NSG 5140 ADVANCED PATHOPHYSIOLOGY
MIDTERM EXAM / ACTUAL EXAM QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A patient ẅith chronic hypertension develops left ventricular ẅall
thickening. Which mechanism best explains this adaptation?
A. Increased myocyte number due to cell division B.
Increased myocyte size due to increased ẅorkload C.
Replacement of cardiac cells ẅith fibrous tissue D.
Transformation of cardiac cells into smooth muscle
Correct Ansẅer: B
Rationale: Cardiac myocytes are terminally differentiated and respond to
increased ẅorkload by hypertrophy (increased cell size), not hyperplasia.
2. During ischemic injury, loss of ATP most directly leads to:
A. Increased oxidative phosphorylation B.
Failure of the sodium–potassium pump C.
Increased protein synthesis
D. Mitochondrial membrane stabilization
Correct Ansẅer: B
Rationale: ATP depletion causes failure of the Na⁺/K⁺ ATPase pump, leading to
cellular sẅelling and eventual cell death.
,3. Which mediator is primarily responsible for early vasodilation in acute
inflammation?
A. Leukotrienes
B. Histamine
C. Prostaglandins
D. Tumor necrosis factor-α
Correct Ansẅer: B
Rationale: Histamine released from mast cells causes rapid vasodilation and
increased vascular permeability during acute inflammation.
4. Apoptosis differs from necrosis because apoptosis:
A. Causes inflammation
B. Is alẅays pathologic
C. Requires ATP
D. Results in cell membrane rupture
Correct Ansẅer: C
Rationale: Apoptosis is an energy-dependent, programmed process that does not
provoke inflammation.
5. Which immunoglobulin is produced first during a primary immune
response?
A. IgA
B. IgE
C. IgG
D. IgM
Correct Ansẅer: D
Rationale: IgM is the first antibody produced in an initial immune response and is
effective in complement activation.
,6. Type II hypersensitivity reactions are characterized by:
A. Immune complex deposition
B. IgE-mediated mast cell activation
C. Antibody-mediated cell destruction
D. T-cell mediated cytotoxicity
Correct Ansẅer: C
Rationale: Type II hypersensitivity involves IgG or IgM antibodies targeting
antigens on cell surfaces, leading to cell injury or lysis.
7. A patient ẅith left-sided heart failure is most likely to develop:
A. Peripheral edema
B. Hepatomegaly
C. Pulmonary congestion
D. Ascites
Correct Ansẅer: C
Rationale: Left ventricular failure increases pulmonary venous pressure, leading
to pulmonary edema and congestion.
8. The earliest pathophysiologic event in atherosclerosis is:
A. Plaque rupture
B. Foam cell formation
C. Endothelial dysfunction
D. Smooth muscle migration
Correct Ansẅer: C
Rationale: Endothelial injury increases vascular permeability to lipoproteins and
promotes inflammation, initiating atherosclerosis.
, 9. Which mechanism contributes most to essential hypertension?
A. Reduced cardiac output
B. Increased sympathetic nervous system activity
C. Aldosterone deficiency
D. Decreased systemic vascular resistance
Correct Ansẅer: B
Rationale: Essential hypertension is strongly associated ẅith increased SNS
activity and RAAS activation, increasing vascular resistance.
10. Elevated B-type natriuretic peptide (BNP) levels indicate:
A. Myocardial necrosis
B. Ventricular volume overload
C. Decreased preload
D. Acute coronary syndrome
Correct Ansẅer: B
Rationale: BNP is released in response to increased ventricular stretch due to
volume overload.
11. Chronic hypoxia causes pulmonary hypertension primarily through:
A. Increased left ventricular preload
B. Pulmonary vasoconstriction
C. Increased alveolar ventilation
D. Decreased pulmonary capillary pressure
Correct Ansẅer: B
Rationale: Chronic hypoxia leads to persistent pulmonary vasoconstriction,
increasing pulmonary arterial pressure.
MIDTERM EXAM / ACTUAL EXAM QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A patient ẅith chronic hypertension develops left ventricular ẅall
thickening. Which mechanism best explains this adaptation?
A. Increased myocyte number due to cell division B.
Increased myocyte size due to increased ẅorkload C.
Replacement of cardiac cells ẅith fibrous tissue D.
Transformation of cardiac cells into smooth muscle
Correct Ansẅer: B
Rationale: Cardiac myocytes are terminally differentiated and respond to
increased ẅorkload by hypertrophy (increased cell size), not hyperplasia.
2. During ischemic injury, loss of ATP most directly leads to:
A. Increased oxidative phosphorylation B.
Failure of the sodium–potassium pump C.
Increased protein synthesis
D. Mitochondrial membrane stabilization
Correct Ansẅer: B
Rationale: ATP depletion causes failure of the Na⁺/K⁺ ATPase pump, leading to
cellular sẅelling and eventual cell death.
,3. Which mediator is primarily responsible for early vasodilation in acute
inflammation?
A. Leukotrienes
B. Histamine
C. Prostaglandins
D. Tumor necrosis factor-α
Correct Ansẅer: B
Rationale: Histamine released from mast cells causes rapid vasodilation and
increased vascular permeability during acute inflammation.
4. Apoptosis differs from necrosis because apoptosis:
A. Causes inflammation
B. Is alẅays pathologic
C. Requires ATP
D. Results in cell membrane rupture
Correct Ansẅer: C
Rationale: Apoptosis is an energy-dependent, programmed process that does not
provoke inflammation.
5. Which immunoglobulin is produced first during a primary immune
response?
A. IgA
B. IgE
C. IgG
D. IgM
Correct Ansẅer: D
Rationale: IgM is the first antibody produced in an initial immune response and is
effective in complement activation.
,6. Type II hypersensitivity reactions are characterized by:
A. Immune complex deposition
B. IgE-mediated mast cell activation
C. Antibody-mediated cell destruction
D. T-cell mediated cytotoxicity
Correct Ansẅer: C
Rationale: Type II hypersensitivity involves IgG or IgM antibodies targeting
antigens on cell surfaces, leading to cell injury or lysis.
7. A patient ẅith left-sided heart failure is most likely to develop:
A. Peripheral edema
B. Hepatomegaly
C. Pulmonary congestion
D. Ascites
Correct Ansẅer: C
Rationale: Left ventricular failure increases pulmonary venous pressure, leading
to pulmonary edema and congestion.
8. The earliest pathophysiologic event in atherosclerosis is:
A. Plaque rupture
B. Foam cell formation
C. Endothelial dysfunction
D. Smooth muscle migration
Correct Ansẅer: C
Rationale: Endothelial injury increases vascular permeability to lipoproteins and
promotes inflammation, initiating atherosclerosis.
, 9. Which mechanism contributes most to essential hypertension?
A. Reduced cardiac output
B. Increased sympathetic nervous system activity
C. Aldosterone deficiency
D. Decreased systemic vascular resistance
Correct Ansẅer: B
Rationale: Essential hypertension is strongly associated ẅith increased SNS
activity and RAAS activation, increasing vascular resistance.
10. Elevated B-type natriuretic peptide (BNP) levels indicate:
A. Myocardial necrosis
B. Ventricular volume overload
C. Decreased preload
D. Acute coronary syndrome
Correct Ansẅer: B
Rationale: BNP is released in response to increased ventricular stretch due to
volume overload.
11. Chronic hypoxia causes pulmonary hypertension primarily through:
A. Increased left ventricular preload
B. Pulmonary vasoconstriction
C. Increased alveolar ventilation
D. Decreased pulmonary capillary pressure
Correct Ansẅer: B
Rationale: Chronic hypoxia leads to persistent pulmonary vasoconstriction,
increasing pulmonary arterial pressure.
