NR507/NR507 Midterm Exam - Advanced Pathophysiology
Updated Q&A (2024/2025)
1. Which of the following is the primary cause of systemic inflammatory response
syndrome (SIRS)?
A) Hypovolemia
B) Infection
C) Trauma
D) Chronic disease
Answer: B) Infection
*Rationale: SIRS is often triggered by infection, but it can also be caused by trauma,
burns, or pancreatitis. However, infection is the most common and primary cause of
SIRS due to the inflammatory mediators it releases.*
2. Which of the following changes in the body is associated with the activation of the
renin-angiotensin-aldosterone system (RAAS) during hypovolemic shock?
A) Decreased blood pressure
B) Decreased heart rate
C) Increased urine output
D) Vasodilation of peripheral blood vessels
Answer: A) Decreased blood pressure
*Rationale: RAAS is activated in response to low blood volume or blood pressure. It
helps increase blood pressure by causing vasoconstriction, increasing fluid retention,
and stimulating aldosterone release, which increases sodium and water retention.*
3. In a patient with acute respiratory distress syndrome (ARDS), which of the following
pathophysiological changes occurs in the lungs?
A) Alveolar collapse and increased pulmonary compliance
B) Increased production of surfactant
C) Diffuse inflammation and pulmonary edema
, D) Decreased alveolar-capillary permeability
Answer: C) Diffuse inflammation and pulmonary edema
*Rationale: ARDS is characterized by diffuse inflammation of the lung tissue, leading
to increased alveolar-capillary permeability, pulmonary edema, and impaired gas
exchange. This results in hypoxia and respiratory failure.*
4. Which of the following is a hallmark of chronic obstructive pulmonary disease
(COPD)?
A) Bronchoconstriction and reversible airflow obstruction
B) Increased lung compliance and decreased expiratory flow rates
C) Fibrosis of lung tissue with thickening of the alveolar walls
D) Hyperinflation and air trapping
Answer: D) Hyperinflation and air trapping
*Rationale: COPD is characterized by chronic inflammation of the airways, leading to
airflow obstruction and air trapping. Hyperinflation is a common feature, especially
during exhalation, leading to difficulty in fully emptying the lungs.*
5. In myocardial infarction (MI), which enzyme is most commonly elevated in the blood,
signaling myocardial injury?
A) Creatine kinase (CK)
B) Aspartate aminotransferase (AST)
C) Troponin I
D) Alkaline phosphatase (ALP)
Answer: C) Troponin I
*Rationale: Troponin I is the most specific and sensitive biomarker for myocardial
injury. It is released into the bloodstream when myocardial cells are damaged, and it
remains elevated for several days post-MI, making it an excellent indicator for
diagnosing MI.*
6. What is the primary pathophysiological mechanism in the development of type 1
diabetes mellitus?
A) Insulin resistance
, B) Autoimmune destruction of pancreatic beta cells
C) Decreased hepatic glucose production
D) Decreased renal glucose excretion
Answer: B) Autoimmune destruction of pancreatic beta cells
*Rationale: In type 1 diabetes mellitus, an autoimmune response destroys the insulin-
producing beta cells in the pancreas, leading to a deficiency in insulin. This causes
hyperglycemia and other metabolic disturbances.*
7. Which of the following best describes the pathophysiology of cirrhosis?
A) Increased bilirubin production due to hemolysis
B) Progressive scarring of the liver tissue with impaired hepatocyte function
C) Decreased serum albumin levels due to kidney damage
D) Accumulation of fatty deposits in the liver cells
Answer: B) Progressive scarring of the liver tissue with impaired hepatocyte function
*Rationale: Cirrhosis is characterized by the progressive replacement of healthy liver
tissue with scar tissue, resulting in impaired liver function, biliary obstruction, and portal
hypertension.*
8. What is the most common cause of chronic kidney disease (CKD)?
A) Diabetes mellitus
B) Hypertension
C) Glomerulonephritis
D) Polycystic kidney disease
Answer: A) Diabetes mellitus
*Rationale: Diabetes mellitus is a leading risk factor for the development of chronic
kidney disease due to hyperglycemia leading to nephropathy.*
9. In which of the following conditions is hypoglycemia most likely to occur?
A) Type 1 diabetes mellitus
B) Type 2 diabetes mellitus
, C) Diabetes insipidus
D) Cushing's syndrome
Answer: A) Type 1 diabetes mellitus
*Rationale: Individuals with type 1 diabetes mellitus are at higher risk of hypoglycemia
due to insulin replacement therapy and an inability to produce insulin naturally.*
10. Which of the following conditions is associated with a significant increase in the risk
of thromboembolism?
A) Atrial fibrillation
B) Hypertension
C) Diabetes mellitus
D) Hyperlipidemia
Answer: A) Atrial fibrillation
*Rationale: Atrial fibrillation increases the risk of thrombus formation in the left atrial
appendage, leading to a higher likelihood of embolic strokes.*
11. What is the primary risk factor for developing hypertension?
A) Obesity
B) Smoking
C) Genetics
D) High sodium intake
Answer: C) Genetics
*Rationale: While multiple factors contribute to hypertension, genetic predisposition
has a significant impact on the development of the condition.*
12. In the context of heart failure, what does a low ejection fraction indicate?
A) Strong contractility of the heart
B) Reduced ability of the heart to pump blood effectively
C) Compensatory mechanisms working effectively
D) High cardiac output
Updated Q&A (2024/2025)
1. Which of the following is the primary cause of systemic inflammatory response
syndrome (SIRS)?
A) Hypovolemia
B) Infection
C) Trauma
D) Chronic disease
Answer: B) Infection
*Rationale: SIRS is often triggered by infection, but it can also be caused by trauma,
burns, or pancreatitis. However, infection is the most common and primary cause of
SIRS due to the inflammatory mediators it releases.*
2. Which of the following changes in the body is associated with the activation of the
renin-angiotensin-aldosterone system (RAAS) during hypovolemic shock?
A) Decreased blood pressure
B) Decreased heart rate
C) Increased urine output
D) Vasodilation of peripheral blood vessels
Answer: A) Decreased blood pressure
*Rationale: RAAS is activated in response to low blood volume or blood pressure. It
helps increase blood pressure by causing vasoconstriction, increasing fluid retention,
and stimulating aldosterone release, which increases sodium and water retention.*
3. In a patient with acute respiratory distress syndrome (ARDS), which of the following
pathophysiological changes occurs in the lungs?
A) Alveolar collapse and increased pulmonary compliance
B) Increased production of surfactant
C) Diffuse inflammation and pulmonary edema
, D) Decreased alveolar-capillary permeability
Answer: C) Diffuse inflammation and pulmonary edema
*Rationale: ARDS is characterized by diffuse inflammation of the lung tissue, leading
to increased alveolar-capillary permeability, pulmonary edema, and impaired gas
exchange. This results in hypoxia and respiratory failure.*
4. Which of the following is a hallmark of chronic obstructive pulmonary disease
(COPD)?
A) Bronchoconstriction and reversible airflow obstruction
B) Increased lung compliance and decreased expiratory flow rates
C) Fibrosis of lung tissue with thickening of the alveolar walls
D) Hyperinflation and air trapping
Answer: D) Hyperinflation and air trapping
*Rationale: COPD is characterized by chronic inflammation of the airways, leading to
airflow obstruction and air trapping. Hyperinflation is a common feature, especially
during exhalation, leading to difficulty in fully emptying the lungs.*
5. In myocardial infarction (MI), which enzyme is most commonly elevated in the blood,
signaling myocardial injury?
A) Creatine kinase (CK)
B) Aspartate aminotransferase (AST)
C) Troponin I
D) Alkaline phosphatase (ALP)
Answer: C) Troponin I
*Rationale: Troponin I is the most specific and sensitive biomarker for myocardial
injury. It is released into the bloodstream when myocardial cells are damaged, and it
remains elevated for several days post-MI, making it an excellent indicator for
diagnosing MI.*
6. What is the primary pathophysiological mechanism in the development of type 1
diabetes mellitus?
A) Insulin resistance
, B) Autoimmune destruction of pancreatic beta cells
C) Decreased hepatic glucose production
D) Decreased renal glucose excretion
Answer: B) Autoimmune destruction of pancreatic beta cells
*Rationale: In type 1 diabetes mellitus, an autoimmune response destroys the insulin-
producing beta cells in the pancreas, leading to a deficiency in insulin. This causes
hyperglycemia and other metabolic disturbances.*
7. Which of the following best describes the pathophysiology of cirrhosis?
A) Increased bilirubin production due to hemolysis
B) Progressive scarring of the liver tissue with impaired hepatocyte function
C) Decreased serum albumin levels due to kidney damage
D) Accumulation of fatty deposits in the liver cells
Answer: B) Progressive scarring of the liver tissue with impaired hepatocyte function
*Rationale: Cirrhosis is characterized by the progressive replacement of healthy liver
tissue with scar tissue, resulting in impaired liver function, biliary obstruction, and portal
hypertension.*
8. What is the most common cause of chronic kidney disease (CKD)?
A) Diabetes mellitus
B) Hypertension
C) Glomerulonephritis
D) Polycystic kidney disease
Answer: A) Diabetes mellitus
*Rationale: Diabetes mellitus is a leading risk factor for the development of chronic
kidney disease due to hyperglycemia leading to nephropathy.*
9. In which of the following conditions is hypoglycemia most likely to occur?
A) Type 1 diabetes mellitus
B) Type 2 diabetes mellitus
, C) Diabetes insipidus
D) Cushing's syndrome
Answer: A) Type 1 diabetes mellitus
*Rationale: Individuals with type 1 diabetes mellitus are at higher risk of hypoglycemia
due to insulin replacement therapy and an inability to produce insulin naturally.*
10. Which of the following conditions is associated with a significant increase in the risk
of thromboembolism?
A) Atrial fibrillation
B) Hypertension
C) Diabetes mellitus
D) Hyperlipidemia
Answer: A) Atrial fibrillation
*Rationale: Atrial fibrillation increases the risk of thrombus formation in the left atrial
appendage, leading to a higher likelihood of embolic strokes.*
11. What is the primary risk factor for developing hypertension?
A) Obesity
B) Smoking
C) Genetics
D) High sodium intake
Answer: C) Genetics
*Rationale: While multiple factors contribute to hypertension, genetic predisposition
has a significant impact on the development of the condition.*
12. In the context of heart failure, what does a low ejection fraction indicate?
A) Strong contractility of the heart
B) Reduced ability of the heart to pump blood effectively
C) Compensatory mechanisms working effectively
D) High cardiac output
