Advanced Pathophysiology South
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, 1.Which type of cellular adaptation involves an increase in the size of existing cells?
a. Hyperplasia
b. Hypertrophy
c. Atrophy
d. Metaplasia
Correct Answer: b. Hypertrophy
Rationale: Hypertrophy refers to the increase in cell size, often in response to increased
workload. Hyperplasia refers to an increase in the number of cells within a tissue or
organ. Atrophy is a decrease in cell size due to disuse or loss of stimulation, and
metaplasia is the reversible replacement of one mature cell type by another mature cell
type.
2. A patient experiences a reduction in cardiac workload leading to a decrease in the size
of myocardial cells. This cellular adaptation is known as:
a. Hypertrophy
b. Atrophy
c. Dysplasia
d. Hyperplasia
Correct Answer: b. Atrophy
Rationale: Atrophy is the shrinking of cells due to a decrease in metabolic demand,
workload, nerve stimulation, or blood supply. Hypertrophy increases cell size,
hyperplasia increases cell count, and dysplasia represents abnormal, disordered
growth.
3. An increase in the number of cells resulting from an increased rate of cellular division is
defined as:
a. Hypertrophy
b. Metaplasia
c. Hyperplasia
d. Anaplasia
Correct Answer: c. Hyperplasia
Rationale: Hyperplasia is characterized by an elevated number of cells due to cell
division. It can be physiological (e.g., compensatory regeneration of the liver or
hormonal stimulation of the endometrium) or pathological when driven by excessive
hormonal stimulation.
,4. A 45-year-old male with chronic gastroesophageal reflux disease (GERD) undergoes an
endoscopy. The biopsy shows the replacement of normal stratified squamous
epithelium with column epithelium in the lower esophagus. This represents:
a. Dysplasia
b. Hyperplasia
c. Metaplasia
d. Atrophy
Correct Answer: c. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type to better withstand a harsh environment. In Barrett's esophagus,
chronic acid exposure drives squamous cells to adapt into columnar epithelial cells.
5. Which term refers to atypical, abnormal changes in the size, shape, and organization of
mature cells, frequently considered a pre-cancerous indicator?
a. Metaplasia
b. Dysplasia
c. Hypertrophy
d. Hyperplasia
Correct Answer: b. Dysplasia
Rationale: Dysplasia is characterized by disordered cellular growth, maturation, and
architectural arrangement. Although it is not a true adaptive process, it is strongly linked
to pre-neoplastic changes and requires direct monitoring.
6. What is the single most common cause of cellular injury encountered in clinical
practice?
a. Chemical poisoning
b. Hypoxia
c. Genetic mutations
d. Physical trauma
Correct Answer: b. Hypoxia
Rationale: Hypoxia, or the lack of sufficient oxygen delivery to tissues, is the leading
cause of cellular injury. It is typically caused by ischemia (reduced blood supply),
respiratory compromise, or a loss of hemoglobin oxygen-carrying capacity.
7. Ischemia differs from progressive hypoxia because ischemia features:
a. Elevated glucose deliver to tissues
b. Reduced delivery of oxygen accompanied by a failure to remove metabolic waste
products
c. Normal arterial blood supply with low atmospheric pressure
d. Rapid increase in cellular ATP synthesis
Correct Answer: b. Reduced delivery of oxygen accompanied by a failure to
remove metabolic waste products
Rationale: Hypoxia is purely an oxygen deficit, whereas ischemia is caused by
mechanical blood flow reduction. Ischemia is more destructive because it stops nutrient
, delivery while trapping acidic, toxic metabolic wastes (like lactic acid) inside the tissue
matrix.
8. When ATP production ceases due to a hypoxic cellular injury, what occurs within the
cell as a direct result of sodium-potassium pump failure?
a. Sodium exits the cell rapidly, causing cellular shrinkage.
b. Intracellular sodium increases, drawing water inside and causing cellular swelling
(oncosis).
c. Potassium levels inside the cell rise dramatically.
d. High-voltage calcium pumps remove all calcium from the cytoplasm.
Correct Answer: b. Intracellular sodium increases, drawing water inside and
causing cellular swelling (oncosis).
Rationale: Without ATP, the energy-dependent \(Na^{+}/K^{+}\) ATPase pump breaks
down. Sodium builds up inside the cell cytoplasm. Water follows sodium osmotically,
creating intracellular swelling, mitochondrial stretching, and hydropic degeneration
(oncosis).
9. Reperfusion injury is a clinical phenomenon caused primarily by the rapid generation of
which molecules upon the restoration of oxygen to ischemic tissue?
a. Intracellular transport globulins
b. Reactive oxygen species (ROS) or free radicals
c. Lysosomal digestive hydrolases
d. Anaerobic glycolytic structural peptides
Correct Answer: b. Reactive oxygen species (ROS) or free radicals
Rationale: Reperfusion injury occurs when blood flow is suddenly restored to an
ischemic zone. The rapid influx of oxygen interacts with damaged mitochondrial electron
chains, producing a burst of reactive oxygen species (ROS) that induce severe lipid
peroxidation and membrane destruction.
10. Which enzyme inside the cytoplasm is specialized to neutralize dangerous superoxide
free radicals (\(O_{2}^{\bullet -}\)) into hydrogen peroxide (\(H_{2}O_{2}\))?
a. Catalase
b. Phospholipase
c. Superoxide dismutase (SOD)
d. Glutathione peroxidase
Correct Answer: c. Superoxide dismutase (SOD)
Rationale: Superoxide dismutase (SOD) acts as a critical antioxidant defense enzyme
by converting the superoxide free radical into hydrogen peroxide. Other enzymes, such
as catalase and glutathione peroxidase, then finish the neutralization into water.