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PATHO 1: EXAM 4 – Comprehensive
Topic Test (2026)
Instructions: Choose the best answer for each of the following questions. Section 1: Endocrine Disorders (Pituitary, Thyroid, Adrenal)
1. A patient presents with severe hypotension, hyponatremia, hyperkalemia, and hypoglycemia. Which endocrine disorder is most likely? a) Cushing syndrome b) Hyperaldosteronism c) Diabetes insipidus d) Addison disease Rationale: Addison disease (primary adrenal insufficiency) results in decreased cortisol (hypoglycemia, hypotension) and decreased aldosterone (hyponatremia, hyperkalemia). 2. A patient with a pituitary adenoma presents with large hands, a coarse facial features, and a deep voice. These symptoms are characteristic of: a) Cushing disease b) Syndrome of inappropriate antidiuretic hormone (SIADH) c) Acromegaly d) Diabetes insipidus Rationale: Acromegaly results from excessive growth hormone (GH) secretion after epiphyseal plate closure, leading to bony overgrowth and soft tissue enlargement. 3. A patient is diagnosed with primary hyperaldosteronism (Conn syndrome). Which lab finding would the nurse expect? a) Hypokalemia and hypertension
b) Hyperkalemia and hypotension c) Hypernatremia and hypercalcemia d) Hyponatremia and hypocalcemia Rationale: Excess aldosterone increases sodium and water retention (HTN) while excreting potassium (hypokalemia).
4. The hallmark sign of Cushing syndrome, distinct from simple obesity, is: a) Generalized weight gain b) Purple striae and moon facies c) Hyperpigmentation of the skin d) Hypotension Rationale: Purple striae (abdominal stretch marks) and moon facies are classic signs of chronic hypercortisolism due to protein catabolism and fat redistribution. 5. A patient post-head injury develops polydipsia and polyuria with a urine specific gravity of 1.001. What is the most likely diagnosis? a) Syndrome of inappropriate antidiuretic hormone (SIADH) b) Diabetes insipidus (DI) c) Hyperglycemic hyperosmolar state d) Psychogenic polydipsia Rationale: Central DI results from a lack of ADH, leading to large volumes of dilute urine (low specific gravity). 6. Which electrolyte imbalance is a critical concern in a patient with SIADH? a) Hyperkalemia b) Hyponatremia c) Hypercalcemia d) Hypomagnesemia Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia. 7. A patient with a thyroidectomy suddenly develops muscle cramps, stridor, and tingling in the fingers. The nurse suspects: a) Thyroid storm b) Hypocalcemia
c) High TSH, High T d) Low TSH, Low T Rationale: In primary hypothyroidism, the thyroid gland fails to produce T4, causing the pituitary to release more TSH.
12. A patient with type 2 diabetes is prescribed a GLP-1 receptor agonist. What is the primary action of this drug class? a) Increases insulin resistance b) Stimulates the liver to produce glucose c) Slows gastric emptying and increases glucose-dependent insulin secretion d) Increases potassium excretion Rationale: GLP-1 agonists enhance insulin secretion only when glucose is high and delay gastric emptying. 13. The dawn phenomenon in diabetes is characterized by: a) Hypoglycemia in the early morning due to excess insulin b) Hyperglycemia in the early morning due to growth hormone surges c) Hypoglycemia after meals d) Unpredictable swings in glucose Rationale: The dawn phenomenon results from a natural overnight release of counterregulatory hormones (GH, cortisol). 14. Diabetic ketoacidosis (DKA) is most commonly associated with: a) Type 1 diabetes b) Type 2 diabetes c) Gestational diabetes d) Diabetes insipidus Rationale: DKA results from absolute insulin deficiency, typical in Type 1 diabetes. 15. Which set of findings is classic for Hyperglycemic Hyperosmolar State (HHS)? a) Ketones present, pH < 7. b) Severe hyperglycemia, no ketones, high osmolality c) Hypoglycemia, diaphoresis
d) Metabolic alkalosis, Kussmaul breathing Rationale: HHS is characterized by extreme hyperglycemia, hyperosmolality, and absence of significant ketosis.
16. A patient with pheochromocytoma experiences episodic hypertension. This is due to excessive secretion of: a) Cortisol b) Catecholamines (epinephrine/norepinephrine) c) Aldosterone d) ADH Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes catecholamines. 17. Which skin finding is associated with Addison disease but not Cushing syndrome? a) Moon facies b) Buffalo hump c) Hyperpigmentation d) Thin, fragile skin Rationale: Hyperpigmentation occurs in Addison disease due to high ACTH levels (which shares a precursor with MSH). 18. Myxedema coma is a life-threatening complication of: a) Hyperthyroidism b) Severe hypothyroidism c) Hyperparathyroidism d) Adrenal crisis Rationale: Myxedema coma is the severe, decompensated state of hypothyroidism. Section 2: Reproductive Disorders
23. Which sexually transmitted infection is associated with the development of pelvic inflammatory disease (PID) and subsequent infertility? a) Trichomoniasis b) Chlamydia trachomatis c) Bacterial vaginosis d) Human papillomavirus (HPV) Rationale: Chlamydia is a leading cause of PID due to ascending infection. 24. A patient is diagnosed with bacterial vaginosis. What is the characteristic presentation? a) Thick, white, curdy discharge b) Foul, fishy odor with thin, grey-white discharge c) Frothy, green discharge d) Painful genital ulcers Rationale: Bacterial vaginosis is characterized by a "fishy" odor due to volatile amines and clue cells on wet mount. 25. Which malignancy is strongly associated with high-risk strains of Human Papillomavirus (HPV 16 and 18)? a) Ovarian cancer b) Cervical cancer c) Endometrial cancer d) Vulvar cancer Rationale: HPV is the causative agent for the majority of cervical cancers. 26. A patient presents with acute scrotal pain, nausea, and vomiting. The testis is elevated and tender. Cremasteric reflex is absent. This is most consistent with: a) Hydrocele b) Testicular torsion c) Epididymitis d) Varicocele Rationale: Testicular torsion is a surgical emergency with sudden pain, absent cremasteric reflex, and nausea.
27. A patient has an elevated PSA (prostate-specific antigen) and a hard, nodular prostate on digital rectal exam. The nurse suspects: a) Benign prostatic hyperplasia (BPH) b) Prostate adenocarcinoma c) Prostatitis d) Urethral stricture Rationale: A hard, nodular prostate is suspicious for malignancy, though PSA can be elevated in both BPH and cancer. 28. What is the primary pathophysiologic mechanism of Benign Prostatic Hyperplasia (BPH)? a) Androgen-dependent hyperplasia of stromal and epithelial cells b) Inflammation of the prostate due to infection c) Metastatic spread of testicular cancer d) Autoimmune destruction of prostate tissue Rationale: BPH is a non-malignant enlargement driven by dihydrotestosterone (DHT) acting on stromal and epithelial cells. 29. A male patient reports erectile dysfunction, loss of libido, and hot flashes. Lab results show low testosterone and high FSH/LH. This indicates: a) Hypogonadotropic hypogonadism b) Hypergonadotropic hypogonadism (Primary testicular failure) c) Prolactinoma d) Androgen insensitivity syndrome Rationale: High FSH/LH with low testosterone indicates the testes are not responding to pituitary stimulation (primary failure). 30. Which complication is unique to preeclampsia compared to gestational hypertension? a) Blood pressure > 140/ b) Edema c) Proteinuria d) Headache
(Trastuzumab) d) High risk for metastasis to the brain only Rationale: HER2+ breast cancer is aggressive but treatable with monoclonal antibodies like trastuzumab.
35. Gynecomastia in males is most commonly caused by an imbalance of: a) Elevated FSH b) Elevated LH c) Increased estrogen/androgen ratio d) Prolactin deficiency Rationale: Gynecomastia results from a relative increase in estrogen activity compared to androgens. **Section 3: Genetics (Inheritance, Chromosomal Disorders, Cancer Genetics)
- A child presents with a wide, webbed neck, low posterior hairline, short stature, and lack of pubertal development. The karyotype is most likely:** a) 47, XXY b) 45, XO (Turner syndrome) c) 47, XY, + d) 46, XY Rationale: Turner syndrome (monosomy X) presents with webbed neck, short stature, and ovarian dysgenesis. 37. A male patient is tall, has long limbs, small testes, gynecomastia, and is infertile. The karyotype is most likely: a) 47, XXY (Klinefelter syndrome) b) 46, XY c) 47, XYY d) 45, XO Rationale: Klinefelter syndrome is characterized by hypergonadotropic hypogonadism and infertility due to an extra X chromosome.
38. A child with Down syndrome (Trisomy 21) is at high risk for which comorbid condition? a) Sickle cell anemia b) Congenital heart defects (AV canal) c) Pyloric stenosis d) Cystic fibrosis Rationale: Approximately 50% of children with Down syndrome have congenital heart defects, particularly atrioventricular septal defects. 39. Which type of genetic disorder follows a "vertical" pattern of inheritance (affecting multiple generations) with males and females equally affected, and no skipping of generations? a) X-linked recessive b) Autosomal recessive c) Autosomal dominant d) Mitochondrial Rationale: Autosomal dominant disorders appear in every generation (vertical transmission) with a 50% chance of inheritance. 40. Cystic fibrosis is an example of which inheritance pattern? a) Autosomal dominant b) Autosomal recessive c) X-linked dominant d) Chromosomal deletion Rationale: CF requires two defective copies of the CFTR gene (one from each carrier parent). 41. Hemophilia A is an X-linked recessive disorder. If a carrier mother (X^H X^h) has a child with a normal father (X^H Y), what is the chance their son will have hemophilia? a) 0% b) 25% c) 50% d) 100%
c) Chromosomal deletion syndrome d) Trinucleotide repeat disorder Rationale: NF1 is autosomal dominant but shows variable expressivity (symptoms vary greatly among affected individuals).
46. A baby is born with a cleft palate, microcephaly, and heart defects. The mother admits to chronic alcohol use during pregnancy. This is an example of: a) A chromosomal abnormality b) A teratogenic effect (multifactorial) c) A single gene disorder d) A Mendelian inheritance pattern Rationale: Fetal Alcohol Syndrome results from an environmental teratogen (alcohol) affecting development, not a genetic mutation inherited from parents. 47. Which tumor suppressor gene is known as the "guardian of the genome" and is mutated in many cancers? a) BRCA b) APC c) TP d) RET Rationale: p53 (TP53) halts the cell cycle to allow for DNA repair or induces apoptosis; it is frequently mutated in cancers. 48. A couple has a child with Tay-Sachs disease. The nurse explains that this disorder is more common in which ethnic group? a) African Americans b) Northern Europeans c) Mediterranean descent d) Ashkenazi Jewish descent Rationale: Tay-Sachs (autosomal recessive lysosomal storage disorder) has a higher carrier frequency in Ashkenazi Jewish populations. 49. A patient has a genetic condition where trinucleotide repeats (CGG) on the X chromosome expand, leading to intellectual disability. This is known as:
a) Angelman syndrome b) DiGeorge syndrome c) Fragile X syndrome d) Cri du chat syndrome Rationale: Fragile X syndrome is the most common inherited cause of intellectual disability, caused by FMR1 gene silencing due to CGG repeats.
50. Which type of RNA is targeted by mRNA-based therapies and CRISPR gene editing to correct genetic defects? a) Ribosomal RNA (rRNA) b) Transfer RNA (tRNA) c) Messenger RNA (mRNA) d) Small nuclear RNA (snRNA) Rationale: mRNA carries the genetic code from DNA to ribosomes; it is the target for many modern therapies aiming to alter protein production. **Section 4: Integrative/High Acuity
- A patient with a history of cirrhosis presents with gynecomastia, spider angiomas, and palmar erythema. This is likely due to:** a) Increased testosterone production b) Increased estrogen levels due to impaired liver metabolism c) Adrenal insufficiency d) Thyroid dysfunction Rationale: The liver cannot metabolize estrogen in cirrhosis, leading to hyperestrogenism signs. 52. A patient with metastatic lung cancer develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should monitor for: a) Hypernatremia b) Hyperkalemia c) Hyponatremia
c) Increases prolactin d) Decreases estrogen Rationale: Spironolactone is an aldosterone antagonist that also has anti-androgen effects, leading to gynecomastia.
57. A patient with type 1 diabetes reports "glucose levels are fine, but I feel shaky and sweaty after taking my insulin." This is most likely: a) Somogyi effect b) Dawn phenomenon c) Hypoglycemia d) Ketoacidosis Rationale: Shaky, sweaty, and confused are adrenergic symptoms of hypoglycemia. 58. A patient presents with a "salt craving" and hyperpigmentation. The nurse suspects: a) Cushing syndrome b) Addison disease c) Hyperaldosteronism d) Diabetes mellitus Rationale: Salt craving is due to aldosterone deficiency (sodium wasting) in Addison disease. 59. A patient with a pituitary tumor secreting prolactin (prolactinoma) would likely present with: a) Hypertension and hirsutism b) Galactorrhea and amenorrhea c) Acromegaly d) Cushing disease Rationale: Prolactin excess causes milk production (galactorrhea) and suppression of GnRH (leading to amenorrhea/infertility). 60. Which finding is a key distinguishing factor between Type 1 and Type 2 diabetes mellitus? a) Polyuria
b) Polydipsia c) Presence of islet cell autoantibodies d) Obesity Rationale: Type 1 is an autoimmune destruction of beta cells, marked by autoantibodies (GAD, IA-2). Section 5: Advanced Concepts and Latest 2026 Updates Questions reflect recent trends in pathology, biomarkers, and targeted therapies.
61. A patient with a genetic mutation in the RET proto-oncogene is at highest risk for developing: a) Breast cancer b) Lung cancer c) Medullary thyroid carcinoma (MTC) d) Colon cancer Rationale: RET mutations are associated with Multiple Endocrine Neoplasia (MEN2) and medullary thyroid cancer. 62. A patient with metastatic prostate cancer is being treated with a PARP inhibitor. This therapy is most effective in patients with mutations in: a) PSMA b) BRCA1/BRCA2 (Homologous Recombination Repair genes) c) Androgen receptor d) PIK3CA Rationale: PARP inhibitors exploit synthetic lethality in cancers with defective DNA repair (HRD), such as BRCA mutations. 63. In 2026, the standard of care for managing moderate to severe inflammatory bowel disease often involves which class of biologic that blocks a specific subunit (IL-23) to reduce inflammation? a) TNF-alpha inhibitors (Infliximab)
67. A patient with Hashimoto thyroiditis is at risk for developing which type of lymphoma? a) Hodgkin lymphoma b) Mucosa-associated lymphoid tissue (MALT) lymphoma c) Burkitt lymphoma d) Follicular lymphoma Rationale: Chronic antigenic stimulation in Hashimoto’s can lead to MALT lymphoma of the thyroid. 68. Which biomarker is used to differentiate between a benign thyroid nodule and papillary thyroid carcinoma on fine-needle aspiration? a) Calcitonin b) BRAF V600E mutation c) Thyroglobulin d) TSH receptor antibody Rationale: The BRAF V600E mutation is highly specific for papillary thyroid cancer and indicates a more aggressive course. 69. A patient with advanced prostate cancer develops resistance to androgen deprivation therapy (ADT). The new term for this state is: a) Androgen-sensitive prostate cancer b) Castration-resistant prostate cancer (CRPC) c) Neuroendocrine prostate cancer d) Localized prostate cancer Rationale: CRPC refers to prostate cancer that progresses despite castrate levels of testosterone. 70. A patient with type 2 diabetes is prescribed a SGLT2 inhibitor (empagliflozin). The nurse should educate the patient about the risk of: a) Weight gain b) Hypoglycemia c) Hyperkalemia d) Euglycemic diabetic ketoacidosis (euDKA)
Rationale: SGLT2 inhibitors can cause DKA with normal or mildly elevated glucose levels (euDKA), especially during illness or surgery. Section 6: Clinical Application and Reasoning
71. A patient with breast cancer is found to be estrogen receptor positive (ER+). What does this imply for treatment? a) The cancer is resistant to chemotherapy b) The cancer is more aggressive c) The cancer may respond to hormonal therapy (tamoxifen, aromatase inhibitors) d) The cancer is metastatic Rationale: ER+ cancers rely on estrogen for growth; they are candidates for endocrine therapy. 72. A patient presents with a diffusely enlarged, nontender thyroid (goiter) and symptoms of hyperthyroidism. The nurse suspects: a) Toxic nodular goiter b) Thyroiditis c) Graves disease d) Thyroid cancer Rationale: Graves disease typically presents with a diffuse, smooth goiter due to stimulation by TSH receptor antibodies. 73. A patient with a known pituitary adenoma develops severe headache, visual field cuts (bitemporal hemianopsia), and vomiting. The nurse recognizes this as: a) Migraine b) Pituitary apoplexy c) Sinusitis d) Diabetic retinopathy Rationale: Pituitary apoplexy is hemorrhage into a pituitary tumor, causing sudden compression of the optic chiasm (visual deficits).
