SUNY Downstate NRMS 5190 Advanced Pathophysiology – Exam 2 Comprehensive Review | Questions & Answers | Latest Fall 2026.

NRMS 5190 Exam 2 – Advanced Pathophysiology | Complete Q&A Review Guide | SUNY Downstate Medical Center | Updated Fall 2026/2027. **1. Which alveolar cell type produces surfactant that reduces surface tension and increases lung compliance?** A. Bronchial smooth muscle cells B. Type I alveolar cells C. Type II alveolar cells D. Pulmonary capillary endothelial cells **2. What does tidal volume (VT) represent?** A. The amount of air that moves into and out of the lungs during normal breathing B. The volume of blood perfusing the lungs each minute C. The total air remaining after maximal expiration D. The amount of air exchanged only during forced breathing **3. Which three processes are required for respiration according to the Exam 2 study guide?** A. Filtration, secretion, and absorption B. Compliance, recoil, and mucociliary clearance C. Ventilation, perfusion, and diffusion D. Inspiration, circulation, and metabolism **4. What is a primary function of the conducting airways in addition to moving air?** A. Producing pulmonary surfactant B. Generating pulmonary capillary blood flow C. Warming, filtering, and humidifying inspired air D. Performing the primary alveolar gas exchange **5. Which virus is identified as the most common cause of the common cold?** A. Parainfluenza virus B. Respiratory syncytial virus C. Influenza C virus D. Rhinovirus **6. Which finding more strongly supports rhinosinusitis than an uncomplicated common cold?** A. Postnasal drip without facial pain B. Clear watery nasal secretions C. Mild hoarseness D. Fever with facial pain **7. Which clinical pattern is most characteristic of influenza in the study guide?** A. Gradual onset of isolated productive cough B. Persistent facial pressure that worsens when bending forward C. Abrupt fever, chills, myalgias, headache, and profound malaise D. Chronic wheezing without systemic symptoms **8. A patient with influenza begins to improve, then develops a new fever, pleuritic chest pain, and productive cough. What complication does the study guide suggest?** A. Uncomplicated viral rhinitis B. Secondary bacterial pneumonia C. Stable chronic bronchitis D. Spontaneous pneumothorax **9. According to the study guide, which antiviral pair is effective against both influenza A and B?** A. Amantadine and rimantadine B. Amoxicillin and erythromycin C. Zanamivir and oseltamivir D. Isoniazid and rifampin **10. Which organism is identified as the most common cause of bacterial pneumonia?** A. Histoplasma capsulatum B. Streptococcus pneumoniae C. Mycobacterium tuberculosis D. Respiratory syncytial virus **11. How does the study guide define hospital-acquired pneumonia?** A. Any pneumonia occurring in a patient older than 65 B. Pneumonia occurring 48 hours or more after hospital admission C. Pneumonia diagnosed before arrival at the hospital D. Pneumonia beginning within the first 12 hours after admission **12. In pulmonary tuberculosis, which cell is described as the primary cell infected after inhaled droplets reach the alveoli?** A. Macrophage B. Neutrophil C. Eosinophil D. Type II alveolar cell **13. What is the granulomatous lesion that contains tubercle bacilli in a person with intact cell-mediated immunity?** A. Hyaline membrane B. Caseous bronchiectatic plug C. Ghon focus D. Atheromatous plaque **14. Which exposure is most consistent with the source of histoplasmosis described in the study guide?** A. Transmission by mosquito bite B. Inhalation of spores from soil contaminated with bird excrement or bat droppings C. Ingestion of undercooked meat D. Direct skin contact with stagnant water **15. Which paraneoplastic syndrome is specifically associated with small cell lung carcinoma in the study guide?** A. Addison disease B. SIADH C. Ulcerative colitis D. Hashimoto thyroiditis **16. Which lung cancer type is described as the most common type in women and nonsmokers?** A. Squamous cell carcinoma B. Large cell carcinoma C. Adenocarcinoma D. Small cell carcinoma **17. What is the central pathophysiologic problem in respiratory distress syndrome of prematurity?** A. Acute obstruction of the superior vena cava B. Surfactant deficiency causing alveolar collapse C. Excess mucus production from goblet-cell hypertrophy D. Permanent dilation of bronchi and bronchioles **18. Which history best fits bronchopulmonary dysplasia as described in the study guide?** A. An adolescent with acute epiglottitis B. A school-aged child with intermittent exercise-induced wheezing C. A premature infant treated with prolonged mechanical ventilation who remains oxygen dependent at 36 weeks D. A healthy term infant with a 2-day common cold **19. Which neurologic change is most consistent with progressively worsening hypoxemia?** A. Isolated loss of appetite without mental change B. Restlessness progressing to confusion, delirium, stupor, and coma C. A fixed pattern of normal cognition despite low oxygen D. Progressive hyperalertness with improved judgment **20. Why can hypercapnia occur without hypoxemia mainly in hypoventilation?** A. Carbon dioxide cannot cross the alveolar membrane B. Renal bicarbonate retention prevents all hypoxemia C. Oxygen diffuses more rapidly than carbon dioxide D. Carbon dioxide diffuses much more readily than oxygen **21. Which hemodynamic consequence is expected in tension pneumothorax?** A. Reduced venous return and reduced cardiac output B. Improved perfusion from decompression of the vena cava C. Selective increase in left ventricular filling without mediastinal shift D. Increased venous return with increased cardiac output **22. What is atelectasis?** A. Infection producing exudate in the pleural cavity B. Lymph in the pleural cavity C. Incomplete expansion of a lung or a portion of a lung D. Blood in the pleural cavity **23. Which feature most clearly distinguishes asthma from COPD in the study guide?** A. COPD is caused only by viral infection B. Asthma has reversible bronchoconstriction C. Asthma always produces permanent airway dilation D. COPD is defined by reversible bronchoconstriction **24. During a prolonged asthma attack, what change contributes to increasing work of breathing?** A. Immediate increase in lung recoil that empties alveoli completely B. Air trapping with hyperinflation behind narrowed airways C. Rapid disappearance of residual lung volume D. Loss of all pulmonary blood flow **25. Which history meets the study guide definition of chronic bronchitis?** A. A single 6-month episode of nonproductive cough B. Intermittent cough for 1 month every 3 years C. Chronic cough for at least 3 consecutive months in at least 2 consecutive years D. Cough for 1 week after influenza **26. Which combination is most closely associated with emphysema in the study guide?** A. Smoking and inherited alpha-1 antitrypsin deficiency B. Rhinovirus infection and low surfactant C. H. pylori infection and NSAID use D. Gallstones and alcohol abuse **27. Which sputum description is most characteristic of bronchiectasis in the study guide?** A. Copious foul-smelling purulent sputum B. No sputum despite severe cough C. Scant clear sputum only in the morning D. Watery nasal drainage without cough **28. Which statement about cystic fibrosis is supported by the Exam 2 notes?** A. It is a transient viral disorder of the upper airway B. It is an X-linked disorder characterized by surfactant excess C. It is an acquired disorder caused only by cigarette smoking D. It is an autosomal recessive disorder with viscid bronchial mucus and impaired mucociliary clearance **29. What is the most common source of pulmonary emboli described in the study guide?** A. Isolated viral rhinitis B. Thyroid hormone excess C. Gastric ulcer disease D. Deep venous thrombosis of the extremities **30. Which finding is most characteristic of ARDS in the study guide?** A. Slow onset of respiratory symptoms over several years B. Marked hypoxemia that is not corrected by supplemental oxygen C. Isolated hyperglycemia without respiratory distress D. Mild hypoxemia rapidly corrected by rest alone **31. Which neurologic injury pattern is specifically linked to cerebral palsy in the study guide?** A. Acute destruction of pancreatic beta cells B. Cholesterol deposition in the gallbladder C. Autoimmune destruction of the thyroid gland D. Periventricular leukomalacia from reduced oxygen supply to white matter **32. Down syndrome is described as resulting from which chromosomal abnormality?** A. A missing Y chromosome B. An extra full or partial copy of chromosome 21 C. An extra chromosome 18 only D. A deletion of all mitochondrial DNA **33. Which finding in an adolescent should raise suspicion for Turner syndrome based on the study guide?** A. Rapid development of acne alone B. Failure to begin menstruation C. Binge eating followed by purging D. Early onset of nocturnal emissions **34. Which vascular bed is especially important in Kawasaki disease because it may become involved as vasculitis progresses?** A. Coronary arteries B. Pulmonary capillaries only C. Portal veins only D. Renal tubules **35. Which viral agent is identified as the most common cause of gastroenteritis in the pediatric section?** A. Epstein-Barr virus B. Rhinovirus C. Influenza A D. Norovirus **36. Which virus accounts for the majority of croup cases in the study guide?** A. Epstein-Barr virus B. Parainfluenza virus C. Hepatitis C virus D. Rhinovirus **37. Which presentation is most concerning for epiglottitis?** A. Drooling, muffled voice, fever, anxiety, and tripod positioning B. Mild rhinorrhea with clear secretions and no distress C. Intermittent abdominal cramping relieved by defecation D. Chronic productive cough with foul-smelling sputum **38. Which organism is identified as the most common cause of bronchiolitis?** A. Streptococcus pneumoniae B. Histoplasma capsulatum C. Respiratory syncytial virus D. Mycobacterium tuberculosis **39. Why can wheezing diminish in severe bronchiolitis?** A. Surfactant production abruptly doubles B. Airflow becomes so limited that less wheezing is generated C. The small airways suddenly become fully normal D. The disease converts to bacterial pneumonia **40. Which set of defects defines Tetralogy of Fallot in the study guide?** A. Pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy B. PDA, coarctation, tricuspid stenosis, and left atrial hypertrophy C. ASD, mitral stenosis, aortic regurgitation, and left ventricular hypertrophy D. VSD, mitral prolapse, pulmonary edema, and left ventricular dilation **41. What shunting pattern is associated with Tetralogy of Fallot in the notes?** A. Left-to-right shunting only B. No shunting at any stage C. Bidirectional shunting caused only by anemia D. Right-to-left shunting **42. Which factor is listed as a major mechanism of heart failure in children with congenital heart disease?** A. Volume overload, pressure overload, or myocardial dysfunction B. Only isolated hypoglycemia C. Only reduced bile production D. Only chronic gastritis **43. Which duration of joint swelling or discomfort is used as an indicator for juvenile rheumatoid arthritis in the study guide?** A. Less than 1 week B. Exactly 3 days C. More than 24 hours D. More than 6 weeks **44. Which pattern best describes bulimia nervosa in the study guide?** A. Persistent inability to swallow because the LES fails to relax B. Progressive weight gain caused by cortisol deficiency C. Binge eating followed by self-induced vomiting or other purging behaviors D. Extreme weight loss due only to self-starvation without bingeing **45. Which statement best distinguishes cell-surface hormone receptors from intracellular receptors in the study guide?** A. Both receptor types are described as having identical mechanisms B. Intracellular receptors act only on ion channels in the plasma membrane C. Cell-surface receptors directly duplicate DNA while intracellular receptors cannot affect gene activity D. Cell-surface receptors often use second messengers, whereas intracellular receptors can alter protein synthesis in the nucleus **46. Endocrine disorders are broadly described as resulting from which two types of dysfunction?** A. Hypofunction or hyperfunction B. Only obstruction or rupture C. Only infection or trauma D. Only dehydration or bleeding **47. Which statement about pituitary tumors is supported by the guide?** A. All pituitary tumors are nonsecretory B. Functional tumors secrete pituitary hormones, while nonfunctional tumors do not C. Functional tumors cannot affect surrounding brain structures D. Only macroadenomas can secrete hormones **48. Approximately how much of the anterior pituitary must be destroyed before hypopituitarism becomes clinically evident?** A. About 25% B. About 75% C. About 50% D. About 10% **49. Which pituitary hormone deficiency is identified as the most serious endocrine deficiency in the notes?** A. Growth hormone excess B. TSH excess C. Prolactin excess D. ACTH deficiency **50. What can happen when hypothalamic GHRH is inadequate?** A. Cortisol secretion becomes permanently excessive B. Thyroid hormone becomes the only growth regulator C. Growth hormone may be produced adequately but released inadequately, causing short stature D. Growth hormone is always excessively released, causing acromegaly **51. Excess growth hormone before fusion of the epiphyses produces which disorder?** A. Pituitary gigantism B. Myxedema C. Acromegaly D. Addison disease **52. Excess growth hormone in adulthood is associated with which disorder?** A. Celiac disease B. Bronchiectasis C. Acromegaly D. Cretinism **53. Which age cutoff is used in the notes to define precocious puberty?** A. Before age 10 in girls and 12 in boys B. Before age 8 in girls and before age 9 in boys C. Before age 14 in girls and 16 in boys D. Before age 6 in both sexes **54. What is the major action of TSH described in the study guide?** A. Stimulating the thyroid gland to produce T3 and T4 B. Stimulating the adrenal cortex to release aldosterone C. Stimulating the liver to form bile salts D. Stimulating pancreatic beta cells to produce insulin **55. Which thyroid-binding protein carries the largest proportion of circulating T3 and T4 in the notes?** A. Hemoglobin B. Albumin C. Thyroxine-binding prealbumin (TBPA) D. Thyroid hormone-binding globulin (TBG) **56. Which laboratory pattern is given for hypothyroidism in the study guide?** A. Low serum T4 with elevated TSH B. High T3 with low glucose only C. High T4 with high TSH D. Low T4 with low cortisol only **57. What is identified as the most common cause of acquired primary hypothyroidism?** A. Cushing disease B. Graves disease C. Hashimoto thyroiditis D. Addison disease **58. Which cluster is most consistent with hypothyroidism?** A. Weight loss, heat intolerance, diarrhea, and tachycardia B. Weight gain, cold intolerance, dry skin, constipation, and bradycardia C. Hemoptysis, foul sputum, and clubbing D. Polyuria, polydipsia, polyphagia, and fruity breath **59. What is the mechanism of Graves disease emphasized in the study guide?** A. Autoantibodies destroy pancreatic beta cells B. Bacterial toxins inhibit T3 production C. Thyroid-stimulating immunoglobulins stimulate normal TSH receptors D. Adrenal antibodies block aldosterone receptors **60. Which manifestation would most strongly suggest thyroid storm rather than uncomplicated hypothyroidism?** A. Slow metabolism with facial puffiness B. Cold intolerance and bradycardia C. Very high fever with severe tachycardia and CNS agitation D. Constipation and dry skin **61. Which three steroid hormone groups are produced by the adrenal cortex according to the guide?** A. ADH, oxytocin, and prolactin B. T3, T4, and calcitonin C. Insulin, glucagon, and somatostatin D. Mineralocorticoids, glucocorticoids, and adrenal androgens **62. Which presentation is most consistent with Addison disease?** A. Weight loss, weakness, orthostatic hypotension, hyponatremia, hyperkalemia, and hyperpigmentation B. Heat intolerance, tachycardia, diarrhea, and weight loss from thyroid excess C. Polycythemia, hypertension, and hypernatremia D. Moon face, buffalo hump, hypertension, and abdominal striae **63. Which finding is characteristic of Cushing syndrome in the study guide?** A. Moon face, buffalo hump, thin skin, abdominal striae, and poor wound healing B. Cold intolerance with bradycardia C. Copious foul-smelling sputum with hemoptysis D. Hyperpigmentation with hyponatremia and hyperkalemia **64. Which mechanism best describes type 1 diabetes in the study guide?** A. Excess cortisol production by the adrenal cortex B. Deficient thyroid hormone production C. Autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency D. Progressive insulin resistance with preserved insulin production only **65. Which mechanism best describes type 2 diabetes in the study guide?** A. Insulin resistance with progressive decline in beta-cell insulin secretion B. Complete absence of insulin from birth in all patients C. Excess growth hormone caused by pituitary failure D. Autoimmune destruction of adrenal cortex **66. Which fasting plasma glucose value is listed as diagnostic for diabetes?** A. 70 mg/dL or higher B. 126 mg/dL or higher C. 90 mg/dL or higher D. 100 mg/dL or higher **67. Which triad defines diabetic ketoacidosis in the notes?** A. Hypernatremia, respiratory alkalosis, and jaundice B. Hyperglycemia, ketosis, and metabolic acidosis C. Hypoglycemia, alkalosis, and bradycardia D. Hypocalcemia, anemia, and alkalosis **68. Which feature most clearly differentiates hyperosmolar hyperglycemic state from DKA in the study guide?** A. Absence of neurologic changes B. Occurrence only in type 1 diabetes C. Severe hyperglycemia and dehydration without ketoacidosis D. Obligate presence of fruity breath and marked ketosis **69. What explains morning hyperglycemia in the Somogyi effect?** A. Increased insulin sensitivity from exercise B. Complete failure of glucagon production C. A morning rise in glucose with no preceding hypoglycemia D. Nocturnal hypoglycemia triggers counter-regulatory hormones and rebound hyperglycemia **70. How does the dawn phenomenon differ from the Somogyi effect in the study guide?** A. It causes early-morning hyperglycemia without a preceding hypoglycemic event B. It is defined by ketoacidosis after meals C. It always follows severe nocturnal hypoglycemia D. It occurs only after acute pancreatitis **71. Which cranial nerves are identified as important to coordinated swallowing?** A. I, II, III, and IV B. V, IX, X, and XII C. VII, VIII, XI, and XIII D. II, IV, VI, and VIII **72. What is the defining abnormality in achalasia?** A. Inflammation of the gastric mucosa by H. pylori B. Excess relaxation of the upper esophageal sphincter only C. Failure of the lower esophageal sphincter to relax D. Loss of bile flow into the intestine **73. What does odynophagia mean?** A. Difficulty breathing B. Loss of appetite C. Forceful vomiting D. Painful swallowing **74. Which mechanism contributes to gastroesophageal reflux according to the guide?** A. Loss of pancreatic enzyme secretion B. Permanent closure of the pylorus C. Transient relaxation of the lower esophageal sphincter, especially after gastric distention or high-fat meals D. Persistent contraction of the lower esophageal sphincter **75. Which risk association is emphasized for esophageal adenocarcinoma?** A. Tuberculosis and histoplasmosis B. Addison disease and Cushing disease C. Barrett esophagus and GERD D. Cystic fibrosis and bronchiolitis **76. Which symptom is identified as the most frequent complaint in esophageal cancer, but typically a late sign?** A. Pruritus B. Hemoptysis C. Polyuria D. Progressive dysphagia **77. Which two major causes of gastric irritation are emphasized in the study guide?** A. Low LDL and high HDL B. Aspirin/NSAID use and H. pylori infection C. Cortisol deficiency and hyponatremia D. Rhinovirus and influenza **78. How do NSAIDs contribute to gastritis in the study guide?** A. They inhibit prostaglandin synthesis and weaken gastric mucosal protection B. They increase surfactant production C. They increase bile storage in the gallbladder D. They stimulate insulin secretion **79. Which organism is identified as the most common cause of chronic gastritis?** A. Escherichia coli O157:H7 B. Mycobacterium tuberculosis C. Epstein-Barr virus D. Helicobacter pylori **80. How does H. pylori survive in the acidic stomach environment according to the notes?** A. It blocks all gastric acid production through insulin B. It secretes urease and produces ammonia that buffers acidity around the organism C. It converts bilirubin into bile salts D. It produces surfactant to coat the stomach **81. Which pain pattern is characteristic of peptic ulcer disease in the study guide?** A. Burning or gnawing epigastric pain when the stomach is empty that may improve with food or antacids B. Substernal crushing pain with exertion C. Sharp pleuritic pain worsened by deep inspiration D. Calf pain only with walking **82. What is Zollinger-Ellison syndrome in the study guide?** A. A viral infection of the small intestine B. A congenital right-to-left cardiac shunt C. An autoimmune thyroid disorder D. A gastrin-secreting tumor that causes excessive gastric acid and ulceration **83. Which intestinal infection is identified as the most common bacterial infection in the study guide?** A. Hepatitis A virus B. Candida albicans C. Escherichia coli D. Norovirus **84. Which description best fits Crohn disease in the study guide?** A. Isolated stomach inflammation caused only by NSAIDs B. Patchy granulomatous inflammation with cobblestone appearance that can occur from mouth to anus C. A functional disorder without inflammatory lesions D. Continuous mucosal disease limited primarily to rectum and colon with common rectal bleeding **85. Which description best fits ulcerative colitis in the study guide?** A. Patchy transmural disease from mouth to anus with rare rectal bleeding B. Ulcerative mucosal disease primarily affecting rectum and colon with common rectal bleeding C. An isolated disorder of the esophagus D. A noninflammatory disorder caused only by anxiety **86. Which presentation is most consistent with celiac disease in infancy?** A. Failure to thrive, diarrhea, abdominal distention, and possible severe malnutrition B. Pulsus paradoxus and wheezing C. Moon face and buffalo hump D. Hemoptysis and foul sputum **87. Which clinical pattern is most consistent with diverticulitis in the study guide?** A. Right upper quadrant pain with jaundice only B. Substernal pain relieved by rest C. Painless progressive dysphagia D. Left lower quadrant pain and tenderness with nausea, vomiting, slight fever, and elevated WBC count **88. Which pain pattern is most typical of appendicitis in the study guide?** A. Chronic left lower quadrant discomfort after meals only B. Posterior chest pain caused by aortic dissection C. Burning substernal pain relieved by antacids D. Abrupt epigastric or periumbilical pain progressing to right lower quadrant pain **89. Which condition is listed as a cause of peritonitis?** A. Stable hypothyroidism B. Uncomplicated common cold C. Ruptured appendix D. Mild acne **90. Which group of findings suggests intestinal malabsorption?** A. Tachycardia, moon face, and abdominal striae B. Stridor, drooling, and tripod posture C. Diarrhea, steatorrhea, flatulence, bloating, weight loss, and muscle wasting D. Hemoptysis, purulent sputum, and cyanosis **91. Which is a major function of the liver identified in the study guide?** A. Synthesis of plasma proteins and blood clotting factors B. Formation of cerebrospinal fluid C. Generation of cardiac conduction impulses D. Production of pulmonary surfactant **92. Which mechanism can cause jaundice according to the study guide?** A. Only decreased pulmonary perfusion B. Excess red blood cell destruction, impaired hepatic bilirubin handling, or obstruction of bile flow C. Only increased thyroid-binding globulin D. Only excess insulin production **93. Which type of jaundice is primarily associated with excessive hemolysis and unconjugated bilirubin?** A. Prehepatic jaundice B. Obstructive postintestinal jaundice C. Intrahepatic cholestasis only D. Posthepatic jaundice **94. Which hepatitis virus requires hepatitis B virus in order to replicate?** A. Hepatitis A virus B. Hepatitis C virus C. Hepatitis E virus D. Hepatitis D virus **95. Which set of findings is most consistent with cirrhosis in the study guide?** A. Stridor, drooling, and inspiratory retractions B. Cold intolerance, bradycardia, and constipation C. Polyuria, polydipsia, and fruity breath only D. Ascites, portal hypertension, esophageal varices, jaundice, splenomegaly, and fetor hepaticus **96. Which complication can result when liver failure impairs conversion of ammonia to urea?** A. Hepatic encephalopathy B. Thyroid storm C. Respiratory distress syndrome D. Bronchiectasis **97. What are the two primary factors contributing to cholesterol gallstone formation in the study guide?** A. Hypoglycemia and hyperkalemia B. Low LDL and high HDL C. Abnormal bile composition and bile stasis D. Excess surfactant and bronchospasm **98. Which condition is listed as a major cause of acute pancreatitis?** A. Celiac disease B. Rhinovirus infection C. Gallstones D. Addison disease **99. Which factor is specifically emphasized as a major risk factor for pancreatic cancer?** A. Cold air exposure B. Rhinovirus infection C. High HDL D. Smoking **100. Which pattern best matches the study guide's description of secondary protein-energy malnutrition?** A. Both forms are described as types of viral gastroenteritis B. Kwashiorkor-like malnutrition with acute illness/trauma and marasmus-like malnutrition with chronic illness C. Kwashiorkor only with chronic CHF and marasmus only with acute burns D. Both forms occur only from thyroid disease