1
SCI 225 Pathophysiology Midterm Exam
Nightingale College Official Practice
Exam Actual 2026/2027 with Detailed
Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+
Graded
TABLE OF CONTENTS
Section 1 | Cellular Injury, Adaptation & Inflammation | Q1 – Q10
Section 2 | Genetics, Immunity & Immune Disorders | Q11 – Q23
Section 3 | Fluid, Electrolyte & Acid-Base Balance | Q24 – Q33
Section 4 | Cardiovascular, Respiratory & Renal Pathophysiology | Q34
– Q43
Section 5 | Endocrine Disorders, Neoplasia & NGN-Style Case Analysis
| Q44 – Q50
Instructions: Choose the single best answer unless otherwise indicated.
Pass: 40/50 correct (80%). Time: 120 minutes.
══════════════════════════════════════
SECTION 1: CELLULAR INJURY, ADAPTATION &
INFLAMMATION Q1 – Q10
══════════════════════════════════════
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Question 1 of 50
A 67-year-old male with a history of chronic obstructive pulmonary
disease presents to the emergency department after being found
unresponsive in his apartment during a heat wave. His core temperature
is 41.2°C (106.2°F), blood pressure is 88/52 mmHg, and he is
tachycardic at 118 bpm. Laboratory studies reveal elevated serum
creatinine kinase, myoglobinuria, and evidence of acute tubular necrosis.
The pathologist examining a skeletal muscle biopsy from this patient
would most likely identify which pattern of tissue death characterized by
enzymatic digestion of cells resulting in transformation of tissue into a
liquid viscous mass?
A. Coagulative necrosis, because the ischemic injury preserves the basic
structural outline of dead cells while denaturing structural proteins
B. Liquefactive necrosis, because the combination of hypoxia,
hyperthermia, and digestive enzyme release causes complete dissolution
of cellular architecture into a fluid state
C. Caseous necrosis, because the granulomatous inflammatory response
produces a cheese-like appearance typical of infectious processes
D. Fat necrosis, because the breakdown of adipose tissue releases fatty
acids that combine with calcium to form chalky white deposits
Correct Answer: B
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Rationale: Liquefactive necrosis is the characteristic pattern seen when
cellular digestion by enzymes transforms tissue into a liquid viscous
mass, commonly occurring in brain infarctions or infections with
abscess formation; in this case, the severe hyperthermia combined with
hypoxic injury triggers massive release of lysosomal enzymes that digest
the muscle tissue completely. Coagulative necrosis (A) maintains the
structural outline of dead tissue for several days and is typical of
ischemic injury in most solid organs except the brain, so it would not
produce the liquefied mass described here. On exams, remember that
brain infarctions always undergo liquefactive necrosis due to high lipid
content and lack of supportive stroma.
Question 2 of 50
A 34-year-old female who has been a competitive weightlifter for 12
years undergoes an echocardiogram as part of a pre-participation sports
physical. The study reveals significant left ventricular wall thickening
measuring 16 mm (normal <12 mm) with normal chamber dimensions
and preserved systolic function. Her primary care physician explains that
her heart has undergone a reversible adaptive response to chronic
increased workload. Which cellular adaptation mechanism best
describes this cardiac finding?
A. Hyperplasia, an increase in the number of cardiomyocytes through
stimulated cell division in response to hemodynamic stress
B. Hypertrophy, an increase in the individual cell size of existing
cardiomyocytes due to increased synthesis of structural proteins and
organelles
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C. Metaplasia, a reversible change in which one differentiated adult cell
type is replaced by another adult cell type better suited to the
environment
D. Dysplasia, a disordered growth pattern characterized by
pleomorphism and loss of normal tissue architecture
Correct Answer: B
Rationale: Hypertrophy represents an increase in cell size rather than
cell number, occurring when cells are subjected to increased mechanical
stress or trophic stimuli; in the heart, chronic pressure overload from
resistance training stimulates individual cardiomyocytes to synthesize
more contractile proteins and organelles, resulting in thickened
ventricular walls. Hyperplasia (A) involves an increase in cell number
through mitotic division, but adult cardiac muscle has extremely limited
regenerative capacity and cannot significantly increase cell numbers,
making this mechanism physiologically impossible for the myocardium.
Remember on your exam that skeletal muscle hypertrophies through
both mechanisms (some satellite cell hyperplasia plus fiber
hypertrophy), whereas cardiac muscle can only hypertrophy.
Question 3 of 50
A 58-year-old male with a 40-pack-year smoking history undergoes
bronchoscopy for evaluation of a persistent cough and hemoptysis.
Biopsy of a lesion in the right mainstem bronch reveals that the normal
ciliated pseudostratified columnar epithelium has been replaced by
stratified squamous epithelium without underlying nuclear atypia or loss
of polarity. The pulmonologist explains that this represents a protective
SCI 225 Pathophysiology Midterm Exam
Nightingale College Official Practice
Exam Actual 2026/2027 with Detailed
Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+
Graded
TABLE OF CONTENTS
Section 1 | Cellular Injury, Adaptation & Inflammation | Q1 – Q10
Section 2 | Genetics, Immunity & Immune Disorders | Q11 – Q23
Section 3 | Fluid, Electrolyte & Acid-Base Balance | Q24 – Q33
Section 4 | Cardiovascular, Respiratory & Renal Pathophysiology | Q34
– Q43
Section 5 | Endocrine Disorders, Neoplasia & NGN-Style Case Analysis
| Q44 – Q50
Instructions: Choose the single best answer unless otherwise indicated.
Pass: 40/50 correct (80%). Time: 120 minutes.
══════════════════════════════════════
SECTION 1: CELLULAR INJURY, ADAPTATION &
INFLAMMATION Q1 – Q10
══════════════════════════════════════
,2
Question 1 of 50
A 67-year-old male with a history of chronic obstructive pulmonary
disease presents to the emergency department after being found
unresponsive in his apartment during a heat wave. His core temperature
is 41.2°C (106.2°F), blood pressure is 88/52 mmHg, and he is
tachycardic at 118 bpm. Laboratory studies reveal elevated serum
creatinine kinase, myoglobinuria, and evidence of acute tubular necrosis.
The pathologist examining a skeletal muscle biopsy from this patient
would most likely identify which pattern of tissue death characterized by
enzymatic digestion of cells resulting in transformation of tissue into a
liquid viscous mass?
A. Coagulative necrosis, because the ischemic injury preserves the basic
structural outline of dead cells while denaturing structural proteins
B. Liquefactive necrosis, because the combination of hypoxia,
hyperthermia, and digestive enzyme release causes complete dissolution
of cellular architecture into a fluid state
C. Caseous necrosis, because the granulomatous inflammatory response
produces a cheese-like appearance typical of infectious processes
D. Fat necrosis, because the breakdown of adipose tissue releases fatty
acids that combine with calcium to form chalky white deposits
Correct Answer: B
,3
Rationale: Liquefactive necrosis is the characteristic pattern seen when
cellular digestion by enzymes transforms tissue into a liquid viscous
mass, commonly occurring in brain infarctions or infections with
abscess formation; in this case, the severe hyperthermia combined with
hypoxic injury triggers massive release of lysosomal enzymes that digest
the muscle tissue completely. Coagulative necrosis (A) maintains the
structural outline of dead tissue for several days and is typical of
ischemic injury in most solid organs except the brain, so it would not
produce the liquefied mass described here. On exams, remember that
brain infarctions always undergo liquefactive necrosis due to high lipid
content and lack of supportive stroma.
Question 2 of 50
A 34-year-old female who has been a competitive weightlifter for 12
years undergoes an echocardiogram as part of a pre-participation sports
physical. The study reveals significant left ventricular wall thickening
measuring 16 mm (normal <12 mm) with normal chamber dimensions
and preserved systolic function. Her primary care physician explains that
her heart has undergone a reversible adaptive response to chronic
increased workload. Which cellular adaptation mechanism best
describes this cardiac finding?
A. Hyperplasia, an increase in the number of cardiomyocytes through
stimulated cell division in response to hemodynamic stress
B. Hypertrophy, an increase in the individual cell size of existing
cardiomyocytes due to increased synthesis of structural proteins and
organelles
, 4
C. Metaplasia, a reversible change in which one differentiated adult cell
type is replaced by another adult cell type better suited to the
environment
D. Dysplasia, a disordered growth pattern characterized by
pleomorphism and loss of normal tissue architecture
Correct Answer: B
Rationale: Hypertrophy represents an increase in cell size rather than
cell number, occurring when cells are subjected to increased mechanical
stress or trophic stimuli; in the heart, chronic pressure overload from
resistance training stimulates individual cardiomyocytes to synthesize
more contractile proteins and organelles, resulting in thickened
ventricular walls. Hyperplasia (A) involves an increase in cell number
through mitotic division, but adult cardiac muscle has extremely limited
regenerative capacity and cannot significantly increase cell numbers,
making this mechanism physiologically impossible for the myocardium.
Remember on your exam that skeletal muscle hypertrophies through
both mechanisms (some satellite cell hyperplasia plus fiber
hypertrophy), whereas cardiac muscle can only hypertrophy.
Question 3 of 50
A 58-year-old male with a 40-pack-year smoking history undergoes
bronchoscopy for evaluation of a persistent cough and hemoptysis.
Biopsy of a lesion in the right mainstem bronch reveals that the normal
ciliated pseudostratified columnar epithelium has been replaced by
stratified squamous epithelium without underlying nuclear atypia or loss
of polarity. The pulmonologist explains that this represents a protective
