NR 507 ADVANCED PATHOPHYSIOLOGY WEEK
8 FINAL EXAM 2026/2027: 100 QUESTIONS &
ANSWERS
SECTION 1: Cellular & Genetic Foundations (15 Questions)
Q1: A 45-year-old with chronic alcohol use develops hepatomegaly. Liver biopsy reveals
enlarged hepatocytes with increased smooth endoplasmic reticulum. This cellular
adaptation is best described as:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: C
Rationale: Pathophysiological Sequence: Chronic alcohol (etiology) → induces
cytochrome P-450 enzymes → SER proliferation (pathogenesis) → hyperplasia
(increase in organelle number/cells) → organ enlargement. NP Link: Explains enzyme
induction and drug interaction potential. Distractors: Atrophy (decrease size),
hypertrophy (increase cell size), metaplasia (cell type change).
Q2: Which genetic disorder demonstrates autosomal dominant inheritance with
complete penetrance?
A. Cystic fibrosis
,B. Sickle cell disease
C. Huntington disease
D. Phenylketonuria
Correct Answer: C
Rationale: Genetics: Huntington = CAG repeat expansion on chr 4; 100% penetrance
(gene = disease). NP Application: 50% transmission risk; genetic counseling imperative.
Distractors: A,B,D = autosomal recessive.
Q3: A tumor suppressor gene mutation leads to unchecked cellular proliferation. Which
gene fits this description?
A. TP53
B. K-RAS
C. BCL-2
D. c-MYC
Correct Answer: A
Rationale: Molecular Path: TP53 (“guardian of genome”) → halts cell cycle / induces
apoptosis; loss-of-function mutations → proliferation. Distractors: K-RAS, c-MYC =
proto-oncogenes (gain-of-function); BCL-2 = anti-apoptotic.
Q4: The “two-hit hypothesis” best explains:
A. Retinoblastoma
B. Neurofibromatosis 1
,C. Marfan syndrome
D. Alpha-1 antitrypsin deficiency
Correct Answer: A
Rationale: Knudson Hypothesis: Two separate mutations in RB1 tumor-suppressor →
retinoblastoma; explains sporadic vs familial patterns. NP Pearl: Screen at-risk infants
early.
Q5: A 30-year-old woman has recurrent deep-vein thrombosis without risk factors. Lab
shows APC resistance. Which mutation is likely?
A. Factor V Leiden
B. Prothrombin G20210A
C. Protein C deficiency
D. Antithrombin deficiency
Correct Answer: A
Rationale: Hypercoag: Factor V Leiden = single base change → resistant to activated
protein C → continued factor Va activity → thrombosis. Prevalence: 3-8% Caucasians;
autosomal dominant.
Q6: Cellular injury from ionizing radiation primarily damages DNA through:
A. Double-strand breaks
B. Base alkylation
C. Depurination
, D. Pyrimidine dimers
Correct Answer: A
Rationale: Radiobiology: X-rays/γ-rays generate hydroxyl radicals → double-strand
breaks → chromosomal aberrations → apoptosis or carcinogenesis. Distractors: UV
light → pyrimidine dimers; alkylating agents → base alkylation.
Q7: In neoplastic progression, angiogenesis is triggered primarily by:
A. VEGF secretion from tumor cells
B. Increased necrosis
C. p53 activation
D. Telomerase inhibition
Correct Answer: A
Rationale: Tumor Biology: Hypoxic tumor cells → HIF-1α → VEGF → endothelial
proliferation → new vessels → metastasis route. Therapy: Bevacizumab (anti-VEGF).
Q8: Which cellular change is irreversible?
A. Hydropic swelling
B. Fatty change
C. Karyorrhexis
D. Glycogen accumulation
Correct Answer: C
8 FINAL EXAM 2026/2027: 100 QUESTIONS &
ANSWERS
SECTION 1: Cellular & Genetic Foundations (15 Questions)
Q1: A 45-year-old with chronic alcohol use develops hepatomegaly. Liver biopsy reveals
enlarged hepatocytes with increased smooth endoplasmic reticulum. This cellular
adaptation is best described as:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: C
Rationale: Pathophysiological Sequence: Chronic alcohol (etiology) → induces
cytochrome P-450 enzymes → SER proliferation (pathogenesis) → hyperplasia
(increase in organelle number/cells) → organ enlargement. NP Link: Explains enzyme
induction and drug interaction potential. Distractors: Atrophy (decrease size),
hypertrophy (increase cell size), metaplasia (cell type change).
Q2: Which genetic disorder demonstrates autosomal dominant inheritance with
complete penetrance?
A. Cystic fibrosis
,B. Sickle cell disease
C. Huntington disease
D. Phenylketonuria
Correct Answer: C
Rationale: Genetics: Huntington = CAG repeat expansion on chr 4; 100% penetrance
(gene = disease). NP Application: 50% transmission risk; genetic counseling imperative.
Distractors: A,B,D = autosomal recessive.
Q3: A tumor suppressor gene mutation leads to unchecked cellular proliferation. Which
gene fits this description?
A. TP53
B. K-RAS
C. BCL-2
D. c-MYC
Correct Answer: A
Rationale: Molecular Path: TP53 (“guardian of genome”) → halts cell cycle / induces
apoptosis; loss-of-function mutations → proliferation. Distractors: K-RAS, c-MYC =
proto-oncogenes (gain-of-function); BCL-2 = anti-apoptotic.
Q4: The “two-hit hypothesis” best explains:
A. Retinoblastoma
B. Neurofibromatosis 1
,C. Marfan syndrome
D. Alpha-1 antitrypsin deficiency
Correct Answer: A
Rationale: Knudson Hypothesis: Two separate mutations in RB1 tumor-suppressor →
retinoblastoma; explains sporadic vs familial patterns. NP Pearl: Screen at-risk infants
early.
Q5: A 30-year-old woman has recurrent deep-vein thrombosis without risk factors. Lab
shows APC resistance. Which mutation is likely?
A. Factor V Leiden
B. Prothrombin G20210A
C. Protein C deficiency
D. Antithrombin deficiency
Correct Answer: A
Rationale: Hypercoag: Factor V Leiden = single base change → resistant to activated
protein C → continued factor Va activity → thrombosis. Prevalence: 3-8% Caucasians;
autosomal dominant.
Q6: Cellular injury from ionizing radiation primarily damages DNA through:
A. Double-strand breaks
B. Base alkylation
C. Depurination
, D. Pyrimidine dimers
Correct Answer: A
Rationale: Radiobiology: X-rays/γ-rays generate hydroxyl radicals → double-strand
breaks → chromosomal aberrations → apoptosis or carcinogenesis. Distractors: UV
light → pyrimidine dimers; alkylating agents → base alkylation.
Q7: In neoplastic progression, angiogenesis is triggered primarily by:
A. VEGF secretion from tumor cells
B. Increased necrosis
C. p53 activation
D. Telomerase inhibition
Correct Answer: A
Rationale: Tumor Biology: Hypoxic tumor cells → HIF-1α → VEGF → endothelial
proliferation → new vessels → metastasis route. Therapy: Bevacizumab (anti-VEGF).
Q8: Which cellular change is irreversible?
A. Hydropic swelling
B. Fatty change
C. Karyorrhexis
D. Glycogen accumulation
Correct Answer: C
