NR 507 Week 1-4 Midterm Exams NR-507 Adv
Pathophysiology Actual Week 1-4 Midterm
Exam Complete 1- 100 Exam Questions
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SECTION I: CELLULAR ADAPTATION, INJURY & DEATH (Questions 1–25)
1. A patient with long-standing hypertension develops thickening of the left
ventricular wall. Which cellular adaptation does this represent?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
Correct Answer: C. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot
divide. In response to increased workload from chronic hypertension, individual
myocardial cells increase in size (hypertrophy) rather than number. This is a
pathological adaptation that initially compensates for increased afterload but
eventually leads to decreased compliance and diastolic dysfunction. Atrophy
refers to decreased cell size, metaplasia is the replacement of one cell type with
another, and hyperplasia involves increased cell number (which does not occur in
cardiac muscle).
2. A 62-year-old smoker undergoes a bronchial biopsy that reveals replacement
of normal ciliated columnar epithelium with stratified squamous epithelium.
This finding is most consistent with:
,A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Neoplasia
Correct Answer: B. Metaplasia
Rationale: Metaplasia is a reversible adaptive change in which one
mature, differentiated cell type is replaced by another mature cell type that can
better withstand environmental stress. In smokers, chronic irritation causes
ciliated columnar epithelium to be replaced by stratified squamous epithelium,
which is more resistant to injury but loses mucociliary function. This is a precursor
to dysplasia and potentially malignancy.
3. Which of the following BEST distinguishes apoptosis from necrosis?
A. Apoptosis causes significant inflammation; necrosis does not
B. Apoptosis is an energy-dependent, programmed process; necrosis is passive
and uncontrolled
C. Apoptosis involves cell swelling; necrosis involves cell shrinkage
D. Apoptosis is always pathological; necrosis can be physiological
Correct Answer: B. Apoptosis is an energy-dependent, programmed
process; necrosis is passive and uncontrolled
Rationale: Apoptosis is a highly regulated, ATP-dependent process of
programmed cell death that eliminates damaged or unwanted cells without
triggering inflammation. In contrast, necrosis is a passive, uncontrolled process
resulting from severe injury that causes cell swelling, membrane rupture, and
inflammation. This fundamental distinction is critical for understanding tissue
injury and repair.
4. A 58-year-old male experiences an acute myocardial infarction. The
irreversibly damaged myocardial tissue would most likely demonstrate which
type of necrosis?
,A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis is characteristic of ischemic injury in
tissues with high protein content, such as the heart, kidney, and spleen. The
underlying tissue architecture remains visible for days despite loss of nuclei,
because ischemia denatures both structural proteins and lysosomal enzymes,
preventing proteolysis. Liquefactive necrosis occurs in the brain, caseous necrosis
in tuberculosis, and fat necrosis in pancreatitis.
5. Which cellular adaptation is characterized by an increase in the number of
cells in an organ or tissue?
A. Hypertrophy
B. Atrophy
C. Metaplasia
D. Hyperplasia
Correct Answer: D. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in a tissue or
organ, resulting from increased cell division. It occurs in tissues capable of mitotic
division, such as the epidermis, intestinal epithelium, and glandular tissue.
Hyperplasia can be physiological (e.g., breast tissue during pregnancy) or
pathological (e.g., endometrial hyperplasia from unopposed estrogen).
6. A patient with chronic gastritis develops replacement of normal gastric
mucosa with intestinal-type epithelium containing goblet cells. This is an
example of:
A. Dysplasia
B. Intestinal metaplasia
, C. Anaplasia
D. Hyperplasia
Correct Answer: B. Intestinal metaplasia
Rationale: Intestinal metaplasia occurs when chronic inflammation causes
gastric epithelial cells to be replaced by intestinal-type epithelium. This is a classic
precursor lesion in the Correa cascade of gastric carcinogenesis, typically
associated with chronic H. pylori infection. It represents an adaptive response
gone awry and is a risk factor for gastric adenocarcinoma.
7. During which phase of the cell cycle does DNA replication occur?
A. G₁ phase
B. S phase
C. G₂ phase
D. M phase
Correct Answer: B. S phase
Rationale: The S (synthesis) phase of interphase is when DNA replication
occurs. During this phase, each chromosome is duplicated to produce two
identical sister chromatids. The G₁ phase precedes S phase and involves cell
growth and preparation for DNA synthesis, while G₂ follows S phase and involves
further growth and preparation for mitosis. Understanding the cell cycle is
fundamental to cancer biology, as dysregulation of these checkpoints leads to
uncontrolled proliferation.
8. A 45-year-old woman with a history of recurrent urinary tract infections is
found to have a bladder biopsy showing disorganized, irregularly shaped cells
with hyperchromatic nuclei and increased mitotic figures. These cells have not
invaded the basement membrane. This finding is most consistent with:
A. Metaplasia
B. Dysplasia
Pathophysiology Actual Week 1-4 Midterm
Exam Complete 1- 100 Exam Questions
Proctored Via Examplify Chamberlain
University With Correct Answers | 100% Pass
Guaranteed | Graded A+ |
SECTION I: CELLULAR ADAPTATION, INJURY & DEATH (Questions 1–25)
1. A patient with long-standing hypertension develops thickening of the left
ventricular wall. Which cellular adaptation does this represent?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
Correct Answer: C. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot
divide. In response to increased workload from chronic hypertension, individual
myocardial cells increase in size (hypertrophy) rather than number. This is a
pathological adaptation that initially compensates for increased afterload but
eventually leads to decreased compliance and diastolic dysfunction. Atrophy
refers to decreased cell size, metaplasia is the replacement of one cell type with
another, and hyperplasia involves increased cell number (which does not occur in
cardiac muscle).
2. A 62-year-old smoker undergoes a bronchial biopsy that reveals replacement
of normal ciliated columnar epithelium with stratified squamous epithelium.
This finding is most consistent with:
,A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Neoplasia
Correct Answer: B. Metaplasia
Rationale: Metaplasia is a reversible adaptive change in which one
mature, differentiated cell type is replaced by another mature cell type that can
better withstand environmental stress. In smokers, chronic irritation causes
ciliated columnar epithelium to be replaced by stratified squamous epithelium,
which is more resistant to injury but loses mucociliary function. This is a precursor
to dysplasia and potentially malignancy.
3. Which of the following BEST distinguishes apoptosis from necrosis?
A. Apoptosis causes significant inflammation; necrosis does not
B. Apoptosis is an energy-dependent, programmed process; necrosis is passive
and uncontrolled
C. Apoptosis involves cell swelling; necrosis involves cell shrinkage
D. Apoptosis is always pathological; necrosis can be physiological
Correct Answer: B. Apoptosis is an energy-dependent, programmed
process; necrosis is passive and uncontrolled
Rationale: Apoptosis is a highly regulated, ATP-dependent process of
programmed cell death that eliminates damaged or unwanted cells without
triggering inflammation. In contrast, necrosis is a passive, uncontrolled process
resulting from severe injury that causes cell swelling, membrane rupture, and
inflammation. This fundamental distinction is critical for understanding tissue
injury and repair.
4. A 58-year-old male experiences an acute myocardial infarction. The
irreversibly damaged myocardial tissue would most likely demonstrate which
type of necrosis?
,A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis is characteristic of ischemic injury in
tissues with high protein content, such as the heart, kidney, and spleen. The
underlying tissue architecture remains visible for days despite loss of nuclei,
because ischemia denatures both structural proteins and lysosomal enzymes,
preventing proteolysis. Liquefactive necrosis occurs in the brain, caseous necrosis
in tuberculosis, and fat necrosis in pancreatitis.
5. Which cellular adaptation is characterized by an increase in the number of
cells in an organ or tissue?
A. Hypertrophy
B. Atrophy
C. Metaplasia
D. Hyperplasia
Correct Answer: D. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in a tissue or
organ, resulting from increased cell division. It occurs in tissues capable of mitotic
division, such as the epidermis, intestinal epithelium, and glandular tissue.
Hyperplasia can be physiological (e.g., breast tissue during pregnancy) or
pathological (e.g., endometrial hyperplasia from unopposed estrogen).
6. A patient with chronic gastritis develops replacement of normal gastric
mucosa with intestinal-type epithelium containing goblet cells. This is an
example of:
A. Dysplasia
B. Intestinal metaplasia
, C. Anaplasia
D. Hyperplasia
Correct Answer: B. Intestinal metaplasia
Rationale: Intestinal metaplasia occurs when chronic inflammation causes
gastric epithelial cells to be replaced by intestinal-type epithelium. This is a classic
precursor lesion in the Correa cascade of gastric carcinogenesis, typically
associated with chronic H. pylori infection. It represents an adaptive response
gone awry and is a risk factor for gastric adenocarcinoma.
7. During which phase of the cell cycle does DNA replication occur?
A. G₁ phase
B. S phase
C. G₂ phase
D. M phase
Correct Answer: B. S phase
Rationale: The S (synthesis) phase of interphase is when DNA replication
occurs. During this phase, each chromosome is duplicated to produce two
identical sister chromatids. The G₁ phase precedes S phase and involves cell
growth and preparation for DNA synthesis, while G₂ follows S phase and involves
further growth and preparation for mitosis. Understanding the cell cycle is
fundamental to cancer biology, as dysregulation of these checkpoints leads to
uncontrolled proliferation.
8. A 45-year-old woman with a history of recurrent urinary tract infections is
found to have a bladder biopsy showing disorganized, irregularly shaped cells
with hyperchromatic nuclei and increased mitotic figures. These cells have not
invaded the basement membrane. This finding is most consistent with:
A. Metaplasia
B. Dysplasia
