NSG 1520 PATHOPHYSIOLOGY EXAM 3
REVIEW QUESTIONS AND ANSWERS
1. Which compensatory mechanism in heart failure is initially beneficial but eventually leads
to increased myocardial oxygen demand and cardiac remodeling?
A. Activation of the Sympathetic Nervous System (SNS)
B. Release of Atrial Natriuretic Peptide (ANP)
C. Downregulation of beta-adrenergic receptors
D. Decrease in peripheral vascular resistance
Answer: A
Conceptual Explanation: The SNS activation increases heart rate and contractility to
maintain cardiac output, but the resulting increase in oxygen demand and vasoconstriction
eventually worsens heart failure and leads to harmful remodeling.
2. A patient presents with paroxysmal nocturnal dyspnea, orthopnea, and bibasilar crackles.
Which of the following is the most likely underlying pathophysiology?
A. Left-sided heart failure causing increased pulmonary capillary hydrostatic pressure
B. Cor pulmonale secondary to chronic obstructive pulmonary disease
,C. Right-sided heart failure causing systemic venous congestion
D. Tricuspid valve regurgitation leading to hepatic engorgement
Answer: A
Conceptual Explanation: These are classic symptoms of left-sided heart failure. Failure of
the left ventricle causes blood to back up into the pulmonary circulation, increasing
hydrostatic pressure and leading to pulmonary edema.
3. In the development of atherosclerosis, what is the primary consequence of LDL oxidation
within the arterial wall?
A. Inhibition of smooth muscle cell proliferation
B. Activation of endothelial cells to release nitric oxide
C. Recruitment of macrophages and formation of foam cells
D. Dissolution of the fibrous cap of an existing plaque
Answer: C
Conceptual Explanation: Oxidized LDL is engulfed by macrophages, which then transform
into foam cells. These foam cells accumulate to form the fatty streak, the earliest visible
lesion of atherosclerosis.
4. Which clinical finding is most indicative of cardiac tamponade?
A. Widened pulse pressure and bradycardia
B. Systolic murmur radiating to the axilla
, C. Beck’s triad: hypotension, JVD, and muffled heart sounds
D. ST-segment elevation in all EKG leads
Answer: C
Conceptual Explanation: Beck’s triad is the hallmark of cardiac tamponade, occurring
when fluid in the pericardial sac compresses the heart and limits diastolic filling.
5. A patient with a history of rheumatic fever presents with a low-pitched diastolic rumble
heard best at the apex. This is characteristic of:
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral regurgitation
D. Mitral stenosis
Answer: D
Conceptual Explanation: Mitral stenosis, often a late sequela of rheumatic fever, causes a
diastolic murmur as blood struggles to flow from the left atrium to the left ventricle
through a narrowed valve.
6. What is the pathophysiological significance of elevated Troponin I and T levels in the
blood?
A. They indicate reversible myocardial ischemia without cell death
B. They are specific markers for skeletal muscle breakdown
REVIEW QUESTIONS AND ANSWERS
1. Which compensatory mechanism in heart failure is initially beneficial but eventually leads
to increased myocardial oxygen demand and cardiac remodeling?
A. Activation of the Sympathetic Nervous System (SNS)
B. Release of Atrial Natriuretic Peptide (ANP)
C. Downregulation of beta-adrenergic receptors
D. Decrease in peripheral vascular resistance
Answer: A
Conceptual Explanation: The SNS activation increases heart rate and contractility to
maintain cardiac output, but the resulting increase in oxygen demand and vasoconstriction
eventually worsens heart failure and leads to harmful remodeling.
2. A patient presents with paroxysmal nocturnal dyspnea, orthopnea, and bibasilar crackles.
Which of the following is the most likely underlying pathophysiology?
A. Left-sided heart failure causing increased pulmonary capillary hydrostatic pressure
B. Cor pulmonale secondary to chronic obstructive pulmonary disease
,C. Right-sided heart failure causing systemic venous congestion
D. Tricuspid valve regurgitation leading to hepatic engorgement
Answer: A
Conceptual Explanation: These are classic symptoms of left-sided heart failure. Failure of
the left ventricle causes blood to back up into the pulmonary circulation, increasing
hydrostatic pressure and leading to pulmonary edema.
3. In the development of atherosclerosis, what is the primary consequence of LDL oxidation
within the arterial wall?
A. Inhibition of smooth muscle cell proliferation
B. Activation of endothelial cells to release nitric oxide
C. Recruitment of macrophages and formation of foam cells
D. Dissolution of the fibrous cap of an existing plaque
Answer: C
Conceptual Explanation: Oxidized LDL is engulfed by macrophages, which then transform
into foam cells. These foam cells accumulate to form the fatty streak, the earliest visible
lesion of atherosclerosis.
4. Which clinical finding is most indicative of cardiac tamponade?
A. Widened pulse pressure and bradycardia
B. Systolic murmur radiating to the axilla
, C. Beck’s triad: hypotension, JVD, and muffled heart sounds
D. ST-segment elevation in all EKG leads
Answer: C
Conceptual Explanation: Beck’s triad is the hallmark of cardiac tamponade, occurring
when fluid in the pericardial sac compresses the heart and limits diastolic filling.
5. A patient with a history of rheumatic fever presents with a low-pitched diastolic rumble
heard best at the apex. This is characteristic of:
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral regurgitation
D. Mitral stenosis
Answer: D
Conceptual Explanation: Mitral stenosis, often a late sequela of rheumatic fever, causes a
diastolic murmur as blood struggles to flow from the left atrium to the left ventricle
through a narrowed valve.
6. What is the pathophysiological significance of elevated Troponin I and T levels in the
blood?
A. They indicate reversible myocardial ischemia without cell death
B. They are specific markers for skeletal muscle breakdown
