Neurologic, Endocrine, and Other Pathophysiology Practice Questions

79 multiple-choice questions on Neurologic, endocrine, and other systems for paramedic and EMT students, from Chapter 9 (Pathophysiology). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

79 practice questions

1. An ischemic stroke is caused by:

   1. A. A clot or embolus blocking cerebral flow
   2. B. Rupture of a vessel bleeding into the brain
   3. C. Bacterial infection of the meninges
   4. D. A seizure that injures the cortex
   Show answer

   Answer: A. A clot or embolus blocking cerebral flow

   About 85 percent of strokes are ischemic. A seizure can mimic stroke, especially with postictal weakness, but it does not block cerebral flow.

2. A hemorrhagic stroke results from:

   1. A. Occlusion of a cerebral artery by a clot
   2. B. Migraine-related spasm of cerebral vessels
   3. C. Severe hypoglycemia injuring the cortex
   4. D. Rupture of a cerebral blood vessel
   Show answer

   Answer: D. Rupture of a cerebral blood vessel

   It often presents with sudden severe headache and rapid deterioration. Blood collects in or around the brain.

3. Increased intracranial pressure compromises the brain by:

   1. A. Raising cerebral perfusion pressure
   2. B. Lowering cerebral perfusion pressure
   3. C. Dropping systemic blood pressure
   4. D. Increasing oxygen delivery to neurons
   Show answer

   Answer: B. Lowering cerebral perfusion pressure

   The skull cannot expand, so pressure rises quickly. Eventually brain tissue herniates through openings in the skull.

4. Cushing triad consists of:

   1. A. Hypoglycemia, seizure activity, and coma
   2. B. Hypertension, bradycardia, and irregular respirations
   3. C. Hypotension, tachycardia, and rapid shallow breathing
   4. D. Fever, neck stiffness, and a petechial rash
   Show answer

   Answer: B. Hypertension, bradycardia, and irregular respirations

   It is a late sign of dangerously increased intracranial pressure.

5. A seizure results from:

   1. A. Abnormal, excessive neuronal discharge
   2. B. Transient global reduction in cerebral blood flow
   3. C. Damage to peripheral nerves in the limbs
   4. D. Compression of the spinal cord at the neck
   Show answer

   Answer: A. Abnormal, excessive neuronal discharge

   Causes include epilepsy, hypoglycemia, fever, trauma, and toxins.

6. Diabetic ketoacidosis develops when:

   1. A. Kidney failure causes acid retention in the blood
   2. B. Excess insulin drives glucose into cells
   3. C. Low glucose triggers stress hormone release
   4. D. Insulin lack forces fat breakdown into ketones
   Show answer

   Answer: D. Insulin lack forces fat breakdown into ketones

   Dehydration from osmotic diuresis is a central problem. Ketones produce metabolic acidosis.

7. Hyperosmolar hyperglycemic state differs from DKA in that it:

   1. A. Has lower glucose levels than DKA typically
   2. B. Causes severe dehydration with little or no ketosis
   3. C. Occurs only in patients with type 1 diabetes
   4. D. Develops within minutes rather than days
   Show answer

   Answer: B. Causes severe dehydration with little or no ketosis

   It is more common in older patients with type 2 diabetes. Glucose is often extremely high.

8. Hypoglycemia threatens the brain because:

   1. A. Neurons need a constant glucose supply
   2. B. The brain stores glucose but cannot release it
   3. C. Low glucose raises intracranial pressure quickly
   4. D. Insulin directly poisons neurons at high levels
   Show answer

   Answer: A. Neurons need a constant glucose supply

   Prolonged hypoglycemia causes permanent injury. Neurons cannot store glucose.

9. Hyperthyroidism typically produces:

   1. A. Cold intolerance, bradycardia, and weight gain
   2. B. Heat intolerance, tachycardia, and weight loss
   3. C. Dry skin, slowed reflexes, and fatigue
   4. D. Hypotension, hypoglycemia, and darkened skin
   Show answer

   Answer: B. Heat intolerance, tachycardia, and weight loss

   Thyroid storm is the life-threatening extreme. Anxiety is also common.

10. Adrenal insufficiency may present with:

    1. A. Weight gain, purple striae, and a moon face
    2. B. Hypertension, hyperglycemia, and edema
    3. C. Weakness, hypotension, and hypoglycemia
    4. D. Tachycardia, heat intolerance, and tremor
    Show answer

    Answer: C. Weakness, hypotension, and hypoglycemia

    Patients on long-term steroids are at risk during illness. They respond poorly to stress.

11. Chronic kidney failure causes problems including:

    1. A. Dehydration, hypokalemia, and alkalosis
    2. B. Fluid overload, hyperkalemia, and acidosis
    3. C. Faster clearance of drugs and lower drug levels
    4. D. Excess erythropoietin and polycythemia
    Show answer

    Answer: B. Fluid overload, hyperkalemia, and acidosis

    Missed dialysis often brings these patients to EMS. Metabolic wastes also accumulate.

12. Liver failure leads to:

    1. A. Polycythemia and high blood viscosity with clots
    2. B. Coagulopathy, jaundice, ascites, and confusion
    3. C. Increased albumin and less fluid retention
    4. D. Improved clotting and reduced bleeding risk
    Show answer

    Answer: B. Coagulopathy, jaundice, ascites, and confusion

    Encephalopathy may present as confusion. Toxins accumulate.

13. Upper gastrointestinal bleeding often presents with:

    1. A. Abdominal distention without other signs
    2. B. Coffee-ground vomit and black, tarry stools
    3. C. Bright red rectal bleeding with normal stools
    4. D. Bright red blood coughed up from the lungs
    Show answer

    Answer: B. Coffee-ground vomit and black, tarry stools

    Blood loss may be substantial before symptoms appear. Vomiting bright red blood also occurs. Blood coughed up from the lungs is hemoptysis, not GI bleeding.

14. Anemia impairs oxygen delivery by:

    1. A. Blocking alveoli and limiting gas exchange
    2. B. Causing vasodilation and low blood pressure
    3. C. Lowering oxygen-carrying hemoglobin
    4. D. Reducing cardiac output and stroke volume
    Show answer

    Answer: C. Lowering oxygen-carrying hemoglobin

    Saturation can be normal while delivery is inadequate.

15. In sickle cell disease, vaso-occlusive crisis occurs when:

    1. A. Sickled red cells block small vessels
    2. B. White cells multiply and invade the joints
    3. C. Hemoglobin levels rise and thicken the blood
    4. D. Platelets clump and block large arteries
    Show answer

    Answer: A. Sickled red cells block small vessels

    Dehydration, infection, and hypoxia can trigger it. The blockage causes ischemia and severe pain.

16. Disseminated intravascular coagulation involves:

    1. A. Isolated clotting without any bleeding risk
    2. B. Isolated bleeding from a single clotting deficit
    3. C. Clotting that consumes factors, then bleeding
    4. D. An excess of platelets causing thrombosis
    Show answer

    Answer: C. Clotting that consumes factors, then bleeding

    It complicates sepsis, trauma, and obstetric emergencies. The clotting is widespread.

17. Which patient has the highest risk of stroke?

    1. A. A 72-year-old with untreated atrial fibrillation and hypertension
    2. B. A 30-year-old with a long history of migraine headaches
    3. C. A 45-year-old with well-controlled asthma on an inhaler
    4. D. A 25-year-old nonsmoking runner with a family history of MI
    Show answer

    Answer: A. A 72-year-old with untreated atrial fibrillation and hypertension

    Stroke risk rises with age, hypertension, diabetes, and especially atrial fibrillation, where stagnant atrial blood forms clots that embolize. Untreated AF in an older hypertensive patient carries high risk, which is why anticoagulation is recommended. The other patients have minimal risk factors.

18. A transient ischemic attack involves:

    1. A. A focal seizure followed by limb weakness
    2. B. A permanent deficit from a small lacunar infarction
    3. C. A small hemorrhage that stops on its own
    4. D. Temporary deficit, usually resolving in minutes
    Show answer

    Answer: D. Temporary deficit, usually resolving in minutes

    A warning of impending stroke. The classic definition was under 24 hours.

19. Thrombotic stroke results from:

    1. A. A clot forming on plaque in a cerebral artery
    2. B. Rupture of a small penetrating cerebral artery
    3. C. Spasm of an artery after an aneurysm bleed
    4. D. A clot traveling from the heart to the brain
    Show answer

    Answer: A. A clot forming on plaque in a cerebral artery

    Often during sleep.

20. Embolic stroke results from:

    1. A. Spasm of a cerebral artery from vasoconstrictors
    2. B. Rupture of a weakened cerebral vessel wall
    3. C. A clot traveling from the heart or carotid
    4. D. A clot forming on plaque within that artery
    Show answer

    Answer: C. A clot traveling from the heart or carotid

    Atrial fibrillation is a common source.

21. Intracerebral hemorrhage results from:

    1. A. An embolus lodging in a cerebral artery
    2. B. Aneurysm rupture into the subarachnoid space
    3. C. Small vessel rupture, often from hypertension
    4. D. A clot forming on cerebral artery plaque
    Show answer

    Answer: C. Small vessel rupture, often from hypertension

    Rapid deterioration.

22. Subarachnoid hemorrhage results from:

    1. A. A clot blocking flow in a cerebral artery
    2. B. Small vessel rupture deep in the brain
    3. C. Ruptured aneurysm bleeding around the brain
    4. D. An embolus lodging in the basilar artery
    Show answer

    Answer: C. Ruptured aneurysm bleeding around the brain

    Worst headache of life. Arteriovenous malformations are another cause.

23. The ischemic penumbra is:

    1. A. Dead tissue at the center of the infarct
    2. B. Bleeding tissue around a hemorrhagic stroke
    3. C. Normal tissue far from the affected vessel
    4. D. Salvageable tissue around the infarct core
    Show answer

    Answer: D. Salvageable tissue around the infarct core

    The target of reperfusion. It is at risk but can be saved.

24. Stroke symptoms depend on:

    1. A. The patient's age at the time of onset
    2. B. The blood pressure measured on arrival
    3. C. The time of day the stroke began
    4. D. The vessel and brain region affected
    Show answer

    Answer: D. The vessel and brain region affected

    Anatomy determines presentation.

25. Left hemisphere stroke commonly produces:

    1. A. Left-sided weakness and neglect
    2. B. Right-sided weakness and aphasia
    3. C. Isolated vision loss in both eyes
    4. D. Left-sided weakness and aphasia
    Show answer

    Answer: B. Right-sided weakness and aphasia

    Language is usually on the left.

26. Right hemisphere stroke commonly produces:

    1. A. Isolated loss of speech production
    2. B. Left-sided weakness and neglect
    3. C. Right-sided weakness and aphasia
    4. D. Right-sided weakness and neglect
    Show answer

    Answer: B. Left-sided weakness and neglect

    Patients may be unaware of deficits.

27. Posterior circulation stroke produces:

    1. A. Dizziness, ataxia, and visual changes
    2. B. Isolated facial droop without other signs
    3. C. Left-sided neglect and gaze preference
    4. D. Aphasia with right-sided arm weakness
    Show answer

    Answer: A. Dizziness, ataxia, and visual changes

    Often missed. Cranial nerve findings are also typical.

28. Hypertension after stroke should:

    1. A. Be treated with nitroglycerin in the field
    2. B. Generally be left alone to perfuse the penumbra
    3. C. Be lowered aggressively to prevent bleeding
    4. D. Be raised with vasopressors to boost flow
    Show answer

    Answer: B. Generally be left alone to perfuse the penumbra

    Permissive hypertension in ischemic stroke.

29. Hypoglycemia must be excluded in stroke because:

    1. A. It is the most common cause of stroke
    2. B. It directly causes ischemic stroke
    3. C. It mimics stroke and is reversible
    4. D. It worsens bleeding in hemorrhagic stroke
    Show answer

    Answer: C. It mimics stroke and is reversible

    Check glucose in every stroke.

30. Increased intracranial pressure results from:

    1. A. Bleeding only, from trauma or aneurysm
    2. B. Mass, edema, hydrocephalus, or bleeding
    3. C. Edema only, from hypoxic brain injury
    4. D. Brain tumors only, from slow-growing masses
    Show answer

    Answer: B. Mass, edema, hydrocephalus, or bleeding

    The Monro-Kellie doctrine. The skull is a fixed space.

31. Compensation for rising ICP initially involves:

    1. A. Herniation of tissue through the foramen
    2. B. Expansion of the skull sutures in adults
    3. C. Systemic hypertension and bradycardia
    4. D. Displacement of CSF and venous blood
    Show answer

    Answer: D. Displacement of CSF and venous blood

    Limited capacity.

32. Herniation syndromes involve:

    1. A. Blood collecting between skull and dura
    2. B. Spinal cord compression at the cervical level
    3. C. CSF draining into the spinal canal
    4. D. Brain shifting and compressing the brainstem
    Show answer

    Answer: D. Brain shifting and compressing the brainstem

    Uncal herniation causes a blown pupil. Tissue is forced through openings in the skull. An epidural hematoma can cause herniation, but the bleed itself is not herniation, and CSF shifting into the spinal canal is an early compensation.

33. Seizure classification includes:

    1. A. Tonic-clonic seizures alone
    2. B. Convulsive and syncopal seizures
    3. C. Focal and generalized seizures
    4. D. Febrile seizures in children alone
    Show answer

    Answer: C. Focal and generalized seizures

    Terms have been updated.

34. Status epilepticus is:

    1. A. A mild focal seizure with preserved awareness
    2. B. A simple febrile seizure lasting a minute
    3. C. A single brief seizure followed by a postictal phase
    4. D. Prolonged or repeated seizures without recovery
    Show answer

    Answer: D. Prolonged or repeated seizures without recovery

    Over 5 minutes requires treatment.

35. Status epilepticus causes harm through:

    1. A. Hyperthermia only, from muscle activity
    2. B. Fall injuries only, without brain damage
    3. C. Hypoxia, acidosis, and neuronal injury
    4. D. Tongue biting and dental injury only
    Show answer

    Answer: C. Hypoxia, acidosis, and neuronal injury

    Brain damage with prolonged seizures. Hyperthermia also contributes.

36. Seizure causes include:

    1. A. Fever only, in children under five years
    2. B. Epilepsy only, in a known seizure patient
    3. C. Head trauma only, in a previously healthy brain
    4. D. Epilepsy, hypoglycemia, hypoxia, and toxins
    Show answer

    Answer: D. Epilepsy, hypoglycemia, hypoxia, and toxins

    Treat reversible causes. Fever, trauma, withdrawal, and infection are also causes.

37. Meningitis pathophysiology involves:

    1. A. Meningeal inflammation that can raise ICP
    2. B. Infection confined to the spinal cord
    3. C. Infection limited to the brain tissue itself
    4. D. Inflammation confined to the skull bones
    Show answer

    Answer: A. Meningeal inflammation that can raise ICP

    Bacterial forms progress rapidly. Vessels may also be involved.

38. Guillain-Barré syndrome involves:

    1. A. Autoimmune damage to motor neurons in the brain
    2. B. Traumatic injury to the cervical spinal cord
    3. C. Autoimmune damage to peripheral nerve myelin
    4. D. Inherited breakdown of skeletal muscle fibers
    Show answer

    Answer: C. Autoimmune damage to peripheral nerve myelin

    Respiratory failure risk. It causes ascending paralysis.

39. Myasthenia gravis involves:

    1. A. Antibodies blocking acetylcholine receptors
    2. B. Loss of dopamine neurons in the brainstem
    3. C. Inherited degeneration of skeletal muscle
    4. D. Antibodies destroying peripheral nerve myelin
    Show answer

    Answer: A. Antibodies blocking acetylcholine receptors

    Myasthenic crisis threatens breathing. Muscle weakness results.

40. Parkinson disease involves:

    1. A. Autoimmune destruction of central myelin
    2. B. Excess dopamine in the basal ganglia
    3. C. Degeneration of skeletal muscle fibers
    4. D. Loss of dopamine-producing neurons
    Show answer

    Answer: D. Loss of dopamine-producing neurons

    Fall risk. Tremor, rigidity, and bradykinesia result.

41. Alzheimer disease involves:

    1. A. Neurodegeneration with plaques and tangles
    2. B. Normal memory changes that come with aging
    3. C. Vascular damage from many small strokes alone
    4. D. A chronic viral infection of the brain
    Show answer

    Answer: A. Neurodegeneration with plaques and tangles

    Most common dementia. It is progressive.

42. Delirium is characterized by:

    1. A. Confusion with no identifiable underlying cause
    2. B. Gradual confusion developing over many years
    3. C. Acute, fluctuating confusion from illness
    4. D. Permanent cognitive decline without recovery
    Show answer

    Answer: C. Acute, fluctuating confusion from illness

    Infection, medication, metabolic.

43. Type 1 diabetes pathophysiology involves:

    1. A. Obesity-driven reduction in insulin action
    2. B. Autoimmune destruction of beta cells
    3. C. Insulin resistance in muscle and fat
    4. D. Age-related decline in pancreatic function
    Show answer

    Answer: B. Autoimmune destruction of beta cells

    Absolute insulin deficiency.

44. Type 2 diabetes pathophysiology involves:

    1. A. Autoimmune destruction of pancreatic beta cells
    2. B. Insulin resistance, then relative deficiency
    3. C. Complete beta cell loss from viral infection
    4. D. Excess glucagon with normal insulin action
    Show answer

    Answer: B. Insulin resistance, then relative deficiency

    Lifestyle and genetics.

45. Hypoglycemia causes include:

    1. A. Excess insulin only, never oral diabetes agents
    2. B. Alcohol intake only, in chronic drinkers
    3. C. Strenuous exercise only, in otherwise healthy people
    4. D. Excess insulin, missed meals, exercise, or alcohol
    Show answer

    Answer: D. Excess insulin, missed meals, exercise, or alcohol

    Ask about recent changes. Oral agents and illness are also causes.

46. Hypoglycemia symptoms result from:

    1. A. Dehydration from glucose-driven osmotic diuresis
    2. B. Brain glucose deprivation alone, not sympathetic
    3. C. Sympathetic activation alone, not brain effects
    4. D. Sympathetic activation and brain glucose deprivation
    Show answer

    Answer: D. Sympathetic activation and brain glucose deprivation

    Shaky and sweaty, then confused.

47. A type 1 diabetic who stopped taking insulin has deep, rapid breathing, a fruity breath odor, and vomiting. What is the mechanism?

    1. A. Excess insulin drives glucose into the cells
    2. B. Alcohol metabolism produces the ketones and acid
    3. C. Anxiety causes respiratory alkalosis and vomiting
    4. D. Lack of insulin forces fat breakdown into ketoacids
    Show answer

    Answer: D. Lack of insulin forces fat breakdown into ketoacids

    Without insulin, cells cannot use glucose, so the body breaks down fat into ketoacids. This causes metabolic acidosis with Kussmaul breathing and a fruity (acetone) odor, plus osmotic diuresis and vomiting. Excess insulin causes hypoglycemia. Alcoholic ketoacidosis needs an alcohol history. Anxiety does not produce ketones.

48. DKA potassium is:

    1. A. Always high and stays high with treatment
    2. B. Often high initially but depleted in total
    3. C. Normal and unaffected by insulin therapy
    4. D. Always low because of urinary losses
    Show answer

    Answer: B. Often high initially but depleted in total

    Monitor carefully. It drops with treatment.

49. An older type 2 diabetic has a glucose of 1,050 mg/dL, profound dehydration, and confusion but normal breathing. Why are ketones minimal?

    1. A. There is no insulin at all in his circulation
    2. B. Some insulin remains, enough to block ketosis
    3. C. Ketones are excreted instantly by the kidneys
    4. D. The glucose reading is falsely high from dehydration
    Show answer

    Answer: B. Some insulin remains, enough to block ketosis

    In HHS, residual insulin is too little to control glucose but enough to prevent fat breakdown into ketones. The result is extreme hyperglycemia and osmotic dehydration without significant acidosis. Absent insulin is DKA. Ketones are not cleared instantly, and readings this high are usually real.

50. Thyroid storm presents with:

    1. A. Fever, tachycardia, and agitation
    2. B. Hypotension, hypoglycemia, and weakness
    3. C. Coma with slow, shallow respirations
    4. D. Hypothermia, bradycardia, and lethargy
    Show answer

    Answer: A. Fever, tachycardia, and agitation

    Life-threatening hyperthyroidism. Heart failure may develop.

51. Myxedema coma presents with:

    1. A. High fever, tachycardia, and agitation
    2. B. Hyperglycemia, ketosis, and dehydration
    3. C. Hypertension, tachycardia, and tremor
    4. D. Hypothermia, bradycardia, and confusion
    Show answer

    Answer: D. Hypothermia, bradycardia, and confusion

    Severe hypothyroidism. Hypotension is also common.

52. Adrenal crisis presents with:

    1. A. Hypotension, hypoglycemia, and vomiting
    2. B. Hyperglycemia, ketosis, and polyuria
    3. C. Hypertension, hyperglycemia, and edema
    4. D. High fever, tachycardia, and agitation
    Show answer

    Answer: A. Hypotension, hypoglycemia, and vomiting

    Steroid-dependent patients under stress. Weakness is also typical.

53. Cushing syndrome pathophysiology involves:

    1. A. Deficient cortisol from adrenal destruction
    2. B. Deficient aldosterone from kidney disease
    3. C. Excess cortisol, often from steroid use
    4. D. Excess insulin from a pancreatic tumor
    Show answer

    Answer: C. Excess cortisol, often from steroid use

    Often from steroid medications. It causes weight gain, hypertension, hyperglycemia, and fragile skin.

54. Acute kidney injury causes include:

    1. A. Urinary obstruction only, such as stones
    2. B. Prerenal, intrinsic, and postrenal causes
    3. C. Nephrotoxic drugs only, such as NSAIDs
    4. D. Urinary infection only, ascending to kidneys
    Show answer

    Answer: B. Prerenal, intrinsic, and postrenal causes

    Prerenal is most common.

55. A patient with chronic kidney disease develops dyspnea, crackles, and leg edema after a salty holiday meal. What is the mechanism?

    1. A. Salt triggers an allergic capillary leak
    2. B. Failing kidneys cannot excrete the extra salt and water
    3. C. Salt overloads the liver and lowers albumin
    4. D. The salt directly weakens the heart muscle so it fails to pump
    Show answer

    Answer: B. Failing kidneys cannot excrete the extra salt and water

    Failing kidneys cannot excrete a sodium and water load, so volume expands and causes edema and pulmonary congestion. Dialysis patients are especially vulnerable between sessions. Dietary salt does not cause an allergic leak, does not lower albumin, and does not directly weaken the heart; the problem is volume the kidneys cannot remove.

56. Dialysis emergencies include:

    1. A. Access bleeding only, from the fistula site
    2. B. Hyperkalemia, fluid overload, and access bleeding
    3. C. Hyperkalemia only, since fluid is well controlled
    4. D. Access infection only, from the catheter
    Show answer

    Answer: B. Hyperkalemia, fluid overload, and access bleeding

    Missed sessions are dangerous. Infection also occurs.

57. A patient with cirrhosis has a minor scalp laceration that keeps oozing despite pressure. Why?

    1. A. His platelet count is too high from cirrhosis
    2. B. Excess vitamin K is blocking clot formation
    3. C. The liver cannot make enough clotting factors
    4. D. The laceration must be arterial, not venous
    Show answer

    Answer: C. The liver cannot make enough clotting factors

    The liver makes most clotting factors, so cirrhosis causes coagulopathy. Splenic sequestration from portal hypertension also lowers platelets. Vitamin K is needed to make clotting factors, so it does not block clotting. A scalp wound oozing despite pressure points to a clotting problem, not an arterial bleed.

58. Portal hypertension results from:

    1. A. Pulmonary hypertension from lung disease
    2. B. Resistance to flow through a scarred liver
    3. C. Backflow from chronic left heart failure
    4. D. Fluid retention from chronic kidney disease
    Show answer

    Answer: B. Resistance to flow through a scarred liver

    Causes varices and ascites.

59. Esophageal varices are dangerous because they:

    1. A. Cause severe chest and back pain
    2. B. Can rupture and bleed massively
    3. C. Block swallowing of solid foods
    4. D. Become infected and cause sepsis
    Show answer

    Answer: B. Can rupture and bleed massively

    Varices are dilated, thin-walled veins caused by portal hypertension; rupture causes massive upper GI bleeding with high mortality. Unruptured varices are usually painless, they are too soft to block swallowing, and infection is not their main danger.

60. Hepatic encephalopathy results from:

    1. A. Ammonia and toxins the liver cannot clear
    2. B. Bacterial infection of the brain tissue
    3. C. Bleeding into the brain from coagulopathy
    4. D. Hypoglycemia from depleted liver glycogen
    Show answer

    Answer: A. Ammonia and toxins the liver cannot clear

    Confusion to coma.

61. GI bleeding pathophysiology involves:

    1. A. Ulcers, varices, tears, or tumors
    2. B. Colon tumors only, in older adults
    3. C. Peptic ulcers only, in most patients
    4. D. Esophageal varices only, in drinkers
    Show answer

    Answer: A. Ulcers, varices, tears, or tumors

    Blood loss may be hidden. Vascular lesions are another source.

62. Peptic ulcer disease is most often caused by:

    1. A. H. pylori infection and NSAID use
    2. B. Emotional stress and chronic anxiety
    3. C. Spicy foods and acidic beverages
    4. D. Alcohol use and cigarette smoking
    Show answer

    Answer: A. H. pylori infection and NSAID use

    Perforation causes peritonitis.

63. Bowel obstruction pathophysiology involves:

    1. A. Bacterial infection of the bowel wall alone
    2. B. Blocked flow with distention and ischemia risk
    3. C. Bleeding from ulcers in the intestinal lining
    4. D. Inflammation of the bowel wall without any blockage
    Show answer

    Answer: B. Blocked flow with distention and ischemia risk

    Strangulation is surgical. Fluid is sequestered in the bowel.

64. Appendicitis pathophysiology involves:

    1. A. A slow-growing tumor at the base of the cecum
    2. B. Luminal obstruction leading to inflammation
    3. C. Bleeding from vessels in the appendix wall
    4. D. Infection spreading from the bloodstream
    Show answer

    Answer: B. Luminal obstruction leading to inflammation

    Rupture causes peritonitis.

65. Pancreatitis pathophysiology involves:

    1. A. Bleeding from erosion of splenic vessels
    2. B. Premature enzyme activation digesting the gland
    3. C. Bacterial infection spreading from the gut
    4. D. Islet cell overproduction of insulin and glucagon
    Show answer

    Answer: B. Premature enzyme activation digesting the gland

    Gallstones and alcohol.

66. Anemia types include:

    1. A. Iron deficiency only, from poor diet
    2. B. Hemolysis only, from immune reactions
    3. C. Iron deficiency, blood loss, or hemolysis
    4. D. Blood loss only, from trauma or GI bleeding
    Show answer

    Answer: C. Iron deficiency, blood loss, or hemolysis

    Different causes, similar symptoms. Marrow failure is another type.

67. Polycythemia increases risk of:

    1. A. Clotting from increased blood viscosity
    2. B. Anemia from accelerated red cell destruction
    3. C. Bleeding from reduced clotting factors
    4. D. Infection from reduced white cell count
    Show answer

    Answer: A. Clotting from increased blood viscosity

    Chronic hypoxia causes secondary polycythemia.

68. Coagulopathy results from:

    1. A. Anticoagulant drugs only, such as warfarin
    2. B. Hemophilia only, as an inherited condition
    3. C. Drugs, liver disease, or factor deficiency
    4. D. Liver disease only, through low factor production
    Show answer

    Answer: C. Drugs, liver disease, or factor deficiency

    Trauma-induced coagulopathy is common. Factor consumption is another cause.

69. A septic patient begins oozing from IV sites and gums. Why does a disorder of clotting cause bleeding?

    1. A. Widespread clotting uses up platelets and factors
    2. B. His platelet count is rising and blocking vessels
    3. C. Fever thins the blood and blocks clotting
    4. D. Sepsis has raised his clotting factor levels
    Show answer

    Answer: A. Widespread clotting uses up platelets and factors

    In DIC, a trigger such as sepsis, trauma, or obstetric catastrophe activates clotting throughout the microcirculation. Platelets and factors are consumed faster than they are made, and fibrinolysis is activated, so the patient bleeds. Platelets fall rather than rise, and clotting factor levels fall rather than rise. Fever does not thin the blood.

70. Musculoskeletal pathophysiology relevant to EMS includes:

    1. A. Sprains and strains only, rarely systemic
    2. B. Fractures, compartment syndrome, and crush injury
    3. C. Chronic arthritis only, not acute injury
    4. D. Fractures only, since soft tissue injury is minor
    Show answer

    Answer: B. Fractures, compartment syndrome, and crush injury

    Systemic effects of muscle injury. Rhabdomyolysis is a key concern.

71. Compartment syndrome pathophysiology involves:

    1. A. Bone fragments directly lacerating the nerves
    2. B. External arterial bleeding from an open wound
    3. C. Rising compartment pressure impairing perfusion
    4. D. Bacterial infection spreading along fascia
    Show answer

    Answer: C. Rising compartment pressure impairing perfusion

    Fasciotomy. Nerve function is also impaired.

72. Crush syndrome pathophysiology involves:

    1. A. Bacterial infection of the crushed muscle
    2. B. Local tissue injury without systemic effects
    3. C. Hemorrhage from the crushed blood vessels
    4. D. Toxin release when crushed tissue is reperfused
    Show answer

    Answer: D. Toxin release when crushed tissue is reperfused

    Prepare before releasing the compression. Potassium, myoglobin, and acid are released.

73. Integumentary pathophysiology includes:

    1. A. Rashes only, without systemic meaning
    2. B. Burns only, as the main skin emergency
    3. C. Skin infections only, such as cellulitis
    4. D. Burns, infections, and pressure injuries
    Show answer

    Answer: D. Burns, infections, and pressure injuries

    The skin reflects systemic disease. Allergic reactions also show in the skin.

74. Burn pathophysiology involves:

    1. A. Local destruction plus systemic fluid loss
    2. B. Pain only, from exposed nerve endings
    3. C. Infection only, appearing days later
    4. D. Skin damage only, without systemic effects
    Show answer

    Answer: A. Local destruction plus systemic fluid loss

    Burn shock. Inflammation and infection risk follow.

75. The zone of coagulation in a burn is:

    1. A. Normal tissue at the burn margin
    2. B. Hyperemic tissue that usually recovers
    3. C. Irreversibly destroyed central tissue
    4. D. Salvageable tissue with reduced flow
    Show answer

    Answer: C. Irreversibly destroyed central tissue

    Surrounded by the zone of stasis.

76. The zone of stasis in a burn:

    1. A. May survive or die depending on care
    2. B. Is undamaged tissue with normal flow
    3. C. Is always lost regardless of care
    4. D. Is already dead at the time of injury
    Show answer

    Answer: A. May survive or die depending on care

    Resuscitation targets it. Perfusion is key.

77. Hypothermia pathophysiology involves:

    1. A. Vasoconstriction only, without other effects
    2. B. Shivering only, without cardiac effects
    3. C. Increased metabolism and heat production
    4. D. Slowed metabolism and dysrhythmias
    Show answer

    Answer: D. Slowed metabolism and dysrhythmias

    Not dead until warm and dead. Coagulopathy and altered drug response also occur.

78. Heat stroke pathophysiology involves:

    1. A. Mild dehydration with intact thermoregulation
    2. B. Heavy sweating with normal mental status
    3. C. Thermoregulatory failure with CNS dysfunction
    4. D. Painful muscle cramps from salt loss
    Show answer

    Answer: C. Thermoregulatory failure with CNS dysfunction

    Rapid cooling is lifesaving. Multi-organ damage follows.

79. Which best summarizes pathophysiology's role in EMS?

    1. A. Mechanisms help anticipate and treat problems
    2. B. It replaces the need for written protocols
    3. C. It applies only to physicians, not paramedics
    4. D. It is academic and rarely used in the field
    Show answer

    Answer: A. Mechanisms help anticipate and treat problems

    Mechanism predicts presentation. It also aids recognition.