NURS 5432 MIDTERM 2026/2027 | Modules 1-4 Practice
Questions & Case Studies | UTA | Pass Guaranteed - A+
Graded
SECTION 1: Module 1 - Foundational Concepts & Pathophysiology
(Q1-Q25)
Q1: A 58-year-old male with a 40 pack-year smoking history presents with a chronic
cough and hemoptysis. Biopsy reveals squamous cell carcinoma of the lung. Which
cellular adaptation best describes the initial metaplastic change in his bronchial
epithelium?
A. Hyperplasia of goblet cells leading to increased mucus production
B. Replacement of pseudostratified ciliated columnar epithelium with stratified
squamous epithelium [CORRECT]
C. Hypertrophy of bronchial smooth muscle cells causing airway narrowing
D. Dysplasia of alveolar type II cells with loss of surfactant production
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another, and in the bronchi of chronic smokers, pseudostratified ciliated columnar
epithelium is replaced by stratified squamous epithelium as a protective adaptation.
While this is reversible if smoking ceases, persistent irritation can lead to dysplasia and
carcinoma. Option A describes hyperplasia, C describes hypertrophy, and D incorrectly
localizes the change to alveolar cells.
,Q2: A patient with rheumatoid arthritis develops joint deformities over several years.
The primary pathophysiologic mechanism responsible for the progressive tissue
destruction involves which of the following?
A. Complement-mediated lysis of synovial fibroblasts
B. Immune complex deposition activating neutrophil release of lysosomal enzymes
[CORRECT]
C. Direct cytotoxic T-cell destruction of articular cartilage
D. Mast cell degranulation causing immediate hypersensitivity in joint spaces
Correct Answer: B
Rationale: Rheumatoid arthritis is a systemic autoimmune disorder characterized by
type III hypersensitivity, where immune complexes deposit in synovial tissue, activate
complement, and recruit neutrophils that release proteolytic enzymes causing cartilage
and bone destruction. While T-cells contribute to pathogenesis, the direct tissue
destruction is primarily mediated by neutrophil enzymes. Option D describes type I
hypersensitivity, which is not the primary mechanism in RA.
Q3: During a routine physical examination, a 45-year-old female is found to have a
well-circumscribed, mobile breast mass that has been present for 3 years without
change. Histology shows proliferation of glandular and fibrous tissue. This benign
change is best classified as:
A. Dysplasia with loss of cellular polarity
B. Metaplasia of ductal epithelium to squamous cells
C. Hyperplasia with increased cell number in normal arrangement [CORRECT]
D. Anaplasia with nuclear pleomorphism and high mitotic index
Correct Answer: C
Rationale: Fibrocystic changes with fibroadenoma represent benign hyperplasia—an
increase in cell number with normal cellular architecture and arrangement. Dysplasia
(A) involves disordered growth with loss of polarity, metaplasia (B) is a change in cell
type, and anaplasia (D) is a hallmark of malignant transformation with loss of
,differentiation. The stability over 3 years and well-circumscribed nature support a
benign hyperplastic process.
Q4: A patient develops acute inflammation after a surgical incision. Which sequence
correctly describes the vascular and cellular events of acute inflammation?
A. Vasoconstriction, stasis, margination, diapedesis, chemotaxis
B. Vasodilation, increased vascular permeability, margination, rolling, adhesion,
transmigration, chemotaxis [CORRECT]
C. Increased permeability, vasodilation, margination, phagocytosis, resolution
D. Vasodilation, stasis, coagulation, fibrinolysis, tissue regeneration
Correct Answer: B
Rationale: Acute inflammation follows a precise sequence: transient vasoconstriction
followed by vasodilation (mediated by histamine, prostaglandins), increased vascular
permeability causing exudate formation, margination of leukocytes, rolling and
adhesion via selectins and integrins, transmigration (diapedesis) through the vessel
wall, and chemotaxis toward inflammatory mediators. Option A incorrectly starts with
vasoconstriction as the primary event, C omits adhesion and transmigration, and D
describes hemostasis rather than inflammation.
Q5: A 6-year-old child with recurrent bacterial infections is found to have a deficiency in
the C3 complement component. Which immunologic function would be most severely
impaired?
A. Cytotoxic T-lymphocyte killing of virally infected cells
B. Antibody production by plasma cells in response to T-dependent antigens
C. Opsonization of bacteria and formation of C3 convertase [CORRECT]
D. Natural killer cell recognition of antibody-coated target cells
Correct Answer: C
Rationale: C3 is the central component of all complement activation pathways
(classical, alternative, and lectin) and is essential for opsonization (C3b coating of
, pathogens for phagocytosis) and formation of C3/C5 convertases. While C3 deficiency
may indirectly affect antibody responses, the most severe impairment is in
opsonization, leading to recurrent pyogenic infections. CTL killing (A) is MHC-restricted
and complement-independent, and NK cell ADCC (D) relies on Fc receptors rather than
C3.
Q6: A patient with systemic lupus erythematosus (SLE) has autoantibodies directed
against double-stranded DNA. Which type of hypersensitivity reaction is primarily
responsible for the renal involvement (lupus nephritis) in this patient?
A. Type I (IgE-mediated immediate hypersensitivity)
B. Type II (Cytotoxic antibody-mediated)
C. Type III (Immune complex-mediated) [CORRECT]
D. Type IV (T-cell-mediated delayed hypersensitivity)
Correct Answer: C
Rationale: Lupus nephritis is the prototypical example of type III hypersensitivity, where
circulating anti-dsDNA antibodies form immune complexes that deposit in the
glomerular basement membrane, activate complement, and incite inflammatory
damage. While SLE involves multiple hypersensitivity types, renal involvement is
primarily immune complex-mediated. Type I (A) involves IgE and mast cells, type II (B)
involves direct cellular targeting, and type IV (D) is T-cell mediated without antibody
involvement.
Q7: A 35-year-old male presents with chronic diarrhea, weight loss, and a rash on his
extensor surfaces. Biopsy reveals dermatitis herpetiformis. Which genetic and
immunologic mechanism is most likely responsible?
A. HLA-B27 association with autoreactive CD8+ T-cells attacking keratinocytes
B. HLA-DQ2/DQ8 association with gluten-sensitive enteropathy and IgA deposition in
dermal papillae [CORRECT]
C. HLA-DR4 association with immune complex deposition in small vessels
Questions & Case Studies | UTA | Pass Guaranteed - A+
Graded
SECTION 1: Module 1 - Foundational Concepts & Pathophysiology
(Q1-Q25)
Q1: A 58-year-old male with a 40 pack-year smoking history presents with a chronic
cough and hemoptysis. Biopsy reveals squamous cell carcinoma of the lung. Which
cellular adaptation best describes the initial metaplastic change in his bronchial
epithelium?
A. Hyperplasia of goblet cells leading to increased mucus production
B. Replacement of pseudostratified ciliated columnar epithelium with stratified
squamous epithelium [CORRECT]
C. Hypertrophy of bronchial smooth muscle cells causing airway narrowing
D. Dysplasia of alveolar type II cells with loss of surfactant production
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another, and in the bronchi of chronic smokers, pseudostratified ciliated columnar
epithelium is replaced by stratified squamous epithelium as a protective adaptation.
While this is reversible if smoking ceases, persistent irritation can lead to dysplasia and
carcinoma. Option A describes hyperplasia, C describes hypertrophy, and D incorrectly
localizes the change to alveolar cells.
,Q2: A patient with rheumatoid arthritis develops joint deformities over several years.
The primary pathophysiologic mechanism responsible for the progressive tissue
destruction involves which of the following?
A. Complement-mediated lysis of synovial fibroblasts
B. Immune complex deposition activating neutrophil release of lysosomal enzymes
[CORRECT]
C. Direct cytotoxic T-cell destruction of articular cartilage
D. Mast cell degranulation causing immediate hypersensitivity in joint spaces
Correct Answer: B
Rationale: Rheumatoid arthritis is a systemic autoimmune disorder characterized by
type III hypersensitivity, where immune complexes deposit in synovial tissue, activate
complement, and recruit neutrophils that release proteolytic enzymes causing cartilage
and bone destruction. While T-cells contribute to pathogenesis, the direct tissue
destruction is primarily mediated by neutrophil enzymes. Option D describes type I
hypersensitivity, which is not the primary mechanism in RA.
Q3: During a routine physical examination, a 45-year-old female is found to have a
well-circumscribed, mobile breast mass that has been present for 3 years without
change. Histology shows proliferation of glandular and fibrous tissue. This benign
change is best classified as:
A. Dysplasia with loss of cellular polarity
B. Metaplasia of ductal epithelium to squamous cells
C. Hyperplasia with increased cell number in normal arrangement [CORRECT]
D. Anaplasia with nuclear pleomorphism and high mitotic index
Correct Answer: C
Rationale: Fibrocystic changes with fibroadenoma represent benign hyperplasia—an
increase in cell number with normal cellular architecture and arrangement. Dysplasia
(A) involves disordered growth with loss of polarity, metaplasia (B) is a change in cell
type, and anaplasia (D) is a hallmark of malignant transformation with loss of
,differentiation. The stability over 3 years and well-circumscribed nature support a
benign hyperplastic process.
Q4: A patient develops acute inflammation after a surgical incision. Which sequence
correctly describes the vascular and cellular events of acute inflammation?
A. Vasoconstriction, stasis, margination, diapedesis, chemotaxis
B. Vasodilation, increased vascular permeability, margination, rolling, adhesion,
transmigration, chemotaxis [CORRECT]
C. Increased permeability, vasodilation, margination, phagocytosis, resolution
D. Vasodilation, stasis, coagulation, fibrinolysis, tissue regeneration
Correct Answer: B
Rationale: Acute inflammation follows a precise sequence: transient vasoconstriction
followed by vasodilation (mediated by histamine, prostaglandins), increased vascular
permeability causing exudate formation, margination of leukocytes, rolling and
adhesion via selectins and integrins, transmigration (diapedesis) through the vessel
wall, and chemotaxis toward inflammatory mediators. Option A incorrectly starts with
vasoconstriction as the primary event, C omits adhesion and transmigration, and D
describes hemostasis rather than inflammation.
Q5: A 6-year-old child with recurrent bacterial infections is found to have a deficiency in
the C3 complement component. Which immunologic function would be most severely
impaired?
A. Cytotoxic T-lymphocyte killing of virally infected cells
B. Antibody production by plasma cells in response to T-dependent antigens
C. Opsonization of bacteria and formation of C3 convertase [CORRECT]
D. Natural killer cell recognition of antibody-coated target cells
Correct Answer: C
Rationale: C3 is the central component of all complement activation pathways
(classical, alternative, and lectin) and is essential for opsonization (C3b coating of
, pathogens for phagocytosis) and formation of C3/C5 convertases. While C3 deficiency
may indirectly affect antibody responses, the most severe impairment is in
opsonization, leading to recurrent pyogenic infections. CTL killing (A) is MHC-restricted
and complement-independent, and NK cell ADCC (D) relies on Fc receptors rather than
C3.
Q6: A patient with systemic lupus erythematosus (SLE) has autoantibodies directed
against double-stranded DNA. Which type of hypersensitivity reaction is primarily
responsible for the renal involvement (lupus nephritis) in this patient?
A. Type I (IgE-mediated immediate hypersensitivity)
B. Type II (Cytotoxic antibody-mediated)
C. Type III (Immune complex-mediated) [CORRECT]
D. Type IV (T-cell-mediated delayed hypersensitivity)
Correct Answer: C
Rationale: Lupus nephritis is the prototypical example of type III hypersensitivity, where
circulating anti-dsDNA antibodies form immune complexes that deposit in the
glomerular basement membrane, activate complement, and incite inflammatory
damage. While SLE involves multiple hypersensitivity types, renal involvement is
primarily immune complex-mediated. Type I (A) involves IgE and mast cells, type II (B)
involves direct cellular targeting, and type IV (D) is T-cell mediated without antibody
involvement.
Q7: A 35-year-old male presents with chronic diarrhea, weight loss, and a rash on his
extensor surfaces. Biopsy reveals dermatitis herpetiformis. Which genetic and
immunologic mechanism is most likely responsible?
A. HLA-B27 association with autoreactive CD8+ T-cells attacking keratinocytes
B. HLA-DQ2/DQ8 association with gluten-sensitive enteropathy and IgA deposition in
dermal papillae [CORRECT]
C. HLA-DR4 association with immune complex deposition in small vessels
