NSG 5003 Final Exam – Advanced
Pathophysiology | Questions,
Answers & Rationales
Cellular Injury, Adaptation & Inflammation
1. A patient experiences prolonged tissue hypoxia. Which cellular change
occurs first as ATP production declines?
A. Increased oxidative phosphorylation
B. Failure of the sodium-potassium pump
C. Increased protein synthesis
D. Increased intracellular calcium removal
Answer: B. Failure of the sodium-potassium pump
Rationale: ATP depletion impairs the Na⁺/K⁺-ATPase, causing sodium and
water to enter cells and producing cellular swelling.
2. Which cellular adaptation involves an increase in cell size?
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: C. Hypertrophy
Rationale: Hypertrophy is enlargement of individual cells, usually caused by
increased workload or hormonal stimulation.
3. A patient with chronic gastroesophageal reflux develops replacement of
esophageal squamous epithelium with columnar epithelium. This is:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Hypertrophy
Answer: B. Metaplasia
Rationale: Metaplasia is a reversible substitution of one differentiated cell
type for another better able to tolerate chronic stress.
,4. Which finding is most characteristic of apoptosis?
A. Cellular swelling
B. Severe inflammation
C. Programmed cellular death
D. Membrane rupture with enzyme release
Answer: C. Programmed cellular death
Rationale: Apoptosis is regulated cell death that generally occurs without the
extensive inflammatory response associated with necrosis.
5. Which intracellular change is particularly important in irreversible cell
injury?
A. Mild glycogen depletion
B. Severe mitochondrial dysfunction
C. Temporary cellular swelling
D. Increased ATP production
Answer: B. Severe mitochondrial dysfunction
Rationale: Irreversible mitochondrial damage prevents adequate ATP
generation and contributes to loss of cellular viability.
6. Which reactive oxygen species can cause lipid peroxidation of cellular
membranes?
A. Free radicals
B. Albumin
C. Sodium ions
D. Bicarbonate
Answer: A. Free radicals
Rationale: Reactive oxygen species attack membrane lipids, proteins, and
DNA, contributing to oxidative cellular injury.
7. Which inflammatory mediator causes vasodilation and contributes to
increased vascular permeability?
A. Histamine
B. Hemoglobin
C. Insulin
D. Albumin
Answer: A. Histamine
Rationale: Histamine released primarily from mast cells causes vasodilation
and increases vascular permeability during acute inflammation.
,8. Which leukocyte is typically predominant during the early phase of acute
bacterial inflammation?
A. Lymphocyte
B. Neutrophil
C. Plasma cell
D. Eosinophil
Answer: B. Neutrophil
Rationale: Neutrophils are the predominant early leukocytes in most acute
bacterial inflammatory responses.
9. Which inflammatory mediator is strongly associated with fever?
A. IL-1
B. Insulin
C. Erythropoietin
D. Albumin
Answer: A. IL-1
Rationale: IL-1 acts on the hypothalamus and promotes prostaglandin
production, contributing to fever.
10. C-reactive protein is best classified as:
A. A clotting factor
B. An acute-phase reactant
C. A neurotransmitter
D. A steroid hormone
Answer: B. An acute-phase reactant
Rationale: CRP is produced by the liver in response to inflammatory cytokines,
particularly IL-6.
11. Which complement component is particularly important for chemotaxis of
neutrophils?
A. C3a
B. C5a
C. C1 inhibitor
D. Factor XII
Answer: B. C5a
Rationale: C5a is a potent chemotactic factor that recruits neutrophils to sites
of inflammation.
, 12. Chronic inflammation is commonly characterized by infiltration with:
A. Neutrophils only
B. Lymphocytes and macrophages
C. Erythrocytes
D. Platelets only
Answer: B. Lymphocytes and macrophages
Rationale: Chronic inflammation commonly involves macrophages,
lymphocytes, plasma cells, and ongoing tissue destruction and repair.
13. A granuloma is primarily composed of:
A. Aggregated activated macrophages
B. Platelets
C. Erythrocytes
D. Adipocytes
Answer: A. Aggregated activated macrophages
Rationale: Granulomas form when activated macrophages organize around
persistent inflammatory stimuli that are difficult to eliminate.
14. Which process describes movement of leukocytes toward a chemical
stimulus?
A. Diapedesis
B. Chemotaxis
C. Opsonization
D. Phagocytosis
Answer: B. Chemotaxis
Rationale: Chemotaxis is directed leukocyte movement toward chemical
signals released at the site of injury or infection.
15. Which process allows leukocytes to pass through the vascular
endothelium?
A. Diapedesis
B. Hypertrophy
C. Osmosis
D. Filtration
Answer: A. Diapedesis
Rationale: Diapedesis allows leukocytes to move between endothelial cells
into injured tissue.
Pathophysiology | Questions,
Answers & Rationales
Cellular Injury, Adaptation & Inflammation
1. A patient experiences prolonged tissue hypoxia. Which cellular change
occurs first as ATP production declines?
A. Increased oxidative phosphorylation
B. Failure of the sodium-potassium pump
C. Increased protein synthesis
D. Increased intracellular calcium removal
Answer: B. Failure of the sodium-potassium pump
Rationale: ATP depletion impairs the Na⁺/K⁺-ATPase, causing sodium and
water to enter cells and producing cellular swelling.
2. Which cellular adaptation involves an increase in cell size?
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: C. Hypertrophy
Rationale: Hypertrophy is enlargement of individual cells, usually caused by
increased workload or hormonal stimulation.
3. A patient with chronic gastroesophageal reflux develops replacement of
esophageal squamous epithelium with columnar epithelium. This is:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Hypertrophy
Answer: B. Metaplasia
Rationale: Metaplasia is a reversible substitution of one differentiated cell
type for another better able to tolerate chronic stress.
,4. Which finding is most characteristic of apoptosis?
A. Cellular swelling
B. Severe inflammation
C. Programmed cellular death
D. Membrane rupture with enzyme release
Answer: C. Programmed cellular death
Rationale: Apoptosis is regulated cell death that generally occurs without the
extensive inflammatory response associated with necrosis.
5. Which intracellular change is particularly important in irreversible cell
injury?
A. Mild glycogen depletion
B. Severe mitochondrial dysfunction
C. Temporary cellular swelling
D. Increased ATP production
Answer: B. Severe mitochondrial dysfunction
Rationale: Irreversible mitochondrial damage prevents adequate ATP
generation and contributes to loss of cellular viability.
6. Which reactive oxygen species can cause lipid peroxidation of cellular
membranes?
A. Free radicals
B. Albumin
C. Sodium ions
D. Bicarbonate
Answer: A. Free radicals
Rationale: Reactive oxygen species attack membrane lipids, proteins, and
DNA, contributing to oxidative cellular injury.
7. Which inflammatory mediator causes vasodilation and contributes to
increased vascular permeability?
A. Histamine
B. Hemoglobin
C. Insulin
D. Albumin
Answer: A. Histamine
Rationale: Histamine released primarily from mast cells causes vasodilation
and increases vascular permeability during acute inflammation.
,8. Which leukocyte is typically predominant during the early phase of acute
bacterial inflammation?
A. Lymphocyte
B. Neutrophil
C. Plasma cell
D. Eosinophil
Answer: B. Neutrophil
Rationale: Neutrophils are the predominant early leukocytes in most acute
bacterial inflammatory responses.
9. Which inflammatory mediator is strongly associated with fever?
A. IL-1
B. Insulin
C. Erythropoietin
D. Albumin
Answer: A. IL-1
Rationale: IL-1 acts on the hypothalamus and promotes prostaglandin
production, contributing to fever.
10. C-reactive protein is best classified as:
A. A clotting factor
B. An acute-phase reactant
C. A neurotransmitter
D. A steroid hormone
Answer: B. An acute-phase reactant
Rationale: CRP is produced by the liver in response to inflammatory cytokines,
particularly IL-6.
11. Which complement component is particularly important for chemotaxis of
neutrophils?
A. C3a
B. C5a
C. C1 inhibitor
D. Factor XII
Answer: B. C5a
Rationale: C5a is a potent chemotactic factor that recruits neutrophils to sites
of inflammation.
, 12. Chronic inflammation is commonly characterized by infiltration with:
A. Neutrophils only
B. Lymphocytes and macrophages
C. Erythrocytes
D. Platelets only
Answer: B. Lymphocytes and macrophages
Rationale: Chronic inflammation commonly involves macrophages,
lymphocytes, plasma cells, and ongoing tissue destruction and repair.
13. A granuloma is primarily composed of:
A. Aggregated activated macrophages
B. Platelets
C. Erythrocytes
D. Adipocytes
Answer: A. Aggregated activated macrophages
Rationale: Granulomas form when activated macrophages organize around
persistent inflammatory stimuli that are difficult to eliminate.
14. Which process describes movement of leukocytes toward a chemical
stimulus?
A. Diapedesis
B. Chemotaxis
C. Opsonization
D. Phagocytosis
Answer: B. Chemotaxis
Rationale: Chemotaxis is directed leukocyte movement toward chemical
signals released at the site of injury or infection.
15. Which process allows leukocytes to pass through the vascular
endothelium?
A. Diapedesis
B. Hypertrophy
C. Osmosis
D. Filtration
Answer: A. Diapedesis
Rationale: Diapedesis allows leukocytes to move between endothelial cells
into injured tissue.
