NR.120.504
Pathophysiology I
Midterm Exam Review
(Questions & Solutions)
2025
1
,1. A patient with acute pancreatitis develops hypocalcemia. Which
mechanism best explains this finding?
A. Renal calcium wasting due to diuretics
B. Precipitation of calcium as calcium–fatty acid soaps
C. Hypoalbuminemia from systemic inflammation
D. Parathyroid hormone suppression by pain medications
ANS: B
Rationale: Fat necrosis releases free fatty acids that chelate calcium,
forming insoluble soaps and reducing serum calcium.
2. In septic shock, which hemodynamic pattern is characteristic during
the hyperdynamic phase?
A. Low cardiac output and increased systemic vascular resistance (SVR)
B. High cardiac output and decreased SVR
C. High pulmonary capillary wedge pressure and low cardiac output
D. Low mixed venous O₂ saturation and increased SVR
ANS: B
Rationale: Early septic shock features vasodilation (↓SVR) with
compensatory tachycardia, raising cardiac output.
3. A tumor suppressor gene mutation removes an intrinsic block to the
cell cycle. Which phase checkpoint is most directly affected?
A. G₁/S transition
B. G₂/M transition
C. Metaphase/anaphase transition
D. Cytokinesis completion
ANS: A
Rationale: Loss of p53 or Rb function abrogates the G₁/S checkpoint,
permitting DNA‐damaged cells to replicate.
2
, 4. A dehydrated patient has BUN:Cr ratio of 28:1 and fractional excretion
of sodium (FeNa) of 0.5%. What type of acute kidney injury is this?
A. Intrinsic renal failure
B. Pre‐renal azotemia
C. Post‐renal obstruction
D. Acute interstitial nephritis
ANS: B
Rationale: Elevated BUN:Cr (>20:1) and low FeNa (<1%) indicate
reduced renal perfusion without tubular damage.
5. A chronic smoker develops squamous metaplasia in his bronchial
epithelium. Which process underlies this adaptation?
A. Genetic mutation in cilia‐forming genes
B. Stem cell reprogramming to a more protective phenotype
C. Accumulation of lipid‐laden macrophages
D. Unregulated proliferation of mucous‐secreting cells
ANS: B
Rationale: Chronic irritation induces basal stem cells to differentiate
into stratified squamous cells better suited to withstanding toxins.
6. In diabetic ketoacidosis, which acid–base disturbance predominates?
A. Metabolic alkalosis with respiratory compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Combined metabolic alkalosis and respiratory acidosis
ANS: B
Rationale: Ketoacid accumulation lowers pH; hyperventilation
(Kussmaul breathing) compensates by reducing CO₂.
7. A burn patient with 40% total body surface area burned shows third‐
spacing. Which fluid shift describes this?
A. From interstitial to vascular compartment
3
Pathophysiology I
Midterm Exam Review
(Questions & Solutions)
2025
1
,1. A patient with acute pancreatitis develops hypocalcemia. Which
mechanism best explains this finding?
A. Renal calcium wasting due to diuretics
B. Precipitation of calcium as calcium–fatty acid soaps
C. Hypoalbuminemia from systemic inflammation
D. Parathyroid hormone suppression by pain medications
ANS: B
Rationale: Fat necrosis releases free fatty acids that chelate calcium,
forming insoluble soaps and reducing serum calcium.
2. In septic shock, which hemodynamic pattern is characteristic during
the hyperdynamic phase?
A. Low cardiac output and increased systemic vascular resistance (SVR)
B. High cardiac output and decreased SVR
C. High pulmonary capillary wedge pressure and low cardiac output
D. Low mixed venous O₂ saturation and increased SVR
ANS: B
Rationale: Early septic shock features vasodilation (↓SVR) with
compensatory tachycardia, raising cardiac output.
3. A tumor suppressor gene mutation removes an intrinsic block to the
cell cycle. Which phase checkpoint is most directly affected?
A. G₁/S transition
B. G₂/M transition
C. Metaphase/anaphase transition
D. Cytokinesis completion
ANS: A
Rationale: Loss of p53 or Rb function abrogates the G₁/S checkpoint,
permitting DNA‐damaged cells to replicate.
2
, 4. A dehydrated patient has BUN:Cr ratio of 28:1 and fractional excretion
of sodium (FeNa) of 0.5%. What type of acute kidney injury is this?
A. Intrinsic renal failure
B. Pre‐renal azotemia
C. Post‐renal obstruction
D. Acute interstitial nephritis
ANS: B
Rationale: Elevated BUN:Cr (>20:1) and low FeNa (<1%) indicate
reduced renal perfusion without tubular damage.
5. A chronic smoker develops squamous metaplasia in his bronchial
epithelium. Which process underlies this adaptation?
A. Genetic mutation in cilia‐forming genes
B. Stem cell reprogramming to a more protective phenotype
C. Accumulation of lipid‐laden macrophages
D. Unregulated proliferation of mucous‐secreting cells
ANS: B
Rationale: Chronic irritation induces basal stem cells to differentiate
into stratified squamous cells better suited to withstanding toxins.
6. In diabetic ketoacidosis, which acid–base disturbance predominates?
A. Metabolic alkalosis with respiratory compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Combined metabolic alkalosis and respiratory acidosis
ANS: B
Rationale: Ketoacid accumulation lowers pH; hyperventilation
(Kussmaul breathing) compensates by reducing CO₂.
7. A burn patient with 40% total body surface area burned shows third‐
spacing. Which fluid shift describes this?
A. From interstitial to vascular compartment
3
