ADVANCED PATHOPHYSIOLOGY MIDTERM
EXAM | ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
1
A 62-year-old man with long-standing hypertension develops concentric left
ventricular hypertrophy. Which cellular process primarily explains the increased
myocardial wall thickness?
A. Hyperplasia
B. Dysplasia
C. Hypertrophy
D. Metaplasia
Answer: C. Hypertrophy.
Rationale: Hypertrophy is an increase in cell size (and functional components) in
response to increased workload. In cardiac muscle (which is terminally
differentiated), cells enlarge rather than proliferate, producing thicker ventricular
walls. Hyperplasia (A) involves increased cell number and typically occurs where
cells can divide; dysplasia and metaplasia are abnormal changes in cell
organization or type, respectively.
2
Which of the following best describes the primary mechanism of tissue injury
caused by ischemia-reperfusion?
A. Excessive ATP production
B. Reactive oxygen species (ROS) generation and calcium overload
C. Inhibition of caspases leading to necrosis
D. Increased DNA methylation
Answer: B. Reactive oxygen species (ROS) generation and calcium overload.
,Rationale: Reperfusion after ischemia leads to sudden oxygen reintroduction,
generating ROS that damage membranes, proteins, and DNA; coupled with
calcium influx causing mitochondrial dysfunction and activation of destructive
enzymes. ATP production is actually impaired (not excessive). Caspase inhibition
(C) is not the main reperfusion mechanism; DNA methylation (D) is unrelated
acutely.
3
A patient with severe sepsis becomes hypotensive and acidotic. Which type of
shock is most consistent with vasodilation from systemic inflammatory mediators
and high cardiac output with low systemic vascular resistance?
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock (septic)
Answer: D. Distributive shock (septic).
Rationale: Distributive shock, especially septic shock, features systemic
vasodilation mediated by cytokines and nitric oxide, leading to low SVR; early
phases can have high or normal cardiac output. Hypovolemic shows low preload
and low CO; cardiogenic has low CO and high SVR; obstructive is from
mechanical impediment.
4
Which cytokine is most responsible for fever production during acute
inflammation by acting on the hypothalamic thermoregulatory center?
A. Interleukin-10 (IL-10)
B. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α)
C. Transforming growth factor-beta (TGF-β)
D. Interferon-gamma (IFN-γ)
,Answer: B. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α).
Rationale: IL-1 and TNF-α are pyrogenic cytokines that induce prostaglandin E2
production in the hypothalamus, raising the temperature set point. IL-10 and TGF-
β are anti-inflammatory; IFN-γ activates macrophages but is not the primary
endogenous pyrogen.
5
A 30-year-old woman presents with hyperthyroidism due to Graves disease. Which
immunologic mechanism is responsible for the pathogenesis?
A. Immune complex deposition in the thyroid
B. Cytotoxic T-cell mediated destruction of thyroid follicles
C. Autoantibody stimulation of the TSH receptor
D. Failure of neutrophil chemotaxis
Answer: C. Autoantibody stimulation of the TSH receptor.
Rationale: Graves disease is caused by thyroid-stimulating immunoglobulins
(TSI) that bind and activate the TSH receptor, causing excess thyroid hormone
production. Immune complexes (A) typify Type III hypersensitivity; cytotoxic T-
cell destruction (B) is seen in some autoimmune thyroiditis; neutrophil chemotaxis
(D) is unrelated.
6
Which of the following genetic mutation types is most likely to result in a
frameshift and severely altered protein product?
A. Single base substitution that changes one amino acid (missense)
B. Silent mutation in the third base of a codon
C. Insertion of two nucleotides into the coding sequence
D. In-frame deletion of three nucleotides
Answer: C. Insertion of two nucleotides into the coding sequence.
Rationale: Insertion of a non-multiple-of-three changes the reading frame
(frameshift), altering downstream amino acids and likely causing premature stop
codons. Missense changes one amino acid; silent has no amino acid change; in-
, frame deletion of three nucleotides removes one amino acid but preserves the
frame.
7
Which ion abnormality most directly predisposes to cardiac arrhythmias in acute
kidney injury due to decreased renal excretion?
A. Hypocalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
Answer: B. Hyperkalemia.
Rationale: The kidneys excrete potassium; AKI reduces this, causing
hyperkalemia which alters cardiac myocyte resting membrane potential, leading to
peaked T waves, widened QRS, and life-threatening arrhythmias. Hypokalemia
also causes arrhythmias but is not characteristic of decreased renal excretion.
Sodium changes less directly provoke arrhythmia.
8
A 45-year-old smoker develops squamous metaplasia of bronchial epithelium.
What is the most accurate description of metaplasia in this setting?
A. Reversible change from one differentiated cell type to another due to chronic
stress
B. Permanent malignant transformation of cells
C. Uncontrolled proliferation of dysplastic cells
D. Accumulation of lipids within epithelial cells
Answer: A. Reversible change from one differentiated cell type to another due
to chronic stress.
Rationale: Metaplasia is an adaptive, reversible replacement of one mature cell
type by another better suited to the stress — e.g., ciliated columnar to squamous in
smokers. It is not itself malignant but can predispose to dysplasia and cancer if
stimulus persists. B and C describe neoplasia/dysplasia; D is steatosis.
EXAM | ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
1
A 62-year-old man with long-standing hypertension develops concentric left
ventricular hypertrophy. Which cellular process primarily explains the increased
myocardial wall thickness?
A. Hyperplasia
B. Dysplasia
C. Hypertrophy
D. Metaplasia
Answer: C. Hypertrophy.
Rationale: Hypertrophy is an increase in cell size (and functional components) in
response to increased workload. In cardiac muscle (which is terminally
differentiated), cells enlarge rather than proliferate, producing thicker ventricular
walls. Hyperplasia (A) involves increased cell number and typically occurs where
cells can divide; dysplasia and metaplasia are abnormal changes in cell
organization or type, respectively.
2
Which of the following best describes the primary mechanism of tissue injury
caused by ischemia-reperfusion?
A. Excessive ATP production
B. Reactive oxygen species (ROS) generation and calcium overload
C. Inhibition of caspases leading to necrosis
D. Increased DNA methylation
Answer: B. Reactive oxygen species (ROS) generation and calcium overload.
,Rationale: Reperfusion after ischemia leads to sudden oxygen reintroduction,
generating ROS that damage membranes, proteins, and DNA; coupled with
calcium influx causing mitochondrial dysfunction and activation of destructive
enzymes. ATP production is actually impaired (not excessive). Caspase inhibition
(C) is not the main reperfusion mechanism; DNA methylation (D) is unrelated
acutely.
3
A patient with severe sepsis becomes hypotensive and acidotic. Which type of
shock is most consistent with vasodilation from systemic inflammatory mediators
and high cardiac output with low systemic vascular resistance?
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributive shock (septic)
Answer: D. Distributive shock (septic).
Rationale: Distributive shock, especially septic shock, features systemic
vasodilation mediated by cytokines and nitric oxide, leading to low SVR; early
phases can have high or normal cardiac output. Hypovolemic shows low preload
and low CO; cardiogenic has low CO and high SVR; obstructive is from
mechanical impediment.
4
Which cytokine is most responsible for fever production during acute
inflammation by acting on the hypothalamic thermoregulatory center?
A. Interleukin-10 (IL-10)
B. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α)
C. Transforming growth factor-beta (TGF-β)
D. Interferon-gamma (IFN-γ)
,Answer: B. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α).
Rationale: IL-1 and TNF-α are pyrogenic cytokines that induce prostaglandin E2
production in the hypothalamus, raising the temperature set point. IL-10 and TGF-
β are anti-inflammatory; IFN-γ activates macrophages but is not the primary
endogenous pyrogen.
5
A 30-year-old woman presents with hyperthyroidism due to Graves disease. Which
immunologic mechanism is responsible for the pathogenesis?
A. Immune complex deposition in the thyroid
B. Cytotoxic T-cell mediated destruction of thyroid follicles
C. Autoantibody stimulation of the TSH receptor
D. Failure of neutrophil chemotaxis
Answer: C. Autoantibody stimulation of the TSH receptor.
Rationale: Graves disease is caused by thyroid-stimulating immunoglobulins
(TSI) that bind and activate the TSH receptor, causing excess thyroid hormone
production. Immune complexes (A) typify Type III hypersensitivity; cytotoxic T-
cell destruction (B) is seen in some autoimmune thyroiditis; neutrophil chemotaxis
(D) is unrelated.
6
Which of the following genetic mutation types is most likely to result in a
frameshift and severely altered protein product?
A. Single base substitution that changes one amino acid (missense)
B. Silent mutation in the third base of a codon
C. Insertion of two nucleotides into the coding sequence
D. In-frame deletion of three nucleotides
Answer: C. Insertion of two nucleotides into the coding sequence.
Rationale: Insertion of a non-multiple-of-three changes the reading frame
(frameshift), altering downstream amino acids and likely causing premature stop
codons. Missense changes one amino acid; silent has no amino acid change; in-
, frame deletion of three nucleotides removes one amino acid but preserves the
frame.
7
Which ion abnormality most directly predisposes to cardiac arrhythmias in acute
kidney injury due to decreased renal excretion?
A. Hypocalcemia
B. Hyperkalemia
C. Hypokalemia
D. Hypernatremia
Answer: B. Hyperkalemia.
Rationale: The kidneys excrete potassium; AKI reduces this, causing
hyperkalemia which alters cardiac myocyte resting membrane potential, leading to
peaked T waves, widened QRS, and life-threatening arrhythmias. Hypokalemia
also causes arrhythmias but is not characteristic of decreased renal excretion.
Sodium changes less directly provoke arrhythmia.
8
A 45-year-old smoker develops squamous metaplasia of bronchial epithelium.
What is the most accurate description of metaplasia in this setting?
A. Reversible change from one differentiated cell type to another due to chronic
stress
B. Permanent malignant transformation of cells
C. Uncontrolled proliferation of dysplastic cells
D. Accumulation of lipids within epithelial cells
Answer: A. Reversible change from one differentiated cell type to another due
to chronic stress.
Rationale: Metaplasia is an adaptive, reversible replacement of one mature cell
type by another better suited to the stress — e.g., ciliated columnar to squamous in
smokers. It is not itself malignant but can predispose to dysplasia and cancer if
stimulus persists. B and C describe neoplasia/dysplasia; D is steatosis.
