NSG 5140 ADVANCED PATHOPHYSIOLOGY –
MIDTERM 1 EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST 2025\2026
1. Which of the following is the primary mechanism of cellular injury in
hypoxic conditions?
A. DNA mutation
B. ATP depletion leading to loss of ion homeostasis
C. Free radical formation
D. Protein misfolding
CORRECT ANSWERB
Rationale: Hypoxia limits oxidative phosphorylation → decreased ATP →
Na⁺/K⁺ pump failure → cell swelling and injury.
2. A patient presents with edema due to heart failure. Which mechanism is
primarily responsible?
A. Increased plasma oncotic pressure
B. Increased hydrostatic pressure in capillaries
C. Decreased capillary permeability
D. Lymphatic obstruction
CORRECT ANSWERB
Rationale: Elevated hydrostatic pressure pushes fluid into interstitial spaces,
causing edema in CHF.
3. Which electrolyte imbalance is most likely in a patient with Addison’s
disease?
A. Hypernatremia, hypokalemia
B. Hypercalcemia, hypermagnesemia
C. Hyponatremia, hyperkalemia
,D. Hypokalemia, hypernatremia
CORRECT ANSWERC
Rationale: Addison’s disease causes aldosterone deficiency → Na⁺ loss
(hyponatremia) and K⁺ retention (hyperkalemia).
4. The hallmark of acute inflammation is:
A. Fibrosis
B. Vasodilation and increased vascular permeability
C. Neoplasia
D. Autoantibody formation
CORRECT ANSWERB
Rationale: Acute inflammation triggers redness, heat, swelling, and pain through
vascular changes.
5. Which intracellular signaling pathway is most directly involved in
apoptosis?
A. MAPK
B. Caspase cascade
C. JAK/STAT
D. PI3K/Akt
CORRECT ANSWERB
Rationale: Caspases mediate programmed cell death by cleaving cellular
substrates.
6. In a patient with chronic liver disease, which lab value best reflects
impaired synthetic function?
A. AST
B. ALT
C. Albumin
D. Bilirubin
,CORRECT ANSWERC
Rationale: Albumin production is reduced in liver dysfunction; low albumin
indicates impaired synthetic capacity.
7. Which type of shock is caused by severe allergic reactions?
A. Cardiogenic
B. Hypovolemic
C. Distributive (anaphylactic)
D. Obstructive
CORRECT ANSWERC
Rationale: Anaphylaxis causes vasodilation and capillary leak → distributive
shock.
8. A patient with type 1 diabetes presents with hyperglycemia, ketonuria, and
acidosis. This is indicative of:
A. HHNS
B. DKA (Diabetic Ketoacidosis)
C. Hypoglycemia
D. Metabolic alkalosis
CORRECT ANSWERB
Rationale: DKA occurs in insulin deficiency → hyperglycemia, lipolysis, ketone
production, and metabolic acidosis.
9. Which type of hypersensitivity reaction is mediated by IgE?
A. Type I
B. Type II
C. Type I
D. Type IV
CORRECT ANSWERC
, Rationale: Type I hypersensitivity involves IgE binding to mast cells →
histamine release → allergic reactions.
10. The most common cause of primary hyperthyroidism is:
A. Pituitary adenoma
B. Thyroid carcinoma
C. Graves’ disease
D. Iodine deficiency
CORRECT ANSWERC
Rationale: Graves’ disease is an autoimmune disorder causing thyroid hormone
overproduction.
11. Which of the following best describes metabolic acidosis?
A. Increased HCO₃⁻, decreased H⁺
B. Decreased HCO₃⁻, decreased pH
C. Increased HCO₃⁻, increased pH
D. Decreased H⁺, increased pH
CORRECT ANSWERB
Rationale: Metabolic acidosis is caused by a primary loss of bicarbonate or
accumulation of acids → low pH.
12. A patient with cirrhosis has ascites. Which mechanism primarily
contributes?
A. High plasma oncotic pressure
B. Portal hypertension and hypoalbuminemia
C. Renal sodium loss
D. Hyperkalemia
CORRECT ANSWERB
Rationale: Increased hydrostatic pressure in portal circulation and low albumin
reduce plasma oncotic pressure → fluid accumulation.
MIDTERM 1 EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED A+
LATEST 2025\2026
1. Which of the following is the primary mechanism of cellular injury in
hypoxic conditions?
A. DNA mutation
B. ATP depletion leading to loss of ion homeostasis
C. Free radical formation
D. Protein misfolding
CORRECT ANSWERB
Rationale: Hypoxia limits oxidative phosphorylation → decreased ATP →
Na⁺/K⁺ pump failure → cell swelling and injury.
2. A patient presents with edema due to heart failure. Which mechanism is
primarily responsible?
A. Increased plasma oncotic pressure
B. Increased hydrostatic pressure in capillaries
C. Decreased capillary permeability
D. Lymphatic obstruction
CORRECT ANSWERB
Rationale: Elevated hydrostatic pressure pushes fluid into interstitial spaces,
causing edema in CHF.
3. Which electrolyte imbalance is most likely in a patient with Addison’s
disease?
A. Hypernatremia, hypokalemia
B. Hypercalcemia, hypermagnesemia
C. Hyponatremia, hyperkalemia
,D. Hypokalemia, hypernatremia
CORRECT ANSWERC
Rationale: Addison’s disease causes aldosterone deficiency → Na⁺ loss
(hyponatremia) and K⁺ retention (hyperkalemia).
4. The hallmark of acute inflammation is:
A. Fibrosis
B. Vasodilation and increased vascular permeability
C. Neoplasia
D. Autoantibody formation
CORRECT ANSWERB
Rationale: Acute inflammation triggers redness, heat, swelling, and pain through
vascular changes.
5. Which intracellular signaling pathway is most directly involved in
apoptosis?
A. MAPK
B. Caspase cascade
C. JAK/STAT
D. PI3K/Akt
CORRECT ANSWERB
Rationale: Caspases mediate programmed cell death by cleaving cellular
substrates.
6. In a patient with chronic liver disease, which lab value best reflects
impaired synthetic function?
A. AST
B. ALT
C. Albumin
D. Bilirubin
,CORRECT ANSWERC
Rationale: Albumin production is reduced in liver dysfunction; low albumin
indicates impaired synthetic capacity.
7. Which type of shock is caused by severe allergic reactions?
A. Cardiogenic
B. Hypovolemic
C. Distributive (anaphylactic)
D. Obstructive
CORRECT ANSWERC
Rationale: Anaphylaxis causes vasodilation and capillary leak → distributive
shock.
8. A patient with type 1 diabetes presents with hyperglycemia, ketonuria, and
acidosis. This is indicative of:
A. HHNS
B. DKA (Diabetic Ketoacidosis)
C. Hypoglycemia
D. Metabolic alkalosis
CORRECT ANSWERB
Rationale: DKA occurs in insulin deficiency → hyperglycemia, lipolysis, ketone
production, and metabolic acidosis.
9. Which type of hypersensitivity reaction is mediated by IgE?
A. Type I
B. Type II
C. Type I
D. Type IV
CORRECT ANSWERC
, Rationale: Type I hypersensitivity involves IgE binding to mast cells →
histamine release → allergic reactions.
10. The most common cause of primary hyperthyroidism is:
A. Pituitary adenoma
B. Thyroid carcinoma
C. Graves’ disease
D. Iodine deficiency
CORRECT ANSWERC
Rationale: Graves’ disease is an autoimmune disorder causing thyroid hormone
overproduction.
11. Which of the following best describes metabolic acidosis?
A. Increased HCO₃⁻, decreased H⁺
B. Decreased HCO₃⁻, decreased pH
C. Increased HCO₃⁻, increased pH
D. Decreased H⁺, increased pH
CORRECT ANSWERB
Rationale: Metabolic acidosis is caused by a primary loss of bicarbonate or
accumulation of acids → low pH.
12. A patient with cirrhosis has ascites. Which mechanism primarily
contributes?
A. High plasma oncotic pressure
B. Portal hypertension and hypoalbuminemia
C. Renal sodium loss
D. Hyperkalemia
CORRECT ANSWERB
Rationale: Increased hydrostatic pressure in portal circulation and low albumin
reduce plasma oncotic pressure → fluid accumulation.
