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NSG 5140 FINAL EXAM ADVANCED
PATHOPHYSIOLOGY 2026 ALL QUESTIONS AND
VERIFIED ANSWERS ALREADY A GRADED
WITH EXPERT FEEDBACK |NEW AND REVISED|
INSTANT DOWNLOAD
1. A 62-year-old patient with a history of chronic hypertension presents
with complaints of progressive dyspnea on exertion and ankle edema.
Echocardiography reveals concentric left ventricular hypertrophy with
preserved ejection fraction. Which pathophysiological mechanism best
explains the development of left ventricular hypertrophy in this patient?
A) Increased cardiac output leading to volume overload
B) Increased afterload resulting in pressure overload and myocyte
hypertrophy
C) Decreased coronary artery perfusion leading to ischemic remodeling
D) Neurohormonal activation causing myocyte hyperplasia
Rationale: Chronic hypertension increases systemic vascular
resistance (afterload), creating pressure overload on the left ventricle.
This triggers myocyte hypertrophy (increase in cell size) as an adaptive
response to maintain wall stress. The myocytes cannot divide
(hyperplasia), so they enlarge to compensate.
2. A 45-year-old patient with a history of alcohol abuse presents with
jaundice, ascites, and confusion. Laboratory findings reveal elevated
ammonia levels. Which pathophysiological mechanism is primarily
responsible for the elevated ammonia in this patient?
A) Increased protein catabolism
B) Impaired hepatic urea cycle function
C) Decreased renal excretion
D) Increased intestinal production
Rationale: The liver converts ammonia to urea through the urea cycle.
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In cirrhosis and liver failure, impaired hepatocyte function reduces
urea cycle activity, leading to hyperammonemia. Elevated ammonia
crosses the blood-brain barrier and contributes to hepatic
encephalopathy.
3. A 58-year-old patient with chronic kidney disease (stage 4) presents
with fatigue, bone pain, and elevated serum phosphate. Laboratory
studies reveal decreased serum calcium and elevated PTH. Which
pathophysiological mechanism is most responsible for the elevated
PTH?
A) Decreased renal production of calcitriol leading to hypocalcemia
and secondary hyperparathyroidism
B) Increased renal excretion of calcium
C) Decreased intestinal absorption of phosphate
D) Primary hyperparathyroidism
Rationale: In chronic kidney disease, decreased renal mass reduces 1-
alpha-hydroxylase activity, impairing conversion of 25-hydroxyvitamin
D to calcitriol (active vitamin D). This leads to hypocalcemia,
stimulating PTH secretion (secondary hyperparathyroidism). Elevated
phosphate further suppresses calcitriol production.
4. A 28-year-old woman with systemic lupus erythematosus (SLE)
presents with pleuritic chest pain and a pericardial friction rub. Which
type of hypersensitivity reaction is primarily responsible for the
pericarditis in SLE?
A) Type I hypersensitivity
B) Type II hypersensitivity
C) Type III hypersensitivity
D) Type IV hypersensitivity
Rationale: SLE is characterized by Type III hypersensitivity reactions
involving immune complex deposition. Immune complexes (antibody-
antigen complexes) deposit in tissues including the pericardium,
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activating complement and causing inflammation. This leads to
pericarditis and pleuritis.
5. A 72-year-old patient with Alzheimer disease is being evaluated for
progressive cognitive decline. Which neuropathological finding is
characteristic of this condition?
A) Lewy bodies in the substantia nigra
B) Neurofibrillary tangles and amyloid plaques in the cerebral
cortex
C) Vascular infarcts in the basal ganglia
D) Frontal lobe atrophy with Pick bodies
Rationale: Alzheimer disease is characterized by extracellular amyloid
(senile) plaques (composed of beta-amyloid protein) and intracellular
neurofibrillary tangles (hyperphosphorylated tau protein). These are
most prominent in the hippocampus and cerebral cortex, leading to
neuronal loss and cognitive decline.
6. A 55-year-old patient with type 2 diabetes mellitus presents with
peripheral neuropathy and retinopathy. The microvascular complications
of diabetes are primarily caused by which pathophysiological
mechanism?
A) Autoimmune destruction of pancreatic beta cells
B) Non-enzymatic glycation of proteins and endothelial dysfunction
C) Hepatic insulin resistance
D) Decreased glucagon secretion
Rationale: Chronic hyperglycemia leads to non-enzymatic glycation of
proteins (formation of advanced glycation end products), oxidative
stress, and endothelial dysfunction. These processes cause
microvascular damage, resulting in neuropathy, retinopathy, and
nephropathy.
7. A 67-year-old patient with a history of smoking presents with
hemoptysis and weight loss. Chest CT reveals a 3 cm mass in the right
upper lobe. Biopsy shows squamous cell carcinoma. Which genetic
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mutation is most commonly associated with squamous cell carcinoma of
the lung?
A) EGFR mutation
B) TP53 mutation
C) ALK rearrangement
D) ROS1 rearrangement
Rationale: Squamous cell carcinoma of the lung is strongly associated
with tobacco smoking and TP53 mutations. EGFR mutations and ALK
rearrangements are more common in adenocarcinoma, particularly in
never-smokers.
8. A 34-year-old woman is diagnosed with Graves disease. Which
laboratory finding is most consistent with this diagnosis?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4
C) Elevated TSH, elevated free T4
D) Low TSH, low free T4
Rationale: Graves disease is caused by thyroid-stimulating
immunoglobulin (TSI) antibodies that activate the TSH receptor,
mimicking TSH and leading to increased thyroid hormone production.
This results in suppressed TSH (low) and elevated free T4
(hyperthyroidism).
9. During ischemic injury, the loss of ATP leads to which cellular event?
A) Increased oxidative phosphorylation
B) Failure of the sodium-potassium pump
C) Increased protein synthesis
D) Mitochondrial membrane stabilization
Rationale: ATP depletion causes failure of the Na⁺/K⁺ ATPase pump,
leading to intracellular sodium accumulation, water influx, cellular
swelling, and eventual cell death if ischemia persists.
10. A 45-year-old patient with a family history of breast cancer is found
to have a mutation in the BRCA1 gene. This gene is classified as which
NSG 5140 FINAL EXAM ADVANCED
PATHOPHYSIOLOGY 2026 ALL QUESTIONS AND
VERIFIED ANSWERS ALREADY A GRADED
WITH EXPERT FEEDBACK |NEW AND REVISED|
INSTANT DOWNLOAD
1. A 62-year-old patient with a history of chronic hypertension presents
with complaints of progressive dyspnea on exertion and ankle edema.
Echocardiography reveals concentric left ventricular hypertrophy with
preserved ejection fraction. Which pathophysiological mechanism best
explains the development of left ventricular hypertrophy in this patient?
A) Increased cardiac output leading to volume overload
B) Increased afterload resulting in pressure overload and myocyte
hypertrophy
C) Decreased coronary artery perfusion leading to ischemic remodeling
D) Neurohormonal activation causing myocyte hyperplasia
Rationale: Chronic hypertension increases systemic vascular
resistance (afterload), creating pressure overload on the left ventricle.
This triggers myocyte hypertrophy (increase in cell size) as an adaptive
response to maintain wall stress. The myocytes cannot divide
(hyperplasia), so they enlarge to compensate.
2. A 45-year-old patient with a history of alcohol abuse presents with
jaundice, ascites, and confusion. Laboratory findings reveal elevated
ammonia levels. Which pathophysiological mechanism is primarily
responsible for the elevated ammonia in this patient?
A) Increased protein catabolism
B) Impaired hepatic urea cycle function
C) Decreased renal excretion
D) Increased intestinal production
Rationale: The liver converts ammonia to urea through the urea cycle.
,2|Page
In cirrhosis and liver failure, impaired hepatocyte function reduces
urea cycle activity, leading to hyperammonemia. Elevated ammonia
crosses the blood-brain barrier and contributes to hepatic
encephalopathy.
3. A 58-year-old patient with chronic kidney disease (stage 4) presents
with fatigue, bone pain, and elevated serum phosphate. Laboratory
studies reveal decreased serum calcium and elevated PTH. Which
pathophysiological mechanism is most responsible for the elevated
PTH?
A) Decreased renal production of calcitriol leading to hypocalcemia
and secondary hyperparathyroidism
B) Increased renal excretion of calcium
C) Decreased intestinal absorption of phosphate
D) Primary hyperparathyroidism
Rationale: In chronic kidney disease, decreased renal mass reduces 1-
alpha-hydroxylase activity, impairing conversion of 25-hydroxyvitamin
D to calcitriol (active vitamin D). This leads to hypocalcemia,
stimulating PTH secretion (secondary hyperparathyroidism). Elevated
phosphate further suppresses calcitriol production.
4. A 28-year-old woman with systemic lupus erythematosus (SLE)
presents with pleuritic chest pain and a pericardial friction rub. Which
type of hypersensitivity reaction is primarily responsible for the
pericarditis in SLE?
A) Type I hypersensitivity
B) Type II hypersensitivity
C) Type III hypersensitivity
D) Type IV hypersensitivity
Rationale: SLE is characterized by Type III hypersensitivity reactions
involving immune complex deposition. Immune complexes (antibody-
antigen complexes) deposit in tissues including the pericardium,
,3|Page
activating complement and causing inflammation. This leads to
pericarditis and pleuritis.
5. A 72-year-old patient with Alzheimer disease is being evaluated for
progressive cognitive decline. Which neuropathological finding is
characteristic of this condition?
A) Lewy bodies in the substantia nigra
B) Neurofibrillary tangles and amyloid plaques in the cerebral
cortex
C) Vascular infarcts in the basal ganglia
D) Frontal lobe atrophy with Pick bodies
Rationale: Alzheimer disease is characterized by extracellular amyloid
(senile) plaques (composed of beta-amyloid protein) and intracellular
neurofibrillary tangles (hyperphosphorylated tau protein). These are
most prominent in the hippocampus and cerebral cortex, leading to
neuronal loss and cognitive decline.
6. A 55-year-old patient with type 2 diabetes mellitus presents with
peripheral neuropathy and retinopathy. The microvascular complications
of diabetes are primarily caused by which pathophysiological
mechanism?
A) Autoimmune destruction of pancreatic beta cells
B) Non-enzymatic glycation of proteins and endothelial dysfunction
C) Hepatic insulin resistance
D) Decreased glucagon secretion
Rationale: Chronic hyperglycemia leads to non-enzymatic glycation of
proteins (formation of advanced glycation end products), oxidative
stress, and endothelial dysfunction. These processes cause
microvascular damage, resulting in neuropathy, retinopathy, and
nephropathy.
7. A 67-year-old patient with a history of smoking presents with
hemoptysis and weight loss. Chest CT reveals a 3 cm mass in the right
upper lobe. Biopsy shows squamous cell carcinoma. Which genetic
, 4|Page
mutation is most commonly associated with squamous cell carcinoma of
the lung?
A) EGFR mutation
B) TP53 mutation
C) ALK rearrangement
D) ROS1 rearrangement
Rationale: Squamous cell carcinoma of the lung is strongly associated
with tobacco smoking and TP53 mutations. EGFR mutations and ALK
rearrangements are more common in adenocarcinoma, particularly in
never-smokers.
8. A 34-year-old woman is diagnosed with Graves disease. Which
laboratory finding is most consistent with this diagnosis?
A) Elevated TSH, low free T4
B) Low TSH, elevated free T4
C) Elevated TSH, elevated free T4
D) Low TSH, low free T4
Rationale: Graves disease is caused by thyroid-stimulating
immunoglobulin (TSI) antibodies that activate the TSH receptor,
mimicking TSH and leading to increased thyroid hormone production.
This results in suppressed TSH (low) and elevated free T4
(hyperthyroidism).
9. During ischemic injury, the loss of ATP leads to which cellular event?
A) Increased oxidative phosphorylation
B) Failure of the sodium-potassium pump
C) Increased protein synthesis
D) Mitochondrial membrane stabilization
Rationale: ATP depletion causes failure of the Na⁺/K⁺ ATPase pump,
leading to intracellular sodium accumulation, water influx, cellular
swelling, and eventual cell death if ischemia persists.
10. A 45-year-old patient with a family history of breast cancer is found
to have a mutation in the BRCA1 gene. This gene is classified as which
