MARYVILLE PATHO NURS 611 EXAM 3 PRACTICE QUESTIONS 2026/2027 AND A
NEW UPDATED STUDY GUIDE COMPLETE ACCURATE EXAM REAL QUESTIONS
WITH WELL ELABORATED ANSWERS AND RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) NEWEST UPDATED VERSION 2026 EDITION
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1. A 65-year-old man with a 40-pack-year smoking history presents with a non-
productive cough and weight loss. A lung biopsy reveals that the normal ciliated
pseudostratified columnar epithelium has been replaced by stratified squamous
epithelium. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C. Metaplasia
Rationale: Metaplasia is a reversible change in which one differentiated cell type
is replaced by another, often in response to chronic irritation. In this patient's
case, the chronic irritation from cigarette smoke has caused the normal
columnar epithelium of the airways to transform into stratified squamous
epithelium. This is a protective mechanism, but it also results in a loss of cilia
and protective mucus, impairing airway function. Hyperplasia (A) is an increase
in the number of cells; dysplasia (B) is disordered cell growth; anaplasia (D) is a
loss of cellular differentiation characteristic of malignancy .
2. A researcher exposes hepatocytes to a toxin that disrupts mitochondrial electron
transport, leading to a rapid depletion of intracellular ATP. Which of the following
cellular events is most likely to occur FIRST as a direct consequence of this ATP
depletion?
,A. Release of cytochrome c into the cytosol
B. Swelling of the cell due to failure of the sodium-potassium (Na+/K+) pump
C. Fragmentation of nuclear DNA into 180-200 base pair fragments
D. Formation of large, amorphous densities in the mitochondria
Correct Answer: B. Swelling of the cell due to failure of the sodium-potassium
(Na+/K+) pump
Rationale: ATP is essential for the function of the Na+/K+ ATPase pump. When
ATP levels drop, this pump fails, causing sodium to accumulate intracellularly.
The subsequent osmotic gradient draws water into the cell, leading to cellular
swelling and dilation of the endoplasmic reticulum. This is an early and
reversible sign of cell injury. The release of cytochrome c (A) and DNA
fragmentation (C) are hallmarks of apoptosis, which is a programmed process,
not the immediate result of ATP loss. The formation of amorphous densities (D)
in mitochondria is a sign of irreversible injury, which occurs later .
3. A 45-year-old woman with a history of hypertension and diabetes presents with
sudden-onset severe chest pain. An ECG shows ST-segment elevation, and cardiac
troponin levels are markedly elevated. Which of the following best describes the
primary mechanism of cell injury occurring in her myocardium?
A. Pressure overload leading to myocyte hypertrophy
B. Apoptosis mediated by death receptors
C. Reperfusion injury due to oxygen free radical generation
D. Direct toxicity from hyperglycemia-induced osmotic stress
Correct Answer: C. Reperfusion injury due to oxygen free radical generation
,Rationale: This patient is experiencing an acute myocardial infarction (heart
attack). The primary injury is ischemic, but the most significant cellular damage
often occurs upon reperfusion, either spontaneously or through medical
intervention. The sudden reintroduction of oxygen triggers a cascade that
generates reactive oxygen species (free radicals), causing lipid peroxidation and
further damage to cell membranes and proteins. While pressure overload (A) can
lead to hypertrophy, it is a chronic, not acute, process. Apoptosis (B) does occur,
but necrosis is the predominant form of cell death in this acute setting.
Hyperglycemia (D) is a risk factor for vascular disease but is not the primary
mechanism of acute ischemic injury .
4. A pathologist examines a tissue section and observes cells with pyknotic
(shriveled) nuclei and deeply eosinophilic (pink) cytoplasm, but the overall cell
outline is preserved. There is no evidence of an inflammatory response in the
surrounding tissue. Which type of cell death is most consistent with these findings?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Apoptosis
Correct Answer: D. Apoptosis
Rationale: Apoptosis is characterized by programmed cell death without
inflammation. The morphological changes include cell shrinkage, pyknosis
(nuclear condensation), and an intensely eosinophilic cytoplasm. Because the
cell contents are neatly packaged into apoptotic bodies and phagocytosed, the
inflammatory response is absent. Coagulative necrosis (A) involves the
preservation of tissue architecture and is typically accompanied by
inflammation. Liquefactive necrosis (B) involves the digestion of dead cells and
, a prominent inflammatory response. Caseous necrosis (C) is a form of necrosis
with a cheese-like, granular appearance, as seen in tuberculosis, and is also
inflammatory .
5. In a patient with prolonged hypotension leading to acute tubular necrosis in the
kidneys, which sequence of events most accurately describes the progression to
cell death?
A. Calcium influx -> activation of endonucleases -> DNA laddering -> cell
shrinkage
B. ATP depletion -> Na+/K+ pump failure -> cell swelling -> rupture of lysosomes
-> autolysis
C. Free radical damage -> lipid peroxidation -> membrane blebbing -> apoptosis
D. Mitochondrial depolarization -> cytochrome c release -> caspase activation ->
phagocytosis
Correct Answer: B. ATP depletion -> Na+/K+ pump failure -> cell swelling ->
rupture of lysosomes -> autolysis
Rationale: In ischemic injury such as acute tubular necrosis, the lack of blood
flow leads to a depletion of oxygen and subsequently ATP. The failure of ATP-
dependent pumps, primarily the Na+/K+ pump, causes an influx of sodium and
water, leading to cell swelling. This is followed by damage to lysosomes, which
release their hydrolytic enzymes into the cytosol, a process known as autolysis.
This pathway is characteristic of necrosis. Options A and D describe apoptosis,
and option C describes necrosis due to free radicals .
6. A 60-year-old man with a history of chronic gastritis undergoes a gastric biopsy.
The pathologist reports a marked reduction in parietal cell numbers, with the
remaining cells showing enlarged nuclei and prominent nucleoli. This cellular
change in the remaining parietal cells is best described as:
NEW UPDATED STUDY GUIDE COMPLETE ACCURATE EXAM REAL QUESTIONS
WITH WELL ELABORATED ANSWERS AND RATIONALES (100% CORRECT
VERIFIED SOLUTIONS) NEWEST UPDATED VERSION 2026 EDITION
|GUARANTEED PASS A+ (BRAND NEW!) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED PASS A+ |JUST RELEASED
1. A 65-year-old man with a 40-pack-year smoking history presents with a non-
productive cough and weight loss. A lung biopsy reveals that the normal ciliated
pseudostratified columnar epithelium has been replaced by stratified squamous
epithelium. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C. Metaplasia
Rationale: Metaplasia is a reversible change in which one differentiated cell type
is replaced by another, often in response to chronic irritation. In this patient's
case, the chronic irritation from cigarette smoke has caused the normal
columnar epithelium of the airways to transform into stratified squamous
epithelium. This is a protective mechanism, but it also results in a loss of cilia
and protective mucus, impairing airway function. Hyperplasia (A) is an increase
in the number of cells; dysplasia (B) is disordered cell growth; anaplasia (D) is a
loss of cellular differentiation characteristic of malignancy .
2. A researcher exposes hepatocytes to a toxin that disrupts mitochondrial electron
transport, leading to a rapid depletion of intracellular ATP. Which of the following
cellular events is most likely to occur FIRST as a direct consequence of this ATP
depletion?
,A. Release of cytochrome c into the cytosol
B. Swelling of the cell due to failure of the sodium-potassium (Na+/K+) pump
C. Fragmentation of nuclear DNA into 180-200 base pair fragments
D. Formation of large, amorphous densities in the mitochondria
Correct Answer: B. Swelling of the cell due to failure of the sodium-potassium
(Na+/K+) pump
Rationale: ATP is essential for the function of the Na+/K+ ATPase pump. When
ATP levels drop, this pump fails, causing sodium to accumulate intracellularly.
The subsequent osmotic gradient draws water into the cell, leading to cellular
swelling and dilation of the endoplasmic reticulum. This is an early and
reversible sign of cell injury. The release of cytochrome c (A) and DNA
fragmentation (C) are hallmarks of apoptosis, which is a programmed process,
not the immediate result of ATP loss. The formation of amorphous densities (D)
in mitochondria is a sign of irreversible injury, which occurs later .
3. A 45-year-old woman with a history of hypertension and diabetes presents with
sudden-onset severe chest pain. An ECG shows ST-segment elevation, and cardiac
troponin levels are markedly elevated. Which of the following best describes the
primary mechanism of cell injury occurring in her myocardium?
A. Pressure overload leading to myocyte hypertrophy
B. Apoptosis mediated by death receptors
C. Reperfusion injury due to oxygen free radical generation
D. Direct toxicity from hyperglycemia-induced osmotic stress
Correct Answer: C. Reperfusion injury due to oxygen free radical generation
,Rationale: This patient is experiencing an acute myocardial infarction (heart
attack). The primary injury is ischemic, but the most significant cellular damage
often occurs upon reperfusion, either spontaneously or through medical
intervention. The sudden reintroduction of oxygen triggers a cascade that
generates reactive oxygen species (free radicals), causing lipid peroxidation and
further damage to cell membranes and proteins. While pressure overload (A) can
lead to hypertrophy, it is a chronic, not acute, process. Apoptosis (B) does occur,
but necrosis is the predominant form of cell death in this acute setting.
Hyperglycemia (D) is a risk factor for vascular disease but is not the primary
mechanism of acute ischemic injury .
4. A pathologist examines a tissue section and observes cells with pyknotic
(shriveled) nuclei and deeply eosinophilic (pink) cytoplasm, but the overall cell
outline is preserved. There is no evidence of an inflammatory response in the
surrounding tissue. Which type of cell death is most consistent with these findings?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Apoptosis
Correct Answer: D. Apoptosis
Rationale: Apoptosis is characterized by programmed cell death without
inflammation. The morphological changes include cell shrinkage, pyknosis
(nuclear condensation), and an intensely eosinophilic cytoplasm. Because the
cell contents are neatly packaged into apoptotic bodies and phagocytosed, the
inflammatory response is absent. Coagulative necrosis (A) involves the
preservation of tissue architecture and is typically accompanied by
inflammation. Liquefactive necrosis (B) involves the digestion of dead cells and
, a prominent inflammatory response. Caseous necrosis (C) is a form of necrosis
with a cheese-like, granular appearance, as seen in tuberculosis, and is also
inflammatory .
5. In a patient with prolonged hypotension leading to acute tubular necrosis in the
kidneys, which sequence of events most accurately describes the progression to
cell death?
A. Calcium influx -> activation of endonucleases -> DNA laddering -> cell
shrinkage
B. ATP depletion -> Na+/K+ pump failure -> cell swelling -> rupture of lysosomes
-> autolysis
C. Free radical damage -> lipid peroxidation -> membrane blebbing -> apoptosis
D. Mitochondrial depolarization -> cytochrome c release -> caspase activation ->
phagocytosis
Correct Answer: B. ATP depletion -> Na+/K+ pump failure -> cell swelling ->
rupture of lysosomes -> autolysis
Rationale: In ischemic injury such as acute tubular necrosis, the lack of blood
flow leads to a depletion of oxygen and subsequently ATP. The failure of ATP-
dependent pumps, primarily the Na+/K+ pump, causes an influx of sodium and
water, leading to cell swelling. This is followed by damage to lysosomes, which
release their hydrolytic enzymes into the cytosol, a process known as autolysis.
This pathway is characteristic of necrosis. Options A and D describe apoptosis,
and option C describes necrosis due to free radicals .
6. A 60-year-old man with a history of chronic gastritis undergoes a gastric biopsy.
The pathologist reports a marked reduction in parietal cell numbers, with the
remaining cells showing enlarged nuclei and prominent nucleoli. This cellular
change in the remaining parietal cells is best described as:
