NR 507 MIDTERM EXAM 2 LATEST VERSIONS
(VERSION A& B) / NR 507 WEEK 4 MIDTERM
ADVANCED PATHOPHYSIOLOGY MIDTERM
EXAM
SECTION 1: CELLULAR ADAPTATION, INJURY & NEOPLASIA
Question 1
A 52-year-old male with chronic liver disease presents with elevated liver
enzymes and bilirubin. Cellular injury in this patient is most likely mediated by
which mechanism?
A. Apoptosis triggered by growth factor withdrawal
B. Free radical injury leading to lipid peroxidation of cell membranes
C. Hypertrophic adaptation without cellular damage
D. Reversible cellular swelling without enzymatic leakage
Correct Answer: B
Rationale: Free radical injury causes lipid peroxidation, disrupting
membrane integrity and leading to enzyme leakage. Hypertrophy is an adaptive
response, not an injury mechanism, and reversible swelling does not explain
elevated enzymes. Free radicals are highly reactive molecules with unpaired
electrons that damage cell membranes, proteins, and DNA. In chronic liver
disease (often related to alcohol metabolism), reactive oxygen species are
generated during ethanol oxidation, leading to hepatocellular damage and
leakage of enzymes such as AST and ALT into the bloodstream.
Question 2
The irreversible marker of cell death on electron microscopy is:
A. Cellular swelling
B. Nuclear pyknosis
C. Mitochondrial amorphous (flocculent) densities
D. Membrane blebbing
, Correct Answer: C
Rationale: Flocculent densities in the mitochondrial matrix are an
irreversible marker of cell death, indicating severe membrane damage. This is the
“point of no return” where cell death is inevitable even if the stressor is removed.
Cellular swelling is the earliest reversible sign, nuclear pyknosis and membrane
blebbing can be seen in both reversible and irreversible injury, but flocculent
mitochondrial densities specifically indicate irreversibility.
Question 3
A 45-year-old woman with a history of smoking develops chronic hypoxia. Her
erythrocyte count is elevated on laboratory testing. This cellular adaptation is
best described as which type?
A. Physiologic hyperplasia in response to tissue demand
B. Compensatory hyperplasia of erythroid precursors
C. Pathologic hypertrophy due to nicotine exposure
D. Metaplasia of respiratory epithelium to squamous type
Correct Answer: B
Rationale: Chronic hypoxia stimulates erythropoietin production, causing
compensatory hyperplasia of erythroid precursors in the bone marrow. This is an
adaptive response to increase oxygen-carrying capacity. Metaplasia occurs in
airway epithelium but does not explain elevated erythrocytes. Hypertrophy refers
to increased cell size, not increased cell number, and does not explain elevated
RBC count. Hyperplasia is an increase in the number of cells in an organ or tissue.
Question 4
Which process describes the decrease in cellular size caused by aging, disuse, or
reduced blood supply?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
, Rationale: Atrophy is the decrease in cellular size due to aging, disuse, or
reduced blood supply. Hypertrophy is an increase in cell size; hyperplasia is an
increase in cell number; metaplasia is the replacement of one cell type with
another. Atrophy can be physiologic (e.g., thymus involution) or pathologic (e.g.,
muscle wasting from immobilization).
Question 5
A 38-year-old female presents with a breast lump that is biopsy-proven to be a
benign tumor. Which characteristic best differentiates this benign neoplasm from
a malignant one?
A. Rapid, invasive growth into surrounding structures
B. Well-differentiated cells that closely resemble normal tissue of origin
C. Ability to metastasize to distant organs via lymphatics
D. Presence of poorly differentiated cells with anaplasia
Correct Answer: B
Rationale: Benign neoplasms are well-differentiated, grow slowly, remain
localized, and do not metastasize. Malignant tumors exhibit rapid growth,
invasion, and metastasis. Benign tumors are typically encapsulated and do not
invade surrounding tissues or spread to distant sites. Their cells closely resemble
the normal tissue of origin, whereas malignant cells show varying degrees of
differentiation, from well-differentiated to anaplastic.
Question 6
A client presents with cellular swelling due to hypoxic injury. This is an example
of:
A. Irreversible cell injury
B. Reversible cell injury (hydropic swelling)
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B
Rationale: Hydropic swelling is a reversible form of cell injury caused by
ATP depletion, leading to failure of the Na⁺/K⁺-ATPase pump and subsequent
, water influx. This is the earliest morphologic sign of cell injury. If the hypoxic
stimulus is removed, the cell can recover; if it persists, irreversible injury and
necrosis ensue. Caseous necrosis is characteristic of tuberculosis, and gangrenous
necrosis typically occurs in extremities with compromised blood supply.
Question 7
What is the earliest reversible morphologic sign of cell injury?
A. Nuclear fragmentation
B. Cellular swelling (hydropic change)
C. Karyolysis
D. Fatty change
Correct Answer: B
Rationale: Cellular swelling is the earliest reversible sign of cell injury,
caused by ATP depletion leading to failure of the Na⁺/K⁺ pump and subsequent
water influx. This is followed by fatty change in some organs. Nuclear
fragmentation and karyolysis are features of irreversible cell death (necrosis).
Fatty change (steatosis) can also be reversible but occurs later than hydropic
swelling in most tissues.
Question 8
The process where a normal cell becomes a cancer cell is called:
A. Metaplasia
B. Dysplasia
C. Cell transformation
D. Anaplasia
Correct Answer: C
Rationale: Cell transformation is the process by which a normal cell
acquires the characteristics of a cancer cell. It involves genetic mutations that lead
to uncontrolled growth, loss of differentiation, and the ability to invade and
metastasize. Metaplasia is a reversible change from one mature cell type to
another; dysplasia refers to disordered growth that is often premalignant;
anaplasia refers to the lack of differentiation seen in malignant cells.
(VERSION A& B) / NR 507 WEEK 4 MIDTERM
ADVANCED PATHOPHYSIOLOGY MIDTERM
EXAM
SECTION 1: CELLULAR ADAPTATION, INJURY & NEOPLASIA
Question 1
A 52-year-old male with chronic liver disease presents with elevated liver
enzymes and bilirubin. Cellular injury in this patient is most likely mediated by
which mechanism?
A. Apoptosis triggered by growth factor withdrawal
B. Free radical injury leading to lipid peroxidation of cell membranes
C. Hypertrophic adaptation without cellular damage
D. Reversible cellular swelling without enzymatic leakage
Correct Answer: B
Rationale: Free radical injury causes lipid peroxidation, disrupting
membrane integrity and leading to enzyme leakage. Hypertrophy is an adaptive
response, not an injury mechanism, and reversible swelling does not explain
elevated enzymes. Free radicals are highly reactive molecules with unpaired
electrons that damage cell membranes, proteins, and DNA. In chronic liver
disease (often related to alcohol metabolism), reactive oxygen species are
generated during ethanol oxidation, leading to hepatocellular damage and
leakage of enzymes such as AST and ALT into the bloodstream.
Question 2
The irreversible marker of cell death on electron microscopy is:
A. Cellular swelling
B. Nuclear pyknosis
C. Mitochondrial amorphous (flocculent) densities
D. Membrane blebbing
, Correct Answer: C
Rationale: Flocculent densities in the mitochondrial matrix are an
irreversible marker of cell death, indicating severe membrane damage. This is the
“point of no return” where cell death is inevitable even if the stressor is removed.
Cellular swelling is the earliest reversible sign, nuclear pyknosis and membrane
blebbing can be seen in both reversible and irreversible injury, but flocculent
mitochondrial densities specifically indicate irreversibility.
Question 3
A 45-year-old woman with a history of smoking develops chronic hypoxia. Her
erythrocyte count is elevated on laboratory testing. This cellular adaptation is
best described as which type?
A. Physiologic hyperplasia in response to tissue demand
B. Compensatory hyperplasia of erythroid precursors
C. Pathologic hypertrophy due to nicotine exposure
D. Metaplasia of respiratory epithelium to squamous type
Correct Answer: B
Rationale: Chronic hypoxia stimulates erythropoietin production, causing
compensatory hyperplasia of erythroid precursors in the bone marrow. This is an
adaptive response to increase oxygen-carrying capacity. Metaplasia occurs in
airway epithelium but does not explain elevated erythrocytes. Hypertrophy refers
to increased cell size, not increased cell number, and does not explain elevated
RBC count. Hyperplasia is an increase in the number of cells in an organ or tissue.
Question 4
Which process describes the decrease in cellular size caused by aging, disuse, or
reduced blood supply?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
, Rationale: Atrophy is the decrease in cellular size due to aging, disuse, or
reduced blood supply. Hypertrophy is an increase in cell size; hyperplasia is an
increase in cell number; metaplasia is the replacement of one cell type with
another. Atrophy can be physiologic (e.g., thymus involution) or pathologic (e.g.,
muscle wasting from immobilization).
Question 5
A 38-year-old female presents with a breast lump that is biopsy-proven to be a
benign tumor. Which characteristic best differentiates this benign neoplasm from
a malignant one?
A. Rapid, invasive growth into surrounding structures
B. Well-differentiated cells that closely resemble normal tissue of origin
C. Ability to metastasize to distant organs via lymphatics
D. Presence of poorly differentiated cells with anaplasia
Correct Answer: B
Rationale: Benign neoplasms are well-differentiated, grow slowly, remain
localized, and do not metastasize. Malignant tumors exhibit rapid growth,
invasion, and metastasis. Benign tumors are typically encapsulated and do not
invade surrounding tissues or spread to distant sites. Their cells closely resemble
the normal tissue of origin, whereas malignant cells show varying degrees of
differentiation, from well-differentiated to anaplastic.
Question 6
A client presents with cellular swelling due to hypoxic injury. This is an example
of:
A. Irreversible cell injury
B. Reversible cell injury (hydropic swelling)
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B
Rationale: Hydropic swelling is a reversible form of cell injury caused by
ATP depletion, leading to failure of the Na⁺/K⁺-ATPase pump and subsequent
, water influx. This is the earliest morphologic sign of cell injury. If the hypoxic
stimulus is removed, the cell can recover; if it persists, irreversible injury and
necrosis ensue. Caseous necrosis is characteristic of tuberculosis, and gangrenous
necrosis typically occurs in extremities with compromised blood supply.
Question 7
What is the earliest reversible morphologic sign of cell injury?
A. Nuclear fragmentation
B. Cellular swelling (hydropic change)
C. Karyolysis
D. Fatty change
Correct Answer: B
Rationale: Cellular swelling is the earliest reversible sign of cell injury,
caused by ATP depletion leading to failure of the Na⁺/K⁺ pump and subsequent
water influx. This is followed by fatty change in some organs. Nuclear
fragmentation and karyolysis are features of irreversible cell death (necrosis).
Fatty change (steatosis) can also be reversible but occurs later than hydropic
swelling in most tissues.
Question 8
The process where a normal cell becomes a cancer cell is called:
A. Metaplasia
B. Dysplasia
C. Cell transformation
D. Anaplasia
Correct Answer: C
Rationale: Cell transformation is the process by which a normal cell
acquires the characteristics of a cancer cell. It involves genetic mutations that lead
to uncontrolled growth, loss of differentiation, and the ability to invade and
metastasize. Metaplasia is a reversible change from one mature cell type to
another; dysplasia refers to disordered growth that is often premalignant;
anaplasia refers to the lack of differentiation seen in malignant cells.
