Advanced Pathophysiology Exam 1 MASTERY GUIDE 2025: 220 Expert-Curated Q&A with Detailed Rationales, System-Based Disorders, and Clinical Case Applications (guaranteed pass)

A certain disease is currently found in 1 of every 10 people in the country and 1,000 people contract the disease yearly. The population of the country is 4,500,000. Which of the following statements is correct?

a. The prevalence of the disease is 10% and the incidence is .02%.

b. The prevalence of the disease is .02% and the incidence is 10%.

c. Neither is correct.

d. There is insufficient data

A

In relation to disease development, the term "etiology" refers to which of the following?

a.number of people with the disease

b. cause of the disease

c. definition of the disease

d. outcome of the disease

B

Which of the following is(are) true about "symptoms"?

a. objective and measurable

b. the same as "signs"

c. both of the above

d. neither of the above

D

In 1992, there were 980 deaths in a Midwestern city with a population of 1,000,000. At the beginning of that year, 900 cases of AIDS existed in this population. During the year, 250 new cases of AIDS were diagnosed, and 75 people died of the disease in 1992.

Using the data given above, what was the incidence rate (per 100,000 population) at the end of 1992 for AIDS?

a. 6

b. 25

c. 88

d. 116

B

What level of prevention is a blood pressure screening program for high school students who are pregnant?

a. primary

b. secondary

c. tertiary

B

Mr. Forbes complains of "indigestion" and becomes sweaty and pale. His wife takes him to the Emergency Department at Northwestern Memorial Hospital. A cardiac catheterization 2 days later shows partial blockage of his right coronary artery (RCA).

Blockage of the right coronary artery can lead to myocardial cell injury because it results in which of the following?

a. bilirubin accumulation in myocardial cells

b. alteration in the genetic material of myocardial cells

c. reduced energy production in myocardial cells

d. activation of the complement system

C

When myocardial cells are injured, the function of the Na-K membrane pump may be impaired. Which of the following may then result?

a.intracellular sodium will increase

b. extracellular potassium will decrease

c. cell volume will decrease

d. all of the above

A

Mr. Forbes is being prepared for open heart surgery when he suffers a myocardial infarction in which a large part of his left ventricle has suffered lethal cell injury.

Mr. Forbes' CPK-MB and LDH1, enzymes associated with myocardial cells, are significantly elevated. What is the best explanation for this?

a. It is a sign that necrotic myocardial cells have released their cytoplasmic contents into the blood.

b. It is a sign of reversible fatty accumulation in the myocardial cells

c. It is a sign that the myocardial cells are undergoing hypertrophy.

d. None of the above.

A

If a tissue specimen of myocardial cells were obtained for examination from Mr. Forbes, which of the following findings would indicate irreversible cell injury?

a. cellular swelling

b. decreased ATP production

c. decreased intracellular calcium

d. dissolution of nuclear material

D

The accumulation of lactic acid that occurs with impaired energy production results from which of the following?

a. increased intracellular glucose

b. increased anaerobic metabolism

c. decreased metabolic rate

d. increased oxidative phosphorylation

B

A mountain climber is stranded at 23,000 feet in the Swiss Alps and has lost all his equipment and supplies in an avalanche. Subsequently, he suffers cell injury due to impaired ATP production. The reason for the decrease in ATP is which of the following?

a. enzyme inhibition

b. uncoupling

c. hypoxia

d. none of the above

C

An elderly patient develops an obstruction in his left middle cerebral artery. The brain tissue supplied by this artery becomes hypoxic. The best explanation for this is which of the following?

a. the obstruction results in decreased blood flow

b. the obstruction results in decreased hemoglobin in the blood

c. while blood flow stays the same, the obstruction reduces oxygen content in the blood

d. none of the above explain the reason for the hypoxia

A

Increased mobilization and delivery of free fatty acids to liver cells can result in fat accumulation. Which of the following problems results in increased mobilization of free fatty acids?

a. anemia

b. hepatic toxins

c. starvation

d. hypoxia

C

Generalized hypoxia results in a switch to anaerobic metabolism in cells. Anaerobic metabolism results in which of the following?

a. decreased lactic acid inside cells

b. decreased arterial pH

c. more effective ATP production

d. increased pH inside cells

B

There is a disease of the spleen, which results in an excessive destruction of RBCs. This increase in RBC destruction can lead to which of the following?

a. hypoxia

b. hypobilirubinemia

c. an increase in platelets

d. all of the above

A

Your body has developed an increased demand for thyroid hormones. This will lead to ____________ of the thyroid gland.

a. atrophy

b. hypertrophy

c. dysplasia

d. metaplasia

B

You palpate a gangrenous leg and note the presence of crepitus. Crepitus is associated with which of the following?

a. wet gangrene

b. dry gangrene

c. gas gangrene

d. all of the above

C

Direct cell membrane destruction may result from which of the following?

a. complement activation

b. bacterial enzymes

c. free radicals

d. all of the above

D

Which of the following is true regarding apoptosis?

a. It occurrence may be physiological or pathological.

b. It does not stimulate the inflammatory process.

c. It results in phagocytosis of the apoptotic cell.

d. all of the above.

D

Insufficient blood flow to a part of the body is defined as:

a. hypoxia.

b. hypoxemia.

c. necrosis.

d. ischemia.

D

A cellular change, which is often precancerous, is called:

a. hyperplasia.

b. metaplasia.

c. dysplasia.

d. hypertrophy.

C

Which of the following changes is indicative of irreversible cell injury?

a. sodium influx into the cytoplasm

b. glycolysis (anaerobic metabolism)

c. detachment of ribosomes from rough endoplasmic reticulum

d. release of lysosomal enzymes

D

Which of the following best describes reperfusion injury?

a. The increased blood pressure in the area of reperfusion causes rupture of small arterioles and release of free radicals.

b. The return of blood flow to the area results in a burst of free radical production from neutrophils that accumulated in the area.

c. Reperfusion injury results from restoration of the function of the sodium-potassium pump.

d. Reperfusion of the area results in apoptosis of the previously ischemic cells.

B

Which of the following best describes free radicals?

a. stable molecules not normally found in the body, but introduced exogenously during ischemia

b. unstable molecules that are normal products of oxidative metabolism and are removed by endogenous antioxidants

c. stable molecules that have an affinity for iron in the cytoplasm of the cell

d. none of the above

B

The usual fate of apoptotic cells is which of the following?

a. metaplastic transformation

b. calcification

c. hypertrophy

d. phagocytosis

e. neoplastic transformation

D

Which of the following statements is true regarding the difference between cell necrosis and apoptosis?

a. Apoptosis is a more rapid process.

b. Apoptosis is usually initiated by ischemia-induced cell injury.

c. Apoptosis is genetically controlled.

d. Apoptosis characteristically involves rupture of the cell membrane.

C

You are a nurse practitioner working in an outpatient clinic. Your patient's echocardiogram shows moderate aortic stenosis (narrowing of the aortic valve). You know that the stenotic valve creates an increased resistance against which the left ventricle contracts. The cellular adaptation most likely to occur in the left ventricle is which of the following?

a. atrophy

b. hypertrophy

c. hyperplasia

d. metaplasia

B

Select the condition that is an example of physiologic hyperplasia.

a. breast enlargement during puberty

b. endometrial hyperplasia from excessive estrogen stimulation

c. prostatic hyperplasia occurring as men age

d. none of the above are physiologic

A

Your patient has a long history of mitral stenosis (narrowing of the mitral valve). As the years go by, the left atrium, which contracts against the increased resistance of the stenotic valve, begins to fail--and output from the left ventricle begins to decline. If the left ventricle were to undergo adaptation, what would it most likely be?

a. atrophy.

b. hypertrophy.

c. hyperplasia.

d. metaplasia.

A

Which of the following is not characteristic of cellular dysplasia?

a. variation in size and shape of cells

b. small, pale nuclei

c. disorderly arrangement of cells

d. preneoplastic change

B

If a normal individual began to take cortisol 100 mgs. every day as a medication, which of the following would result?

a. hypertrophy of the adrenal gland

b. hyperplasia of the adrenal gland

c. atrophy of the adrenal gland

d. hypertrophy and hyperplasia of the adrenal gland

C

If a normal individual began to take thyroid hormone 100 mcgs. every day as a medication, which of the following would result?

a. hypertrophy of the thyroid gland

b. hyperplasia of the thyroid gland

c. atrophy of the thyroid gland

d. hypertrophy and hyperplasia of the thyroid gland

B

Chronic alcoholism can result in the development of a fatty liver because it results in which of the following?

a. increased production of free fatty acids

b. increased conversion of free fatty acids to triglycerides

c. decreased oxidation of cholesterol, triglycerides, and phospholipids

d. decreased binding of cholesterol, triglycerides, and phospholipids to apoproteins

A

Which of the following is the primary difference between wet and dry gangrene?

a. Infection and inflammation are present in wet gangrene.

b. Wet gangrene results from arterial occlusion and dry gangrene from venous stasis.

c. Dry gangrene involves the presence of Clostridium perfringens.

d. Wet gangrene occurs only in internal organs.

E

Which of the following components is not involved in apoptosis?

a. Bcl-2

b. apaf-1

c. caspase 9

d. cytochrome c

e. HLA 2

E

Some cancer-causing viruses are able to protect the cells that they transform from undergoing apoptosis by interfering with the action of the apoptosis promoter called:

a. TNF-alpha.

b. Fas.

c. p53.

d. IL-2.

e. INF-beta.

C

Which of the following diseases is thought to be related to free radical damage?

a. osteoarthritis

b. detached retina

c. cerebral aneurysm

d. cancer

D

Which of the following enzymes, released from dying cells, may indicate problems in the liver?

a. alanine aminotransferase

b. aspartate aminotransferase c. alkaline phosphatase

d. all of the above

e. none of the above

D

Researchers hypothesize that the disappearance of dopamine-generating cells in the midbrain in Parkinson's Disease may be related to oxidative stress due to a decrease in the amount of glutathione in the midbrain. The best explanation for this theory is which of the following?

a. DNA synthesis requires glutathione for optimal development.

b. Dopamine synthesis requires glutathione to prevent free radical production.

c. Free radicals produced via dopamine synthesis are neutralized by glutathione.

d. Glutathione is needed for entry of dopamine into the cerebral circulation.

C

Which of the following is(are) true regarding aging?

a. may involve an increase in autoantibodies

b. may result from damage accumulation

c. both are true

d. neither is true

C

In theories of aging, cross-linking implies which of the following?

a. The lifespan and number of times a cell can replicate are preprogrammed.

b. The number of cell doublings is limited.

c. There is oxygen toxicity.

d. Cell permeability decreases.

D

Etiology

Causative factors in a particular disease

Iatrogenic

produced by treatment

Epidemiology

risk factors and distribution in populations

Incidence

number of new cases

Prevalence

number of existing cases both new and old

clinical manifestations

signs, symptoms, and diagnostic criteria

how are symptoms and signs different

symptoms are what the patient reports

signs are objective or measurable

outcomes

cure, remission, chronicity, or death

primary prevention

Efforts to prevent an injury or illness from ever occurring.

secondary prevention

-focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status

-examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail

Tertiary prevention

-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning

-examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury

Atrophy

Decrease or shrinkage in cellular size.Most common in skeletal muscle, heart, secondary sex organs, and brain.

Physiologic atrophy

occurs with early development. Ex. Thymus gland gets physiologic atrophy during childhood.

pathologic atrophy

occurs as a result of decreases in workload, pressure, use, blood supply, nutrition, hormonal stimulation, and nervous stimulation

hypertrophy

Increase in the size of the cells that increase the size of the affected organ. Heart and kidneys (responsive to enlargement) and skeletal muscle.

physiologic hypertrophy

occurs with increased demand, stimulation of hormones, and growth factors. Ex. Pregnancy causes hormone induced hypertrophy of the uterus, in skeletal muscle occurs as a response to heavy workload.

pathologic hypertrophy

results from chronic hemodynamic overload. Ex. Hypertension or heart valve dysfunction. Hypertrophic cells have increased accumulation of ER, plasma membrane, myofilaments, mitochondria (not cellular fluid). Nucleus is also hypertrophic with increased DNA synthesis. Triggers for cardiac hypertrophy include mechanical signals (stretch) and trophic signals (growth factors and vasoactive agents).

Hyperplasia

increase in number of cells in an organ/tissue as a response to injury that results from an increased rate of cellular division

compensatory Physiologic hyperplasia

is an adaptive mechanism that enables certain organs to regenerate. Occurs in skin, intestines, hepatocytes, bone marrow, and fibroblasts. Ex. Is when skin gets callus in response to mechanical stimulus.

Hormonal physiologic hyperplasia

Hormonal occurs mainly from estrogen dependent organs such as uterus and breasts.Ex- after ovulation estrogen stimulates endometrium to grow/thicken for fertilized ovum.

Pathologic hyperplasia

he abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells. These cells have enlargement of the nucleus, clumping of chromatin (package and protect DNA), and the presence of one or more large nucleoli. Ex. Benign prostatic hyperplasia (BPH) and endometriosis-both the result of hormonal imbalance.

Metaplasia

reversible replacement of one mature cell type (epithelial or mesenchymal) by another, sometimes less differentiated, cell type.

Cause of metaplasia

develops from reprogramming of stem cells. Found in association with tissue damage, repair, and regeneration.

pathophysiology of metaplasia

Adaptive replacement cell may be more suitable to the changed conditions in the surrounding environment. Ex. GERD damages squamous epithelium of the esophagus, cells are replaced by glandular epithelium which may tolerate the acid better. Not always beneficial. Ex. Smoking causes changes in bronchi cells, which don't have cilia or secrete mucus, causing loss of protective mechanism.

What is the significance of metaplasia

Can be reversed if stimulus is removed. If continues, can cause malignant transformation.

Dysplasia

abnormal changes in the size, shape, and organization of mature cells. mostly found in epithelia

Significance of dysplasia

can be reversed if it does not involve the entire epithelium. When dysplastic changes penetrate the basement membrane it is considered a preinvasive neoplasm (carcinoma in situ)

mechanisms of cell injury

ATP depletion, mitochondrial damage, accumulation of oxygen and oxygen-derived free radicals

membrane damage

protein folding defects

DNA damage defects

calcium level alterations

reperfusion injury

injury to tissue that occurs after blood flow is restored

restoration of needed oxygen is accompanied by oxidative stress with the generation of toxic oxygen radicals which damage cellular membranes and mitochndria

What helps reperfusion injury?

antioxidants and anti-inflammatory drugs

examples of cell injury

ischemic and hypoxic injury

ischemia-reperfusion injury

oxidative stress or accumulation of oxygen-derived free radicals induced injury

chemical injury

Cell injury: ATP depletion

loss of mitochondrial ATP and decreased ATP synthesis

results include:

cellular swelling

decreased protein synthesis

decreased membrane transport

lipogenesis

all changes that contribute to loss of integrity of the plasma membrane

Cell injury: Oxygen and oxygen-derived free radicals

lack of oxygen is key in progression of cell injury in ischemia (reduced blood supply)

activated oxygen species (free radicals) cause destruction of cell membranes and cell structure

Cell Injury: Intracellular calcium and loss of calcium steady state

Normally intracellular cytosolic calcium concentrations are very low; ischemia and certain chemicals can cause an increase in cytosolic Ca concentrations

sustained levels of Ca continue to increase with damage to plasma membrane

Ca causes intracellular damage by activating enzymes

Cellular events that occur with ischemia-hypoxic injury

-Decrease in oxygen reaching the cell

-decrease in ATP production within mitochondria

-failed NA+/K pump

-Na, Ca enter cell, K leaves

-organelle swelling

-protein synthesis stops

-ATP via oxidative phosphorylation declines, glycolysis increases

-glycogen stores depleated

-lactic acid produced

-decrease in intracellular Ph declines

-rupture of lysosomes

-autodigestion of the cell contents and membrane

Deleterious effects of free radicals on cells

-unstable compounds with an unpaired electron in outer ring

-anxious to "mate" with other substances

affinity for lipid substances

(there is a phospholipid bilayer membrane around cell)

-combine avidly with cell and organelle membranes

-lipid peroxidation - dissolution of the membrane

-"drills a hole"

examples o diseases linked to oxygen-derived free radicals

aging

atherosclerosis

brain disorders

Cancer

Cardiac myopathy

Diabetes

Eye disorders

inflammatory disorders

iron overload

emphysema

radiation injury

reperfusion injury

rheumatoid arthritis

sleep apnea

Burns

Most types of cellular accumulations occur as a result of what 4 mechanisms

1 - insufficient removal of normal substance because of altered packaging/transport

2-abnormal substance (result of mutated gene) accumulated because of deficits in protein folding, transport, or abnormal degredation

3 - endogenous substance not effectively catabolized because of lack of vital lysosomal enzyme

4 - harmful exogenous materials such as heavy metals, dusts, microorganisms that accumulate because of inhalation, ingestion, or infection

normal substances that cause cell accumulation

water

protein

lipid

carbs

abnormal substances that cause cell accumulation

-endogenous: product of abnormal metabolism synthesis

-exogenous: infectious agent or material

pathophysiology of reperfusion injury

-generation of highly reactive oxygen intermediates (oxidative stress)

-these radicals cause further membrane damage and mitochondrial calcium overload

what does reperfusion cause

-causes creation of free radicals, pH alterations, inflammatory signaling, osmotic changes, gap junction changes, calcium overload, apoptosis

7 possible mechanisms of fatty accumulation

-increased movement of free fatty acids into the liver

-Failure of metabolic process that converts fatty acids to phospholipids resulting in the preferential conversion of the fatty acids to triglycerides

-increased synthesis of triglycerides from fatty acids

-decreased synthesis of apoproteins (lipid acceptors)

-failure of lipids to bind with apoproteins and form lipoproteins

-failure of mechanisms that transport lipoproteins out of the cell

-direct damage to the ER by free radicals released by alcohol's toxic effects

pathogenesis of bilirubin

-released when RBCs break down

-released into blood (unconjugated)

-fat-soluble, cannot be elimintated through urine

-unconjugated is taken up in the liver cells, bound to glucuronic acid, becomes conjugated bilirubin

-can now be eliminated through the kidney

-some becomes part of bile, some is eliminated in urine and feces giving yellow and brown color (bilirubin is a pigment)

What is jaundice caused by

excess bilirubin

what is excess bilirubin caused by

-diseases that cause destruction of RBC (hemolytic jaundice)

-Diseases affecting the metabolism and excretion of bilirubin in the liver

-diseases that can obstruct the common bile duct (gallstones/pancreatic tumors)

Effects of free cytosolic calcium

-normally removed by ATP dependent calcium pumps

-If abnormal permeability of calcium ion channels, direct damage to membranes, or depletion of ATP (i.e. hypoxic injury)

-then calcium level increases

-if not buffered or pumped out, uncontrolled enzyme activation takes place

-leading to: phosphorylation of protein and chromatin fragmentation, membrane damage, cytoskeletal disassembly (damage), nucleus chromatin damage

-often final pathway in many causes of cell death

pyknosis

in some cells the nucleus shrinks and becomes a small dense (clumped together) mass of genetic material. The pyknotic nucleus eventually dissolves (by karyolysis)

karyorrhexias

a degenerative cellular process involving fragmentation of the nucleus and the breakup of the chromatin into unstructured granules

karyolysis

nuclear dissolution and lysis of chromatin from the action of hydrolytic enzymes. Result of the action of hydrolytic lysosomal enzymes on DNA

Liquefactive necrosis

brain infarct, bacterial infections; wet gangrene

type of necrosis which results in a transformation of the tissue into a liquid viscous mass.

coagulative necrosis

primarily occurs in kidneys, heart, and adrenal glands

results from hypoxia caused by severe ischemia or chemical injury

most common

usually replaced by scar/fibrous tissue

caseous necrosis

commonly results from tuberculous pulmonary infection

combination of coagulative and liquefactive

the dead cells disintegrate but the debris is not digest completely by hydrolases

tissues appear soft and granular and resemble clumped cheese

Fat necrosis

occurs in the breast, pancreas, and other abdominal structures

cellular dissolution caused by powerful enzymes called lipases

break down triglycerides releasing free fatty acids which combine with calcium, magnesium, and sodium ions, creating soaps

necrotic tissue appears opaque and chalk white

Gangrenous necrosis

refers to death of tissue and results from severe hypoxic injury

commonly occurring becasuse of arteriosclerosis especially in lower leg

with hypoxia and subsequent bacterial invasion, the tissues undergo necrosis

dry gangrene

an area that is free of infection and in which the line of demarcation between live and dead tissue is apparent

tissue becomes dry and shrunken - mummified

wet gangrene

often malodorous and the line of demarcation between live and dead tissue is unclear until the infection is arrested

gas gangrene

wet gangrene caused by clostridium perfringes, an organisms that produces gas within the destroyed tissue. This accumulation of gas produces a distinctive sound on palpation of the area called crepitus

systemic manifestations of cellular injury

fever

increased heart rate

increase in number of leukocytes

pain

presence of cellular enzymes in extracellular fluid

lactate dehydrogenase

CK

AST

ALT

ALP

amylase

aldolase

tropinins