NSG 5140 Midterm Exam Review Adv Pathophysiology
South College NSG 5140 Advanced Pathophysiology
Exam Questions and Answers | 100% Pass Guaranteed |
Graded A+ | 2026/2027
Question 1: A 65-year-old male with chronic heart failure presents with worsening
dyspnea and peripheral edema. Which cellular adaptation is most likely occurring in his
myocardial tissue in response to prolonged pressure overload?
A) Hyperplasia
B) Atrophy
C) Metaplasia
D) Hypertrophy
Answer: D
Rationale: Hypertrophy is an increase in individual cell size due to increased workload,
as seen in myocardial cells responding to chronic pressure overload from hypertension
or valve disease . Cardiac myocytes are terminally differentiated and cannot undergo
hyperplasia .
Question 2: A pathologist examines a biopsy from the bronchial epithelium of a chronic
smoker. The normal pseudostratified ciliated columnar epithelium is replaced by
stratified squamous epithelium. Which molecular event is most likely initiating this
change?
A) Increased expression of anti-apoptotic Bcl-2 in basal cells
B) Reprogramming of stem cells due to chronic irritation and altered transcription
factor signaling
C) Somatic mutation in the p53 gene
D) Epigenetic silencing of E-cadherin
Answer: B
Rationale: Metaplasia results from reprogramming of tissue-resident stem cells or
undifferentiated cells in response to chronic stress, often involving changes in
,transcription factors (e.g., Sox2, p63) . p53 mutation is associated with dysplasia/cancer,
not metaplasia .
Question 3: A researcher studying pressure overload in cardiac myocytes observes that
sustained mechanical stretch leads to increased protein synthesis and cell enlargement
without cell division. Which intracellular signaling pathway is most directly responsible
for this adaptive response?
A) Activation of the PI3K/Akt/mTOR pathway leading to increased translation
B) Induction of p53-mediated cell cycle arrest
C) Upregulation of caspases
D) Activation of the unfolded protein response
Answer: A
Rationale: Cardiac myocytes respond to increased workload by undergoing
hypertrophy, driven by the PI3K/Akt/mTOR pathway that enhances protein synthesis .
p53 activation would promote apoptosis or senescence, not hypertrophy .
Question 4: In a patient with prolonged ischemia due to renal artery stenosis, proximal
tubular epithelial cells exhibit swelling of mitochondria and dilation of the endoplasmic
reticulum on electron microscopy. Which phase of cell injury does this morphology
represent?
A) Irreversible injury; massive calcium influx
B) Reversible injury; depletion of ATP leading to failure of ion pumps
C) Necroptosis; activation of RIP kinases
D) Apoptosis; cytochrome c release
Answer: B
Rationale: Cellular swelling with mitochondrial and ER changes is characteristic of
reversible injury due to ATP depletion causing failure of Na⁺/K⁺ ATPase . Calcium influx
and mitochondrial damage are features of irreversible injury .
,Question 5: Which of the following is the hallmark of reversible cellular injury?
A) Nuclear pyknosis
B) Cellular swelling
C) Karyorrhexis
D) Apoptosis
Answer: B
Rationale: Reversible injury involves failure of ion pumps leading to water influx and cell
swelling . Nuclear changes like pyknosis, karyorrhexis, and karyolysis indicate irreversible
injury .
Question 6: A patient with myocardial infarction develops coagulative necrosis. Which
organs are most commonly affected by coagulative necrosis?
A) Brain and spinal cord
B) Heart, kidney, and spleen
C) Lungs and liver
D) Skin and muscle
Answer: B
Rationale: Coagulative necrosis is the most common type of necrosis and occurs in
ischemic injury to solid organs (except the brain), including the heart, kidney, and
spleen . The brain undergoes liquefactive necrosis .
Question 7: In the brain, ischemic injury leads to which type of necrosis?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B
, Rationale: In the brain, ischemic injury leads to enzymatic digestion of dead cells,
resulting in liquefactive necrosis . The brain has high levels of proteolytic enzymes and
high lipid content, contributing to liquefaction and cyst formation .
Question 8: Which of the following best distinguishes apoptosis from necrosis?
A) Apoptosis triggers intense inflammation
B) Apoptosis is programmed, controlled cell death; necrosis is uncontrolled and
often inflammatory
C) Apoptosis affects large tissue areas
D) Apoptosis occurs only in pathological conditions
Answer: B
Rationale: Apoptosis is an orderly, energy-dependent process for removing damaged
or unneeded cells without inflammation . Necrosis is uncontrolled cell death that
triggers an inflammatory response .
Question 9: Which of the following is a feature of both necrosis and apoptosis?
A) Inflammation
B) ATP dependency
C) Cell membrane disruption
D) Nuclear fragmentation
Answer: D
Rationale: Both necrosis and apoptosis can result in nuclear fragmentation
(karyorrhexis) . However, necrosis is ATP-independent, causes inflammation, and leads to
cell lysis, while apoptosis is ATP-dependent, does not cause inflammation, and results in
apoptotic body formation .
Question 10: A patient with chronic alcohol abuse develops fatty liver. This is an
example of:
South College NSG 5140 Advanced Pathophysiology
Exam Questions and Answers | 100% Pass Guaranteed |
Graded A+ | 2026/2027
Question 1: A 65-year-old male with chronic heart failure presents with worsening
dyspnea and peripheral edema. Which cellular adaptation is most likely occurring in his
myocardial tissue in response to prolonged pressure overload?
A) Hyperplasia
B) Atrophy
C) Metaplasia
D) Hypertrophy
Answer: D
Rationale: Hypertrophy is an increase in individual cell size due to increased workload,
as seen in myocardial cells responding to chronic pressure overload from hypertension
or valve disease . Cardiac myocytes are terminally differentiated and cannot undergo
hyperplasia .
Question 2: A pathologist examines a biopsy from the bronchial epithelium of a chronic
smoker. The normal pseudostratified ciliated columnar epithelium is replaced by
stratified squamous epithelium. Which molecular event is most likely initiating this
change?
A) Increased expression of anti-apoptotic Bcl-2 in basal cells
B) Reprogramming of stem cells due to chronic irritation and altered transcription
factor signaling
C) Somatic mutation in the p53 gene
D) Epigenetic silencing of E-cadherin
Answer: B
Rationale: Metaplasia results from reprogramming of tissue-resident stem cells or
undifferentiated cells in response to chronic stress, often involving changes in
,transcription factors (e.g., Sox2, p63) . p53 mutation is associated with dysplasia/cancer,
not metaplasia .
Question 3: A researcher studying pressure overload in cardiac myocytes observes that
sustained mechanical stretch leads to increased protein synthesis and cell enlargement
without cell division. Which intracellular signaling pathway is most directly responsible
for this adaptive response?
A) Activation of the PI3K/Akt/mTOR pathway leading to increased translation
B) Induction of p53-mediated cell cycle arrest
C) Upregulation of caspases
D) Activation of the unfolded protein response
Answer: A
Rationale: Cardiac myocytes respond to increased workload by undergoing
hypertrophy, driven by the PI3K/Akt/mTOR pathway that enhances protein synthesis .
p53 activation would promote apoptosis or senescence, not hypertrophy .
Question 4: In a patient with prolonged ischemia due to renal artery stenosis, proximal
tubular epithelial cells exhibit swelling of mitochondria and dilation of the endoplasmic
reticulum on electron microscopy. Which phase of cell injury does this morphology
represent?
A) Irreversible injury; massive calcium influx
B) Reversible injury; depletion of ATP leading to failure of ion pumps
C) Necroptosis; activation of RIP kinases
D) Apoptosis; cytochrome c release
Answer: B
Rationale: Cellular swelling with mitochondrial and ER changes is characteristic of
reversible injury due to ATP depletion causing failure of Na⁺/K⁺ ATPase . Calcium influx
and mitochondrial damage are features of irreversible injury .
,Question 5: Which of the following is the hallmark of reversible cellular injury?
A) Nuclear pyknosis
B) Cellular swelling
C) Karyorrhexis
D) Apoptosis
Answer: B
Rationale: Reversible injury involves failure of ion pumps leading to water influx and cell
swelling . Nuclear changes like pyknosis, karyorrhexis, and karyolysis indicate irreversible
injury .
Question 6: A patient with myocardial infarction develops coagulative necrosis. Which
organs are most commonly affected by coagulative necrosis?
A) Brain and spinal cord
B) Heart, kidney, and spleen
C) Lungs and liver
D) Skin and muscle
Answer: B
Rationale: Coagulative necrosis is the most common type of necrosis and occurs in
ischemic injury to solid organs (except the brain), including the heart, kidney, and
spleen . The brain undergoes liquefactive necrosis .
Question 7: In the brain, ischemic injury leads to which type of necrosis?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B
, Rationale: In the brain, ischemic injury leads to enzymatic digestion of dead cells,
resulting in liquefactive necrosis . The brain has high levels of proteolytic enzymes and
high lipid content, contributing to liquefaction and cyst formation .
Question 8: Which of the following best distinguishes apoptosis from necrosis?
A) Apoptosis triggers intense inflammation
B) Apoptosis is programmed, controlled cell death; necrosis is uncontrolled and
often inflammatory
C) Apoptosis affects large tissue areas
D) Apoptosis occurs only in pathological conditions
Answer: B
Rationale: Apoptosis is an orderly, energy-dependent process for removing damaged
or unneeded cells without inflammation . Necrosis is uncontrolled cell death that
triggers an inflammatory response .
Question 9: Which of the following is a feature of both necrosis and apoptosis?
A) Inflammation
B) ATP dependency
C) Cell membrane disruption
D) Nuclear fragmentation
Answer: D
Rationale: Both necrosis and apoptosis can result in nuclear fragmentation
(karyorrhexis) . However, necrosis is ATP-independent, causes inflammation, and leads to
cell lysis, while apoptosis is ATP-dependent, does not cause inflammation, and results in
apoptotic body formation .
Question 10: A patient with chronic alcohol abuse develops fatty liver. This is an
example of:
