Downstate Medical Center NRMS 5190 Advanced Pathophysiology – Exam 1 Review Guide | Complete Answered review A+, Fall 2026/2027.

NRMS 5190 Advanced Pathophysiology Exam 1 – Complete Review Guide | Downstate Medical Center | Updated Fall 2026 1. Which statement best defines pathophysiology? A. The study of disease occurrence in human populations B. The description of the evolution of a disease as acute or chronic C. The study of the body's response to dysfunction or disease; the physiology of altered health D. The designation of the cause of a health problem 2. In the disease process, which term refers specifically to the cause of disease? A. Morphologic change B. Clinical course C. Pathogenesis D. Etiology 3. A student is asked to explain the sequence of events from contact with an etiologic agent until disease expression. Which concept is being tested? A. Morbidity B. Diagnosis C. Pathogenesis D. Etiology 4. Where does transcription occur according to the study guide? A. At the lysosome B. In the cell nucleus C. In the extracellular space D. Within the Golgi complex only 5. Which process uses an mRNA template to synthesize a protein? A. Osmosis B. Translation C. Transcription D. Endocytosis 6. What is the role of tRNA during protein synthesis? A. It transports amino acids to ribosomes so the mRNA message can be translated B. It copies DNA into a complementary DNA strand C. It destroys excess cell parts D. It carries cholesterol back to the liver 7. Disruption of molecular chaperone mechanisms is associated in the guide with which outcome? A. Increased sodium elimination by the kidneys B. Permanent opening of all ion channels C. Immediate conversion of epithelial cells to connective tissue D. Denatured, insoluble proteins that can form inclusion bodies 8. What is the main function of cilia on respiratory epithelial linings described in the guide? A. Synthesize ribosomal RNA B. Generate ATP for the epithelial cell C. Sweep bacteria and dust trapped in mucus up the airways toward the mouth D. Store intracellular calcium 9. Which human cell type is identified in the guide as having a flagellum? A. Red blood cell B. Sperm cell C. Osteoclast D. Keratinocyte 10. Which statement about mitochondria is supported by the study guide? A. They lack ribosomes B. They are the primary site of transcription of nuclear DNA C. They contain their own DNA and help regulate apoptosis D. Their DNA is inherited primarily from the father 11. What does the Na+/K+-ATPase pump do? A. Moves glucose by simple diffusion B. Moves water from high solute concentration to low solute concentration C. Moves 3 Na+ out of the cell and 2 K+ into the cell using ATP D. Moves 2 Na+ out and 3 K+ in without energy 12. A tissue increases the number of its cells in response to increased demand. Which adaptation is this? A. Atrophy B. Hyperplasia C. Necrosis D. Hypertrophy 13. Breast and uterine enlargement during pregnancy are examples of which cellular adaptation in the guide? A. Necrosis B. Compensatory hyperplasia C. Metastatic calcification D. Hormonal hyperplasia 14. Liver regeneration after removal of part of the liver is an example of which adaptation? A. Metaplasia B. Compensatory hyperplasia C. Hormonal hyperplasia D. Dystrophic calcification 15. Chronic irritation causes one mature cell type to be replaced by a hardier cell type of the same general tissue category. Which adaptation is this? A. Hypertrophy B. Metaplasia C. Apoptosis D. Hyperplasia 16. Which chronic condition is identified as a risk factor for Barrett esophagus? A. Raynaud disease B. Klinefelter syndrome C. Diabetes insipidus D. GERD 17. What causes the yellow discoloration of tissues in jaundice according to the guide? A. Excess intracellular potassium B. Excess collagen deposition C. Low serum LDL D. Retention and buildup of bilirubin 18. What does the study guide identify as the ultimate cause of cell death? A. Hypoxia B. Increased anatomic reserve C. High HDL D. Hyperplasia 19. A cell has severe genetic damage that cannot be repaired. Which response is most consistent with the guide? A. The cell becomes a red blood cell B. The cell permanently increases sodium entry C. The cell undergoes apoptosis to avoid passing on damaged DNA D. The cell must undergo hyperplasia 20. Too little apoptosis is associated in the guide with which disease process? A. Diabetes insipidus B. Cancer C. Orthostatic hypotension D. Raynaud disease 21. What term refers to cell death in an organ or tissue that is still part of a living person? A. Apoptosis B. Hyperplasia C. Necrosis D. Metaplasia 22. Which mutation must occur for a DNA change to be transmitted to offspring? A. A mutation confined to a somatic skin cell B. A mutation only in extracellular matrix C. A mutation in the germ cell line D. A mutation limited to a mature red blood cell 23. Which statement correctly distinguishes genotype from phenotype? A. Phenotype is inherited but genotype is not B. Genotype is inherited genetic information; phenotype is the recognizable physical or biochemical expression associated with it C. Genotype is only visible physical appearance D. Phenotype is the chromosome count only 24. What does Mendel's first law, the law of segregation, state? A. Only dominant alleles enter germ cells B. All alleles remain paired in every gamete C. Mitochondrial DNA is inherited from both parents equally D. The two alleles at a gene locus separate so each germ cell receives one allele 25. What does Mendel's second law, the law of independent assortment, describe? A. Only recessive alleles assort independently B. All gene loci are inherited as one fixed block C. Alleles from different gene loci segregate independently and recombine randomly in the zygote D. Chromosomes never separate during meiosis 26. An affected parent with an autosomal dominant disorder has what chance of transmitting the disorder to each offspring according to the guide? A. 25% B. 50% C. 100% D. 0% 27. Which description best fits autosomal recessive inheritance? A. Only affected fathers transmit the disorder B. Only one mutated allele is needed in every case C. The disorder is always inherited through mitochondrial DNA D. Both parents may be unaffected carriers, and the disorder can affect both sexes 28. An unaffected mother carries one normal X and one mutant X for an X-linked recessive disorder. Which statement is supported by the guide? A. No daughter can ever carry the mutant X B. The father transmits his X chromosome to all sons C. She has a 50% chance of transmitting the mutant X to a son D. Every son must inherit the mutant X 29. Phenylketonuria in the study guide is associated with buildup of which substance? A. Cholesterol B. Aldosterone C. Phenylalanine D. Bilirubin 30. Which chromosomal disorder is caused by trisomy 21 from meiotic nondisjunction? A. Klinefelter syndrome B. Down syndrome C. Fragile X syndrome D. Turner syndrome 31. Which chromosomal pattern is associated with Turner syndrome in the guide? A. Monosomy X B. 47, XXY C. Trisomy 21 D. Autosomal dominant inheritance 32. Which chromosomal pattern is associated with Klinefelter syndrome? A. Trisomy 21 B. 46, XX only C. 45, X D. 47, XXY 33. How are mitochondrial DNA disorders inherited according to the guide? A. Through the maternal line B. Only through the paternal line C. Only through the Y chromosome D. Only through autosomal dominant inheritance 34. During which period does the guide say the embryo is most susceptible to teratogenic agents? A. Organogenesis, about 15-60 days after conception B. Only during the final 24 hours before delivery C. Only after birth D. Only after puberty 35. Which finding is consistent with fetal alcohol syndrome as described in the guide? A. Isolated high HDL without developmental effects B. Growth retardation with CNS involvement and characteristic facial changes C. Only aortic dissection D. Monosomy X with no CNS findings 36. Which feature best distinguishes a malignant neoplasm from a benign neoplasm in the study guide? A. Always remaining as a single well-differentiated mass B. Ability to invade, enter blood or lymph, and form secondary tumors C. Always having a lower grade than benign tissue D. Inability to affect blood supply 37. What does anaplasia mean in the context of cancer? A. Increase in normal cell specialization B. Physiologic reserve C. Movement of water by osmosis D. Loss of cell differentiation 38. Which statement about tumor grade is consistent with the guide? A. Grade 5 tumors are always benign B. Grade 1 tumors are always the most anaplastic C. Tumor grade refers only to the organ where metastasis occurs D. Grade 1 tumors are well differentiated, while grade 5 tumors are poorly differentiated with marked anaplasia 39. What happens when a normal proto-oncogene undergoes a cancer-promoting mutation? A. It can become an oncogene that promotes cancer cell growth B. It permanently stops all cell growth C. It changes into mitochondrial DNA D. It becomes a tumor suppressor gene 40. Why is angiogenesis important to an enlarging tumor according to the guide? A. It supplies new blood vessels needed for tumor survival and metastasis B. It causes all tumor cells to undergo apoptosis C. It converts malignant cells to benign cells D. It prevents nutrient delivery to tumors 41. Which group contains only childhood cancers or solid tumors named in the guide? A. Neuroblastoma, Wilms tumor, rhabdomyosarcoma, retinoblastoma B. Raynaud disease, SIADH, pericarditis, psoriasis C. Atherosclerosis, vasculitis, PAD, orthostatic hypotension D. Turner syndrome, Klinefelter syndrome, PKU, Marfan syndrome 42. How does negative feedback help maintain homeostasis? A. It always increases the monitored value regardless of the set point B. It moves a monitored value back toward its set point when the value rises above or falls below that point C. It prevents all physiologic adaptation D. It eliminates the need for endocrine responses 43. Which statement about body-fluid distribution is correct? A. ICF contains one-third and is high in sodium; ECF contains two-thirds and is high in potassium B. ECF contains no sodium C. ICF contains about two-thirds of body water and is high in potassium; ECF contains about one-third and is high in sodium D. Both compartments have identical ion concentrations 44. Which mechanism can contribute to edema? A. Decreased capillary permeability B. Improved lymph flow C. Increased capillary filtration pressure D. Increased plasma colloidal osmotic pressure only 45. Which pairing correctly matches water regulation? A. ADH regulates only water intake; thirst regulates sodium elimination B. Both are unrelated to extracellular osmolality C. Thirst regulates potassium excretion; ADH regulates LDL D. Thirst regulates water intake; ADH regulates water output 46. A patient has intense thirst and heavy urination due to deficiency of, or decreased response to, ADH. Which disorder is described? A. SIADH B. Metabolic alkalosis C. Diabetes insipidus D. Raynaud disease 47. Which finding best fits SIADH in the guide? A. Loss of all extracellular water without thirst B. Continued ADH secretion despite decreased serum osmolality, causing water retention and dilutional hyponatremia C. Too little ADH with heavy urination D. Excessive sodium elimination only when arterial pressure falls 48. How do the kidneys respond to arterial pressure changes in sodium regulation according to the guide? A. Do not participate in sodium regulation B. Always retain sodium regardless of pressure C. Eliminate sodium when pressure decreases and retain it when pressure increases D. Retain sodium when arterial pressure decreases and eliminate sodium when arterial pressure increases 49. Which statement about potassium is emphasized in the guide? A. Potassium is found only outside cells B. Normal extracellular potassium is about 3.5-5.0 mEq/L and potassium is central to resting membrane potential C. Potassium does not affect membrane potential D. Normal extracellular potassium is 10-12 mEq/L and has no cardiac role 50. Which severe consequence is associated with hypokalemia in the guide? A. Dilutional hyponatremia from excess ADH B. Increased HDL transport to the liver C. Muscle paralysis with possible respiratory insufficiency and cardiac arrhythmias D. Pulsus paradoxus 51. Which finding is described as an early symptom of hyperkalemia? A. Pulsus paradoxus B. Short palpebral fissures C. Nocturnal incontinence only D. Paresthesias or numbness and tingling in the fingers and toes 52. Which laboratory pattern is consistent with metabolic acidosis? A. pH below 7.35 with PCO2 above 45 as the primary disturbance B. pH below 7.35 with HCO3 below 22 C. pH above 7.45 with HCO3 above 26 D. pH above 7.45 with PCO2 below 35 as the primary disturbance 53. Which laboratory pattern is consistent with metabolic alkalosis? A. pH above 7.45 with HCO3 above 26 B. pH below 7.35 with PCO2 above 45 C. pH below 7.35 with HCO3 below 22 D. pH above 7.45 with PCO2 below 35 as the primary disturbance 54. Which laboratory pattern is consistent with respiratory acidosis? A. pH above 7.45 with HCO3 above 26 as the primary disturbance B. pH below 7.35 with PCO2 above 45 mmHg C. pH below 7.35 with HCO3 below 22 as the primary disturbance D. pH above 7.45 with PCO2 below 35 mmHg 55. Which laboratory pattern is consistent with respiratory alkalosis? A. pH below 7.35 with PCO2 above 45 mmHg B. pH above 7.45 with HCO3 above 26 as the primary disturbance C. pH below 7.35 with HCO3 below 22 D. pH above 7.45 with PCO2 below 35 mmHg 56. An ABG shows pH 7.30, HCO3 18 mEq/L, and PCO2 31 mmHg. Which disturbance best matches the guide's patterns? A. Metabolic alkalosis B. Respiratory alkalosis C. Respiratory acidosis D. Metabolic acidosis with respiratory compensation 57. An ABG shows pH 7.50, PCO2 30 mmHg, and HCO3 23 mEq/L. Which disturbance best matches the guide's patterns? A. Respiratory alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Metabolic alkalosis 58. Which sequence correctly follows blood flow through the basic circulatory circuit? A. Left heart → pulmonary artery → lungs → vena cava → right heart → aorta B. Right heart → pulmonary artery → lungs → pulmonary veins → left heart → aorta C. Right heart → aorta → lungs → pulmonary veins → left heart D. Pulmonary veins → right heart → aorta → lungs → left heart 59. How is cardiac output calculated? A. Cardiac output = stroke volume × heart rate B. Cardiac output = systolic pressure − diastolic pressure C. Cardiac output = blood pressure × HDL D. Cardiac output = preload × potassium 60. What is the major function of capillaries in the microcirculation? A. Exchange of oxygen, nutrients, carbon dioxide, and wastes between blood and tissues B. Produce aldosterone C. Generate the normal SA node rhythm D. Store most intracellular potassium 61. Which factor is strongly emphasized as a cause of endothelial dysfunction and atherosclerotic risk? A. Smoking B. Increased anatomic reserve C. High HDL D. Mitosis 62. Which statement correctly matches systolic and diastolic pressure? A. Both represent only atrial contraction B. Systolic pressure reflects ventricular contraction; diastolic pressure reflects ventricular relaxation C. Systolic pressure reflects ventricular relaxation; diastolic reflects contraction D. Both are unrelated to ventricular activity 63. Which lipid pattern is the desired goal in atherosclerosis prevention according to the guide? A. Low LDL and high HDL B. High LDL and low HDL C. Low HDL regardless of LDL D. High LDL and high triglycerides only 64. Which complication is emphasized for medium-sized arteries affected by atherosclerosis? A. Ischemia and infarction from vessel occlusion B. Only cardiac tamponade C. Only increased anatomic reserve D. Only dilutional hyponatremia 65. A sudden arterial occlusion in a leg causes acute pain, pallor, coldness, absent pulses, paresthesia, and weakness. Which concept does this most strongly represent? A. Acute arterial embolic/occlusive event B. SIADH C. Stable angina D. Chronic venous insufficiency 66. What is the primary symptom of chronic obstructive peripheral artery disease in the guide? A. Intermittent claudication B. Dilutional hyponatremia C. Hemoptysis D. Pulsus paradoxus 67. Cold exposure triggers intense digital vasospasm followed by pallor, cyanosis, and numbness. Which condition best matches the guide? A. Diabetes insipidus B. Raynaud disease C. Cardiac tamponade D. Turner syndrome 68. Where do atherosclerosis-induced aneurysms occur most commonly according to the guide? A. Pulmonary vein B. Mitral valve leaflet C. Superior vena cava only D. Abdominal portion of the aorta 69. Which statement about aortic dissection pain is supported by the guide? A. Both types are always painless B. Ascending dissection causes only leg pain C. Descending dissection causes only jaw pain D. Ascending aortic dissection can cause anterior chest pain; descending dissection often causes back pain 70. Which three components form Virchow's triad? A. Hypercoagulability, blood stasis, and vessel wall injury B. Preload, afterload, and cardiac output C. Aneurysm, edema, and jaundice D. Hypertension, hyperplasia, and hypoxia 71. Which is a recognized cause of secondary hypertension in the guide? A. Mitosis B. High HDL C. Increased elastin D. Kidney disease 72. Which target-organ effect of chronic hypertension is listed in the guide? A. Left ventricular hypertrophy B. Increased ovarian development C. Improved retinal perfusion D. Decreased atherosclerotic risk 73. A patient with a pericardial effusion develops restricted cardiac movement and impaired ventricular contraction. Which finding is highlighted as key for cardiac tamponade? A. Intermittent claudication B. Kussmaul breathing from metabolic acidosis C. Saw-tooth atrial flutter waves D. Pulsus paradoxus 74. Which feature most strongly distinguishes unstable angina from stable angina in the guide? A. Stable angina always occurs at rest B. Unstable angina is always relieved immediately by rest C. Stable angina is caused by complete AV block D. Unstable angina may occur at rest and is more severe, prolonged, or frequent 75. Which presentation best matches STEMI manifestations listed in the guide? A. Only chronic calf pain with walking B. Abrupt severe crushing substernal pain radiating to the left arm, neck, or jaw with anxiety and cool moist skin C. Only jaundice without chest symptoms D. Only thirst and heavy urination 76. Which statement about dilated cardiomyopathy is emphasized in the guide? A. It is caused only by SIADH B. It is a common cause of heart failure, a leading indication for heart transplantation, and alcohol is the most common cause listed C. It never causes ventricular enlargement D. It is defined by increased HDL 77. Which organism is emphasized as a major cause of infective endocarditis in IV drug users? A. Staphylococcus epidermidis B. Staphylococcus aureus C. Rubella virus D. Cytomegalovirus 78. What is the most common cause of mitral valve stenosis listed in the guide? A. Diabetes insipidus B. Raynaud disease C. Rheumatic fever D. Hyperkalemia 79. Which causes of aortic stenosis are listed in the guide? A. Aging, congenital malformations, and rheumatic heart disease B. Turner syndrome, Klinefelter syndrome, and PKU C. SIADH, diabetes insipidus, and hypokalemia D. Only endothelial dysfunction from smoking 80. Which statement correctly distinguishes preload from afterload? A. Preload and afterload are identical B. Preload is arterial resistance; afterload is venous filling during diastole C. Both terms describe only heart rate D. Preload is ventricular filling pressure before contraction; afterload is the resistance the heart must overcome during systole 81. Which symptom is emphasized as a major manifestation of left-sided heart failure? A. Only a wide gap between the toes B. Shortness of breath from pulmonary congestion C. Only finger pallor from vasospasm D. Only jaundice 82. For the purpose of the exam review, which finding is specifically emphasized as a sign of acute heart failure? A. Low LDL B. Short stature with normal proportions C. Weight gain from fluid retention and edema D. Persistent weight loss as the only acute sign 83. Which structure is the primary pacemaker of the heart? A. Bundle of His B. SA node C. AV node D. Purkinje fibers 84. What is the normal conduction sequence described in the guide after the SA node fires? A. AV node → pulmonary veins → SA node → Bundle of His B. Purkinje fibers → SA node → aorta → AV node C. SA node → mitral valve → capillaries → Purkinje fibers D. SA node → internodal pathways → AV node → Bundle of His → Purkinje fibers 85. What is the key electrical event of phase 0 of the cardiac action potential? A. Complete refractory recovery after phase 4 B. Resting diastolic repolarization C. Atrial contraction represented by the P wave only D. Rapid depolarization responsible for the QRS complex 86. What does phase 4 represent in the cardiac action potential? A. Aortic valve stenosis B. The period of maximal platelet aggregation C. Rapid upstroke responsible for QRS D. Resting membrane potential and diastolic repolarization 87. Why is potassium especially important in cardiac electrophysiology according to the guide? A. It is the main cause of all atherosclerotic plaques B. It is central to establishing and maintaining the resting membrane potential of cardiac muscle cells C. It is only involved in bilirubin excretion D. It replaces sodium in all extracellular fluid 88. During which phases can a cardiac cell not be stimulated to generate another action potential, according to the guide? A. Only before phase 0 begins B. Only late phase 3 C. Only phase 4 D. Phases 0, 1, 2, and the early part of phase 3 89. At what point does the guide say cardiac arrhythmia development is especially likely because even a weak stimulus can evoke a response? A. At the end of phase 3 and beginning of phase 4 B. Only at the beginning of phase 0 C. Only during the entire absolute refractory period D. Only during systole before phase 0 90. Which rhythm is described as having a saw-tooth pattern with a regular ventricular rate? A. Third-degree AV block B. Atrial flutter C. Atrial fibrillation D. Ventricular fibrillation 91. Which rhythm is described as rapid, unorganized atrial activation with an irregular ventricular rate? A. Sinus rhythm B. First-degree AV block C. Atrial flutter D. Atrial fibrillation 92. Paroxysmal supraventricular tachycardia may result from which mechanism described in the guide? A. Only Turner syndrome B. AV nodal reentry or an accessory pathway such as Wolff-Parkinson-White syndrome C. Only low HDL D. Only aortic regurgitation 93. Which ventricular rhythm is described as quivering without effective contraction and producing little to no blood flow? A. Atrial flutter B. Stable angina C. First-degree AV block D. Ventricular fibrillation 94. Long QT syndrome may lead to which dangerous rhythm according to the guide? A. Only first-degree AV block B. Torsades de Pointes, a polymorphic ventricular tachycardia C. Only atrial flutter D. Only sinus bradycardia 95. A major ECG abnormality is seen unexpectedly. What is the first action emphasized in the guide? A. Verify correct lead placement B. Diagnose aortic dissection C. Immediately classify the patient as having SIADH D. Assume the rhythm is ventricular fibrillation 96. Which ECG feature best fits first-degree AV block? A. Prolonged PR interval greater than 200 ms with every P wave followed by a QRS complex B. No P waves with a saw-tooth pattern C. Progressive PR lengthening followed by a dropped QRS only D. Complete dissociation of P waves and QRS complexes 97. Which pattern best describes Mobitz type I second-degree AV block? A. Progressive PR interval lengthening before a dropped QRS complex B. Every P wave followed by a QRS with no PR prolongation C. Complete dissociation of atria and ventricles D. Constant PR intervals with sudden dropped QRS complexes 98. Which pattern best describes Mobitz type II second-degree AV block? A. A saw-tooth atrial rhythm B. No relationship at all between P waves and QRS complexes C. Progressive PR lengthening before each dropped QRS D. Constant PR intervals with sudden dropped QRS complexes 99. Which ECG relationship is characteristic of third-degree, or complete, AV block? A. Atrial and ventricular rates are always identical B. P waves and QRS complexes occur independently with no fixed relationship C. Only the QRS complex disappears while atrial and ventricular activity remain synchronized D. Every P wave is followed by a QRS with a fixed PR interval 100. Which clinical problem can result from third-degree AV block according to the guide? A. Only hypercholesterolemia B. Only intermittent claudication C. Decreased cardiac output with syncope called a Stokes-Adams attack D. Only jaundice