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HESI EXIT ADVANCED PATHOPHYSIOLOGY 2023 COMPLETE
EXAM [NEW 2025/2026 UPDATE] ALL COMPREHENSIVE
QUESTIONS AND A DETAILED BREAKDOWN OF ALL ANSWERS
EXAM | COMPLETE TEST SOLUTION | PASSED & REWORDED
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- A patient with chronic obstructive pulmonary disease (COPD) is experiencing increased shortness of breath and productive cough. Which pathophysiologic process is most likely responsible? A. Bronchial smooth muscle constriction B. Alveolar hyperinflation C. Mucous gland hypertrophy D. Decreased airway resistance Hypertrophy of mucous glands leads to excessive mucus production, worsening airflow obstruction in COPD.
- A patient has a left-sided heart failure. Which hemodynamic change is expected? A. Increased right ventricular preload B. Increased pulmonary capillary wedge pressure C. Decreased left atrial pressure D. Decreased systemic vascular resistance Left-sided heart failure causes blood to back up into the lungs, increasing pulmonary capillary pressures.
- Which compensatory mechanism initially maintains cardiac output during early heart failure? A. Decreased sympathetic tone B. Decreased preload C. Increased heart rate D. Decreased contractility The body responds by activating the sympathetic nervous system, increasing heart rate to maintain cardiac output.
- What is the primary pathophysiologic feature of emphysema? A. Alveolar hyperplasia B. Destruction of alveolar walls C. Bronchial smooth muscle hypertrophy D. Increased mucous secretion Emphysema involves loss of alveolar walls, leading to decreased surface area for gas exchange.
- Which finding best indicates right-sided heart failure? A. Dyspnea on exertion B. Peripheral edema C. Bibasilar crackles D. Orthopnea Right-sided failure leads to systemic venous congestion, resulting in peripheral edema.
- In septic shock, what is the main cause of hypotension? A. Decreased blood volume
D. Decreased sympathetic tone Cortisol enhances the action of catecholamines and increases sodium retention, raising blood pressure. 10.Which lab value would you expect in SIADH? A. High serum sodium B. Low serum osmolality C. High urine output D. Low urine specific gravity SIADH causes water retention, diluting plasma and lowering serum osmolality. 11.A patient with nephrotic syndrome is at increased risk for: A. Anemia B. Infection C. Hyperkalemia D. Hypertension Proteinuria leads to loss of immunoglobulins, increasing infection risk. 12.What is the underlying pathophysiology of asthma? A. Loss of alveolar surface area B. Airway inflammation and hyperresponsiveness C. Excessive surfactant production D. Decreased capillary perfusion Asthma is characterized by reversible airway inflammation and bronchoconstriction.
13.A patient with acute pancreatitis is at risk for hypocalcemia due to: A. Increased parathyroid hormone secretion B. Increased albumin binding C. Saponification of fat D. Increased vitamin D activation Calcium binds to free fatty acids in the necrotic tissue, leading to hypocalcemia. 14.What finding is expected in a patient with SIADH? A. High urine osmolality B. Low ADH levels C. Hypernatremia D. High serum osmolality SIADH causes water retention and concentrated urine with high osmolality. 15.Which condition leads to hyperaldosteronism? A. Addison’s disease B. Conn’s syndrome C. SIADH D. Diabetes insipidus Conn’s syndrome is primary hyperaldosteronism, causing excessive aldosterone secretion. 16.Which change occurs in chronic kidney disease? A. Decreased phosphate levels B. Decreased PTH levels
B. Hypocalcemia C. Hyperkalemia D. Hypernatremia Hypocalcemia increases neuromuscular excitability, causing Chvostek’s sign. 21.Which change would you expect in a patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? A. Increased serum sodium B. Decreased urine sodium C. Increased urine sodium D. Increased serum osmolality In SIADH, excess ADH causes water retention but sodium continues to be excreted, leading to concentrated urine with high sodium levels. 22.What is the primary mechanism of hypoxemia in pneumonia? A. Intrapulmonary shunting B. Increased dead space ventilation C. Decreased oxygen demand D. Increased ventilation-perfusion ratio Consolidation of alveoli causes blood to pass through non-ventilated areas, resulting in shunting. 23.Which condition is associated with a positive Trousseau’s sign? A. Hypernatremia B. Hypercalcemia
C. Hypocalcemia D. Hyperkalemia Hypocalcemia increases neuromuscular excitability, producing Trousseau’s sign when the arm is occluded. 24.What finding is expected in metabolic acidosis? A. Decreased hydrogen ion concentration B. Increased bicarbonate C. Decreased pH D. Increased base excess Excess acid or bicarbonate loss lowers pH in metabolic acidosis. 25.What is the main pathophysiologic process in cystic fibrosis? A. Defective chloride channels B. Decreased mucus production C. Excess surfactant D. Bronchial hyperreactivity CF is caused by mutations in the CFTR gene affecting chloride transport, leading to thick mucus. 26.What laboratory finding is typical for nephrotic syndrome? A. Proteinuria >3.5 g/day B. Hematuria C. Bacteriuria D. Hyperkalemia Nephrotic syndrome is defined by massive proteinuria due to increased glomerular permeability.
31.Which hormone imbalance is associated with pheochromocytoma? A. Increased insulin B. Increased catecholamines C. Decreased cortisol D. Increased TSH Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamines. 32.What is the initial pathophysiologic event in Type 1 diabetes mellitus? A. Insulin resistance B. Autoimmune destruction of beta cells C. Excess glucagon D. Decreased hepatic glucose production Type 1 DM results from autoimmune destruction of pancreatic beta cells. 33.Which finding is expected with syndrome of Cushing’s? A. Hypotension B. Hyperglycemia C. Hyponatremia D. Weight loss Excess cortisol raises blood glucose through gluconeogenesis. 34.What is the main cause of pulmonary edema in left-sided heart failure? A. Decreased hydrostatic pressure B. Decreased capillary permeability C. Increased pulmonary capillary hydrostatic pressure D. Decreased oncotic pressure
Blood backs up into pulmonary circulation, increasing hydrostatic pressure and causing fluid leakage into alveoli. 35.Which acid-base imbalance is seen with severe diarrhea? A. Metabolic alkalosis B. Respiratory alkalosis C. Metabolic acidosis D. Respiratory acidosis Loss of bicarbonate-rich intestinal fluids leads to metabolic acidosis. 36.Which condition causes hypercalcemia? A. Chronic renal failure B. Hyperparathyroidism C. Vitamin D deficiency D. Acute pancreatitis Increased PTH stimulates bone resorption, raising serum calcium. 37.Which is a classic sign of Addison’s disease? A. Hyperpigmentation B. Weight gain C. Hypertension D. Hyperglycemia Low cortisol leads to increased ACTH, which stimulates melanocytes causing skin darkening. 38.What is a common finding in hypothyroidism? A. Tachycardia B. Heat intolerance
B. Hematuria C. Proteinuria >3.5 g/day D. Hypotension Glomerular inflammation causes RBC leakage, resulting in hematuria. 43.Which is a common cause of metabolic alkalosis? A. Diuretic therapy B. Diarrhea C. Renal failure D. Ketoacidosis Diuretics cause hydrogen and potassium loss, leading to alkalosis. 44.Which electrolyte imbalance is linked with massive blood transfusions? A. Hyperkalemia B. Hypermagnesemia C. Hypocalcemia D. Hyponatremia Citrate in stored blood binds calcium, lowering free calcium levels. 45.Which factor contributes to ascites in liver cirrhosis? A. Increased oncotic pressure B. Portal hypertension C. Increased albumin synthesis D. Decreased capillary hydrostatic pressure Portal hypertension increases hydrostatic pressure, causing fluid leakage into the abdomen.
46.Which hormone is deficient in diabetes insipidus? A. Insulin B. Cortisol C. ADH D. Aldosterone DI is caused by inadequate ADH or renal unresponsiveness to ADH. 47.Which condition is characterized by hypercoagulability? A. Hemophilia B. Polycythemia vera C. Thrombocytopenia D. DIC (late stage) Excess RBCs and platelets in PV increase blood viscosity and clot risk. 48.Which compensatory mechanism occurs with chronic hypoxia? A. Polycythemia B. Increased clotting time C. Hypoventilation D. Metabolic alkalosis Hypoxia stimulates erythropoietin release, increasing RBC production. 49.What is a common cause of prerenal acute kidney injury? A. Acute glomerulonephritis B. Hypovolemia C. Nephrotoxic drugs D. Urinary obstruction Prerenal AKI is due to decreased perfusion, often from volume loss.
ARDS involves severe hypoxemia that does not respond to oxygen therapy. 54.Which is a feature of chronic bronchitis? A. Decreased mucous production B. Destruction of alveolar walls C. Excessive sputum production D. Reversible airway obstruction only Chronic bronchitis involves hypersecretion of mucus and chronic productive cough. 55.Which condition is linked to macrocytic anemia? A. Iron deficiency B. Vitamin B12 deficiency C. Chronic blood loss D. Thalassemia B12 deficiency impairs DNA synthesis, leading to large, immature RBCs. 56.Which mechanism causes edema in nephrotic syndrome? A. Decreased plasma oncotic pressure B. Increased plasma protein C. Increased capillary oncotic pressure D. Decreased hydrostatic pressure Protein loss in urine lowers oncotic pressure, allowing fluid to shift into interstitial spaces. 57.What is the primary defect in Parkinson’s disease? A. Increased dopamine
B. Decreased acetylcholine C. Decreased dopamine D. Increased serotonin Degeneration of dopamine-producing neurons leads to motor symptoms. 58.Which electrolyte imbalance is common in adrenal insufficiency? A. Hypernatremia B. Hyperkalemia C. Hypercalcemia D. Hypophosphatemia Aldosterone deficiency impairs potassium excretion, causing hyperkalemia. 59.Which lab finding is expected in SIADH? A. Hypernatremia B. Increased serum osmolality C. Increased urine output D. Decreased serum sodium Water retention dilutes sodium, resulting in hyponatremia. 60.Which condition can cause metabolic acidosis with an increased anion gap? A. Vomiting B. Diabetic ketoacidosis C. Nasogastric suction D. Diuretic therapy DKA produces excess ketones, raising the anion gap.
D. Low serum osmolality Hemoconcentration due to fluid loss increases hematocrit. 65.Which compensatory mechanism is activated during hypovolemic shock? A. RAAS activation B. ADH suppression C. Parasympathetic stimulation D. Vasodilation RAAS retains sodium and water to increase blood volume. 66.Which type of anemia is caused by chronic blood loss? A. Aplastic anemia B. Pernicious anemia C. Iron deficiency anemia D. Hemolytic anemia Chronic blood loss depletes iron stores. 67.A patient with diabetic nephropathy will likely develop: A. Hypercalcemia B. Proteinuria C. Polycythemia D. Hypoglycemia Glomerular damage causes protein to leak into urine. 68.Which factor contributes to hepatic encephalopathy? A. Hypoglycemia B. Ammonia accumulation C. Hyperalbuminemia
D. Hypernatremia Damaged liver fails to convert ammonia to urea, leading to neurotoxicity. 69.What is the classic sign of myasthenia gravis? A. Hyperreflexia B. Muscle weakness that worsens with activity C. Spasticity D. Cogwheel rigidity Autoantibodies block acetylcholine receptors, causing muscle fatigue. 70.Which condition increases the risk for atherosclerosis? A. Hypocholesterolemia B. Hyperlipidemia C. Hypernatremia D. Hypoglycemia Elevated cholesterol promotes plaque formation in arteries. 71.Which pathophysiology explains hypertension in chronic kidney disease? A. Decreased aldosterone B. Decreased sympathetic tone C. RAAS activation and fluid retention D. Decreased ADH secretion CKD activates RAAS, leading to vasoconstriction and volume expansion. 72.Which is a characteristic of ulcerative colitis? A. Transmural inflammation B. Skip lesions C. Cobblestone mucosa
