MSN NA – NSG 521 Advanced Pathophysiology
Complete Final Exam (Qns & Ans)
2025
1. Scenario: A 60-year-old patient with a history of diabetes
and hypertension presents with crushing chest pain and ST-
segment elevation on the EKG. Which cellular event is primarily
responsible for the irreversible myocardial injury in this scenario?
Options:
A) Calcium overload and free radical formation
B) Increased nitric oxide synthesis
C) Activation of ATP-sensitive potassium channels
D) Inhibition of inflammatory mediators
ANS: A) Calcium overload and free radical formation
Rationale: Prolonged ischemia causes intracellular calcium to
accumulate, which, together with the formation of reactive
©2025
,oxygen species, damages cellular membrane structures and
enzymes, leading to irreversible myocardial cell injury.
2. Scenario: A patient with chronic obstructive pulmonary
disease (COPD) presents with an acute exacerbation. Which
inflammatory mediator plays the most critical role in recruiting
neutrophils to the lungs during such an exacerbation?
Options:
A) Interleukin-8 (IL-8)
B) Interleukin-2 (IL-2)
C) Interleukin-10 (IL-10)
D) Interferon-gamma (IFN-γ)
ANS: A) Interleukin-8 (IL-8)
Rationale: IL-8 is a potent chemotactic factor that recruits
neutrophils to the site of inflammation, thereby playing a key role
in the pathophysiology of acute COPD exacerbations.
3. Scenario: A 55-year-old patient with liver cirrhosis develops
confusion and asterixis. Which pathophysiologic mechanism best
explains the neuropsychiatric manifestations observed in hepatic
encephalopathy?
Options:
A) Hyperammonemia-induced astrocyte swelling
B) Hypoglycemia-induced neuronal injury
©2025
, C) Direct neurotoxicity from bile acids
D) Excessive cytokine-mediated neurotransmitter inhibition
ANS: A) Hyperammonemia-induced astrocyte swelling
Rationale: In liver cirrhosis, the liver’s inability to detoxify
ammonia allows it to accumulate, leading to astrocyte swelling
(cerebral edema) and the neuropsychiatric manifestations seen in
hepatic encephalopathy.
4. Scenario: An alcoholic patient is admitted with severe
abdominal pain and is diagnosed with acute pancreatitis. What
pathophysiologic process primarily underlies pancreatic tissue
injury in acute pancreatitis?
Options:
A) Autodigestion by prematurely activated pancreatic enzymes
B) Direct toxin-mediated cellular apoptosis
C) Infection-induced necrosis
D) Autoimmune destruction of acinar cells
ANS: A) Autodigestion by prematurely activated pancreatic
enzymes
Rationale: In acute pancreatitis, premature activation of
pancreatic enzymes within the pancreas leads to autodigestion of
pancreatic tissue, triggering inflammation and necrosis.
©2025
, 5. Scenario: A 45-year-old woman experiences a thyroid storm
with marked tachycardia, hypertension, and high-output cardiac
failure. Which mechanism best explains the hemodynamic
instability observed in thyrotoxicosis?
Options:
A) Upregulation of beta-adrenergic receptors causing increased
cardiac contractility
B) Direct myocardial toxicity of thyroid hormones
C) Increased vagal tone reducing diastolic filling time
D) Inhibition of intracellular calcium uptake in cardiac
myocytes
ANS: A) Upregulation of beta-adrenergic receptors causing
increased cardiac contractility
Rationale: Thyroid hormones increase the expression and
sensitivity of beta-adrenergic receptors, leading to tachycardia,
increased contractility, and ultimately hemodynamic instability.
6. Scenario: A patient with sepsis develops multiple organ
dysfunction syndrome (MODS). Which pathophysiologic process
is most responsible for the widespread cellular damage in this
patient?
Options:
A) A cytokine storm with increased vascular permeability
B) Direct microbial invasion of organ tissues
©2025
Complete Final Exam (Qns & Ans)
2025
1. Scenario: A 60-year-old patient with a history of diabetes
and hypertension presents with crushing chest pain and ST-
segment elevation on the EKG. Which cellular event is primarily
responsible for the irreversible myocardial injury in this scenario?
Options:
A) Calcium overload and free radical formation
B) Increased nitric oxide synthesis
C) Activation of ATP-sensitive potassium channels
D) Inhibition of inflammatory mediators
ANS: A) Calcium overload and free radical formation
Rationale: Prolonged ischemia causes intracellular calcium to
accumulate, which, together with the formation of reactive
©2025
,oxygen species, damages cellular membrane structures and
enzymes, leading to irreversible myocardial cell injury.
2. Scenario: A patient with chronic obstructive pulmonary
disease (COPD) presents with an acute exacerbation. Which
inflammatory mediator plays the most critical role in recruiting
neutrophils to the lungs during such an exacerbation?
Options:
A) Interleukin-8 (IL-8)
B) Interleukin-2 (IL-2)
C) Interleukin-10 (IL-10)
D) Interferon-gamma (IFN-γ)
ANS: A) Interleukin-8 (IL-8)
Rationale: IL-8 is a potent chemotactic factor that recruits
neutrophils to the site of inflammation, thereby playing a key role
in the pathophysiology of acute COPD exacerbations.
3. Scenario: A 55-year-old patient with liver cirrhosis develops
confusion and asterixis. Which pathophysiologic mechanism best
explains the neuropsychiatric manifestations observed in hepatic
encephalopathy?
Options:
A) Hyperammonemia-induced astrocyte swelling
B) Hypoglycemia-induced neuronal injury
©2025
, C) Direct neurotoxicity from bile acids
D) Excessive cytokine-mediated neurotransmitter inhibition
ANS: A) Hyperammonemia-induced astrocyte swelling
Rationale: In liver cirrhosis, the liver’s inability to detoxify
ammonia allows it to accumulate, leading to astrocyte swelling
(cerebral edema) and the neuropsychiatric manifestations seen in
hepatic encephalopathy.
4. Scenario: An alcoholic patient is admitted with severe
abdominal pain and is diagnosed with acute pancreatitis. What
pathophysiologic process primarily underlies pancreatic tissue
injury in acute pancreatitis?
Options:
A) Autodigestion by prematurely activated pancreatic enzymes
B) Direct toxin-mediated cellular apoptosis
C) Infection-induced necrosis
D) Autoimmune destruction of acinar cells
ANS: A) Autodigestion by prematurely activated pancreatic
enzymes
Rationale: In acute pancreatitis, premature activation of
pancreatic enzymes within the pancreas leads to autodigestion of
pancreatic tissue, triggering inflammation and necrosis.
©2025
, 5. Scenario: A 45-year-old woman experiences a thyroid storm
with marked tachycardia, hypertension, and high-output cardiac
failure. Which mechanism best explains the hemodynamic
instability observed in thyrotoxicosis?
Options:
A) Upregulation of beta-adrenergic receptors causing increased
cardiac contractility
B) Direct myocardial toxicity of thyroid hormones
C) Increased vagal tone reducing diastolic filling time
D) Inhibition of intracellular calcium uptake in cardiac
myocytes
ANS: A) Upregulation of beta-adrenergic receptors causing
increased cardiac contractility
Rationale: Thyroid hormones increase the expression and
sensitivity of beta-adrenergic receptors, leading to tachycardia,
increased contractility, and ultimately hemodynamic instability.
6. Scenario: A patient with sepsis develops multiple organ
dysfunction syndrome (MODS). Which pathophysiologic process
is most responsible for the widespread cellular damage in this
patient?
Options:
A) A cytokine storm with increased vascular permeability
B) Direct microbial invasion of organ tissues
©2025
