HSC 4558 Exam 2 V3 | HSC 4558 Pathophysiology II | Actual Q&A with
Rationale (HSC4558 Exam 2) | University of Central Florida
1. A 45-year-old male presents with severe flank pain radiating to the groin and hematuria.
Imaging confirms the presence of a renal calculus. Which of the following is the most
common component of renal stones?
A. Calcium oxalate
B. Uric acid
C. Cystine
D. Struvite
Answer: A
Explanation: Calcium oxalate is the primary constituent in approximately 70-80% of all
kidney stones diagnosed in the United States. These stones often form in the presence of
hypercalciuria or hyperoxaluria, which increases the saturation of these ions in the urine.
Proper diagnosis usually requires imaging and chemical analysis of the passed calculus.
2. In the context of Acute Kidney Injury (AKI), which phase is characterized by a significant
decrease in Glomerular Filtration Rate (GFR) and the accumulation of nitrogenous wastes in
the blood?
A. Initiation phase
B. Diuretic phase
C. Oliguric phase
D. Recovery phase
Answer: C
Explanation: The oliguric phase is defined by a reduction in urine output to less than 400
mL/day and a marked increase in serum creatinine and BUN levels. During this period, the
kidneys are unable to effectively filter metabolic waste, leading to systemic electrolyte
imbalances. This phase typically lasts between 1 to 2 weeks but can vary based on the
underlying etiology.
3. A patient with Chronic Kidney Disease (CKD) develops secondary hyperparathyroidism.
What is the primary physiological trigger for this compensatory mechanism?
A. Direct stimulation of the parathyroid gland by excessive urea levels
B. Hypocalcemia resulting from hyperphosphatemia and decreased Vitamin D activation
C. Increased renal excretion of calcium due to loop diuretic usage
,D. Hypernatremia causing osmotic shifts in the parathyroid cells
Answer: B
Explanation: As renal function declines, the kidneys lose the ability to excrete phosphate
and activate Vitamin D (calcitriol). The resulting hyperphosphatemia leads to low serum
calcium levels through precipitation and inhibited activation. Consequently, the
parathyroid glands secrete excess PTH to mobilize calcium from the bone, leading to renal
osteodystrophy.
4. Which clinical manifestation is a hallmark sign of Nephrotic Syndrome, distinguishing it
from Nephritic Syndrome?
A. Gross hematuria
B. Periorbital edema with red blood cell casts
C. Acute hypertension and oliguria
D. Massive proteinuria (>3.5 g/day) and hypoalbuminemia
Answer: D
Explanation: Nephrotic syndrome involves increased permeability of the glomerular
basement membrane specifically to proteins. This leads to profound loss of albumin,
resulting in decreased plasma oncotic pressure and generalized edema (anasarca). In
contrast, Nephritic syndrome is primarily inflammatory, characterized by hematuria and
active urinary sediment.
5. Prerenal Acute Kidney Injury is most commonly caused by which of the following
mechanisms?
A. Direct toxic injury to the tubular epithelial cells
B. Obstruction of the ureters by bilateral calculi
C. Hypoperfusion to the kidneys without intrinsic damage
D. Autoimmune inflammation of the glomeruli
Answer: C
Explanation: Prerenal AKI is caused by factors that reduce systemic blood pressure or
cardiac output, leading to decreased renal blood flow. Common causes include dehydration,
hemorrhage, or heart failure, where the renal parenchyma remains intact initially. If
hypoperfusion persists, it may lead to intrinsic damage such as Acute Tubular Necrosis
(ATN).
6. A 52-year-old female presents with frequent heartburn and regurgitation, especially after
large meals. A biopsy shows simple squamous epithelium replaced by columnar epithelium.
This condition is known as:
A. Esophageal varices
, B. Barrett’s Esophagus
C. Achalasia
D. Mallory-Weiss tear
Answer: B
Explanation: Barrett’s Esophagus is a metaplastic change where the normal stratified
squamous epithelium of the esophagus is replaced by intestinal-like columnar cells. This
process is a defensive response to chronic acid exposure from Gastroesophageal Reflux
Disease (GERD). It is significant because it serves as a precursor to esophageal
adenocarcinoma.
7. Which of the following is the most common cause of Peptic Ulcer Disease (PUD)?
A. Excessive intake of spicy foods
B. Zollinger-Ellison syndrome
C. Chronic psychological stress
D. Helicobacter pylori infection
Answer: D
Explanation: H. pylori is a gram-negative bacterium that colonizes the gastric mucosa and
causes chronic inflammation. It weakens the protective mucus layer, allowing gastric acid
to damage the underlying tissue. While NSAID use is also a major cause, H. pylori remains
the leading global factor for ulcer development.
8. Ulcerative Colitis is typically characterized by which of the following pathological features?
A. Continuous mucosal inflammation limited to the colon and rectum
B. Transmural inflammation leading to fistulas
C. Skip lesions throughout the entire GI tract
D. Granuloma formation in the terminal ileum
Answer: A
Explanation: Ulcerative Colitis (UC) is an inflammatory bowel disease that specifically
affects the mucosal layer of the large intestine. Unlike Crohn’s disease, UC begins in the
rectum and spreads proximally in a continuous fashion. The clinical hallmark of UC is
bloody diarrhea and abdominal cramping.
9. A patient with advanced liver cirrhosis develops ascites. Which physiological factor
contributes most significantly to this fluid accumulation?
A. Increased synthesis of plasma proteins
B. Portal hypertension and decreased albumin production
Rationale (HSC4558 Exam 2) | University of Central Florida
1. A 45-year-old male presents with severe flank pain radiating to the groin and hematuria.
Imaging confirms the presence of a renal calculus. Which of the following is the most
common component of renal stones?
A. Calcium oxalate
B. Uric acid
C. Cystine
D. Struvite
Answer: A
Explanation: Calcium oxalate is the primary constituent in approximately 70-80% of all
kidney stones diagnosed in the United States. These stones often form in the presence of
hypercalciuria or hyperoxaluria, which increases the saturation of these ions in the urine.
Proper diagnosis usually requires imaging and chemical analysis of the passed calculus.
2. In the context of Acute Kidney Injury (AKI), which phase is characterized by a significant
decrease in Glomerular Filtration Rate (GFR) and the accumulation of nitrogenous wastes in
the blood?
A. Initiation phase
B. Diuretic phase
C. Oliguric phase
D. Recovery phase
Answer: C
Explanation: The oliguric phase is defined by a reduction in urine output to less than 400
mL/day and a marked increase in serum creatinine and BUN levels. During this period, the
kidneys are unable to effectively filter metabolic waste, leading to systemic electrolyte
imbalances. This phase typically lasts between 1 to 2 weeks but can vary based on the
underlying etiology.
3. A patient with Chronic Kidney Disease (CKD) develops secondary hyperparathyroidism.
What is the primary physiological trigger for this compensatory mechanism?
A. Direct stimulation of the parathyroid gland by excessive urea levels
B. Hypocalcemia resulting from hyperphosphatemia and decreased Vitamin D activation
C. Increased renal excretion of calcium due to loop diuretic usage
,D. Hypernatremia causing osmotic shifts in the parathyroid cells
Answer: B
Explanation: As renal function declines, the kidneys lose the ability to excrete phosphate
and activate Vitamin D (calcitriol). The resulting hyperphosphatemia leads to low serum
calcium levels through precipitation and inhibited activation. Consequently, the
parathyroid glands secrete excess PTH to mobilize calcium from the bone, leading to renal
osteodystrophy.
4. Which clinical manifestation is a hallmark sign of Nephrotic Syndrome, distinguishing it
from Nephritic Syndrome?
A. Gross hematuria
B. Periorbital edema with red blood cell casts
C. Acute hypertension and oliguria
D. Massive proteinuria (>3.5 g/day) and hypoalbuminemia
Answer: D
Explanation: Nephrotic syndrome involves increased permeability of the glomerular
basement membrane specifically to proteins. This leads to profound loss of albumin,
resulting in decreased plasma oncotic pressure and generalized edema (anasarca). In
contrast, Nephritic syndrome is primarily inflammatory, characterized by hematuria and
active urinary sediment.
5. Prerenal Acute Kidney Injury is most commonly caused by which of the following
mechanisms?
A. Direct toxic injury to the tubular epithelial cells
B. Obstruction of the ureters by bilateral calculi
C. Hypoperfusion to the kidneys without intrinsic damage
D. Autoimmune inflammation of the glomeruli
Answer: C
Explanation: Prerenal AKI is caused by factors that reduce systemic blood pressure or
cardiac output, leading to decreased renal blood flow. Common causes include dehydration,
hemorrhage, or heart failure, where the renal parenchyma remains intact initially. If
hypoperfusion persists, it may lead to intrinsic damage such as Acute Tubular Necrosis
(ATN).
6. A 52-year-old female presents with frequent heartburn and regurgitation, especially after
large meals. A biopsy shows simple squamous epithelium replaced by columnar epithelium.
This condition is known as:
A. Esophageal varices
, B. Barrett’s Esophagus
C. Achalasia
D. Mallory-Weiss tear
Answer: B
Explanation: Barrett’s Esophagus is a metaplastic change where the normal stratified
squamous epithelium of the esophagus is replaced by intestinal-like columnar cells. This
process is a defensive response to chronic acid exposure from Gastroesophageal Reflux
Disease (GERD). It is significant because it serves as a precursor to esophageal
adenocarcinoma.
7. Which of the following is the most common cause of Peptic Ulcer Disease (PUD)?
A. Excessive intake of spicy foods
B. Zollinger-Ellison syndrome
C. Chronic psychological stress
D. Helicobacter pylori infection
Answer: D
Explanation: H. pylori is a gram-negative bacterium that colonizes the gastric mucosa and
causes chronic inflammation. It weakens the protective mucus layer, allowing gastric acid
to damage the underlying tissue. While NSAID use is also a major cause, H. pylori remains
the leading global factor for ulcer development.
8. Ulcerative Colitis is typically characterized by which of the following pathological features?
A. Continuous mucosal inflammation limited to the colon and rectum
B. Transmural inflammation leading to fistulas
C. Skip lesions throughout the entire GI tract
D. Granuloma formation in the terminal ileum
Answer: A
Explanation: Ulcerative Colitis (UC) is an inflammatory bowel disease that specifically
affects the mucosal layer of the large intestine. Unlike Crohn’s disease, UC begins in the
rectum and spreads proximally in a continuous fashion. The clinical hallmark of UC is
bloody diarrhea and abdominal cramping.
9. A patient with advanced liver cirrhosis develops ascites. Which physiological factor
contributes most significantly to this fluid accumulation?
A. Increased synthesis of plasma proteins
B. Portal hypertension and decreased albumin production
