NR-283 Pathophysiology - Set 2 - Part 2

Correct Answer: Elevated hydrostatic pressure in the systemic veins

Blood cannot return easily to the failing right ventricle, so pressure builds backward through the venous system and capillaries. That extra push forces fluid into dependent tissues and congests the liver. Option b is incorrect because low albumin causes edema when the liver cannot manufacture protein, as in cirrhosis. Here the liver is congested by backed up blood rather than failing to synthesize. Option c is incorrect because histamine widens capillary junctions during inflammation and allergic reactions, producing warm red localized swelling. Nothing in this picture suggests an inflammatory or allergic trigger for the fluid. Option d is incorrect because lymphatic blockage after node removal, tumor or radiation gives firm non pitting swelling confined to one region. Deep pitting in both ankles points somewhere else entirely.

Correct Answer: Most likely a carrier of one allele

Among children of two carriers, one quarter are unaffected non carriers, half are carriers, and one quarter are affected. Once disease is excluded, two of the three remaining outcomes are carrier status. Option a is incorrect because a completely clear genotype accounts for only one of the three healthy outcomes. Carrier status is twice as likely, so betting on no abnormal allele understates what the Punnett square shows. Option c is incorrect because cystic fibrosis declares itself early with meconium ileus, salty skin, recurrent lung infection, and poor growth. A silent affected phase lasting into later childhood does not fit this disorder. Option d is incorrect because delayed adult onset belongs to dominant conditions such as Huntington disease and adult polycystic kidney disease. Recessive enzyme and channel defects like this one show themselves from infancy.

Correct Answer: The drugs damage normal fast dividing tissue

Cytotoxic drugs cannot tell a malignant dividing cell from a normal one. Hair follicles, mucous membranes, and bone marrow turn over fastest, so they absorb the damage and produce the familiar toxicities. Option a is incorrect because deposition in tissue is not the mechanism; these agents circulate everywhere. Damage lands where cells divide quickly, which is why marrow counts fall along with the visible changes. Option b is incorrect because allergy involves immune recognition of a drug and shows up as rash, wheezing, or hypotension during infusion. Predictable hair and mucosal loss follows a different pathway entirely. Option d is incorrect because hormone blockade belongs to endocrine therapy for breast and prostate disease, and its problems are hot flashes and bone thinning. Cytotoxic agents work directly on dividing cells.

Correct Answer: Chemical buffer pairs already present in blood

Buffer pairs such as bicarbonate and carbonic acid accept or release hydrogen ions the moment pH shifts. They act instantly but only neutralize acid in place, since removing it from the body needs lungs or kidneys. Option a is incorrect because tubular secretion of hydrogen ion is a renal maneuver that begins over hours and needs three to five days to reach full strength. Nothing about it is immediate. Option b is incorrect because making new bicarbonate is the kidney's most complete answer to a fixed acid load, yet it is also the slowest. Days pass before the serum bicarbonate reflects that work. Option c is incorrect because deeper faster breathing starts in one to three minutes and peaks over hours, which is quick but not instant. It also corrects only part of a pH disturbance.

Correct Answer: Autosomal dominant inheritance without carrier states

Appearance in every generation, equal involvement of both sexes, and an affected parent behind each affected child mark autosomal dominance. One allele is enough, so unaffected people carry nothing to pass along. Option a is incorrect because recessive conditions surface sporadically after skipping generations, since healthy heterozygotes hide the allele. A pedigree with an affected person in every single generation argues against that silent transmission. Option c is incorrect because X linked recessive disease strikes mainly males and travels through unaffected daughters. The described family affects both sexes roughly equally, and daughters here are affected outright rather than silently carrying. Option d is incorrect because mitochondrial disorders descend along the maternal line alone, so an affected father transmits to none of his children. This pedigree shows fathers passing the trait to offspring.

Correct Answer: Platelets adhere and build a temporary plug

Vascular spasm buys a few seconds, then platelets stick to exposed collagen, change shape, release their granules, and bind one another into a soft plug. Coagulation reinforces that plug afterward. Option b is incorrect because the fibrin mesh belongs to the third phase, arriving only after the cascade has run and thrombin has appeared. Placing it second skips the platelet work that must come first. Option c is incorrect because dissolving a clot is fibrinolysis, which happens during healing once the vessel has repaired itself. Starting that process moments after injury would reopen the wound rather than seal it. Option d is incorrect because tissue factor starts the extrinsic pathway and cannot skip the intervening steps. Prothrombin must first become thrombin, and only then does thrombin cleave fibrinogen into the fibrin strands.

Correct Answer: An autonomous marrow producing red cells without hormonal signal

Polycythemia vera is a marrow neoplasm whose erythrocyte receptor never registers that enough cells exist, so production runs unchecked. Because the marrow works on its own, erythropoietin is suppressed rather than raised. Option a is incorrect because hypoxia from lung disease or altitude drives secondary polycythemia, and in that form the hormone level runs high. A low value rules the compensatory pathway out. Option c is incorrect because dehydration produces a relative rise, with red cell mass unchanged and the hematocrit correcting once fluids are replaced. Neither splenomegaly nor the itching described belongs to simple volume contraction. Option d is incorrect because the spleen stores only a small reserve and cannot flood the circulation this way. It grows here for the opposite reason, straining to filter an overloaded blood volume.

Correct Answer: Sideroblastic anemia from impaired heme synthesis

Alcohol blocks heme synthesis, so iron reaches the developing cell but cannot be built into hemoglobin. It piles up as a ring around the nucleus, and the surplus deposits in liver, spleen, and heart. Option a is incorrect because a client short of iron shows a low ferritin and a rising iron binding capacity. Here the stores are overflowing, which points to a utilization failure rather than an empty supply. Option b is incorrect because hepcidin traps iron inside macrophages during inflammation, lowering serum iron while ferritin stays normal or high. Serum iron is elevated in this client, and no inflammatory illness is described. Option c is incorrect because inherited globin underproduction declares itself in early childhood with skeletal deformity and transfusion dependence. An adult whose anemia tracks decades of drinking does not fit that inherited timeline at all.

Correct Answer: Rigid sickled cells occluding small vessels and starving tissue

Exertion, cold, and dehydration all drive hemoglobin S to polymerize. The cells stiffen into crescents, lose the ability to bend through capillaries, clump together, and block flow, so tissue downstream becomes ischemic and painful. Option a is incorrect because antibody coated cells describe autoimmune hemolysis, a different disorder entirely. That mechanism produces gradual jaundice and an enlarging spleen, not the abrupt bone and chest pain triggered by exertion. Option b is incorrect because marrow widening causes the chronic skull and facial changes of thalassemia, developing over years. Nothing about a single afternoon of cold and exertion could expand marrow fast enough to hurt. Option d is incorrect because iron overload settles in the liver, heart, pancreas, and skin after many transfusions. Its joint complaint is a slow arthropathy of the hands, quite unlike this sudden crisis.

Correct Answer: Metabolic acidosis with respiratory compensation underway

Ketoacids consume bicarbonate and drive pH down, which defines a metabolic acidosis. The deep labored Kussmaul pattern is the lungs blowing off carbon dioxide to pull the pH back toward normal. Option b is incorrect because a lung driven acidosis requires carbon dioxide to build up from poor ventilation, as in an opioid overdose. This client is breathing harder than normal, not less. Option c is incorrect because alkalosis means the pH has risen, and bicarbonate would be elevated rather than depleted. Vomiting or gastric suction produces that pattern, and neither appears in this presentation. Option d is incorrect because hyperventilation from anxiety or pain lifts pH above the normal range while carbon dioxide falls. Here the pH is already low, so an alkalotic label cannot be applied.

Correct Answer: An extra X chromosome alongside a Y

Klinefelter syndrome carries an extra X with the Y. The additional X impairs testicular development, so testes stay small and firm, testosterone falls, gonadotropins rise, and gynecomastia with azoospermia follows. Option a is incorrect because monosomy X occurs in females and produces short stature with ovarian failure. A phenotypic male with a Y chromosome cannot carry that karyotype at all. Option b is incorrect because trisomy twenty one is identified in infancy by hypotonia and characteristic facies, and it brings cognitive impairment. Tall stature with isolated hypogonadism does not describe that syndrome. Option c is incorrect because losing part of chromosome five causes cri du chat, marked by a cat like cry, microcephaly, and severe intellectual disability from birth. Nothing in this presentation matches.

Correct Answer: Obstruction of the superior vena cava

A mediastinal mass compresses the superior vena cava, so venous blood from the head, neck, and arms cannot return freely. Pressure backs up, producing facial swelling, distended veins, and dyspnea that lying flat worsens. Option a is incorrect because cord compression announces itself with back pain, then weakness, a sensory level, and loss of bowel or bladder control. Facial swelling has no place in that syndrome. Option b is incorrect because pericardial fluid produces muffled heart sounds, hypotension, and neck vein distention without the facial and arm edema seen here. The upper body swelling points above the heart instead. Option d is incorrect because axillary lymphatic blockage swells one arm and follows node dissection or nodal tumor. It cannot explain bilateral facial puffiness or visible chest wall veins.

Correct Answer: Each child faces a one in two chance

Huntington disease is autosomal dominant, so a single copy causes illness and each pregnancy carries a fifty percent risk regardless of the child's sex. Onset after the reproductive years is what delays recognition. Option b is incorrect because sex plays no part in autosomal transmission. The Huntington allele sits on chromosome four, an autosome, so daughters stand at precisely the same risk as their brothers. Option c is incorrect because a one in four figure belongs to two carrier parents in autosomal recessive disease, such as cystic fibrosis. Dominant conditions need only one transmitted allele, which doubles that figure. Option d is incorrect because carrier status does not exist in dominant disorders. Anyone who inherits the Huntington allele will eventually develop chorea and cognitive decline, so no family member quietly harbors it.

Correct Answer: Aortic dissection from a weakened connective tissue wall

Marfan syndrome is an autosomal dominant defect of fibrillin, the protein that gives connective tissue its strength. The aortic root dilates and can tear, so tearing chest pain signals dissection until disproved. Option a is incorrect because a ruptured apical bleb produces sudden breathlessness with absent breath sounds and a shifted trachea. The described pain travels toward the back, which fits a vascular tear instead. Option c is incorrect because clot travel to the lung follows stasis, vessel injury, or a clotting tendency, none of which this active teenager has. Pleuritic pain and hypoxia would dominate rather than tearing. Option d is incorrect because inflamed rib cartilage causes localized tenderness reproduced by pressing the chest wall. Labeling this pain musculoskeletal would delay imaging in a boy whose inherited disorder threatens his aorta.

Correct Answer: "Each pregnancy carries the same one in four risk."

Recessive recurrence risk is fixed at one in four for every conception because each gamete pairing is an independent event. Previous affected children neither raise nor lower the odds for the next pregnancy. Option b is incorrect because chance does not keep a running ledger across pregnancies. Both parents still carry one abnormal allele each, and the same combination of gametes remains possible every single time. Option c is incorrect because autosomal recessive conditions strike sons and daughters at identical rates. Restricting risk to daughters describes X linked thinking, which does not apply to a gene sitting on an autosome. Option d is incorrect because a family with two affected children has the strongest possible indication for carrier testing and prenatal diagnosis. Declining evaluation removes the only chance to prepare for early treatment.

Correct Answer: The mass expands within a rigid skull

The cranium cannot enlarge, so any expanding mass inside it raises intracranial pressure once compensation is exhausted. Location, not malignant behavior, makes this benign tumor life threatening, which is why site matters. Option a is incorrect because seeding to distant organs is metastasis, and metastasis never occurs with a benign lesion. The stem states the tumor has stayed put, so distant deposits cannot explain the picture. Option b is incorrect because loss of differentiation describes anaplasia, a hallmark of malignancy that this lesion does not show. The tumor described remains encapsulated and continues to resemble its parent tissue. Option d is incorrect because a fibrous capsule is inert connective tissue that walls the growth off. It secretes no mediators, and cytokine release belongs to inflammation and to the cachexia of advanced cancer.

Correct Answer: Bloodstream spread through veins to the lungs

Sarcomas favor the bloodstream, entering thin walled veins and capillaries. Venous blood returns to the right heart and is filtered by the pulmonary capillary bed, so the lungs receive the first deposits. Option a is incorrect because the lymphatic route is characteristic of carcinomas and would have left tumor in the draining nodes. Those nodes are reported clear, which argues against lymphatic travel here. Option b is incorrect because seeding requires a serosal cavity such as the peritoneum or pleura for cells to float across. A bone tumor in the leg has no access to such a space. Option c is incorrect because local extension moves tumor into muscle and soft tissue next to the bone. Nothing about creeping along tissue planes can place nodules in an organ on the far side of the circulation.

Correct Answer: Pink frothy sputum with falling oxygen saturation

Frothy pink sputum with dropping saturation means fluid has crossed into the alveoli and gas exchange is failing. Pulmonary edema is an emergency, and airway and breathing outrank every other overload finding. Option a is incorrect because visible neck vein distention confirms a full venous system and belongs in the picture of overload. It is expected here and does not by itself threaten oxygenation. Option c is incorrect because a two kilogram gain reflects roughly two liters of retained fluid and is the most sensitive early measure of the problem. Sensitive is not the same as immediately dangerous. Option d is incorrect because pitting edema in the legs marks fluid sitting in the interstitium, where it threatens skin integrity but not gas exchange. Swollen tissue can wait while the lungs cannot.

Correct Answer: It is anaplastic and highly aggressive

Undifferentiated cells with variable size and numerous mitotic figures define anaplasia, the hallmark of cancer and the basis of grading. Tumors this primitive are graded high and behave aggressively. Option b is incorrect because well differentiated tumors still resemble their parent tissue closely enough for the pathologist to name it. Losing that resemblance entirely is the opposite finding and signals rapid growth. Option c is incorrect because benign lesions show cells similar to normal tissue, near-normal mitoses, and a fibrous boundary. None of those features appear here, and bizarre mitotic figures never belong to a benign growth. Option d is incorrect because dysplasia keeps recognizable tissue architecture and may regress when chronic irritation stops. Complete loss of identity puts this specimen well past that reversible stage.

Correct Answer: Multiple myeloma with malignant plasma cells activating osteoclasts

Malignant plasma cells collect in bone, switch on osteoclasts, and dissolve it, which frees calcium and carves lytic holes. The light chains they secrete spill into urine as Bence Jones protein and injure the tubules. Option a is incorrect because secondary deposits from a solid tumor do not generate monoclonal light chains. Without that protein in the urine, the classic marker tying this presentation together would be missing. Option c is incorrect because that lymphoma announces itself with painless enlarged nodes in the neck and Reed Sternberg cells on biopsy. Skull lesions and a soaring calcium are not features of it. Option d is incorrect because an empty marrow lowers all three blood lines without touching the skeleton or the calcium level. Bone destruction requires cells that recruit osteoclasts, and marrow failure recruits nothing at all.