WGU D236 Pathophysiology Pre-Assessment
2025-2026 – Questions 1-200 with Verified
Answers
SECTION 1: CELLULAR ADAPTATION AND INJURY
1. A cell exposed to chronic hypoxia upregulates hypoxia-inducible
factor 1 (HIF-1). Which of the following is the most direct consequence
of HIF-1 stabilization?
A) Increased glycolytic enzyme expression and erythropoietin production
B) Activation of caspase cascades leading to apoptosis
C) Upregulation of p53 and cell cycle arrest
D) Increased mitochondrial biogenesis via PGC-1α
*A) Increased glycolytic enzyme expression and erythropoietin
production *
Rationale: HIF-1α promotes adaptation to hypoxia by inducing glycolytic
enzymes (to compensate for reduced oxidative phosphorylation) and
erythropoietin (to increase oxygen delivery). Apoptosis is not a direct HIF-1
effect; p53 is activated by severe hypoxia but not directly by HIF-1; PGC-1α is
involved in mitochondrial biogenesis but not primarily induced by HIF-1 .
2. A patient with prolonged ischemia followed by reperfusion develops
increased cellular injury. Which mechanism is most responsible for
reperfusion injury?
,A) ATP depletion
B) Anaerobic glycolysis
C) Free radical formation
D) Sodium-potassium pump failure
*C) Free radical formation *
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic
tissue, leading to the generation of reactive oxygen species (free radicals) that
cause additional cellular damage. ATP depletion, anaerobic glycolysis, and
sodium-potassium pump failure are mechanisms of ischemic injury, not
reperfusion injury .
3. A patient with chronic hepatitis B develops hepatocellular
carcinoma. Which cellular change is most directly associated with
malignant transformation?
A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Atrophy
*B) Dysplasia *
Rationale: Dysplasia is characterized by disordered cellular growth,
pleomorphism, and increased mitotic activity. Severe dysplasia is considered
a pre-neoplastic condition that can progress to carcinoma in situ and
invasive cancer .
4. A pathologist examines a tissue section showing cells with enlarged
nuclei, prominent nucleoli, and a high nuclear-to-cytoplasmic ratio.
Some cells exhibit mitotic figures with abnormal spindles. Which
,pattern of cellular adaptation or injury is predominantly present?
A) Metaplasia with compensatory hyperplasia
B) Dysplasia with potential for malignant transformation
C) Reversible cell injury with hydropic change
D) Apoptosis with autophagic vacuole formation
*B) Dysplasia with potential for malignant transformation *
Rationale: Dysplasia is characterized by disordered cellular growth,
pleomorphism (variation in size and shape), hyperchromatic nuclei, and
increased mitotic activity. Severe dysplasia is considered a pre-neoplastic
condition that can progress to carcinoma in situ and invasive cancer .
5. A patient with chronic gastroesophageal reflux disease (GERD)
develops a change in the epithelium of the lower esophagus from
stratified squamous to columnar epithelium. What is this process
called?
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
*B) Metaplasia *
Rationale: Metaplasia is a reversible change in which one differentiated cell
type is replaced by another cell type, often in response to chronic irritation or
inflammation. In Barrett esophagus, the squamous epithelium of the
esophagus is replaced by columnar epithelium, which is more resistant to the
acidic environment but increases the risk of adenocarcinoma .
, 6. A patient with a history of hypertension develops left ventricular
hypertrophy. This is an example of which type of cellular adaptation?
A) Physiologic hypertrophy
B) Pathologic hypertrophy
C) Physiologic hyperplasia
D) Pathologic hyperplasia
*B) Pathologic hypertrophy *
Rationale: Pathologic hypertrophy occurs as a compensatory response to
increased workload or stress. In hypertension, the left ventricle hypertrophies
to overcome increased systemic vascular resistance, leading to thickened
myocardial walls and increased cardiac mass .
7. A patient who is 8 weeks pregnant experiences an increase in the
size of her uterus. This is an example of:
A) Physiologic hypertrophy
B) Pathologic hypertrophy
C) Physiologic hyperplasia
D) Pathologic hyperplasia
*C) Physiologic hyperplasia *
Rationale: Physiologic hyperplasia is a normal, hormonally mediated increase
in cell number that occurs in response to a specific stimulus. During
pregnancy, estrogen and progesterone stimulate hyperplasia of uterine
smooth muscle cells and glandular epithelium .
8. A patient with chronic obstructive pulmonary disease (COPD) has
been smoking for 40 years. The bronchial epithelium shows an
increase in the number of goblet cells. This adaptation is best
2025-2026 – Questions 1-200 with Verified
Answers
SECTION 1: CELLULAR ADAPTATION AND INJURY
1. A cell exposed to chronic hypoxia upregulates hypoxia-inducible
factor 1 (HIF-1). Which of the following is the most direct consequence
of HIF-1 stabilization?
A) Increased glycolytic enzyme expression and erythropoietin production
B) Activation of caspase cascades leading to apoptosis
C) Upregulation of p53 and cell cycle arrest
D) Increased mitochondrial biogenesis via PGC-1α
*A) Increased glycolytic enzyme expression and erythropoietin
production *
Rationale: HIF-1α promotes adaptation to hypoxia by inducing glycolytic
enzymes (to compensate for reduced oxidative phosphorylation) and
erythropoietin (to increase oxygen delivery). Apoptosis is not a direct HIF-1
effect; p53 is activated by severe hypoxia but not directly by HIF-1; PGC-1α is
involved in mitochondrial biogenesis but not primarily induced by HIF-1 .
2. A patient with prolonged ischemia followed by reperfusion develops
increased cellular injury. Which mechanism is most responsible for
reperfusion injury?
,A) ATP depletion
B) Anaerobic glycolysis
C) Free radical formation
D) Sodium-potassium pump failure
*C) Free radical formation *
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic
tissue, leading to the generation of reactive oxygen species (free radicals) that
cause additional cellular damage. ATP depletion, anaerobic glycolysis, and
sodium-potassium pump failure are mechanisms of ischemic injury, not
reperfusion injury .
3. A patient with chronic hepatitis B develops hepatocellular
carcinoma. Which cellular change is most directly associated with
malignant transformation?
A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Atrophy
*B) Dysplasia *
Rationale: Dysplasia is characterized by disordered cellular growth,
pleomorphism, and increased mitotic activity. Severe dysplasia is considered
a pre-neoplastic condition that can progress to carcinoma in situ and
invasive cancer .
4. A pathologist examines a tissue section showing cells with enlarged
nuclei, prominent nucleoli, and a high nuclear-to-cytoplasmic ratio.
Some cells exhibit mitotic figures with abnormal spindles. Which
,pattern of cellular adaptation or injury is predominantly present?
A) Metaplasia with compensatory hyperplasia
B) Dysplasia with potential for malignant transformation
C) Reversible cell injury with hydropic change
D) Apoptosis with autophagic vacuole formation
*B) Dysplasia with potential for malignant transformation *
Rationale: Dysplasia is characterized by disordered cellular growth,
pleomorphism (variation in size and shape), hyperchromatic nuclei, and
increased mitotic activity. Severe dysplasia is considered a pre-neoplastic
condition that can progress to carcinoma in situ and invasive cancer .
5. A patient with chronic gastroesophageal reflux disease (GERD)
develops a change in the epithelium of the lower esophagus from
stratified squamous to columnar epithelium. What is this process
called?
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
*B) Metaplasia *
Rationale: Metaplasia is a reversible change in which one differentiated cell
type is replaced by another cell type, often in response to chronic irritation or
inflammation. In Barrett esophagus, the squamous epithelium of the
esophagus is replaced by columnar epithelium, which is more resistant to the
acidic environment but increases the risk of adenocarcinoma .
, 6. A patient with a history of hypertension develops left ventricular
hypertrophy. This is an example of which type of cellular adaptation?
A) Physiologic hypertrophy
B) Pathologic hypertrophy
C) Physiologic hyperplasia
D) Pathologic hyperplasia
*B) Pathologic hypertrophy *
Rationale: Pathologic hypertrophy occurs as a compensatory response to
increased workload or stress. In hypertension, the left ventricle hypertrophies
to overcome increased systemic vascular resistance, leading to thickened
myocardial walls and increased cardiac mass .
7. A patient who is 8 weeks pregnant experiences an increase in the
size of her uterus. This is an example of:
A) Physiologic hypertrophy
B) Pathologic hypertrophy
C) Physiologic hyperplasia
D) Pathologic hyperplasia
*C) Physiologic hyperplasia *
Rationale: Physiologic hyperplasia is a normal, hormonally mediated increase
in cell number that occurs in response to a specific stimulus. During
pregnancy, estrogen and progesterone stimulate hyperplasia of uterine
smooth muscle cells and glandular epithelium .
8. A patient with chronic obstructive pulmonary disease (COPD) has
been smoking for 40 years. The bronchial epithelium shows an
increase in the number of goblet cells. This adaptation is best
