NUR 634 Final Exam Actual Exam QUESTIONS
AND ANSWERS 2026 | Advanced
Pathophysiology | Complete Q&A Graded A+ |
Pass Guaranteed - A+ Graded
Question 1 A 58-year-old male smoker presents with a persistent cough. A lung biopsy reveals
replacement of normal ciliated columnar epithelium with stratified squamous epithelium. This
cellular adaptation is best described as:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is a reversible change in which one mature cell type is replaced by
another mature cell type, often in response to chronic irritation. In smokers, chronic irritation
causes respiratory epithelium to undergo squamous metaplasia, replacing delicate ciliated
columnar cells with tougher stratified squamous epithelium. While protective against irritation,
this increases cancer risk.
• Dysplasia (A) shows abnormal cellular features with loss of normal architecture,
representing pre-malignant change.
• Hyperplasia (C) is an increase in cell number, not cell type replacement.
• Anaplasia (D) is loss of differentiation seen in malignant tumors.
Question 2 A patient with prolonged hypotension develops acute tubular necrosis. The primary
mechanism of cellular injury is:
A. Chemical injury
B. Hypoxic injury [CORRECT]
C. Infectious injury
D. Immunologic injury
Correct Answer: B
Rationale: Prolonged hypotension leads to decreased renal perfusion, causing ischemic/hypoxic
,injury to the renal tubules. Without adequate oxygen, cells switch to anaerobic metabolism,
leading to ATP depletion, failure of the sodium-potassium pump, cellular swelling, and
ultimately cell death. The proximal tubule is particularly vulnerable due to high metabolic
demand.
• Chemical injury (A) involves toxins or drugs.
• Infectious injury (C) involves pathogens.
• Immunologic injury (D) involves immune-mediated damage.
Question 3 Which type of necrosis is characterized by preservation of tissue architecture for
several days after cell death?
A. Liquefactive necrosis
B. Coagulative necrosis [CORRECT]
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Coagulative necrosis (from ischemia in solid organs like heart, kidney, spleen)
denatures proteins and enzymes, preventing rapid autolysis and preserving tissue architecture for
several days. This allows the inflammatory response to demarcate the infarct.
• Liquefactive necrosis (A) occurs in brain (enzyme-rich) and bacterial infections, causing
rapid liquefaction.
• Caseous necrosis (C) has cheese-like appearance seen in tuberculosis, with complete
architecture destruction.
• Fat necrosis (D) shows chalky white deposits from saponification (calcium soap
formation).
Question 4 A patient with rheumatoid arthritis has autoantibodies against which self-antigen?
A. Acetylcholine receptors
B. IgG Fc portion [CORRECT]
C. Thyroid peroxidase
D. Islet cells
Correct Answer: B
Rationale: Rheumatoid arthritis is associated with rheumatoid factor (IgM autoantibodies
,against the Fc portion of IgG) and anti-CCP (cyclic citrullinated peptide) antibodies. These form
immune complexes that deposit in joints, causing inflammation and destruction.
• Acetylcholine receptors (A) are targeted in myasthenia gravis.
• Thyroid peroxidase (C) is targeted in Hashimoto's thyroiditis.
• Islet cells (D) are targeted in type 1 diabetes mellitus.
Question 5 A patient experiences anaphylaxis after receiving penicillin. Which type of
hypersensitivity reaction is this?
A. Type I [CORRECT]
B. Type II
C. Type III
D. Type IV
Correct Answer: A
Rationale: Anaphylaxis is a Type I (immediate) hypersensitivity reaction mediated by IgE
antibodies binding to mast cells and basophils, causing cross-linking and massive release of
histamine, leukotrienes, and prostaglandins. This causes vasodilation, increased vascular
permeability, bronchoconstriction, and potentially fatal shock.
• Type II (B) is antibody-mediated cytotoxicity (e.g., hemolytic anemia).
• Type III (C) is immune complex-mediated (e.g., serum sickness).
• Type IV (D) is delayed-type T-cell mediated (e.g., contact dermatitis).
Question 6 Granulomatous inflammation is characteristic of which condition?
A. Acute appendicitis
B. Tuberculosis [CORRECT]
C. Viral hepatitis
D. Bacterial pneumonia (typical)
Correct Answer: B
Rationale: Granulomatous inflammation, featuring granulomas (collections of epithelioid
macrophages, multinucleated giant cells, and lymphocytes), is characteristic of tuberculosis,
sarcoidosis, fungal infections, and foreign body reactions. This represents a cell-mediated
immune response to persistent intracellular pathogens or foreign material.
• Acute appendicitis (A) shows acute suppurative inflammation.
, • Viral hepatitis (C) shows lymphocytic infiltration and hepatocyte injury.
• Typical bacterial pneumonia (D) shows acute neutrophilic infiltration.
Question 7 A patient with severe burns develops systemic inflammatory response syndrome
(SIRS). The primary mediator driving this response is:
A. Histamine only
B. Tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1) [CORRECT]
C. Serotonin only
D. Acetylcholine
Correct Answer: B
Rationale: Severe tissue injury releases pro-inflammatory cytokines TNF-α and IL-1 from
macrophages, initiating the systemic inflammatory cascade. These cause fever, increased
vascular permeability, activation of complement and coagulation cascades, and potentially lead
to septic shock or multiple organ dysfunction.
• Histamine (A) is important locally but not the primary systemic mediator.
• Serotonin (C) and acetylcholine (D) are not primary inflammatory mediators in SIRS.
Question 8 Apoptosis differs from necrosis in that apoptosis:
A. Always causes inflammation
B. Is an energy-dependent, programmed process without inflammation [CORRECT]
C. Results from acute injury only
D. Involves cell swelling and membrane rupture
Correct Answer: B
Rationale: Apoptosis is programmed cell death requiring ATP, characterized by cell shrinkage,
chromatin condensation, formation of apoptotic bodies, and phagocytosis without inflammation.
It maintains membrane integrity until late stages. Necrosis involves ATP depletion, cell swelling,
membrane rupture, and inflammatory response.
• Necrosis (A, C, D features) is passive, energy-independent, and inflammatory.
Question 9 A patient with chronic hepatitis C develops hepatic fibrosis. The primary cell
responsible for collagen deposition is:
A. Hepatocytes
B. Kupffer cells
AND ANSWERS 2026 | Advanced
Pathophysiology | Complete Q&A Graded A+ |
Pass Guaranteed - A+ Graded
Question 1 A 58-year-old male smoker presents with a persistent cough. A lung biopsy reveals
replacement of normal ciliated columnar epithelium with stratified squamous epithelium. This
cellular adaptation is best described as:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is a reversible change in which one mature cell type is replaced by
another mature cell type, often in response to chronic irritation. In smokers, chronic irritation
causes respiratory epithelium to undergo squamous metaplasia, replacing delicate ciliated
columnar cells with tougher stratified squamous epithelium. While protective against irritation,
this increases cancer risk.
• Dysplasia (A) shows abnormal cellular features with loss of normal architecture,
representing pre-malignant change.
• Hyperplasia (C) is an increase in cell number, not cell type replacement.
• Anaplasia (D) is loss of differentiation seen in malignant tumors.
Question 2 A patient with prolonged hypotension develops acute tubular necrosis. The primary
mechanism of cellular injury is:
A. Chemical injury
B. Hypoxic injury [CORRECT]
C. Infectious injury
D. Immunologic injury
Correct Answer: B
Rationale: Prolonged hypotension leads to decreased renal perfusion, causing ischemic/hypoxic
,injury to the renal tubules. Without adequate oxygen, cells switch to anaerobic metabolism,
leading to ATP depletion, failure of the sodium-potassium pump, cellular swelling, and
ultimately cell death. The proximal tubule is particularly vulnerable due to high metabolic
demand.
• Chemical injury (A) involves toxins or drugs.
• Infectious injury (C) involves pathogens.
• Immunologic injury (D) involves immune-mediated damage.
Question 3 Which type of necrosis is characterized by preservation of tissue architecture for
several days after cell death?
A. Liquefactive necrosis
B. Coagulative necrosis [CORRECT]
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Coagulative necrosis (from ischemia in solid organs like heart, kidney, spleen)
denatures proteins and enzymes, preventing rapid autolysis and preserving tissue architecture for
several days. This allows the inflammatory response to demarcate the infarct.
• Liquefactive necrosis (A) occurs in brain (enzyme-rich) and bacterial infections, causing
rapid liquefaction.
• Caseous necrosis (C) has cheese-like appearance seen in tuberculosis, with complete
architecture destruction.
• Fat necrosis (D) shows chalky white deposits from saponification (calcium soap
formation).
Question 4 A patient with rheumatoid arthritis has autoantibodies against which self-antigen?
A. Acetylcholine receptors
B. IgG Fc portion [CORRECT]
C. Thyroid peroxidase
D. Islet cells
Correct Answer: B
Rationale: Rheumatoid arthritis is associated with rheumatoid factor (IgM autoantibodies
,against the Fc portion of IgG) and anti-CCP (cyclic citrullinated peptide) antibodies. These form
immune complexes that deposit in joints, causing inflammation and destruction.
• Acetylcholine receptors (A) are targeted in myasthenia gravis.
• Thyroid peroxidase (C) is targeted in Hashimoto's thyroiditis.
• Islet cells (D) are targeted in type 1 diabetes mellitus.
Question 5 A patient experiences anaphylaxis after receiving penicillin. Which type of
hypersensitivity reaction is this?
A. Type I [CORRECT]
B. Type II
C. Type III
D. Type IV
Correct Answer: A
Rationale: Anaphylaxis is a Type I (immediate) hypersensitivity reaction mediated by IgE
antibodies binding to mast cells and basophils, causing cross-linking and massive release of
histamine, leukotrienes, and prostaglandins. This causes vasodilation, increased vascular
permeability, bronchoconstriction, and potentially fatal shock.
• Type II (B) is antibody-mediated cytotoxicity (e.g., hemolytic anemia).
• Type III (C) is immune complex-mediated (e.g., serum sickness).
• Type IV (D) is delayed-type T-cell mediated (e.g., contact dermatitis).
Question 6 Granulomatous inflammation is characteristic of which condition?
A. Acute appendicitis
B. Tuberculosis [CORRECT]
C. Viral hepatitis
D. Bacterial pneumonia (typical)
Correct Answer: B
Rationale: Granulomatous inflammation, featuring granulomas (collections of epithelioid
macrophages, multinucleated giant cells, and lymphocytes), is characteristic of tuberculosis,
sarcoidosis, fungal infections, and foreign body reactions. This represents a cell-mediated
immune response to persistent intracellular pathogens or foreign material.
• Acute appendicitis (A) shows acute suppurative inflammation.
, • Viral hepatitis (C) shows lymphocytic infiltration and hepatocyte injury.
• Typical bacterial pneumonia (D) shows acute neutrophilic infiltration.
Question 7 A patient with severe burns develops systemic inflammatory response syndrome
(SIRS). The primary mediator driving this response is:
A. Histamine only
B. Tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1) [CORRECT]
C. Serotonin only
D. Acetylcholine
Correct Answer: B
Rationale: Severe tissue injury releases pro-inflammatory cytokines TNF-α and IL-1 from
macrophages, initiating the systemic inflammatory cascade. These cause fever, increased
vascular permeability, activation of complement and coagulation cascades, and potentially lead
to septic shock or multiple organ dysfunction.
• Histamine (A) is important locally but not the primary systemic mediator.
• Serotonin (C) and acetylcholine (D) are not primary inflammatory mediators in SIRS.
Question 8 Apoptosis differs from necrosis in that apoptosis:
A. Always causes inflammation
B. Is an energy-dependent, programmed process without inflammation [CORRECT]
C. Results from acute injury only
D. Involves cell swelling and membrane rupture
Correct Answer: B
Rationale: Apoptosis is programmed cell death requiring ATP, characterized by cell shrinkage,
chromatin condensation, formation of apoptotic bodies, and phagocytosis without inflammation.
It maintains membrane integrity until late stages. Necrosis involves ATP depletion, cell swelling,
membrane rupture, and inflammatory response.
• Necrosis (A, C, D features) is passive, energy-independent, and inflammatory.
Question 9 A patient with chronic hepatitis C develops hepatic fibrosis. The primary cell
responsible for collagen deposition is:
A. Hepatocytes
B. Kupffer cells
