WGU D236 PATHOPHYSIOLOGY EXAM LATEST 2024
QUESTIONS AND ANSWERS GRADED A+
1. What is Starling's Law of Capillary forces? How does this
explain why a nutritionally deficient child would have
edema?
Starling’s Law describes how fluids move across the capillary membrane.
There are two major opposing forces that act to balance each other,
hydrostatic pressure (pushing water out of the capillaries) and osmotic
pressure (including oncontic pressure, which pushes fluid into the capillaries).
Both electrolytes and proteins (oncontic pressure) in the blood affect osmotic
pressure, high electrolyte and protein concentrations in the blood would cause
water to leave the cells and interstitial space and enter the blood stream to
dilute the high concentrations. On, the other hand, low electrolyte and protein
concentrations (as seen in a nutritionally deficient child) would cause water to
leave the capillaries and enter the cells and interstitial fluid which can lead to
edema.
2. How does the RAAS (Renin-Angiotensin-
Aldosterone System) result in increased blood volume
and increased blood pressure?
A drop in blood pressure is sensed by the kidneys by low perfusion,
which in turn begins to secrete renin. Renin then triggers the liver to produce
angiotensinogen, which is converted to Angiotensin I in the lungs and then
angiotensin II by the enzyme Angiotensin-converting enzyme (ACE).
Angiotensin II stimulates peripheral arterial vasoconstriction which raises BP.
Angiotensin II is also stimulating the adrenal gland to release aldosterone,

which acts to increase sodium and water reabsorption increasing blood
volume, while also increased potassium secretion in urine.
3. How can hyperkalemia lead to cardiac arrest?
Normal levels of potassium are between 3.5 and 5.2 mEq/dL.
Hyperkalemia refers to potassium levels higher that 5.2 mEq/dL. A major
function of potassium is to conduct nerve impulses in muscles. Too low and
muscle weakness occurs and too much can cause muscle spasms. This is
especially dangerous in the heart muscle and an irregular heartbeat can cause
a heart attack.
4. The body uses the Protein Buffering System, Phosphate
Buffering System, and Carbonic Acid- Bicarbonate
System to regulate and maintain homeostatic pH, what is
the consequence of a pH imbalance?
Proteins contain many acidic and basic group that can be affected by
pH changes. Any increase or decrease in blood pH can alter the structure of
the protein (denature), thereby affecting its function as well.
5. Describe the laboratory findings associated with
metabolic
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Normal ABGs (Arterial Blood Gases) Blood pH: 7.35-7.45 PCO2:
35-45 mm Hg PO2: 90-100 mm Hg HCO3-: 22-26 mEq/L SaO2: 95-100%
Respiratory acidosis and alkalosis are marked by changes in PCO2. Higher
= acidosis and lower = alkalosis Metabolic acidosis and alkalosis are
caused by something other than abnormal CO2 levels. This could include
toxicity, diabetes, renal failure or excessive GI losses. Here are the rules to
follow to determine if is respiratory or metabolic in nature. -If pH and PCO2
are moving in opposite directions, then it is the pCO2 levels that are causing
the imbalance and it is respiratory in nature. -If PCO2 is normal or is moving
tin the same direction as the pH, then the imbalance is metabolic in nature.
6. The anion gap is the difference between measured cations
(Na+ and K+) and measured anions (Cl- and HCO3-), this
calculation can be useful in determining the cause of metabolic
acidosis. Why would an increased anion gap be observed in
diabetic ketoacidosis or lactic acidosis?
The anion gap is the calculation of unmeasured anions in the blood.
Lactic acid and ketones both lead to the production of unmeasured anions,
which remove HCO3- (a measured anion) due to buffering of the excess
H+ and therefore leads to an increase in the AG.
7. Why is it important to maintain a homeostatic balance
of glucose in the blood (ie describe the pathogenesis of
diabetes)?
Insulin is the hormone responsible for initiating the uptake of glucose
by the cells. Cells use glucose to produce energy (ATP). In a normal
individual, when blood glucose increases, the pancreas is signaled to
produced in insulin, which binds to insulin receptors on a cells surface and
initiates the uptake of glucose. Glucose is a very reactive molecule and if left
in the blood, it can start to bind to other proteins and lipids, which can lead to
loss of function. AGEs are advanced glycation end products that are a result
of glucose reacting with the endothelial lining, which can lead to damage in
the heart and kidneys.
8. Compare and contrast Type I and Type II Diabetes
Type I diabetes is caused by lack of insulin. With out insulin
signaling, glucose will not be taken into the cell and leads to high blood
glucose (hyperglycemia). Type I is usually treated with insulin injections.
Type II diabetes is caused by a desensitization to insulin signaling. The
insulin receptors are no longer responding to insulin, which also leads to
hyperglycemia. Type II is usually treated with drugs to increase the
sensitization to insulin (metformin), dietary and life-style changes or
insulin injections.
9. Describe some reasons for a patient needing dialysis AEIOU-
acidosis. Electrolytes, I nto x i c at ion / I n g e st io n , overload, uremia. Patients
with kidney or heart failure. A build up of phosphates, urea and
magnesium are removed
from the blood using a semi-permeable membrane and dialysate. AEIOU:
A— acidosis; E

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opposite direction. Waste from the blood diffuses through the
semipermeable membrane separating the blood from the dialysate.
Peritoneal Dialysis does not use a machine, but instead injects a solution of
water and glucose into the abdominal cavity. The peritoneum acts as the
membrane instead of dialysis tubing. The waste products diffuse into the
abdominal cavity and the waste solution is then drained from the body.
Peritoneal dialysis offers continuous filtration and is less disruption to the
patient’s daily routines. However, it does require some training of the patient
and is not recommended for individuals who are overweight or have severe
kidney failure. Hemodialysis provides medical care, but 3 times a week for
several hours sitting at a hospital or clinic.
Individuals with acute kidney failure are recommended to use hemo
11. Essential Question: How does homeostasis and
maintaining optimal physiological health impact your
wellbeing?
Homeostasis acts to create a constant and stable environment in the
body despite internal and external changes. Proteins and other cellular
processes require optimal conditions in order to carry out their functions.
Alterations in pH, salt concentration, temperature, glucose levels, etc. can
have negative effects on health, so it is vital for mechanisms that regulate
homeostasis to function properly for maintaining good health.
Lesson 2: Cellular Response and Adaptation
1. Differentiate between Innate Immunity and
Adaptive Immunity.
The innate immune system encompasses physical barriers and
chemical and cellular defenses. Physical barriers protect the body from
invasion. These include things like the skin and eyelashes. Chemical barriers
are defense mechanisms that can destroy harmful agent. Examples include
tears, mucous, and stomach acid. Cellular defenses of the innate immune
response are non- specific. These cellular defenses identify pathogens and
substances that are potentially dangerous and takes steps to neutralize or
destroy them. Adaptive immunity is an organism’s acquired immunity to a
specific pathogen. As such, it’s also referred to as acquired immunity. Adaptive
immunity is not immediate, nor does it always last throughout an organism’s
entire lifespan, although it can. The adaptive immune response is marked by
clonal expansion of T and B lymphocytes, releasing many antibody copies to
neutralize or destroy their target antigen.
2. What is a way that Adaptive Immunity can
recruit innate immunity?
The innate immune response to microbes stimulates adaptive immune
responses and influences the nature of the adaptive responses. Conversely,
adaptive immune

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responses often work by enhancing the protective mechanisms of innate
immunity, making them more capable of effectively combating pathogenic
microbes.
3. 3. Why are some infections harder on children while
other infections are harder on the elderly?
Children have not been exposed to many pathogens yet, so they lack memory cells and
have not built- up immunity yet. The elderly have a depleted naïve T cell population from
years of battling infections, so the likelihood of getting a match is less.
4. Describe how and why our injury response results in
the signs of redness, swelling, heat, and pain? Be sure to
use chemokines, histamine, and vasodilation in your
response.
An injury causes an inflammatory response which is responsible for the
redness, swelling, heat and pain. Upon injury, cells on the surface begin to
release chemokines which act as messengers that something has happened.
Mast cells are also alerted to release histamines which travel to the endothelial
cells of capillaries and causes vasodilation, which is related to swelling and
redness. Vasodilation also causes the capillaries to become leaky which allows
for histamines, chemokines and even pathogen particles to enter the blood
stream where they are met by neutrophils (non-specific) which start to adhere
to the capillary wall and squeeze through the leaky holes (diapedesis or
extravasation) to phagocytose pathogens and damaged cells. Dendritic cells
just under the surface of skin are also activated to phagocytose foreign
particles.
Other B cells, T cells (specific) and the complement system also squeeze
through the capillary wall to create an area of congestion.
5. Explain dominant vs recessive genetic diseases. What is a
"carrier" in recessive genetic diseases?
The human genome contains 23 pairs of chromosome (22
autosomes and 1 pair of sex chromosomes). The pairs are homologous
and contain the same genes in the same order. This means that every gene
has a copy, one inherited from your mother and the other from your father.
Not all versions of a gene (alleles) are treated the same by the cell. Some are
expressed over others. A dominant gene is a gene that is expressed, even if
you only have one copy. The dominant gene will be expressed over the
recessive gene, which must have two copies to be expressed. In a

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dominant genetic disease, all it takes is one copy of the disease to have
the disease.
Recessive genetic diseases require that the individual gets two copies of the
gene to have the disease.
Someone who is a carrier for a recessive genetic disease is healthy, but
contains a copy of the disease gene, potentially passing it to their offspring.
6. Describe how to determine the probability of
clinical outcomes given information about the parents
(eg two heterozygous carriers of sickle cell disease)

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Punnett Squares can be used to determine the potential probabilities
of certain traits being passed to offspring. If you know the genotypes of each
parent (ie
homozygous or heterozygous for the trait), you can determine the possible
outcomes. Heterozygous means that the parent has one copy of each gene,
homozygous means the parent has the same copy for each gene (either
both dominant genes or both recessive genes).
7. What are some of the consequences of alcohol exposure
in pregnancy?
ND-PAE (neurobehavioral disorder-prenatal alcohol exposure) can cause birth defects
and developmental disabilities (fetal alcohol spectrum disorders-FASDs). Affects thinking and
memory, causes behavioral issues and linked to trouble with everyday functioning
8. What are some of the distinctive features associated with
trisomy 21, or Down's Syndrome? Why is increased
maternal age a risk factor?
Distinct features of Down’s syndrome include intellectual disabilities and common
physical features that include slanted eyes, flattened bridge of the nose and forehead, short in
stature, poor muscle tone, loose joints and single palmar crease. As a woman’s eggs age, they
can have mistakes in meiosis potentially leading to a nondisjunction event causing trisomy 21
9. What is Spina Bifida? Why are relative deficiencies in
Folic acid or B12 associated with Spina Bifida?
Failure to close the neural tube early in gestation due to low folic acid and B-12. These
vitamins help activate DNA synthesis in the developing fetus in the first 4 weeks of pregnancy,
that are responsible for closing up the spinal column. Three types of spina bifida. 1) spina bifida
occulta (most common, less severe)
2) Meningocele (least common) 3) Myelomeningocele (most severe).
10. Essential Question: How does the body's cellular
responses and adaptations react to disruptions?
The body uses the RAAS system to regulate blood volume and
pressure, the immune response reacts to fight infection, the inflammatory
response reacts to injury
Lesson 3: Musculoskeletal Pathophysiology
1. Describe how calcitonin, parathyroid hormone, and
calcitriol (Vitamin D) work together to maintain
normal blood calcium levels.
Pages 926, 968, and 980 of text. Vitamin D: UV light stimulates formation of
cholecalciferol, which is hydroxylated in the liver and the kidney into the active form
of Vitamin D, calcitriol. Calcitriol stimulates absorption of calcium and phosphorus

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from the GI tract in the intestine and phosphate in the kidney. Calcitriol increases the
calcification of osteoid. Calcitriol also stimulates the formation of bone by raising the
levels of calcium and phosphorus in the blood. Low vitamin D levels can cause
hypocalcemia, which stimulates the parathyroid gland to release parathyroid hormone
(PTH). PTH stimulates osteoclasts to resorb bone calcium to increase blood calcium
levels. PTH also stimulates

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W WGU D236 PATHOPHYSIOLOGY
osteoblasts to form bone. PTH stimulates kidneys to reabsorb calcium into the
blood and to synthesize vitamin D. When blood calcium gets too high, the
thyroid is stimulated to release calcitonin (suppresses osteoclast activity and
calcium will be used to form bone).
2. Describe the function of osteocytes within lacunae of bone
Osteocytes absorb nutrients from the bloodstream and distribute them within the bone structure.
Osteocytes absorb waste products from the bone and excrete them into the bloodstream.
3. Describe bone remodeling. Which cells are
involved in this process and what is their function?
Osteoclasts breakdown older bone structure and secrete the release calcium into the
bloodstream. Osteoblasts absorb calcium from the bloodstream and use it to build new bone
structure. Working together, these two cell types allow for regeneration of damaged bone
structure.
4. Describe the process of articular degeneration. Which
cells are involved in this process and what is their
function?
Articular Degeneration is the thinning and breakdown of the articular
cartilage that covers joints and acts as a lubricant and cushion. This articular
cartilage is comprised of chondrocytes in a matrix of collagen and aggrecan.
The chondrocytes produce enzymes and other proteins that slowly break down
and reform the matrix, allowing for regeneration. Stress caused by being
overweight or physical trauma can cause chondrocytes to speed up the matrix
breakdown process relative to the reformation process, leading to a thinning of
the articular cartilage.
5. What is rickets? How does it develop? Who usually
develops rickets? How can rickets be treated?
Pages 979-980 of text. Rickets is, primarily, due to a deficiency of vitamin D (due to
sunlight exposure), which leads to a deficiency of blood calcium. Rickets can lead to bone
weakness, deformity, and susceptibility to fracture. Rickets results from a failure to calcify
osteoid due to low amounts of blood calcium and low vitamin D (typically). There are many
different types of rickets. Children, especially under age 2, are most likely to be diagnosed with
rickets. Infants can develop rickets if their mother's diet was low in vitamin D or in calcium, and
breastmilk is low in vitamin D, so mother and baby need to supplement vitamin D (and calcium).
The best way to treat rickets is to prevent it by taking supplements of vitamin D and calcium,
eating food/drink containing vitamin D/calcium, and getting sufficient sunlight. Physical therapy
with weight-bearing exercise can help to treat rickets, as well. It is a multi step process to make
the active form of Vit D
6. How does Denosumab treat osteoporosis?
Denosumab is a monoclonal antibody that binds to osteoclasts and inhibits their
Calcium- withdrawing capability.
7. Distinguish between open reduction and internal
fixation (ORIF) and hip replacement surgery.
Open reduction and internal fixation involves ―surgical opening’ and insertion of
hardware into the patient that assists with maintaining proper bone alignment during the
healing process. Hip replacement involves replacement of a fractured hip joint with a

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Text, pages 981-984. Degenerative disc disease (DDD) is a disorder
of the intervertebral discs. When the discs deteriorate, they cause improper
alignment of the spinal column. Some anatomical issues that result are
thinning discs, herniated discs (nucleus pulposus leaking through annulus
fibrosus cartilage), bulging discs, and degenerated discs (possible with the
formation of osteophytes). Lumbar DDD results in pain in the buttock and
thighs that gets worse with sitting, bending, lifting or twisting; weakness and
numbness in the lower body, such as sciatica. Cervical DDD can result in
chronic neck pain that radiates to shoulders and down the arms, weakness of
a r m s/ han d s, and numbness and tingling in a r ms/ han d s.
9. What is sepsis, what are symptoms of sepsis, and how
can sepsis be treated?
Page 937 of text. Sepsis is an infection of the blood. Fever, chills, and increased
pressure in the affected area are symptoms, as well as the area of injury will be warm,
edematous, and erythematous. If the infection is advanced, a purulent (pus-like) discharge can
develop, as well as a foul odor. The patient is treated with IV antibiotics in the hospital. When
they are allowed to go home, they are given oral antibiotics. In the context of musculoskeletal
injury, as part of treatment, the debridement of the wound and removal of orthopedic hardware
will be needed to clean up infected region around injury, if it exists.
10. How does compartment syndrome develop? Which part
of our body tends to develop compartment syndrome? How
do patients typically recognize they may need to seek
medical assistance for rhabdomyolysis? What is the most
sensitive laboratory test for rhabdomyolosis?
Page 936 of text and video in course materials. Because the fascia around the muscles,
nerves and blood vessels do not stretch, compartments surrounded by fascia cannot tolerate
swelling or bleeding internally. When this happens, tissue pressure can exceed perfusion
pressure, and compartment syndrome develops. The area can feel very hard due to the pressure.
It is common in the lower leg and the forearm, and can be present in several potential body
compartments. Several issues develop, and then exacerbate, the compartment syndrome,
including constriction of veins, then arteries and compressed nerves. These lead to tissue
necrosis, ischemia, leaky capillaries, and edema. This gives even higher pressure and can lead to
increase Mb in the blood as muscles break down (rhabdomyolysis). Mb in the kidneys can lead
to renal toxicity and tea-colored urine, which is, typically, a patient's first indication that they
have rhabdomyolysis. The most sensitive laboratory test is an elevated creatine
11. What is a pulmonary embolism? What is a fat
embolism?
When might a patient develop a pulmonary embolism?
When
might a patient develop a fat embolism? How are they
treated? Page 937 of the text. A pulmonary embolism is a blood clot
that has obstructed an artery in the lungs. A fat embolism occurs when fat
globules released from marrow of a fractured bone block microvasculature in
the lung or other organs, such as the brain. A pulmonary embolism may
often develop due to orthopedic surgery and in individuals with low
mobility and blood hypercoagulation tendency. Anticoagulant may be

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2024 WGU D236 Pathophysiology Practice Exam With Answers (134 Solved Questions)

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