APUS NURS325 Midterm Exam (pdf) | 2026/2027 | Integrated
Pathophysiology & Clinical Pharmacology Q&A | Pathophysiology
1. The cellular adaptation characterized by a decrease in cell size and a
reduction in metabolic activity is known as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Atrophy
Correct Answer: Atrophy
Rationale: Atrophy is a decrease in cell size and function, often resulting from
reduced workload, loss of innervation, diminished blood supply, or
inadequate nutrition. It is a common adaptive response meant to reduce
cellular oxygen demand.
2. A patient with chronic hypertension develops an enlarged heart muscle.
Which cellular adaptation is most likely responsible for this change?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Dysplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy is an increase in cell size, often in response to
increased workload or hormonal stimulation, leading to organ enlargement.
In hypertension, the cardiac muscle cells enlarge to compensate for the
increased workload.
3. The replacement of normal columnar epithelial cells in the esophagus with
squamous epithelial cells due to chronic acid reflux is an example of:
A) Dysplasia
B) Hyperplasia
,C) Metaplasia
D) Anaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another, often in response to chronic irritation. Barrett esophagus,
where squamous epithelium replaces columnar epithelium, is a classic
example.
4. A biopsy report indicates "moderate to severe dysplasia." What is the
most significant clinical implication of this finding?
A) It is a benign, reversible cellular change.
B) It is a premalignant condition that requires close monitoring.
C) It is a sign of acute inflammation.
D) It is a normal finding in a postmenopausal woman.
Correct Answer: It is a premalignant condition that requires close monitoring.
Rationale: Dysplasia is an abnormal change in cell size, shape, and
organization and is considered a premalignant condition. Moderate to severe
dysplasia indicates a higher risk of progression to carcinoma in situ and
requires further evaluation and monitoring.
5. What is the primary mechanism of cellular injury in ischemia?
A) Direct damage by free radicals
B) Depletion of adenosine triphosphate (ATP)
C) Disruption of the cell membrane by toxins
D) Uncontrolled influx of calcium
Correct Answer: Depletion of adenosine triphosphate (ATP)
Rationale: Ischemia reduces oxygen and glucose delivery, leading to
decreased ATP production. ATP depletion impairs sodium-potassium pump
function, causing cellular swelling and initiating a cascade of injury that can
lead to cell death.
,6. A hallmark of irreversible cell injury is:
A) Cellular swelling
B) Loss of microvilli
C) Nuclear pyknosis
D) Fatty change
Correct Answer: Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation) is an
irreversible change indicating cell death. Cellular swelling, loss of microvilli,
and fatty change are reversible injuries.
7. A patient with a myocardial infarction shows coagulative necrosis on
histology. What is the defining characteristic of coagulative necrosis?
A) Liquefaction of tissue with pus formation
B) Preservation of the cell outline for several days
C) Formation of granulomas
D) Fatty acid accumulation in the cytoplasm
Correct Answer: Preservation of the cell outline for several days
Rationale: Coagulative necrosis is the most common type of necrosis,
typically seen in ischemic injury (e.g., MI). It is characterized by the
preservation of the basic cell and tissue architecture for several days after
cell death.
8. Which type of necrosis is associated with chronic inflammation and is
characterized by a collection of macrophages and fibroblasts forming a
nodular structure?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
, D) Granulomatous necrosis
Correct Answer: Granulomatous necrosis
Rationale: Granulomatous necrosis is a form of necrosis associated with
chronic inflammation, where macrophages and fibroblasts aggregate to form
a granuloma. This is seen in conditions like tuberculosis and sarcoidosis.
9. A patient with tuberculosis develops caseous necrosis in the lung. What
gross appearance is characteristic of this type of necrosis?
A) Firm, pale tissue
B) Soft, creamy, cheesy white material
C) Yellow, greasy material
D) Clear, liquefied tissue
Correct Answer: Soft, creamy, cheesy white material
Rationale: Caseous necrosis is characterized by a soft, creamy, cheesy white
appearance. It is a combination of coagulative and liquefactive necrosis,
often seen in tuberculosis.
10. The initial step in the inflammatory response is:
A) Vasodilation
B) Margination of leukocytes
C) Mast cell degranulation
D) Phagocytosis
Correct Answer: Mast cell degranulation
Rationale: Mast cell degranulation releases histamine and other
inflammatory mediators, which initiate the inflammatory cascade. This leads
to vasodilation and increased vascular permeability.
11. Which of the following cells is the first to arrive at the site of acute
inflammation?
Pathophysiology & Clinical Pharmacology Q&A | Pathophysiology
1. The cellular adaptation characterized by a decrease in cell size and a
reduction in metabolic activity is known as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Atrophy
Correct Answer: Atrophy
Rationale: Atrophy is a decrease in cell size and function, often resulting from
reduced workload, loss of innervation, diminished blood supply, or
inadequate nutrition. It is a common adaptive response meant to reduce
cellular oxygen demand.
2. A patient with chronic hypertension develops an enlarged heart muscle.
Which cellular adaptation is most likely responsible for this change?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Dysplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy is an increase in cell size, often in response to
increased workload or hormonal stimulation, leading to organ enlargement.
In hypertension, the cardiac muscle cells enlarge to compensate for the
increased workload.
3. The replacement of normal columnar epithelial cells in the esophagus with
squamous epithelial cells due to chronic acid reflux is an example of:
A) Dysplasia
B) Hyperplasia
,C) Metaplasia
D) Anaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type with another, often in response to chronic irritation. Barrett esophagus,
where squamous epithelium replaces columnar epithelium, is a classic
example.
4. A biopsy report indicates "moderate to severe dysplasia." What is the
most significant clinical implication of this finding?
A) It is a benign, reversible cellular change.
B) It is a premalignant condition that requires close monitoring.
C) It is a sign of acute inflammation.
D) It is a normal finding in a postmenopausal woman.
Correct Answer: It is a premalignant condition that requires close monitoring.
Rationale: Dysplasia is an abnormal change in cell size, shape, and
organization and is considered a premalignant condition. Moderate to severe
dysplasia indicates a higher risk of progression to carcinoma in situ and
requires further evaluation and monitoring.
5. What is the primary mechanism of cellular injury in ischemia?
A) Direct damage by free radicals
B) Depletion of adenosine triphosphate (ATP)
C) Disruption of the cell membrane by toxins
D) Uncontrolled influx of calcium
Correct Answer: Depletion of adenosine triphosphate (ATP)
Rationale: Ischemia reduces oxygen and glucose delivery, leading to
decreased ATP production. ATP depletion impairs sodium-potassium pump
function, causing cellular swelling and initiating a cascade of injury that can
lead to cell death.
,6. A hallmark of irreversible cell injury is:
A) Cellular swelling
B) Loss of microvilli
C) Nuclear pyknosis
D) Fatty change
Correct Answer: Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation) is an
irreversible change indicating cell death. Cellular swelling, loss of microvilli,
and fatty change are reversible injuries.
7. A patient with a myocardial infarction shows coagulative necrosis on
histology. What is the defining characteristic of coagulative necrosis?
A) Liquefaction of tissue with pus formation
B) Preservation of the cell outline for several days
C) Formation of granulomas
D) Fatty acid accumulation in the cytoplasm
Correct Answer: Preservation of the cell outline for several days
Rationale: Coagulative necrosis is the most common type of necrosis,
typically seen in ischemic injury (e.g., MI). It is characterized by the
preservation of the basic cell and tissue architecture for several days after
cell death.
8. Which type of necrosis is associated with chronic inflammation and is
characterized by a collection of macrophages and fibroblasts forming a
nodular structure?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
, D) Granulomatous necrosis
Correct Answer: Granulomatous necrosis
Rationale: Granulomatous necrosis is a form of necrosis associated with
chronic inflammation, where macrophages and fibroblasts aggregate to form
a granuloma. This is seen in conditions like tuberculosis and sarcoidosis.
9. A patient with tuberculosis develops caseous necrosis in the lung. What
gross appearance is characteristic of this type of necrosis?
A) Firm, pale tissue
B) Soft, creamy, cheesy white material
C) Yellow, greasy material
D) Clear, liquefied tissue
Correct Answer: Soft, creamy, cheesy white material
Rationale: Caseous necrosis is characterized by a soft, creamy, cheesy white
appearance. It is a combination of coagulative and liquefactive necrosis,
often seen in tuberculosis.
10. The initial step in the inflammatory response is:
A) Vasodilation
B) Margination of leukocytes
C) Mast cell degranulation
D) Phagocytosis
Correct Answer: Mast cell degranulation
Rationale: Mast cell degranulation releases histamine and other
inflammatory mediators, which initiate the inflammatory cascade. This leads
to vasodilation and increased vascular permeability.
11. Which of the following cells is the first to arrive at the site of acute
inflammation?
