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ADVANCED PATHOPHYSIOLOGY EXAM
2025 Complete Q&A Study Guide
(Verified Questions & Answers)
The american college of cardiology and the american heart association have the following classifications for blood pressure? - CORRECT ANSWER normal: < 120/ elevated 120-129/ < hypertension stage 1: 130-139/ 80- 89 hypertension stage 2: > 140/ 90 **The higher value determines the stage What two factors play a role in primary/essential HTN - CORRECT ANSWER genetics and the environment Altered hemodynamics from an underlying primary disease or drug contributes to? - CORRECT ANSWER Secondary HTN What is the most significant factor in causing targeted organ damage? - CORRECT ANSWER systolic HTN HTN increases the risk of having what 3 medical conditions: - CORRECT ANSWER MI, Renal disease and stroke What are risk factors for hypertension? - CORRECT ANSWER High salt and fat intake, obesity, stress, alcohol consumption, inactivity, caffeine, and vitamin D deficiency, African American, DM, cigarettes Define primary hypertension - CORRECT ANSWER an overactivity of the SNS and RAAS and alterations to the natriuretic peptides What factors contribute to primary HTN - CORRECT ANSWER inflammation endothelial dysfunction obesity-related hormones insulin resistance
A systemic disease process that raises peripheral vascular resistance and or cardiac output coincides with? - CORRECT ANSWER Secondary HTN What is complicated hypertension? - CORRECT ANSWER - chronic hypertensive damage to the walls of systemic blood vessels
- smooth muscle cells undergo hypertrophy and hyperplasia with fibrosis (development of excessive fibrous connective tissue) of the tunica intima and media
- REMODLING Malignant hypertension/hypertensive crisis - CORRECT ANSWER rare, lifethreatening type of hypertension evidenced by optic-nerve (eye) edema and extremely high systolic and diastolic blood pressure ~ diastolic is using greater than 140 ~ STROKE What are the clinical manifestations of hypertension? - CORRECT ANSWER early stages have no s/s ~ slow onset A patient says they heard that hypertension can be present for many years without knowing. How would you respond? - CORRECT ANSWER Yes, HTN is known as the silent disease and comprehensive physicals and identification of risk factors are pivotal to catching HTN. An individual has primary HTN and recurrent strokes. Which drug should the nurse prepare to administer? - CORRECT ANSWER Ace inhibitors. A decrease in SBP and DBP upon standing by > 20/10 mmHg is considered what? - CORRECT ANSWER Orthostatic hypotension The lack in compensation in response to gravitational changes on circulation, leading to pooling and vasodilation coincides with? - CORRECT ANSWER orthostatic hypotension What is the difference between primary and secondary orthostatic hypotension? - CORRECT ANSWER primary: change in position secondary: neurological, aging or dehydration What is the main clinical manifestation of orthostatic hypotension - CORRECT ANSWER fainting upon standing
What is intermittent claudication? - CORRECT ANSWER Leg pain that is brought on by exercise and relieved by rest. It is characteristic of peripheral artery occlusion/ arterial insufficiency. It is dull or cramp like and consistently occurs in the same area of the leg and with same amount of distance ~ obstruction of arterial blood flow in the iliofemoral vessels Any vascular disorder that narrows or occludes the coronary arteries is considered? - CORRECT ANSWER CAD CAD is the imbalance of? - CORRECT ANSWER coronary supply of blood and myocardial demand for oxygen and nutrients Dyslipidemia has a strong link between? - CORRECT ANSWER Lipoproteins and CAD Define triglycerides - CORRECT ANSWER dietary fat packaged into chylomicrons for absorption into the small intestine What are chylomicrons? - CORRECT ANSWER Chylomicrons are tiny fatty droplets composed of triglycerides, small amounts of phospholipids, cholesterol, free fatty acids, and some protein. What makes up the different cholesterol molecules? - CORRECT ANSWER VLDL: mainly triglycerides + carrier protein LDL: cholesterol + carrier protein HDL: phospholipid + carrier protein What molecule is responsible for reverse cholesterol transport? - CORRECT ANSWER HDL Increased LDL, Low levels of HDL, elevated serum VLDL and increased lipoprotein are all indicators for? - CORRECT ANSWER Coronary risk What is a reversible myocardial ischemia and a harbinger of impending infarction? - CORRECT ANSWER Unstable Angina Define unstable angina? - CORRECT ANSWER Transient episodes of thrombotic vessel occlusion and vasoconstriction at the site of plaque damage with a return of perfusion before significant myocardial necrosis can occur.
A prolonged ischemia causing irreversible damage to heart muscle and subsequent myocyte necrosis is? - CORRECT ANSWER Myocardial Infarction What structure changes occur during an MI? - CORRECT ANSWER Myocardial stunning Hibernating myocardium Myocardial remodling The temporary loss of contractility that persists for hours to days after perfusion has been restored to the heart is? - CORRECT ANSWER myocardial stunning A myocardial tissue that persistently undergoes metabolic adaptation to prolong myocyte survival is consistent with? - CORRECT ANSWER Hibernating myocardium Myocardial remodeling is a process that occurs in the myocardium after? - CORRECT ANSWER MI In most cases, repair and remodeling of the myocardium causes? - CORRECT ANSWER more problems ~ renal failure Stable plaques are associated with? - CORRECT ANSWER stable angina Unstable plaques are associated with? - CORRECT ANSWER acute coronary syndromes During a MI, angiotensin II plays a major role in/ - CORRECT ANSWER peripheral vasoconstriction and fluid retention ~ increasing myocardial work load~ exacerbating a decrease in contractility hypersecretion of GH ~ promotion of catecholamine release ~ causing acute coronary spasms causes myocyte hypertrophy, scarring, and loss of contractile function int eh scarred areas distal to the infarction What are the two major types of MI - CORRECT ANSWER Subendocardial and transmural What are the clinical manifestations of MI - CORRECT ANSWER Sudden, severe chest pain, nausea, vomitting, severe indigestion, diaphoresis, peripheral vasoconstriction, and inflammation.
What is heart failure? - CORRECT ANSWER the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients ischemic heart disease and hypertension are risk factors for? - CORRECT ANSWER heart failure Describe left (congestive) heart failure - CORRECT ANSWER HFrEF or HFpEF ventricular remodeling What is the most common cause of decreased cardiac contractility? - CORRECT ANSWER MI When is preload increased? - CORRECT ANSWER decreased contractility excess plama volume An increase in peripheral vascular resistance correlates to? - CORRECT ANSWER Increased Afterload An inability of the heart to generate adequate cardiac output to perfuse tissues is which type of heart failure? - CORRECT ANSWER systolic Systolic heart failure sees an increase in? - CORRECT ANSWER Catecholamines RAAS ADH Naturiuetic peptides Inflammatory cytokines myocyte calcium transport Insulin resistance DOE, orthopnea, cough with frothy sputum, fatigue, edema and decrease urine output are characteristically seen in? - CORRECT ANSWER Systolic heart failure HFrEF correlates to? - CORRECT ANSWER systolic heart failure HFpEF correlates to? - CORRECT ANSWER Diastolic heart failure A decreased compliancy of the left ventricle and abnormal diastolic relaxation occurs in?
- CORRECT ANSWER Diastolic heart failure Define lusitropy - CORRECT ANSWER abnormal diastolic relaxation
DOE and fatigue are characteristically seen in? - CORRECT ANSWER Diastolic heart failure Right Side heart failure is the inability of the right ventricle to provide? - CORRECT ANSWER adequate blood flow in the pulmonary circulation Increased left ventricular filling pressure may be a precursor to? - CORRECT ANSWER right heart failure diffuse hypoxic pulmonary disease - CORRECT ANSWER What usually causes right heart failure What are the clinical manifestations of right heart failure? - CORRECT ANSWER JVD, peripheral edema, hepatosplenomegaly What is high output heart failure? - CORRECT ANSWER uncommon; body needs excessive CO; causes include severe anemia and thyrotoxicosis and beriberi Systolic heart failure is associated with the activation of the? - CORRECT ANSWER RAAS A disturbance in heart rhythm and rate. - CORRECT ANSWER dysrhythmia An acute inflammation of the pericardium is? - CORRECT ANSWER Acute pericarditis A 34 y/o male presents with fever, myalgias, and malaise for four days but recently reports sudden server chest pain. What do you suspect to be the cause? - CORRECT ANSWER Acute pericarditis An accumulation of fluid in the pericardial cavity is? - CORRECT ANSWER Pericardial effusion what is a major concern of untreated pericardial effusion? - CORRECT ANSWER Cardiac Tamponade What is constrictive pericarditis? - CORRECT ANSWER Fibrous reparative thickening of pericardial layers that restricts diastolic ventricular filling
A patient presents with valvular disease, with an echo report showing a constricted, narrowed aortic valve. Is this stenosis or regurgitation of the aortic valve? - CORRECT ANSWER stenosis A 89 y/o women presents for a yearly echocardiogram after having an aortic valve replaced 5 years ago. Upon reading the echo report, the aortic valve seems to be fully functional yet the mitral valve is not shutting completely and seems to be incompetent. What form of valvular dysfunction do you suspect? - CORRECT ANSWER regurgitation Cardiac murmurs are helpful in discerning what in respect to valvular disease? - CORRECT ANSWER which valve is abnormal diminished blood flow from the LV into the aorta is seen in? - CORRECT ANSWER aortic stenosis Mitral stenosis is impaired blood flow from the left atrium to the? - CORRECT ANSWER left ventricle what is the most common cause of mitral stenosis - CORRECT ANSWER acute rheumatic fever What are the clinical manifestations of mitral stenosis - CORRECT ANSWER opening snap of the valve A 76 year old male presents with a widened pulse pressure. There is also a diastolic murmur auscultated in the 2/3rd intercostal space. What do you as the provider suspect to be occurring? - CORRECT ANSWER Aortic regurgitation An increased stroke volume and diastolic back flow is seen in which valvular regurgitation? - CORRECT ANSWER aortic what are the most common causes of mitral regurgitation? - CORRECT ANSWER MV prolaps rheumatic heart disease infective endocarditis MI connective tissue disease dilated cardiomyopathy A 20 y/o female with congenital heart disease presents to your clinic with hypertension, hepatosplenomegaly, and dependent edema +3. Upon auscultation you hear a murmur mid systole and suspect valvular dysfunction. Which valve do you suspect to have
regurgitation? - CORRECT ANSWER Tricuspid ~ volume overload, increased systemic venous blood pressure, right heart failure What is mitral valve prolapse syndrome? - CORRECT ANSWER Anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole. What patient would have an asymptomatic valve disease? - CORRECT ANSWER one with MV prolapse syndrome A person has a diagnosis of valvular regurgitation. What pathophysiologic process is the person experiencing? - CORRECT ANSWER Failure to close the valve completely, permitting the back flow fo blood to continue. Define rheumatic fever - CORRECT ANSWER A diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic streptococci Clinical manifestations of rheumatic fever include? - CORRECT ANSWER fever, lympahdenopathy, arthralgia, N/V, epistaxis What is the result of untreated, rheumatic fever? - CORRECT ANSWER rheumatic heart disease An abnormal response to the M proteins that cross react with normal tissues, along with fibrinoid necrotic deposits (aschoff bodies) may be seen in? - CORRECT ANSWER Rheumatic fever A 35 year old female presents to your clinic with a temperature of 102.8, systolic murmur, bilateral hip pain, swollen lymph nodes of the supraclavicular and posterior cervical, a truncal rash, and reports of abnormal, sudden involuntary movements. You perform a complete head to toe assessment and come to conclusion that the patient has? - CORRECT ANSWER rheumatic fever A student asks the healthcare professional to describe exotoxins. Which statement by the professional is best? a. Exotoxins are contained in cell walls of gram-negative bacteria. b. Exotoxins are released during the lysis of bacteria. c. Exotoxins are able to initiate the complement and coagulation cascades.
Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine b. Epinephrine c. Cortisol d. Adrenocorticotropic hormone (ACTH) - CORRECT ANSWER A. The release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. Epinephrine's effects are primarily on the cardiovascular system. Cortisol's chief effects involve metabolic processes. By inhibiting the use of metabolic substances while promoting their formation, cortisol mobilizes glucose, amino acids, lipids, and fatty acids and delivers them to the bloodstream. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids. A student asks the healthcare professional how immunity is decreased by stress. The professional responds that during a stress response, the helper T (Th) 1 response is suppressed by which hormone? a. ACTH b. Cortisol c. Prolactin d. Growth hormone - CORRECT ANSWER B. Cortisol acts to suppress the activity of Th1 cells, which leads to a decrease in innate immunity and the proinflammatory response. Cortisol also stimulates the activity of Th2 cells, which increases adaptive immunity and the antiinflammatory response. ACTH binds with specific receptors on the adrenal glands which causes the release of the glucocorticoids. Prolactin is secreted in response to a variety of stressful stimuli and acts as a second messenger for IL-2 and has a positive influence on B-cell activation and differentiation. Growth hormone affects protein, lipid, and carbohydrate metabolism; counters effects of insulin; and is involved in tissue repair. Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of what? a. Epinephrine and aldosterone b. Norepinephrine and cortisol c. Epinephrine and norepinephrine d. Acetylcholine and cortisol - CORRECT ANSWER C. The sympathetic nervous system is aroused during the stress response and causes the medulla of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine) into the bloodstream. Sympathetic stimulation of the adrenal medulla does not cause the secretion of aldosterone, cortisol, or acetylcholine.
A severely stressed patient has cold, clammy skin. The healthcare professional quizzes the student about this effect. The student correctly answers that this effect is directly from which action? a. Epinephrine dilating blood vessels leading to the vital organs b. Norepinephrine constricting blood vessels in the skin c. Dilating the airways to increased oxygenation of the tissues d. Dysfunctional temperature regulation from cortisol secretion - CORRECT ANSWER B. In a stress response, the actions of norepinephrine and epinephrine are complementary. While epinephrine dilates blood vessels to the vital organs (among other things), norepinephrine constricts blood vessels in the viscera and skin, providing more blood supply for those vital organs. The clinical result is cold, clammy skin. Epinephrine can also dilate airways, but this does not produce the skin changes as described. Temperature dysregulation is not the cause of the cold, clammy skin. Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure? a. Adrenal cortex b. Pancreas c. Liver d. Anterior pituitary - CORRECT ANSWER C. One of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the liver. The adrenal cortex, pancreas, and anterior pituitary do not produce stimulation of gluconeogenesis when exposed to cortisol. What effect do androgens have on lymphocytes? a. Suppression of B-cell responses and enhancement of T-cell responses b. Suppression of T-cell responses and enhancement of B-cell responses c. Suppression of B- and T-cell responses d. Enhancement of B- and T-cell responses - CORRECT ANSWER C. Androgens suppress T- and B-cell responses. Androgens do not enhance either B- or T-cell responses Which statement is true concerning the differences between stress-induced hormonal alterations of men and women? a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women. c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age. d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men. - CORRECT ANSWER B. Androgens appear to induce a greater degree of
Which term is used to describe a cell showing a loss of cellular differentiation? a. Dysplasia b. Hyperplasia c. Metaplasia d. Anaplasia - CORRECT ANSWER D Anaplasia is defined as the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure. In clinical specimens, anaplasia is recognized by a loss of organization and a significant increase in nuclear size with evidence of ongoing proliferation. Dysplasia is the presence of an abnormal cell type within a tissue and often is called "precancerous." Hyperplasia is an enlargement of an organ or tissue due to increased production of its cells, also often considered precancerous. Metaplasia is an abnormal change in the characteristics of a tissue. What is apoptosis? a. Normal mechanism for cells to self-destruct when growth is excessive b. Antigrowth signal activated by the tumor-suppressor gene Rb c. Mutation of cell growth stimulated by the TP53 gene d. Transformation of cells from dysplasia to anaplasia - CORRECT ANSWER A. Normal cells have a mechanism that causes them to self-destruct when growth is excessive and cell cycle checkpoints have been ignored. Unchecked proliferation could lead to malignancy. What are tumor cell markers? a. Hormones, enzymes, antigens, and antibodies that are produced by cancer cells b. Receptor sites on tumor cells that can be identified and marked c. Cytokines that are produced against cancer cells d. Identification marks that are used in administering radiation therapy - CORRECT ANSWER A. Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies. Tumor markers are not receptor sites, cytokines, or identification marks for radiation. What is one function of the tumor cell marker? a. To provide a definitive diagnosis of cancer b. To treat certain types of cancer c. To predict where cancers will develop d. To screen individuals at high risk for cancer - CORRECT ANSWER D Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. The two other uses for these markers are to help diagnosis a specific type of cancer (not give a definitive diagnosis) and to follow the clinical course of a tumor. Which statement supports the hypothesis that intestinal polyps are benign neoplasms and the first stage in the development of colon cancer?
a. Cancer cells accumulate slower than non-cancer cells. b. An accumulation of mutations in specific genes is required to develop cancer. c. Tumor invasion and metastasis progress more slowly in the gastrointestinal tract. d. Apoptosis is triggered by diverse stimuli, including excessive growth. - CORRECT ANSWER B. Multiple genetic mutations are required for the evolution of full-blown cancer. This sequential development of cancer has been well documented in the transformation of benign colon polyps to colon cancer. Autocrine stimulation is the ability of cancer cells to do what? a. Stimulate angiogenesis to create their own blood supply b. Encourage secretions that turn off normal growth inhibitors c. Secrete growth factors that stimulate their own growth d. Divert nutrients away from normal tissue for their own use - CORRECT ANSWER C. Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. The other options describe other activities of cancer cells, but not autocrine stimulation. A student studying biology asks the professor to describe how the ras gene is involved in cancer proliferation. What explanation by the professor is best? a. It suppresses the action of the tumor-suppressor genes. b. It changes the way the growth promotion genes work. c. A mutation in this gene allows continuous cell growth. d. It activates a cell surface receptor that allows signaling to the nucleus. - CORRECT ANSWER C. Up to one-third of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing. The remaining options do not describe how ras contributes to cancer formation and growth. How does the ras gene convert from a proto-oncogene to an oncogene? a. Designating a chromosome that has a piece of one chromosome fused to a piece of another chromosome b. Duplicating a small piece of a chromosome, repeatedly making numerous copies c. Altering one or more nucleotide base pairs d. Promoting proliferation of growth signals by impairing tumor-suppressor genes - CORRECT ANSWER C A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation. Fusion, duplications, and proliferation of growth signals are not the cause of a ras gene converting to an oncogene.
of one or a few nucleotide base pairs. Gene amplification is the result of repeated duplication of a region of a chromosome, so that instead of the normal two copies of a gene, tens or even hundreds of copies are present. Chromosome fusion occurs during translocation. In childhood neuroblastoma, the N-myc oncogene undergoes which type of mutation of normal gene to oncogene? a. Point mutation b. Chromosome fusion c. Gene amplification d. Chromosome translocation - CORRECT ANSWER C. Amplifications are the result of the duplication of a small piece of a chromosome over and over again; consequently, instead of the normal two copies of a gene, tens or even hundreds of copies are present. The N-myc oncogene is amplified in 25% of childhood neuroblastoma. Why are two "hits" required to inactivate tumor-suppressor genes? a. Each allele must be altered, and each person has two copies, or alleles, of each gene, one from each parent. b. The first hit stops tissue growth, and the second hit is needed to cause abnormal tissue growth. c. Tumor-suppressor genes are larger than proto-oncogenes, requiring two hits to affect carcinogenesis. d. The first hit is insufficient to cause enough damage to cause a mutation. - CORRECT ANSWER A. A single genetic event can activate an oncogene, acting in a dominant manner in the cell. However, each person has two copies, or alleles, of each gene, one from each parent. Therefore two hits are required to inactivate the two alleles of a tumor-suppressor gene, allowing the process to become active. The remaining options do not describe the reason two hits are required. How do cancer cells use the enzyme telomerase? a. To repair the telomeres to restore somatic cell growth b. As an intracellular signaling chemical to stimulate cell division c. To switch off the telomerase to enable cells to divide indefinitely d. To switch on the telomerase to enable cells to divide indefinitely - CORRECT ANSWER D Cancer cells, when they reach a critical age, somehow activate telomerase to restore and maintain their telomeres and thereby make it possible for cells to divide over and over again. What are characteristics of benign tumors? a. Benign tumors invade local tissues. b. Benign tumors spread through the lymph nodes. c. Benign tumors cause systemic symptoms.
d. Benign tumors include the suffix - oma. - CORRECT ANSWER D Benign tumors are usually encapsulated and well-differentiated. They retain some normal tissue structure and do not invade the capsules surrounding them or spread to regional lymph nodes or distant locations. Benign tumors are generally named according to the tissues from which they arise and include the suffix - oma. Benign tumors do not cause systemic symptoms What does the health professions student learn about benign tumors? a. The resulting pain is severe. b. Benign tumors are not encapsulated. c. Benign tumors are fast growing. d. The cells are well-differentiated. - CORRECT ANSWER D. A benign tumor is well- differentiated with its tissue appearing similar to the tissue from which it arose. The other options are characteristic of a malignant tumor. What is the major virus involved in the development of cervical cancer? a. Herpes simplex virus type 6 b. Herpes simplex virus type 2 c. Human papillomavirus d. Human immunodeficiency virus - CORRECT ANSWER C. Infection with specific subtypes of human papillomavirus (HPV) causes virtually all cervical cancers. The remaining options are not known to be associated with cervical cancer. A healthcare professional is caring for four patients with cancer. Which patient does the professional educate about brachytherapy? a. Lung b. Colon c. Cervical d. Brain - CORRECT ANSWER C. Radiation sources, such as small 125I-labeled capsules (also called seeds), can also be temporarily placed into body cavities, a delivery method termed brachytherapy. Brachytherapy is useful in the treatment of cervical, prostate, and head and neck cancers. Brachytherapy is not used in the treatment of the other cancers. The Papanicolaou (Pap) test is used to screen for which cancer? a. Ovarian b. Uterine c. Cervical d. Vaginal - CORRECT ANSWER C. The Pap test, an examination of cervical epithelial scrapings, readily detects early oncogenic human papillomavirus (HPV) infection. The Pap test is not used for screening the other cancer sites listed.
