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NR 507 – Advanced Pathophysiology (Chamberlain
University, 2026/2027) – Midterm Exam Review with
Verified Questions & Answers (Grade A)
SECTION 1: CELLULAR ADAPTATION, INJURY & NEOPLASIA (Questions 1–20)
1. A 55-year-old male with chronic hypertension presents with an enlarged heart. This increase in
cardiac muscle mass is primarily due to which cellular adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot divide. They respond to
increased workload (afterload) from chronic hypertension by increasing in size (hypertrophy) rather
than number (hyperplasia). This is a physiologic adaptation that can become pathologic if sustained .
2. A patient with chronic GERD develops Barrett esophagus, where normal squamous epithelium is
replaced by columnar epithelium. This process is known as:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Hyperplasia
Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
typically in response to chronic irritation. While initially protective, Barrett esophagus increases the
risk for dysplasia and esophageal adenocarcinoma .
3. Which of the following is a characteristic feature of apoptosis?
A) Cellular swelling and membrane rupture
B) Triggers an inflammatory response
C) Involves organized cell shrinkage and fragmentation
D) Results from ATP depletion
Answer: C) Involves organized cell shrinkage and fragmentation
Rationale: Apoptosis is a highly regulated, energy-dependent process of programmed cell death
essential for normal development and tissue homeostasis. Unlike necrosis, it does NOT cause
inflammation. Necrosis is characterized by cellular swelling, membrane rupture, and inflammation .
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4. Which of the following is the primary mechanism of cellular injury in a patient with a myocardial
infarction?
A) Accumulation of calcium
B) Hypoxic injury due to ischemia
C) Free radical formation
D) Chemical toxicity
Answer: B) Hypoxic injury due to ischemia
Rationale: Ischemia leads to lack of oxygen (hypoxia), halting ATP production. This causes the
sodium-potassium pump to fail, resulting in cellular swelling and death. This is the fundamental
mechanism of injury in MI .
5. Which type of necrosis is most characteristic of a myocardial infarction?
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B) Coagulative necrosis
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs such as the heart,
kidney, and liver. The cellular architecture is preserved for several days due to protein denaturation .
6. Which type of necrosis is most common in the brain following ischemia?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Gangrenous necrosis
Answer: B) Liquefactive necrosis
Rationale: Brain tissue liquefies due to enzymatic digestion during ischemic injury, characteristic of
liquefactive necrosis. This results in the formation of cystic spaces filled with fluid and cellular
debris .
7. Caseous necrosis is characteristic of which condition?
A) Tuberculosis
B) Myocardial infarction
C) Pancreatitis
D) Gangrene
Answer: A) Tuberculosis
Rationale: Caseous necrosis (cheese-like appearance) is characteristic of tuberculosis, representing a
combination of coagulative and liquefactive necrosis with granulomatous inflammation .
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8. Necrosis is distinguished from apoptosis by the presence of:
A) Cellular swelling only
B) Membrane rupture only
C) Inflammatory response only
D) All of the above
Answer: D) All of the above
Rationale: Necrosis is characterized by cellular swelling, membrane rupture, leakage of cellular
contents, and an inflammatory response. Apoptosis is orderly, does not cause inflammation, and is a
normal physiologic process .
9. Which of the following is a characteristic of malignant tumors?
A) Well-differentiated cells resembling tissue of origin
B) Encapsulated growth without invasion
C) Slow growth and localized spread
D) Invasion and metastasis
Answer: D) Invasion and metastasis
Rationale: Malignant tumors are characterized by invasion of surrounding tissues and metastasis to
distant sites. They typically have poorly differentiated cells, rapid growth, and are not encapsulated.
Benign tumors are well-differentiated, encapsulated, and do not metastasize .
10. The "two-hit hypothesis" applies to which gene type?
A) Proto-oncogenes
B) Tumor suppressor genes
C) Oncogenes
D) DNA repair genes
Answer: B) Tumor suppressor genes
Rationale: The two-hit hypothesis applies to tumor suppressor genes, where both alleles must be
inactivated (e.g., Rb, p53) for loss of function and cancer development. This contrasts with
oncogenes, where only one allele needs to be activated .
11. Anaplasia in malignant tumors refers to:
A) Well-differentiated cells resembling tissue of origin
B) Lack of differentiation and loss of cellular characteristics
C) Encapsulated growth without invasion
D) Slow growth and localized spread
Answer: B) Lack of differentiation and loss of cellular characteristics
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Rationale: Anaplasia is the hallmark of malignancy, characterized by a lack of differentiation, loss of
cellular characteristics, pleomorphism, and atypical mitoses .
12. Which of the following is a benign tumor characteristic?
A) Rapid growth rate
B) Poorly differentiated cells
C) Well-differentiated, resembles tissue of origin
D) Metastasis to distant sites
Answer: C) Well-differentiated, resembles tissue of origin
Rationale: Benign tumors are well-differentiated, resemble their tissue of origin, grow slowly, and
do not metastasize. Malignant tumors are poorly differentiated, grow rapidly, invade tissues, and
metastasize .
13. Which organelle is primarily responsible for energy production in cells?
A) Nucleus
B) Golgi apparatus
C) Mitochondrion
D) Endoplasmic reticulum
Answer: C) Mitochondrion
Rationale: Mitochondria generate ATP through oxidative phosphorylation, providing energy for
cellular functions. This makes them the "powerhouses" of the cell .
14. The earliest reversible morphologic sign of cell injury is:
A) Nuclear pyknosis
B) Cellular swelling (hydropic change)
C) Fatty change
D) Apoptotic bodies
Answer: B) Cellular swelling (hydropic change)
Rationale: Cellular swelling is the earliest reversible morphologic sign of cell injury. It occurs due to
ATP depletion leading to Na+/K+ pump failure, causing accumulation of intracellular sodium and
water .
15. Which protein is most directly responsible for apoptosis execution?
A) Cytochrome C
B) Caspases
C) Bcl-2
D) p53
NR 507 – Advanced Pathophysiology (Chamberlain
University, 2026/2027) – Midterm Exam Review with
Verified Questions & Answers (Grade A)
SECTION 1: CELLULAR ADAPTATION, INJURY & NEOPLASIA (Questions 1–20)
1. A 55-year-old male with chronic hypertension presents with an enlarged heart. This increase in
cardiac muscle mass is primarily due to which cellular adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot divide. They respond to
increased workload (afterload) from chronic hypertension by increasing in size (hypertrophy) rather
than number (hyperplasia). This is a physiologic adaptation that can become pathologic if sustained .
2. A patient with chronic GERD develops Barrett esophagus, where normal squamous epithelium is
replaced by columnar epithelium. This process is known as:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Hyperplasia
Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another,
typically in response to chronic irritation. While initially protective, Barrett esophagus increases the
risk for dysplasia and esophageal adenocarcinoma .
3. Which of the following is a characteristic feature of apoptosis?
A) Cellular swelling and membrane rupture
B) Triggers an inflammatory response
C) Involves organized cell shrinkage and fragmentation
D) Results from ATP depletion
Answer: C) Involves organized cell shrinkage and fragmentation
Rationale: Apoptosis is a highly regulated, energy-dependent process of programmed cell death
essential for normal development and tissue homeostasis. Unlike necrosis, it does NOT cause
inflammation. Necrosis is characterized by cellular swelling, membrane rupture, and inflammation .
,2
4. Which of the following is the primary mechanism of cellular injury in a patient with a myocardial
infarction?
A) Accumulation of calcium
B) Hypoxic injury due to ischemia
C) Free radical formation
D) Chemical toxicity
Answer: B) Hypoxic injury due to ischemia
Rationale: Ischemia leads to lack of oxygen (hypoxia), halting ATP production. This causes the
sodium-potassium pump to fail, resulting in cellular swelling and death. This is the fundamental
mechanism of injury in MI .
5. Which type of necrosis is most characteristic of a myocardial infarction?
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
Answer: B) Coagulative necrosis
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs such as the heart,
kidney, and liver. The cellular architecture is preserved for several days due to protein denaturation .
6. Which type of necrosis is most common in the brain following ischemia?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Gangrenous necrosis
Answer: B) Liquefactive necrosis
Rationale: Brain tissue liquefies due to enzymatic digestion during ischemic injury, characteristic of
liquefactive necrosis. This results in the formation of cystic spaces filled with fluid and cellular
debris .
7. Caseous necrosis is characteristic of which condition?
A) Tuberculosis
B) Myocardial infarction
C) Pancreatitis
D) Gangrene
Answer: A) Tuberculosis
Rationale: Caseous necrosis (cheese-like appearance) is characteristic of tuberculosis, representing a
combination of coagulative and liquefactive necrosis with granulomatous inflammation .
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8. Necrosis is distinguished from apoptosis by the presence of:
A) Cellular swelling only
B) Membrane rupture only
C) Inflammatory response only
D) All of the above
Answer: D) All of the above
Rationale: Necrosis is characterized by cellular swelling, membrane rupture, leakage of cellular
contents, and an inflammatory response. Apoptosis is orderly, does not cause inflammation, and is a
normal physiologic process .
9. Which of the following is a characteristic of malignant tumors?
A) Well-differentiated cells resembling tissue of origin
B) Encapsulated growth without invasion
C) Slow growth and localized spread
D) Invasion and metastasis
Answer: D) Invasion and metastasis
Rationale: Malignant tumors are characterized by invasion of surrounding tissues and metastasis to
distant sites. They typically have poorly differentiated cells, rapid growth, and are not encapsulated.
Benign tumors are well-differentiated, encapsulated, and do not metastasize .
10. The "two-hit hypothesis" applies to which gene type?
A) Proto-oncogenes
B) Tumor suppressor genes
C) Oncogenes
D) DNA repair genes
Answer: B) Tumor suppressor genes
Rationale: The two-hit hypothesis applies to tumor suppressor genes, where both alleles must be
inactivated (e.g., Rb, p53) for loss of function and cancer development. This contrasts with
oncogenes, where only one allele needs to be activated .
11. Anaplasia in malignant tumors refers to:
A) Well-differentiated cells resembling tissue of origin
B) Lack of differentiation and loss of cellular characteristics
C) Encapsulated growth without invasion
D) Slow growth and localized spread
Answer: B) Lack of differentiation and loss of cellular characteristics
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Rationale: Anaplasia is the hallmark of malignancy, characterized by a lack of differentiation, loss of
cellular characteristics, pleomorphism, and atypical mitoses .
12. Which of the following is a benign tumor characteristic?
A) Rapid growth rate
B) Poorly differentiated cells
C) Well-differentiated, resembles tissue of origin
D) Metastasis to distant sites
Answer: C) Well-differentiated, resembles tissue of origin
Rationale: Benign tumors are well-differentiated, resemble their tissue of origin, grow slowly, and
do not metastasize. Malignant tumors are poorly differentiated, grow rapidly, invade tissues, and
metastasize .
13. Which organelle is primarily responsible for energy production in cells?
A) Nucleus
B) Golgi apparatus
C) Mitochondrion
D) Endoplasmic reticulum
Answer: C) Mitochondrion
Rationale: Mitochondria generate ATP through oxidative phosphorylation, providing energy for
cellular functions. This makes them the "powerhouses" of the cell .
14. The earliest reversible morphologic sign of cell injury is:
A) Nuclear pyknosis
B) Cellular swelling (hydropic change)
C) Fatty change
D) Apoptotic bodies
Answer: B) Cellular swelling (hydropic change)
Rationale: Cellular swelling is the earliest reversible morphologic sign of cell injury. It occurs due to
ATP depletion leading to Na+/K+ pump failure, causing accumulation of intracellular sodium and
water .
15. Which protein is most directly responsible for apoptosis execution?
A) Cytochrome C
B) Caspases
C) Bcl-2
D) p53
