NR 507 Advanced Pathophysiology
ACTUAL EXAM | Week 4 Midterm
Exam Practice Set | 100 Questions |
Complete Solutions | Chamberlain
University | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: CELLULAR ADAPTATION, INJURY, AND DEATH (15 QUESTIONS)
Q1: A 68-year-old male with a 40 pack-year smoking history presents with chronic cough and
dyspnea. Bronchial biopsy reveals normal ciliated pseudostratified columnar epithelium replaced by
stratified squamous epithelium. This cellular adaptation is best described as:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Hyperplasia
D. Hypertrophy
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
often in response to chronic irritation or stress. In chronic smokers, chronic irritation causes
columnar epithelium to transform to squamous epithelium (better suited to handle irritation). While
this is protective, it increases risk for malignant transformation. Dysplasia (A) represents
disordered, precancerous cellular growth. Hyperplasia (C) involves increased cell numbers.
Hypertrophy (D) involves increased cell size.
,Chamberlain Note: Metaplasia is REVERSIBLE if the stimulus is removed (e.g., smoking cessation).
However, it can progress to dysplasia and carcinoma if irritation persists.
Q2: A 72-year-old female with long-standing hypertension undergoes echocardiography showing
left ventricular wall thickening with normal chamber size. The myocardial cells demonstrate an
increase in which of the following?
A. Cell number only
B. Cell size only [CORRECT]
C. Both cell number and cell size
D. Neither cell number nor cell size
Correct Answer: B
Rationale: Left ventricular hypertrophy (LVH) in hypertension represents cellular
hypertrophy—increased myocardial cell SIZE due to increased workload against elevated afterload.
Cardiac myocytes are terminally differentiated cells with minimal proliferative capacity; therefore,
they cannot undergo hyperplasia (increased cell number). The heart enlarges through individual
cell enlargement, not increased cell count.
Chamberlain Note: Hypertrophy vs. Hyperplasia: Permanent cells (cardiac muscle, neurons,
skeletal muscle) undergo only hypertrophy. Labile cells (skin, gut epithelium) and stable cells
(hepatocytes) can undergo hyperplasia.
Q3: A patient experiences massive blood loss during trauma surgery. Several hours later, the
remaining hepatocytes show an increase in both cell size and number. These cellular adaptations
represent:
A. Hypertrophy only
B. Hyperplasia only
C. Hypertrophy and hyperplasia [CORRECT]
D. Atrophy and metaplasia
Correct Answer: C
,Rationale: Hepatocytes are stable cells capable of both hypertrophy (increased cell size) and
hyperplasia (increased cell number). Following hepatic tissue loss (e.g., trauma, resection),
remaining hepatocytes undergo both adaptations to restore liver mass. This demonstrates the
liver's remarkable regenerative capacity.
Chamberlain Note: Liver regeneration is a classic example of compensatory growth involving both
hypertrophy and hyperplasia, mediated by growth factors (HGF, EGF) and cytokines (IL-6, TNF-α).
Q4: A 45-year-old female presents with cervical dysplasia following persistent HPV infection. Which
pathologic finding distinguishes dysplasia from normal cellular adaptation?
A. Decreased nuclear-to-cytoplasmic ratio
B. Loss of cellular orientation and maturation patterns [CORRECT]
C. Uniform cell size and shape
D. Normal chromatin patterns
Correct Answer: B
Rationale: Dysplasia (disordered growth) is characterized by loss of cellular orientation, failure of
normal maturation patterns, nuclear pleomorphism, hyperchromasia, and increased
nuclear-to-cytoplasmic ratio. Unlike metaplasia (reversible change), dysplasia represents a
preneoplastic condition with disordered architectural and cytological features.
Chamberlain Note: Cervical intraepithelial neoplasia (CIN) represents progressive dysplasia. CIN I
(mild) involves lower 1/3 of epithelium; CIN III (severe/carcinoma in situ) involves full thickness.
Q5: A 60-year-old male with coronary artery disease develops crushing chest pain. Cardiac
catheterization reveals 95% left anterior descending artery occlusion. Within minutes, myocardial
cells show cellular swelling, loss of glycogen, and mitochondrial swelling. These changes represent:
A. Reversible injury [CORRECT]
B. Coagulative necrosis
C. Apoptosis
D. Autolysis
, Correct Answer: A
Rationale: Early ischemic changes (within minutes to hours) include cellular swelling, loss of
glycogen, mitochondrial swelling, and bleb formation—these represent REVERSIBLE injury if blood
flow is restored. Irreversible injury (necrosis) requires 20-40 minutes of ischemia and is
characterized by nuclear changes (pyknosis, karyorrhexis, karyolysis), lysosomal rupture, and
severe mitochondrial vacuolization.
Chamberlain Note: Critical concept: ATP depletion causes Na+/K+-ATPase pump failure → cellular
swelling. Membrane damage (indicated by loss of phospholipids) signals IRREVERSIBLE injury.
Q6: A trauma patient develops compartment syndrome with prolonged limb ischemia. Following
fasciotomy and reperfusion, the muscle tissue demonstrates calcium deposition within
mitochondria, indicating:
A. Fat necrosis
B. Caseous necrosis
C. Irreversible ischemic injury [CORRECT]
D. Apoptotic cell death
Correct Answer: C
Rationale: Mitochondrial calcium overload with calcium deposition (pathognomonic for
IRREVERSIBLE ischemic injury) occurs due to loss of calcium homeostasis. The mitochondria
accumulate calcium phosphate deposits visible on electron microscopy. This represents the "point
of no return" in cellular injury, triggering cell death pathways.
Chamberlain Note: Ischemia-reperfusion injury paradoxically worsens damage through generation
of reactive oxygen species (ROS), calcium overload, and inflammatory cell activation.
Q7: Post-mortem examination of brain tissue following cerebral infarction shows liquefactive
necrosis. The dominant cellular mechanism responsible for this type of necrosis is:
A. Protein denaturation preserving tissue architecture
B. Enzymatic digestion by hydrolytic enzymes [CORRECT]
ACTUAL EXAM | Week 4 Midterm
Exam Practice Set | 100 Questions |
Complete Solutions | Chamberlain
University | Verified Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: CELLULAR ADAPTATION, INJURY, AND DEATH (15 QUESTIONS)
Q1: A 68-year-old male with a 40 pack-year smoking history presents with chronic cough and
dyspnea. Bronchial biopsy reveals normal ciliated pseudostratified columnar epithelium replaced by
stratified squamous epithelium. This cellular adaptation is best described as:
A. Dysplasia
B. Metaplasia [CORRECT]
C. Hyperplasia
D. Hypertrophy
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
often in response to chronic irritation or stress. In chronic smokers, chronic irritation causes
columnar epithelium to transform to squamous epithelium (better suited to handle irritation). While
this is protective, it increases risk for malignant transformation. Dysplasia (A) represents
disordered, precancerous cellular growth. Hyperplasia (C) involves increased cell numbers.
Hypertrophy (D) involves increased cell size.
,Chamberlain Note: Metaplasia is REVERSIBLE if the stimulus is removed (e.g., smoking cessation).
However, it can progress to dysplasia and carcinoma if irritation persists.
Q2: A 72-year-old female with long-standing hypertension undergoes echocardiography showing
left ventricular wall thickening with normal chamber size. The myocardial cells demonstrate an
increase in which of the following?
A. Cell number only
B. Cell size only [CORRECT]
C. Both cell number and cell size
D. Neither cell number nor cell size
Correct Answer: B
Rationale: Left ventricular hypertrophy (LVH) in hypertension represents cellular
hypertrophy—increased myocardial cell SIZE due to increased workload against elevated afterload.
Cardiac myocytes are terminally differentiated cells with minimal proliferative capacity; therefore,
they cannot undergo hyperplasia (increased cell number). The heart enlarges through individual
cell enlargement, not increased cell count.
Chamberlain Note: Hypertrophy vs. Hyperplasia: Permanent cells (cardiac muscle, neurons,
skeletal muscle) undergo only hypertrophy. Labile cells (skin, gut epithelium) and stable cells
(hepatocytes) can undergo hyperplasia.
Q3: A patient experiences massive blood loss during trauma surgery. Several hours later, the
remaining hepatocytes show an increase in both cell size and number. These cellular adaptations
represent:
A. Hypertrophy only
B. Hyperplasia only
C. Hypertrophy and hyperplasia [CORRECT]
D. Atrophy and metaplasia
Correct Answer: C
,Rationale: Hepatocytes are stable cells capable of both hypertrophy (increased cell size) and
hyperplasia (increased cell number). Following hepatic tissue loss (e.g., trauma, resection),
remaining hepatocytes undergo both adaptations to restore liver mass. This demonstrates the
liver's remarkable regenerative capacity.
Chamberlain Note: Liver regeneration is a classic example of compensatory growth involving both
hypertrophy and hyperplasia, mediated by growth factors (HGF, EGF) and cytokines (IL-6, TNF-α).
Q4: A 45-year-old female presents with cervical dysplasia following persistent HPV infection. Which
pathologic finding distinguishes dysplasia from normal cellular adaptation?
A. Decreased nuclear-to-cytoplasmic ratio
B. Loss of cellular orientation and maturation patterns [CORRECT]
C. Uniform cell size and shape
D. Normal chromatin patterns
Correct Answer: B
Rationale: Dysplasia (disordered growth) is characterized by loss of cellular orientation, failure of
normal maturation patterns, nuclear pleomorphism, hyperchromasia, and increased
nuclear-to-cytoplasmic ratio. Unlike metaplasia (reversible change), dysplasia represents a
preneoplastic condition with disordered architectural and cytological features.
Chamberlain Note: Cervical intraepithelial neoplasia (CIN) represents progressive dysplasia. CIN I
(mild) involves lower 1/3 of epithelium; CIN III (severe/carcinoma in situ) involves full thickness.
Q5: A 60-year-old male with coronary artery disease develops crushing chest pain. Cardiac
catheterization reveals 95% left anterior descending artery occlusion. Within minutes, myocardial
cells show cellular swelling, loss of glycogen, and mitochondrial swelling. These changes represent:
A. Reversible injury [CORRECT]
B. Coagulative necrosis
C. Apoptosis
D. Autolysis
, Correct Answer: A
Rationale: Early ischemic changes (within minutes to hours) include cellular swelling, loss of
glycogen, mitochondrial swelling, and bleb formation—these represent REVERSIBLE injury if blood
flow is restored. Irreversible injury (necrosis) requires 20-40 minutes of ischemia and is
characterized by nuclear changes (pyknosis, karyorrhexis, karyolysis), lysosomal rupture, and
severe mitochondrial vacuolization.
Chamberlain Note: Critical concept: ATP depletion causes Na+/K+-ATPase pump failure → cellular
swelling. Membrane damage (indicated by loss of phospholipids) signals IRREVERSIBLE injury.
Q6: A trauma patient develops compartment syndrome with prolonged limb ischemia. Following
fasciotomy and reperfusion, the muscle tissue demonstrates calcium deposition within
mitochondria, indicating:
A. Fat necrosis
B. Caseous necrosis
C. Irreversible ischemic injury [CORRECT]
D. Apoptotic cell death
Correct Answer: C
Rationale: Mitochondrial calcium overload with calcium deposition (pathognomonic for
IRREVERSIBLE ischemic injury) occurs due to loss of calcium homeostasis. The mitochondria
accumulate calcium phosphate deposits visible on electron microscopy. This represents the "point
of no return" in cellular injury, triggering cell death pathways.
Chamberlain Note: Ischemia-reperfusion injury paradoxically worsens damage through generation
of reactive oxygen species (ROS), calcium overload, and inflammatory cell activation.
Q7: Post-mortem examination of brain tissue following cerebral infarction shows liquefactive
necrosis. The dominant cellular mechanism responsible for this type of necrosis is:
A. Protein denaturation preserving tissue architecture
B. Enzymatic digestion by hydrolytic enzymes [CORRECT]
