NR 507
Advanced Pathophysiology
Complete Midterm Review
(Questions & Solutions)
2025
1
,1. A 58-year-old patient with long-standing hypertension and
hyperlipidemia develops acute chest pain radiating to the left arm.
Troponin I is elevated and ECG shows ST-segment elevations in leads V2–
V4. Which pathophysiologic mechanism most closely describes the
myocardial injury?
- A. Transmural necrosis from prolonged ischemia
- B. Subendocardial ischemia due to hypotension
- C. Apoptosis triggered by catecholamine surge
- D. Reperfusion injury mediated by free radicals
ANS: A
Rationale: Transmural infarction involves full-thickness myocardial
necrosis from sustained coronary occlusion. Subendocardial ischemia
affects only inner layers; apoptosis and reperfusion injury occur later or
after reperfusion.
2. A 45-year-old patient presents with fatigue, pruritus, and right upper
quadrant discomfort. Labs reveal elevated alkaline phosphatase,
antimitochondrial antibodies, and a cholestatic pattern. Which disorder is
most consistent?
- A. Primary biliary cholangitis
- B. Autoimmune hepatitis
- C. Primary sclerosing cholangitis
- D. Gilbert syndrome
ANS: A
Rationale: PBC features cholestatic enzymes, antimitochondrial
antibodies, and intrahepatic duct destruction. PSC has p-ANCA and
beading on cholangiography. AIH shows high transaminases; Gilbert is
benign hyperbilirubinemia.
3. A 32-year-old patient experiences episodes of palpitations with sudden
onset of heart rate around 180 bpm. Vagal maneuvers are ineffective.
2
,Which arrhythmia mechanism is most likely?
- A. Reentrant circuit in the atrioventricular node
- B. Enhanced automaticity of Purkinje fibers
- C. Triggered activity from afterdepolarizations
- D. Bundle branch block leading to arrhythmia
ANS: A
Rationale: Paroxysmal supraventricular tachycardia often arises from
AV nodal reentry, causing sudden, regular tachycardia at high rates.
4. A patient with acute pancreatitis has serum calcium of 6.5 mg/dL and
prolonged QT interval. Which mechanism contributes to hypocalcemia?
- A. Saponification of fat with calcium binding in necrotic areas
- B. Increased parathyroid hormone secretion
- C. Renal calcium wasting due to diuresis
- D. Increased calcitonin release from the thyroid
ANS: A
Rationale: Pancreatic lipases release free fatty acids that bind calcium
and form soaps, lowering serum calcium. PTH increases but cannot offset
rapid loss.
5. A 28-year-old female with type II diabetes on metformin presents with
confusion and deep, rapid breathing. ABG shows pH 7.11, PaCO₂ 22 mm
Hg, HCO₃⁻ 8 mEq/L. Which disturbance is present?
- A. Metabolic acidosis with respiratory compensation
- B. Respiratory alkalosis with renal compensation
- C. Mixed metabolic and respiratory acidosis
- D. Metabolic alkalosis with respiratory compensation
ANS: A
Rationale: Low pH and low bicarbonate confirm metabolic acidosis.
Reduced PaCO₂ reflects respiratory compensation via hyperventilation.
6. A 50-year-old man with septic shock develops petechiae, prolonged
3
, PT/aPTT, and elevated D-dimer. Which process explains these findings?
- A. Disseminated intravascular coagulation with consumption of
clotting factors
- B. Hemophilia A due to factor VIII deficiency
- C. Vitamin K deficiency from malabsorption
- D. Thrombotic thrombocytopenic purpura with ADAMTS13 inhibition
ANS: A
Rationale: DIC involves widespread microthrombosis consuming
platelets and coagulation factors, then bleeding with high fibrin
degradation products.
7. A patient with COPD chronically retains CO₂, with a PaCO₂ of 60 mm
Hg. Which compensatory change in HCO₃⁻ is expected?
- A. Increased renal reabsorption of HCO₃⁻ after several days
- B. Immediate decrease in HCO₃⁻ within minutes
- C. No change regardless of PaCO₂
- D. Metabolic acidosis with decreased HCO₃⁻
ANS: A
Rationale: In chronic respiratory acidosis, kidneys compensate over
days by reabsorbing bicarbonate to maintain near-normal pH.
8. A 35-year-old patient develops hyperosmolar hyperglycemic state
(HHS). Which feature distinguishes HHS from diabetic ketoacidosis
(DKA)?
- A. Marked hyperglycemia with minimal ketone production
- B. Presence of metabolic acidosis
- C. Elevated anion gap
- D. Profound ketosis with ketonuria
ANS: A
Rationale: HHS features severe hyperglycemia and hyperosmolarity
without significant ketosis or acidosis; DKA has high ketones and anion
gap acidosis.
4
Advanced Pathophysiology
Complete Midterm Review
(Questions & Solutions)
2025
1
,1. A 58-year-old patient with long-standing hypertension and
hyperlipidemia develops acute chest pain radiating to the left arm.
Troponin I is elevated and ECG shows ST-segment elevations in leads V2–
V4. Which pathophysiologic mechanism most closely describes the
myocardial injury?
- A. Transmural necrosis from prolonged ischemia
- B. Subendocardial ischemia due to hypotension
- C. Apoptosis triggered by catecholamine surge
- D. Reperfusion injury mediated by free radicals
ANS: A
Rationale: Transmural infarction involves full-thickness myocardial
necrosis from sustained coronary occlusion. Subendocardial ischemia
affects only inner layers; apoptosis and reperfusion injury occur later or
after reperfusion.
2. A 45-year-old patient presents with fatigue, pruritus, and right upper
quadrant discomfort. Labs reveal elevated alkaline phosphatase,
antimitochondrial antibodies, and a cholestatic pattern. Which disorder is
most consistent?
- A. Primary biliary cholangitis
- B. Autoimmune hepatitis
- C. Primary sclerosing cholangitis
- D. Gilbert syndrome
ANS: A
Rationale: PBC features cholestatic enzymes, antimitochondrial
antibodies, and intrahepatic duct destruction. PSC has p-ANCA and
beading on cholangiography. AIH shows high transaminases; Gilbert is
benign hyperbilirubinemia.
3. A 32-year-old patient experiences episodes of palpitations with sudden
onset of heart rate around 180 bpm. Vagal maneuvers are ineffective.
2
,Which arrhythmia mechanism is most likely?
- A. Reentrant circuit in the atrioventricular node
- B. Enhanced automaticity of Purkinje fibers
- C. Triggered activity from afterdepolarizations
- D. Bundle branch block leading to arrhythmia
ANS: A
Rationale: Paroxysmal supraventricular tachycardia often arises from
AV nodal reentry, causing sudden, regular tachycardia at high rates.
4. A patient with acute pancreatitis has serum calcium of 6.5 mg/dL and
prolonged QT interval. Which mechanism contributes to hypocalcemia?
- A. Saponification of fat with calcium binding in necrotic areas
- B. Increased parathyroid hormone secretion
- C. Renal calcium wasting due to diuresis
- D. Increased calcitonin release from the thyroid
ANS: A
Rationale: Pancreatic lipases release free fatty acids that bind calcium
and form soaps, lowering serum calcium. PTH increases but cannot offset
rapid loss.
5. A 28-year-old female with type II diabetes on metformin presents with
confusion and deep, rapid breathing. ABG shows pH 7.11, PaCO₂ 22 mm
Hg, HCO₃⁻ 8 mEq/L. Which disturbance is present?
- A. Metabolic acidosis with respiratory compensation
- B. Respiratory alkalosis with renal compensation
- C. Mixed metabolic and respiratory acidosis
- D. Metabolic alkalosis with respiratory compensation
ANS: A
Rationale: Low pH and low bicarbonate confirm metabolic acidosis.
Reduced PaCO₂ reflects respiratory compensation via hyperventilation.
6. A 50-year-old man with septic shock develops petechiae, prolonged
3
, PT/aPTT, and elevated D-dimer. Which process explains these findings?
- A. Disseminated intravascular coagulation with consumption of
clotting factors
- B. Hemophilia A due to factor VIII deficiency
- C. Vitamin K deficiency from malabsorption
- D. Thrombotic thrombocytopenic purpura with ADAMTS13 inhibition
ANS: A
Rationale: DIC involves widespread microthrombosis consuming
platelets and coagulation factors, then bleeding with high fibrin
degradation products.
7. A patient with COPD chronically retains CO₂, with a PaCO₂ of 60 mm
Hg. Which compensatory change in HCO₃⁻ is expected?
- A. Increased renal reabsorption of HCO₃⁻ after several days
- B. Immediate decrease in HCO₃⁻ within minutes
- C. No change regardless of PaCO₂
- D. Metabolic acidosis with decreased HCO₃⁻
ANS: A
Rationale: In chronic respiratory acidosis, kidneys compensate over
days by reabsorbing bicarbonate to maintain near-normal pH.
8. A 35-year-old patient develops hyperosmolar hyperglycemic state
(HHS). Which feature distinguishes HHS from diabetic ketoacidosis
(DKA)?
- A. Marked hyperglycemia with minimal ketone production
- B. Presence of metabolic acidosis
- C. Elevated anion gap
- D. Profound ketosis with ketonuria
ANS: A
Rationale: HHS features severe hyperglycemia and hyperosmolarity
without significant ketosis or acidosis; DKA has high ketones and anion
gap acidosis.
4
