NSG 5003 Advanced Pathophysiology | South
University | Academic Year 2026/2027
SECTION I: CELLULAR ADAPTATION, INJURY & DEATH (Q1–Q20)
Q1. A 68-year-old male with a 40-year history of smoking presents with chronic
cough and weight loss. Biopsy of a lung mass reveals squamous cell carcinoma.
Which cellular adaptation most likely preceded the development of this
malignancy?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Rationale: Chronic exposure to cigarette smoke causes columnar ciliated
epithelium of the respiratory tract to transform into stratified squamous
epithelium (metaplasia) as an adaptive protective mechanism. Metaplasia
represents a reversible change from one mature cell type to another, but
persistent irritation can progress to dysplasia and eventually malignancy.
Q2. A 55-year-old female presents with increasing left ventricular wall thickness
and reduced chamber size. She has a history of long-standing untreated
hypertension. Which cellular adaptation best describes the changes in her
myocardium?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Rationale: Hypertrophy is an increase in cell size resulting in increased
tissue mass, commonly seen in cardiac muscle in response to increased afterload
from chronic hypertension. Unlike hyperplasia, hypertrophy occurs in tissues
composed of permanent cells (such as cardiac myocytes) that have limited
capacity for cell division.
,Q3. A 45-year-old female undergoes a total hysterectomy for benign uterine
fibroids. Following removal of estrogen stimulation, the endometrial tissue
undergoes significant reduction in size. Which cellular process describes this
change?
A. Physiologic atrophy
B. Pathologic atrophy
C. Hypertrophy
D. Hyperplasia
Rationale: Physiologic atrophy occurs with normal hormonal changes,
such as the decrease in endometrial tissue after menopause or following removal
of estrogen-producing organs. This is a normal, expected reduction in cell size and
number due to decreased hormonal stimulation.
Q4. A patient with chronic gastroesophageal reflux disease (GERD) undergoes
endoscopy, which reveals replacement of the normal stratified squamous
epithelium of the lower esophagus with columnar epithelium containing goblet
cells. What is this adaptive change called?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Rationale: Barrett esophagus is a classic example of metaplasia, in which
the normal stratified squamous epithelium of the distal esophagus is replaced by
intestinal-type columnar epithelium containing goblet cells in response to chronic
acid exposure. This adaptive substitution is intended to better withstand the
refluxed gastric contents but is a premalignant condition that increases the risk of
adenocarcinoma.
,Q5. A 30-year-old male has been immobilized in a long leg cast for 6 weeks
following a femoral fracture. Examination reveals noticeable reduction in muscle
mass of the affected limb. Which type of atrophy has occurred?
A. Disuse atrophy
B. Physiologic atrophy
C. Denervation atrophy
D. Ischemic atrophy
Rationale: Disuse atrophy results from prolonged inactivity or
immobilization. Skeletal muscle rapidly loses mass when not subjected to regular
mechanical stress, as occurs during casting or bed rest.
Q6. A decrease in the size of cells is termed:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
Rationale: Atrophy is a decrease in cell size. Hypertrophy is an increase in
cell size, hyperplasia is an increase in cell number, and dysplasia refers to variable
cell size and shape within a tissue.
Q7. An increase in the number of cells in a tissue is:
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Rationale: Hyperplasia is an increase in cell number. Hypertrophy involves
larger cells, not more cells. Atrophy is shrinkage of cells, and metaplasia is
conversion to another mature cell type.
, Q8. Cells that vary in size and shape within a tissue describe:
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Anaplasia
Rationale: Dysplasia is characterized by cells that vary in size and shape.
Metaplasia involves orderly replacement by another mature cell type,
hypertrophy is uniform enlargement, and anaplasia represents complete lack of
differentiation.
Q9. Undifferentiated cells with variable nuclear and cellular structure are
described as:
A. Anaplasia
B. Dysplasia
C. Metaplasia
D. Hyperplasia
Rationale: Anaplasia refers to undifferentiated cells and is a hallmark of
malignancy. Dysplasia involves abnormal but still differentiated cells, metaplasia
is mature replacement, and hyperplasia is increased number of normal cells.
Q10. Oxygen deficit due to respiratory or circulatory problems is:
A. Ischemia
B. Hypoxia
C. Infarction
D. Anoxia
Rationale: Ischemia is oxygen deficit caused by respiratory or circulatory
problems. Hypoxia is reduced oxygen in tissue (the result), infarction is an area of
necrosis from prolonged ischemia, and anoxia is total absence of oxygen.
University | Academic Year 2026/2027
SECTION I: CELLULAR ADAPTATION, INJURY & DEATH (Q1–Q20)
Q1. A 68-year-old male with a 40-year history of smoking presents with chronic
cough and weight loss. Biopsy of a lung mass reveals squamous cell carcinoma.
Which cellular adaptation most likely preceded the development of this
malignancy?
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Dysplasia
Rationale: Chronic exposure to cigarette smoke causes columnar ciliated
epithelium of the respiratory tract to transform into stratified squamous
epithelium (metaplasia) as an adaptive protective mechanism. Metaplasia
represents a reversible change from one mature cell type to another, but
persistent irritation can progress to dysplasia and eventually malignancy.
Q2. A 55-year-old female presents with increasing left ventricular wall thickness
and reduced chamber size. She has a history of long-standing untreated
hypertension. Which cellular adaptation best describes the changes in her
myocardium?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Rationale: Hypertrophy is an increase in cell size resulting in increased
tissue mass, commonly seen in cardiac muscle in response to increased afterload
from chronic hypertension. Unlike hyperplasia, hypertrophy occurs in tissues
composed of permanent cells (such as cardiac myocytes) that have limited
capacity for cell division.
,Q3. A 45-year-old female undergoes a total hysterectomy for benign uterine
fibroids. Following removal of estrogen stimulation, the endometrial tissue
undergoes significant reduction in size. Which cellular process describes this
change?
A. Physiologic atrophy
B. Pathologic atrophy
C. Hypertrophy
D. Hyperplasia
Rationale: Physiologic atrophy occurs with normal hormonal changes,
such as the decrease in endometrial tissue after menopause or following removal
of estrogen-producing organs. This is a normal, expected reduction in cell size and
number due to decreased hormonal stimulation.
Q4. A patient with chronic gastroesophageal reflux disease (GERD) undergoes
endoscopy, which reveals replacement of the normal stratified squamous
epithelium of the lower esophagus with columnar epithelium containing goblet
cells. What is this adaptive change called?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Rationale: Barrett esophagus is a classic example of metaplasia, in which
the normal stratified squamous epithelium of the distal esophagus is replaced by
intestinal-type columnar epithelium containing goblet cells in response to chronic
acid exposure. This adaptive substitution is intended to better withstand the
refluxed gastric contents but is a premalignant condition that increases the risk of
adenocarcinoma.
,Q5. A 30-year-old male has been immobilized in a long leg cast for 6 weeks
following a femoral fracture. Examination reveals noticeable reduction in muscle
mass of the affected limb. Which type of atrophy has occurred?
A. Disuse atrophy
B. Physiologic atrophy
C. Denervation atrophy
D. Ischemic atrophy
Rationale: Disuse atrophy results from prolonged inactivity or
immobilization. Skeletal muscle rapidly loses mass when not subjected to regular
mechanical stress, as occurs during casting or bed rest.
Q6. A decrease in the size of cells is termed:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
Rationale: Atrophy is a decrease in cell size. Hypertrophy is an increase in
cell size, hyperplasia is an increase in cell number, and dysplasia refers to variable
cell size and shape within a tissue.
Q7. An increase in the number of cells in a tissue is:
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Rationale: Hyperplasia is an increase in cell number. Hypertrophy involves
larger cells, not more cells. Atrophy is shrinkage of cells, and metaplasia is
conversion to another mature cell type.
, Q8. Cells that vary in size and shape within a tissue describe:
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Anaplasia
Rationale: Dysplasia is characterized by cells that vary in size and shape.
Metaplasia involves orderly replacement by another mature cell type,
hypertrophy is uniform enlargement, and anaplasia represents complete lack of
differentiation.
Q9. Undifferentiated cells with variable nuclear and cellular structure are
described as:
A. Anaplasia
B. Dysplasia
C. Metaplasia
D. Hyperplasia
Rationale: Anaplasia refers to undifferentiated cells and is a hallmark of
malignancy. Dysplasia involves abnormal but still differentiated cells, metaplasia
is mature replacement, and hyperplasia is increased number of normal cells.
Q10. Oxygen deficit due to respiratory or circulatory problems is:
A. Ischemia
B. Hypoxia
C. Infarction
D. Anoxia
Rationale: Ischemia is oxygen deficit caused by respiratory or circulatory
problems. Hypoxia is reduced oxygen in tissue (the result), infarction is an area of
necrosis from prolonged ischemia, and anoxia is total absence of oxygen.
