,NR 507 Exam 1 Advanced Pathophysiology I Questions And Answers
2026/2027 Chamberlain
1. A 65-year-old male with a 50-pack-year smoking history presents with a
chronic cough. A bronchoscopy reveals that the normal ciliated columnar
epithelium of the airways has been replaced by stratified squamous
epithelium. This cellular change is best described as:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
**Correct Answer:** B) Metaplasia
**Rationale:** Metaplasia is the reversible substitution of one differentiated
cell type for another in response to chronic irritation. In this case, chronic
smoke exposure causes columnar epithelium to convert to squamous
epithelium, which is more protective but loses mucus-clearing function.
Hyperplasia refers to an increase in cell number, dysplasia to disordered
growth, and anaplasia to loss of differentiation (malignant).
2. A breast biopsy from a 30-year-old woman with a BRCA1 mutation shows
ductal epithelium with loss of polarity, nuclear pleomorphism, and increased
mitotic figures, but the myoepithelial layer remains intact. This finding is
consistent with:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Carcinoma in situ
**Correct Answer:** C) Dysplasia
,**Rationale:** Dysplasia is characterized by disordered growth with cytologic
atypia (loss of polarity, pleomorphism, increased mitoses) confined within
the basement membrane. It represents a pre-neoplastic change. Carcinoma
in situ (D) would involve cells that have not invaded but are malignant, while
simple hyperplasia (A) lacks atypia.
3. A 55-year-old man with COPD presents with a barrel chest and a flattened
diaphragm on chest X-ray. These physical changes are primarily the result of:
A) Apoptosis of type I alveolar cells
B) Centrilobular emphysema with loss of elastic recoil leading to air trapping
C) Hyperplasia of bronchial smooth muscle
D) Hypertrophy of mucus glands
**Correct Answer:** B) Centrilobular emphysema with loss of elastic recoil
leading to air trapping
**Rationale:** Emphysema destroys alveolar walls, leading to a loss of elastic
recoil. This causes air trapping and hyperinflation of the lungs, which pushes
the diaphragm downward (flattening it) and increases the anteroposterior
diameter of the chest (barrel chest). The other options describe other COPD
pathologies (chronic bronchitis, asthma).
4. A 70-year-old man with congestive heart failure (CHF) develops bilateral
pitting edema in his lower extremities. Which alteration in Starling forces is
primarily responsible for this edema?
A) Increased plasma oncotic pressure
B) Increased interstitial hydrostatic pressure
C) Increased capillary hydrostatic pressure
D) Decreased capillary oncotic pressure
**Correct Answer:** C) Increased capillary hydrostatic pressure
, **Rationale:** In heart failure, increased venous pressure leads to increased
capillary hydrostatic pressure. This forces fluid out of the capillaries and into
the interstitial space, resulting in edema. Plasma oncotic pressure is typically
decreased in conditions like liver disease or malnutrition, not CHF.
5. A 25-year-old man with acute appendicitis has right lower quadrant pain,
fever, and neutrophilia. Which inflammatory mediator is most responsible for
neutrophil margination and chemotaxis to the site of infection?
A) Interleukin-1 (IL-1)
B) Histamine
C) Complement fragment C5a
D) Bradykinin
**Correct Answer:** C) Complement fragment C5a
**Rationale:** C5a is a potent chemoattractant that causes neutrophil
margination (adhesion to endothelium) and chemotaxis (movement toward
the site of inflammation). IL-1 causes fever and the acute-phase response,
histamine causes vasodilation, and bradykinin causes pain and vasodilation.
6. A 60-year-old woman with rheumatoid arthritis has hand X-rays showing
pannus formation. Pannus is best described as:
A) Granulation tissue with fibroblasts and neovessels invading cartilage
B) Caseating necrosis with multinucleated giant cells
C) Fibrinoid necrosis of vessel walls
D) Amyloid deposition in the synovium
**Correct Answer:** A) Granulation tissue with fibroblasts and neovessels
invading cartilage
2026/2027 Chamberlain
1. A 65-year-old male with a 50-pack-year smoking history presents with a
chronic cough. A bronchoscopy reveals that the normal ciliated columnar
epithelium of the airways has been replaced by stratified squamous
epithelium. This cellular change is best described as:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
**Correct Answer:** B) Metaplasia
**Rationale:** Metaplasia is the reversible substitution of one differentiated
cell type for another in response to chronic irritation. In this case, chronic
smoke exposure causes columnar epithelium to convert to squamous
epithelium, which is more protective but loses mucus-clearing function.
Hyperplasia refers to an increase in cell number, dysplasia to disordered
growth, and anaplasia to loss of differentiation (malignant).
2. A breast biopsy from a 30-year-old woman with a BRCA1 mutation shows
ductal epithelium with loss of polarity, nuclear pleomorphism, and increased
mitotic figures, but the myoepithelial layer remains intact. This finding is
consistent with:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Carcinoma in situ
**Correct Answer:** C) Dysplasia
,**Rationale:** Dysplasia is characterized by disordered growth with cytologic
atypia (loss of polarity, pleomorphism, increased mitoses) confined within
the basement membrane. It represents a pre-neoplastic change. Carcinoma
in situ (D) would involve cells that have not invaded but are malignant, while
simple hyperplasia (A) lacks atypia.
3. A 55-year-old man with COPD presents with a barrel chest and a flattened
diaphragm on chest X-ray. These physical changes are primarily the result of:
A) Apoptosis of type I alveolar cells
B) Centrilobular emphysema with loss of elastic recoil leading to air trapping
C) Hyperplasia of bronchial smooth muscle
D) Hypertrophy of mucus glands
**Correct Answer:** B) Centrilobular emphysema with loss of elastic recoil
leading to air trapping
**Rationale:** Emphysema destroys alveolar walls, leading to a loss of elastic
recoil. This causes air trapping and hyperinflation of the lungs, which pushes
the diaphragm downward (flattening it) and increases the anteroposterior
diameter of the chest (barrel chest). The other options describe other COPD
pathologies (chronic bronchitis, asthma).
4. A 70-year-old man with congestive heart failure (CHF) develops bilateral
pitting edema in his lower extremities. Which alteration in Starling forces is
primarily responsible for this edema?
A) Increased plasma oncotic pressure
B) Increased interstitial hydrostatic pressure
C) Increased capillary hydrostatic pressure
D) Decreased capillary oncotic pressure
**Correct Answer:** C) Increased capillary hydrostatic pressure
, **Rationale:** In heart failure, increased venous pressure leads to increased
capillary hydrostatic pressure. This forces fluid out of the capillaries and into
the interstitial space, resulting in edema. Plasma oncotic pressure is typically
decreased in conditions like liver disease or malnutrition, not CHF.
5. A 25-year-old man with acute appendicitis has right lower quadrant pain,
fever, and neutrophilia. Which inflammatory mediator is most responsible for
neutrophil margination and chemotaxis to the site of infection?
A) Interleukin-1 (IL-1)
B) Histamine
C) Complement fragment C5a
D) Bradykinin
**Correct Answer:** C) Complement fragment C5a
**Rationale:** C5a is a potent chemoattractant that causes neutrophil
margination (adhesion to endothelium) and chemotaxis (movement toward
the site of inflammation). IL-1 causes fever and the acute-phase response,
histamine causes vasodilation, and bradykinin causes pain and vasodilation.
6. A 60-year-old woman with rheumatoid arthritis has hand X-rays showing
pannus formation. Pannus is best described as:
A) Granulation tissue with fibroblasts and neovessels invading cartilage
B) Caseating necrosis with multinucleated giant cells
C) Fibrinoid necrosis of vessel walls
D) Amyloid deposition in the synovium
**Correct Answer:** A) Granulation tissue with fibroblasts and neovessels
invading cartilage
