NR507 Final Exam 2026 / NR 507 Week 8
Exam Advanced Pathophysiology
Expected Questions and Answers -
Chamberlain
SECTION 1: CELLULAR ADAPTATION, INJURY, AND NEOPLASIA
Question 1: A 68-year-old male with a history of long-standing hypertension presents
with echocardiographic findings showing thickening of the left ventricular myocardium.
This cellular change is best described as which type of adaptation?
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Rationale: Cardiac myocytes are terminally differentiated cells that cannot undergo
mitosis to increase in number. In response to chronically increased afterload from
hypertension, these cells adapt by increasing in size (hypertrophy) to generate greater
contractile force. This is a compensatory mechanism that increases workload capacity
but can eventually become maladaptive, leading to heart failure. Hyperplasia involves an
increase in cell number and occurs in tissues capable of division. Metaplasia is the
replacement of one mature cell type with another, while dysplasia involves abnormal
cellular organization and is considered premalignant .
,Question 2: A 55-year-old chronic smoker undergoes a bronchoscopy following a
persistent cough. Biopsy reveals that the normal ciliated pseudostratified columnar
epithelium of the airways has been replaced by stratified squamous epithelium. What is
this adaptation called?
A) Anaplasia
B) Atrophy
C) Metaplasia
D) Hyperplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type, often as an adaptive response to chronic irritation such as cigarette
smoke. The stratified squamous epithelium is more resistant to the damaging effects of
smoke but loses the protective mucociliary clearance function of the normal columnar
epithelium. While initially protective, this change increases the risk for malignant
transformation. Anaplasia refers to loss of cellular differentiation characteristic of
malignant tumors .
Question 3: During an autopsy, a pathologist notes an area of brain tissue necrosis that
appears soft, liquefied, and is forming a cystic cavity. What type of necrosis is this?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Rationale: Liquefactive necrosis occurs primarily in the brain and central nervous system
following ischemic injury. The tissue is digested by hydrolytic enzymes from
inflammatory cells, resulting in a soft, liquid mass that eventually forms a cystic cavity.
Coagulative necrosis (most common in myocardial infarction) preserves tissue
architecture for days. Caseous necrosis (associated with tuberculosis) produces a
"cheesy" material, and fat necrosis (associated with acute pancreatitis) results from
enzymatic fat breakdown .
,Question 4: A biopsy from a cervical lesion shows atypical cells that have not breached
the basement membrane. How is this lesion classified?
A) Invasive adenocarcinoma
B) Carcinoma in situ
C) Benign adenoma
D) Metastatic sarcoma
Rationale: Carcinoma in situ (CIS) refers to an early-stage, localized epithelial tumor
that has not broken through the local basement membrane. At this stage, the lesion is
considered preinvasive and has not yet acquired the ability to metastasize. If untreated,
CIS can progress to invasive carcinoma. The term "in situ" indicates that the malignant
cells remain confined to their site of origin. This is distinct from invasive cancer, which
penetrates the basement membrane, and benign tumors, which are well-differentiated
and non-invasive .
Question 5: A patient with chronic alcoholism develops fatty liver. What is the
mechanism of this cellular change?
A) Toxic injury causing intracellular accumulation
B) Ischemic injury
C) Physical injury
D) Infectious injury
Rationale: Alcohol is a hepatotoxin that interferes with mitochondrial fatty acid
oxidation and increases fatty acid synthesis, leading to the accumulation of triglycerides
within hepatocytes (steatosis). This is a reversible form of cellular injury. The fatty
accumulation represents a metabolic disturbance rather than cell death. Toxic injury can
result from various substances including alcohol, drugs, and environmental toxins.
Ischemic injury results from reduced blood flow, physical injury from trauma, and
infectious injury from pathogens .
Question 6: Which cellular change is considered an irreversible indicator of necrosis?
A) Cellular swelling
B) Nuclear pyknosis
, C) Fatty accumulation
D) Mitochondrial swelling
Rationale: Nuclear pyknosis (nuclear condensation with chromatin clumping) is an
irreversible indicator of necrosis. Other irreversible nuclear changes include karyorrhexis
(nuclear fragmentation) and karyolysis (nuclear dissolution). Cellular swelling and fatty
accumulation are reversible changes associated with early cellular injury. Mitochondrial
swelling can occur in reversible injury but becomes irreversible when accompanied by
mitochondrial calcium accumulation and membrane disruption .
Question 7: A patient with a breast tumor is found to have a BRCA1 gene mutation. This
gene is primarily involved in which cellular process?
A) Apoptosis regulation
B) DNA repair
C) Cell cycle progression
D) Signal transduction
Rationale: BRCA1 is a tumor suppressor gene that plays a critical role in DNA repair
through homologous recombination. Mutations in BRCA1 significantly increase the risk
for breast and ovarian cancers because damaged DNA cannot be properly repaired,
leading to genomic instability and malignant transformation. The p53 gene, not BRCA1,
is primarily responsible for apoptosis regulation in response to DNA damage.
Oncogenes, not tumor suppressors, typically regulate cell cycle progression .
Question 8: The "two-hit hypothesis" is associated with which type of gene?
A) Proto-oncogenes
B) Tumor suppressor genes
C) Caretaker genes
D) Apoptosis genes
Rationale: The two-hit hypothesis applies to tumor suppressor genes, where both
alleles must be inactivated (two "hits") for loss of function and cancer development. This
was first described for the retinoblastoma (Rb) gene and also applies to p53 and other
tumor suppressors. In contrast, only one allele needs to be activated (gain-of-function
Exam Advanced Pathophysiology
Expected Questions and Answers -
Chamberlain
SECTION 1: CELLULAR ADAPTATION, INJURY, AND NEOPLASIA
Question 1: A 68-year-old male with a history of long-standing hypertension presents
with echocardiographic findings showing thickening of the left ventricular myocardium.
This cellular change is best described as which type of adaptation?
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Rationale: Cardiac myocytes are terminally differentiated cells that cannot undergo
mitosis to increase in number. In response to chronically increased afterload from
hypertension, these cells adapt by increasing in size (hypertrophy) to generate greater
contractile force. This is a compensatory mechanism that increases workload capacity
but can eventually become maladaptive, leading to heart failure. Hyperplasia involves an
increase in cell number and occurs in tissues capable of division. Metaplasia is the
replacement of one mature cell type with another, while dysplasia involves abnormal
cellular organization and is considered premalignant .
,Question 2: A 55-year-old chronic smoker undergoes a bronchoscopy following a
persistent cough. Biopsy reveals that the normal ciliated pseudostratified columnar
epithelium of the airways has been replaced by stratified squamous epithelium. What is
this adaptation called?
A) Anaplasia
B) Atrophy
C) Metaplasia
D) Hyperplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type, often as an adaptive response to chronic irritation such as cigarette
smoke. The stratified squamous epithelium is more resistant to the damaging effects of
smoke but loses the protective mucociliary clearance function of the normal columnar
epithelium. While initially protective, this change increases the risk for malignant
transformation. Anaplasia refers to loss of cellular differentiation characteristic of
malignant tumors .
Question 3: During an autopsy, a pathologist notes an area of brain tissue necrosis that
appears soft, liquefied, and is forming a cystic cavity. What type of necrosis is this?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Rationale: Liquefactive necrosis occurs primarily in the brain and central nervous system
following ischemic injury. The tissue is digested by hydrolytic enzymes from
inflammatory cells, resulting in a soft, liquid mass that eventually forms a cystic cavity.
Coagulative necrosis (most common in myocardial infarction) preserves tissue
architecture for days. Caseous necrosis (associated with tuberculosis) produces a
"cheesy" material, and fat necrosis (associated with acute pancreatitis) results from
enzymatic fat breakdown .
,Question 4: A biopsy from a cervical lesion shows atypical cells that have not breached
the basement membrane. How is this lesion classified?
A) Invasive adenocarcinoma
B) Carcinoma in situ
C) Benign adenoma
D) Metastatic sarcoma
Rationale: Carcinoma in situ (CIS) refers to an early-stage, localized epithelial tumor
that has not broken through the local basement membrane. At this stage, the lesion is
considered preinvasive and has not yet acquired the ability to metastasize. If untreated,
CIS can progress to invasive carcinoma. The term "in situ" indicates that the malignant
cells remain confined to their site of origin. This is distinct from invasive cancer, which
penetrates the basement membrane, and benign tumors, which are well-differentiated
and non-invasive .
Question 5: A patient with chronic alcoholism develops fatty liver. What is the
mechanism of this cellular change?
A) Toxic injury causing intracellular accumulation
B) Ischemic injury
C) Physical injury
D) Infectious injury
Rationale: Alcohol is a hepatotoxin that interferes with mitochondrial fatty acid
oxidation and increases fatty acid synthesis, leading to the accumulation of triglycerides
within hepatocytes (steatosis). This is a reversible form of cellular injury. The fatty
accumulation represents a metabolic disturbance rather than cell death. Toxic injury can
result from various substances including alcohol, drugs, and environmental toxins.
Ischemic injury results from reduced blood flow, physical injury from trauma, and
infectious injury from pathogens .
Question 6: Which cellular change is considered an irreversible indicator of necrosis?
A) Cellular swelling
B) Nuclear pyknosis
, C) Fatty accumulation
D) Mitochondrial swelling
Rationale: Nuclear pyknosis (nuclear condensation with chromatin clumping) is an
irreversible indicator of necrosis. Other irreversible nuclear changes include karyorrhexis
(nuclear fragmentation) and karyolysis (nuclear dissolution). Cellular swelling and fatty
accumulation are reversible changes associated with early cellular injury. Mitochondrial
swelling can occur in reversible injury but becomes irreversible when accompanied by
mitochondrial calcium accumulation and membrane disruption .
Question 7: A patient with a breast tumor is found to have a BRCA1 gene mutation. This
gene is primarily involved in which cellular process?
A) Apoptosis regulation
B) DNA repair
C) Cell cycle progression
D) Signal transduction
Rationale: BRCA1 is a tumor suppressor gene that plays a critical role in DNA repair
through homologous recombination. Mutations in BRCA1 significantly increase the risk
for breast and ovarian cancers because damaged DNA cannot be properly repaired,
leading to genomic instability and malignant transformation. The p53 gene, not BRCA1,
is primarily responsible for apoptosis regulation in response to DNA damage.
Oncogenes, not tumor suppressors, typically regulate cell cycle progression .
Question 8: The "two-hit hypothesis" is associated with which type of gene?
A) Proto-oncogenes
B) Tumor suppressor genes
C) Caretaker genes
D) Apoptosis genes
Rationale: The two-hit hypothesis applies to tumor suppressor genes, where both
alleles must be inactivated (two "hits") for loss of function and cancer development. This
was first described for the retinoblastoma (Rb) gene and also applies to p53 and other
tumor suppressors. In contrast, only one allele needs to be activated (gain-of-function
