NSG 530 Exam 3 Actual Exam V1 | NSG 530 Advanced
Pathophysiology (NSG530 Exam 3) [PDF] | Wilkes University
1. A 52-year-old patient presents with polyuria, polydipsia, and a fasting blood glucose of 145
mg/dL. Which mechanism best describes the underlying pathophysiology of this condition?
A. Absolute deficiency of insulin due to autoimmune destruction of beta cells
B. Excessive production of glucagon from alpha cells in the absence of glucose regulation
C. Peripheral insulin resistance and compensatory hyperinsulinemia followed by beta cell
exhaustion
D. Increased renal threshold for glucose leading to osmotic diuresis
Answer: C
Rationale: The patient’s clinical presentation and fasting glucose level suggest Type 2
Diabetes Mellitus. In this condition, the primary defect is insulin resistance in peripheral
tissues such as skeletal muscle and the liver. Initially, the pancreas compensates by
secreting more insulin, but eventually, the beta cells fail to keep up, leading to
hyperglycemia and classic symptoms like polyuria.
2. A 45-year-old female presents with unintended weight loss, heat intolerance, and a visible
enlargement in the neck. Laboratory tests reveal low TSH and elevated free T4. What is the
most likely pathological cause?
A. Hashimoto’s thyroiditis leading to follicular destruction
B. Thyroid-stimulating immunoglobulins (TSI) binding to TSH receptors
C. A benign pituitary adenoma secreting excessive TSH
D. Iodine deficiency causing compensatory hypertrophy of the thyroid gland
Answer: B
Rationale: Grave’s disease is an autoimmune disorder characterized by the production of
thyroid-stimulating immunoglobulins. These antibodies act as agonists at the TSH
receptors on thyroid follicular cells, stimulating the overproduction of thyroid hormones.
This leads to the suppression of TSH via the negative feedback loop and the systemic
manifestations of hyperthyroidism.
3. A patient with a history of small cell lung cancer presents with confusion, serum sodium of
122 mEq/L, and high urine osmolarity. Which hormonal imbalance is responsible for this
state?
A. Excessive production of Antidiuretic Hormone (ADH)
B. Excessive production of Aldosterone
,C. Deficiency of Antidiuretic Hormone (ADH)
D. Resistance of the renal tubules to ADH
Answer: A
Rationale: The Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is common in
small cell lung cancer due to ectopic hormone production. Excess ADH leads to increased
water reabsorption in the renal collecting ducts, resulting in dilutional hyponatremia and
concentrated urine. The patient’s low serum sodium and high urine osmolarity are classic
clinical markers of this metabolic abnormality.
4. Which of the following describes the mechanism by which chronic liver cirrhosis leads to
the development of ascites?
A. Increased oncotic pressure due to overproduction of albumin
B. Decreased capillary hydrostatic pressure in the portal system
C. Portal hypertension and decreased plasma oncotic pressure due to hypoalbuminemia
D. Excessive renal excretion of sodium and water
Answer: C
Rationale: Ascites in cirrhosis results from a combination of portal hypertension and
impaired synthetic function of the liver. Reduced albumin production lowers the plasma
oncotic pressure, which normally keeps fluid in the intravascular space. Simultaneously,
portal hypertension increases hydrostatic pressure, forcing fluid out of the hepatic
capillaries and into the peritoneal cavity.
5. A 65-year-old male with chronic kidney disease (CKD) presents with a hemoglobin of 8.5
g/dL. What is the primary cause of this anemia?
A. Chronic blood loss from the gastrointestinal tract
B. Iron deficiency due to dietary restrictions
C. Reduced production of erythropoietin by the kidneys
D. Hemolysis caused by uremic toxins in the blood
Answer: C
Rationale: Erythropoietin is a hormone produced by the interstitial cells of the kidney in
response to hypoxia to stimulate red blood cell production. As CKD progresses, the
functional renal mass decreases, leading to a significant drop in erythropoietin synthesis.
This results in a normocytic, normochromic anemia that often requires exogenous
replacement therapy.
, 6. A 30-year-old female presents with central obesity, a ‘buffalo hump,’ and purple striae on
her abdomen. Her serum cortisol is elevated, and ACTH is suppressed. What is the likely
diagnosis?
A. Cushing’s Disease (Pituitary adenoma)
B. Adrenal adenoma producing cortisol
C. Addison’s Disease
D. Ectopic ACTH production from a lung tumor
Answer: B
Rationale: Cushing’s syndrome caused by a primary adrenal adenoma results in
autonomous cortisol secretion. The high levels of cortisol provide negative feedback to the
pituitary, which suppresses ACTH production. This distinguishes primary adrenal
Cushing’s from pituitary-mediated Cushing’s disease, where ACTH would be elevated.
7. A patient reports epigastric pain that is relieved by eating but returns 2 to 3 hours later.
This clinical manifestation is most characteristic of:
A. Gastric ulcer
B. Duodenal ulcer
C. Acute pancreatitis
D. Gastroesophageal reflux disease (GERD)
Answer: B
Rationale: Duodenal ulcers typically present with pain that occurs when the stomach is
empty, as acid enters the duodenum without a food buffer. Eating often provides
temporary relief because the pyloric sphincter closes and alkaline secretions increase. In
contrast, gastric ulcer pain is often exacerbated by eating due to increased acid production
and mechanical irritation.
8. Which of the following conditions is characterized by transmural inflammation and can
affect any part of the gastrointestinal tract from the mouth to the anus?
A. Ulcerative colitis
B. Diverticulitis
C. Celiac disease
D. Crohn’s disease
Answer: D
Rationale: Crohn’s disease is an inflammatory bowel disease characterized by ‘skip
lesions’ and transmural inflammation of the GI tract wall. Unlike ulcerative colitis, which is
Pathophysiology (NSG530 Exam 3) [PDF] | Wilkes University
1. A 52-year-old patient presents with polyuria, polydipsia, and a fasting blood glucose of 145
mg/dL. Which mechanism best describes the underlying pathophysiology of this condition?
A. Absolute deficiency of insulin due to autoimmune destruction of beta cells
B. Excessive production of glucagon from alpha cells in the absence of glucose regulation
C. Peripheral insulin resistance and compensatory hyperinsulinemia followed by beta cell
exhaustion
D. Increased renal threshold for glucose leading to osmotic diuresis
Answer: C
Rationale: The patient’s clinical presentation and fasting glucose level suggest Type 2
Diabetes Mellitus. In this condition, the primary defect is insulin resistance in peripheral
tissues such as skeletal muscle and the liver. Initially, the pancreas compensates by
secreting more insulin, but eventually, the beta cells fail to keep up, leading to
hyperglycemia and classic symptoms like polyuria.
2. A 45-year-old female presents with unintended weight loss, heat intolerance, and a visible
enlargement in the neck. Laboratory tests reveal low TSH and elevated free T4. What is the
most likely pathological cause?
A. Hashimoto’s thyroiditis leading to follicular destruction
B. Thyroid-stimulating immunoglobulins (TSI) binding to TSH receptors
C. A benign pituitary adenoma secreting excessive TSH
D. Iodine deficiency causing compensatory hypertrophy of the thyroid gland
Answer: B
Rationale: Grave’s disease is an autoimmune disorder characterized by the production of
thyroid-stimulating immunoglobulins. These antibodies act as agonists at the TSH
receptors on thyroid follicular cells, stimulating the overproduction of thyroid hormones.
This leads to the suppression of TSH via the negative feedback loop and the systemic
manifestations of hyperthyroidism.
3. A patient with a history of small cell lung cancer presents with confusion, serum sodium of
122 mEq/L, and high urine osmolarity. Which hormonal imbalance is responsible for this
state?
A. Excessive production of Antidiuretic Hormone (ADH)
B. Excessive production of Aldosterone
,C. Deficiency of Antidiuretic Hormone (ADH)
D. Resistance of the renal tubules to ADH
Answer: A
Rationale: The Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is common in
small cell lung cancer due to ectopic hormone production. Excess ADH leads to increased
water reabsorption in the renal collecting ducts, resulting in dilutional hyponatremia and
concentrated urine. The patient’s low serum sodium and high urine osmolarity are classic
clinical markers of this metabolic abnormality.
4. Which of the following describes the mechanism by which chronic liver cirrhosis leads to
the development of ascites?
A. Increased oncotic pressure due to overproduction of albumin
B. Decreased capillary hydrostatic pressure in the portal system
C. Portal hypertension and decreased plasma oncotic pressure due to hypoalbuminemia
D. Excessive renal excretion of sodium and water
Answer: C
Rationale: Ascites in cirrhosis results from a combination of portal hypertension and
impaired synthetic function of the liver. Reduced albumin production lowers the plasma
oncotic pressure, which normally keeps fluid in the intravascular space. Simultaneously,
portal hypertension increases hydrostatic pressure, forcing fluid out of the hepatic
capillaries and into the peritoneal cavity.
5. A 65-year-old male with chronic kidney disease (CKD) presents with a hemoglobin of 8.5
g/dL. What is the primary cause of this anemia?
A. Chronic blood loss from the gastrointestinal tract
B. Iron deficiency due to dietary restrictions
C. Reduced production of erythropoietin by the kidneys
D. Hemolysis caused by uremic toxins in the blood
Answer: C
Rationale: Erythropoietin is a hormone produced by the interstitial cells of the kidney in
response to hypoxia to stimulate red blood cell production. As CKD progresses, the
functional renal mass decreases, leading to a significant drop in erythropoietin synthesis.
This results in a normocytic, normochromic anemia that often requires exogenous
replacement therapy.
, 6. A 30-year-old female presents with central obesity, a ‘buffalo hump,’ and purple striae on
her abdomen. Her serum cortisol is elevated, and ACTH is suppressed. What is the likely
diagnosis?
A. Cushing’s Disease (Pituitary adenoma)
B. Adrenal adenoma producing cortisol
C. Addison’s Disease
D. Ectopic ACTH production from a lung tumor
Answer: B
Rationale: Cushing’s syndrome caused by a primary adrenal adenoma results in
autonomous cortisol secretion. The high levels of cortisol provide negative feedback to the
pituitary, which suppresses ACTH production. This distinguishes primary adrenal
Cushing’s from pituitary-mediated Cushing’s disease, where ACTH would be elevated.
7. A patient reports epigastric pain that is relieved by eating but returns 2 to 3 hours later.
This clinical manifestation is most characteristic of:
A. Gastric ulcer
B. Duodenal ulcer
C. Acute pancreatitis
D. Gastroesophageal reflux disease (GERD)
Answer: B
Rationale: Duodenal ulcers typically present with pain that occurs when the stomach is
empty, as acid enters the duodenum without a food buffer. Eating often provides
temporary relief because the pyloric sphincter closes and alkaline secretions increase. In
contrast, gastric ulcer pain is often exacerbated by eating due to increased acid production
and mechanical irritation.
8. Which of the following conditions is characterized by transmural inflammation and can
affect any part of the gastrointestinal tract from the mouth to the anus?
A. Ulcerative colitis
B. Diverticulitis
C. Celiac disease
D. Crohn’s disease
Answer: D
Rationale: Crohn’s disease is an inflammatory bowel disease characterized by ‘skip
lesions’ and transmural inflammation of the GI tract wall. Unlike ulcerative colitis, which is
