nu 621 advanced pathophysiology exam herzing uni 2
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NU 621
Advanced
Pathophysiology
COMPLETED EXAM
2024
,1. A 65-year-old man with a history of hypertension, diabetes, and
chronic kidney disease presents to the emergency department
with shortness of breath, chest pain, and palpitations. He is
diagnosed with atrial fibrillation and is started on anticoagulation
therapy. Which of the following is the most likely underlying
pathophysiological mechanism of his atrial fibrillation?
A) Increased sympathetic tone
B) Electrical reentry
C) Myocardial ischemia
D) Ventricular hypertrophy
Answer: B) Electrical reentry
Rationale: Atrial fibrillation is a common arrhythmia that results
from multiple reentrant wavelets of electrical activity in the atria,
causing irregular and rapid atrial contractions. The reentry can be
triggered by factors such as hypertension, diabetes, ischemia,
inflammation, or electrolyte imbalance, which alter the atrial
tissue properties and create areas of slow conduction or
unidirectional block. Electrical reentry is the most common
mechanism of atrial fibrillation, while increased sympathetic tone,
myocardial ischemia, and ventricular hypertrophy are more likely
to cause other types of arrhythmias.
2. A 50-year-old woman with a history of rheumatoid arthritis and
osteoporosis is admitted to the hospital with a fever, cough, and
dyspnea. She is diagnosed with community-acquired pneumonia
and is started on antibiotics. A chest X-ray reveals a right lower
lobe consolidation. Which of the following is the most likely
pathophysiological process that leads to the formation of
consolidation in pneumonia?
A) Alveolar collapse
B) Bronchial obstruction
C) Inflammatory exudate
D) Pulmonary edema
Answer: C) Inflammatory exudate
,Rationale: Pneumonia is an infection of the lower respiratory tract
that causes inflammation and damage to the alveoli and
bronchioles. The inflammatory response leads to the accumulation
of exudate, which is a fluid rich in cells, proteins, and debris, in the
alveolar spaces. The exudate displaces air and reduces gas
exchange, resulting in consolidation, which is a solidification or
opacification of the lung parenchyma. Alveolar collapse, bronchial
obstruction, and pulmonary edema are other causes of
consolidation, but they are less likely in this case.
3. A 40-year-old man with a history of alcohol abuse and
pancreatitis presents to the clinic with abdominal pain, jaundice,
and weight loss. He is diagnosed with pancreatic cancer and is
referred to an oncologist for further management. Which of the
following is the most likely pathophysiological mechanism of his
jaundice?
A) Hemolysis
B) Hepatocellular dysfunction
C) Biliary obstruction
D) Cholestasis
Answer: C) Biliary obstruction
Rationale: Jaundice is a yellowish discoloration of the skin and
mucous membranes due to elevated levels of bilirubin in the
blood. Bilirubin is a breakdown product of hemoglobin that is
normally conjugated by the liver and excreted into the bile. Biliary
obstruction is a common cause of jaundice in pancreatic cancer, as
the tumor can compress or invade the common bile duct and
prevent the flow of bile into the duodenum. This leads to
increased levels of conjugated bilirubin in the blood and urine, as
well as pale stools and dark urine. Hemolysis, hepatocellular
dysfunction, and cholestasis are other causes of jaundice, but they
are less likely in this case.
4. A 35-year-old woman with a history of systemic lupus
erythematosus (SLE) and chronic steroid use presents to the clinic
, with fatigue, weakness, and muscle pain. She is diagnosed with
adrenal insufficiency and is started on hydrocortisone replacement
therapy. Which of the following is the most likely
pathophysiological type of her adrenal insufficiency?
A) Primary
B) Secondary
C) Tertiary
D) Acute
Answer: B) Secondary
Rationale: Adrenal insufficiency is a condition in which the adrenal
glands produce insufficient amounts of cortisol, which is a steroid
hormone that regulates metabolism, inflammation, immune
response, and stress response. There are different types of adrenal
insufficiency depending on the level of dysfunction in the
hypothalamic-pituitary-adrenal (HPA) axis. Primary adrenal
insufficiency (also known as Addison's disease) is caused by
damage or destruction of the adrenal cortex, which leads to low
levels of cortisol and aldosterone, and high levels of
adrenocorticotropic hormone (ACTH). Secondary adrenal
insufficiency is caused by inadequate stimulation of the adrenal
cortex by ACTH, which leads to low levels of cortisol, normal or low
levels of aldosterone, and low or normal levels of ACTH. Tertiary
adrenal insufficiency is caused by inadequate stimulation of the
pituitary gland by corticotropin-releasing hormone (CRH), which
leads to low levels of cortisol, normal or low levels of aldosterone,
and low levels of ACTH and CRH. Acute adrenal insufficiency (also
known as adrenal crisis) is a life-threatening condition that occurs
when there is a sudden drop in cortisol levels due to stress,
trauma, infection, or withdrawal of steroid therapy. In this case,
the most likely type of adrenal insufficiency is secondary, as
chronic steroid use can suppress the HPA axis and reduce the
production of ACTH.
5. A 60-year-old woman with a history of hypertension,
hyperlipidemia, and smoking presents to the emergency
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