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UTMB 5355 Advanced Pathophysiology – Exam 4 Practice Exam
2026/2027 Newest Edition
100 Questions with Verified Answers & Detailed Rationales
Section 1: Acute Coronary Syndrome & Angina (Questions 1–25)
1. Prinzmetal angina is characterized by chest pain that:
A. Occurs only with exertion
B. Occurs at rest, typically at night, due to vasospasm
C. Is always associated with atherosclerosis
D. Resolves with rest
Answer: B
Rationale: Prinzmetal angina is chest pain that may occur at rest, typically at night, usually
caused by vasospasm, and may or may not be associated with atherosclerosis .
2. Which of the following is NOT one of the three diagnoses encompassed by Acute
Coronary Syndrome?
A. Unstable angina
B. Non-ST elevation myocardial infarction (NSTEMI)
C. ST elevation myocardial infarction (STEMI)
D. Stable angina
Answer: D
Rationale: Acute Coronary Syndrome encompasses three diagnoses: unstable angina,
NSTEMI, and STEMI. Stable angina is not included .
3. Unstable angina is caused by a labile thrombus that occludes blood flow for no longer
than:
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 60 minutes
Answer: B
Rationale: Unstable angina is caused by a labile thrombus that does not occlude blood flow
for any longer than 20 minutes. Perfusion is restored before myocardial necrosis occurs .
4. NSTEMI results in myocardial necrosis in which layer of the heart?
A. Epicardium
B. Myocardium
C. Endocardium
D. Pericardium
, 2
Answer: C
Rationale: NSTEMI results in myocardial necrosis in the myocardium directly below the
endocardium (innermost layer of ventricles). It does not involve the full thickness of the
ventricular wall .
5. Which ECG finding is characteristic of NSTEMI?
A. ST elevation
B. ST depression or T wave inversion
C. Q wave formation
D. Normal ECG
Answer: B
Rationale: NSTEMI presents with ST depression (hence the name NON ST elevation) or T
wave inversion on ECG .
6. STEMI involves:
A. Only the subendocardial layer
B. The entire thickness of the ventricular wall (transmural infarct)
C. Only the epicardium
D. Only the atria
Answer: B
Rationale: STEMI includes the entire thickness of the ventricular wall (transmural infarct) and
presents with ST elevation on ECG .
7. How long can cardiac cells remain viable in a severely hypoxic state before coagulative
necrosis occurs?
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 60 minutes
Answer: B
Rationale: Cardiac cells can remain viable in a severely hypoxic state for 20 minutes. After 20
minutes, coagulative necrosis occurs .
8. Reperfusion injury is caused by:
A. Continued ischemia
B. Release of toxic oxygen radicals, calcium influx, and pH changes
C. Decreased catecholamine release
D. Reduced angiotensin II
, 3
Answer: B
Rationale: Reperfusion injury is caused when blood flow is restored, triggering release of
toxic oxygen radicals, calcium influx, and pH changes that cause persistently open
mitochondrial permeability and contribute to cell death .
9. Troponin levels peak at what time after MI onset?
A. 2-4 hours
B. 12 hours
C. 24 hours
D. 48 hours
Answer: C
Rationale: Troponins are detected in 2-4 hours of onset of pain, peak in 24 hours, and
disappear in 7-10 days .
10. What is the most common cause of death following MI?
A. Left ventricular failure
B. Ventricular fibrillation
C. Ventricular free wall rupture
D. Pulmonary edema
Answer: B
Rationale: The most common cause of death following MI is V-Fib, which is associated with
cardiogenic shock .
11. Ventricular free wall rupture typically occurs how many days after MI?
A. 1-2 days
B. 4-7 days
C. 10-14 days
D. 21 days
Answer: B
Rationale: Ventricular free wall rupture occurs in 4-7 days and is associated with thrombosis
of the LAD (left anterior descending) coronary artery. It results in cardiac tamponade from
hemorrhage into the pericardial space .
12. Papillary muscle rupture is associated with which coronary artery?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Posterior descending
UTMB 5355 Advanced Pathophysiology – Exam 4 Practice Exam
2026/2027 Newest Edition
100 Questions with Verified Answers & Detailed Rationales
Section 1: Acute Coronary Syndrome & Angina (Questions 1–25)
1. Prinzmetal angina is characterized by chest pain that:
A. Occurs only with exertion
B. Occurs at rest, typically at night, due to vasospasm
C. Is always associated with atherosclerosis
D. Resolves with rest
Answer: B
Rationale: Prinzmetal angina is chest pain that may occur at rest, typically at night, usually
caused by vasospasm, and may or may not be associated with atherosclerosis .
2. Which of the following is NOT one of the three diagnoses encompassed by Acute
Coronary Syndrome?
A. Unstable angina
B. Non-ST elevation myocardial infarction (NSTEMI)
C. ST elevation myocardial infarction (STEMI)
D. Stable angina
Answer: D
Rationale: Acute Coronary Syndrome encompasses three diagnoses: unstable angina,
NSTEMI, and STEMI. Stable angina is not included .
3. Unstable angina is caused by a labile thrombus that occludes blood flow for no longer
than:
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 60 minutes
Answer: B
Rationale: Unstable angina is caused by a labile thrombus that does not occlude blood flow
for any longer than 20 minutes. Perfusion is restored before myocardial necrosis occurs .
4. NSTEMI results in myocardial necrosis in which layer of the heart?
A. Epicardium
B. Myocardium
C. Endocardium
D. Pericardium
, 2
Answer: C
Rationale: NSTEMI results in myocardial necrosis in the myocardium directly below the
endocardium (innermost layer of ventricles). It does not involve the full thickness of the
ventricular wall .
5. Which ECG finding is characteristic of NSTEMI?
A. ST elevation
B. ST depression or T wave inversion
C. Q wave formation
D. Normal ECG
Answer: B
Rationale: NSTEMI presents with ST depression (hence the name NON ST elevation) or T
wave inversion on ECG .
6. STEMI involves:
A. Only the subendocardial layer
B. The entire thickness of the ventricular wall (transmural infarct)
C. Only the epicardium
D. Only the atria
Answer: B
Rationale: STEMI includes the entire thickness of the ventricular wall (transmural infarct) and
presents with ST elevation on ECG .
7. How long can cardiac cells remain viable in a severely hypoxic state before coagulative
necrosis occurs?
A. 10 minutes
B. 20 minutes
C. 30 minutes
D. 60 minutes
Answer: B
Rationale: Cardiac cells can remain viable in a severely hypoxic state for 20 minutes. After 20
minutes, coagulative necrosis occurs .
8. Reperfusion injury is caused by:
A. Continued ischemia
B. Release of toxic oxygen radicals, calcium influx, and pH changes
C. Decreased catecholamine release
D. Reduced angiotensin II
, 3
Answer: B
Rationale: Reperfusion injury is caused when blood flow is restored, triggering release of
toxic oxygen radicals, calcium influx, and pH changes that cause persistently open
mitochondrial permeability and contribute to cell death .
9. Troponin levels peak at what time after MI onset?
A. 2-4 hours
B. 12 hours
C. 24 hours
D. 48 hours
Answer: C
Rationale: Troponins are detected in 2-4 hours of onset of pain, peak in 24 hours, and
disappear in 7-10 days .
10. What is the most common cause of death following MI?
A. Left ventricular failure
B. Ventricular fibrillation
C. Ventricular free wall rupture
D. Pulmonary edema
Answer: B
Rationale: The most common cause of death following MI is V-Fib, which is associated with
cardiogenic shock .
11. Ventricular free wall rupture typically occurs how many days after MI?
A. 1-2 days
B. 4-7 days
C. 10-14 days
D. 21 days
Answer: B
Rationale: Ventricular free wall rupture occurs in 4-7 days and is associated with thrombosis
of the LAD (left anterior descending) coronary artery. It results in cardiac tamponade from
hemorrhage into the pericardial space .
12. Papillary muscle rupture is associated with which coronary artery?
A. Left anterior descending
B. Right coronary artery
C. Left circumflex
D. Posterior descending
