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

​

Reversible cell injury is best indicated by:
A) Karyorrhexis
B) Mitochondrial swelling and cellular edema
C) Pyknosis
D) Karyolysis

​

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

​

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

​

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

​

The primary phagocytic cells that arrive first to sites of acute bacterial infection are:
A) Lymphocytes
B) Eosinophils
C) Neutrophils
D) Basophils

​

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

​

Delayed wound healing is most directly impaired by deficiency of:
A) Vitamin C
B) Vitamin D
C) Vitamin K
D) Vitamin A

​

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

​

Type III hypersensitivity is best exemplified by:
A) Anaphylaxis
B) Autoimmune hemolysis
C) Immune complex deposition causing tissue inflammation
D) Contact dermatitis

​

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

​

A thrombus that dislodges and travels to a distant site is called:
A) A hematoma
B) An embolus
C) A petechia
D) A purpura

​

Shock from severe blood loss is primarily:
A) Distributive shock
B) Cardiogenic shock
C) Hypovolemic shock
D) Obstructive shock

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

Addison disease involves:
A) Excess cortisol and aldosterone
B) Primary adrenal insufficiency with cortisol ± aldosterone deficiency
C) Excess thyroid hormone
D) Growth hormone excess

​

Syndrome of inappropriate antidiuretic hormone secretion leads to:
A) Hypernatremia
B) Hyponatremia due to water retention
C) Hyperkalemia from aldosterone excess
D) Metabolic acidosis

​

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

​

Respiratory alkalosis is most directly caused by:
A) Hypoventilation
B) Hyperventilation lowering carbon dioxide
C) Increased bicarbonate loss in urine
D) Lactic acid accumulation

​

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

​

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

​

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

​

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

​

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

​

Gout results from:
A) Calcium pyrophosphate deposition
B) Monosodium urate crystal deposition due to hyperuricemia
C) Low serum calcium
D) Excess vitamin C

​

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

​

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

​

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

​

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

​

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

​

Hypertension causes left ventricular hypertrophy primarily by:
A) Decreasing afterload
B) Increasing afterload and wall stress
C) Increasing venous return
D) Reducing systemic resistance

 

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

​

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

​

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

​

Hemophilia A results from deficiency of:
A) Clotting factor VIII
B) Clotting factor IX
C) Fibrinogen
D) Vitamin K

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

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

​

Hyperkalemia can cause life-threatening:
A) Skin rash
B) Cardiac conduction abnormalities and arrhythmias
C) Bone fractures
D) Diuresis

​

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

​

Acute inflammation systemic effects include:
A) Hypothermia
B) Fever, elevated acute-phase proteins, and leukocytosis
C) Absolute lymphopenia only
D) Decreased hepatic protein synthesis

​

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

​

Hemolytic anemia increases:
A) Plasma haptoglobin
B) Indirect (unconjugated) bilirubin and lactate dehydrogenase
C) Red cell lifespan
D) Serum iron-binding capacity

​

Human immunodeficiency virus pathophysiology primarily involves loss of:
A) Neutrophils
B) CD4-positive helper T lymphocytes
C) Platelets
D) Eosinophils

​

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

​

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

​

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

​

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

​

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

​

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

​

Hypercoagulability may be increased by:
A) Antithrombin deficiency or factor V mutation that resists inactivation
B) Low fibrinogen
C) Thrombocytopenia
D) Low prothrombin

​

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

​

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

​

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

​

True or false: Cellular swelling is an early, reversible response to hypoxic injury.

​

True or false: Necrosis is a regulated, noninflammatory process of cell death.

​

True or false: Chronic inflammation features macrophages, lymphocytes, and tissue repair with fibrosis.

​

True or false: Immune complex–mediated disease results from antibodies binding directly to cell surface antigens only.

​

True or false: Shock from sepsis is due to profound vasodilation, capillary leak, and cellular metabolic dysfunction.

​

True or false: In heart failure, activation of the renin–angiotensin–aldosterone system reduces afterload and improves long-term outcomes.

 

True or false: In restrictive lung disease, total lung capacity is typically reduced.

 

True or false: In obstructive lung disease, the ratio of forced expiratory volume in one second to forced vital capacity is usually increased.

 

True or false: In metabolic alkalosis, the kidneys typically excrete bicarbonate when volume and chloride are adequate.

 

True or false: Severe hyponatremia may cause seizures due to cerebral edema.

 

Fill in the blank: The cellular machinery that tags proteins for degradation uses ____________________________ to mark them for the proteasome.

 

Fill in the blank: The irreversible nuclear changes of cell death include pyknosis, ____________________________, and karyolysis.

 

Fill in the blank: During acute inflammation, endothelial contraction creates ____________________________ that increase vascular permeability.

 

Fill in the blank: The protein-rich edema seen in acute respiratory distress syndrome is called ____________________________ edema.

 

Fill in the blank: The earliest gross lesion of atherosclerosis is the ____________________________ streak.

 

Fill in the blank: Persistent high arterial pressure produces left ventricular ____________________________.

 

Fill in the blank: In iron deficiency, red cells are ____________________________ and ____________________________.

 

Fill in the blank: The compensatory respiratory response to metabolic acidosis is called ____________________________ ventilation.

 

Fill in the blank: In nephrotic syndrome, loss of plasma proteins lowers plasma ____________________________ pressure, promoting edema.

 

Fill in the blank: Excess antidiuretic hormone causes dilutional ____________________________.

 

Short answer: Define reversible cell injury in one sentence.

 

Short answer: Explain why immune complex deposition causes tissue damage.

 

Short answer: State how left-sided heart failure can lead to shortness of breath.

 

Short answer: Describe how chronic hyperglycemia damages small blood vessels.

 

Short answer: Why does portal hypertension cause ascites?

 

Short answer: What is the key difference between ulcerative colitis and Crohn disease in distribution?

 

Short answer: How does hyperventilation alter blood pH?

 

Short answer: Explain why dehydration can precipitate sickling in sickle cell disease.

 

Short answer: Why is vitamin C important in wound healing?

 

Short answer: What is a granuloma and why does it form?