SCI 225 Pathophysiology — Midterm Exam — Nightingale College 2026/2027
SCI 225 PATHOPHYSIOLOGY — MIDTERM EXAM
Nightingale College, 2026/2027
OFFICIAL PRACTICE EXAM
Name: ____________________ Date: ____________________ Score: _______ / 50
Total Questions: 50 | Time: 120 minutes | Passing Score: 80% (40/50)
Instructions: Choose the single best answer unless otherwise indicated. (SATA = Select All That Apply)
EXAM SECTIONS
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%)
Section Topic Questions Points
1 Cellular Injury, Q1–Q10 10
Adaptation &
Inflammation
2 Genetics, Immunity & Q11–Q23 13
Immune Disorders
3 Fluid, Electrolyte & Q24–Q33 10
Acid-Base Balance
4 Cardiovascular, Q34–Q43 10
Respiratory & Renal
Pathophysiology
5 Neoplasia, Endocrine Q44–Q50 7
Disorders & NGN-Style
Case Analysis
TOTAL 50 50
SECTION 1: CELLULAR INJURY, ADAPTATION & INFLAMMATION Q1 – Q10
1
, SCI 225 Pathophysiology — Midterm Exam — Nightingale College 2026/2027
Question 1 of 50
A 58-year-old man with a history of coronary artery disease presents to the emergency department with crushing
substernal chest pain that began 40 minutes ago. An ECG reveals ST-segment elevation in leads V1 through V4.
A cardiac biopsy taken during catheterization would most likely show which of the following early cellular
changes in the affected myocardium?
A. Cellular swelling with dilation of the endoplasmic reticulum and blebbing of the plasma membrane
B. Karyorrhexis with eosinophilic cytoplasm and nuclear fragmentation
C. Coagulative necrosis with preserved cell outlines and loss of nuclei
D. Apoptotic bodies containing intact organelles surrounded by intact membranes
Question 2 of 50
A 45-year-old woman who has been a heavy smoker for 25 years undergoes bronchoscopy for a persistent cough.
Biopsy of the bronchial epithelium shows columnar ciliated cells being replaced by stratified squamous
epithelium. Which of the following best describes this cellular adaptation?
A. Hyperplasia due to chronic irritation from cigarette B. Metaplasia representing a reversible replacement
smoke of one mature cell type by another
C. Dysplasia characterized by disordered growth with D. Atrophy resulting from reduced trophic stimulation
atypical nuclear features to the respiratory epithelium
Question 3 of 50
A 32-year-old man sustains a deep laceration on his forearm from a rusty nail. Within hours, the wound becomes
red, warm, and edematous. Histamine released from mast cells in this early inflammatory response primarily
causes which of the following vascular changes?
A. Vasoconstriction of arterioles to limit blood loss at the injury site
B. Thrombosis of capillary beds to prevent bacterial dissemination from the wound
C. Increased vascular permeability leading to leakage of protein-rich fluid into the interstitium
D. Increased synthesis of prostaglandins that attract neutrophils to the injury site
Question 4 of 50
A 65-year-old woman with long-standing diabetes mellitus presents with a non-healing ulcer on her left foot. A
biopsy of the ulcer edge shows tissue with a cheesy, white appearance and microscopic examination reveals
necrotic debris surrounded by a granulomatous inflammatory response with epithelioid macrophages and
Langhans giant cells. Which type of necrosis is most consistent with these findings?
A. Liquefactive necrosis from bacterial enzymatic B. Coagulative necrosis from ischemic injury to the
digestion of tissue affected tissue
C. Fat necrosis resulting from enzymatic breakdown of D. Caseous necrosis associated with a
adipose tissue granulomatous inflammatory response
2
, SCI 225 Pathophysiology — Midterm Exam — Nightingale College 2026/2027
Question 5 of 50
A 70-year-old man with peripheral arterial disease develops gangrene in several toes of his right foot. The affected
tissue appears dark black and shriveled, and surgical pathology shows coagulative necrosis with superimposed
bacterial decomposition. Which of the following best explains why this patient developed dry gangrene rather
than liquefactive necrosis?
A. Arterial occlusion caused ischemic coagulative necrosis before significant bacterial invasion occurred
B. Venous outflow obstruction led to massive edema and bacterial liquefaction of the tissue
C. An anaerobic bacterial infection produced gas and enzymatic tissue destruction in the toes
D. The immune system mounted a robust neutrophilic response causing liquefactive necrosis
Question 6 of 50
A 28-year-old woman undergoes a routine Papanicolaou smear, and the results show cervical epithelial cells with
abnormal nuclear enlargement, hyperchromasia, and disordered maturation from the basal layer to the surface. A
biopsy confirms these findings. This cellular change is best classified as which of the following?
A. Metaplasia from chronic irritation of the cervical B. Dysplasia featuring atypical nuclear changes and
epithelium loss of normal tissue organization
C. Hyperplasia with an increased number of normal- D. Apoptosis of cervical epithelial cells secondary to
appearing cells HPV infection
Question 7 of 50
A 40-year-old man presents with fever, tachycardia, and a swollen, erythematous right lower leg following a deep
puncture wound sustained three days ago. Laboratory tests reveal an elevated white blood cell count with a left
shift and elevated C-reactive protein. The complement system is activated through the alternative pathway in this
patient. Which of the following is the primary trigger for activation of the alternative complement pathway?
A. Antigen-antibody complex formation on the B. Mannose-binding lectin attaching to bacterial
bacterial cell surface surface carbohydrates
C. Spontaneous hydrolysis of C3 that is stabilized by D. Binding of C1q to the Fc region of IgM or IgG
microbial surface molecules antibodies
Question 8 of 50
A 55-year-old man with a 30-year history of heavy alcohol use presents with abdominal distension and jaundice.
A liver biopsy shows enlargement of hepatocytes with accumulation of lipid droplets, Mallory bodies, and mild
fibrosis around the central veins. If this patient abstains from alcohol, which of the following cellular changes is
most likely reversible in his liver?
A. Fibrosis around the central veins and portal tracts of B. Bile duct proliferation and bridging fibrosis between
the liver portal areas
C. Mallory body formation within the cytoplasm of D. Hepatocellular fatty change with steatosis and
hepatocytes cellular enlargement
3
SCI 225 PATHOPHYSIOLOGY — MIDTERM EXAM
Nightingale College, 2026/2027
OFFICIAL PRACTICE EXAM
Name: ____________________ Date: ____________________ Score: _______ / 50
Total Questions: 50 | Time: 120 minutes | Passing Score: 80% (40/50)
Instructions: Choose the single best answer unless otherwise indicated. (SATA = Select All That Apply)
EXAM SECTIONS
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%)
Section Topic Questions Points
1 Cellular Injury, Q1–Q10 10
Adaptation &
Inflammation
2 Genetics, Immunity & Q11–Q23 13
Immune Disorders
3 Fluid, Electrolyte & Q24–Q33 10
Acid-Base Balance
4 Cardiovascular, Q34–Q43 10
Respiratory & Renal
Pathophysiology
5 Neoplasia, Endocrine Q44–Q50 7
Disorders & NGN-Style
Case Analysis
TOTAL 50 50
SECTION 1: CELLULAR INJURY, ADAPTATION & INFLAMMATION Q1 – Q10
1
, SCI 225 Pathophysiology — Midterm Exam — Nightingale College 2026/2027
Question 1 of 50
A 58-year-old man with a history of coronary artery disease presents to the emergency department with crushing
substernal chest pain that began 40 minutes ago. An ECG reveals ST-segment elevation in leads V1 through V4.
A cardiac biopsy taken during catheterization would most likely show which of the following early cellular
changes in the affected myocardium?
A. Cellular swelling with dilation of the endoplasmic reticulum and blebbing of the plasma membrane
B. Karyorrhexis with eosinophilic cytoplasm and nuclear fragmentation
C. Coagulative necrosis with preserved cell outlines and loss of nuclei
D. Apoptotic bodies containing intact organelles surrounded by intact membranes
Question 2 of 50
A 45-year-old woman who has been a heavy smoker for 25 years undergoes bronchoscopy for a persistent cough.
Biopsy of the bronchial epithelium shows columnar ciliated cells being replaced by stratified squamous
epithelium. Which of the following best describes this cellular adaptation?
A. Hyperplasia due to chronic irritation from cigarette B. Metaplasia representing a reversible replacement
smoke of one mature cell type by another
C. Dysplasia characterized by disordered growth with D. Atrophy resulting from reduced trophic stimulation
atypical nuclear features to the respiratory epithelium
Question 3 of 50
A 32-year-old man sustains a deep laceration on his forearm from a rusty nail. Within hours, the wound becomes
red, warm, and edematous. Histamine released from mast cells in this early inflammatory response primarily
causes which of the following vascular changes?
A. Vasoconstriction of arterioles to limit blood loss at the injury site
B. Thrombosis of capillary beds to prevent bacterial dissemination from the wound
C. Increased vascular permeability leading to leakage of protein-rich fluid into the interstitium
D. Increased synthesis of prostaglandins that attract neutrophils to the injury site
Question 4 of 50
A 65-year-old woman with long-standing diabetes mellitus presents with a non-healing ulcer on her left foot. A
biopsy of the ulcer edge shows tissue with a cheesy, white appearance and microscopic examination reveals
necrotic debris surrounded by a granulomatous inflammatory response with epithelioid macrophages and
Langhans giant cells. Which type of necrosis is most consistent with these findings?
A. Liquefactive necrosis from bacterial enzymatic B. Coagulative necrosis from ischemic injury to the
digestion of tissue affected tissue
C. Fat necrosis resulting from enzymatic breakdown of D. Caseous necrosis associated with a
adipose tissue granulomatous inflammatory response
2
, SCI 225 Pathophysiology — Midterm Exam — Nightingale College 2026/2027
Question 5 of 50
A 70-year-old man with peripheral arterial disease develops gangrene in several toes of his right foot. The affected
tissue appears dark black and shriveled, and surgical pathology shows coagulative necrosis with superimposed
bacterial decomposition. Which of the following best explains why this patient developed dry gangrene rather
than liquefactive necrosis?
A. Arterial occlusion caused ischemic coagulative necrosis before significant bacterial invasion occurred
B. Venous outflow obstruction led to massive edema and bacterial liquefaction of the tissue
C. An anaerobic bacterial infection produced gas and enzymatic tissue destruction in the toes
D. The immune system mounted a robust neutrophilic response causing liquefactive necrosis
Question 6 of 50
A 28-year-old woman undergoes a routine Papanicolaou smear, and the results show cervical epithelial cells with
abnormal nuclear enlargement, hyperchromasia, and disordered maturation from the basal layer to the surface. A
biopsy confirms these findings. This cellular change is best classified as which of the following?
A. Metaplasia from chronic irritation of the cervical B. Dysplasia featuring atypical nuclear changes and
epithelium loss of normal tissue organization
C. Hyperplasia with an increased number of normal- D. Apoptosis of cervical epithelial cells secondary to
appearing cells HPV infection
Question 7 of 50
A 40-year-old man presents with fever, tachycardia, and a swollen, erythematous right lower leg following a deep
puncture wound sustained three days ago. Laboratory tests reveal an elevated white blood cell count with a left
shift and elevated C-reactive protein. The complement system is activated through the alternative pathway in this
patient. Which of the following is the primary trigger for activation of the alternative complement pathway?
A. Antigen-antibody complex formation on the B. Mannose-binding lectin attaching to bacterial
bacterial cell surface surface carbohydrates
C. Spontaneous hydrolysis of C3 that is stabilized by D. Binding of C1q to the Fc region of IgM or IgG
microbial surface molecules antibodies
Question 8 of 50
A 55-year-old man with a 30-year history of heavy alcohol use presents with abdominal distension and jaundice.
A liver biopsy shows enlargement of hepatocytes with accumulation of lipid droplets, Mallory bodies, and mild
fibrosis around the central veins. If this patient abstains from alcohol, which of the following cellular changes is
most likely reversible in his liver?
A. Fibrosis around the central veins and portal tracts of B. Bile duct proliferation and bridging fibrosis between
the liver portal areas
C. Mallory body formation within the cytoplasm of D. Hepatocellular fatty change with steatosis and
hepatocytes cellular enlargement
3
