SUNY Downstate Medical Center
NRMS 5190 | Pathophysiology
Exam 1 Study Guide | 100%
Updated fall 2026/27, A+ Guide.
Course
NRMS 5190 (NRMS5190)
1. A patient develops reversible cellular injury after a temporary reduction in tissue
perfusion. Which cellular change is most characteristic of early reversible injury?
A. Cellular swelling
B. Nuclear fragmentation
C. Membrane rupture
D. Lysosomal destruction
Answer: A. Cellular swelling
Rationale: Cellular swelling is a classic early manifestation of reversible injury, usually
resulting from failure of ATP-dependent ion pumps and intracellular accumulation of sodium and
water.
2. Which mechanism is primarily responsible for cellular injury during severe ischemia?
A. Increased ATP production
B. Reduced oxidative phosphorylation
C. Increased protein synthesis
D. Increased intracellular pH
Answer: B. Reduced oxidative phosphorylation
Rationale: Ischemia decreases oxygen delivery, impairing mitochondrial oxidative
phosphorylation and ATP production. ATP depletion disrupts ion pumps, metabolism, and
cellular homeostasis.
3. A decrease in ATP production causes failure of the sodium-potassium ATPase. What is
the expected consequence?
A. Sodium moves out of the cell
B. Potassium accumulates outside the cell
C. Sodium accumulates inside the cell
D. Calcium is completely removed from the cell
Answer: C. Sodium accumulates inside the cell
,Rationale: ATP depletion impairs the sodium-potassium pump, causing intracellular sodium and
water accumulation, producing cellular swelling.
4. Which organelle is primarily responsible for aerobic ATP production?
A. Lysosome
B. Golgi apparatus
C. Mitochondrion
D. Ribosome
Answer: C. Mitochondrion
Rationale: Mitochondria generate most cellular ATP through oxidative phosphorylation.
Mitochondrial dysfunction is therefore a major component of cellular injury.
5. A patient experiences prolonged tissue hypoxia. Which metabolic adaptation occurs
initially?
A. Increased aerobic metabolism
B. Increased anaerobic glycolysis
C. Complete cessation of glycolysis
D. Increased oxidative phosphorylation
Answer: B. Increased anaerobic glycolysis
Rationale: When oxygen is insufficient, cells increase anaerobic glycolysis to generate limited
ATP. This causes increased lactate production and intracellular acidosis.
6. Why does severe hypoxia cause intracellular acidosis?
A. Increased bicarbonate production
B. Accumulation of lactic acid
C. Increased oxygen consumption
D. Increased mitochondrial ATP production
Answer: B. Accumulation of lactic acid
Rationale: Anaerobic glycolysis converts pyruvate to lactate. Accumulation of lactate
contributes to decreased intracellular pH.
7. Which finding most strongly suggests irreversible cellular injury?
A. Mild cellular swelling
B. Fatty change
C. Severe membrane damage
D. Temporary reduction in ATP
Answer: C. Severe membrane damage
,Rationale: Severe plasma membrane damage, inability to reverse mitochondrial dysfunction,
and extensive nuclear destruction are characteristic of irreversible injury.
8. Which nuclear change involves fragmentation of the nucleus?
A. Pyknosis
B. Karyorrhexis
C. Karyolysis
D. Hypertrophy
Answer: B. Karyorrhexis
Rationale: Pyknosis is nuclear condensation, karyorrhexis is nuclear fragmentation, and
karyolysis is dissolution of the nucleus.
9. What is apoptosis?
A. Uncontrolled cell rupture caused by infection
B. Programmed cell death
C. Cellular enlargement caused by increased workload
D. Accumulation of intracellular lipids
Answer: B. Programmed cell death
Rationale: Apoptosis is a regulated form of cell death that removes unwanted or damaged cells
with relatively little surrounding inflammation.
10. Which feature distinguishes apoptosis from necrosis?
A. Apoptosis usually causes extensive inflammation
B. Apoptosis involves regulated cellular dismantling
C. Apoptosis always results from ischemia
D. Apoptosis causes immediate rupture of the cell membrane
Answer: B. Apoptosis involves regulated cellular dismantling
Rationale: Apoptosis involves activation of intracellular pathways, cellular shrinkage, chromatin
condensation, and fragmentation into apoptotic bodies.
11. Which process occurs when a cell increases in size because of increased workload?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: B. Hypertrophy
, Rationale: Hypertrophy is an increase in individual cell size. It commonly occurs when cells
experience increased functional demand.
12. A patient develops an enlarged heart in response to chronic hypertension. Which
adaptation is most directly involved?
A. Cardiac myocyte hypertrophy
B. Cardiac myocyte hyperplasia
C. Metaplasia
D. Apoptosis
Answer: A. Cardiac myocyte hypertrophy
Rationale: Cardiac muscle cells have limited ability to divide. Chronic pressure overload
therefore produces enlargement primarily through hypertrophy.
13. Which cellular adaptation involves an increase in the number of cells?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in cell number caused by increased cellular proliferation.
14. Which situation is most likely to produce atrophy?
A. Increased workload
B. Chronic immobilization
C. Increased hormonal stimulation
D. Increased nutritional intake
Answer: B. Chronic immobilization
Rationale: Reduced workload, such as prolonged immobilization, can cause disuse atrophy
through decreased protein synthesis and increased protein degradation.
15. What is metaplasia?
A. Irreversible malignant transformation
B. Replacement of one mature cell type with another mature cell type
C. Increased cell size
D. Programmed cell death
Answer: B. Replacement of one mature cell type with another mature cell type
NRMS 5190 | Pathophysiology
Exam 1 Study Guide | 100%
Updated fall 2026/27, A+ Guide.
Course
NRMS 5190 (NRMS5190)
1. A patient develops reversible cellular injury after a temporary reduction in tissue
perfusion. Which cellular change is most characteristic of early reversible injury?
A. Cellular swelling
B. Nuclear fragmentation
C. Membrane rupture
D. Lysosomal destruction
Answer: A. Cellular swelling
Rationale: Cellular swelling is a classic early manifestation of reversible injury, usually
resulting from failure of ATP-dependent ion pumps and intracellular accumulation of sodium and
water.
2. Which mechanism is primarily responsible for cellular injury during severe ischemia?
A. Increased ATP production
B. Reduced oxidative phosphorylation
C. Increased protein synthesis
D. Increased intracellular pH
Answer: B. Reduced oxidative phosphorylation
Rationale: Ischemia decreases oxygen delivery, impairing mitochondrial oxidative
phosphorylation and ATP production. ATP depletion disrupts ion pumps, metabolism, and
cellular homeostasis.
3. A decrease in ATP production causes failure of the sodium-potassium ATPase. What is
the expected consequence?
A. Sodium moves out of the cell
B. Potassium accumulates outside the cell
C. Sodium accumulates inside the cell
D. Calcium is completely removed from the cell
Answer: C. Sodium accumulates inside the cell
,Rationale: ATP depletion impairs the sodium-potassium pump, causing intracellular sodium and
water accumulation, producing cellular swelling.
4. Which organelle is primarily responsible for aerobic ATP production?
A. Lysosome
B. Golgi apparatus
C. Mitochondrion
D. Ribosome
Answer: C. Mitochondrion
Rationale: Mitochondria generate most cellular ATP through oxidative phosphorylation.
Mitochondrial dysfunction is therefore a major component of cellular injury.
5. A patient experiences prolonged tissue hypoxia. Which metabolic adaptation occurs
initially?
A. Increased aerobic metabolism
B. Increased anaerobic glycolysis
C. Complete cessation of glycolysis
D. Increased oxidative phosphorylation
Answer: B. Increased anaerobic glycolysis
Rationale: When oxygen is insufficient, cells increase anaerobic glycolysis to generate limited
ATP. This causes increased lactate production and intracellular acidosis.
6. Why does severe hypoxia cause intracellular acidosis?
A. Increased bicarbonate production
B. Accumulation of lactic acid
C. Increased oxygen consumption
D. Increased mitochondrial ATP production
Answer: B. Accumulation of lactic acid
Rationale: Anaerobic glycolysis converts pyruvate to lactate. Accumulation of lactate
contributes to decreased intracellular pH.
7. Which finding most strongly suggests irreversible cellular injury?
A. Mild cellular swelling
B. Fatty change
C. Severe membrane damage
D. Temporary reduction in ATP
Answer: C. Severe membrane damage
,Rationale: Severe plasma membrane damage, inability to reverse mitochondrial dysfunction,
and extensive nuclear destruction are characteristic of irreversible injury.
8. Which nuclear change involves fragmentation of the nucleus?
A. Pyknosis
B. Karyorrhexis
C. Karyolysis
D. Hypertrophy
Answer: B. Karyorrhexis
Rationale: Pyknosis is nuclear condensation, karyorrhexis is nuclear fragmentation, and
karyolysis is dissolution of the nucleus.
9. What is apoptosis?
A. Uncontrolled cell rupture caused by infection
B. Programmed cell death
C. Cellular enlargement caused by increased workload
D. Accumulation of intracellular lipids
Answer: B. Programmed cell death
Rationale: Apoptosis is a regulated form of cell death that removes unwanted or damaged cells
with relatively little surrounding inflammation.
10. Which feature distinguishes apoptosis from necrosis?
A. Apoptosis usually causes extensive inflammation
B. Apoptosis involves regulated cellular dismantling
C. Apoptosis always results from ischemia
D. Apoptosis causes immediate rupture of the cell membrane
Answer: B. Apoptosis involves regulated cellular dismantling
Rationale: Apoptosis involves activation of intracellular pathways, cellular shrinkage, chromatin
condensation, and fragmentation into apoptotic bodies.
11. Which process occurs when a cell increases in size because of increased workload?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: B. Hypertrophy
, Rationale: Hypertrophy is an increase in individual cell size. It commonly occurs when cells
experience increased functional demand.
12. A patient develops an enlarged heart in response to chronic hypertension. Which
adaptation is most directly involved?
A. Cardiac myocyte hypertrophy
B. Cardiac myocyte hyperplasia
C. Metaplasia
D. Apoptosis
Answer: A. Cardiac myocyte hypertrophy
Rationale: Cardiac muscle cells have limited ability to divide. Chronic pressure overload
therefore produces enlargement primarily through hypertrophy.
13. Which cellular adaptation involves an increase in the number of cells?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in cell number caused by increased cellular proliferation.
14. Which situation is most likely to produce atrophy?
A. Increased workload
B. Chronic immobilization
C. Increased hormonal stimulation
D. Increased nutritional intake
Answer: B. Chronic immobilization
Rationale: Reduced workload, such as prolonged immobilization, can cause disuse atrophy
through decreased protein synthesis and increased protein degradation.
15. What is metaplasia?
A. Irreversible malignant transformation
B. Replacement of one mature cell type with another mature cell type
C. Increased cell size
D. Programmed cell death
Answer: B. Replacement of one mature cell type with another mature cell type
