NURS 6501
Advanced Pathophysiology
Complete Midterms Review
(Questions & Solutions)
2025
1
,Multiple Choice Questions (1–18)
1. A 58‐year‐old man presents with crushing chest pain radiating to
his left arm. Troponin levels and ECG confirm an acute
myocardial infarction (MI). Which sequence best describes the
pathophysiology of myocardial necrosis in MI?
o A. Ischemia → anaerobic metabolism → ATP depletion →
membrane pump failure → cell death
o B. Platelet activation → vasodilation → reperfusion injury →
apoptosis
o C. Collateral circulation → lactic acidosis → calcium influx →
cell survival
o D. Oxidative stress → nitric oxide overproduction →
mitochondrial biogenesis
Correct ANS: A
Rationale: Acute ischemia shifts cardiomyocytes to anaerobic
glycolysis, depletes ATP, disrupts Na⁺/K⁺‐ATPase function, and leads
to irreversible cell injury and death.
2. A patient with severe pancreatitis develops acute respiratory
distress syndrome (ARDS). Which mechanism primarily drives
pulmonary edema in ARDS?
o A. Increased capillary hydrostatic pressure
o B. Decreased oncotic pressure
o C. Endothelial injury → increased permeability → protein‐
rich fluid leak
o D. Lymphatic obstruction
Correct ANS: C
Rationale: In ARDS, inflammatory mediators injure capillary
endothelium, increasing permeability and allowing protein‐rich
exudate into alveoli.
3. A 45-year-old woman in septic shock has warm, flushed skin,
hypotension, and a high cardiac output. Which mediator is most
responsible for the profound vasodilation?
2
, o A. Thromboxane A₂
o B. Nitric oxide
o C. Endothelin‐1
o D. Serotonin
Correct ANS: B
Rationale: Sepsis triggers inducible nitric oxide synthase in
endothelium and macrophages, producing NO and causing systemic
vasodilation.
4. An ICU patient develops disseminated intravascular coagulation
(DIC). Which laboratory profile is most consistent with DIC?
o A. ↑ Platelets, ↓ PT/PTT, ↓ Fibrin degradation products
o B. ↓ Platelets, ↑ PT/PTT, ↑ Fibrin degradation products
o C. ↓ Platelets, ↓ PT/PTT, ↑ Fibrinogen
o D. ↑ Platelets, ↑ PT/PTT, ↓ D-dimer
Correct ANS: B
Rationale: DIC consumes platelets and clotting factors, prolonging
PT/PTT, while fibrinolysis elevates fibrin degradation products (eg, D-
dimer).
5. A teenager with type 1 diabetes presents with polyuria,
polydipsia, and Kussmaul respirations. Labs show
hyperglycemia and an anion gap metabolic acidosis. Which
process produces the anion gap in diabetic ketoacidosis (DKA)?
o A. Lactic acid accumulation
o B. Ketone body (β-hydroxybutyrate and acetoacetate)
formation
o C. Uremic toxin retention
o D. Chloride shift in red blood cells
Correct ANS: B
Rationale: Insulin deficiency drives lipolysis and hepatic
ketogenesis, producing acidic ketone bodies that increase the anion
gap.
6. A hospitalized patient is found to have hyponatremia, low serum
osmolality, and inappropriately concentrated urine. Which
condition explains these findings?
3
Advanced Pathophysiology
Complete Midterms Review
(Questions & Solutions)
2025
1
,Multiple Choice Questions (1–18)
1. A 58‐year‐old man presents with crushing chest pain radiating to
his left arm. Troponin levels and ECG confirm an acute
myocardial infarction (MI). Which sequence best describes the
pathophysiology of myocardial necrosis in MI?
o A. Ischemia → anaerobic metabolism → ATP depletion →
membrane pump failure → cell death
o B. Platelet activation → vasodilation → reperfusion injury →
apoptosis
o C. Collateral circulation → lactic acidosis → calcium influx →
cell survival
o D. Oxidative stress → nitric oxide overproduction →
mitochondrial biogenesis
Correct ANS: A
Rationale: Acute ischemia shifts cardiomyocytes to anaerobic
glycolysis, depletes ATP, disrupts Na⁺/K⁺‐ATPase function, and leads
to irreversible cell injury and death.
2. A patient with severe pancreatitis develops acute respiratory
distress syndrome (ARDS). Which mechanism primarily drives
pulmonary edema in ARDS?
o A. Increased capillary hydrostatic pressure
o B. Decreased oncotic pressure
o C. Endothelial injury → increased permeability → protein‐
rich fluid leak
o D. Lymphatic obstruction
Correct ANS: C
Rationale: In ARDS, inflammatory mediators injure capillary
endothelium, increasing permeability and allowing protein‐rich
exudate into alveoli.
3. A 45-year-old woman in septic shock has warm, flushed skin,
hypotension, and a high cardiac output. Which mediator is most
responsible for the profound vasodilation?
2
, o A. Thromboxane A₂
o B. Nitric oxide
o C. Endothelin‐1
o D. Serotonin
Correct ANS: B
Rationale: Sepsis triggers inducible nitric oxide synthase in
endothelium and macrophages, producing NO and causing systemic
vasodilation.
4. An ICU patient develops disseminated intravascular coagulation
(DIC). Which laboratory profile is most consistent with DIC?
o A. ↑ Platelets, ↓ PT/PTT, ↓ Fibrin degradation products
o B. ↓ Platelets, ↑ PT/PTT, ↑ Fibrin degradation products
o C. ↓ Platelets, ↓ PT/PTT, ↑ Fibrinogen
o D. ↑ Platelets, ↑ PT/PTT, ↓ D-dimer
Correct ANS: B
Rationale: DIC consumes platelets and clotting factors, prolonging
PT/PTT, while fibrinolysis elevates fibrin degradation products (eg, D-
dimer).
5. A teenager with type 1 diabetes presents with polyuria,
polydipsia, and Kussmaul respirations. Labs show
hyperglycemia and an anion gap metabolic acidosis. Which
process produces the anion gap in diabetic ketoacidosis (DKA)?
o A. Lactic acid accumulation
o B. Ketone body (β-hydroxybutyrate and acetoacetate)
formation
o C. Uremic toxin retention
o D. Chloride shift in red blood cells
Correct ANS: B
Rationale: Insulin deficiency drives lipolysis and hepatic
ketogenesis, producing acidic ketone bodies that increase the anion
gap.
6. A hospitalized patient is found to have hyponatremia, low serum
osmolality, and inappropriately concentrated urine. Which
condition explains these findings?
3
