SCI 225 Pathophysiology — Midterm Exam (Nightingale College, 2026/2027)
SCI 225 PATHOPHYSIOLOGY
MIDTERM EXAM (Nightingale College, 2026/2027)
OFFICIAL PRACTICE EXAM 2026/2027
Total Questions: 50 | Time: 120 min | Pass: 80% (40/50)
Name: ____________________ Date: ____________________ Score: _______ / 50
TABLE OF CONTENTS
Section 1 | CELLULAR INJURY, ADAPTATION & INFLAMMATION | Q1 – Q10 (20%)
Section 2 | GENETICS, IMMUNITY & IMMUNE DISORDERS | Q11 – Q23 (25%)
Section 3 | FLUID, ELECTROLYTE & ACID-BASE BALANCE | Q24 – Q33 (20%)
Section 4 | CARDIOVASCULAR, RESPIRATORY & RENAL PATHOPHYSIOLOGY | Q34 – Q43
(20%)
Section 5 | NEOPLASIA, ENDOCRINE DISORDERS & NGN-STYLE CASE ANALYSIS | Q44 – Q50
(15%)
Instructions: Choose the single best answer unless indicated otherwise (SATA). Passing score: 40/50 (80%) in 120
minutes.
SECTION 1: CELLULAR INJURY, ADAPTATION & INFLAMMATION
Q1 – Q10
Question 1 of 50
A 58-year-old man presents with crushing substernal chest pain. Coronary angiography reveals complete
occlusion of the left anterior descending artery. Laboratory analysis of the affected myocardial tissue would most
likely demonstrate which of the following as the earliest intracellular change from the ischemia?
A. Nuclear pyknosis and karyorrhexis
B. Cellular swelling from sodium-potassium pump failure ✓ CORRECT
C. Calcium deposition in the mitochondrial matrix
D. Release of intracellular lysosomal enzymes into the cytosol
Correct Answer: B
Rationale: In reversible cell injury caused by ischemia, the earliest change is the failure of ATP-dependent sodium-
potassium pumps, leading to intracellular accumulation of sodium and water and resulting in cellular swelling and
1
, SCI 225 Pathophysiology — Midterm Exam (Nightingale College, 2026/2027)
endoplasmic reticulum dilation. Nuclear pyknosis and lysosomal enzyme release occur later in irreversible injury,
while mitochondrial calcium deposition is a feature of necrosis, not the initial reversible stage. Recognizing that ATP
depletion precedes all structural damage is a high-yield exam concept.
Question 2 of 50
A 45-year-old woman with a long-standing history of poorly controlled hypertension is found to have an enlarged
left ventricle on echocardiography, with a wall thickness of 16 mm. The myocardial cells have increased in size
but not in number. Which of the following best describes this adaptive response?
A. Metaplastic transformation of cardiac tissue
B. Hyperplasia of ventricular myocytes
C. Dysplastic changes from chronic injury
D. Hypertrophy secondary to increased mechanical load ✓ CORRECT
Correct Answer: D
Rationale: Hypertrophy is an adaptive increase in cell size, not number, in response to increased mechanical workload
such as chronic hypertension forcing the left ventricle to pump against elevated systemic vascular resistance.
Hyperplasia involves an increase in cell number and is uncommon in permanent cardiac myocytes, while metaplasia is
a change from one mature cell type to another and dysplasia refers to disordered cellular growth with malignant
potential.
Question 3 of 50
A 32-year-old man with a history of intravenous drug use develops a high fever and rapidly progressive
neurological decline. A brain MRI reveals a well-circumscribed lesion in the right frontal lobe with central
liquefaction surrounded by a thin capsule. A biopsy of the lesion would most likely demonstrate which type of
necrosis?
A. Liquefactive necrosis with complete enzymatic dissolution of tissue ✓ CORRECT
B. Coagulative necrosis with preserved cellular outlines
C. Caseous necrosis with a granulomatous inflammatory response
D. Fat necrosis with saponification of adipose tissue
Correct Answer: A
Rationale: Liquefactive necrosis characterizes brain abscesses because the CNS has limited capacity for coagulative
necrosis due to its high lipid content and lack of supporting connective tissue; the intense neutrophilic infiltration
releases hydrolytic enzymes that completely dissolve the tissue into a liquid. Coagulative necrosis preserves cellular
outlines and is typical of myocardial infarction, while caseous necrosis is classically associated with tuberculosis and
fat necrosis with pancreatic injury.
2
, SCI 225 Pathophysiology — Midterm Exam (Nightingale College, 2026/2027)
Question 4 of 50
A 22-year-old graduate student is found to have T-lymphocytes undergoing programmed cell death in the thymus
as part of normal immune development. Which of the following most accurately distinguishes this process from
necrotic cell death?
A. Cell swelling and loss of membrane integrity
B. Infiltration of neutrophils and release of cellular contents into the extracellular space
C. Cell shrinkage, chromatin condensation, and formation of apoptotic bodies without inflammation ✓
CORRECT
D. Release of intracellular enzymes that damage surrounding healthy tissue
Correct Answer: C
Rationale: Apoptosis is a highly regulated, energy-dependent form of programmed cell death characterized by cell
shrinkage, chromatin condensation, membrane blebbing, and formation of apoptotic bodies that are rapidly
phagocytosed by macrophages without triggering an inflammatory response. Necrosis, in contrast, involves cell
swelling, loss of membrane integrity, and the release of intracellular contents that generate significant local
inflammation and tissue damage.
Question 5 of 50
A 28-year-old woman sustains a laceration to her forearm. Within minutes, the area around the wound becomes
red, warm, and edematous. Which of the following mediators is most directly responsible for the initial increase in
vascular permeability and vasodilation observed during this acute inflammatory response?
A. Prostaglandin E2 from activated platelets
B. Tumor necrosis factor-alpha from tissue macrophages
C. Bradykinin generated by the complement cascade
D. Histamine released from mast cells in the perivascular tissue ✓ CORRECT
Correct Answer: D
Rationale: Histamine is the primary mediator responsible for the immediate transient increase in vascular permeability
and vasodilation during the early phases of acute inflammation; it is stored in granules of mast cells and basophils and
is released rapidly upon tissue injury, causing endothelial cell contraction and widening of interendothelial gaps.
Prostaglandins amplify vasodilation and sensitize nociceptors but are not the initial mediator, while bradykinin and
TNF-alpha act later in the inflammatory cascade.
Question 6 of 50
A hospitalized patient develops a Streptococcus pneumoniae infection. Laboratory tests reveal elevated C3a and
C5a levels, and the patient exhibits increased vascular permeability and neutrophil chemotaxis at the site of
infection. Through which pathway was the complement system most likely activated in this patient?
3
SCI 225 PATHOPHYSIOLOGY
MIDTERM EXAM (Nightingale College, 2026/2027)
OFFICIAL PRACTICE EXAM 2026/2027
Total Questions: 50 | Time: 120 min | Pass: 80% (40/50)
Name: ____________________ Date: ____________________ Score: _______ / 50
TABLE OF CONTENTS
Section 1 | CELLULAR INJURY, ADAPTATION & INFLAMMATION | Q1 – Q10 (20%)
Section 2 | GENETICS, IMMUNITY & IMMUNE DISORDERS | Q11 – Q23 (25%)
Section 3 | FLUID, ELECTROLYTE & ACID-BASE BALANCE | Q24 – Q33 (20%)
Section 4 | CARDIOVASCULAR, RESPIRATORY & RENAL PATHOPHYSIOLOGY | Q34 – Q43
(20%)
Section 5 | NEOPLASIA, ENDOCRINE DISORDERS & NGN-STYLE CASE ANALYSIS | Q44 – Q50
(15%)
Instructions: Choose the single best answer unless indicated otherwise (SATA). Passing score: 40/50 (80%) in 120
minutes.
SECTION 1: CELLULAR INJURY, ADAPTATION & INFLAMMATION
Q1 – Q10
Question 1 of 50
A 58-year-old man presents with crushing substernal chest pain. Coronary angiography reveals complete
occlusion of the left anterior descending artery. Laboratory analysis of the affected myocardial tissue would most
likely demonstrate which of the following as the earliest intracellular change from the ischemia?
A. Nuclear pyknosis and karyorrhexis
B. Cellular swelling from sodium-potassium pump failure ✓ CORRECT
C. Calcium deposition in the mitochondrial matrix
D. Release of intracellular lysosomal enzymes into the cytosol
Correct Answer: B
Rationale: In reversible cell injury caused by ischemia, the earliest change is the failure of ATP-dependent sodium-
potassium pumps, leading to intracellular accumulation of sodium and water and resulting in cellular swelling and
1
, SCI 225 Pathophysiology — Midterm Exam (Nightingale College, 2026/2027)
endoplasmic reticulum dilation. Nuclear pyknosis and lysosomal enzyme release occur later in irreversible injury,
while mitochondrial calcium deposition is a feature of necrosis, not the initial reversible stage. Recognizing that ATP
depletion precedes all structural damage is a high-yield exam concept.
Question 2 of 50
A 45-year-old woman with a long-standing history of poorly controlled hypertension is found to have an enlarged
left ventricle on echocardiography, with a wall thickness of 16 mm. The myocardial cells have increased in size
but not in number. Which of the following best describes this adaptive response?
A. Metaplastic transformation of cardiac tissue
B. Hyperplasia of ventricular myocytes
C. Dysplastic changes from chronic injury
D. Hypertrophy secondary to increased mechanical load ✓ CORRECT
Correct Answer: D
Rationale: Hypertrophy is an adaptive increase in cell size, not number, in response to increased mechanical workload
such as chronic hypertension forcing the left ventricle to pump against elevated systemic vascular resistance.
Hyperplasia involves an increase in cell number and is uncommon in permanent cardiac myocytes, while metaplasia is
a change from one mature cell type to another and dysplasia refers to disordered cellular growth with malignant
potential.
Question 3 of 50
A 32-year-old man with a history of intravenous drug use develops a high fever and rapidly progressive
neurological decline. A brain MRI reveals a well-circumscribed lesion in the right frontal lobe with central
liquefaction surrounded by a thin capsule. A biopsy of the lesion would most likely demonstrate which type of
necrosis?
A. Liquefactive necrosis with complete enzymatic dissolution of tissue ✓ CORRECT
B. Coagulative necrosis with preserved cellular outlines
C. Caseous necrosis with a granulomatous inflammatory response
D. Fat necrosis with saponification of adipose tissue
Correct Answer: A
Rationale: Liquefactive necrosis characterizes brain abscesses because the CNS has limited capacity for coagulative
necrosis due to its high lipid content and lack of supporting connective tissue; the intense neutrophilic infiltration
releases hydrolytic enzymes that completely dissolve the tissue into a liquid. Coagulative necrosis preserves cellular
outlines and is typical of myocardial infarction, while caseous necrosis is classically associated with tuberculosis and
fat necrosis with pancreatic injury.
2
, SCI 225 Pathophysiology — Midterm Exam (Nightingale College, 2026/2027)
Question 4 of 50
A 22-year-old graduate student is found to have T-lymphocytes undergoing programmed cell death in the thymus
as part of normal immune development. Which of the following most accurately distinguishes this process from
necrotic cell death?
A. Cell swelling and loss of membrane integrity
B. Infiltration of neutrophils and release of cellular contents into the extracellular space
C. Cell shrinkage, chromatin condensation, and formation of apoptotic bodies without inflammation ✓
CORRECT
D. Release of intracellular enzymes that damage surrounding healthy tissue
Correct Answer: C
Rationale: Apoptosis is a highly regulated, energy-dependent form of programmed cell death characterized by cell
shrinkage, chromatin condensation, membrane blebbing, and formation of apoptotic bodies that are rapidly
phagocytosed by macrophages without triggering an inflammatory response. Necrosis, in contrast, involves cell
swelling, loss of membrane integrity, and the release of intracellular contents that generate significant local
inflammation and tissue damage.
Question 5 of 50
A 28-year-old woman sustains a laceration to her forearm. Within minutes, the area around the wound becomes
red, warm, and edematous. Which of the following mediators is most directly responsible for the initial increase in
vascular permeability and vasodilation observed during this acute inflammatory response?
A. Prostaglandin E2 from activated platelets
B. Tumor necrosis factor-alpha from tissue macrophages
C. Bradykinin generated by the complement cascade
D. Histamine released from mast cells in the perivascular tissue ✓ CORRECT
Correct Answer: D
Rationale: Histamine is the primary mediator responsible for the immediate transient increase in vascular permeability
and vasodilation during the early phases of acute inflammation; it is stored in granules of mast cells and basophils and
is released rapidly upon tissue injury, causing endothelial cell contraction and widening of interendothelial gaps.
Prostaglandins amplify vasodilation and sensitize nociceptors but are not the initial mediator, while bradykinin and
TNF-alpha act later in the inflammatory cascade.
Question 6 of 50
A hospitalized patient develops a Streptococcus pneumoniae infection. Laboratory tests reveal elevated C3a and
C5a levels, and the patient exhibits increased vascular permeability and neutrophil chemotaxis at the site of
infection. Through which pathway was the complement system most likely activated in this patient?
3
