NR 507 Final Exam – Advanced Pathophysiology (2026)
– Comprehensive Practice Exam – Questions,
ANSWER>.>s & Option-by-Option Rationales
A patient suffers prolonged ischemia to a limb. Which mechanism best explains the early cellular
swelling seen on biopsy?
A. Decreased ATP production impairing the Na+/K+ pump — Correct: Na+ and water accumulate
intracellularly.
B. Increased oxidative phosphorylation — Incorrect: ischemia halts aerobic phosphorylation.
C. Enhanced protein synthesis — Incorrect: synthesis falls with ATP loss.
D. Selective potassium influx — Incorrect: pump failure retains sodium, not potassium.
Correct ANSWER>.>: A
After thrombolytic therapy restores coronary flow, additional myocyte injury occurs. The primary
mechanism is:
A. Reactive oxygen species burst on reperfusion — Correct: free radicals damage membranes and DNA.
B. Restored ATP triggering necrosis — Incorrect: ATP restoration is protective.
C. Complement suppression — Incorrect: complement is activated, worsening injury.
D. Decreased intracellular calcium — Incorrect: calcium overload drives damage.
Correct ANSWER>.>: A
Endoscopy of a chronic GERD patient shows Barrett esophagus. This adaptation is best described as:
A. Replacement of squamous by columnar intestinal-type epithelium — Correct: metaplasia to acid-
resistant cells.
B. Replacement of columnar by squamous epithelium — Incorrect: direction is reversed.
C. Simple squamous hyperplasia — Incorrect: cell type changes, not just number.
D. Dysplasia with malignant nuclei — Incorrect: dysplasia is disordered, preneoplastic growth.
Correct ANSWER>.>: A
Which feature distinguishes apoptosis from necrosis?
A. Cell swelling with inflammation — Incorrect: that describes necrosis.
,B. Caspase-mediated shrinkage without inflammation — Correct: programmed, contained death.
C. Random DNA degradation — Incorrect: apoptosis shows orderly laddering.
D. Membrane rupture releasing contents — Incorrect: that is necrosis.
Correct ANSWER>.>: B
A brain infarct is examined at autopsy. The expected necrosis pattern is:
A. Coagulative — Incorrect: seen in most organs except brain.
B. Liquefactive — Correct: enzymatic digestion in CNS and abscesses.
C. Caseous — Incorrect: characteristic of TB/fungal infection.
D. Fat — Incorrect: seen in pancreas/breast trauma.
Correct ANSWER>.>: B
A lung biopsy shows soft, "cheesy" granulomatous necrosis. The most likely cause is:
A. Tuberculosis — Correct: caseous necrosis is classic.
B. Myocardial ischemia — Incorrect: causes coagulative necrosis.
C. Bacterial abscess — Incorrect: causes liquefactive necrosis.
D. Acute pancreatitis — Incorrect: causes fat necrosis.
Correct ANSWER>.>: A
Fat necrosis is most characteristically associated with:
A. Acute pancreatitis — Correct: lipase releases fatty acids that bind calcium (saponification).
B. Hepatic cirrhosis — Incorrect: not a fat-necrosis process.
C. Renal infarction — Incorrect: coagulative necrosis.
D. Cerebral stroke — Incorrect: liquefactive necrosis.
Correct ANSWER>.>: A
Malignant hypertension produces which vascular necrosis pattern?
A. Fibrinoid — Correct: immune/plasma proteins deposit in vessel walls.
B. Coagulative — Incorrect: parenchymal ischemic pattern.
C. Caseous — Incorrect: granulomatous infection pattern.
D. Liquefactive — Incorrect: CNS/abscess pattern.
Correct ANSWER>.>: A
A patient with an autosomal dominant disorder asks about risk to each child. The correct risk is:
,A. 50% per child — Correct: one mutant allele suffices; vertical transmission.
B. 25% — Incorrect: that is autosomal recessive recurrence.
C. 75% — Incorrect: no such single-gene ratio here.
D. Risk only for sons — Incorrect: AD affects both sexes equally.
Correct ANSWER>.>: A
A carrier mother of an X-linked recessive disease asks about her sons. Each son's risk is:
A. 50% affected — Correct: sons receive the single X from mother.
B. 25% — Incorrect: underestimates X-linked risk to sons.
C. 100% — Incorrect: only if mother is homozygous.
D. 0% — Incorrect: carriers transmit to half of sons.
Correct ANSWER>.>: A
A disorder transmitted only through affected mothers to all children suggests:
A. Mitochondrial inheritance — Correct: mtDNA is maternally inherited.
B. Autosomal dominant — Incorrect: fathers would also transmit.
C. X-linked recessive — Incorrect: no male-to-male, but not all children affected.
D. Genomic imprinting — Incorrect: parent-of-origin silencing, not maternal-only transmission.
Correct ANSWER>.>: A
Which finding is most associated with trisomy 21?
A. Endocardial cushion (AV canal) defects — Correct: classic cardiac lesion; risk rises with maternal age.
B. Coarctation of the aorta — Incorrect: more typical of Turner syndrome.
C. Cystic kidneys — Incorrect: associated with PKD.
D. Tall stature — Incorrect: Down syndrome causes short stature.
Correct ANSWER>.>: A
A female neonate has webbed neck and lymphedema. The karyotype and key cardiac lesion are:
A. 45,X with coarctation — Correct: Turner syndrome features.
B. 47,XXY — Incorrect: Klinefelter (male).
C. Trisomy 18 — Incorrect: Edwards, different phenotype.
D. 46,XX deletion 22q11 — Incorrect: DiGeorge syndrome.
Correct ANSWER>.>: A
, A tall male with gynecomastia, small testes, and infertility most likely has:
A. 47,XXY — Correct: Klinefelter syndrome.
B. 45,X — Incorrect: female Turner phenotype.
C. Trisomy 13 — Incorrect: Patau, severe malformations.
D. 47,XYY — Incorrect: usually normal fertility, tall.
Correct ANSWER>.>: A
Sickle cell disease results from which mutation?
A. Missense substitution (glutamate → valine) in β-globin — Correct: produces HbS that polymerizes
when deoxygenated.
B. Frameshift deletion — Incorrect: not the mechanism.
C. Trinucleotide expansion — Incorrect: seen in Huntington/Fragile X.
D. Chromosomal translocation — Incorrect: seen in cancers like CML.
Correct ANSWER>.>: A
Anticipation (earlier onset in successive generations) is characteristic of:
A. Huntington disease (CAG expansion) — Correct: repeats expand, especially via paternal transmission.
B. Cystic fibrosis — Incorrect: recessive point mutation, no anticipation.
C. Hemophilia A — Incorrect: X-linked, stable mutation.
D. Marfan syndrome — Incorrect: FBN1 mutation, variable but not anticipatory.
Correct ANSWER>.>: A
Café-au-lait macules, neurofibromas, and Lisch nodules indicate:
A. Neurofibromatosis type 1 — Correct: AD, NF1 (neurofibromin) on chromosome 17.
B. Tuberous sclerosis — Incorrect: ash-leaf spots, seizures, angiofibromas.
C. Von Hippel–Lindau — Incorrect: hemangioblastomas, renal cancer.
D. Li-Fraumeni — Incorrect: p53 germline, multiple cancers.
Correct ANSWER>.>: A
A tall patient with upward lens dislocation and aortic root dilation has a defect in:
A. Fibrillin-1 (FBN1) — Correct: Marfan syndrome; aortic dissection risk.
B. Collagen type III — Incorrect: vascular Ehlers-Danlos.
C. Collagen type I — Incorrect: osteogenesis imperfecta.
– Comprehensive Practice Exam – Questions,
ANSWER>.>s & Option-by-Option Rationales
A patient suffers prolonged ischemia to a limb. Which mechanism best explains the early cellular
swelling seen on biopsy?
A. Decreased ATP production impairing the Na+/K+ pump — Correct: Na+ and water accumulate
intracellularly.
B. Increased oxidative phosphorylation — Incorrect: ischemia halts aerobic phosphorylation.
C. Enhanced protein synthesis — Incorrect: synthesis falls with ATP loss.
D. Selective potassium influx — Incorrect: pump failure retains sodium, not potassium.
Correct ANSWER>.>: A
After thrombolytic therapy restores coronary flow, additional myocyte injury occurs. The primary
mechanism is:
A. Reactive oxygen species burst on reperfusion — Correct: free radicals damage membranes and DNA.
B. Restored ATP triggering necrosis — Incorrect: ATP restoration is protective.
C. Complement suppression — Incorrect: complement is activated, worsening injury.
D. Decreased intracellular calcium — Incorrect: calcium overload drives damage.
Correct ANSWER>.>: A
Endoscopy of a chronic GERD patient shows Barrett esophagus. This adaptation is best described as:
A. Replacement of squamous by columnar intestinal-type epithelium — Correct: metaplasia to acid-
resistant cells.
B. Replacement of columnar by squamous epithelium — Incorrect: direction is reversed.
C. Simple squamous hyperplasia — Incorrect: cell type changes, not just number.
D. Dysplasia with malignant nuclei — Incorrect: dysplasia is disordered, preneoplastic growth.
Correct ANSWER>.>: A
Which feature distinguishes apoptosis from necrosis?
A. Cell swelling with inflammation — Incorrect: that describes necrosis.
,B. Caspase-mediated shrinkage without inflammation — Correct: programmed, contained death.
C. Random DNA degradation — Incorrect: apoptosis shows orderly laddering.
D. Membrane rupture releasing contents — Incorrect: that is necrosis.
Correct ANSWER>.>: B
A brain infarct is examined at autopsy. The expected necrosis pattern is:
A. Coagulative — Incorrect: seen in most organs except brain.
B. Liquefactive — Correct: enzymatic digestion in CNS and abscesses.
C. Caseous — Incorrect: characteristic of TB/fungal infection.
D. Fat — Incorrect: seen in pancreas/breast trauma.
Correct ANSWER>.>: B
A lung biopsy shows soft, "cheesy" granulomatous necrosis. The most likely cause is:
A. Tuberculosis — Correct: caseous necrosis is classic.
B. Myocardial ischemia — Incorrect: causes coagulative necrosis.
C. Bacterial abscess — Incorrect: causes liquefactive necrosis.
D. Acute pancreatitis — Incorrect: causes fat necrosis.
Correct ANSWER>.>: A
Fat necrosis is most characteristically associated with:
A. Acute pancreatitis — Correct: lipase releases fatty acids that bind calcium (saponification).
B. Hepatic cirrhosis — Incorrect: not a fat-necrosis process.
C. Renal infarction — Incorrect: coagulative necrosis.
D. Cerebral stroke — Incorrect: liquefactive necrosis.
Correct ANSWER>.>: A
Malignant hypertension produces which vascular necrosis pattern?
A. Fibrinoid — Correct: immune/plasma proteins deposit in vessel walls.
B. Coagulative — Incorrect: parenchymal ischemic pattern.
C. Caseous — Incorrect: granulomatous infection pattern.
D. Liquefactive — Incorrect: CNS/abscess pattern.
Correct ANSWER>.>: A
A patient with an autosomal dominant disorder asks about risk to each child. The correct risk is:
,A. 50% per child — Correct: one mutant allele suffices; vertical transmission.
B. 25% — Incorrect: that is autosomal recessive recurrence.
C. 75% — Incorrect: no such single-gene ratio here.
D. Risk only for sons — Incorrect: AD affects both sexes equally.
Correct ANSWER>.>: A
A carrier mother of an X-linked recessive disease asks about her sons. Each son's risk is:
A. 50% affected — Correct: sons receive the single X from mother.
B. 25% — Incorrect: underestimates X-linked risk to sons.
C. 100% — Incorrect: only if mother is homozygous.
D. 0% — Incorrect: carriers transmit to half of sons.
Correct ANSWER>.>: A
A disorder transmitted only through affected mothers to all children suggests:
A. Mitochondrial inheritance — Correct: mtDNA is maternally inherited.
B. Autosomal dominant — Incorrect: fathers would also transmit.
C. X-linked recessive — Incorrect: no male-to-male, but not all children affected.
D. Genomic imprinting — Incorrect: parent-of-origin silencing, not maternal-only transmission.
Correct ANSWER>.>: A
Which finding is most associated with trisomy 21?
A. Endocardial cushion (AV canal) defects — Correct: classic cardiac lesion; risk rises with maternal age.
B. Coarctation of the aorta — Incorrect: more typical of Turner syndrome.
C. Cystic kidneys — Incorrect: associated with PKD.
D. Tall stature — Incorrect: Down syndrome causes short stature.
Correct ANSWER>.>: A
A female neonate has webbed neck and lymphedema. The karyotype and key cardiac lesion are:
A. 45,X with coarctation — Correct: Turner syndrome features.
B. 47,XXY — Incorrect: Klinefelter (male).
C. Trisomy 18 — Incorrect: Edwards, different phenotype.
D. 46,XX deletion 22q11 — Incorrect: DiGeorge syndrome.
Correct ANSWER>.>: A
, A tall male with gynecomastia, small testes, and infertility most likely has:
A. 47,XXY — Correct: Klinefelter syndrome.
B. 45,X — Incorrect: female Turner phenotype.
C. Trisomy 13 — Incorrect: Patau, severe malformations.
D. 47,XYY — Incorrect: usually normal fertility, tall.
Correct ANSWER>.>: A
Sickle cell disease results from which mutation?
A. Missense substitution (glutamate → valine) in β-globin — Correct: produces HbS that polymerizes
when deoxygenated.
B. Frameshift deletion — Incorrect: not the mechanism.
C. Trinucleotide expansion — Incorrect: seen in Huntington/Fragile X.
D. Chromosomal translocation — Incorrect: seen in cancers like CML.
Correct ANSWER>.>: A
Anticipation (earlier onset in successive generations) is characteristic of:
A. Huntington disease (CAG expansion) — Correct: repeats expand, especially via paternal transmission.
B. Cystic fibrosis — Incorrect: recessive point mutation, no anticipation.
C. Hemophilia A — Incorrect: X-linked, stable mutation.
D. Marfan syndrome — Incorrect: FBN1 mutation, variable but not anticipatory.
Correct ANSWER>.>: A
Café-au-lait macules, neurofibromas, and Lisch nodules indicate:
A. Neurofibromatosis type 1 — Correct: AD, NF1 (neurofibromin) on chromosome 17.
B. Tuberous sclerosis — Incorrect: ash-leaf spots, seizures, angiofibromas.
C. Von Hippel–Lindau — Incorrect: hemangioblastomas, renal cancer.
D. Li-Fraumeni — Incorrect: p53 germline, multiple cancers.
Correct ANSWER>.>: A
A tall patient with upward lens dislocation and aortic root dilation has a defect in:
A. Fibrillin-1 (FBN1) — Correct: Marfan syndrome; aortic dissection risk.
B. Collagen type III — Incorrect: vascular Ehlers-Danlos.
C. Collagen type I — Incorrect: osteogenesis imperfecta.
