# NSG 5140 Week 5 Midterm Exam – Advanced
Pathophysiology Practice Questions
Section 1: Cellular Injury, Adaptation, and Death (Questions 1-40)
**1. Which of the following is the primary mechanism of cellular injury in hypoxic conditions?**
A) DNA mutation
B) ATP depletion leading to loss of ion homeostasis
C) Free radical formation
D) Protein misfolding
**Answer: B**
*Rationale:* Hypoxia limits oxidative phosphorylation, leading to decreased ATP production. The
Na⁺/K⁺ ATPase pump requires ATP to maintain ion gradients; its failure causes intracellular sodium
accumulation, water influx, and cellular swelling, which is the hallmark of hypoxic cellular injury .
**2. A patient with chronic hypertension develops left ventricular wall thickening. Which mechanism
best explains this adaptation?**
A) Increased myocyte number due to cell division
B) Increased myocyte size due to increased workload
C) Replacement of cardiac cells with fibrous tissue
D) Transformation of cardiac cells into smooth muscle
**Answer: B**
*Rationale:* Cardiac myocytes are terminally differentiated and respond to increased workload by
hypertrophy (increased cell size), not hyperplasia. The increased workload from chronic hypertension
causes the myocytes to enlarge, resulting in left ventricular wall thickening .
**3. Which of the following is the hallmark of reversible cellular injury?**
A) Nuclear pyknosis
B) Failure of ion pumps leading to cell swelling
C) Membrane rupture
D) Lysosomal enzyme release
**Answer: B**
,*Rationale:* Reversible injury involves cellular swelling due to ion pump failure. If the insult is
removed, the cell can recover. Irreversible injury involves membrane damage and nuclear changes
such as pyknosis .
**4. During ischemia, the switch from aerobic to anaerobic metabolism leads to which immediate
intracellular change?**
A) Increased ATP production
B) Increased intracellular pH
C) Accumulation of lactic acid
D) Decreased intracellular sodium
**Answer: C**
*Rationale:* Ischemia causes decreased oxygen supply, leading to anaerobic metabolism which
produces lactic acid as a byproduct, causing intracellular acidosis and cellular injury .
**5. What is a consequence of plasma membrane damage to the mitochondria?**
A) Enzymatic digestion halts DNA synthesis
B) Influx of calcium ions halts ATP production
C) Edema from sodium influx causes reduction in ATP production
D) Potassium shifts out of the mitochondria, destroying infrastructure
**Answer: B**
*Rationale:* Plasma membrane damage allows calcium to enter the cell and accumulate in
mitochondria. Excess calcium disrupts oxidative phosphorylation and ATP production, leading to cell
injury and potential apoptosis .
**6. A researcher observes that sustained mechanical stretch of cardiac myocytes leads to increased
protein synthesis and cell enlargement. Which intracellular signaling pathway is most directly
responsible for this adaptive response?**
A) Activation of the PI3K/Akt/mTOR pathway leading to increased translation
B) Induction of p53-mediated cell cycle arrest and senescence
C) Upregulation of caspases and initiation of apoptosis
D) Activation of the unfolded protein response due to ER stress
**Answer: A**
*Rationale:* Cardiac myocytes respond to increased workload by undergoing hypertrophy, driven by
the PI3K/Akt/mTOR pathway that enhances protein synthesis. This pathway promotes cell growth
rather than division .
,**7. A chronic smoker develops persistent cough and mucus hypersecretion due to an increased
number of mucus-secreting cells replacing normal ciliated columnar epithelium. This cellular change is
best described as:**
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
**Answer: C**
*Rationale:* Metaplasia is a reversible replacement of one differentiated cell type by another. In
chronic smokers, ciliated columnar epithelium is replaced by squamous or mucus-secreting cells as an
adaptive response to chronic irritation .
**8. Which cellular organelle is responsible for ATP production?**
A) Ribosome
B) Golgi apparatus
C) Mitochondria
D) Endoplasmic reticulum
**Answer: C**
*Rationale:* Mitochondria are the site of oxidative phosphorylation and ATP production. They are
often called the "powerhouse" of the cell. Cellular injury that damages mitochondria leads to ATP
depletion and cell death .
**9. A patient's biopsy reveals dysplastic cells. This finding indicates:**
A) Normal cellular appearance
B) Fully differentiated cells
C) Disordered cellular growth
D) Reversible cellular adaptation
**Answer: C**
*Rationale:* Dysplasia indicates abnormal cell growth with disordered differentiation. While it can be
a precursor to cancer, it may be reversible if the irritant is removed .
**10. Which of the following is an example of physiologic hyperplasia?**
A) Endometrial hyperplasia during the menstrual cycle
B) Benign prostatic hyperplasia
, C) Hyperplasia of the epidermis in callus formation
D) Hyperplasia of the thyroid gland in Graves' disease
**Answer: A**
*Rationale:* Physiologic hyperplasia is a normal, controlled response to a stimulus. Endometrial
hyperplasia during the menstrual cycle is a normal physiologic process. Benign prostatic hyperplasia
and thyroid hyperplasia in Graves' disease are pathologic .
**11. A cell adapts to a decreased workload by decreasing in size. This process is called:**
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
**Answer: C**
*Rationale:* Atrophy is a decrease in cell size due to reduced workload, denervation, decreased blood
supply, or inadequate nutrition. It is a reversible adaptation if the stimulus is removed .
**12. Chronic exposure to gastric acid in the lower esophagus causes the normal stratified squamous
epithelium to change to columnar epithelium. This change is called:**
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
**Answer: C**
*Rationale:* Metaplasia is the reversible replacement of one differentiated cell type with another. In
Barrett's esophagus, the normal squamous epithelium is replaced by columnar epithelium due to
chronic acid exposure .
**13. A patient with a massive myocardial infarction develops cardiogenic shock. Which best
describes the cellular response to prolonged ischemia?**
A) Apoptosis with cellular shrinkage
B) Necrosis with cellular swelling and rupture
C) Autophagy with cellular digestion
D) Metaplasia with cellular replacement
**Answer: B**
Pathophysiology Practice Questions
Section 1: Cellular Injury, Adaptation, and Death (Questions 1-40)
**1. Which of the following is the primary mechanism of cellular injury in hypoxic conditions?**
A) DNA mutation
B) ATP depletion leading to loss of ion homeostasis
C) Free radical formation
D) Protein misfolding
**Answer: B**
*Rationale:* Hypoxia limits oxidative phosphorylation, leading to decreased ATP production. The
Na⁺/K⁺ ATPase pump requires ATP to maintain ion gradients; its failure causes intracellular sodium
accumulation, water influx, and cellular swelling, which is the hallmark of hypoxic cellular injury .
**2. A patient with chronic hypertension develops left ventricular wall thickening. Which mechanism
best explains this adaptation?**
A) Increased myocyte number due to cell division
B) Increased myocyte size due to increased workload
C) Replacement of cardiac cells with fibrous tissue
D) Transformation of cardiac cells into smooth muscle
**Answer: B**
*Rationale:* Cardiac myocytes are terminally differentiated and respond to increased workload by
hypertrophy (increased cell size), not hyperplasia. The increased workload from chronic hypertension
causes the myocytes to enlarge, resulting in left ventricular wall thickening .
**3. Which of the following is the hallmark of reversible cellular injury?**
A) Nuclear pyknosis
B) Failure of ion pumps leading to cell swelling
C) Membrane rupture
D) Lysosomal enzyme release
**Answer: B**
,*Rationale:* Reversible injury involves cellular swelling due to ion pump failure. If the insult is
removed, the cell can recover. Irreversible injury involves membrane damage and nuclear changes
such as pyknosis .
**4. During ischemia, the switch from aerobic to anaerobic metabolism leads to which immediate
intracellular change?**
A) Increased ATP production
B) Increased intracellular pH
C) Accumulation of lactic acid
D) Decreased intracellular sodium
**Answer: C**
*Rationale:* Ischemia causes decreased oxygen supply, leading to anaerobic metabolism which
produces lactic acid as a byproduct, causing intracellular acidosis and cellular injury .
**5. What is a consequence of plasma membrane damage to the mitochondria?**
A) Enzymatic digestion halts DNA synthesis
B) Influx of calcium ions halts ATP production
C) Edema from sodium influx causes reduction in ATP production
D) Potassium shifts out of the mitochondria, destroying infrastructure
**Answer: B**
*Rationale:* Plasma membrane damage allows calcium to enter the cell and accumulate in
mitochondria. Excess calcium disrupts oxidative phosphorylation and ATP production, leading to cell
injury and potential apoptosis .
**6. A researcher observes that sustained mechanical stretch of cardiac myocytes leads to increased
protein synthesis and cell enlargement. Which intracellular signaling pathway is most directly
responsible for this adaptive response?**
A) Activation of the PI3K/Akt/mTOR pathway leading to increased translation
B) Induction of p53-mediated cell cycle arrest and senescence
C) Upregulation of caspases and initiation of apoptosis
D) Activation of the unfolded protein response due to ER stress
**Answer: A**
*Rationale:* Cardiac myocytes respond to increased workload by undergoing hypertrophy, driven by
the PI3K/Akt/mTOR pathway that enhances protein synthesis. This pathway promotes cell growth
rather than division .
,**7. A chronic smoker develops persistent cough and mucus hypersecretion due to an increased
number of mucus-secreting cells replacing normal ciliated columnar epithelium. This cellular change is
best described as:**
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
**Answer: C**
*Rationale:* Metaplasia is a reversible replacement of one differentiated cell type by another. In
chronic smokers, ciliated columnar epithelium is replaced by squamous or mucus-secreting cells as an
adaptive response to chronic irritation .
**8. Which cellular organelle is responsible for ATP production?**
A) Ribosome
B) Golgi apparatus
C) Mitochondria
D) Endoplasmic reticulum
**Answer: C**
*Rationale:* Mitochondria are the site of oxidative phosphorylation and ATP production. They are
often called the "powerhouse" of the cell. Cellular injury that damages mitochondria leads to ATP
depletion and cell death .
**9. A patient's biopsy reveals dysplastic cells. This finding indicates:**
A) Normal cellular appearance
B) Fully differentiated cells
C) Disordered cellular growth
D) Reversible cellular adaptation
**Answer: C**
*Rationale:* Dysplasia indicates abnormal cell growth with disordered differentiation. While it can be
a precursor to cancer, it may be reversible if the irritant is removed .
**10. Which of the following is an example of physiologic hyperplasia?**
A) Endometrial hyperplasia during the menstrual cycle
B) Benign prostatic hyperplasia
, C) Hyperplasia of the epidermis in callus formation
D) Hyperplasia of the thyroid gland in Graves' disease
**Answer: A**
*Rationale:* Physiologic hyperplasia is a normal, controlled response to a stimulus. Endometrial
hyperplasia during the menstrual cycle is a normal physiologic process. Benign prostatic hyperplasia
and thyroid hyperplasia in Graves' disease are pathologic .
**11. A cell adapts to a decreased workload by decreasing in size. This process is called:**
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
**Answer: C**
*Rationale:* Atrophy is a decrease in cell size due to reduced workload, denervation, decreased blood
supply, or inadequate nutrition. It is a reversible adaptation if the stimulus is removed .
**12. Chronic exposure to gastric acid in the lower esophagus causes the normal stratified squamous
epithelium to change to columnar epithelium. This change is called:**
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
**Answer: C**
*Rationale:* Metaplasia is the reversible replacement of one differentiated cell type with another. In
Barrett's esophagus, the normal squamous epithelium is replaced by columnar epithelium due to
chronic acid exposure .
**13. A patient with a massive myocardial infarction develops cardiogenic shock. Which best
describes the cellular response to prolonged ischemia?**
A) Apoptosis with cellular shrinkage
B) Necrosis with cellular swelling and rupture
C) Autophagy with cellular digestion
D) Metaplasia with cellular replacement
**Answer: B**
