SCI 225 Pathophysiology Midterm Examination
Nightingale College | Latest 2026/2027 Total
Questions 150 | Format: Multiple
Choice | Advanced/Hard Difficulty
INSTRUCTIONS:
Select the single best answer for each question. Each question has one correct answer. Read
each question carefully and consider the underlying pathophysiological mechanisms before
selecting your response.
SECTION A: CELLULAR INJURY, ADAPTATION, AND DEATH (Questions 1–15)
1. A 68-year-old patient with chronic heart failure presents with muscle wasting and
generalized weakness. Which cellular adaptation best explains this clinical presentation?
• A. Hypertrophy
• B. Hyperplasia
• C. Atrophy
• D. Metaplasia
• E. Dysplasia
,Correct Answer: C. Atrophy
Rationale: Atrophy is the decrease in cell size and organ size due to reduced workload, loss of
innervation, diminished blood supply, inadequate nutrition, or aging. In chronic heart failure,
decreased cardiac output leads to reduced tissue perfusion, causing disuse atrophy of skeletal
muscles. Hypertrophy (A) is an increase in cell size; hyperplasia (B) is an increase in cell number;
metaplasia (D) is replacement of one cell type with another; dysplasia (E) is abnormal cellular
growth.
2. A pathologist examining a myocardial tissue sample from a patient who suffered a
myocardial infarction observes coagulative necrosis. Which of the following best describes the
mechanism of cell death in this scenario?
• A. Programmed cell death with cellular shrinkage
• B. Unregulated cell death with cellular swelling and membrane rupture
• C. Replacement of one cell type with another
• D. Increase in cell size without division
• E. Abnormal cellular growth with nuclear atypia
Correct Answer: B. Unregulated cell death with cellular swelling and membrane rupture
Rationale: Coagulative necrosis is a form of unregulated cell death (necrosis) characterized by
cellular swelling, denaturation of proteins, and rupture of cell membranes, typically following
ischemic injury such as myocardial infarction. Apoptosis (A) is programmed cell death with
cellular shrinkage. Metaplasia (C), hypertrophy (D), and dysplasia (E) are not forms of cell death.
3. A patient with chronic alcoholism develops liver cirrhosis. The liver biopsy reveals
replacement of normal hepatocytes with fibrous tissue. This pathological process is best
described as:
• A. Apoptosis
• B. Necrosis
• C. Fibrosis
• D. Atrophy
• E. Hyperplasia
,Correct Answer: C. Fibrosis
Rationale: Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue as a
reparative or reactive process, often following chronic inflammation or injury. In alcoholic liver
disease, repeated injury leads to fibrotic scar tissue replacing functional hepatocytes. Apoptosis
(A) and necrosis (B) are forms of cell death; atrophy (D) is reduction in cell size; hyperplasia (E) is
increased cell number.
4. Which of the following cellular changes is characteristic of reversible cell injury?
• A. Nuclear pyknosis
• B. Karyorrhexis
• C. Cellular swelling and fatty change
• D. Karyolysis
• E. Formation of apoptotic bodies
Correct Answer: C. Cellular swelling and fatty change
Rationale: Reversible cell injury is characterized by cellular swelling (hydropic change) and fatty
change (accumulation of lipid vacuoles). These changes indicate cellular dysfunction but are not
yet lethal. Nuclear pyknosis (A), karyorrhexis (B), and karyolysis (D) are features of irreversible
injury and necrosis. Apoptotic bodies (E) are characteristic of apoptosis.
5. A 45-year-old woman with chronic gastroesophageal reflux disease develops Barrett's
esophagus. The esophageal biopsy shows replacement of stratified squamous epithelium with
columnar epithelium. This cellular adaptation is termed:
• A. Hyperplasia
• B. Hypertrophy
• C. Metaplasia
• D. Dysplasia
• E. Anaplasia
Correct Answer: C. Metaplasia
, Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
often in response to chronic irritation. Barrett's esophagus represents metaplasia of the
esophageal squamous epithelium to columnar epithelium in response to chronic acid exposure.
Hyperplasia (A) is increased cell number; hypertrophy (B) is increased cell size; dysplasia (D) is
abnormal cellular growth; anaplasia (E) is loss of differentiation in malignant cells.
6. A patient with prolonged hypoxia develops cellular injury. Which of the following is the
earliest biochemical event in hypoxic cell injury?
• A. Increased intracellular calcium
• B. ATP depletion
• C. Reactive oxygen species generation
• D. Mitochondrial damage
• E. DNA fragmentation
Correct Answer: B. ATP depletion
Rationale: In hypoxic injury, the earliest biochemical event is depletion of ATP due to reduced
oxidative phosphorylation. ATP depletion leads to failure of the sodium-potassium pump,
cellular swelling, and subsequent calcium influx. Increased intracellular calcium (A), reactive
oxygen species (C), mitochondrial damage (D), and DNA fragmentation (E) occur as downstream
consequences of ATP depletion.
7. A 72-year-old patient with severe atherosclerosis develops a cerebral infarction. The type of
necrosis most likely observed in the affected brain tissue is:
• A. Coagulative necrosis
• B. Liquefactive necrosis
• C. Caseous necrosis
• D. Fat necrosis
• E. Fibrinoid necrosis
Correct Answer: B. Liquefactive necrosis
Nightingale College | Latest 2026/2027 Total
Questions 150 | Format: Multiple
Choice | Advanced/Hard Difficulty
INSTRUCTIONS:
Select the single best answer for each question. Each question has one correct answer. Read
each question carefully and consider the underlying pathophysiological mechanisms before
selecting your response.
SECTION A: CELLULAR INJURY, ADAPTATION, AND DEATH (Questions 1–15)
1. A 68-year-old patient with chronic heart failure presents with muscle wasting and
generalized weakness. Which cellular adaptation best explains this clinical presentation?
• A. Hypertrophy
• B. Hyperplasia
• C. Atrophy
• D. Metaplasia
• E. Dysplasia
,Correct Answer: C. Atrophy
Rationale: Atrophy is the decrease in cell size and organ size due to reduced workload, loss of
innervation, diminished blood supply, inadequate nutrition, or aging. In chronic heart failure,
decreased cardiac output leads to reduced tissue perfusion, causing disuse atrophy of skeletal
muscles. Hypertrophy (A) is an increase in cell size; hyperplasia (B) is an increase in cell number;
metaplasia (D) is replacement of one cell type with another; dysplasia (E) is abnormal cellular
growth.
2. A pathologist examining a myocardial tissue sample from a patient who suffered a
myocardial infarction observes coagulative necrosis. Which of the following best describes the
mechanism of cell death in this scenario?
• A. Programmed cell death with cellular shrinkage
• B. Unregulated cell death with cellular swelling and membrane rupture
• C. Replacement of one cell type with another
• D. Increase in cell size without division
• E. Abnormal cellular growth with nuclear atypia
Correct Answer: B. Unregulated cell death with cellular swelling and membrane rupture
Rationale: Coagulative necrosis is a form of unregulated cell death (necrosis) characterized by
cellular swelling, denaturation of proteins, and rupture of cell membranes, typically following
ischemic injury such as myocardial infarction. Apoptosis (A) is programmed cell death with
cellular shrinkage. Metaplasia (C), hypertrophy (D), and dysplasia (E) are not forms of cell death.
3. A patient with chronic alcoholism develops liver cirrhosis. The liver biopsy reveals
replacement of normal hepatocytes with fibrous tissue. This pathological process is best
described as:
• A. Apoptosis
• B. Necrosis
• C. Fibrosis
• D. Atrophy
• E. Hyperplasia
,Correct Answer: C. Fibrosis
Rationale: Fibrosis is the formation of excess fibrous connective tissue in an organ or tissue as a
reparative or reactive process, often following chronic inflammation or injury. In alcoholic liver
disease, repeated injury leads to fibrotic scar tissue replacing functional hepatocytes. Apoptosis
(A) and necrosis (B) are forms of cell death; atrophy (D) is reduction in cell size; hyperplasia (E) is
increased cell number.
4. Which of the following cellular changes is characteristic of reversible cell injury?
• A. Nuclear pyknosis
• B. Karyorrhexis
• C. Cellular swelling and fatty change
• D. Karyolysis
• E. Formation of apoptotic bodies
Correct Answer: C. Cellular swelling and fatty change
Rationale: Reversible cell injury is characterized by cellular swelling (hydropic change) and fatty
change (accumulation of lipid vacuoles). These changes indicate cellular dysfunction but are not
yet lethal. Nuclear pyknosis (A), karyorrhexis (B), and karyolysis (D) are features of irreversible
injury and necrosis. Apoptotic bodies (E) are characteristic of apoptosis.
5. A 45-year-old woman with chronic gastroesophageal reflux disease develops Barrett's
esophagus. The esophageal biopsy shows replacement of stratified squamous epithelium with
columnar epithelium. This cellular adaptation is termed:
• A. Hyperplasia
• B. Hypertrophy
• C. Metaplasia
• D. Dysplasia
• E. Anaplasia
Correct Answer: C. Metaplasia
, Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
often in response to chronic irritation. Barrett's esophagus represents metaplasia of the
esophageal squamous epithelium to columnar epithelium in response to chronic acid exposure.
Hyperplasia (A) is increased cell number; hypertrophy (B) is increased cell size; dysplasia (D) is
abnormal cellular growth; anaplasia (E) is loss of differentiation in malignant cells.
6. A patient with prolonged hypoxia develops cellular injury. Which of the following is the
earliest biochemical event in hypoxic cell injury?
• A. Increased intracellular calcium
• B. ATP depletion
• C. Reactive oxygen species generation
• D. Mitochondrial damage
• E. DNA fragmentation
Correct Answer: B. ATP depletion
Rationale: In hypoxic injury, the earliest biochemical event is depletion of ATP due to reduced
oxidative phosphorylation. ATP depletion leads to failure of the sodium-potassium pump,
cellular swelling, and subsequent calcium influx. Increased intracellular calcium (A), reactive
oxygen species (C), mitochondrial damage (D), and DNA fragmentation (E) occur as downstream
consequences of ATP depletion.
7. A 72-year-old patient with severe atherosclerosis develops a cerebral infarction. The type of
necrosis most likely observed in the affected brain tissue is:
• A. Coagulative necrosis
• B. Liquefactive necrosis
• C. Caseous necrosis
• D. Fat necrosis
• E. Fibrinoid necrosis
Correct Answer: B. Liquefactive necrosis
