NR-283 Pathophysiology - Set 5 - Part 2

Correct Answer: Cataract from clouding of the lens

Lens proteins denature and clump with age, scattering light instead of transmitting it. Vision dims and blurs gradually, glare and halos appear at night, and the eye stays white and free of pain. Option a is incorrect because sudden obstruction of aqueous outflow brings severe eye pain, headache, vomiting, a red eye and a fixed mid dilated pupil. That picture arrives within hours and is a true emergency. Option b is incorrect because a detaching retina announces itself abruptly with a shower of floaters, flashes of light and a shadow moving across the field. Months of gradual dimming does not describe it. Option c is incorrect because new vessels growing under the macula leak and bend straight lines, leaving a dark blind spot in the center while side vision stays intact. Glare at night is not its hallmark.

Correct Answer: "Each of my children would face a one in two chance."

Huntington disease is autosomal dominant with essentially full penetrance, so every child of an affected parent carries a fifty percent risk regardless of sex. The expanded repeat is passed directly and does not skip generations. Option b is incorrect because the gene sits on chromosome four, an autosome, not on a sex chromosome. Daughters and sons inherit it at identical rates, and believing otherwise would leave half the family falsely reassured. Option c is incorrect because skipping generations describes recessive or reduced penetrance conditions. Huntington disease shows anticipation instead, with the repeat lengthening across generations so that onset tends to arrive earlier in each successive one. Option d is incorrect because slow stiff movement belongs to Parkinson disease. Striatal degeneration here removes inhibition and releases movement, giving irregular jerky chorea that starts in the arms and face, plus writhing and flinging motions.

Correct Answer: Epidural bleeding from a torn middle meningeal artery

A temporal fracture tears the middle meningeal artery, and arterial blood strips the dura from bone. The lucid interval reflects intact compensation, which fails abruptly once the collection outgrows the reserve. Urgent evacuation is needed. Option a is incorrect because that venous collection builds over weeks in an atrophic older brain, often after trauma too minor to recall. A one hour turnaround in a teenager does not match its timetable. Option c is incorrect because widespread axonal tearing knocks the client out at impact and keeps them out. There is no interval of normal conversation, and the initial scan usually looks far better than the client does. Option d is incorrect because a rebound bruise sits opposite the blow and produces focal signs tied to the injured lobe. Bruised tissue swells over a day or two, not within a single hour.

Correct Answer: Depth of invasion into the dermis

Melanoma spreads by growing downward into lymphatics and blood vessels, so thickness measured through the dermis predicts survival better than anything visible on the surface. The deeper lesion carries the worse outlook. Option a is incorrect because width helps flag a suspicious mole during screening but says little about prognosis once the tumor is removed. A wide, thin lesion may still sit entirely above the vessels that carry cells away. Option b is incorrect because variegated color is one of the screening criteria that prompts biopsy, not a measure of how far disease has traveled. Two lesions with identical coloring can behave completely differently. Option c is incorrect because site influences where melanoma tends to appear in men and women, and soles and nail beds are diagnosed late. Anatomy shapes detection rather than the biology that drives spread.

Correct Answer: Stage three with visible adipose tissue

Visible fat in the wound bed defines full-thickness loss without exposure of deeper structures, which is stage three. Rolled edges and undermining are common at this stage, and depth remains measurable because no eschar hides it. Option a is incorrect because stage two stops at the dermis, showing a pink moist bed or a serum-filled blister with no fat, slough or tunneling. Exposed adipose tissue moves the injury past that boundary. Option b is incorrect because staging reaches four only when fascia, muscle, tendon, ligament, cartilage or bone is exposed or can be palpated in the base. The examiner found none of those structures here. Option d is incorrect because a wound is called unstageable when slough or eschar covers the base so the true depth cannot be judged. This bed is fully visible, so the depth can be assigned.

Correct Answer: Failing diaphragm function and ventilatory support

The phrenic nerve arises from the third through fifth cervical segments, so a lesion at the fourth threatens the diaphragm. Ascending cord edema can raise the functional level further, and ventilation fails before oxygen saturation drops. Option b is incorrect because hip flexion with strong arms describes a lumbar lesion far below this one. A high cervical injury takes the arms as well, leaving the client dependent for every activity of daily living. Option c is incorrect because triceps innervation and the push up transfer belong to the seventh and eighth cervical segments. At the fourth, elbow extension is simply gone along with everything else below the shoulders. Option d is incorrect because saddle numbness with a flaccid bowel points to the cauda equina, at or below the first lumbar vertebra. Damage that low spares breathing entirely and never produces tetraplegia.

Correct Answer: Abnormal nerve firing plus reorganized cortical maps

Cut nerve endings form neuromas that discharge on their own, the dorsal horn becomes sensitized, and neighboring areas invade the cortical map of the lost limb. The brain therefore places real pain in the absent foot. Option a is incorrect because infected tissue would be red, hot, swollen and draining, and the pain would sit in the stump itself. This wound is clean and the sensation comes from a part that no longer exists. Option b is incorrect because referral sends organ pain to a body surface that shares its spinal segment, such as the shoulder in gallbladder disease. One leg does not project sensation into the other. Option d is incorrect because grief after losing a limb is real and deserves support, yet it is not what generates this sensation. Phantom pain has measurable changes in nerve, cord and cortex behind it.

Correct Answer: Lichenification from repeated rubbing and scratching

Chronic rubbing thickens the epidermis and accentuates the normal skin lines, producing the leathery patches called lichenification. It is a secondary lesion because it develops from an existing dermatitis rather than on normal skin. Option b is incorrect because keloid describes scar tissue that overgrows past the borders of the original injury, usually after surgery, burns or piercings. Nothing here has been cut or wounded through the dermis. Option c is incorrect because a plaque is a primary lesion, raised, solid and flat-topped, that arises on skin which was previously normal. The elbows here show thickening of already inflamed skin instead. Option d is incorrect because steroid-induced atrophy thins the skin until it looks translucent and paper-like, with skin markings lost rather than exaggerated. That is the opposite of the thickened surface being described.

Correct Answer: Neurovascular status distal to the injured joint

A displaced bone end can stretch or tear the nerves and vessels crossing the joint, so circulation, sensation and movement below the injury are checked and documented before and after any splinting or reduction. Option a is incorrect because comparing the uninjured side helps interpret findings but reveals nothing about perfusion to the damaged limb. Moving the healthy shoulder cannot detect an axillary nerve injury on the other side. Option b is incorrect because skin checks belong to routine cast and splint care once the limb is immobilized. They come nowhere near the urgency of finding a threatened vessel or nerve first. Option c is incorrect because a pain score guides analgesia and is expected with any dislocation, so it adds little discriminating information. Severe pain is already obvious and does not reveal ischemia developing quietly.

Correct Answer: Compensatory displacement of fluid and blood became exhausted

The vault holds a fixed volume, so early growth is absorbed by shifting cerebrospinal fluid out and shrinking venous blood. Once that reserve is spent, each further milliliter drives pressure up steeply. Option a is incorrect because adult cranial sutures fused long ago, leaving a rigid box with no give. Only an infant with open fontanelles can enlarge the vault, and that is why head circumference is tracked in babies. Option c is incorrect because autoregulation holds cerebral flow steady across a set arterial pressure range and does nothing about volume inside the vault. Severe injury usually damages it, leaving perfusion to follow blood pressure passively. Option d is incorrect because tissue loss takes months or years, not hours. Chronic atrophy does buy room for a slow bleed in an older brain, yet it offers nothing during an acute pressure crisis.

Correct Answer: Delirium superimposed on the existing dementia

Dementia does not change over hours. Acute inattention, clouded awareness, visual hallucinations and a reversed sleep pattern define delirium, and in an older adult a urinary or pulmonary infection is the usual trigger. Option a is incorrect because dementia advances over months and years, never across a single evening. Treating this sudden shift as disease progression would leave an infection or metabolic derangement untreated while the client deteriorates further. Option b is incorrect because depressed older adults show psychomotor slowing, complain openly about memory and answer test questions with repeated statements of not knowing. Their level of consciousness stays clear and hallucinations are rare. Option c is incorrect because labeling late day agitation as sundowning stops the search for a cause. Attention here is markedly impaired and hallucinations are present, which pushes the picture well past ordinary evening restlessness.

Correct Answer: It is the earliest sign of rising pressure

Change in level of consciousness is the first and most sensitive marker of neurologic decline. Restlessness, irritability and confusion appear while compensation still holds, long before pupils change or vital signs shift. Option b is incorrect because dismissing new agitation as tiredness is exactly how deterioration gets missed. Restlessness after head trauma is treated as cerebral hypoxia until assessment proves otherwise, and it warrants prompt reporting. Option c is incorrect because herniation announces itself with a fixed dilated pupil, posturing and collapsing consciousness. This client still converses and moves normally, so the crisis described by that option has not arrived. Option d is incorrect because falling pressure would restore clear thinking rather than blunt it. New confusion points the other direction entirely, marking the moment reserve begins to fail and volume starts to matter.

Correct Answer: Alzheimer disease with amyloid plaques and tau tangles

Alzheimer disease produces extracellular amyloid beta plaques and intracellular neurofibrillary tangles of hyperphosphorylated tau. Tangles collapse the microtubule transport system, neurons in the hippocampus die first, and recent memory fails before remote memory does. Option a is incorrect because Lewy bodies are round alpha synuclein inclusions, not the paired lesions described here. That dementia announces itself with fluctuating alertness, well formed visual hallucinations and spontaneous parkinsonism rather than isolated memory decline. Option b is incorrect because infarcts and small vessel ischemic damage leave cavities and gliosis on autopsy, never plaques and tangles. The clinical course also steps down abruptly after each stroke instead of sliding gradually downward. Option d is incorrect because frontotemporal disease damages frontal and temporal lobes in adults under sixty, stripping away social judgement and empathy while memory stays relatively intact early on.

Correct Answer: Rising compartment pressure collapsing the capillary circulation

Bleeding and edema inside a closed fascial space raise pressure until venules collapse and capillary flow stops. Muscle and nerve become ischemic while a palpable pulse remains, so pain and tension appear first. Option a is incorrect because a torn or blocked artery abolishes the distal pulse and leaves the limb cold and white. This client still has a radial pulse and a warm, tensely swollen forearm. Option c is incorrect because marrow fat reaching the lungs produces dyspnea, confusion and a petechial rash a day or more after a long bone injury, not localized forearm pain on stretch. Option d is incorrect because clot in a deep vein causes aching swelling and warmth without the exquisite pain on passive stretch. Venous obstruction alone does not drive tissue pressure past the level that stops capillary perfusion.

Correct Answer: The lip lesion spreads to nodes more readily

The pearly rolled lesion is a basal cell carcinoma, which invades locally but rarely travels. The scaly lip nodule is a squamous cell carcinoma, and lip and ear sites carry real risk of nodal spread. Option a is incorrect because pigment cells give rise to melanoma, not to either lesion described. Basal and squamous carcinomas both begin in epidermal keratinocytes, which is why neither is typically a dark pigmented growth. Option b is incorrect because the pearly nasal growth is the least likely of the skin cancers to travel anywhere. It burrows locally and can destroy cartilage on the nose, yet distant deposits are rare. Option c is incorrect because ultraviolet damage drives both tumors, and this client has spent decades outdoors. Chronic cumulative exposure is the classic setting for squamous lesions on the lip, ear and dorsal hands.

Correct Answer: Resistance and pain when the knee is straightened

Inflamed meninges make any stretch painful. With the hip flexed, extending the knee pulls on irritated nerve roots and produces the resistance of a positive Kernig sign, matching the stiff neck and photophobia. Option a is incorrect because loss of muscle tone with absent reflexes signals a lower motor neuron problem. Inflamed meninges irritate nerve roots and make stretching painful, yet reflex arcs themselves remain intact. Option b is incorrect because mastoid bruising marks a fracture at the base of the skull after trauma. This student has an infectious illness, and no blow to the head appears in the history. Option d is incorrect because transient monocular blindness comes from an embolus in the ophthalmic artery and warns of carotid disease. Fever with a stiff neck points to infection instead of a vascular event.

Correct Answer: Flooding of glutamate causing calcium loaded excitotoxicity

Energy failure stops the sodium potassium pump, so glutamate pours into the extracellular space and overstimulates receptors. Calcium then floods the neuron, activating destructive enzymes and free radicals, and the cell dies from excitotoxicity. Option b is incorrect because dopamine depletion in that midbrain nucleus produces the slowed, rigid movement of Parkinson disease. It unfolds across years of degeneration and has no part in the minutes long death of ischemic tissue. Option c is incorrect because antibodies against that junction receptor describe myasthenia gravis, a disorder of muscle fatigue. Signal transmission fails at the muscle rather than inside brain tissue, so no neuronal necrosis follows. Option d is incorrect because stronger inhibitory signaling quiets neurons and protects them from overfiring. Drugs that boost this pathway calm seizure activity, so it would shield the penumbra instead of destroying the core.

Correct Answer: Sustained firing outstrips oxygen supply and injures neurons

Continuous seizing multiplies cerebral oxygen demand at the moment ventilation fails, so metabolism turns anaerobic and lactic acid builds. Neurons die if the activity is not stopped, which is why status epilepticus is an emergency. Option a is incorrect because demand climbs sharply during sustained contraction rather than falling. Consumption rises several fold while the client is barely moving air, and that gap is the whole danger of the event. Option c is incorrect because clenched muscles and pooled secretions threaten the airway instead of guarding it. Side lying positioning and suction are needed precisely because aspiration is a leading complication here. Option d is incorrect because repeated discharges lengthen recovery and can leave permanent loss. Rhabdomyolysis, hyperthermia and cerebral edema accumulate with duration, so mortality climbs the longer the activity runs unchecked.

Correct Answer: Bell palsy of the facial nerve

Bell palsy is a lower motor neuron lesion of the facial nerve, so the entire half of the face including the forehead is paralyzed. Hyperacusis and lost taste fit the same nerve, and limb findings stay normal. Option a is incorrect because cortical lesions spare the forehead, which receives fibers from both hemispheres. A client with a stroke can still raise the brow and close the eye, and usually has limb weakness or speech trouble as well. Option b is incorrect because that disorder brings brief stabbing facial pain set off by touch, chewing or a cold draft. It causes no weakness at all, and this client describes droop rather than pain. Option c is incorrect because the fifth cranial nerve carries facial sensation and drives the chewing muscles. Damage there produces numbness of the cheek and a weak bite, never an inability to lift the eyebrow.

Correct Answer: Silent vertebral compression fractures caused by osteoporosis

Osteoporosis thins trabecular bone until vertebral bodies collapse under ordinary load. These compression fractures are often painless, so the accumulated loss shows up as shortened stature and thoracic kyphosis instead. Option b is incorrect because sustained muscle spasm causes guarding, tenderness and limited motion that the client would notice. Spasm cannot shorten the skeleton, since height depends on the vertebral bodies themselves. Option c is incorrect because disc degeneration trims only a few millimeters from each level and usually announces itself with stiffness and back pain. Several inches of loss points to collapsed bone instead. Option d is incorrect because slouching is a postural habit that straightens when the person is asked to stand tall. A fixed kyphotic curve with measured height loss reflects structural bone failure.