HSC 4558 Final Exam V3 | HSC 4558 Pathophysiology II | Actual Q&A
with Rationale (HSC4558 Final Exam) | University of Central Florida
1. A patient presents with polydipsia, polyphagia, and weight loss despite increased appetite.
Laboratory tests reveal an absolute deficiency of insulin. Which pathophysiologic process
most likely explains these findings?
A. Peripheral insulin resistance and beta cell exhaustion
B. Autoimmune destruction of pancreatic beta cells
C. Excessive secretion of glucagon-like peptide-1
D. Secondary hypercortisolism leading to glucose intolerance
Answer: B
Explanation: Type 1 Diabetes Mellitus involves an autoimmune-mediated destruction of
the insulin-secreting beta cells in the Islets of Langerhans. This absolute insulin deficiency
prevents glucose from entering the cells, forcing the body to use fat and protein for fuel,
which results in weight loss and ketone production. The lack of intracellular glucose
triggers the polyphagia, while hyperglycemia leads to osmotic diuresis and subsequent
polydipsia.
2. A 55-year-old male with chronic kidney disease (CKD) is found to have a low hemoglobin
level and fatigue. What is the primary cause of this patient’s anemia?
A. Inadequate production of erythropoietin by the kidneys
B. Iron deficiency due to poor intestinal absorption
C. Chronic occult gastrointestinal bleeding from uremic ulcers
D. Increased destruction of red blood cells in the spleen
Answer: A
Explanation: In the setting of chronic kidney disease, the peritubular fibroblasts in the
renal cortex fail to produce sufficient erythropoietin. Erythropoietin is the primary
hormone responsible for stimulating the bone marrow to produce red blood cells in
response to hypoxia. Without this signal, erythropoiesis declines significantly, resulting in a
normocytic, normochromic anemia that is characteristic of renal failure.
3. Which clinical manifestation is a hallmark sign of the nephrotic syndrome?
A. Acute elevation of serum creatinine due to tubular necrosis
,B. Gross hematuria and red blood cell casts
C. Proteinuria exceeding 3.5 grams per 24 hours
D. Severe flank pain radiating to the groin
Answer: C
Explanation: Nephrotic syndrome is defined by massive proteinuria, typically greater than
3.5 grams per day, caused by increased glomerular permeability. This loss of protein leads
to hypoalbuminemia, which reduces plasma oncotic pressure and results in generalized
edema. Hyperlipidemia and lipiduria are also common secondary findings as the liver
increases lipoprotein synthesis to compensate for the lost albumin.
4. During the progression of cirrhosis, what is the underlying mechanism responsible for the
development of esophageal varices?
A. Direct irritation of the esophagus by refluxed gastric acid
B. Decreased production of clotting factors by the hepatocytes
C. Hypoalbuminemia causing fluid shifts into the mediastinum
D. Systemic hypotension causing venous collapse
E. Increased resistance to blood flow through the portal venous system
Answer: E
Explanation: Portal hypertension occurs when fibrotic changes in the liver distort the
architecture and obstruct the flow of blood from the portal vein into the hepatic sinusoids.
To bypass this obstruction, blood is diverted into collateral vessels, such as the esophageal
veins, which have thinner walls and were not intended for high pressure. These vessels
become engorged and dilated, forming varices that are highly susceptible to rupture and
life-threatening hemorrhage.
5. A patient is diagnosed with Hashimoto Thyroiditis. Which laboratory result would the
nurse expect to see?
A. Decreased Serum TSH and Increased Free T4
B. Increased Serum TSH and Increased Free T4
C. Increased Serum TSH and Decreased Free T4
D. Decreased Serum TSH and Decreased Free T4
Answer: C
Explanation: Hashimoto thyroiditis is an autoimmune disorder that results in the chronic
destruction of the thyroid gland, leading to primary hypothyroidism. As the thyroid gland
fails to produce adequate amounts of T3 and T4, the anterior pituitary responds by
increasing the secretion of Thyroid Stimulating Hormone (TSH) via the negative feedback
, loop. Consequently, a diagnostic hallmark of this condition is a low level of circulating
thyroid hormones paired with an elevated TSH level.
6. Which condition is characterized by the excessive production of cortisol, resulting in a
‘moon face’ and ‘buffalo hump’ appearance?
A. Addison’s Disease
B. Conn’s Syndrome
C. Pheochromocytoma
D. Cushing’s Syndrome
Answer: D
Explanation: Cushing’s syndrome results from chronic exposure to excessive levels of
cortisol, whether from an endogenous source like a pituitary tumor or exogenous
glucocorticoid use. The hormone cortisol alters fat distribution, leading to truncal obesity, a
fatty hump between the shoulders, and a rounded facial appearance. Additionally, it causes
protein wasting and skin thinning, which often results in the formation of purple striae on
the abdomen.
7. What is the primary pathophysiologic change seen in Multiple Sclerosis (MS)?
A. Depletion of dopamine in the substantia nigra
B. Demyelination of nerve fibers in the central nervous system
C. Loss of acetylcholine receptors at the neuromuscular junction
D. Accumulation of amyloid-beta plaques in the cerebral cortex
Answer: B
Explanation: Multiple Sclerosis is a chronic, immune-mediated inflammatory disease
where the body attacks the myelin sheath covering axons in the brain and spinal cord. This
demyelination disrupts the saltatory conduction of nerve impulses, leading to a wide
variety of neurological symptoms such as visual disturbances and motor weakness. Over
time, the repeated inflammatory episodes lead to the formation of sclerotic plaques or
scars throughout the CNS.
8. A patient experiencing an acute asthma attack displays increased airway resistance and
difficulty breathing. Which immune mediator is primarily responsible for this immediate
hypersensitivity reaction?
A. IgG and T-helper cells
B. IgM and the complement system
C. IgE and mast cell degranulation
D. Neutrophils and protease release
with Rationale (HSC4558 Final Exam) | University of Central Florida
1. A patient presents with polydipsia, polyphagia, and weight loss despite increased appetite.
Laboratory tests reveal an absolute deficiency of insulin. Which pathophysiologic process
most likely explains these findings?
A. Peripheral insulin resistance and beta cell exhaustion
B. Autoimmune destruction of pancreatic beta cells
C. Excessive secretion of glucagon-like peptide-1
D. Secondary hypercortisolism leading to glucose intolerance
Answer: B
Explanation: Type 1 Diabetes Mellitus involves an autoimmune-mediated destruction of
the insulin-secreting beta cells in the Islets of Langerhans. This absolute insulin deficiency
prevents glucose from entering the cells, forcing the body to use fat and protein for fuel,
which results in weight loss and ketone production. The lack of intracellular glucose
triggers the polyphagia, while hyperglycemia leads to osmotic diuresis and subsequent
polydipsia.
2. A 55-year-old male with chronic kidney disease (CKD) is found to have a low hemoglobin
level and fatigue. What is the primary cause of this patient’s anemia?
A. Inadequate production of erythropoietin by the kidneys
B. Iron deficiency due to poor intestinal absorption
C. Chronic occult gastrointestinal bleeding from uremic ulcers
D. Increased destruction of red blood cells in the spleen
Answer: A
Explanation: In the setting of chronic kidney disease, the peritubular fibroblasts in the
renal cortex fail to produce sufficient erythropoietin. Erythropoietin is the primary
hormone responsible for stimulating the bone marrow to produce red blood cells in
response to hypoxia. Without this signal, erythropoiesis declines significantly, resulting in a
normocytic, normochromic anemia that is characteristic of renal failure.
3. Which clinical manifestation is a hallmark sign of the nephrotic syndrome?
A. Acute elevation of serum creatinine due to tubular necrosis
,B. Gross hematuria and red blood cell casts
C. Proteinuria exceeding 3.5 grams per 24 hours
D. Severe flank pain radiating to the groin
Answer: C
Explanation: Nephrotic syndrome is defined by massive proteinuria, typically greater than
3.5 grams per day, caused by increased glomerular permeability. This loss of protein leads
to hypoalbuminemia, which reduces plasma oncotic pressure and results in generalized
edema. Hyperlipidemia and lipiduria are also common secondary findings as the liver
increases lipoprotein synthesis to compensate for the lost albumin.
4. During the progression of cirrhosis, what is the underlying mechanism responsible for the
development of esophageal varices?
A. Direct irritation of the esophagus by refluxed gastric acid
B. Decreased production of clotting factors by the hepatocytes
C. Hypoalbuminemia causing fluid shifts into the mediastinum
D. Systemic hypotension causing venous collapse
E. Increased resistance to blood flow through the portal venous system
Answer: E
Explanation: Portal hypertension occurs when fibrotic changes in the liver distort the
architecture and obstruct the flow of blood from the portal vein into the hepatic sinusoids.
To bypass this obstruction, blood is diverted into collateral vessels, such as the esophageal
veins, which have thinner walls and were not intended for high pressure. These vessels
become engorged and dilated, forming varices that are highly susceptible to rupture and
life-threatening hemorrhage.
5. A patient is diagnosed with Hashimoto Thyroiditis. Which laboratory result would the
nurse expect to see?
A. Decreased Serum TSH and Increased Free T4
B. Increased Serum TSH and Increased Free T4
C. Increased Serum TSH and Decreased Free T4
D. Decreased Serum TSH and Decreased Free T4
Answer: C
Explanation: Hashimoto thyroiditis is an autoimmune disorder that results in the chronic
destruction of the thyroid gland, leading to primary hypothyroidism. As the thyroid gland
fails to produce adequate amounts of T3 and T4, the anterior pituitary responds by
increasing the secretion of Thyroid Stimulating Hormone (TSH) via the negative feedback
, loop. Consequently, a diagnostic hallmark of this condition is a low level of circulating
thyroid hormones paired with an elevated TSH level.
6. Which condition is characterized by the excessive production of cortisol, resulting in a
‘moon face’ and ‘buffalo hump’ appearance?
A. Addison’s Disease
B. Conn’s Syndrome
C. Pheochromocytoma
D. Cushing’s Syndrome
Answer: D
Explanation: Cushing’s syndrome results from chronic exposure to excessive levels of
cortisol, whether from an endogenous source like a pituitary tumor or exogenous
glucocorticoid use. The hormone cortisol alters fat distribution, leading to truncal obesity, a
fatty hump between the shoulders, and a rounded facial appearance. Additionally, it causes
protein wasting and skin thinning, which often results in the formation of purple striae on
the abdomen.
7. What is the primary pathophysiologic change seen in Multiple Sclerosis (MS)?
A. Depletion of dopamine in the substantia nigra
B. Demyelination of nerve fibers in the central nervous system
C. Loss of acetylcholine receptors at the neuromuscular junction
D. Accumulation of amyloid-beta plaques in the cerebral cortex
Answer: B
Explanation: Multiple Sclerosis is a chronic, immune-mediated inflammatory disease
where the body attacks the myelin sheath covering axons in the brain and spinal cord. This
demyelination disrupts the saltatory conduction of nerve impulses, leading to a wide
variety of neurological symptoms such as visual disturbances and motor weakness. Over
time, the repeated inflammatory episodes lead to the formation of sclerotic plaques or
scars throughout the CNS.
8. A patient experiencing an acute asthma attack displays increased airway resistance and
difficulty breathing. Which immune mediator is primarily responsible for this immediate
hypersensitivity reaction?
A. IgG and T-helper cells
B. IgM and the complement system
C. IgE and mast cell degranulation
D. Neutrophils and protease release
