NUR 631 / NUR631 Advanced Physiology and
Pathophysiology Midterm Exam Actual 2026/2027 with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section 1: Cellular & Molecular Pathophysiology (Q1–Q14)
Q1: Which cellular adaptation is characterized by a decrease in cell size and
functional activity in response to decreased workload?
A. Hyperplasia
B. Hypertrophy
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is the decrease in cell size and functional activity resulting from
reduced workload, decreased stimulation, or inadequate nutrition, as seen in
immobilized skeletal muscle.
Q2: The primary mechanism of cellular injury caused by ischemia is:
A. Accumulation of glycogen in the cytoplasm
B. Depletion of ATP and subsequent loss of sodium-potassium pump function
[CORRECT]
C. Excessive protein synthesis
D. Increased mitochondrial DNA replication
Correct Answer: B
Rationale: Ischemia deprives cells of oxygen, halting oxidative phosphorylation and
ATP production; without ATP, the Na⁺/K⁺-ATPase fails, leading to cellular swelling
and calcium influx.
Q3: Apoptosis differs from necrosis primarily because apoptosis:
A. Involves cell swelling and membrane rupture
B. Triggers an inflammatory response in surrounding tissues
,C. Is a programmed, energy-dependent process without inflammation [CORRECT]
D. Results from acute traumatic injury only
Correct Answer: C
Rationale: Apoptosis is a genetically programmed, ATP-dependent process of cell
death that maintains membrane integrity and does not trigger inflammation, unlike
necrosis which involves cell rupture and inflammatory mediator release.
Q4: Metaplasia is best described as:
A. An increase in the number of cells in a tissue
B. The replacement of one differentiated cell type with another [CORRECT]
C. A decrease in cell size due to reduced workload
D. The abnormal growth of cells with loss of differentiation
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature differentiated cell
type with another, often as an adaptive response to chronic irritation, such as
squamous metaplasia in the bronchial epithelium of smokers.
Q5: Which type of necrosis is most commonly associated with ischemia of the heart,
kidney, and spleen?
A. Caseous necrosis
B. Liquefactive necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Coagulative necrosis preserves the tissue architecture for several days
due to denaturation of structural proteins, and it is the characteristic pattern in
ischemic injury of solid organs such as the heart, kidney, and spleen.
Q6: Free radical injury to cellular membranes is primarily caused by:
A. Lipid peroxidation and destruction of membrane phospholipids [CORRECT]
B. Excessive collagen deposition
C. Increased glycogen storage
D. DNA methylation
Correct Answer: A
Rationale: Free radicals attack polyunsaturated fatty acids in membrane
phospholipids through lipid peroxidation, causing membrane fragmentation,
increased permeability, and cellular dysfunction.
, Q7: In the cell cycle, which phase is most vulnerable to radiation-induced DNA
damage?
A. G0 phase
B. G1 phase
C. S phase
D. M phase [CORRECT]
Correct Answer: D
Rationale: The M (mitotic) phase is highly radiosensitive because chromosomes are
condensed and spindle formation is occurring; radiation disrupts chromosomal
segregation and causes cell death.
Q8: A cell that has lost contact inhibition and continues to proliferate uncontrollably
has undergone which type of cellular alteration?
A. Dysplasia
B. Hyperplasia
C. Malignant transformation [CORRECT]
D. Physiologic adaptation
Correct Answer: C
Rationale: Loss of contact inhibition and uncontrolled proliferation are hallmarks of
malignant transformation, distinguishing cancer cells from normal cells that stop
dividing when they contact neighboring cells.
Q9: Which organelle is responsible for initiating the intrinsic pathway of apoptosis?
A. Lysosome
B. Mitochondrion [CORRECT]
C. Golgi apparatus
D. Peroxisome
Correct Answer: B
Rationale: The intrinsic pathway of apoptosis is initiated by mitochondrial release of
cytochrome c, which activates caspase-9 and subsequently the executioner
caspases, leading to programmed cell death.
Q10: Reperfusion injury after restoration of blood flow is primarily caused by:
A. Decreased oxygen delivery
B. Generation of reactive oxygen species and calcium overload [CORRECT]
C. Increased glycogen synthesis
D. Reduced inflammatory cytokines
Correct Answer: B
Pathophysiology Midterm Exam Actual 2026/2027 with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
Section 1: Cellular & Molecular Pathophysiology (Q1–Q14)
Q1: Which cellular adaptation is characterized by a decrease in cell size and
functional activity in response to decreased workload?
A. Hyperplasia
B. Hypertrophy
C. Atrophy [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is the decrease in cell size and functional activity resulting from
reduced workload, decreased stimulation, or inadequate nutrition, as seen in
immobilized skeletal muscle.
Q2: The primary mechanism of cellular injury caused by ischemia is:
A. Accumulation of glycogen in the cytoplasm
B. Depletion of ATP and subsequent loss of sodium-potassium pump function
[CORRECT]
C. Excessive protein synthesis
D. Increased mitochondrial DNA replication
Correct Answer: B
Rationale: Ischemia deprives cells of oxygen, halting oxidative phosphorylation and
ATP production; without ATP, the Na⁺/K⁺-ATPase fails, leading to cellular swelling
and calcium influx.
Q3: Apoptosis differs from necrosis primarily because apoptosis:
A. Involves cell swelling and membrane rupture
B. Triggers an inflammatory response in surrounding tissues
,C. Is a programmed, energy-dependent process without inflammation [CORRECT]
D. Results from acute traumatic injury only
Correct Answer: C
Rationale: Apoptosis is a genetically programmed, ATP-dependent process of cell
death that maintains membrane integrity and does not trigger inflammation, unlike
necrosis which involves cell rupture and inflammatory mediator release.
Q4: Metaplasia is best described as:
A. An increase in the number of cells in a tissue
B. The replacement of one differentiated cell type with another [CORRECT]
C. A decrease in cell size due to reduced workload
D. The abnormal growth of cells with loss of differentiation
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature differentiated cell
type with another, often as an adaptive response to chronic irritation, such as
squamous metaplasia in the bronchial epithelium of smokers.
Q5: Which type of necrosis is most commonly associated with ischemia of the heart,
kidney, and spleen?
A. Caseous necrosis
B. Liquefactive necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Coagulative necrosis preserves the tissue architecture for several days
due to denaturation of structural proteins, and it is the characteristic pattern in
ischemic injury of solid organs such as the heart, kidney, and spleen.
Q6: Free radical injury to cellular membranes is primarily caused by:
A. Lipid peroxidation and destruction of membrane phospholipids [CORRECT]
B. Excessive collagen deposition
C. Increased glycogen storage
D. DNA methylation
Correct Answer: A
Rationale: Free radicals attack polyunsaturated fatty acids in membrane
phospholipids through lipid peroxidation, causing membrane fragmentation,
increased permeability, and cellular dysfunction.
, Q7: In the cell cycle, which phase is most vulnerable to radiation-induced DNA
damage?
A. G0 phase
B. G1 phase
C. S phase
D. M phase [CORRECT]
Correct Answer: D
Rationale: The M (mitotic) phase is highly radiosensitive because chromosomes are
condensed and spindle formation is occurring; radiation disrupts chromosomal
segregation and causes cell death.
Q8: A cell that has lost contact inhibition and continues to proliferate uncontrollably
has undergone which type of cellular alteration?
A. Dysplasia
B. Hyperplasia
C. Malignant transformation [CORRECT]
D. Physiologic adaptation
Correct Answer: C
Rationale: Loss of contact inhibition and uncontrolled proliferation are hallmarks of
malignant transformation, distinguishing cancer cells from normal cells that stop
dividing when they contact neighboring cells.
Q9: Which organelle is responsible for initiating the intrinsic pathway of apoptosis?
A. Lysosome
B. Mitochondrion [CORRECT]
C. Golgi apparatus
D. Peroxisome
Correct Answer: B
Rationale: The intrinsic pathway of apoptosis is initiated by mitochondrial release of
cytochrome c, which activates caspase-9 and subsequently the executioner
caspases, leading to programmed cell death.
Q10: Reperfusion injury after restoration of blood flow is primarily caused by:
A. Decreased oxygen delivery
B. Generation of reactive oxygen species and calcium overload [CORRECT]
C. Increased glycogen synthesis
D. Reduced inflammatory cytokines
Correct Answer: B
