SOUTH COLLEGE NSG 5140 Advanced Pathophysiology
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Questions 1–15: Cellular Adaptation, Injury, & Death
Question 1
A 58-year-old male with long-standing Barrett's esophagus exhibits a change from
normal stratified squamous epithelium to non-ciliated column-like cells with goblet
cells in the distal esophagus. Which statement best characterizes this cellular
change?
A) It represents irreversible dysplasia driven by $p53$ gene activation.
B) It is a reversible metaplastic adaptation to chronic gastroesophageal acid
reflux.
C) It is a pathologic hyperplasia induced by elevated systemic gastrin levels.
D) It is an irreversible hypertrophic response of mucosal stem cells.
Correct Answer: B
Rationale: Barrett's esophagus is a classic example of intestinal metaplasia,
where continuous acid exposure causes stem cells of the esophageal epithelium to
reprogram into columnar epithelium with goblet cells (which secrete protective
,mucus). Metaplasia is reversible if the chronic stressor is removed, though
prolonged metaplasia can progress to dysplasia and adenocarcinoma.
Question 2
During ischemia, cellular swelling occurs early in the hypoxic cascade. What is the
primary cause of this water accumulation inside the cytoplasm?
A) Accelerated protein translation causing increased intracellular oncotic
pressure
B) Activation of apoptosis caspases degrading the phospholipid bilayer
C) Depletion of ATP impairing the plasma membrane
$\text{Na}^+/\text{K}^+$-ATPase pump
D) Influx of extracellular calcium displacing cytosolic sodium ions
Correct Answer: C
Rationale: Hypoxia impairs mitochondrial oxidative phosphorylation, leading to
ATP depletion. Without ATP, the energy-dependent $\text{Na}^+/\text{K}^+$-
ATPase pump fails. Sodium accumulates inside the cell, creating an osmotic
gradient that draws water into the cytoplasm (hydropic swelling).
Question 3
A 45-year-old female undergoes a total hysterectomy. Histologic examination of
the uterine smooth muscle reveals a significant increase in cell size and total cell
count driven by estrogen stimulation. Which two cellular processes occurred
concurrently?
A) Metaplasia and Dysplasia
, B) Hypertrophy and Hyperplasia
C) Anaplasia and Atrophy
D) Dysplasia and Hypertrophy
Correct Answer: B
Rationale: Estrogen stimulation during pregnancy or pathological uterine states
induces both hypertrophy (increase in individual smooth muscle cell size) and
hyperplasia (increase in the overall number of smooth muscle cells via mitosis)
because smooth muscle cells retain mitotic potential.
Question 4
A patient suffers an ischemic stroke resulting in a focal lesion in the left cerebral
hemisphere. Autopsy of the brain tissue weeks later reveals a fluid-filled cavity
surrounded by glial cells. Which pattern of necrosis occurred?
A) Coagulative necrosis
B) Caseous necrosis
C) Liquefactive necrosis
D) Fat necrosis
Correct Answer: C
Rationale: Ischemic injury in the central nervous system (CNS) results in
liquefactive necrosis. Brain tissue is rich in hydrolytic enzymes and lipids,
causing rapid enzymatic digestion of cellular structures into a liquid mass, which is
eventually cleared by macrophages leaving a cystic space.
Question 5
, Which morphological feature distinguishes Apoptosis from Necrosis on
microscopic examination?
A) Cellular swelling and early loss of membrane integrity
B) Severe inflammatory infiltrate into surrounding tissue
C) Chromatin condensation (pyknosis) with intact plasma membrane
forming apoptotic bodies
D) Massive enzymatic digestion of extracellular matrix
Correct Answer: C
Rationale: Apoptosis is programmed, controlled cell death characterized by cell
shrinkage, chromatin condensation, and membrane blebbing into apoptotic bodies
that are rapidly phagocytosed without triggering inflammation. In contrast,
necrosis involves cell swelling, membrane rupture, and a significant acute
inflammatory response.
Question 6
Intracellular free calcium overload during severe cell injury causes irreversible
damage primarily through which mechanism?
A) Direct inactivation of ribosomal RNA subunits
B) Premature activation of intracellular enzymes including phospholipases,
endonucleases, and proteases
C) Blockade of voltage-gated potassium channels in the inner mitochondrial
membrane
D) Competitive inhibition of cytosol glucose transport
Correct Answer: B
Made Easy: All Newest Questions Covering All Midterm
Topics|Instant Download Pdf
Questions 1–15: Cellular Adaptation, Injury, & Death
Question 1
A 58-year-old male with long-standing Barrett's esophagus exhibits a change from
normal stratified squamous epithelium to non-ciliated column-like cells with goblet
cells in the distal esophagus. Which statement best characterizes this cellular
change?
A) It represents irreversible dysplasia driven by $p53$ gene activation.
B) It is a reversible metaplastic adaptation to chronic gastroesophageal acid
reflux.
C) It is a pathologic hyperplasia induced by elevated systemic gastrin levels.
D) It is an irreversible hypertrophic response of mucosal stem cells.
Correct Answer: B
Rationale: Barrett's esophagus is a classic example of intestinal metaplasia,
where continuous acid exposure causes stem cells of the esophageal epithelium to
reprogram into columnar epithelium with goblet cells (which secrete protective
,mucus). Metaplasia is reversible if the chronic stressor is removed, though
prolonged metaplasia can progress to dysplasia and adenocarcinoma.
Question 2
During ischemia, cellular swelling occurs early in the hypoxic cascade. What is the
primary cause of this water accumulation inside the cytoplasm?
A) Accelerated protein translation causing increased intracellular oncotic
pressure
B) Activation of apoptosis caspases degrading the phospholipid bilayer
C) Depletion of ATP impairing the plasma membrane
$\text{Na}^+/\text{K}^+$-ATPase pump
D) Influx of extracellular calcium displacing cytosolic sodium ions
Correct Answer: C
Rationale: Hypoxia impairs mitochondrial oxidative phosphorylation, leading to
ATP depletion. Without ATP, the energy-dependent $\text{Na}^+/\text{K}^+$-
ATPase pump fails. Sodium accumulates inside the cell, creating an osmotic
gradient that draws water into the cytoplasm (hydropic swelling).
Question 3
A 45-year-old female undergoes a total hysterectomy. Histologic examination of
the uterine smooth muscle reveals a significant increase in cell size and total cell
count driven by estrogen stimulation. Which two cellular processes occurred
concurrently?
A) Metaplasia and Dysplasia
, B) Hypertrophy and Hyperplasia
C) Anaplasia and Atrophy
D) Dysplasia and Hypertrophy
Correct Answer: B
Rationale: Estrogen stimulation during pregnancy or pathological uterine states
induces both hypertrophy (increase in individual smooth muscle cell size) and
hyperplasia (increase in the overall number of smooth muscle cells via mitosis)
because smooth muscle cells retain mitotic potential.
Question 4
A patient suffers an ischemic stroke resulting in a focal lesion in the left cerebral
hemisphere. Autopsy of the brain tissue weeks later reveals a fluid-filled cavity
surrounded by glial cells. Which pattern of necrosis occurred?
A) Coagulative necrosis
B) Caseous necrosis
C) Liquefactive necrosis
D) Fat necrosis
Correct Answer: C
Rationale: Ischemic injury in the central nervous system (CNS) results in
liquefactive necrosis. Brain tissue is rich in hydrolytic enzymes and lipids,
causing rapid enzymatic digestion of cellular structures into a liquid mass, which is
eventually cleared by macrophages leaving a cystic space.
Question 5
, Which morphological feature distinguishes Apoptosis from Necrosis on
microscopic examination?
A) Cellular swelling and early loss of membrane integrity
B) Severe inflammatory infiltrate into surrounding tissue
C) Chromatin condensation (pyknosis) with intact plasma membrane
forming apoptotic bodies
D) Massive enzymatic digestion of extracellular matrix
Correct Answer: C
Rationale: Apoptosis is programmed, controlled cell death characterized by cell
shrinkage, chromatin condensation, and membrane blebbing into apoptotic bodies
that are rapidly phagocytosed without triggering inflammation. In contrast,
necrosis involves cell swelling, membrane rupture, and a significant acute
inflammatory response.
Question 6
Intracellular free calcium overload during severe cell injury causes irreversible
damage primarily through which mechanism?
A) Direct inactivation of ribosomal RNA subunits
B) Premature activation of intracellular enzymes including phospholipases,
endonucleases, and proteases
C) Blockade of voltage-gated potassium channels in the inner mitochondrial
membrane
D) Competitive inhibition of cytosol glucose transport
Correct Answer: B
