Cardiac
Respira
tory
renal
Respira
tory
Cardiac
100

Question:
A 30 year old female presents with fever, flank pain, and costovertebral angle tenderness. He also reports dysuria and urinary frequency for the past several days. Which of the following statements best describes the pathophysiology of acute pyelonephritis?

A. Viral infection of the renal parenchyma triggers a cytokine storm, resulting in acute tubular necrosis.
B. Direct hematogenous spread of pathogens from the lungs commonly leads to pyelonephritis.
C. Bacteria ascend from the lower urinary tract (bladder) to the renal pelvis, causing inflammation of the kidney.
D. Immune complexes deposit in the glomeruli, leading to an autoimmune reaction within the renal cortex.

What is C. Bacteria ascend from the lower urinary tract (bladder) to the renal pelvis, causing inflammation of the kidney.

100

A 68-year-old man presents to the emergency department with complaints of palpitations, fatigue, and shortness of breath. An electrocardiogram (EKG) reveals an irregularly irregular rhythm with no discernible P waves and a heart rate of 130 beats per minute. Which of the following best describes the pathophysiologic mechanism underlying his condition?

  • A. Disorganized atrial electrical activity leading to ineffective atrial contractions

  • B. Ventricular re-entrant circuits resulting in sustained tachycardia

  • C. Atrioventricular (AV) nodal block causing a regular, slow ventricular rate

  • D. Prolonged PR interval delaying conduction from the atria to the ventricles

What is 

A. Disorganized atrial electrical activity leading to ineffective atrial contractions

100

Which of the following is the primary function of the kidneys?

A. Synthesize digestive enzymes

B. Filter blood and excrete waste products

C. Produce bile for fat digestion

D. Store glycogen for energy regulation

What is 

B. Filter blood and excrete waste products



100

A 28-year-old woman presents with recurrent episodes of wheezing, shortness of breath, and chest tightness, which are often triggered by exposure to pet dander and exercise. Which of the following best describes the underlying pathophysiologic mechanism of her condition, asthma?

A. Chronic inflammation leading to airway hyperresponsiveness, bronchoconstriction, and increased mucus production

B. Direct viral infection of the bronchial epithelium resulting in permanent airway remodeling

C. Destruction of alveolar walls reducing the elastic recoil necessary for expiration

D. Left ventricular dysfunction causing pulmonary congestion and reactive airway narrowing

 What is 

A. Chronic inflammation leading to airway hyperresponsiveness, bronchoconstriction, and increased mucus production



100

A 68-year-old woman with a history of chronic heart failure presents with increasing fatigue, peripheral edema, and abdominal distension. On physical exam, you note elevated jugular venous pressure and hepatomegaly. Which of the following best explains the underlying pathophysiologic process in right-sided heart failure?

  • A. Reduced left ventricular contractility leading to pulmonary congestion

  • B. Impaired right ventricular function resulting in systemic venous congestion

  • C. Aortic stenosis causing increased afterload and myocardial ischemia

  • D. Pericardial effusion limiting diastolic filling of the heart

What is
B. Impaired right ventricular function resulting in systemic venous congestion



200

Question:
A 45-year-old patient with a history of intravenous drug use presents with fever, malaise, and a new cardiac murmur. Which of the following best describes the pathophysiologic process underlying his condition?

  • A. Deposition of cholesterol plaques in the coronary arteries leading to myocardial infarction

  • B. Autoimmune-mediated inflammation of the myocardium leading to conduction abnormalities

  • C. Damage to the endocardial surface with subsequent deposition of platelets and fibrin, forming vegetations that become colonized by bacteria

  • D. Thickening and calcification of the aortic valve resulting in impaired valve function

What is C. Damage to the endocardial surface with subsequent deposition of platelets and fibrin, forming vegetations that become colonized by bacteria

200

A 65-year-old woman with severe kyphoscoliosis presents with shortness of breath and fatigue during daily activities. Her chest wall appears rigid and exhibits limited movement during respiration. Which of the following best describes how her condition affects the mechanics of breathing?

  • A. Increased lung compliance reduces the work of breathing

  • B. Decreased chest wall compliance leads to reduced tidal volume and increased work of breathing

  • C. Enhanced diaphragmatic excursion improves alveolar ventilation

  • D. Decreased airway resistance facilitates expiratory flow

What is 

B. Decreased chest wall compliance leads to reduced tidal volume and increased work of breathing

200

A 28-year-old female presents to the clinic with dysuria, increased urinary frequency, and suprapubic discomfort. Laboratory results confirm a urinary tract infection. Which of the following best explains the pathophysiology behind her symptoms?

A. Bacteria ascend from the urethra to the bladder, adhering to uroepithelial cells via fimbriae, which triggers an inflammatory response.

B. A reduction in glomerular filtration rate leads to the accumulation of metabolic waste products, causing irritation of the urinary tract.

C. An autoimmune reaction targets the bladder mucosa, resulting in inflammation and pain.

D. A viral infection of the renal parenchyma leads to direct damage of the urinary system.

What is 

A. Bacteria ascend from the urethra to the bladder, adhering to uroepithelial cells via fimbriae, which triggers an inflammatory response.



200

A 60-year-old man with a 40-pack-year smoking history presents with progressive shortness of breath and difficulty with exertion. His pulmonary function tests show a decreased diffusing capacity for carbon monoxide (DLCO) and increased total lung capacity. Which of the following best describes the underlying pathophysiologic mechanism of his condition, emphysema?

A. Inflammatory destruction of alveolar walls leading to loss of elastic recoil and decreased gas exchange

B. Chronic bronchial inflammation resulting in mucus hypersecretion and airway obstruction

C. Bronchial smooth muscle hypertrophy causing reversible airway narrowing

D. Interstitial fibrosis thickening the alveolar-capillary membrane and impairing diffusion

What is 


A. Inflammatory destruction of alveolar walls leading to loss of elastic recoil and decreased gas exchange

200

Question: A 45-year-old man with a history of intravenous drug use presents with persistent fever, malaise, and a new heart murmur. On physical examination, you observe splinter hemorrhages, Osler nodes, and Janeway lesions. Which of the following findings would be the least likely associated with infective endocarditis?

Options: A. Splinter hemorrhages
B. Osler nodes
C. Janeway lesions
D. Pericardial friction rub

What is
D. Pericardial friction rub



300

A 65-year-old woman presents to the emergency department with crushing chest pain radiating to her left arm, accompanied by diaphoresis and nausea. Her ECG shows ST-segment elevations in the anterior leads. Which of the following best describes the pathophysiologic event leading to her condition?

  • A. Sudden coronary vasospasm causing transient ischemia

  • B. Rupture of an atherosclerotic plaque with activation of the clotting cascade and formation of an occlusive thrombus

  • C. Progressive coronary artery narrowing due to chronic calcification resulting in stable angina

  • D. Myocardial inflammation due to a viral infection

What is 
B. Rupture of an atherosclerotic plaque with activation of the clotting cascade and formation of an occlusive thrombus

300

A 60-year-old man is admitted to the emergency department with severe respiratory distress. His arterial blood gas (ABG) analysis shows the following values: pH 7.25, PaCO₂ 55 mm Hg, PaO₂ 55 mm Hg, and HCO₃⁻ 24 mEq/L. Which set of ABG values best indicates acute respiratory failure?

  • A. pH 7.40, PaCO₂ 40 mm Hg, PaO₂ 80 mm Hg, HCO₃⁻ 24 mEq/L

  • B. pH 7.30, PaCO₂ 45 mm Hg, PaO₂ 70 mm Hg, HCO₃⁻ 24 mEq/L

  • C. pH 7.25, PaCO₂ 55 mm Hg, PaO₂ 55 mm Hg, HCO₃⁻ 24 mEq/L

  • D. pH 7.45, PaCO₂ 35 mm Hg, PaO₂ 90 mm Hg, HCO₃⁻ 24 mEq/L

What is 

C. pH 7.25, PaCO₂ 55 mm Hg, PaO₂ 55 mm Hg, HCO₃⁻ 24 mEq/L

300

A 42-year-old patient presents to the emergency department with severe flank pain, hematuria, and nausea. Imaging reveals a kidney stone in the left ureter. Based on your knowledge of kidney stone pathophysiology, which statement best explains how these stones typically form?

A. Salts in the urine become supersaturated, then precipitate from a liquid to a solid, and grow through crystallization or aggregation, which can be influenced by urine pH and the presence or absence of stone inhibitors like uromodulin.
B. Bacteria in the bloodstream travel to the kidneys, forming large aggregates that block urine flow and solidify into stones.
C. Proteins in the nephron directly convert into solid masses under acidic conditions.
D. Urine that is overly dilute fails to filter out electrolytes, causing them to spontaneously solidify without any other factors.



What is 

A. Salts in the urine become supersaturated, then precipitate from a liquid to a solid, and grow through crystallization or aggregation, which can be influenced by urine pH and the presence or absence of stone inhibitors like uromodulin.

300

A 55-year-old man with a 35-pack-year smoking history presents with a productive cough that has persisted for the past 4 months each year over the last 3 years. Which of the following best describes the underlying pathophysiologic mechanism of his condition, chronic bronchitis?

A. Hyperplasia of mucus-secreting glands in the bronchi leading to increased mucus production and airway obstruction

B. Destruction of alveolar walls resulting in decreased surface area for gas exchange

C. Granulomatous inflammation of the bronchi associated with immune-mediated tissue injury

D. Acute neutrophilic infiltration of the airways causing transient airway inflammation

What is


A. Hyperplasia of mucus-secreting glands in the bronchi leading to increased mucus production and airway obstruction



300

Question:
A 62-year-old man is recovering from elective knee replacement surgery and has been largely immobilized postoperatively. On postoperative day 3, he reports pain, swelling, and tenderness in his left calf. Which of the following best describes the underlying pathophysiologic mechanism that most likely led to his condition?

A. Activation of the clotting cascade due to direct bacterial invasion of the venous wall
B. Endothelial injury, venous stasis, and a hypercoagulable state (Virchow’s triad)
C. Systemic inflammation causing increased vascular permeability and interstitial edema
D. Autonomic dysregulation leading to peripheral vasoconstriction and subsequent thrombosis

What is 

B. Endothelial injury, venous stasis, and a hypercoagulable state (Virchow’s triad)



400

A 58-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with chest pain that began 45 minutes ago while he was at rest. He describes the pain as a heavy, pressure-like sensation in the center of his chest that radiates to his left shoulder and jaw. In addition, he reports shortness of breath, diaphoresis, and nausea. Which of the following clinical manifestations is most characteristic of a myocardial infarction?

Options:
A. Sharp, localized chest pain that worsens with deep inspiration
B. Crushing, pressure-like chest pain radiating to the left shoulder and jaw
C. Mild, intermittent chest discomfort relieved by rest
D. Sudden onset of stabbing pain on the right side of the chest

What is 
B. Crushing, pressure-like chest pain radiating to the left shoulder and jaw


400

A 45-year-old man is admitted with severe pneumonia and subsequently develops rapidly worsening hypoxemia despite supplemental oxygen. A chest X-ray reveals diffuse bilateral infiltrates. Which of the following best describes the pathophysiologic mechanism underlying his condition, diagnosed as acute respiratory distress syndrome (ARDS)?

  • A. Increased pulmonary capillary permeability leading to non-cardiogenic pulmonary edema

  • B. Left ventricular dysfunction resulting in elevated pulmonary hydrostatic pressure

  • C. Obstruction of the alveoli by mucus plugs secondary to infection

  • D. Selective destruction of type II pneumocytes causing decreased surfactant production only

What is 

A. Increased pulmonary capillary permeability leading to non-cardiogenic pulmonary edema



400

A 30-year-old female presents with fever, flank pain, and costovertebral angle tenderness. She also reports dysuria and urinary frequency for the past several days. Which of the following statements best describes the pathophysiology of acute pyelonephritis?

A. Bacteria ascend from the lower urinary tract (bladder) to the renal pelvis, causing inflammation of the kidney.

B. Immune complexes deposit in the glomeruli, leading to an autoimmune reaction within the renal cortex.

C. Viral infection of the renal parenchyma triggers a cytokine storm, resulting in acute tubular necrosis.

D. Direct hematogenous spread of pathogens from the lungs commonly leads to pyelonephritis.

What is

 A. Bacteria ascend from the lower urinary tract (bladder) to the renal pelvis, causing inflammation of the kidney.

400

A 35-year-old man who recently immigrated from a high-prevalence region for tuberculosis presents with a chronic productive cough, night sweats, unintentional weight loss, and intermittent hemoptysis. His chest X-ray reveals a cavitary lesion in the upper lobe. Which of the following diagnostic tests is most appropriate to help confirm a diagnosis of active pulmonary tuberculosis?

A. Tuberculin skin test (Mantoux test)

B. Sputum smear for acid-fast bacilli (AFB)

C. QuantiFERON-TB Gold assay

D. Chest CT scan

What is  

B. Sputum smear for acid-fast bacilli (AFB)

400

A 28-year-old woman reports that whenever she is exposed to cold temperatures or experiences stress, her fingers undergo a series of color changes. Initially, they turn white, then blue, and finally red as warmth returns. She also mentions experiencing numbness and tingling during these episodes. Which of the following best describes the typical clinical manifestations of primary Raynaud phenomenon?

A. Permanent digital ulceration and scarring
B. Transient, symmetric color changes in the fingers triggered by cold or stress
C. Asymmetrical color changes with prolonged pallor in the affected digits
D. Constant cyanosis with no resolution upon warming

What is 

B. Transient, symmetric color changes in the fingers triggered by cold or stress

500

A 72-year-old man with a history of long-standing hypertension presents with shortness of breath on exertion, orthopnea, and a nonproductive cough. On physical examination, you note bilateral rales and an S3 heart sound. Which of the following best describes the underlying pathophysiologic process of left-sided heart failure in this patient?

  • A. Impaired left ventricular contractility leading to pulmonary congestion

  • B. Right ventricular dilation due to increased pulmonary vascular resistance

  • C. Valvular insufficiency causing systemic venous congestion

  • D. Pericardial thickening resulting in constrictive physiology

What is 

A. Impaired left ventricular contractility leading to pulmonary congestion



500

A 28-year-old woman presents with recurrent episodes of wheezing, shortness of breath, and chest tightness, which are often triggered by exposure to pet dander and exercise. Which of the following best describes the underlying pathophysiologic mechanism of her condition, asthma?

A. Chronic inflammation leading to airway hyperresponsiveness, bronchoconstriction, and increased mucus production
B. Direct viral infection of the bronchial epithelium resulting in permanent airway remodeling
C. Destruction of alveolar walls reducing the elastic recoil necessary for expiration
D. Left ventricular dysfunction causing pulmonary congestion and reactive airway narrowing



What is 

A. Chronic inflammation leading to airway hyperresponsiveness, bronchoconstriction, and increased mucus production



500

A 10-year-old child is brought to the clinic with complaints of periorbital edema, cola-colored urine, and mild hypertension about two weeks after a sore throat. Which of the following best explains the pathophysiology of her condition?

A. Immune complex deposition in the glomeruli following a streptococcal infection
B. Direct bacterial invasion of the glomeruli causing immediate inflammation
C. T-cell mediated cytotoxicity targeting the renal tubular cells
D. Deposition of light chains in the kidney leading to amyloid formation



What is

A. Immune complex deposition in the glomeruli following a streptococcal infection



500

A 40-year-old man involved in a high-impact motor vehicle collision presents to the emergency department with severe chest pain and difficulty breathing. On examination, you observe a segment of his chest wall that moves in the opposite direction of the rest of the thorax during inspiration.

Question:

Which of the following best describes the underlying pathophysiologic mechanism of his condition, known as flail chest?

A) Fracture of at least two consecutive ribs in two or more places, resulting in a free-floating segment of the chest wall
B) Multiple rib fractures leading to a rigid, non-compliant chest wall
C) Collapse of the lung due to a hemothorax with subsequent mediastinal shift
D) Neuromuscular impairment causing loss of intercostal muscle function and respiratory failure

What is A) Fracture of at least two consecutive ribs in two or more places, resulting in a free-floating segment of the chest wall

500

A 55-year-old woman presents with chronic lower extremity swelling, aching pain, and visible varicosities after years of prolonged standing at work. Which of the following best explains the pathophysiologic mechanism behind her condition?

A. Increased arterial pressure causing rupture of small vessels
B. Incompetent venous valves leading to venous reflux and pooling of blood
C. Lymphatic obstruction resulting in protein-rich edema
D. Capillary inflammation with subsequent leakage of plasma into the interstitial space



What is B. Incompetent venous valves leading to venous reflux and pooling of blood