Portage Learning Pathophysiology
(NURS 231 / BIOD 331): The Ultimate
-Question Modules 1-10 Exam Review
with Rationales
MODULE 1: Cellular Adaptation, Injury, and Death
1. Define atrophy and provide a clinical example.
Answer: Atrophy is a decrease in cellular size, resulting in reduced tissue mass.
Example: Disuse atrophy of skeletal muscles following prolonged bed rest or
immobilization.
Rationale: Atrophy occurs when there is decreased workload, loss of innervation,
diminished blood supply, or inadequate nutrition. Cells shrink to conserve energy
and reduce metabolic demands. This is an adaptive response, though prolonged
atrophy can become irreversible .
2. True/False: Hypertrophy can occur under normal and pathological conditions.
Answer: True
Rationale: Physiologic hypertrophy occurs with increased workload (e.g., skeletal
muscle enlargement from exercise). Pathologic hypertrophy occurs when the
heart must pump against resistance (e.g., hypertension leading to left ventricular
hypertrophy) .
3. Define hyperplasia and provide an example.
, Answer: Hyperplasia is an increase in the number of cells in an organ or tissue
due to increased mitotic division. Example: Hormonal hyperplasia of breast tissue
during pregnancy or endometrial hyperplasia during the menstrual cycle.
Rationale: Hyperplasia is stimulated by hormones or growth factors and can be
physiologic (compensatory or hormonal) or pathologic (excessive stimulation).
Unlike hypertrophy, hyperplasia only occurs in tissues with the capacity for cell
division .
4. What is metaplasia?
Answer: Metaplasia is the reversible replacement of one differentiated cell type
with another differentiated cell type in response to chronic irritation or
inflammation.
Rationale: Metaplasia represents an adaptive substitution of cells better suited to
survive in a changed environment. Example: Squamous metaplasia in the
respiratory tract of smokers, where ciliated columnar epithelium is replaced by
stratified squamous epithelium. This is reversible if the irritant is removed .
5. True/False: Metaplastic cells are better prepared to survive under stressful
circumstances.
Answer: False
Rationale: While metaplastic cells may be more resistant to the irritant, they are
not better prepared for survival—they actually lose specialized functions (like
ciliary action) and may be more susceptible to malignant transformation .
6. What is dysplasia and why is it clinically significant?
Answer: Dysplasia is disordered cellular growth characterized by abnormal cell
size, shape, and organization. It is clinically significant because it is considered a
precancerous condition that may progress to malignancy.
, Rationale: Dysplasia often results from chronic irritation or inflammation and is
graded as mild, moderate, or severe. Severe dysplasia is often indistinguishable
from carcinoma in situ .
7. Differentiate between apoptosis and necrosis.
Answer: Apoptosis is programmed, controlled cell death that is energy-
dependent and does not trigger inflammation. Necrosis is uncontrolled, passive
cell death caused by injury, leading to cellular swelling, membrane rupture, and
inflammatory response.
Rationale: Apoptosis is essential for normal tissue turnover, development, and
elimination of damaged cells. It involves cellular shrinkage, chromatin
condensation, and formation of apoptotic bodies. Necrosis occurs from ischemia,
toxins, trauma, or infection and results in cellular swelling, organelle dysfunction,
and release of inflammatory mediators .
8. What are the characteristics of reversible cell injury?
Answer: Reversible cell injury is characterized by cellular swelling (hydropic
change) and fatty changes (lipid accumulation) without nuclear changes.
Rationale: When the injurious stimulus is removed, the cell can return to normal
function. Hallmarks include loss of ion homeostasis, ATP depletion, and swelling
of mitochondria and ER. The nucleus remains intact .
9. Describe the three types of necrosis and their characteristics.
Answer: (1) Coagulative necrosis: Tissue architecture is preserved; seen in
ischemic injury (e.g., myocardial infarction). (2) Liquefactive necrosis: Tissue is
digested into liquid; seen in brain infarcts and bacterial infections. (3) Caseous
necrosis: Soft, cheese-like appearance; characteristic of tuberculosis.
Rationale: The type of necrosis depends on the tissue and the cause. Coagulative
necrosis involves denaturation of proteins. Liquefactive necrosis results from
, enzymatic digestion. Caseous necrosis represents a combination of coagulative
and liquefactive necrosis .
10. Compare and contrast dry gangrene and wet gangrene.
Answer: Dry gangrene: Occurs when blood supply is slowly reduced; tissue
becomes dry, shrinks, turns dark brown/black; spread is slow; no infection; form of
coagulation necrosis. Wet gangrene: Sudden reduction in blood flow; tissue is
cold, swollen, with foul odor and pus; bacteria involved; very painful; rapid spread;
common in trauma .
Rationale: Dry gangrene typically affects extremities in diabetic patients; the
tissue mummifies and separates. Wet gangrene develops from sudden blockage
and bacterial superinfection, creating a life-threatening emergency requiring
immediate treatment .
11. What is the most common cause of cellular injury?
Answer: Hypoxia (oxygen deficiency)
Rationale: Hypoxia is the most frequent cause of cell injury and death. It may
result from ischemia (reduced blood flow), anemia, carbon monoxide poisoning,
or respiratory disease. Without oxygen, oxidative phosphorylation ceases, ATP
production declines, and cells switch to anaerobic metabolism .
12. How does free radical injury damage cells?
Answer: Free radicals cause injury by lipid peroxidation of cell membranes,
protein damage, and DNA damage.
Rationale: Free radicals are highly reactive molecules with unpaired electrons.
They initiate chain reactions that damage cellular components. Cells utilize
antioxidant defense systems (vitamins E and C, glutathione, superoxide dismutase)
to neutralize them. When these defenses are overwhelmed, injury occurs .
13. Describe the function of mitochondria in cellular metabolism.
(NURS 231 / BIOD 331): The Ultimate
-Question Modules 1-10 Exam Review
with Rationales
MODULE 1: Cellular Adaptation, Injury, and Death
1. Define atrophy and provide a clinical example.
Answer: Atrophy is a decrease in cellular size, resulting in reduced tissue mass.
Example: Disuse atrophy of skeletal muscles following prolonged bed rest or
immobilization.
Rationale: Atrophy occurs when there is decreased workload, loss of innervation,
diminished blood supply, or inadequate nutrition. Cells shrink to conserve energy
and reduce metabolic demands. This is an adaptive response, though prolonged
atrophy can become irreversible .
2. True/False: Hypertrophy can occur under normal and pathological conditions.
Answer: True
Rationale: Physiologic hypertrophy occurs with increased workload (e.g., skeletal
muscle enlargement from exercise). Pathologic hypertrophy occurs when the
heart must pump against resistance (e.g., hypertension leading to left ventricular
hypertrophy) .
3. Define hyperplasia and provide an example.
, Answer: Hyperplasia is an increase in the number of cells in an organ or tissue
due to increased mitotic division. Example: Hormonal hyperplasia of breast tissue
during pregnancy or endometrial hyperplasia during the menstrual cycle.
Rationale: Hyperplasia is stimulated by hormones or growth factors and can be
physiologic (compensatory or hormonal) or pathologic (excessive stimulation).
Unlike hypertrophy, hyperplasia only occurs in tissues with the capacity for cell
division .
4. What is metaplasia?
Answer: Metaplasia is the reversible replacement of one differentiated cell type
with another differentiated cell type in response to chronic irritation or
inflammation.
Rationale: Metaplasia represents an adaptive substitution of cells better suited to
survive in a changed environment. Example: Squamous metaplasia in the
respiratory tract of smokers, where ciliated columnar epithelium is replaced by
stratified squamous epithelium. This is reversible if the irritant is removed .
5. True/False: Metaplastic cells are better prepared to survive under stressful
circumstances.
Answer: False
Rationale: While metaplastic cells may be more resistant to the irritant, they are
not better prepared for survival—they actually lose specialized functions (like
ciliary action) and may be more susceptible to malignant transformation .
6. What is dysplasia and why is it clinically significant?
Answer: Dysplasia is disordered cellular growth characterized by abnormal cell
size, shape, and organization. It is clinically significant because it is considered a
precancerous condition that may progress to malignancy.
, Rationale: Dysplasia often results from chronic irritation or inflammation and is
graded as mild, moderate, or severe. Severe dysplasia is often indistinguishable
from carcinoma in situ .
7. Differentiate between apoptosis and necrosis.
Answer: Apoptosis is programmed, controlled cell death that is energy-
dependent and does not trigger inflammation. Necrosis is uncontrolled, passive
cell death caused by injury, leading to cellular swelling, membrane rupture, and
inflammatory response.
Rationale: Apoptosis is essential for normal tissue turnover, development, and
elimination of damaged cells. It involves cellular shrinkage, chromatin
condensation, and formation of apoptotic bodies. Necrosis occurs from ischemia,
toxins, trauma, or infection and results in cellular swelling, organelle dysfunction,
and release of inflammatory mediators .
8. What are the characteristics of reversible cell injury?
Answer: Reversible cell injury is characterized by cellular swelling (hydropic
change) and fatty changes (lipid accumulation) without nuclear changes.
Rationale: When the injurious stimulus is removed, the cell can return to normal
function. Hallmarks include loss of ion homeostasis, ATP depletion, and swelling
of mitochondria and ER. The nucleus remains intact .
9. Describe the three types of necrosis and their characteristics.
Answer: (1) Coagulative necrosis: Tissue architecture is preserved; seen in
ischemic injury (e.g., myocardial infarction). (2) Liquefactive necrosis: Tissue is
digested into liquid; seen in brain infarcts and bacterial infections. (3) Caseous
necrosis: Soft, cheese-like appearance; characteristic of tuberculosis.
Rationale: The type of necrosis depends on the tissue and the cause. Coagulative
necrosis involves denaturation of proteins. Liquefactive necrosis results from
, enzymatic digestion. Caseous necrosis represents a combination of coagulative
and liquefactive necrosis .
10. Compare and contrast dry gangrene and wet gangrene.
Answer: Dry gangrene: Occurs when blood supply is slowly reduced; tissue
becomes dry, shrinks, turns dark brown/black; spread is slow; no infection; form of
coagulation necrosis. Wet gangrene: Sudden reduction in blood flow; tissue is
cold, swollen, with foul odor and pus; bacteria involved; very painful; rapid spread;
common in trauma .
Rationale: Dry gangrene typically affects extremities in diabetic patients; the
tissue mummifies and separates. Wet gangrene develops from sudden blockage
and bacterial superinfection, creating a life-threatening emergency requiring
immediate treatment .
11. What is the most common cause of cellular injury?
Answer: Hypoxia (oxygen deficiency)
Rationale: Hypoxia is the most frequent cause of cell injury and death. It may
result from ischemia (reduced blood flow), anemia, carbon monoxide poisoning,
or respiratory disease. Without oxygen, oxidative phosphorylation ceases, ATP
production declines, and cells switch to anaerobic metabolism .
12. How does free radical injury damage cells?
Answer: Free radicals cause injury by lipid peroxidation of cell membranes,
protein damage, and DNA damage.
Rationale: Free radicals are highly reactive molecules with unpaired electrons.
They initiate chain reactions that damage cellular components. Cells utilize
antioxidant defense systems (vitamins E and C, glutathione, superoxide dismutase)
to neutralize them. When these defenses are overwhelmed, injury occurs .
13. Describe the function of mitochondria in cellular metabolism.
