NR 507 MIDTERM Exam 2026 NR507 Advanced
Pathophysiology - cardiac, pulmonary,
hematology, renal Actual Exam Expected
Questions and Answers () (Verified
Answers)- Chamberlain
Section 1: Cellular Biology, Genetics & Adaptation
1. A 52-year-old male with chronic alcohol use disorder presents with 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 of cell membranes
B. Apoptosis triggered solely by growth factor withdrawal
C. Hypertrophic adaptation without cellular damage
D. Reversible cellular swelling without enzymatic leakage
Correct Answer: A
Rationale: Chronic alcohol metabolism generates reactive oxygen species
(ROS) that cause lipid peroxidation, disrupting membrane integrity and leading to
enzyme leakage (elevated AST/ALT) and impaired bilirubin conjugation.
Hypertrophy is an adaptive response, not an injury mechanism. Reversible
swelling alone does not explain elevated liver enzymes.
2. A 45-year-old woman with a history of smoking develops chronic hypoxia. Her
erythrocyte count is elevated. This cellular adaptation is best described as:
A. Physiologic hyperplasia in response to tissue demand
B. Pathologic hypertrophy due to nicotine exposure
C. Compensatory hyperplasia of erythroid precursors
D. Metaplasia of respiratory epithelium to squamous type
Correct Answer: C
, Rationale: Chronic hypoxia stimulates erythropoietin (EPO) production by
the kidney, leading to compensatory hyperplasia of erythroid precursors in the
bone marrow (polycythemia). Metaplasia occurs in airway epithelium due to
smoking but does not explain elevated erythrocytes.
3. A 60-year-old male undergoes cardiac catheterization and experiences
reperfusion injury after clot dissolution. Which cellular event is the primary
driver of reperfusion injury?
A. Calcium overload leading to mitochondrial permeability transition
B. Immediate restoration of ATP without cellular consequences
C. Suppression of inflammatory cytokine release from neutrophils
D. Decreased generation of reactive oxygen species in myocardium
Correct Answer: A
Rationale: Reperfusion causes calcium overload and opening of the
mitochondrial permeability transition pore (mPTP), leading to mitochondrial
damage and cell death. ROS generation increases, not decreases, during
reperfusion. ATP restoration is initially beneficial but does not prevent mPTP
opening.
4. A 38-year-old female presents with a biopsy-proven benign breast tumor.
Which characteristic best differentiates this benign neoplasm from a malignant
one?
A. Well-differentiated cells that closely resemble normal tissue of origin
B. Rapid, invasive growth into surrounding structures
C. Ability to metastasize to distant organs via lymphatics
D. Presence of poorly differentiated cells with anaplasia
Correct Answer: A
Rationale: Benign neoplasms are well-differentiated, grow slowly, remain
localized, and do not metastasize. Malignant tumors exhibit rapid growth,
,invasion, and metastasis. Anaplasia (lack of differentiation) is a hallmark of
malignancy.
5. 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
Rationale: Atrophy is the decrease in cellular size due to aging, disuse, or
reduced blood supply. Hypertrophy is an increase in cell size; hyperplasia is an
increase in cell number; metaplasia is the replacement of one cell type with
another.
6. A client presents with cellular swelling due to hypoxic injury. This is an
example of:
A. Irreversible cell injury
B. Reversible cell injury (hydropic swelling)
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B
Rationale: Hydropic (vacuolar) swelling is a reversible form of cell injury
caused by failure of ATP-dependent ion pumps, leading to sodium and water
accumulation. Irreversible injury involves membrane rupture, enzymatic
digestion, and necrosis.
7. A 28-year-old male with sickle cell trait asks about his risk of passing the trait
to his children. Which genetic pattern applies?
, A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial inheritance
Correct Answer: B
Rationale: Sickle cell disease is inherited in an autosomal recessive
pattern. A person with sickle cell trait (heterozygous, HbAS) has one normal allele
and one mutated allele. If both parents are carriers, each child has a 25% risk of
disease and 50% risk of being a carrier.
8. Which of the following is the most common cause of Down syndrome?
A. Maternal nondisjunction during meiosis
B. Paternal nondisjunction during meiosis
C. Robertsonian translocation
D. Mosaicism
Correct Answer: A
Rationale: Approximately 95% of Down syndrome cases result from
maternal nondisjunction (usually meiosis I), leading to trisomy 21. Translocation
accounts for ~4%, and mosaicism for ~1%.
9. A patient with chronic hypertension develops left ventricular hypertrophy.
This is an example of:
A. Physiologic hypertrophy
B. Pathologic hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Pathophysiology - cardiac, pulmonary,
hematology, renal Actual Exam Expected
Questions and Answers () (Verified
Answers)- Chamberlain
Section 1: Cellular Biology, Genetics & Adaptation
1. A 52-year-old male with chronic alcohol use disorder presents with 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 of cell membranes
B. Apoptosis triggered solely by growth factor withdrawal
C. Hypertrophic adaptation without cellular damage
D. Reversible cellular swelling without enzymatic leakage
Correct Answer: A
Rationale: Chronic alcohol metabolism generates reactive oxygen species
(ROS) that cause lipid peroxidation, disrupting membrane integrity and leading to
enzyme leakage (elevated AST/ALT) and impaired bilirubin conjugation.
Hypertrophy is an adaptive response, not an injury mechanism. Reversible
swelling alone does not explain elevated liver enzymes.
2. A 45-year-old woman with a history of smoking develops chronic hypoxia. Her
erythrocyte count is elevated. This cellular adaptation is best described as:
A. Physiologic hyperplasia in response to tissue demand
B. Pathologic hypertrophy due to nicotine exposure
C. Compensatory hyperplasia of erythroid precursors
D. Metaplasia of respiratory epithelium to squamous type
Correct Answer: C
, Rationale: Chronic hypoxia stimulates erythropoietin (EPO) production by
the kidney, leading to compensatory hyperplasia of erythroid precursors in the
bone marrow (polycythemia). Metaplasia occurs in airway epithelium due to
smoking but does not explain elevated erythrocytes.
3. A 60-year-old male undergoes cardiac catheterization and experiences
reperfusion injury after clot dissolution. Which cellular event is the primary
driver of reperfusion injury?
A. Calcium overload leading to mitochondrial permeability transition
B. Immediate restoration of ATP without cellular consequences
C. Suppression of inflammatory cytokine release from neutrophils
D. Decreased generation of reactive oxygen species in myocardium
Correct Answer: A
Rationale: Reperfusion causes calcium overload and opening of the
mitochondrial permeability transition pore (mPTP), leading to mitochondrial
damage and cell death. ROS generation increases, not decreases, during
reperfusion. ATP restoration is initially beneficial but does not prevent mPTP
opening.
4. A 38-year-old female presents with a biopsy-proven benign breast tumor.
Which characteristic best differentiates this benign neoplasm from a malignant
one?
A. Well-differentiated cells that closely resemble normal tissue of origin
B. Rapid, invasive growth into surrounding structures
C. Ability to metastasize to distant organs via lymphatics
D. Presence of poorly differentiated cells with anaplasia
Correct Answer: A
Rationale: Benign neoplasms are well-differentiated, grow slowly, remain
localized, and do not metastasize. Malignant tumors exhibit rapid growth,
,invasion, and metastasis. Anaplasia (lack of differentiation) is a hallmark of
malignancy.
5. 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
Rationale: Atrophy is the decrease in cellular size due to aging, disuse, or
reduced blood supply. Hypertrophy is an increase in cell size; hyperplasia is an
increase in cell number; metaplasia is the replacement of one cell type with
another.
6. A client presents with cellular swelling due to hypoxic injury. This is an
example of:
A. Irreversible cell injury
B. Reversible cell injury (hydropic swelling)
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B
Rationale: Hydropic (vacuolar) swelling is a reversible form of cell injury
caused by failure of ATP-dependent ion pumps, leading to sodium and water
accumulation. Irreversible injury involves membrane rupture, enzymatic
digestion, and necrosis.
7. A 28-year-old male with sickle cell trait asks about his risk of passing the trait
to his children. Which genetic pattern applies?
, A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial inheritance
Correct Answer: B
Rationale: Sickle cell disease is inherited in an autosomal recessive
pattern. A person with sickle cell trait (heterozygous, HbAS) has one normal allele
and one mutated allele. If both parents are carriers, each child has a 25% risk of
disease and 50% risk of being a carrier.
8. Which of the following is the most common cause of Down syndrome?
A. Maternal nondisjunction during meiosis
B. Paternal nondisjunction during meiosis
C. Robertsonian translocation
D. Mosaicism
Correct Answer: A
Rationale: Approximately 95% of Down syndrome cases result from
maternal nondisjunction (usually meiosis I), leading to trisomy 21. Translocation
accounts for ~4%, and mosaicism for ~1%.
9. A patient with chronic hypertension develops left ventricular hypertrophy.
This is an example of:
A. Physiologic hypertrophy
B. Pathologic hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
