NR 507 Advanced Pathophysiology Midterm |
Chamberlain University | Academic Year 2026/2027 |
Midterm
SECTION I: CELLULAR BIOLOGY, GENETICS & CELLULAR ADAPTATION
1. Which type of cellular adaptation is characterized by an increase in cell size
without an increase in cell number?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy refers to an increase in the size of individual cells,
leading to an increase in organ size, without an increase in cell number. It
commonly occurs in tissues that cannot divide, such as cardiac muscle and
skeletal muscle. Hyperplasia involves an increase in cell number, not size. Atrophy
is a decrease in cell size, and metaplasia is the replacement of one differentiated
cell type with another.
2. A 45-year-old woman has a cervical biopsy that shows replacement of normal
columnar epithelium with stratified squamous epithelium. Which cellular
adaptation does this represent?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
Correct Answer: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature,
differentiated cell type with another mature, differentiated cell type. In the
cervix, chronic irritation can cause columnar epithelium to be replaced by
,stratified squamous epithelium, which is more resistant to stress. Dysplasia refers
to disordered growth with loss of uniformity and architectural orientation.
Anaplasia is a hallmark of malignancy, characterized by lack of differentiation.
3. Which of the following is the most common cause of cellular injury?
A. Hypoxia
B. Radiation
C. Chemical toxins
D. Infectious agents
Correct Answer: A. Hypoxia
Rationale: Hypoxia, or oxygen deprivation, is the most common and
significant cause of cellular injury and cell death. It can result from ischemia,
anemia, or inadequate oxygen delivery. When oxygen is lacking, oxidative
phosphorylation ceases, ATP production falls, and the sodium-potassium pump
fails, leading to cellular swelling and eventually necrosis. While radiation,
chemicals, and infections can all cause injury, hypoxia is the most frequent
mechanism.
4. A patient with chronic alcohol use disorder develops hepatomegaly. A liver
biopsy reveals an increase in the number of hepatocytes. Which adaptive
mechanism is responsible?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or
tissue, resulting in increased organ mass. It occurs in tissues capable of mitotic
division, such as the liver, epidermis, and intestinal epithelium. Chronic alcohol
,exposure can stimulate hepatocyte proliferation as an adaptive response, leading
to hepatomegaly. Hypertrophy refers to increased cell size, not number.
5. Which of the following best describes the mechanism of cellular injury in
reperfusion injury?
A. Decreased ATP production
B. Generation of reactive oxygen species (free radicals)
C. Activation of autophagy
D. Increased protein synthesis
Correct Answer: B. Generation of reactive oxygen species (free radicals)
Rationale: Reperfusion injury occurs when blood supply is restored to
ischemic tissue. During reperfusion, a burst of reactive oxygen species (ROS) is
generated, which can cause lipid peroxidation, protein denaturation, and DNA
damage. This oxidative stress exacerbates cellular injury rather than alleviating it.
Decreased ATP production is a feature of ischemia itself, not reperfusion injury.
6. A 67-year-old man with chronic obstructive pulmonary disease (COPD) shows
enlargement of the right ventricle. Which cellular adaptation is most likely
responsible?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
Correct Answer: C. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot
divide. When the right ventricle is subjected to chronic pressure overload (as in
COPD with pulmonary hypertension), the individual myocytes increase in size
(hypertrophy) to compensate. This leads to right ventricular hypertrophy.
Hyperplasia is not possible in cardiac muscle because these cells lack mitotic
capacity.
, 7. Which of the following is a reversible form of cellular injury characterized by
accumulation of water within the cell?
A. Coagulative necrosis
B. Hydropic swelling
C. Apoptosis
D. Fat necrosis
Correct Answer: B. Hydropic swelling
Rationale: Hydropic swelling is the most common manifestation of
reversible cell injury. It results from failure of the sodium-potassium ATPase pump
due to ATP depletion, leading to sodium and water accumulation within the cell.
Coagulative necrosis is an irreversible form of cell death, typically from ischemia.
Apoptosis is programmed cell death, and fat necrosis occurs in adipose tissue.
8. Which type of necrosis is most commonly associated with ischemia in the
heart, kidney, and spleen?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis is characterized by preservation of tissue
architecture for a period of time after cell death, with a firm, pale appearance. It
is the hallmark of ischemic injury in solid organs such as the heart, kidney, and
spleen. Liquefactive necrosis occurs in the brain and in abscesses, caseous
necrosis is characteristic of tuberculosis, and fat necrosis occurs in the pancreas
and breast tissue.
9. A 32-year-old woman undergoes a tuberculin skin test (PPD) that shows
induration after 48 hours. Which type of hypersensitivity reaction is this?
Chamberlain University | Academic Year 2026/2027 |
Midterm
SECTION I: CELLULAR BIOLOGY, GENETICS & CELLULAR ADAPTATION
1. Which type of cellular adaptation is characterized by an increase in cell size
without an increase in cell number?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy refers to an increase in the size of individual cells,
leading to an increase in organ size, without an increase in cell number. It
commonly occurs in tissues that cannot divide, such as cardiac muscle and
skeletal muscle. Hyperplasia involves an increase in cell number, not size. Atrophy
is a decrease in cell size, and metaplasia is the replacement of one differentiated
cell type with another.
2. A 45-year-old woman has a cervical biopsy that shows replacement of normal
columnar epithelium with stratified squamous epithelium. Which cellular
adaptation does this represent?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
Correct Answer: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature,
differentiated cell type with another mature, differentiated cell type. In the
cervix, chronic irritation can cause columnar epithelium to be replaced by
,stratified squamous epithelium, which is more resistant to stress. Dysplasia refers
to disordered growth with loss of uniformity and architectural orientation.
Anaplasia is a hallmark of malignancy, characterized by lack of differentiation.
3. Which of the following is the most common cause of cellular injury?
A. Hypoxia
B. Radiation
C. Chemical toxins
D. Infectious agents
Correct Answer: A. Hypoxia
Rationale: Hypoxia, or oxygen deprivation, is the most common and
significant cause of cellular injury and cell death. It can result from ischemia,
anemia, or inadequate oxygen delivery. When oxygen is lacking, oxidative
phosphorylation ceases, ATP production falls, and the sodium-potassium pump
fails, leading to cellular swelling and eventually necrosis. While radiation,
chemicals, and infections can all cause injury, hypoxia is the most frequent
mechanism.
4. A patient with chronic alcohol use disorder develops hepatomegaly. A liver
biopsy reveals an increase in the number of hepatocytes. Which adaptive
mechanism is responsible?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells in an organ or
tissue, resulting in increased organ mass. It occurs in tissues capable of mitotic
division, such as the liver, epidermis, and intestinal epithelium. Chronic alcohol
,exposure can stimulate hepatocyte proliferation as an adaptive response, leading
to hepatomegaly. Hypertrophy refers to increased cell size, not number.
5. Which of the following best describes the mechanism of cellular injury in
reperfusion injury?
A. Decreased ATP production
B. Generation of reactive oxygen species (free radicals)
C. Activation of autophagy
D. Increased protein synthesis
Correct Answer: B. Generation of reactive oxygen species (free radicals)
Rationale: Reperfusion injury occurs when blood supply is restored to
ischemic tissue. During reperfusion, a burst of reactive oxygen species (ROS) is
generated, which can cause lipid peroxidation, protein denaturation, and DNA
damage. This oxidative stress exacerbates cellular injury rather than alleviating it.
Decreased ATP production is a feature of ischemia itself, not reperfusion injury.
6. A 67-year-old man with chronic obstructive pulmonary disease (COPD) shows
enlargement of the right ventricle. Which cellular adaptation is most likely
responsible?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
Correct Answer: C. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot
divide. When the right ventricle is subjected to chronic pressure overload (as in
COPD with pulmonary hypertension), the individual myocytes increase in size
(hypertrophy) to compensate. This leads to right ventricular hypertrophy.
Hyperplasia is not possible in cardiac muscle because these cells lack mitotic
capacity.
, 7. Which of the following is a reversible form of cellular injury characterized by
accumulation of water within the cell?
A. Coagulative necrosis
B. Hydropic swelling
C. Apoptosis
D. Fat necrosis
Correct Answer: B. Hydropic swelling
Rationale: Hydropic swelling is the most common manifestation of
reversible cell injury. It results from failure of the sodium-potassium ATPase pump
due to ATP depletion, leading to sodium and water accumulation within the cell.
Coagulative necrosis is an irreversible form of cell death, typically from ischemia.
Apoptosis is programmed cell death, and fat necrosis occurs in adipose tissue.
8. Which type of necrosis is most commonly associated with ischemia in the
heart, kidney, and spleen?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis is characterized by preservation of tissue
architecture for a period of time after cell death, with a firm, pale appearance. It
is the hallmark of ischemic injury in solid organs such as the heart, kidney, and
spleen. Liquefactive necrosis occurs in the brain and in abscesses, caseous
necrosis is characteristic of tuberculosis, and fat necrosis occurs in the pancreas
and breast tissue.
9. A 32-year-old woman undergoes a tuberculin skin test (PPD) that shows
induration after 48 hours. Which type of hypersensitivity reaction is this?
