Page 1 of 126
NSG 5140 Advanced Pathophysiology Midterm Exam Review 2
South College EXAM QUESTIONS AND CORRECT VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR – JUST RELEASED
NSG 5140 Advanced Pathophysiology Midterm Exam Review 2 | South College
EXAM COVERAGE OVERVIEW (10 Key Points)
1. Cellular Biology and Adaptation: Metaplasia is reversible cell replacement; hypertrophy
= increased cell size; hyperplasia = increased cell number; atrophy = decreased cell size
and function .
2. Cellular Injury and Death: Hypoxic injury → ATP depletion → Na⁺/K⁺-ATPase pump
failure → cellular swelling . Necrosis triggers inflammation; apoptosis does not .
3. Fluid, Electrolyte, and Acid-Base Imbalances: Nephrotic syndrome → hypoalbuminemia
→ decreased plasma oncotic pressure → generalized edema .
4. Hyperkalemia & Acid-Base: Hyperkalemia causes peaked T waves . Renal failure causes
impaired K⁺ excretion .
5. Immunity and Hypersensitivity: Type I = IgE-mediated anaphylaxis; Type III = immune
complex deposition (lupus nephritis) .
6. Genetic Disorders: 22q11.2 deletion (DiGeorge syndrome) → truncus arteriosus .
Duodenal atresia → double-bubble sign on X-ray .
7. Cardiovascular Pathophysiology: Atherosclerosis begins with endothelial injury → fatty
streak → plaque . Doxorubicin cardiotoxicity = free radical damage .
8. Pulmonary Pathophysiology: COPD → V/Q mismatch → hypoxemia; advanced disease
→ hypercapnia . PE → high V/Q mismatch .
9. Renal and Urological Pathophysiology: CKD → erythropoietin deficiency → anemia of
chronic disease . Preeclampsia → endothelial dysfunction .
10. Endocrine Pathophysiology: Pheochromocytoma → adrenal medulla tumor →
catecholamines → episodic hypertension . Addison's disease → hypoaldosteronism →
hyponatremia + hyperkalemia .
SECTION 1: CELLULAR BIOLOGY AND ADAPTATION (Questions 1-40)
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1. A 60-year-old man with long-standing hypertension has left ventricular hypertrophy on
echocardiogram. Which cellular adaptation best explains this finding?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in individual cell size due to increased workload, as seen
in myocardial cells responding to chronic pressure overload from hypertension. Cardiac
myocytes are terminally differentiated and cannot undergo hyperplasia .
2. A chronic smoker's bronchial epithelium changes from ciliated columnar to stratified
squamous. This is best described as:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Anaplasia
Answer: B) Metaplasia
Rationale: Metaplasia is a reversible change where one differentiated cell type is replaced by
another more resistant cell type. In smokers, the normal pseudostratified ciliated columnar
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epithelium is replaced by stratified squamous epithelium as a protective adaptation to chronic
irritation .
3. A Pap smear shows disordered epithelial cell growth with variation in size, shape, and
nuclear appearance, but cells have not invaded the basement membrane. This is best
described as:
A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Neoplasia
Answer: B) Dysplasia
Rationale: Dysplasia is characterized by disordered cellular growth with pleomorphism
(variation in size and shape), hyperchromatic nuclei, and loss of normal architectural
organization. It is potentially reversible but may progress to carcinoma in situ .
4. Which cellular adaptation is characterized by a decrease in cell size and function due to
decreased workload or loss of innervation?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Answer: C) Atrophy
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Rationale: Atrophy is a reduction in cell size and function resulting from disuse, denervation,
ischemia, malnutrition, or decreased hormonal stimulation .
5. A 58-year-old male with chronic alcoholism presents with abdominal pain and jaundice.
Hepatocyte swelling with intracellular fat accumulation is noted on biopsy. Which cellular
adaptation is primarily responsible for this finding?
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Steatosis
Answer: D) Steatosis
Rationale: Steatosis (fatty change) is the abnormal accumulation of triglycerides within
hepatocytes, commonly caused by alcohol toxicity. Hyperplasia is increased cell number;
metaplasia is replacement of one cell type with another; hypertrophy is increased cell size
without fat accumulation .
6. What is the primary mechanism of cellular injury in hypoxia?
A) Free radical damage
B) ATP depletion leading to loss of ion homeostasis
C) DNA mutation
D) Lipid peroxidation
Answer: B) ATP depletion leading to loss of ion homeostasis
NSG 5140 Advanced Pathophysiology Midterm Exam Review 2
South College EXAM QUESTIONS AND CORRECT VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR – JUST RELEASED
NSG 5140 Advanced Pathophysiology Midterm Exam Review 2 | South College
EXAM COVERAGE OVERVIEW (10 Key Points)
1. Cellular Biology and Adaptation: Metaplasia is reversible cell replacement; hypertrophy
= increased cell size; hyperplasia = increased cell number; atrophy = decreased cell size
and function .
2. Cellular Injury and Death: Hypoxic injury → ATP depletion → Na⁺/K⁺-ATPase pump
failure → cellular swelling . Necrosis triggers inflammation; apoptosis does not .
3. Fluid, Electrolyte, and Acid-Base Imbalances: Nephrotic syndrome → hypoalbuminemia
→ decreased plasma oncotic pressure → generalized edema .
4. Hyperkalemia & Acid-Base: Hyperkalemia causes peaked T waves . Renal failure causes
impaired K⁺ excretion .
5. Immunity and Hypersensitivity: Type I = IgE-mediated anaphylaxis; Type III = immune
complex deposition (lupus nephritis) .
6. Genetic Disorders: 22q11.2 deletion (DiGeorge syndrome) → truncus arteriosus .
Duodenal atresia → double-bubble sign on X-ray .
7. Cardiovascular Pathophysiology: Atherosclerosis begins with endothelial injury → fatty
streak → plaque . Doxorubicin cardiotoxicity = free radical damage .
8. Pulmonary Pathophysiology: COPD → V/Q mismatch → hypoxemia; advanced disease
→ hypercapnia . PE → high V/Q mismatch .
9. Renal and Urological Pathophysiology: CKD → erythropoietin deficiency → anemia of
chronic disease . Preeclampsia → endothelial dysfunction .
10. Endocrine Pathophysiology: Pheochromocytoma → adrenal medulla tumor →
catecholamines → episodic hypertension . Addison's disease → hypoaldosteronism →
hyponatremia + hyperkalemia .
SECTION 1: CELLULAR BIOLOGY AND ADAPTATION (Questions 1-40)
, Page 2 of 126
1. A 60-year-old man with long-standing hypertension has left ventricular hypertrophy on
echocardiogram. Which cellular adaptation best explains this finding?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in individual cell size due to increased workload, as seen
in myocardial cells responding to chronic pressure overload from hypertension. Cardiac
myocytes are terminally differentiated and cannot undergo hyperplasia .
2. A chronic smoker's bronchial epithelium changes from ciliated columnar to stratified
squamous. This is best described as:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Anaplasia
Answer: B) Metaplasia
Rationale: Metaplasia is a reversible change where one differentiated cell type is replaced by
another more resistant cell type. In smokers, the normal pseudostratified ciliated columnar
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epithelium is replaced by stratified squamous epithelium as a protective adaptation to chronic
irritation .
3. A Pap smear shows disordered epithelial cell growth with variation in size, shape, and
nuclear appearance, but cells have not invaded the basement membrane. This is best
described as:
A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Neoplasia
Answer: B) Dysplasia
Rationale: Dysplasia is characterized by disordered cellular growth with pleomorphism
(variation in size and shape), hyperchromatic nuclei, and loss of normal architectural
organization. It is potentially reversible but may progress to carcinoma in situ .
4. Which cellular adaptation is characterized by a decrease in cell size and function due to
decreased workload or loss of innervation?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Answer: C) Atrophy
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Rationale: Atrophy is a reduction in cell size and function resulting from disuse, denervation,
ischemia, malnutrition, or decreased hormonal stimulation .
5. A 58-year-old male with chronic alcoholism presents with abdominal pain and jaundice.
Hepatocyte swelling with intracellular fat accumulation is noted on biopsy. Which cellular
adaptation is primarily responsible for this finding?
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Steatosis
Answer: D) Steatosis
Rationale: Steatosis (fatty change) is the abnormal accumulation of triglycerides within
hepatocytes, commonly caused by alcohol toxicity. Hyperplasia is increased cell number;
metaplasia is replacement of one cell type with another; hypertrophy is increased cell size
without fat accumulation .
6. What is the primary mechanism of cellular injury in hypoxia?
A) Free radical damage
B) ATP depletion leading to loss of ion homeostasis
C) DNA mutation
D) Lipid peroxidation
Answer: B) ATP depletion leading to loss of ion homeostasis
