,NR 507 Advanced Pathophysiology Exam Prep —
Comprehensive Review + Practice MCQs —
Chamberlain College of Nursing 2025/2026
1. A 58-year-old male with a 40-year history of hypertension undergoes echocardiography that reveals left
ventricular wall thickening without an increase in the number of myocardial cells. Which cellular adaptation
best describes this finding?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in cell size, resulting in organ enlargement. Cardiac myocytes are
permanent cells that cannot divide, so they respond to increased workload (chronic pressure overload from
hypertension) by enlarging rather than proliferating. Hyperplasia involves an increase in cell number and does
not occur in cardiac muscle. Metaplasia is the replacement of one differentiated cell type with another, and
dysplasia refers to disordered growth with loss of uniformity.
2. A 62-year-old female with a 30-year smoking history undergoes bronchoscopy for a persistent cough. Biopsy
reveals replacement of normal ciliated columnar epithelium with stratified squamous epithelium. This cellular
adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
,Correct Answer: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with another that is better able to
withstand adverse environmental conditions. Chronic cigarette smoke irritates the bronchial epithelium,
causing ciliated columnar cells to be replaced by more robust stratified squamous cells. While metaplasia itself
is not malignant, it can progress to dysplasia if the irritant persists.
3. During severe hypoxia, which molecular event directly initiates cellular swelling and eventual necrosis?
A. Increased ATP production via anaerobic glycolysis
B. Failure of the Na⁺/K⁺-ATPase pump due to ATP depletion
C. Activation of caspase enzymes in the intrinsic apoptotic pathway
D. Accumulation of misfolded proteins in the endoplasmic reticulum
Correct Answer: B. Failure of the Na⁺/K⁺-ATPase pump due to ATP depletion
Rationale: Hypoxia halts oxidative phosphorylation, causing critical ATP depletion. Without ATP, the Na⁺/K⁺-
ATPase pump fails, leading to intracellular sodium accumulation, water influx, and cellular swelling. This is the
fundamental mechanism of hypoxic cell injury. Caspase activation relates to apoptosis, not hypoxic necrosis,
and anaerobic glycolysis is insufficient to maintain ATP-dependent pump function.
4. A 45-year-old male with chronic alcoholism presents with jaundice and hepatomegaly. Liver biopsy shows
hepatocytes with enlarged, pale-staining cytoplasm containing lipid vacuoles. This finding represents:
A. Coagulative necrosis
B. Steatosis (fatty change)
, C. Glycogen accumulation
D. Apoptotic bodies
Correct Answer: B. Steatosis (fatty change)
Rationale: Steatosis is the abnormal accumulation of triglycerides within parenchymal cells, most commonly
hepatocytes. Chronic alcohol consumption impairs fatty acid oxidation and lipoprotein export, causing lipid
vacuoles to accumulate. This is a reversible form of sublethal cell injury. Coagulative necrosis involves protein
denaturation and preservation of tissue architecture, which is not described here.
5. A 68-year-old male presents with sudden-onset chest pain. ECG shows ST-segment elevation, and troponin is
elevated. The predominant type of necrosis occurring in the affected myocardium is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs, including the heart, kidney,
and liver. Tissue architecture is preserved for several days because structural proteins are denatured but not
immediately degraded. Liquefactive necrosis occurs in the brain and bacterial abscesses. Caseous necrosis is
associated with tuberculosis, and fat necrosis occurs in the pancreas and breast tissue.
6. A 55-year-old female presents with a brain infarct. The affected brain tissue undergoes enzymatic digestion,
resulting in a soft, liquefied mass. This type of necrosis is:
Comprehensive Review + Practice MCQs —
Chamberlain College of Nursing 2025/2026
1. A 58-year-old male with a 40-year history of hypertension undergoes echocardiography that reveals left
ventricular wall thickening without an increase in the number of myocardial cells. Which cellular adaptation
best describes this finding?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is an increase in cell size, resulting in organ enlargement. Cardiac myocytes are
permanent cells that cannot divide, so they respond to increased workload (chronic pressure overload from
hypertension) by enlarging rather than proliferating. Hyperplasia involves an increase in cell number and does
not occur in cardiac muscle. Metaplasia is the replacement of one differentiated cell type with another, and
dysplasia refers to disordered growth with loss of uniformity.
2. A 62-year-old female with a 30-year smoking history undergoes bronchoscopy for a persistent cough. Biopsy
reveals replacement of normal ciliated columnar epithelium with stratified squamous epithelium. This cellular
adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
,Correct Answer: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with another that is better able to
withstand adverse environmental conditions. Chronic cigarette smoke irritates the bronchial epithelium,
causing ciliated columnar cells to be replaced by more robust stratified squamous cells. While metaplasia itself
is not malignant, it can progress to dysplasia if the irritant persists.
3. During severe hypoxia, which molecular event directly initiates cellular swelling and eventual necrosis?
A. Increased ATP production via anaerobic glycolysis
B. Failure of the Na⁺/K⁺-ATPase pump due to ATP depletion
C. Activation of caspase enzymes in the intrinsic apoptotic pathway
D. Accumulation of misfolded proteins in the endoplasmic reticulum
Correct Answer: B. Failure of the Na⁺/K⁺-ATPase pump due to ATP depletion
Rationale: Hypoxia halts oxidative phosphorylation, causing critical ATP depletion. Without ATP, the Na⁺/K⁺-
ATPase pump fails, leading to intracellular sodium accumulation, water influx, and cellular swelling. This is the
fundamental mechanism of hypoxic cell injury. Caspase activation relates to apoptosis, not hypoxic necrosis,
and anaerobic glycolysis is insufficient to maintain ATP-dependent pump function.
4. A 45-year-old male with chronic alcoholism presents with jaundice and hepatomegaly. Liver biopsy shows
hepatocytes with enlarged, pale-staining cytoplasm containing lipid vacuoles. This finding represents:
A. Coagulative necrosis
B. Steatosis (fatty change)
, C. Glycogen accumulation
D. Apoptotic bodies
Correct Answer: B. Steatosis (fatty change)
Rationale: Steatosis is the abnormal accumulation of triglycerides within parenchymal cells, most commonly
hepatocytes. Chronic alcohol consumption impairs fatty acid oxidation and lipoprotein export, causing lipid
vacuoles to accumulate. This is a reversible form of sublethal cell injury. Coagulative necrosis involves protein
denaturation and preservation of tissue architecture, which is not described here.
5. A 68-year-old male presents with sudden-onset chest pain. ECG shows ST-segment elevation, and troponin is
elevated. The predominant type of necrosis occurring in the affected myocardium is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs, including the heart, kidney,
and liver. Tissue architecture is preserved for several days because structural proteins are denatured but not
immediately degraded. Liquefactive necrosis occurs in the brain and bacterial abscesses. Caseous necrosis is
associated with tuberculosis, and fat necrosis occurs in the pancreas and breast tissue.
6. A 55-year-old female presents with a brain infarct. The affected brain tissue undergoes enzymatic digestion,
resulting in a soft, liquefied mass. This type of necrosis is:
