Cellular hypoxia most directly impairs the cell’s ability to:
A) Maintain DNA repair enzymes
B) Synthesize structural protein
C) Generate adenosine triphosphate through oxidative phosphorylation
D) Transport glucose across the membrane
Correct answer: C
Explanation: Oxygen is the final electron acceptor in the electron transport chain, so hypoxia limits oxidative phosphorylation and adenosine triphosphate production.

​

Reversible cell injury is best indicated by:
A) Karyorrhexis
B) Mitochondrial swelling and cellular edema
C) Pyknosis
D) Karyolysis
Correct answer: B
Explanation: Early, reversible injury features hydropic change and organelle swelling, while nuclear fragmentation indicates irreversible injury.

​

Apoptosis differs from necrosis because apoptosis typically:
A) Causes extensive inflammation
B) Results from accidental injury
C) Produces cell shrinkage with membrane blebbing and intact membrane
D) Always follows infection
Correct answer: C
Explanation: Apoptosis is programmed cell death with cell shrinkage and preserved membrane integrity that limits inflammation.

 

The cardinal signs of acute inflammation include:
A) Redness, heat, swelling, pain, and loss of function
B) Cough, fever, rash, nausea, and vomiting
C) Pallor, weakness, thirst, hunger, and insomnia
D) Cyanosis, clubbing, tremor, delirium, and coma
Correct answer: A
Explanation: Vasodilation and increased permeability cause redness, heat, and swelling; mediators contribute to pain and loss of function.

 

Increased vascular permeability during acute inflammation is primarily due to:
A) Platelet aggregation
B) Endothelial contraction caused by chemical mediators
C) Decreased hydrostatic pressure
D) Loss of plasma proteins into lymphatics only
Correct answer: B
Explanation: Histamine and other mediators cause endothelial cells to contract and widen intercellular gaps.

 

The primary phagocytic cells that arrive first to sites of acute bacterial infection are:
A) Lymphocytes
B) Eosinophils
C) Neutrophils
D) Basophils
Correct answer: C
Explanation: Neutrophils are the earliest responders in acute bacterial inflammation.

 

Granulomas characteristically form in response to:
A) Acute pyogenic infection
B) Persistent, poorly degradable agents or some intracellular pathogens
C) Immediate hypersensitivity to pollen
D) Acute toxin exposure only
Correct answer: B
Explanation: Granulomatous inflammation contains activated macrophages that wall off indigestible or persistent stimuli.

 

Delayed wound healing is most directly impaired by deficiency of:
A) Vitamin C
B) Vitamin D
C) Vitamin K
D) Vitamin A
Correct answer: A
Explanation: Vitamin C is required for collagen hydroxylation and stable collagen formation in repair.

 

Type I (immediate) hypersensitivity is mediated mainly by:
A) T lymphocytes only
B) Mast cells bound to immunoglobulin E and release of histamine
C) Immune complexes deposited in tissues
D) Cytotoxic T lymphocyte killing of target cells
Correct answer: B
Explanation: Allergen–immunoglobulin E cross-linking on mast cells triggers mediator release.

 

Type III hypersensitivity is best exemplified by:
A) Anaphylaxis
B) Autoimmune hemolysis
C) Immune complex deposition causing tissue inflammation
D) Contact dermatitis
Correct answer: C
Explanation: Preformed antigen–antibody complexes deposit in vessels and tissues, activating complement.

 

Edema results when:
A) Plasma oncotic pressure rises
B) Lymphatic drainage increases
C) Capillary hydrostatic pressure increases or plasma oncotic pressure falls
D) Interstitial hydrostatic pressure rises above plasma oncotic pressure
Correct answer: C
Explanation: Fluid shifts into the interstitium with increased capillary pressure or decreased plasma proteins.

 

A thrombus that dislodges and travels to a distant site is called:
A) A hematoma
B) An embolus
C) A petechia
D) A purpura
Correct answer: B
Explanation: A mobile intravascular mass is an embolus.

 

Shock from severe blood loss is primarily:
A) Distributive shock
B) Cardiogenic shock
C) Hypovolemic shock
D) Obstructive shock
Correct answer: C
Explanation: Hemorrhage reduces circulating volume and venous return, lowering cardiac output.

 

Atherosclerotic plaque formation begins with:
A) Smooth muscle apoptosis
B) Endothelial injury and lipid accumulation in the intima
C) Immediate calcification of the media
D) Acute bacterial infection of the vessel wall
Correct answer: B
Explanation: Endothelial dysfunction and low-density lipoprotein infiltration initiate fatty streaks.

 

Left-sided heart failure most commonly leads to:
A) Peripheral edema and hepatomegaly first
B) Pulmonary congestion and dyspnea
C) Portal hypertension
D) Increased urinary output
Correct answer: B
Explanation: Reduced left ventricular output raises pulmonary venous pressure causing lung congestion.

 

Right-sided heart failure commonly causes:
A) Pulmonary edema without peripheral signs
B) Peripheral edema, jugular venous distension, and hepatomegaly
C) Hematemesis
D) Hematuria only
Correct answer: B
Explanation: Systemic venous congestion produces dependent edema and liver enlargement.

 

Myocardial ischemia occurs when:
A) Coronary blood supply is insufficient for myocardial oxygen demand
B) Systemic arterial pressure is increased
C) Venous return exceeds cardiac output
D) The sinoatrial node fails
Correct answer: A
Explanation: Imbalance of supply and demand causes ischemia and potential infarction.

 

Anemia is defined physiologically as:
A) Increased blood viscosity
B) Reduced oxygen-carrying capacity due to low hemoglobin or red cell number
C) Increased plasma volume
D) Increased platelet count
Correct answer: B
Explanation: Anemia lowers tissue oxygen delivery.

 

Iron deficiency anemia typically shows:
A) Large red cells with increased hemoglobin
B) Small, pale red cells with low hemoglobin
C) Normal-sized red cells with high hemoglobin
D) Fragmented red cells with high iron stores
Correct answer: B
Explanation: Iron deficiency impairs hemoglobin synthesis, producing microcytic, hypochromic cells.

 

Sickle cell disease pathophysiology centers on:
A) Loss of membrane cholesterol
B) Abnormal hemoglobin polymerization under low oxygen tension
C) Excess iron deposition in red cells
D) Lack of erythropoietin production
Correct answer: B
Explanation: Hemoglobin S polymerizes when deoxygenated, distorting red cells and obstructing microcirculation.

 

Chronic obstructive pulmonary disease airflow limitation is primarily due to:
A) Acute airway spasm only
B) Small airway remodeling and alveolar destruction leading to airflow obstruction
C) Increased chest wall elasticity
D) Low carbon dioxide production
Correct answer: B
Explanation: Chronic inflammation remodels airways and destroys alveoli, narrowing and collapsing airways.

 

Asthma pathophysiology prominently features:
A) Fixed airway scarring without inflammation
B) Reversible airway narrowing, bronchial hyperresponsiveness, and inflammation
C) Loss of alveolar walls without mucus
D) Pulmonary vascular thrombosis only
Correct answer: B
Explanation: Airway smooth muscle constriction and inflammation produce variable airflow limitation.

 

Pneumonia impairs gas exchange primarily by:
A) Decreasing tidal volume permanently
B) Filling alveoli with inflammatory exudate
C) Increasing surfactant production
D) Removing carbon dioxide faster
Correct answer: B
Explanation: Exudate-filled alveoli reduce ventilation–perfusion matching and diffusion.

 

Pulmonary embolism most immediately causes:
A) Increased alveolar ventilation to all lung units
B) Ventilation–perfusion mismatch with dead space ventilation
C) Bronchospasm in all airways
D) Increased surfactant in embolized segments
Correct answer: B
Explanation: Perfusion to an area ceases while ventilation continues, creating dead space.

 

Acute kidney injury prerenal type is commonly due to:
A) Obstruction of the ureter
B) Severe dehydration reducing renal perfusion
C) Intrinsic glomerular disease
D) Toxic damage to tubules only
Correct answer: B
Explanation: Low effective arterial blood volume reduces glomerular filtration.

 

Nephrotic syndrome is characterized by:
A) Massive proteinuria with hypoalbuminemia and edema
B) Hematuria without protein loss
C) Oliguria and azotemia only
D) Kidney stones
Correct answer: A
Explanation: Increased glomerular permeability to protein lowers plasma oncotic pressure, causing edema.

 

Liver cirrhosis leads to portal hypertension by:
A) Increased pulmonary resistance
B) Fibrosis and nodular regeneration that distort hepatic architecture
C) Increased kidney perfusion
D) Increased bile production
Correct answer: B
Explanation: Fibrotic scarring raises intrahepatic resistance to portal blood flow.

 

Jaundice results when:
A) Bilirubin production decreases
B) Bilirubin accumulates in tissues due to impaired metabolism or excretion
C) Red cell mass increases
D) Bile salts decrease
Correct answer: B
Explanation: Elevated circulating bilirubin deposits in skin and sclera.

 

Type 1 diabetes mellitus pathophysiology involves:
A) Peripheral insulin resistance only
B) Autoimmune destruction of pancreatic beta cells causing insulin deficiency
C) Excess glucagon suppression
D) Overproduction of insulin by alpha cells
Correct answer: B
Explanation: Immune-mediated beta cell loss leads to absolute insulin deficiency.

 

Type 2 diabetes mellitus is primarily characterized by:
A) Absolute lack of insulin
B) Peripheral insulin resistance and relative insulin deficiency
C) Autoimmune islet cell destruction
D) Pancreatic enzyme deficiency
Correct answer: B
Explanation: Target tissues respond poorly to insulin, and secretion is often inadequate for demand.

 

Hyperthyroidism commonly results in:
A) Slowed basal metabolic rate, cold intolerance, and bradycardia
B) Increased basal metabolic rate, heat intolerance, and tachycardia
C) Hypercalcemia only
D) Severe neutropenia
Correct answer: B
Explanation: Excess thyroid hormone increases metabolic processes and sympathetic effects.

 

Hypothyroidism commonly causes:
A) Heat intolerance and weight loss
B) Cold intolerance, weight gain tendency, and bradycardia
C) Severe hypertension in all cases
D) Increased deep tendon reflexes
Correct answer: B
Explanation: Low thyroid hormone slows metabolism and reduces heart rate.

 

Cushing syndrome pathophysiology features:
A) Cortisol deficiency
B) Prolonged exposure to excess cortisol increasing gluconeogenesis and protein catabolism
C) Excess aldosterone only
D) Increased insulin sensitivity
Correct answer: B
Explanation: Cortisol excess alters carbohydrate, protein, and fat metabolism and suppresses immunity.

 

Addison disease involves:
A) Excess cortisol and aldosterone
B) Primary adrenal insufficiency with cortisol ± aldosterone deficiency
C) Excess thyroid hormone
D) Growth hormone excess
Correct answer: B
Explanation: Adrenal cortex failure reduces glucocorticoids and often mineralocorticoids.

 

Syndrome of inappropriate antidiuretic hormone secretion leads to:
A) Hypernatremia
B) Hyponatremia due to water retention
C) Hyperkalemia from aldosterone excess
D) Metabolic acidosis
Correct answer: B
Explanation: Excess antidiuretic hormone causes water retention that dilutes plasma sodium.

 

Metabolic acidosis is defined by:
A) Increased blood pH and bicarbonate
B) Decreased blood pH with low bicarbonate
C) Increased carbon dioxide causing high pH
D) Normal bicarbonate with high pH
Correct answer: B
Explanation: Primary bicarbonate loss or acid accumulation lowers pH.

 

Respiratory alkalosis is most directly caused by:
A) Hypoventilation
B) Hyperventilation lowering carbon dioxide
C) Increased bicarbonate loss in urine
D) Lactic acid accumulation
Correct answer: B
Explanation: Excess ventilation decreases carbon dioxide, raising pH.

 

Ischemic stroke pathophysiology typically involves:
A) Intracranial hemorrhage into brain parenchyma
B) Thrombotic or embolic occlusion causing focal brain ischemia
C) Peripheral nerve demyelination
D) Global hypoxia only
Correct answer: B
Explanation: Arterial blockage reduces blood flow to a brain region.

 

Parkinson disease pathophysiology includes loss of:
A) Serotonergic neurons in the brainstem
B) Dopaminergic neurons in the substantia nigra with striatal dopamine depletion
C) Cortical pyramidal neurons
D) Peripheral motor neurons
Correct answer: B
Explanation: Dopamine deficiency disrupts basal ganglia circuits controlling movement.

 

Multiple sclerosis involves:
A) Peripheral nerve axon degeneration only
B) Immune-mediated demyelination in the central nervous system
C) Pure muscle disease
D) Bone marrow failure
Correct answer: B
Explanation: Inflammatory demyelination produces neurological deficits separated in time and space.

 

Osteoporosis pathophysiology is best described as:
A) Increased bone formation
B) Reduced bone mass and microarchitectural deterioration
C) Inflammation of bone marrow
D) Excess mineralization
Correct answer: B
Explanation: Bone resorption exceeds formation, reducing bone strength.

 

Rheumatoid arthritis joint damage is driven mainly by:
A) Pure mechanical wear
B) Autoimmune synovial inflammation with pannus formation
C) Crystals of monosodium urate
D) Bacterial infection in all cases
Correct answer: B
Explanation: Immune-mediated synovitis erodes cartilage and bone.

 

Gout results from:
A) Calcium pyrophosphate deposition
B) Monosodium urate crystal deposition due to hyperuricemia
C) Low serum calcium
D) Excess vitamin C
Correct answer: B
Explanation: Elevated uric acid precipitates crystals that trigger inflammation.

 

Benign tumors are distinguished from malignant tumors by:
A) Ability to invade and metastasize
B) Slow growth and lack of invasion or metastasis
C) Presence of necrosis only
D) Lack of blood supply
Correct answer: B
Explanation: Malignancy is defined by invasion and potential metastasis; benign tumors remain localized.

 

Hallmarks of cancer include:
A) Increased apoptosis only
B) Sustained proliferative signaling, evasion of growth suppressors, and ability to invade and metastasize
C) Complete dependence on external growth factors
D) Perfect DNA repair
Correct answer: B
Explanation: Cancers share core biological capabilities enabling growth and spread.

 

Paraneoplastic syndromes are:
A) Direct tumor mass effects
B) Symptoms caused by tumor-derived substances or immune cross-reaction distant from tumor
C) Metastases only
D) Benign cysts
Correct answer: B
Explanation: Tumor products or immune responses produce systemic effects unrelated to local tumor presence.

 

Sepsis pathophysiology features:
A) Localized inflammation only
B) Dysregulated host response to infection leading to organ dysfunction
C) Purely allergic reaction
D) Autoimmune attack without microbes
Correct answer: B
Explanation: Widespread inflammatory and coagulation changes cause tissue hypoperfusion and failure.

 

Disseminated intravascular coagulation is characterized by:
A) Isolated thrombocytosis
B) Widespread microthrombi with consumption of platelets and clotting factors causing bleeding
C) Pure platelet function defects
D) Stable coagulation
Correct answer: B
Explanation: Systemic activation of coagulation leads to both thrombosis and bleeding.

 

Hypertension causes left ventricular hypertrophy primarily by:
A) Decreasing afterload
B) Increasing afterload and wall stress
C) Increasing venous return
D) Reducing systemic resistance
Correct answer: B
Explanation: The ventricle adapts to chronic pressure overload with hypertrophy.

 

Aortic stenosis pathophysiology leads to:
A) Volume overload of the left ventricle
B) Pressure overload of the left ventricle with concentric hypertrophy
C) Right ventricular failure first
D) Mitral regurgitation only
Correct answer: B
Explanation: Obstruction to outflow increases systolic wall stress.

 

Mitral regurgitation primarily causes:
A) Pressure overload of the left ventricle
B) Volume overload of the left atrium and ventricle
C) Right-to-left shunt
D) Aortic dilation
Correct answer: B
Explanation: Backflow during systole increases chamber volumes.

 

Anaphylaxis pathophysiology involves:
A) Immune complex deposition only
B) Rapid, systemic mast cell degranulation due to immunoglobulin E–mediated hypersensitivity
C) T lymphocyte cytotoxicity only
D) Pure psychogenic response
Correct answer: B
Explanation: Widespread mediator release causes vasodilation, bronchospasm, and shock.

 

Hemophilia A results from deficiency of:
A) Clotting factor VIII
B) Clotting factor IX
C) Fibrinogen
D) Vitamin K
Correct answer: A
Explanation: Classic hemophilia A is factor VIII deficiency causing impaired intrinsic coagulation.

 

Vitamin K deficiency impairs coagulation because:
A) It removes platelets from blood
B) It prevents gamma-carboxylation of several clotting factors needed to bind calcium
C) It destroys fibrin
D) It increases fibrinolysis
Correct answer: B
Explanation: Gamma-carboxylation is required for factor activity on phospholipid surfaces.

 

Obstructive jaundice from gallstones causes pale stool because:
A) More bile pigments enter the intestine
B) Less bile reaches the intestine, reducing pigment in stool
C) Red cells are destroyed faster
D) The pancreas secretes extra pigment
Correct answer: B
Explanation: Bile flow blockage prevents bilirubin from entering the gut.

 

Helicobacter pylori contributes to peptic ulcer formation mainly by:
A) Increasing gastric mucosal defenses
B) Producing inflammation and toxins that weaken mucosal protection
C) Neutralizing stomach acid entirely
D) Increasing gastric blood flow only
Correct answer: B
Explanation: Infection induces mucosal damage and increases susceptibility to acid injury.

 

Gastroesophageal reflux disease pathophysiology involves:
A) Hypertonic lower esophageal sphincter
B) Transient relaxation or hypotonia of the lower esophageal sphincter allowing acid reflux
C) Absence of gastric acid
D) Increased upper esophageal sphincter pressure
Correct answer: B
Explanation: Incompetent barrier permits acidic gastric contents to contact the esophagus.

 

Ulcerative colitis primarily affects:
A) The entire gastrointestinal tract with skip lesions
B) The colon and rectum with continuous mucosal inflammation
C) Only the stomach
D) Only the small intestine
Correct answer: B
Explanation: It involves continuous mucosal disease beginning in the rectum.

 

Crohn disease is characterized by:
A) Mucosal-only continuous lesions
B) Transmural, patchy inflammation that can affect any gastrointestinal segment
C) Exclusive rectal involvement
D) Only infectious ulcers
Correct answer: B
Explanation: Crohn disease has skip lesions and transmural inflammation.

 

Alcoholic liver disease early changes include:
A) Massive fibrosis first
B) Fat accumulation in hepatocytes (steatosis)
C) Complete regeneration without fat
D) Pure cholestasis only
Correct answer: B
Explanation: Steatosis precedes steatohepatitis and fibrosis with continued injury.

 

Acute pancreatitis is most directly caused by:
A) Autoimmune attack on beta cells
B) Premature activation of digestive enzymes within the pancreas
C) Lack of protein intake
D) Excess bicarbonate secretion
Correct answer: B
Explanation: Intrapancreatic enzyme activation injures acinar cells and triggers inflammation.

 

Hyperventilation in metabolic acidosis is a compensatory response aiming to:
A) Retain carbon dioxide
B) Lower carbon dioxide to raise pH
C) Raise bicarbonate directly
D) Increase lactic acid
Correct answer: B
Explanation: Respiratory compensation reduces carbon dioxide to buffer the acidosis.

 

Hyponatremia due to excess water intake produces cerebral symptoms mainly because:
A) Sodium enters neurons
B) Water shifts into brain cells causing cellular swelling
C) Blood pressure rises
D) Calcium falls
Correct answer: B
Explanation: Hypo-osmolality drives water into cells, increasing intracranial pressure.

 

Hyperkalemia can cause life-threatening:
A) Skin rash
B) Cardiac conduction abnormalities and arrhythmias
C) Bone fractures
D) Diuresis
Correct answer: B
Explanation: Elevated potassium disturbs resting membrane potential and conduction.

 

Hypocalcemia increases neuromuscular excitability by:
A) Stabilizing neuronal membranes
B) Lowering threshold for action potential generation
C) Decreasing sodium channel activity
D) Increasing bone mineralization
Correct answer: B
Explanation: Low ionized calcium facilitates sodium entry and excitability.

 

Acute inflammation systemic effects include:
A) Hypothermia
B) Fever, elevated acute-phase proteins, and leukocytosis
C) Absolute lymphopenia only
D) Decreased hepatic protein synthesis
Correct answer: B
Explanation: Cytokines induce fever and acute-phase protein production.

 

Vitamin B12 deficiency anemia is associated with:
A) Microcytic red cells
B) Macrocytic red cells due to impaired DNA synthesis
C) Normal-sized red cells with excess hemoglobin
D) Hemolysis only
Correct answer: B
Explanation: Ineffective DNA synthesis produces large erythroid precursors and macrocytosis.

 

Hemolytic anemia increases:
A) Plasma haptoglobin
B) Indirect (unconjugated) bilirubin and lactate dehydrogenase
C) Red cell lifespan
D) Serum iron-binding capacity
Correct answer: B
Explanation: Red cell destruction releases hemoglobin and enzymes, consuming haptoglobin and raising bilirubin.

 

Human immunodeficiency virus pathophysiology primarily involves loss of:
A) Neutrophils
B) CD4-positive helper T lymphocytes
C) Platelets
D) Eosinophils
Correct answer: B
Explanation: Viral replication destroys helper T cells, impairing immunity.

 

Autoimmunity arises when:
A) Tolerance to self antigens fails
B) Pathogens are eliminated
C) Antibodies only bind food antigens
D) Bone marrow stops producing leukocytes
Correct answer: A
Explanation: Failure of central or peripheral tolerance permits self-reactive lymphocytes to act.

 

Allergic asthma airway obstruction is partly due to:
A) Alveolar fibrosis only
B) Bronchial smooth muscle contraction and mucus hypersecretion
C) Destruction of alveolar septa
D) Pulmonary emboli
Correct answer: B
Explanation: Mediators induce bronchospasm and mucus, narrowing airways.

 

Obesity contributes to insulin resistance by:
A) Increasing insulin receptor number
B) Adipokine dysregulation and ectopic lipid interfering with insulin signaling
C) Eliminating free fatty acids
D) Enhancing glucose transporter translocation
Correct answer: B
Explanation: Inflammatory signals and lipid in muscle and liver blunt insulin action.

 

Nonalcoholic fatty liver disease is most closely linked to:
A) Severe protein deficiency
B) Insulin resistance and metabolic syndrome
C) Acute viral infection only
D) High calcium diet
Correct answer: B
Explanation: Insulin resistance promotes hepatic fat accumulation and inflammation.

 

Acute respiratory distress syndrome pathophysiology involves:
A) Airway smooth muscle spasm only
B) Diffuse alveolar damage with increased permeability and noncardiogenic pulmonary edema
C) Pure right heart failure
D) Airway foreign body
Correct answer: B
Explanation: Injury to alveolar–capillary barrier causes protein-rich edema and hypoxemia.

 

Sickle cell vaso-occlusive crises are precipitated by:
A) Hyperoxygenation
B) Dehydration, hypoxia, or acidosis promoting hemoglobin S polymerization
C) Excess iron therapy
D) High calcium intake
Correct answer: B
Explanation: These conditions favor polymerization and red cell sickling.

 

Hypercoagulability may be increased by:
A) Antithrombin deficiency or factor V mutation that resists inactivation
B) Low fibrinogen
C) Thrombocytopenia
D) Low prothrombin
Correct answer: A
Explanation: Reduced natural anticoagulant function promotes thrombosis.

 

Aortic aneurysm risk increases with:
A) Decreased blood pressure
B) Degenerative loss of elastic tissue in the media and hypertension
C) Increased collagen cross-linking
D) Low lipid levels
Correct answer: B
Explanation: Structural weakening and pressure stress dilate the aorta.

 

Hypertrophic cardiomyopathy obstructive physiology is due to:
A) Dilated ventricle
B) Thickened interventricular septum and systolic anterior motion of the mitral valve
C) Thin ventricular walls
D) Right ventricular outflow stenosis only
Correct answer: B
Explanation: Septal hypertrophy and mitral movement narrow the left ventricular outflow tract.

 

Baroreceptor reflex in acute hemorrhage acts to:
A) Lower heart rate
B) Increase heart rate and systemic vascular resistance to maintain pressure
C) Reduce renin release
D) Increase urine output immediately
Correct answer: B
Explanation: Decreased stretch increases sympathetic output to preserve perfusion.

 

True or false: Cellular swelling is an early, reversible response to hypoxic injury.
Correct answer: True
Explanation: Loss of adenosine triphosphate impairs ion pumps, causing osmotic water gain.

 

True or false: Necrosis is a regulated, noninflammatory process of cell death.
Correct answer: False
Explanation: Necrosis is unregulated, often ruptures membranes, and incites inflammation.

 

True or false: Chronic inflammation features macrophages, lymphocytes, and tissue repair with fibrosis.
Correct answer: True
Explanation: Persistent stimuli recruit mononuclear cells and promote scarring.

 

True or false: Immune complex–mediated disease results from antibodies binding directly to cell surface antigens only.
Correct answer: False
Explanation: Type III hypersensitivity involves circulating complexes depositing in tissues.

 

True or false: Shock from sepsis is due to profound vasodilation, capillary leak, and cellular metabolic dysfunction.
Correct answer: True
Explanation: Dysregulated mediators cause distributive shock and impaired oxygen use.

 

True or false: In heart failure, activation of the renin–angiotensin–aldosterone system reduces afterload and improves long-term outcomes.
Correct answer: False
Explanation: It initially compensates but chronically increases afterload and fluid retention, worsening failure.

 

True or false: In restrictive lung disease, total lung capacity is typically reduced.
Correct answer: True
Explanation: Fibrosis or chest wall restriction limits expansion and volume.

 

True or false: In obstructive lung disease, the ratio of forced expiratory volume in one second to forced vital capacity is usually increased.
Correct answer: False
Explanation: Airflow limitation reduces the ratio.

 

True or false: In metabolic alkalosis, the kidneys typically excrete bicarbonate when volume and chloride are adequate.
Correct answer: True
Explanation: Renal compensation reduces bicarbonate to restore pH when not volume depleted.

 

True or false: Severe hyponatremia may cause seizures due to cerebral edema.
Correct answer: True
Explanation: Low plasma osmolality drives water into neurons, increasing excitability.

 

Fill in the blank: The cellular machinery that tags proteins for degradation uses ____________________________ to mark them for the proteasome.
Correct answer: ubiquitin
Explanation: Ubiquitinylation targets proteins for proteasomal breakdown.

 

Fill in the blank: The irreversible nuclear changes of cell death include pyknosis, ____________________________, and karyolysis.
Correct answer: karyorrhexis
Explanation: Nuclear condensation, fragmentation, and dissolution mark irreversible injury.

 

Fill in the blank: During acute inflammation, endothelial contraction creates ____________________________ that increase vascular permeability.
Correct answer: intercellular gaps
Explanation: Gaps allow plasma proteins and fluid to exit vessels.

 

Fill in the blank: The protein-rich edema seen in acute respiratory distress syndrome is called ____________________________ edema.
Correct answer: noncardiogenic
Explanation: Permeability, not hydrostatic pressure, causes this edema.

 

Fill in the blank: The earliest gross lesion of atherosclerosis is the ____________________________ streak.
Correct answer: fatty
Explanation: Lipid-laden foam cells form fatty streaks.

 

Fill in the blank: Persistent high arterial pressure produces left ventricular ____________________________.
Correct answer: hypertrophy
Explanation: Chronic pressure overload stimulates myocyte growth.

 

Fill in the blank: In iron deficiency, red cells are ____________________________ and ____________________________.
Correct answer: microcytic; hypochromic
Explanation: Small cells with low hemoglobin reflect iron lack.

 

Fill in the blank: The compensatory respiratory response to metabolic acidosis is called ____________________________ ventilation.
Correct answer: hyperventilation
Explanation: Lowering carbon dioxide helps raise pH.

 

Fill in the blank: In nephrotic syndrome, loss of plasma proteins lowers plasma ____________________________ pressure, promoting edema.
Correct answer: oncotic
Explanation: Reduced oncotic pull favors interstitial fluid accumulation.

 

Fill in the blank: Excess antidiuretic hormone causes dilutional ____________________________.
Correct answer: hyponatremia
Explanation: Water retention dilutes sodium concentration.

 

Short answer: Define reversible cell injury in one sentence.
Correct answer: Reversible cell injury includes functional and structural changes like cellular swelling and fatty change that return to normal if the stress is removed.
Explanation: Energy production and ion gradients recover when the insult ceases.

 

Short answer: Explain why immune complex deposition causes tissue damage.
Correct answer: Deposited antigen–antibody complexes activate complement and recruit inflammatory cells that release enzymes and oxidants, injuring tissues.
Explanation: Complement and leukocyte mediators damage local structures.

 

Short answer: State how left-sided heart failure can lead to shortness of breath.
Correct answer: Elevated left atrial and pulmonary venous pressures cause pulmonary capillary transudation, reducing gas exchange and causing dyspnea.
Explanation: Fluid in alveoli impairs oxygen diffusion.

 

Short answer: Describe how chronic hyperglycemia damages small blood vessels.
Correct answer: Persistent high glucose leads to nonenzymatic glycation of proteins and thickening of basement membranes, reducing perfusion and causing microvascular disease.
Explanation: Glycation and oxidative stress impair microcirculation.

 

Short answer: Why does portal hypertension cause ascites?
Correct answer: Increased portal venous pressure and low albumin raise hydrostatic pressure and lower oncotic pressure, shifting fluid into the peritoneal cavity.
Explanation: Starling forces favor fluid movement out of vessels.

 

Short answer: What is the key difference between ulcerative colitis and Crohn disease in distribution?
Correct answer: Ulcerative colitis affects colon and rectum in a continuous pattern, while Crohn disease has patchy, transmural lesions anywhere from mouth to anus.
Explanation: Continuity and depth of inflammation differ.

 

Short answer: How does hyperventilation alter blood pH?
Correct answer: Hyperventilation reduces arterial carbon dioxide, shifting the bicarbonate buffer to raise pH and cause respiratory alkalosis.
Explanation: Carbon dioxide is acidic; lowering it increases pH.

 

Short answer: Explain why dehydration can precipitate sickling in sickle cell disease.
Correct answer: Dehydration increases intracellular hemoglobin concentration, promoting polymerization and red cell sickling at lower oxygen levels.
Explanation: Concentrated hemoglobin S favors polymer formation.

 

Short answer: Why is vitamin C important in wound healing?
Correct answer: Vitamin C is required for hydroxylation of proline and lysine in collagen, stabilizing collagen cross-links for strong scar formation.
Explanation: Without hydroxylation, collagen is weak.

 

Short answer: What is a granuloma and why does it form?
Correct answer: A granuloma is a collection of activated macrophages and lymphocytes that forms to contain persistent, poorly degradable substances or pathogens.
Explanation: It walls off resistant stimuli.