NR507 Advanced Pathophysiology Midterm
Exam -Chamberlain University
SECTION 1: CELLULAR ADAPTATION, INJURY & NEOPLASIA (Questions 1-40)
Question 1
A 68-year-old male with a 50-pack-year smoking history undergoes a lung biopsy. Pathological
examination reveals disorganized cellular architecture, pleomorphic nuclei, and loss of normal
differentiation. These findings are characteristic of:
A) Metaplasia
B) Hyperplasia
C) Dysplasia
D) Anaplasia
Answer: D
Anaplasia refers to the loss of cellular differentiation and architectural disorganization characteristic of
malignant neoplasms. Features include pleomorphism (variation in size and shape), hyperchromatic
nuclei, and abnormal mitotic figures.
Question 2
A patient with chronic hypertension has an enlarged heart. This increase in muscle mass is primarily due
to which cellular adaptation?
A) Hyperplasia
B) Metaplasia
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,C) Hypertrophy
D) Dysplasia
Answer: C
Hypertrophy is an increase in cell size leading to organ enlargement. Cardiac muscle cells are terminally
differentiated and cannot divide, so they adapt to increased workload through hypertrophy, not
hyperplasia (increase in cell number).
Question 3
The irreversible point in cellular injury where cell death is inevitable, even if the stressor is removed, is
known as the:
A) Point of no return
B) Cellular apoptosis threshold
C) Necrotic point
D) Ischemic threshold
Answer: A
The "point of no return" is a key concept where mitochondrial damage becomes so severe that ATP
production ceases entirely, leading to irreversible membrane and DNA damage.
Question 4
Which of the following is a characteristic feature of apoptosis?
A) Elicits a significant inflammatory response
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,B) Results in cellular swelling and rupture
C) Involves organized cell shrinkage and fragmentation
D) Is always a pathological process
Answer: C
Apoptosis is a programmed, controlled cell death that does not cause inflammation. Necrosis is
characterized by cell swelling, rupture, and inflammation.
Question 5
Ischemia-reperfusion injury causes additional cellular damage primarily due to:
A) Immediate restoration of ATP levels
B) Influx of calcium and generation of oxygen-free radicals
C) Rapid normalization of pH
D) Prevention of inflammatory cell infiltration
Answer: B
When blood flow returns (reperfusion), it brings oxygen which leads to a burst of free radical production
and an influx of calcium, exacerbating the injury caused by the initial ischemia.
Question 6
A 3-year-old male presents with a unilateral Wilms tumor. Genetic analysis shows loss of heterozygosity
at the WT1 locus on chromosome 11. This finding supports which mechanism of tumor suppressor gene
inactivation?
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, A) Two-hit hypothesis
B) Oncogene amplification
C) Epigenetic silencing
D) Trinucleotide repeat expansion
Answer: A
The two-hit hypothesis (Knudson) explains that both alleles of a tumor suppressor gene must be
inactivated for cancer development. Loss of heterozygosity represents the second hit.
Question 7
A client who smokes has a change in the bronchial epithelium from ciliated columnar to stratified
squamous. This is an example of:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: D
Metaplasia is the reversible replacement of one differentiated cell type with another. In smokers, the
normal ciliated columnar epithelium of the bronchi transforms into stratified squamous epithelium as a
protective adaptation to chronic irritation.
Question 8
Which type of necrosis is characterized by a cheese-like appearance and is most commonly associated
with tuberculosis?
4|Page
Exam -Chamberlain University
SECTION 1: CELLULAR ADAPTATION, INJURY & NEOPLASIA (Questions 1-40)
Question 1
A 68-year-old male with a 50-pack-year smoking history undergoes a lung biopsy. Pathological
examination reveals disorganized cellular architecture, pleomorphic nuclei, and loss of normal
differentiation. These findings are characteristic of:
A) Metaplasia
B) Hyperplasia
C) Dysplasia
D) Anaplasia
Answer: D
Anaplasia refers to the loss of cellular differentiation and architectural disorganization characteristic of
malignant neoplasms. Features include pleomorphism (variation in size and shape), hyperchromatic
nuclei, and abnormal mitotic figures.
Question 2
A patient with chronic hypertension has an enlarged heart. This increase in muscle mass is primarily due
to which cellular adaptation?
A) Hyperplasia
B) Metaplasia
1|Page
,C) Hypertrophy
D) Dysplasia
Answer: C
Hypertrophy is an increase in cell size leading to organ enlargement. Cardiac muscle cells are terminally
differentiated and cannot divide, so they adapt to increased workload through hypertrophy, not
hyperplasia (increase in cell number).
Question 3
The irreversible point in cellular injury where cell death is inevitable, even if the stressor is removed, is
known as the:
A) Point of no return
B) Cellular apoptosis threshold
C) Necrotic point
D) Ischemic threshold
Answer: A
The "point of no return" is a key concept where mitochondrial damage becomes so severe that ATP
production ceases entirely, leading to irreversible membrane and DNA damage.
Question 4
Which of the following is a characteristic feature of apoptosis?
A) Elicits a significant inflammatory response
2|Page
,B) Results in cellular swelling and rupture
C) Involves organized cell shrinkage and fragmentation
D) Is always a pathological process
Answer: C
Apoptosis is a programmed, controlled cell death that does not cause inflammation. Necrosis is
characterized by cell swelling, rupture, and inflammation.
Question 5
Ischemia-reperfusion injury causes additional cellular damage primarily due to:
A) Immediate restoration of ATP levels
B) Influx of calcium and generation of oxygen-free radicals
C) Rapid normalization of pH
D) Prevention of inflammatory cell infiltration
Answer: B
When blood flow returns (reperfusion), it brings oxygen which leads to a burst of free radical production
and an influx of calcium, exacerbating the injury caused by the initial ischemia.
Question 6
A 3-year-old male presents with a unilateral Wilms tumor. Genetic analysis shows loss of heterozygosity
at the WT1 locus on chromosome 11. This finding supports which mechanism of tumor suppressor gene
inactivation?
3|Page
, A) Two-hit hypothesis
B) Oncogene amplification
C) Epigenetic silencing
D) Trinucleotide repeat expansion
Answer: A
The two-hit hypothesis (Knudson) explains that both alleles of a tumor suppressor gene must be
inactivated for cancer development. Loss of heterozygosity represents the second hit.
Question 7
A client who smokes has a change in the bronchial epithelium from ciliated columnar to stratified
squamous. This is an example of:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: D
Metaplasia is the reversible replacement of one differentiated cell type with another. In smokers, the
normal ciliated columnar epithelium of the bronchi transforms into stratified squamous epithelium as a
protective adaptation to chronic irritation.
Question 8
Which type of necrosis is characterized by a cheese-like appearance and is most commonly associated
with tuberculosis?
4|Page
