nu 621 advanced pathophysiology latest exam 2024 h
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NU 621
ADVANCED
PATHOPHYSIOLOGY
COMPLETED
STUDYGUIDE
,1. A 65-year-old man with a history of hypertension, diabetes, and coronary artery disease presents to
the emergency department with chest pain, dyspnea, and diaphoresis. He is diagnosed with an
acute myocardial infarction (AMI) and is given aspirin, nitroglycerin, morphine, and oxygen. Which
of the following pathophysiological processes is most likely responsible for his AMI?
a) Atherosclerosis of the coronary arteries leading to plaque rupture and thrombus formation
b) Vasospasm of the coronary arteries leading to ischemia and necrosis of the myocardium
c) Embolism of the coronary arteries from a source in the left atrium or ventricle
d) Inflammation of the coronary arteries leading to endothelial dysfunction and vasoconstriction
*Answer: a) Atherosclerosis of the coronary arteries leading to plaque rupture and thrombus
formation*
Rationale: Atherosclerosis is the most common cause of AMI, accounting for about 90% of cases. It
involves the accumulation of lipids, inflammatory cells, and fibrous tissue in the intima of the
arterial wall, forming plaques that narrow the lumen and reduce blood flow. When a plaque
ruptures, it exposes its contents to the blood, triggering platelet aggregation and thrombus
formation that can occlude the artery and cause ischemia and necrosis of the myocardium.
2. A 50-year-old woman with a history of rheumatoid arthritis and chronic kidney disease is admitted
to the hospital with fatigue, weakness, anorexia, nausea, and vomiting. Her laboratory tests reveal
a serum calcium level of 12.5 mg/dL (normal range: 8.5-10.5 mg/dL), a serum phosphorus level of
6.8 mg/dL (normal range: 2.5-4.5 mg/dL), and a serum parathyroid hormone (PTH) level of 120
pg/mL (normal range: 10-65 pg/mL). Which of the following pathophysiological processes is most
likely responsible for her hypercalcemia?
a) Increased bone resorption due to PTH excess
b) Decreased renal excretion due to kidney failure
c) Increased intestinal absorption due to vitamin D deficiency
d) Decreased bone formation due to rheumatoid arthritis
*Answer: a) Increased bone resorption due to PTH excess*
Rationale: Hypercalcemia is defined as a serum calcium level above 10.5 mg/dL. It can be caused by
various conditions, such as malignancy, hyperparathyroidism, granulomatous diseases, and
medications. In this case, the patient has secondary hyperparathyroidism, which is a compensatory
response to chronic kidney disease. The kidneys are unable to excrete phosphorus and synthesize
vitamin D, leading to hypocalcemia and hyperphosphatemia. These stimulate the parathyroid
glands to secrete more PTH, which acts on the bones to increase calcium release into the blood.
3. A 40-year-old man with a history of asthma presents to the clinic with cough, wheezing, chest
tightness, and shortness of breath. He reports that his symptoms worsen at night and during
, exercise. He uses an albuterol inhaler as needed for relief. Which of the following
pathophysiological processes is most likely responsible for his asthma?
a) Bronchial hyperresponsiveness leading to bronchoconstriction and airway obstruction
b) Chronic inflammation leading to mucus hypersecretion and airway remodeling
c) Hypersensitivity reaction leading to mast cell degranulation and histamine release
d) All of the above
*Answer: d) All of the above*
Rationale: Asthma is a chronic respiratory disorder characterized by reversible airflow obstruction,
bronchial hyperresponsiveness, and airway inflammation. It can be triggered by various factors,
such as allergens, irritants, infections, exercise, stress, or cold air. When exposed to a trigger, the
airways undergo three main pathophysiological processes: bronchoconstriction due to smooth
muscle contraction; inflammation due to immune cell activation and cytokine production; and
mucus hypersecretion due to goblet cell stimulation and mucosal edema. These processes result in
airway narrowing, increased resistance, decreased compliance, and impaired gas exchange.
1. A 65-year-old man with a history of hypertension, diabetes, and coronary artery disease presents
to the emergency department with chest pain, dyspnea, and diaphoresis. He is diagnosed with an
acute myocardial infarction (AMI) and is given aspirin, nitroglycerin, morphine, and oxygen. He is
also scheduled for an urgent coronary angiography. Which of the following statements best
describes the pathophysiology of AMI?
a) AMI is caused by a sudden occlusion of a coronary artery by a thrombus that forms on a ruptured
atherosclerotic plaque.
b) AMI is caused by a gradual narrowing of a coronary artery by atherosclerosis that reduces blood
flow to the myocardium.
c) AMI is caused by a spasm of a coronary artery that temporarily interrupts blood flow to the
myocardium.
d) AMI is caused by an embolus that originates from the left atrium and lodges in a coronary artery.
*Answer: A. Rationale: AMI is most commonly caused by a sudden occlusion of a coronary artery by
a thrombus that forms on a ruptured atherosclerotic plaque. This leads to ischemia and necrosis of
the myocardial tissue supplied by the affected artery. The other options are less common causes of
AMI.*
2. A 50-year-old woman with a history of rheumatoid arthritis and chronic kidney disease is
admitted to the hospital with signs and symptoms of heart failure. She has bilateral crackles in her
lungs, jugular venous distension, peripheral edema, and an enlarged liver. Her blood pressure is
160/100 mmHg and her heart rate is 110 beats per minute. She is diagnosed with diastolic heart
failure and is started on diuretics, angiotensin-converting enzyme inhibitors, and beta-blockers.
Which of the following statements best explains the pathophysiology of diastolic heart failure?
a) Diastolic heart failure is caused by impaired ventricular relaxation that reduces diastolic filling
, and stroke volume.
b) Diastolic heart failure is caused by increased ventricular contractility that increases systolic
ejection and afterload.
c) Diastolic heart failure is caused by reduced ventricular compliance that increases diastolic
pressure and pulmonary congestion.
d) Diastolic heart failure is caused by decreased ventricular preload that reduces cardiac output and
tissue perfusion.
*Answer: C. Rationale: Diastolic heart failure is caused by reduced ventricular compliance that
increases diastolic pressure and pulmonary congestion. This can result from conditions that cause
ventricular hypertrophy, fibrosis, or infiltration, such as hypertension, diabetes, ischemic heart
disease, rheumatic heart disease, or amyloidosis. The other options are not consistent with diastolic
heart failure.*
3. A 40-year-old man with a history of asthma and allergic rhinitis presents to his primary care
provider with wheezing, coughing, chest tightness, and shortness of breath. He reports that his
symptoms have worsened over the past week and that his albuterol inhaler does not provide much
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