Which
of the following is the most likely pathophysiologic mechanism?
A. Autoimmune destruction of thyroid follicular cells
B. Excessive iodine intake
C. Pituitary adenoma secreting TSH
D. Thyroid hormone resistance
Answer: A
Rationale: The presentation is primary hypothyroidism, most
commonly caused by Hashimoto thyroiditis—an autoimmune
destruction of thyroid follicular cells. Elevated TSH with low free
T4 indicates primary thyroid failure. Iodine excess can cause
hypothyroidism but is not the most likely mechanism. A TSH-
secreting adenoma would cause hyperthyroidism. Thyroid
hormone resistance is rare and would show elevated T4 with
elevated TSH.
Question 2
, Page |2
Which of the following best describes the pathophysiology of
type 2 diabetes mellitus?
A. Autoimmune destruction of beta cells leading to absolute
insulin deficiency
B. Insulin resistance with progressive beta-cell dysfunction
C. Excessive glucagon secretion without insulin resistance
D. Genetic defect causing complete absence of insulin receptors
Answer: B
Rationale: Type 2 DM is characterized by insulin resistance in
peripheral tissues and progressive beta-cell dysfunction leading
to relative insulin deficiency. Type 1 DM involves autoimmune
beta-cell destruction. Glucagon excess is secondary, not the
primary defect. Complete absence of insulin receptors is a rare
genetic syndrome.
Question 3
A patient with chronic kidney disease develops anemia. Which
factor is the most important cause of this anemia?
A. Increased red blood cell destruction
B. Decreased erythropoietin production
C. Iron overload
D. Folate deficiency
Answer: B
Rationale: The kidneys produce erythropoietin (EPO) in
, Page |3
response to hypoxia. In CKD, damaged renal tissue produces
less EPO, leading to decreased erythropoiesis and anemia.
Hemolysis, iron overload, and folate deficiency may contribute
but are not the primary mechanism.
Question 4
In acute respiratory distress syndrome (ARDS), the primary
pathophysiologic event is:
A. Bronchoconstriction causing airflow obstruction
B. Diffuse alveolar-capillary membrane damage leading to
increased permeability
C. Pulmonary embolism obstructing blood flow
D. Pleural effusion compressing the lung
Answer: B
Rationale: ARDS is characterized by diffuse injury to the
alveolar-capillary membrane from inflammatory mediators,
causing increased permeability, pulmonary edema, and
impaired gas exchange. Bronchoconstriction is more typical of
asthma; embolism and effusion are different conditions.
Question 5
Which gene is most commonly mutated in familial
adenomatous polyposis (FAP)?
, Page |4
A. BRCA1
B. APC
C. p53
D. RET
Answer: B
Rationale: FAP is caused by mutations in the APC (adenomatous
polyposis coli) gene, a tumor suppressor. BRCA1 is associated
with breast/ovarian cancer, p53 with Li-Fraumeni, and RET with
multiple endocrine neoplasia type 2.
Question 6
A patient with systemic lupus erythematosus (SLE) is likely to
have which type of hypersensitivity reaction?
A. Type I
B. Type II
C. Type III
D. Type IV
Answer: C
Rationale: SLE is a classic example of type III hypersensitivity,
mediated by immune complex deposition (DNA–anti-DNA
complexes) in tissues, leading to inflammation and organ
damage. Type I is IgE-mediated allergy; type II is antibody-
mediated cytotoxicity; type IV is T-cell–mediated delayed
hypersensitivity.
