2026 NR 507/ NR507-NP Midterm Exam Actual
Questions with 100% Correct Answers | Verified |
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PART I: Cellular Adaptation, Injury & Death
1. A 68-year-old male with long-standing hypertension undergoes
echocardiography that reveals an enlarged left ventricle with thickened walls.
The increase in myocardial cell size without an increase in cell number is best
described as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Correct Answer: B) Hypertrophy
Rationale: Hypertrophy refers to an increase in cell size leading to organ
enlargement, commonly occurring in terminally differentiated cells like cardiac
myocytes that cannot divide. This is an adaptive response to chronic pressure
overload from hypertension, allowing the heart to maintain cardiac output
against increased afterload . Hyperplasia (A) involves an increase in cell number
and does not occur in mature cardiac muscle. Metaplasia (C) is the replacement of
one cell type with another. Dysplasia (D) refers to disordered growth and is
premalignant.
2. A pathologist examines a liver biopsy from a patient with a 20-year history of
alcohol abuse. Many hepatocytes contain large clear vacuoles that displace the
nucleus to the periphery. The most likely composition of these vacuoles is:
A) Glycogen
B) Triglycerides
C) Protein aggregates
D) Hemosiderin
, Correct Answer: B) Triglycerides
Rationale: Alcoholic fatty liver disease is characterized by steatosis, the
abnormal accumulation of triglycerides within hepatocytes. Chronic alcohol
consumption alters lipid metabolism, leading to increased fatty acid synthesis and
decreased fatty acid oxidation, resulting in triglyceride accumulation . Glycogen
appears different histologically, protein aggregates form Mallory bodies, and
hemosiderin represents iron storage.
3. Which mechanism is primarily responsible for cellular swelling during early
ischemia?
A) Increased sodium-potassium ATPase activity
B) Failure of the sodium-potassium ATPase pump
C) Enhanced calcium extrusion through membrane pumps
D) Activation of apoptotic caspases
Correct Answer: B) Failure of the sodium-potassium ATPase pump
Rationale: Ischemia depletes ATP, impairing the function of the Na⁺/K⁺
ATPase pump. Without adequate ATP, the pump fails, causing sodium to
accumulate intracellularly, which osmotically draws water into the cell and
produces cellular swelling (hydropic swelling) . This is the hallmark of reversible
cell injury. Enhanced calcium extrusion (C) is not the primary driver of ischemic
swelling.
4. A 30-year-old woman with a BRCA1 mutation undergoes breast biopsy
showing ductal epithelium with loss of polarity, nuclear pleomorphism, and
increased mitoses, but the myoepithelial layer remains intact. This finding is
best described as:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Carcinoma in situ
, Correct Answer: C) Dysplasia
Rationale: Dysplasia is characterized by disordered growth with cytologic
atypia including loss of polarity, nuclear pleomorphism, and increased mitotic
figures, but the basement membrane remains intact . This represents a pre-
neoplastic change. Carcinoma in situ (D) also has an intact basement membrane
but involves the full thickness of the epithelium. Metaplasia (B) is a reversible
change from one differentiated cell type to another.
5. Which type of necrosis is most commonly associated with tuberculosis
infection?
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
Correct Answer: C) Caseous necrosis
Rationale: Caseous necrosis is characterized by a "cheese-like" appearance
and is classically associated with tuberculosis and fungal infections. It represents a
combination of coagulative and liquefactive necrosis with granulomatous
inflammation . Liquefactive necrosis (A) is seen in bacterial abscesses and brain
infarcts. Coagulative necrosis (B) occurs in ischemic injury to solid organs.
6. During reperfusion injury after myocardial infarction, which cellular event is
the primary driver of tissue damage?
A) Immediate restoration of ATP without consequences
B) Calcium overload leading to mitochondrial permeability transition
C) Suppression of inflammatory cytokine release
D) Decreased generation of reactive oxygen species
Correct Answer: B) Calcium overload leading to mitochondrial
permeability transition
, Rationale: Reperfusion injury occurs when blood flow is restored to
ischemic tissue. The primary mechanism involves calcium overload, which triggers
opening of the mitochondrial permeability transition pore, leading to
mitochondrial dysfunction and cell death . Paradoxically, reactive oxygen species
generation increases rather than decreases during reperfusion.
7. 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) Atrophy
Rationale: Atrophy is the decrease in cellular size due to aging, disuse,
reduced blood supply, or loss of trophic signals. It represents a reduction in
structural components of the cell . Hypertrophy (A) is an increase in cell size;
hyperplasia (C) is an increase in cell number; metaplasia (D) is the replacement of
one cell type with another.
8. A 52-year-old male with chronic liver disease has laboratory findings showing
elevated liver enzymes and bilirubin. Cellular injury in this patient is most likely
mediated by which mechanism?
A) Free radical injury leading to lipid peroxidation
B) Apoptosis triggered by growth factor withdrawal only
C) Hypertrophic adaptation without cellular damage
D) Reversible cellular swelling without enzymatic leakage
Correct Answer: A) Free radical injury leading to lipid peroxidation
Rationale: Free radical injury causes lipid peroxidation of cell membranes,
disrupting membrane integrity and leading to leakage of intracellular enzymes
such as AST and ALT, as well as bilirubin elevation . Hypertrophy (C) is an adaptive
Questions with 100% Correct Answers | Verified |
Latest Update
PART I: Cellular Adaptation, Injury & Death
1. A 68-year-old male with long-standing hypertension undergoes
echocardiography that reveals an enlarged left ventricle with thickened walls.
The increase in myocardial cell size without an increase in cell number is best
described as:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Correct Answer: B) Hypertrophy
Rationale: Hypertrophy refers to an increase in cell size leading to organ
enlargement, commonly occurring in terminally differentiated cells like cardiac
myocytes that cannot divide. This is an adaptive response to chronic pressure
overload from hypertension, allowing the heart to maintain cardiac output
against increased afterload . Hyperplasia (A) involves an increase in cell number
and does not occur in mature cardiac muscle. Metaplasia (C) is the replacement of
one cell type with another. Dysplasia (D) refers to disordered growth and is
premalignant.
2. A pathologist examines a liver biopsy from a patient with a 20-year history of
alcohol abuse. Many hepatocytes contain large clear vacuoles that displace the
nucleus to the periphery. The most likely composition of these vacuoles is:
A) Glycogen
B) Triglycerides
C) Protein aggregates
D) Hemosiderin
, Correct Answer: B) Triglycerides
Rationale: Alcoholic fatty liver disease is characterized by steatosis, the
abnormal accumulation of triglycerides within hepatocytes. Chronic alcohol
consumption alters lipid metabolism, leading to increased fatty acid synthesis and
decreased fatty acid oxidation, resulting in triglyceride accumulation . Glycogen
appears different histologically, protein aggregates form Mallory bodies, and
hemosiderin represents iron storage.
3. Which mechanism is primarily responsible for cellular swelling during early
ischemia?
A) Increased sodium-potassium ATPase activity
B) Failure of the sodium-potassium ATPase pump
C) Enhanced calcium extrusion through membrane pumps
D) Activation of apoptotic caspases
Correct Answer: B) Failure of the sodium-potassium ATPase pump
Rationale: Ischemia depletes ATP, impairing the function of the Na⁺/K⁺
ATPase pump. Without adequate ATP, the pump fails, causing sodium to
accumulate intracellularly, which osmotically draws water into the cell and
produces cellular swelling (hydropic swelling) . This is the hallmark of reversible
cell injury. Enhanced calcium extrusion (C) is not the primary driver of ischemic
swelling.
4. A 30-year-old woman with a BRCA1 mutation undergoes breast biopsy
showing ductal epithelium with loss of polarity, nuclear pleomorphism, and
increased mitoses, but the myoepithelial layer remains intact. This finding is
best described as:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Carcinoma in situ
, Correct Answer: C) Dysplasia
Rationale: Dysplasia is characterized by disordered growth with cytologic
atypia including loss of polarity, nuclear pleomorphism, and increased mitotic
figures, but the basement membrane remains intact . This represents a pre-
neoplastic change. Carcinoma in situ (D) also has an intact basement membrane
but involves the full thickness of the epithelium. Metaplasia (B) is a reversible
change from one differentiated cell type to another.
5. Which type of necrosis is most commonly associated with tuberculosis
infection?
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
Correct Answer: C) Caseous necrosis
Rationale: Caseous necrosis is characterized by a "cheese-like" appearance
and is classically associated with tuberculosis and fungal infections. It represents a
combination of coagulative and liquefactive necrosis with granulomatous
inflammation . Liquefactive necrosis (A) is seen in bacterial abscesses and brain
infarcts. Coagulative necrosis (B) occurs in ischemic injury to solid organs.
6. During reperfusion injury after myocardial infarction, which cellular event is
the primary driver of tissue damage?
A) Immediate restoration of ATP without consequences
B) Calcium overload leading to mitochondrial permeability transition
C) Suppression of inflammatory cytokine release
D) Decreased generation of reactive oxygen species
Correct Answer: B) Calcium overload leading to mitochondrial
permeability transition
, Rationale: Reperfusion injury occurs when blood flow is restored to
ischemic tissue. The primary mechanism involves calcium overload, which triggers
opening of the mitochondrial permeability transition pore, leading to
mitochondrial dysfunction and cell death . Paradoxically, reactive oxygen species
generation increases rather than decreases during reperfusion.
7. 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) Atrophy
Rationale: Atrophy is the decrease in cellular size due to aging, disuse,
reduced blood supply, or loss of trophic signals. It represents a reduction in
structural components of the cell . Hypertrophy (A) is an increase in cell size;
hyperplasia (C) is an increase in cell number; metaplasia (D) is the replacement of
one cell type with another.
8. A 52-year-old male with chronic liver disease has laboratory findings showing
elevated liver enzymes and bilirubin. Cellular injury in this patient is most likely
mediated by which mechanism?
A) Free radical injury leading to lipid peroxidation
B) Apoptosis triggered by growth factor withdrawal only
C) Hypertrophic adaptation without cellular damage
D) Reversible cellular swelling without enzymatic leakage
Correct Answer: A) Free radical injury leading to lipid peroxidation
Rationale: Free radical injury causes lipid peroxidation of cell membranes,
disrupting membrane integrity and leading to leakage of intracellular enzymes
such as AST and ALT, as well as bilirubin elevation . Hypertrophy (C) is an adaptive
