NSG 5140 Final Exam Review Advanced Pathophysiology
Questions and Correct Answers
Question 1
Electrolyte imbalance with Chvostek's sign
Correct Answer
Hypocalcemia, where low calcium increases neuromuscular excitability, producing
facial muscle twitching.
Question 1: A patient experiences cellular swelling and membrane blebbing due to
failure of the sodium-potassium ATPase pump. This process is characteristic of?
A. Apoptosis
B. Necrosis
C. Autophagy
D. Pyroptosis
CORRECT ANSWER: B. Necrosis
Rationale: ATP depletion leads to sodium influx, osmotic swelling, and eventual cell
rupture characteristic of necrotic cell death.
Question 2: Which cytokine is primarily responsible for the systemic manifestations of
acute inflammation such as fever and hepatic acute phase response?
A. IL-1
B. IL-4
C. IL-10
D. TGF-beta
CORRECT ANSWER: A. IL-1
Rationale: IL-1 acts on the hypothalamus to induce fever and stimulates hepatocytes
to produce acute phase proteins like CRP.
Question 3: In a patient with chronic granulomatous disease, the defect lies in?
A. NADPH oxidase leading to impaired oxidative burst
B. Complement C3
C. B cell maturation
D. T cell receptor signaling
CORRECT ANSWER: A. NADPH oxidase leading to impaired oxidative burst
Rationale: Deficient superoxide production impairs killing of catalase-positive
organisms, resulting in recurrent granulomatous infections.
Question 4: The hallmark histologic feature of irreversible cell injury is?
A. Mitochondrial vacuolization and amorphous densities
B. Cellular swelling
C. Chromatin clumping
D. Ribosomal detachment
Page 1 of 87
,CORRECT ANSWER: A. Mitochondrial vacuolization and amorphous densities
Rationale: These changes indicate severe mitochondrial damage and transition to
irreversible injury.
Question 5: A patient with longstanding hypertension develops left ventricular
hypertrophy. This represents?
A. Pathologic hypertrophy
B. Physiologic hypertrophy
C. Hyperplasia
D. Metaplasia
CORRECT ANSWER: A. Pathologic hypertrophy
Rationale: Pressure overload from hypertension causes myocyte enlargement
without cell division, leading to maladaptive remodeling.
Question 6: The primary mechanism of tissue damage in reperfusion injury is?
A. Generation of reactive oxygen species
B. Calcium overload only
C. Neutrophil margination
D. Complement activation exclusively
CORRECT ANSWER: A. Generation of reactive oxygen species
Rationale: Reintroduction of oxygen leads to free radical formation causing lipid
peroxidation and cell death.
Question 7: In amyloidosis, the misfolded proteins form?
A. Beta-pleated sheet fibrils
B. Alpha helices
C. Random coils
D. Globular structures
CORRECT ANSWER: A. Beta-pleated sheet fibrils
Rationale: The characteristic beta-pleated sheet configuration confers Congo red
staining and apple-green birefringence.
Question 8: A mutation leading to uncontrolled cell proliferation due to loss of tumor
suppressor function is seen in?
A. Retinoblastoma gene (RB)
B. BCL-2 overexpression
C. RAS activation
D. MYC amplification
CORRECT ANSWER: A. Retinoblastoma gene (RB)
Rationale: Loss of RB removes inhibition of the cell cycle at the G1/S checkpoint.
Question 9: The process by which epithelial cells acquire mesenchymal features during
cancer invasion is called?
Page 2 of 87
,A. Epithelial-mesenchymal transition
B. Metaplasia
C. Dysplasia
D. Hyperplasia
CORRECT ANSWER: A. Epithelial-mesenchymal transition
Rationale: EMT enables motility, invasiveness, and metastatic potential through loss
of E-cadherin and gain of vimentin.
Question 10: In type 1 hypersensitivity, mast cell degranulation is triggered by?
A. Cross-linking of IgE on Fc epsilon RI receptors
B. IgG binding
C. Complement C5a
D. Direct toxin effect
CORRECT ANSWER: A. Cross-linking of IgE on Fc epsilon RI receptors
Rationale: Allergen-induced cross-linking releases histamine, leukotrienes, and other
mediators.
Question 11: A patient with cirrhosis develops hepatocellular carcinoma. The most
important risk factor is?
A. Chronic inflammation and regenerative nodules
B. Acute hepatitis A
C. Alcohol cessation
D. Low AFP levels
CORRECT ANSWER: A. Chronic inflammation and regenerative nodules
Rationale: Persistent hepatocyte turnover in cirrhosis promotes accumulation of
genetic mutations.
Question 12: The Warburg effect in cancer cells refers to?
A. Increased aerobic glycolysis
B. Oxidative phosphorylation preference
C. Decreased glucose uptake
D. Normal ATP production
CORRECT ANSWER: A. Increased aerobic glycolysis
Rationale: Cancer cells preferentially use glycolysis even in oxygen-rich
environments to support rapid proliferation.
Question 13: Liquefactive necrosis is typically seen in?
A. Brain infarction and bacterial abscesses
B. Myocardial infarction
C. Caseous necrosis in TB
D. Fat necrosis in pancreas
Page 3 of 87
, CORRECT ANSWER: A. Brain infarction and bacterial abscesses
Rationale: High lipid content and enzymatic digestion lead to complete tissue
liquefaction.
Question 14: In systemic lupus erythematosus, the characteristic autoantibody is
directed against?
A. Nuclear antigens (ANA)
B. Acetylcholine receptor
C. TSH receptor
D. Intrinsic factor
CORRECT ANSWER: A. Nuclear antigens (ANA)
Rationale: ANA is the screening test, with anti-dsDNA and anti-Smith being more
specific.
Question 15: The primary pathologic process in emphysema is?
A. Destruction of alveolar walls by protease-antiprotease imbalance
B. Fibrosis of alveolar walls
C. Hyperplasia of type II pneumocytes
D. Mucous gland hyperplasia
CORRECT ANSWER: A. Destruction of alveolar walls by protease-antiprotease
imbalance
Rationale: Alpha-1 antitrypsin deficiency or smoking leads to unchecked elastase
activity.
Question 16: A patient with diabetic ketoacidosis develops Kussmaul respirations due
to?
A. Compensatory respiratory alkalosis for metabolic acidosis
B. Hypoxemia
C. Central nervous system depression
D. Pulmonary edema
CORRECT ANSWER: A. Compensatory respiratory alkalosis for metabolic
acidosis
Rationale: Deep, rapid breathing eliminates CO2 to counteract anion gap acidosis.
Question 17: The most common mechanism of oncogene activation is?
A. Point mutation, amplification, or translocation
B. Deletion
C. Promoter methylation
D. Histone deacetylation
CORRECT ANSWER: A. Point mutation, amplification, or translocation
Rationale: These genetic alterations lead to constitutive activation of growth
signaling pathways.
Page 4 of 87
Questions and Correct Answers
Question 1
Electrolyte imbalance with Chvostek's sign
Correct Answer
Hypocalcemia, where low calcium increases neuromuscular excitability, producing
facial muscle twitching.
Question 1: A patient experiences cellular swelling and membrane blebbing due to
failure of the sodium-potassium ATPase pump. This process is characteristic of?
A. Apoptosis
B. Necrosis
C. Autophagy
D. Pyroptosis
CORRECT ANSWER: B. Necrosis
Rationale: ATP depletion leads to sodium influx, osmotic swelling, and eventual cell
rupture characteristic of necrotic cell death.
Question 2: Which cytokine is primarily responsible for the systemic manifestations of
acute inflammation such as fever and hepatic acute phase response?
A. IL-1
B. IL-4
C. IL-10
D. TGF-beta
CORRECT ANSWER: A. IL-1
Rationale: IL-1 acts on the hypothalamus to induce fever and stimulates hepatocytes
to produce acute phase proteins like CRP.
Question 3: In a patient with chronic granulomatous disease, the defect lies in?
A. NADPH oxidase leading to impaired oxidative burst
B. Complement C3
C. B cell maturation
D. T cell receptor signaling
CORRECT ANSWER: A. NADPH oxidase leading to impaired oxidative burst
Rationale: Deficient superoxide production impairs killing of catalase-positive
organisms, resulting in recurrent granulomatous infections.
Question 4: The hallmark histologic feature of irreversible cell injury is?
A. Mitochondrial vacuolization and amorphous densities
B. Cellular swelling
C. Chromatin clumping
D. Ribosomal detachment
Page 1 of 87
,CORRECT ANSWER: A. Mitochondrial vacuolization and amorphous densities
Rationale: These changes indicate severe mitochondrial damage and transition to
irreversible injury.
Question 5: A patient with longstanding hypertension develops left ventricular
hypertrophy. This represents?
A. Pathologic hypertrophy
B. Physiologic hypertrophy
C. Hyperplasia
D. Metaplasia
CORRECT ANSWER: A. Pathologic hypertrophy
Rationale: Pressure overload from hypertension causes myocyte enlargement
without cell division, leading to maladaptive remodeling.
Question 6: The primary mechanism of tissue damage in reperfusion injury is?
A. Generation of reactive oxygen species
B. Calcium overload only
C. Neutrophil margination
D. Complement activation exclusively
CORRECT ANSWER: A. Generation of reactive oxygen species
Rationale: Reintroduction of oxygen leads to free radical formation causing lipid
peroxidation and cell death.
Question 7: In amyloidosis, the misfolded proteins form?
A. Beta-pleated sheet fibrils
B. Alpha helices
C. Random coils
D. Globular structures
CORRECT ANSWER: A. Beta-pleated sheet fibrils
Rationale: The characteristic beta-pleated sheet configuration confers Congo red
staining and apple-green birefringence.
Question 8: A mutation leading to uncontrolled cell proliferation due to loss of tumor
suppressor function is seen in?
A. Retinoblastoma gene (RB)
B. BCL-2 overexpression
C. RAS activation
D. MYC amplification
CORRECT ANSWER: A. Retinoblastoma gene (RB)
Rationale: Loss of RB removes inhibition of the cell cycle at the G1/S checkpoint.
Question 9: The process by which epithelial cells acquire mesenchymal features during
cancer invasion is called?
Page 2 of 87
,A. Epithelial-mesenchymal transition
B. Metaplasia
C. Dysplasia
D. Hyperplasia
CORRECT ANSWER: A. Epithelial-mesenchymal transition
Rationale: EMT enables motility, invasiveness, and metastatic potential through loss
of E-cadherin and gain of vimentin.
Question 10: In type 1 hypersensitivity, mast cell degranulation is triggered by?
A. Cross-linking of IgE on Fc epsilon RI receptors
B. IgG binding
C. Complement C5a
D. Direct toxin effect
CORRECT ANSWER: A. Cross-linking of IgE on Fc epsilon RI receptors
Rationale: Allergen-induced cross-linking releases histamine, leukotrienes, and other
mediators.
Question 11: A patient with cirrhosis develops hepatocellular carcinoma. The most
important risk factor is?
A. Chronic inflammation and regenerative nodules
B. Acute hepatitis A
C. Alcohol cessation
D. Low AFP levels
CORRECT ANSWER: A. Chronic inflammation and regenerative nodules
Rationale: Persistent hepatocyte turnover in cirrhosis promotes accumulation of
genetic mutations.
Question 12: The Warburg effect in cancer cells refers to?
A. Increased aerobic glycolysis
B. Oxidative phosphorylation preference
C. Decreased glucose uptake
D. Normal ATP production
CORRECT ANSWER: A. Increased aerobic glycolysis
Rationale: Cancer cells preferentially use glycolysis even in oxygen-rich
environments to support rapid proliferation.
Question 13: Liquefactive necrosis is typically seen in?
A. Brain infarction and bacterial abscesses
B. Myocardial infarction
C. Caseous necrosis in TB
D. Fat necrosis in pancreas
Page 3 of 87
, CORRECT ANSWER: A. Brain infarction and bacterial abscesses
Rationale: High lipid content and enzymatic digestion lead to complete tissue
liquefaction.
Question 14: In systemic lupus erythematosus, the characteristic autoantibody is
directed against?
A. Nuclear antigens (ANA)
B. Acetylcholine receptor
C. TSH receptor
D. Intrinsic factor
CORRECT ANSWER: A. Nuclear antigens (ANA)
Rationale: ANA is the screening test, with anti-dsDNA and anti-Smith being more
specific.
Question 15: The primary pathologic process in emphysema is?
A. Destruction of alveolar walls by protease-antiprotease imbalance
B. Fibrosis of alveolar walls
C. Hyperplasia of type II pneumocytes
D. Mucous gland hyperplasia
CORRECT ANSWER: A. Destruction of alveolar walls by protease-antiprotease
imbalance
Rationale: Alpha-1 antitrypsin deficiency or smoking leads to unchecked elastase
activity.
Question 16: A patient with diabetic ketoacidosis develops Kussmaul respirations due
to?
A. Compensatory respiratory alkalosis for metabolic acidosis
B. Hypoxemia
C. Central nervous system depression
D. Pulmonary edema
CORRECT ANSWER: A. Compensatory respiratory alkalosis for metabolic
acidosis
Rationale: Deep, rapid breathing eliminates CO2 to counteract anion gap acidosis.
Question 17: The most common mechanism of oncogene activation is?
A. Point mutation, amplification, or translocation
B. Deletion
C. Promoter methylation
D. Histone deacetylation
CORRECT ANSWER: A. Point mutation, amplification, or translocation
Rationale: These genetic alterations lead to constitutive activation of growth
signaling pathways.
Page 4 of 87
