Wilkes University NSG 530 Advanced Pathophysiology Exam 4 (pdf) |
2026/2027 | Patho Q&A | Pathophysiology
1. A patient with chronic gastroesophageal reflux disease (GERD) undergoes
an upper endoscopy. The biopsy report indicates that the squamous
epithelium of the lower esophagus has been replaced by columnar
epithelium. This change is best described as:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Anaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another, often in response to chronic irritation. In Barrett's
esophagus (due to chronic GERD), the normal squamous epithelium is
replaced by columnar epithelium as an adaptive response. This metaplastic
change is a risk factor for esophageal adenocarcinoma. Dysplasia is
disordered cellular growth that is a precursor to cancer, hyperplasia is an
increase in cell number, and anaplasia is undifferentiated growth
characteristic of malignancy.
2. A patient presents with severe epigastric pain radiating to the back,
nausea, and vomiting. Serum amylase and lipase are markedly elevated.
Which diagnosis is most likely?
A) Acute cholecystitis
B) Acute pancreatitis
C) Peptic ulcer disease
D) Gastroesophageal reflux disease
Correct Answer: Acute pancreatitis
,Rationale: Acute pancreatitis is characterized by severe epigastric pain that
radiates to the back, along with nausea and vomiting. Elevations in serum
amylase and lipase (greater than three times the upper limit of normal) are
diagnostic. Alcohol abuse and gallstones are the most common risk factors.
The pain is often described as boring or penetrating and is worsened by
eating.
3. A patient with acute pancreatitis is placed on NPO (nothing by mouth)
status. The primary rationale for this intervention is to:
A) Prevent aspiration
B) Reduce pancreatic stimulation and secretion
C) Decrease gastric acid production
D) Promote bowel rest
Correct Answer: Reduce pancreatic stimulation and secretion
Rationale: NPO status reduces pancreatic stimulation and secretion, allowing
the pancreas to rest and heal. Oral intake stimulates pancreatic enzyme
release, which can worsen inflammation. Nutritional support is initiated after
the acute phase.
4. Which of the following is a complication of chronic pancreatitis?
A) Diabetes mellitus
B) Pancreatic insufficiency
C) Malabsorption
D) All of the above
Correct Answer: All of the above
,Rationale: Chronic pancreatitis can lead to diabetes mellitus (due to
destruction of islet cells), pancreatic insufficiency (decreased enzyme
production), and malabsorption (resulting from enzyme deficiency). These
complications require ongoing management and monitoring.
5. A patient with cirrhosis develops confusion, lethargy, and a flapping
tremor (asterixis). Which condition is most likely?
A) Portal hypertension
B) Hepatic encephalopathy
C) Ascites
D) Esophageal varices
Correct Answer: Hepatic encephalopathy
Rationale: Hepatic encephalopathy is characterized by confusion, altered
mental status, and asterixis (flapping tremor) due to the accumulation of
ammonia and other toxins in the brain from impaired liver function. The liver
normally converts ammonia to urea, but in cirrhosis this function is
compromised.
6. Which medication is used to reduce ammonia levels in hepatic
encephalopathy?
A) Furosemide
B) Lactulose
C) Omeprazole
D) Metronidazole
Correct Answer: Lactulose
, Rationale: Lactulose is a non-absorbable disaccharide used to treat hepatic
encephalopathy. It acidifies the colon, trapping ammonia and promoting its
excretion in the stool, thereby reducing serum ammonia levels and
improving neurological symptoms.
7. A patient with portal hypertension is at risk for which complication?
A) Esophageal varices
B) Splenomegaly
C) Ascites
D) All of the above
Correct Answer: All of the above
Rationale: Portal hypertension causes increased pressure in the portal
venous system, leading to esophageal varices (dilated veins in the
esophagus at risk of rupture), splenomegaly (enlarged spleen), and ascites
(accumulation of fluid in the peritoneal cavity). These are major
complications of cirrhosis.
8. A patient with cirrhosis develops ascites. Which pathophysiologic
mechanism contributes to this condition?
A) Increased portal pressure and decreased albumin production
B) Increased albumin production
C) Decreased portal pressure
D) Increased urine output
Correct Answer: Increased portal pressure and decreased albumin production
2026/2027 | Patho Q&A | Pathophysiology
1. A patient with chronic gastroesophageal reflux disease (GERD) undergoes
an upper endoscopy. The biopsy report indicates that the squamous
epithelium of the lower esophagus has been replaced by columnar
epithelium. This change is best described as:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Anaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another, often in response to chronic irritation. In Barrett's
esophagus (due to chronic GERD), the normal squamous epithelium is
replaced by columnar epithelium as an adaptive response. This metaplastic
change is a risk factor for esophageal adenocarcinoma. Dysplasia is
disordered cellular growth that is a precursor to cancer, hyperplasia is an
increase in cell number, and anaplasia is undifferentiated growth
characteristic of malignancy.
2. A patient presents with severe epigastric pain radiating to the back,
nausea, and vomiting. Serum amylase and lipase are markedly elevated.
Which diagnosis is most likely?
A) Acute cholecystitis
B) Acute pancreatitis
C) Peptic ulcer disease
D) Gastroesophageal reflux disease
Correct Answer: Acute pancreatitis
,Rationale: Acute pancreatitis is characterized by severe epigastric pain that
radiates to the back, along with nausea and vomiting. Elevations in serum
amylase and lipase (greater than three times the upper limit of normal) are
diagnostic. Alcohol abuse and gallstones are the most common risk factors.
The pain is often described as boring or penetrating and is worsened by
eating.
3. A patient with acute pancreatitis is placed on NPO (nothing by mouth)
status. The primary rationale for this intervention is to:
A) Prevent aspiration
B) Reduce pancreatic stimulation and secretion
C) Decrease gastric acid production
D) Promote bowel rest
Correct Answer: Reduce pancreatic stimulation and secretion
Rationale: NPO status reduces pancreatic stimulation and secretion, allowing
the pancreas to rest and heal. Oral intake stimulates pancreatic enzyme
release, which can worsen inflammation. Nutritional support is initiated after
the acute phase.
4. Which of the following is a complication of chronic pancreatitis?
A) Diabetes mellitus
B) Pancreatic insufficiency
C) Malabsorption
D) All of the above
Correct Answer: All of the above
,Rationale: Chronic pancreatitis can lead to diabetes mellitus (due to
destruction of islet cells), pancreatic insufficiency (decreased enzyme
production), and malabsorption (resulting from enzyme deficiency). These
complications require ongoing management and monitoring.
5. A patient with cirrhosis develops confusion, lethargy, and a flapping
tremor (asterixis). Which condition is most likely?
A) Portal hypertension
B) Hepatic encephalopathy
C) Ascites
D) Esophageal varices
Correct Answer: Hepatic encephalopathy
Rationale: Hepatic encephalopathy is characterized by confusion, altered
mental status, and asterixis (flapping tremor) due to the accumulation of
ammonia and other toxins in the brain from impaired liver function. The liver
normally converts ammonia to urea, but in cirrhosis this function is
compromised.
6. Which medication is used to reduce ammonia levels in hepatic
encephalopathy?
A) Furosemide
B) Lactulose
C) Omeprazole
D) Metronidazole
Correct Answer: Lactulose
, Rationale: Lactulose is a non-absorbable disaccharide used to treat hepatic
encephalopathy. It acidifies the colon, trapping ammonia and promoting its
excretion in the stool, thereby reducing serum ammonia levels and
improving neurological symptoms.
7. A patient with portal hypertension is at risk for which complication?
A) Esophageal varices
B) Splenomegaly
C) Ascites
D) All of the above
Correct Answer: All of the above
Rationale: Portal hypertension causes increased pressure in the portal
venous system, leading to esophageal varices (dilated veins in the
esophagus at risk of rupture), splenomegaly (enlarged spleen), and ascites
(accumulation of fluid in the peritoneal cavity). These are major
complications of cirrhosis.
8. A patient with cirrhosis develops ascites. Which pathophysiologic
mechanism contributes to this condition?
A) Increased portal pressure and decreased albumin production
B) Increased albumin production
C) Decreased portal pressure
D) Increased urine output
Correct Answer: Increased portal pressure and decreased albumin production
