NR507 Final Exam 2027 / NR 507 Week 8 Exam
Advanced Pathophysiology Expected
Questions and Answers () (Verified
Answers)- Chamberlain
SECTION I: CELLULAR BIOLOGY, INJURY & GENETICS
Q1. A 58-year-old male construction worker presents with chronic fatigue and
shortness of breath. He has a 30-year history of smoking two packs per day. His
arterial blood gas reveals a carboxyhemoglobin level of 12%. Cardiac myocytes
show mitochondrial swelling and cristae disruption on electron microscopy. The
cellular injury pattern observed is best classified as which type of injury?
A. Ischemic injury due to reduced arterial blood flow
B. Hypoxic injury due to decreased oxygen-carrying capacity of hemoglobin
C. Chemical injury due to direct toxin-mediated destruction
D. Apoptotic injury due to programmed cell death
Correct Answer: B
Rationale: Carbon monoxide binds hemoglobin with approximately 200–
250 times the affinity of oxygen, drastically reducing oxygen-carrying capacity and
causing hypoxic injury to tissues. Mitochondrial swelling and cristae disruption are
hallmark ultrastructural features of hypoxic injury. Ischemic injury refers
specifically to reduced blood flow, which is not the primary mechanism here.
Chemical injury would involve direct toxin-mediated membrane destruction, and
apoptosis is programmed cell death without inflammation. The key differentiator
is that the blood flow to the myocardium is not compromised—the oxygen
transport capacity is.
Q2. A 42-year-old female with poorly controlled hypertension is admitted with
severe headache and visual disturbances. Echocardiography reveals significant
,left ventricular wall thickening, and myocardial biopsy shows enlarged cardiac
myocytes with increased cytoplasmic structural proteins. This myocardial change
is best described as which cellular adaptation?
A. Hyperplasia resulting from increased number of cardiac myocytes
B. Hypertrophy resulting from increased cell size due to chronic pressure overload
C. Metaplasia resulting from replacement of one mature cell type
D. Dysplasia resulting from disorganized cellular proliferation
Correct Answer: B
Rationale: Cardiac myocytes are terminally differentiated permanent cells
that cannot undergo hyperplasia (they have lost the ability to divide). They
respond to chronic pressure overload by increasing in size through the addition of
structural proteins, which defines hypertrophy. Hyperplasia involves an increase
in cell number, which is impossible in cardiac muscle. Metaplasia is the
replacement of one mature cell type by another, and dysplasia refers to
abnormal, disorganized cellular development—neither applies to cardiac
myocytes.
Q3. A 4-year-old boy is brought to the emergency department with a 2-day
history of high fever, severe sore throat, and swollen cervical lymph nodes. A
complete blood count reveals leukocytosis with atypical lymphocytes. Which
cellular adaptation or pathologic process best explains the lymphoid tissue
changes?
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of cells in a tissue or
organ in response to a stimulus. In this case, the lymphoid tissue is undergoing
reactive hyperplasia in response to infection, producing increased numbers of
lymphocytes and atypical lymphocytes. Atrophy would involve shrinkage,
,metaplasia involves replacement of one cell type with another, and dysplasia
involves abnormal cellular development with loss of polarity and nuclear atypia—
none of which are consistent with an acute infectious process.
Q4. A 65-year-old male with a long history of smoking presents with chronic
bronchitis. His bronchial epithelium has replaced the normal ciliated columnar
cells with stratified squamous epithelium. Which cellular adaptation is this?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another more resilient type in response to chronic stress. In
smokers, chronic irritation causes ciliated columnar epithelium to be replaced by
stratified squamous epithelium, which is more resistant to injury but loses
mucociliary function. Hyperplasia refers to an increase in cell number, dysplasia
involves abnormal cellular development with loss of polarity and nuclear atypia,
and anaplasia refers to lack of differentiation seen in malignant tumors.
Q5. A 45-year-old female undergoes an endometrial biopsy that reveals
abnormal, disorderly proliferative changes with loss of polarity and nuclear
atypia. Which cellular adaptation best describes this finding?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
Correct Answer: C
Rationale: Dysplasia refers to abnormal, disorganized cellular
development with loss of polarity, nuclear atypia, and increased mitotic activity. It
, is often a precursor to neoplasia but is not itself neoplastic. Hyperplasia is an
increase in cell number with normal cellular organization. Metaplasia is
replacement of one mature cell type by another. Neoplasia refers to new,
uncontrolled growth that persists after the inciting stimulus is removed.
Q6. A pathologist examines a tumor and notes a mutation in the TP53 gene. What
is the normal function of the p53 protein that is lost in this mutation?
A. Promotion of cell cycle progression
B. DNA repair and induction of apoptosis in damaged cells
C. Stimulation of angiogenesis
D. Activation of telomerase
Correct Answer: B
Rationale: The TP53 gene encodes the p53 protein, often called the
"guardian of the genome." Its normal functions include arresting the cell cycle to
allow DNA repair, and inducing apoptosis if DNA damage is irreparable. Loss of
p53 function allows damaged cells to proliferate, contributing to oncogenesis.
Promotion of cell cycle progression is a function of oncogenes (e.g., RAS, MYC),
not p53. Angiogenesis and telomerase activation are also pro-tumorigenic
processes not directly mediated by p53.
Q7. A couple is referred for genetic counseling after having a child with cystic
fibrosis. They are asymptomatic carriers. What is the inheritance pattern for this
disorder?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive
Correct Answer: B
Rationale: Cystic fibrosis is a classic autosomal recessive disorder requiring
two mutated alleles for disease manifestation. Carriers with one mutated allele
Advanced Pathophysiology Expected
Questions and Answers () (Verified
Answers)- Chamberlain
SECTION I: CELLULAR BIOLOGY, INJURY & GENETICS
Q1. A 58-year-old male construction worker presents with chronic fatigue and
shortness of breath. He has a 30-year history of smoking two packs per day. His
arterial blood gas reveals a carboxyhemoglobin level of 12%. Cardiac myocytes
show mitochondrial swelling and cristae disruption on electron microscopy. The
cellular injury pattern observed is best classified as which type of injury?
A. Ischemic injury due to reduced arterial blood flow
B. Hypoxic injury due to decreased oxygen-carrying capacity of hemoglobin
C. Chemical injury due to direct toxin-mediated destruction
D. Apoptotic injury due to programmed cell death
Correct Answer: B
Rationale: Carbon monoxide binds hemoglobin with approximately 200–
250 times the affinity of oxygen, drastically reducing oxygen-carrying capacity and
causing hypoxic injury to tissues. Mitochondrial swelling and cristae disruption are
hallmark ultrastructural features of hypoxic injury. Ischemic injury refers
specifically to reduced blood flow, which is not the primary mechanism here.
Chemical injury would involve direct toxin-mediated membrane destruction, and
apoptosis is programmed cell death without inflammation. The key differentiator
is that the blood flow to the myocardium is not compromised—the oxygen
transport capacity is.
Q2. A 42-year-old female with poorly controlled hypertension is admitted with
severe headache and visual disturbances. Echocardiography reveals significant
,left ventricular wall thickening, and myocardial biopsy shows enlarged cardiac
myocytes with increased cytoplasmic structural proteins. This myocardial change
is best described as which cellular adaptation?
A. Hyperplasia resulting from increased number of cardiac myocytes
B. Hypertrophy resulting from increased cell size due to chronic pressure overload
C. Metaplasia resulting from replacement of one mature cell type
D. Dysplasia resulting from disorganized cellular proliferation
Correct Answer: B
Rationale: Cardiac myocytes are terminally differentiated permanent cells
that cannot undergo hyperplasia (they have lost the ability to divide). They
respond to chronic pressure overload by increasing in size through the addition of
structural proteins, which defines hypertrophy. Hyperplasia involves an increase
in cell number, which is impossible in cardiac muscle. Metaplasia is the
replacement of one mature cell type by another, and dysplasia refers to
abnormal, disorganized cellular development—neither applies to cardiac
myocytes.
Q3. A 4-year-old boy is brought to the emergency department with a 2-day
history of high fever, severe sore throat, and swollen cervical lymph nodes. A
complete blood count reveals leukocytosis with atypical lymphocytes. Which
cellular adaptation or pathologic process best explains the lymphoid tissue
changes?
A. Atrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of cells in a tissue or
organ in response to a stimulus. In this case, the lymphoid tissue is undergoing
reactive hyperplasia in response to infection, producing increased numbers of
lymphocytes and atypical lymphocytes. Atrophy would involve shrinkage,
,metaplasia involves replacement of one cell type with another, and dysplasia
involves abnormal cellular development with loss of polarity and nuclear atypia—
none of which are consistent with an acute infectious process.
Q4. A 65-year-old male with a long history of smoking presents with chronic
bronchitis. His bronchial epithelium has replaced the normal ciliated columnar
cells with stratified squamous epithelium. Which cellular adaptation is this?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another more resilient type in response to chronic stress. In
smokers, chronic irritation causes ciliated columnar epithelium to be replaced by
stratified squamous epithelium, which is more resistant to injury but loses
mucociliary function. Hyperplasia refers to an increase in cell number, dysplasia
involves abnormal cellular development with loss of polarity and nuclear atypia,
and anaplasia refers to lack of differentiation seen in malignant tumors.
Q5. A 45-year-old female undergoes an endometrial biopsy that reveals
abnormal, disorderly proliferative changes with loss of polarity and nuclear
atypia. Which cellular adaptation best describes this finding?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
Correct Answer: C
Rationale: Dysplasia refers to abnormal, disorganized cellular
development with loss of polarity, nuclear atypia, and increased mitotic activity. It
, is often a precursor to neoplasia but is not itself neoplastic. Hyperplasia is an
increase in cell number with normal cellular organization. Metaplasia is
replacement of one mature cell type by another. Neoplasia refers to new,
uncontrolled growth that persists after the inciting stimulus is removed.
Q6. A pathologist examines a tumor and notes a mutation in the TP53 gene. What
is the normal function of the p53 protein that is lost in this mutation?
A. Promotion of cell cycle progression
B. DNA repair and induction of apoptosis in damaged cells
C. Stimulation of angiogenesis
D. Activation of telomerase
Correct Answer: B
Rationale: The TP53 gene encodes the p53 protein, often called the
"guardian of the genome." Its normal functions include arresting the cell cycle to
allow DNA repair, and inducing apoptosis if DNA damage is irreparable. Loss of
p53 function allows damaged cells to proliferate, contributing to oncogenesis.
Promotion of cell cycle progression is a function of oncogenes (e.g., RAS, MYC),
not p53. Angiogenesis and telomerase activation are also pro-tumorigenic
processes not directly mediated by p53.
Q7. A couple is referred for genetic counseling after having a child with cystic
fibrosis. They are asymptomatic carriers. What is the inheritance pattern for this
disorder?
A. Autosomal dominant
B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive
Correct Answer: B
Rationale: Cystic fibrosis is a classic autosomal recessive disorder requiring
two mutated alleles for disease manifestation. Carriers with one mutated allele
