South College NSG 5140 Advanced Pathophysiology
Midterm Exam
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 South College NSG 5140 Advanced Pathophysiology Midterm Exam
Page 1
,Q1
A 55-year-old male with chronic heart failure develops marked peripheral edema. Which cellular
adaptation occurs in his myocardium due to increased workload?
A) Atrophy
B) Hyperplasia
C) Hypertrophy CORRECT
D) Metaplasia
Rationale
Hypertrophy is an increase in cell size, not cell number, which occurs in response to increased workload.
Chronic heart failure increases the workload on the myocardium, causing individual cardiac muscle cells
to enlarge. Cardiac muscle cells are terminally differentiated and cannot undergo hyperplasia (B).
Atrophy (A) is a decrease in cell size. Metaplasia (D) is the replacement of one cell type with another.
Q2
A pathologist examining a tissue sample notes "coagulative necrosis" in a kidney specimen. This
type of necrosis is MOST commonly associated with:
A) Ischemia CORRECT
B) Tuberculosis
C) Pancreatitis
D) Bacterial infection
Rationale
Coagulative necrosis is the most common type of necrosis and is typically caused by ischemia (loss of
blood supply) in solid organs such as the kidney, heart, and liver. The tissue architecture is preserved for
several days, with cells showing increased eosinophilia and loss of nuclei. Caseous necrosis (B) is
associated with tuberculosis. Fat necrosis (C) is associated with pancreatitis. Liquefactive necrosis (D) is
associated with bacterial infections and the central nervous system.
Q3
A patient with chronic alcoholism develops thiamine deficiency leading to Wernicke-Korsakoff
syndrome. The cellular injury in this condition is BEST described as:
A) Hypoxic injury
Page 2
,B) Nutritional injury CORRECT
C) Chemical injury
D) Physical injury
Rationale
Thiamine (vitamin B1) deficiency is a nutritional cause of cellular injury. Thiamine is an essential
coenzyme in carbohydrate metabolism, and its deficiency leads to impaired glucose utilization and ATP
production, particularly affecting neurons. This results in Wernicke-Korsakoff syndrome, characterized by
confusion, ataxia, and ophthalmoplegia.
Q4
A patient with chronic liver disease develops cirrhosis. The liver tissue shows extensive scarring
and nodule formation. This is BEST described as:
A) Regeneration
B) Repair by fibrosis CORRECT
C) Resolution
D) Hyperplasia
Rationale
Fibrosis is the replacement of damaged tissue with collagenous scar tissue when regeneration is not
possible. In cirrhosis, chronic liver injury leads to extensive fibrosis and nodular regeneration. Resolution
(C) involves complete restoration of normal tissue architecture, which does not occur in cirrhosis.
Regeneration (A) is the replacement of damaged tissue with identical functional tissue, which is limited in
the liver after extensive injury.
Q5
A patient with a tumor shows cells with atypical mitotic figures and invasion into surrounding
tissues. These findings are MOST consistent with:
A) Benign neoplasm
B) Malignant neoplasm CORRECT
C) Dysplasia
D) Metaplasia
Page 3
, Rationale
Malignant neoplasms (cancers) are characterized by invasion into surrounding tissues and the ability to
metastasize. Atypical mitotic figures and pleomorphism are also features of malignancy. Benign
neoplasms (A) are localized and do not invade or metastasize. Dysplasia (C) is a pre-neoplastic
condition without invasion. Metaplasia (D) is an adaptive change, not a neoplastic process.
Q6
Cellular injury due to hypoxia FIRST affects which cellular function?
A) Protein synthesis
B) Aerobic respiration / ATP production in mitochondria CORRECT
C) DNA replication
D) Anaerobic glycolysis
Rationale
Hypoxia deprives mitochondria of O2 as final electron acceptor. Oxidative phosphorylation stops within
seconds-minutes, ATP falls, Na+/K+ pump fails leading to cell swelling. Other functions fail downstream.
Q7
Which is the hallmark of irreversible cell injury?
A) Cellular swelling
B) Fatty change
C) Plasma membrane disruption and release of intracellular contents CORRECT
D) Glycogen depletion
Rationale
Reversible injury shows swelling and blebbing but membrane intact. Irreversible is marked by loss of
membrane integrity, mitochondrial vacuolization, and DAMPs release.
Q8
Apoptosis vs necrosis: which statement is true?
A) Apoptosis causes inflammation
Page 4
Midterm Exam
150 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 South College NSG 5140 Advanced Pathophysiology Midterm Exam
Page 1
,Q1
A 55-year-old male with chronic heart failure develops marked peripheral edema. Which cellular
adaptation occurs in his myocardium due to increased workload?
A) Atrophy
B) Hyperplasia
C) Hypertrophy CORRECT
D) Metaplasia
Rationale
Hypertrophy is an increase in cell size, not cell number, which occurs in response to increased workload.
Chronic heart failure increases the workload on the myocardium, causing individual cardiac muscle cells
to enlarge. Cardiac muscle cells are terminally differentiated and cannot undergo hyperplasia (B).
Atrophy (A) is a decrease in cell size. Metaplasia (D) is the replacement of one cell type with another.
Q2
A pathologist examining a tissue sample notes "coagulative necrosis" in a kidney specimen. This
type of necrosis is MOST commonly associated with:
A) Ischemia CORRECT
B) Tuberculosis
C) Pancreatitis
D) Bacterial infection
Rationale
Coagulative necrosis is the most common type of necrosis and is typically caused by ischemia (loss of
blood supply) in solid organs such as the kidney, heart, and liver. The tissue architecture is preserved for
several days, with cells showing increased eosinophilia and loss of nuclei. Caseous necrosis (B) is
associated with tuberculosis. Fat necrosis (C) is associated with pancreatitis. Liquefactive necrosis (D) is
associated with bacterial infections and the central nervous system.
Q3
A patient with chronic alcoholism develops thiamine deficiency leading to Wernicke-Korsakoff
syndrome. The cellular injury in this condition is BEST described as:
A) Hypoxic injury
Page 2
,B) Nutritional injury CORRECT
C) Chemical injury
D) Physical injury
Rationale
Thiamine (vitamin B1) deficiency is a nutritional cause of cellular injury. Thiamine is an essential
coenzyme in carbohydrate metabolism, and its deficiency leads to impaired glucose utilization and ATP
production, particularly affecting neurons. This results in Wernicke-Korsakoff syndrome, characterized by
confusion, ataxia, and ophthalmoplegia.
Q4
A patient with chronic liver disease develops cirrhosis. The liver tissue shows extensive scarring
and nodule formation. This is BEST described as:
A) Regeneration
B) Repair by fibrosis CORRECT
C) Resolution
D) Hyperplasia
Rationale
Fibrosis is the replacement of damaged tissue with collagenous scar tissue when regeneration is not
possible. In cirrhosis, chronic liver injury leads to extensive fibrosis and nodular regeneration. Resolution
(C) involves complete restoration of normal tissue architecture, which does not occur in cirrhosis.
Regeneration (A) is the replacement of damaged tissue with identical functional tissue, which is limited in
the liver after extensive injury.
Q5
A patient with a tumor shows cells with atypical mitotic figures and invasion into surrounding
tissues. These findings are MOST consistent with:
A) Benign neoplasm
B) Malignant neoplasm CORRECT
C) Dysplasia
D) Metaplasia
Page 3
, Rationale
Malignant neoplasms (cancers) are characterized by invasion into surrounding tissues and the ability to
metastasize. Atypical mitotic figures and pleomorphism are also features of malignancy. Benign
neoplasms (A) are localized and do not invade or metastasize. Dysplasia (C) is a pre-neoplastic
condition without invasion. Metaplasia (D) is an adaptive change, not a neoplastic process.
Q6
Cellular injury due to hypoxia FIRST affects which cellular function?
A) Protein synthesis
B) Aerobic respiration / ATP production in mitochondria CORRECT
C) DNA replication
D) Anaerobic glycolysis
Rationale
Hypoxia deprives mitochondria of O2 as final electron acceptor. Oxidative phosphorylation stops within
seconds-minutes, ATP falls, Na+/K+ pump fails leading to cell swelling. Other functions fail downstream.
Q7
Which is the hallmark of irreversible cell injury?
A) Cellular swelling
B) Fatty change
C) Plasma membrane disruption and release of intracellular contents CORRECT
D) Glycogen depletion
Rationale
Reversible injury shows swelling and blebbing but membrane intact. Irreversible is marked by loss of
membrane integrity, mitochondrial vacuolization, and DAMPs release.
Q8
Apoptosis vs necrosis: which statement is true?
A) Apoptosis causes inflammation
Page 4
