WGU D236 PATHOPHYSIOLOGY FINAL
EXAM-with solutions-2023-2024
Section 1: Cellular Adaptation, Injury, and Death
1. A 68-year-old male has been on bedrest for 3 weeks following a left femoral fracture.
Physical therapy notes significant weakness and reduced muscle mass in his left leg compared
to the right. Which cellular adaptation best explains this finding?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a reduction in cell size due to decreased workload, disuse, or
inadequate nutrition. Disuse atrophy occurs rapidly with immobilization. Hypertrophy (A) is an
increase in cell size, not a decrease. Hyperplasia (B) is an increase in cell number, which requires
mitotic capacity. Metaplasia (D) is a reversible change from one mature cell type to another, not
a change in cell size or number.
2. A 52-year-old woman presents with postmenopausal bleeding. Endometrial biopsy reveals
an increased number of endometrial glands with crowded, irregular architecture. This finding
is most consistent with which cellular adaptation?
A. Physiologic hypertrophy
B. Pathologic hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Endometrial hyperplasia is caused by pathologic hyperplasia driven by prolonged
estrogen stimulation without adequate progesterone opposition. The increased glandular cell
number leads to crowded architecture and abnormal bleeding. Physiologic hypertrophy (A)
increases cell size, not number. Atrophy (C) decreases cell size. Metaplasia (D) involves
replacement of one cell type with another.
,3. A 45-year-old smoker with a 20 pack-year history undergoes bronchoscopy. Biopsy of the
tracheal epithelium shows replacement of normal ciliated columnar epithelium with stratified
squamous epithelium. This adaptive change is known as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible transformation of one differentiated cell type to
another, often in response to chronic irritation. Smoking-induced injury causes ciliated columnar
epithelium to transform into stratified squamous epithelium, which is more resistant to tobacco
toxins. Hyperplasia (A) increases cell number. Dysplasia (B) involves abnormal maturation and
disordered growth. Anaplasia (D) refers to undifferentiated cells seen in malignancy.
4. A 38-year-old woman has a Pap smear showing abnormal cells with nuclear
hyperchromasia, pleomorphism, and increased nuclear-to-cytoplasmic ratio confined to the
epithelial layer. This finding is most consistent with:
A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Dysplasia is characterized by abnormal cell growth with changes in size, shape,
and organization, including nuclear hyperchromasia, pleomorphism, and loss of normal polarity.
It is considered a precancerous lesion. When confined to the epithelial layer, it has not yet
invaded the basement membrane. Metaplasia (A) is a reversible cell-type change without
nuclear atypia. Anaplasia (D) indicates fully malignant, undifferentiated cells.
5. A 55-year-old male presents with right upper quadrant pain and fever following an episode
of hypotension during surgery. CT shows a wedge-shaped area of coagulative necrosis in the
,liver. A separate patient has a brain abscess with liquefactive necrosis. What best explains the
difference in necrosis type between these two organs?
A. The liver has a richer blood supply than the brain
B. The liver has more lysosomal enzymes that prevent liquefaction
C. The brain has high lipid and low protein content with limited regenerative capacity
D. The liver undergoes apoptosis while the brain undergoes necrosis
Correct Answer: C
Rationale: The type of necrosis depends on tissue composition. Coagulative necrosis occurs
in organs with high protein and low lipid content (heart, liver, kidneys); denatured proteins
maintain tissue architecture. Liquefactive necrosis occurs in the brain and abscesses because
the brain has high lipid content and low protein content, and enzymes rapidly digest dead cells.
6. Which statement best describes apoptosis?
A. Apoptosis describes an increase in the number of cells
B. Apoptosis occurs in irreversibly damaged cells and causes inflammation
C. Apoptosis is an increase in the size of cells
D. Apoptosis is the natural removal of injured or worn-out cells without inflammation
Correct Answer: D
Rationale: Apoptosis is programmed cell death characterized by cell shrinkage, DNA
fragmentation, and formation of apoptotic bodies without inflammation. It is a normal
physiologic process for removing injured or worn-out cells. Necrosis, in contrast, involves
swelling and inflammation.
7. A patient has been exercising his arms repeatedly with resistance training. Which
statement by the nurse explains the increase in the size of the arms?
A. "Your cells have atrophied in response to increased oxygen."
B. "Your cells have hypertrophied in response to increased workload."
C. "You have increased your number of cells due to increased oxygenation."
D. "You have caused the cells to clump together in response to exercise."
Correct Answer: B
, Rationale: Hypertrophy is an increase in cell size in response to increased workload. Skeletal
muscle cells cannot divide, so they respond to resistance training by enlarging existing cells.
Atrophy (A) is a decrease in cell size. Hyperplasia (C) is an increase in cell number, which does
not occur in skeletal muscle.
8. What can the nurse tell family members to best explain muscle atrophy of a family member
who has been in a persistent coma?
A. "Cell size has increased in response to immobility."
B. "Cells hypertrophy in response to disuse."
C. "Cell size decreases as workload declines."
D. "Cells need more oxygen the longer they are immobile."
Correct Answer: C
Rationale: Atrophy is a decrease in cell size and metabolic activity due to reduced workload,
denervation, diminished blood supply, inadequate nutrition, or aging. In a comatose patient,
muscles are not being used, so cell size decreases as workload declines. Hypertrophy (B) is an
increase in cell size.
9. A patient with a deficient oxidative phosphorylation pathway is most likely to experience
which metabolic adaptation, and what is the primary consequence?
A. Increased fatty acid oxidation, leading to excess ATP production
B. Upregulation of anaerobic glycolysis, leading to increased lactate production
C. Enhanced ketone body synthesis, leading to metabolic alkalosis
D. Activation of the pentose phosphate pathway, leading to increased NADPH
Correct Answer: B
Rationale: Deficient oxidative phosphorylation shifts metabolism to anaerobic glycolysis,
producing ATP but also pyruvate, which is converted to lactate to regenerate NAD⁺. Increased
lactate can cause lactic acidosis. Fatty acid oxidation requires oxidative phosphorylation. Ketone
bodies are produced in starvation, not as a direct compensation for oxidative phosphorylation
defects.
10. Which type of necrosis is most commonly associated with ischemia in the brain?
EXAM-with solutions-2023-2024
Section 1: Cellular Adaptation, Injury, and Death
1. A 68-year-old male has been on bedrest for 3 weeks following a left femoral fracture.
Physical therapy notes significant weakness and reduced muscle mass in his left leg compared
to the right. Which cellular adaptation best explains this finding?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a reduction in cell size due to decreased workload, disuse, or
inadequate nutrition. Disuse atrophy occurs rapidly with immobilization. Hypertrophy (A) is an
increase in cell size, not a decrease. Hyperplasia (B) is an increase in cell number, which requires
mitotic capacity. Metaplasia (D) is a reversible change from one mature cell type to another, not
a change in cell size or number.
2. A 52-year-old woman presents with postmenopausal bleeding. Endometrial biopsy reveals
an increased number of endometrial glands with crowded, irregular architecture. This finding
is most consistent with which cellular adaptation?
A. Physiologic hypertrophy
B. Pathologic hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Endometrial hyperplasia is caused by pathologic hyperplasia driven by prolonged
estrogen stimulation without adequate progesterone opposition. The increased glandular cell
number leads to crowded architecture and abnormal bleeding. Physiologic hypertrophy (A)
increases cell size, not number. Atrophy (C) decreases cell size. Metaplasia (D) involves
replacement of one cell type with another.
,3. A 45-year-old smoker with a 20 pack-year history undergoes bronchoscopy. Biopsy of the
tracheal epithelium shows replacement of normal ciliated columnar epithelium with stratified
squamous epithelium. This adaptive change is known as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible transformation of one differentiated cell type to
another, often in response to chronic irritation. Smoking-induced injury causes ciliated columnar
epithelium to transform into stratified squamous epithelium, which is more resistant to tobacco
toxins. Hyperplasia (A) increases cell number. Dysplasia (B) involves abnormal maturation and
disordered growth. Anaplasia (D) refers to undifferentiated cells seen in malignancy.
4. A 38-year-old woman has a Pap smear showing abnormal cells with nuclear
hyperchromasia, pleomorphism, and increased nuclear-to-cytoplasmic ratio confined to the
epithelial layer. This finding is most consistent with:
A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Dysplasia is characterized by abnormal cell growth with changes in size, shape,
and organization, including nuclear hyperchromasia, pleomorphism, and loss of normal polarity.
It is considered a precancerous lesion. When confined to the epithelial layer, it has not yet
invaded the basement membrane. Metaplasia (A) is a reversible cell-type change without
nuclear atypia. Anaplasia (D) indicates fully malignant, undifferentiated cells.
5. A 55-year-old male presents with right upper quadrant pain and fever following an episode
of hypotension during surgery. CT shows a wedge-shaped area of coagulative necrosis in the
,liver. A separate patient has a brain abscess with liquefactive necrosis. What best explains the
difference in necrosis type between these two organs?
A. The liver has a richer blood supply than the brain
B. The liver has more lysosomal enzymes that prevent liquefaction
C. The brain has high lipid and low protein content with limited regenerative capacity
D. The liver undergoes apoptosis while the brain undergoes necrosis
Correct Answer: C
Rationale: The type of necrosis depends on tissue composition. Coagulative necrosis occurs
in organs with high protein and low lipid content (heart, liver, kidneys); denatured proteins
maintain tissue architecture. Liquefactive necrosis occurs in the brain and abscesses because
the brain has high lipid content and low protein content, and enzymes rapidly digest dead cells.
6. Which statement best describes apoptosis?
A. Apoptosis describes an increase in the number of cells
B. Apoptosis occurs in irreversibly damaged cells and causes inflammation
C. Apoptosis is an increase in the size of cells
D. Apoptosis is the natural removal of injured or worn-out cells without inflammation
Correct Answer: D
Rationale: Apoptosis is programmed cell death characterized by cell shrinkage, DNA
fragmentation, and formation of apoptotic bodies without inflammation. It is a normal
physiologic process for removing injured or worn-out cells. Necrosis, in contrast, involves
swelling and inflammation.
7. A patient has been exercising his arms repeatedly with resistance training. Which
statement by the nurse explains the increase in the size of the arms?
A. "Your cells have atrophied in response to increased oxygen."
B. "Your cells have hypertrophied in response to increased workload."
C. "You have increased your number of cells due to increased oxygenation."
D. "You have caused the cells to clump together in response to exercise."
Correct Answer: B
, Rationale: Hypertrophy is an increase in cell size in response to increased workload. Skeletal
muscle cells cannot divide, so they respond to resistance training by enlarging existing cells.
Atrophy (A) is a decrease in cell size. Hyperplasia (C) is an increase in cell number, which does
not occur in skeletal muscle.
8. What can the nurse tell family members to best explain muscle atrophy of a family member
who has been in a persistent coma?
A. "Cell size has increased in response to immobility."
B. "Cells hypertrophy in response to disuse."
C. "Cell size decreases as workload declines."
D. "Cells need more oxygen the longer they are immobile."
Correct Answer: C
Rationale: Atrophy is a decrease in cell size and metabolic activity due to reduced workload,
denervation, diminished blood supply, inadequate nutrition, or aging. In a comatose patient,
muscles are not being used, so cell size decreases as workload declines. Hypertrophy (B) is an
increase in cell size.
9. A patient with a deficient oxidative phosphorylation pathway is most likely to experience
which metabolic adaptation, and what is the primary consequence?
A. Increased fatty acid oxidation, leading to excess ATP production
B. Upregulation of anaerobic glycolysis, leading to increased lactate production
C. Enhanced ketone body synthesis, leading to metabolic alkalosis
D. Activation of the pentose phosphate pathway, leading to increased NADPH
Correct Answer: B
Rationale: Deficient oxidative phosphorylation shifts metabolism to anaerobic glycolysis,
producing ATP but also pyruvate, which is converted to lactate to regenerate NAD⁺. Increased
lactate can cause lactic acidosis. Fatty acid oxidation requires oxidative phosphorylation. Ketone
bodies are produced in starvation, not as a direct compensation for oxidative phosphorylation
defects.
10. Which type of necrosis is most commonly associated with ischemia in the brain?
