SCI 225 PATHOPHYSIOLOGY
MIDTERM EXAM
Nightingale College — 2026/2027 Academic Year
EXAM OVERVIEW
Section 1 | CELLULAR INJURY, ADAPTATION & INFLAMMATION | Q1 – Q10
Section 2 | GENETICS, IMMUNITY & IMMUNE DISORDERS | Q11 – Q23
Section 3 | FLUID, ELECTROLYTE & ACID-BASE BALANCE | Q24 – Q33
Section 4 | CARDIOVASCULAR, RESPIRATORY & RENAL PATHOPHYSIOLOGY | Q34 – Q43
Section 5 | NEOPLASIA, ENDOCRINE DISORDERS & NGN-STYLE CASE ANALYSIS | Q44 – Q50
Total Questions: 50 | Time: 120 min | Passing Score: 80% (40/50)
Instructions: Choose the single best answer unless otherwise indicated. SATA questions require selecting all correct
options. Passing Score: 40 of 50 in 120 minutes.
Name: Date: Score: ________ / 50
______________________ ______________________
______ ______
Section 1 Section 2 Section 3 Section 4 Section 5 TOTAL
20% 25% 20% 20% 15%
Points / 10 / 10 / 10 / 10 / 10 / 50
Score
SECTION 1: CELLULAR INJURY, ADAPTATION & INFLAMMATION
Question 1 of 50
A 58-year-old man with a 40-pack-year smoking history presents with chronic productive cough and increasing
dyspnea. A bronchial biopsy reveals that the normal ciliated columnar epithelium has been replaced by stratified
squamous epithelium. This cellular change is best described as which of the following?
A. Metaplasia, a reversible replacement of one adult B. Dysplasia, a precancerous change involving
cell type by another atypical cell morphology
C. Hyperplasia, an increase in the number of normal- D. Anaplasia, a loss of cellular differentiation seen in
appearing cells malignancy
Correct Answer: A
Rationale: Metaplasia is a reversible adaptive response in which one differentiated adult cell type is replaced
by another, such as columnar epithelium transforming to squamous epithelium in response to chronic tobacco
irritation. Dysplasia refers to atypical cellular changes that are precancerous, not an adaptive replacement of
one normal cell type for another.
1
,Question 2 of 50
A 72-year-old woman is bedridden following a cerebrovascular accident. Over several weeks, the nurse notes
that her left gastrocnemius muscle has visibly decreased in size. Which pathophysiologic process best accounts
for this finding?
A. Hypertrophy resulting from increased workload on B. Hyperplasia due to hormonal stimulation of muscle
the muscle fibers satellite cells
C. Atrophy caused by decreased mechanical D. Metaplasia from prolonged immobility altering
stimulation and reduced blood flow muscle fiber type
Correct Answer: C
Rationale: Disuse atrophy occurs when cells experience reduced mechanical stimulation or neural input,
leading to a decrease in cell size and organelle content through decreased protein synthesis and increased
protein degradation. Hypertrophy would involve an increase in cell size, which is the opposite of what is
observed in this bedridden patient.
Question 3 of 50
A 45-year-old man with a history of hypertension presents to the emergency department with severe crushing
chest pain. Coronary angiography reveals complete occlusion of the left anterior descending artery. Cardiac
biopsy from the affected region would most likely show which of the following in the first 30 minutes after
occlusion?
A. Coagulative necrosis with preserved cellular B. Cellular swelling and dilation of the endoplasmic
outlines reticulum due to ATP depletion
C. Karyorrhexis and nuclear fragmentation indicating D. Liquefactive necrosis with infiltration of
irreversible injury neutrophils
Correct Answer: B
Rationale: In the first minutes of ischemia, ATP depletion causes failure of the sodium-potassium pump, leading
to sodium and water accumulation inside the cell and early dilation of the endoplasmic reticulum, a hallmark of
reversible cell injury. Coagulative necrosis and karyorrhexis develop later, typically after 20 to 30 minutes of
severe ischemia in cardiac myocytes, marking the transition to irreversible injury.
Question 4 of 50
A 34-year-old man presents with a painful, erythematous, swollen right great toe following a seafood banquet.
Joint aspiration reveals needle-shaped, negatively birefringent crystals. The necrosis-like tissue damage in this
condition is most accurately classified as which of the following?
A. Liquefactive necrosis resulting from neutrophilic B. Fat necrosis caused by lipase activity on adipose
enzymatic digestion tissue
C. Caseous necrosis associated with granulomatous D. Enzymatic fat necrosis from calcium soap
inflammation formation in adipose cells
Correct Answer: A
Rationale: The intense neutrophilic infiltrate in gouty arthritis releases lysosomal enzymes that digest the
surrounding tissue, producing a liquefactive pattern of necrosis. Fat necrosis occurs specifically in the context
of acute pancreatitis, where pancreatic lipase acts on peripancreatic fat, and has no relation to urate crystal
deposition.
2
, Question 5 of 50
A pathologist examines a lung specimen from a patient who died of disseminated tuberculosis and observes soft,
cheese-like granulomatous lesions. Which type of necrosis is most characteristic of this finding?
A. Liquefactive necrosis with complete dissolution of B. Coagulative necrosis maintaining the original
tissue architecture tissue outlines
C. Caseous necrosis appearing as an amorphous, D. Gangrenous necrosis involving both coagulative
granular debris field and liquefactive patterns
Correct Answer: C
Rationale: Caseous necrosis is the hallmark of granulomatous inflammation caused by Mycobacterium
tuberculosis, appearing as a soft, cheese-like amorphous debris that lacks the preserved cellular outlines seen in
coagulative necrosis. Coagulative necrosis is typical of ischemic injury in solid organs such as the heart and
kidneys, where tissue architecture is maintained despite cell death.
Question 6 of 50
A 67-year-old woman with poorly controlled diabetes mellitus develops a non-healing wound on her right foot.
Examination reveals the tissue is black, dry, and shriveled. Which of the following best describes the
pathogenesis of this type of tissue death?
A. Liquefactive necrosis from bacterial protease B. Dry gangrene resulting from arterial insufficiency
activity overwhelming host defenses with superimposed coagulative necrosis
C. Wet gangrene caused by venous congestion and D. Caseous necrosis driven by a cell-mediated
anaerobic bacterial infection immune response to tissue antigens
Correct Answer: B
Rationale: Dry gangrene develops when arterial blood flow is severely compromised, as commonly occurs in
diabetic vascular disease, leading to coagulative necrosis that desiccates the tissue into a dry, black
appearance. Wet gangrene involves venous congestion and superimposed bacterial infection producing
liquefactive necrosis, which is not the pattern seen in this dry, shriveled wound.
Question 7 of 50
During a routine well-child examination, a pediatrician notes that thymic involution is occurring in a healthy 14-
year-old girl. Which of the following best explains the physiologic mechanism driving this process?
A. Ischemic injury from reduced thymic arterial blood B. Programmed cell death mediated by caspase
supply with aging activation without inflammation
C. Necrotic cell death caused by accumulated toxic D. Autoimmune destruction of thymic epithelial cells
metabolites in the gland by cytotoxic T lymphocytes
Correct Answer: B
Rationale: Apoptosis is a form of programmed cell death characterized by cell shrinkage, chromatin
condensation, caspase activation, and formation of apoptotic bodies that are phagocytosed without eliciting an
inflammatory response. Necrosis, in contrast, involves cellular swelling and membrane rupture that releases
intracellular contents, triggering inflammation in the surrounding tissue.
3
MIDTERM EXAM
Nightingale College — 2026/2027 Academic Year
EXAM OVERVIEW
Section 1 | CELLULAR INJURY, ADAPTATION & INFLAMMATION | Q1 – Q10
Section 2 | GENETICS, IMMUNITY & IMMUNE DISORDERS | Q11 – Q23
Section 3 | FLUID, ELECTROLYTE & ACID-BASE BALANCE | Q24 – Q33
Section 4 | CARDIOVASCULAR, RESPIRATORY & RENAL PATHOPHYSIOLOGY | Q34 – Q43
Section 5 | NEOPLASIA, ENDOCRINE DISORDERS & NGN-STYLE CASE ANALYSIS | Q44 – Q50
Total Questions: 50 | Time: 120 min | Passing Score: 80% (40/50)
Instructions: Choose the single best answer unless otherwise indicated. SATA questions require selecting all correct
options. Passing Score: 40 of 50 in 120 minutes.
Name: Date: Score: ________ / 50
______________________ ______________________
______ ______
Section 1 Section 2 Section 3 Section 4 Section 5 TOTAL
20% 25% 20% 20% 15%
Points / 10 / 10 / 10 / 10 / 10 / 50
Score
SECTION 1: CELLULAR INJURY, ADAPTATION & INFLAMMATION
Question 1 of 50
A 58-year-old man with a 40-pack-year smoking history presents with chronic productive cough and increasing
dyspnea. A bronchial biopsy reveals that the normal ciliated columnar epithelium has been replaced by stratified
squamous epithelium. This cellular change is best described as which of the following?
A. Metaplasia, a reversible replacement of one adult B. Dysplasia, a precancerous change involving
cell type by another atypical cell morphology
C. Hyperplasia, an increase in the number of normal- D. Anaplasia, a loss of cellular differentiation seen in
appearing cells malignancy
Correct Answer: A
Rationale: Metaplasia is a reversible adaptive response in which one differentiated adult cell type is replaced
by another, such as columnar epithelium transforming to squamous epithelium in response to chronic tobacco
irritation. Dysplasia refers to atypical cellular changes that are precancerous, not an adaptive replacement of
one normal cell type for another.
1
,Question 2 of 50
A 72-year-old woman is bedridden following a cerebrovascular accident. Over several weeks, the nurse notes
that her left gastrocnemius muscle has visibly decreased in size. Which pathophysiologic process best accounts
for this finding?
A. Hypertrophy resulting from increased workload on B. Hyperplasia due to hormonal stimulation of muscle
the muscle fibers satellite cells
C. Atrophy caused by decreased mechanical D. Metaplasia from prolonged immobility altering
stimulation and reduced blood flow muscle fiber type
Correct Answer: C
Rationale: Disuse atrophy occurs when cells experience reduced mechanical stimulation or neural input,
leading to a decrease in cell size and organelle content through decreased protein synthesis and increased
protein degradation. Hypertrophy would involve an increase in cell size, which is the opposite of what is
observed in this bedridden patient.
Question 3 of 50
A 45-year-old man with a history of hypertension presents to the emergency department with severe crushing
chest pain. Coronary angiography reveals complete occlusion of the left anterior descending artery. Cardiac
biopsy from the affected region would most likely show which of the following in the first 30 minutes after
occlusion?
A. Coagulative necrosis with preserved cellular B. Cellular swelling and dilation of the endoplasmic
outlines reticulum due to ATP depletion
C. Karyorrhexis and nuclear fragmentation indicating D. Liquefactive necrosis with infiltration of
irreversible injury neutrophils
Correct Answer: B
Rationale: In the first minutes of ischemia, ATP depletion causes failure of the sodium-potassium pump, leading
to sodium and water accumulation inside the cell and early dilation of the endoplasmic reticulum, a hallmark of
reversible cell injury. Coagulative necrosis and karyorrhexis develop later, typically after 20 to 30 minutes of
severe ischemia in cardiac myocytes, marking the transition to irreversible injury.
Question 4 of 50
A 34-year-old man presents with a painful, erythematous, swollen right great toe following a seafood banquet.
Joint aspiration reveals needle-shaped, negatively birefringent crystals. The necrosis-like tissue damage in this
condition is most accurately classified as which of the following?
A. Liquefactive necrosis resulting from neutrophilic B. Fat necrosis caused by lipase activity on adipose
enzymatic digestion tissue
C. Caseous necrosis associated with granulomatous D. Enzymatic fat necrosis from calcium soap
inflammation formation in adipose cells
Correct Answer: A
Rationale: The intense neutrophilic infiltrate in gouty arthritis releases lysosomal enzymes that digest the
surrounding tissue, producing a liquefactive pattern of necrosis. Fat necrosis occurs specifically in the context
of acute pancreatitis, where pancreatic lipase acts on peripancreatic fat, and has no relation to urate crystal
deposition.
2
, Question 5 of 50
A pathologist examines a lung specimen from a patient who died of disseminated tuberculosis and observes soft,
cheese-like granulomatous lesions. Which type of necrosis is most characteristic of this finding?
A. Liquefactive necrosis with complete dissolution of B. Coagulative necrosis maintaining the original
tissue architecture tissue outlines
C. Caseous necrosis appearing as an amorphous, D. Gangrenous necrosis involving both coagulative
granular debris field and liquefactive patterns
Correct Answer: C
Rationale: Caseous necrosis is the hallmark of granulomatous inflammation caused by Mycobacterium
tuberculosis, appearing as a soft, cheese-like amorphous debris that lacks the preserved cellular outlines seen in
coagulative necrosis. Coagulative necrosis is typical of ischemic injury in solid organs such as the heart and
kidneys, where tissue architecture is maintained despite cell death.
Question 6 of 50
A 67-year-old woman with poorly controlled diabetes mellitus develops a non-healing wound on her right foot.
Examination reveals the tissue is black, dry, and shriveled. Which of the following best describes the
pathogenesis of this type of tissue death?
A. Liquefactive necrosis from bacterial protease B. Dry gangrene resulting from arterial insufficiency
activity overwhelming host defenses with superimposed coagulative necrosis
C. Wet gangrene caused by venous congestion and D. Caseous necrosis driven by a cell-mediated
anaerobic bacterial infection immune response to tissue antigens
Correct Answer: B
Rationale: Dry gangrene develops when arterial blood flow is severely compromised, as commonly occurs in
diabetic vascular disease, leading to coagulative necrosis that desiccates the tissue into a dry, black
appearance. Wet gangrene involves venous congestion and superimposed bacterial infection producing
liquefactive necrosis, which is not the pattern seen in this dry, shriveled wound.
Question 7 of 50
During a routine well-child examination, a pediatrician notes that thymic involution is occurring in a healthy 14-
year-old girl. Which of the following best explains the physiologic mechanism driving this process?
A. Ischemic injury from reduced thymic arterial blood B. Programmed cell death mediated by caspase
supply with aging activation without inflammation
C. Necrotic cell death caused by accumulated toxic D. Autoimmune destruction of thymic epithelial cells
metabolites in the gland by cytotoxic T lymphocytes
Correct Answer: B
Rationale: Apoptosis is a form of programmed cell death characterized by cell shrinkage, chromatin
condensation, caspase activation, and formation of apoptotic bodies that are phagocytosed without eliciting an
inflammatory response. Necrosis, in contrast, involves cellular swelling and membrane rupture that releases
intracellular contents, triggering inflammation in the surrounding tissue.
3
