NR 507 / NR507 Advanced Pathophysiology Midterm
Exam Practice Test Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Cellular & Molecular Pathophysiology (14 Questions)
Q1: A 58-year-old patient with chronic alcoholism presents with hepatomegaly and
elevated liver enzymes. Liver biopsy reveals Mallory bodies within hepatocytes.
Which cellular adaptation process is most directly responsible for this finding?
A. Hypertrophy
B. Hyperplasia
C. Accumulation of intermediate filaments [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Mallory bodies represent aggregates of damaged cytokeratin intermediate
filaments, a form of intracellular accumulation characteristic of alcoholic liver
disease.
Q2: During ischemic cell injury, which intracellular change occurs first and is
considered reversible?
A. Mitochondrial swelling with loss of cristae
B. Decreased ATP production and cellular swelling [CORRECT]
C. Karyorrhexis and cell membrane rupture
D. Lysosomal enzyme release
Correct Answer: B
Rationale: Decreased ATP leads to failure of the Na+/K+-ATPase pump, causing
cellular swelling; this is the earliest reversible change in ischemic injury.
,Q3: A patient with emphysema has elevated serum alpha-1 antitrypsin levels but low
functional activity. Genetic testing reveals the ZZ phenotype. Which mechanism of
cell injury is primarily responsible?
A. Free radical generation
B. Protein misfolding and ER stress [CORRECT]
C. Calcium overload
D. Hypoxia
Correct Answer: B
Rationale: The ZZ mutation causes alpha-1 antitrypsin to misfold and accumulate in
hepatocyte ER, leading to ER stress and reduced secretion, while unopposed
elastase causes lung damage.
Q4: A biopsy specimen shows cells with shrunken, intensely eosinophilic cytoplasm
and pyknotic nuclei. The cell borders remain intact, and there is no inflammatory
infiltrate. This most likely represents:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis [CORRECT]
D. Caseous necrosis
Correct Answer: C
Rationale: Apoptosis is characterized by cell shrinkage, chromatin condensation
(pyknosis), intact cell membranes, and absence of inflammation, distinguishing it
from necrosis.
Q5: Which statement accurately describes the intrinsic pathway of apoptosis?
A. It is initiated by death receptor-ligand binding on the cell surface
B. It requires activation of caspase-8 as the initiator caspase
C. It is triggered by mitochondrial release of cytochrome c and activation of
caspase-9 [CORRECT]
D. It is exclusively activated by external signals
Correct Answer: C
Rationale: The intrinsic pathway involves mitochondrial outer membrane
permeabilization, cytochrome c release, apoptosome formation, and caspase-9
activation.
, Q6: A 45-year-old woman develops cervical dysplasia following persistent HPV
infection. The E6 and E7 viral proteins target which tumor suppressor proteins?
A. RB and BCL-2
B. p53 and RB [CORRECT]
C. p21 and BAX
D. PTEN and APC
Correct Answer: B
Rationale: HPV E6 binds and degrades p53, while E7 inhibits RB, disrupting cell cycle
checkpoints and promoting malignant transformation.
Q7: Which type of cellular adaptation is demonstrated when chronic irritation of the
bronchial epithelium leads to replacement of pseudostratified ciliated columnar
epithelium with stratified squamous epithelium?
A. Dysplasia
B. Hyperplasia
C. Metaplasia [CORRECT]
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type
with another, often in response to chronic irritation or stress.
Q8: A patient with chronic renal failure develops metastatic calcification. Which
laboratory finding best explains this pathologic process?
A. Decreased phosphate levels
B. Hyperphosphatemia with secondary hyperparathyroidism [CORRECT]
C. Hypocalcemia alone
D. Respiratory alkalosis
Correct Answer: B
Rationale: In chronic kidney disease, hyperphosphatemia lowers ionized calcium,
triggering PTH release and calcium-phosphate deposition in normal tissues.
Q9: Reperfusion injury following myocardial infarction is mediated primarily by:
A. Persistent hypoxia
B. Generation of reactive oxygen species and calcium overload [CORRECT]
C. Purely mechanical damage to cell membranes
D. Decreased pH alone
Correct Answer: B
Exam Practice Test Actual 2026/2027 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Cellular & Molecular Pathophysiology (14 Questions)
Q1: A 58-year-old patient with chronic alcoholism presents with hepatomegaly and
elevated liver enzymes. Liver biopsy reveals Mallory bodies within hepatocytes.
Which cellular adaptation process is most directly responsible for this finding?
A. Hypertrophy
B. Hyperplasia
C. Accumulation of intermediate filaments [CORRECT]
D. Metaplasia
Correct Answer: C
Rationale: Mallory bodies represent aggregates of damaged cytokeratin intermediate
filaments, a form of intracellular accumulation characteristic of alcoholic liver
disease.
Q2: During ischemic cell injury, which intracellular change occurs first and is
considered reversible?
A. Mitochondrial swelling with loss of cristae
B. Decreased ATP production and cellular swelling [CORRECT]
C. Karyorrhexis and cell membrane rupture
D. Lysosomal enzyme release
Correct Answer: B
Rationale: Decreased ATP leads to failure of the Na+/K+-ATPase pump, causing
cellular swelling; this is the earliest reversible change in ischemic injury.
,Q3: A patient with emphysema has elevated serum alpha-1 antitrypsin levels but low
functional activity. Genetic testing reveals the ZZ phenotype. Which mechanism of
cell injury is primarily responsible?
A. Free radical generation
B. Protein misfolding and ER stress [CORRECT]
C. Calcium overload
D. Hypoxia
Correct Answer: B
Rationale: The ZZ mutation causes alpha-1 antitrypsin to misfold and accumulate in
hepatocyte ER, leading to ER stress and reduced secretion, while unopposed
elastase causes lung damage.
Q4: A biopsy specimen shows cells with shrunken, intensely eosinophilic cytoplasm
and pyknotic nuclei. The cell borders remain intact, and there is no inflammatory
infiltrate. This most likely represents:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis [CORRECT]
D. Caseous necrosis
Correct Answer: C
Rationale: Apoptosis is characterized by cell shrinkage, chromatin condensation
(pyknosis), intact cell membranes, and absence of inflammation, distinguishing it
from necrosis.
Q5: Which statement accurately describes the intrinsic pathway of apoptosis?
A. It is initiated by death receptor-ligand binding on the cell surface
B. It requires activation of caspase-8 as the initiator caspase
C. It is triggered by mitochondrial release of cytochrome c and activation of
caspase-9 [CORRECT]
D. It is exclusively activated by external signals
Correct Answer: C
Rationale: The intrinsic pathway involves mitochondrial outer membrane
permeabilization, cytochrome c release, apoptosome formation, and caspase-9
activation.
, Q6: A 45-year-old woman develops cervical dysplasia following persistent HPV
infection. The E6 and E7 viral proteins target which tumor suppressor proteins?
A. RB and BCL-2
B. p53 and RB [CORRECT]
C. p21 and BAX
D. PTEN and APC
Correct Answer: B
Rationale: HPV E6 binds and degrades p53, while E7 inhibits RB, disrupting cell cycle
checkpoints and promoting malignant transformation.
Q7: Which type of cellular adaptation is demonstrated when chronic irritation of the
bronchial epithelium leads to replacement of pseudostratified ciliated columnar
epithelium with stratified squamous epithelium?
A. Dysplasia
B. Hyperplasia
C. Metaplasia [CORRECT]
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell type
with another, often in response to chronic irritation or stress.
Q8: A patient with chronic renal failure develops metastatic calcification. Which
laboratory finding best explains this pathologic process?
A. Decreased phosphate levels
B. Hyperphosphatemia with secondary hyperparathyroidism [CORRECT]
C. Hypocalcemia alone
D. Respiratory alkalosis
Correct Answer: B
Rationale: In chronic kidney disease, hyperphosphatemia lowers ionized calcium,
triggering PTH release and calcium-phosphate deposition in normal tissues.
Q9: Reperfusion injury following myocardial infarction is mediated primarily by:
A. Persistent hypoxia
B. Generation of reactive oxygen species and calcium overload [CORRECT]
C. Purely mechanical damage to cell membranes
D. Decreased pH alone
Correct Answer: B
