,NURS 6501 Advanced Pathophysiology Exam Prep
— Comprehensive Review + Practice MCQs —
Walden University 2025/2026
1. A 68-year-old male with chronic hypertension develops left ventricular enlargement. Echocardiography
shows increased wall thickness without an increase in the number of cardiomyocytes. Which cellular
adaptation has occurred?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot undergo mitotic division. When faced
with increased workload (as in chronic hypertension), cardiomyocytes increase in size rather than number — a
process called hypertrophy. Hyperplasia (increase in cell number) cannot occur in cardiac muscle. Metaplasia
involves replacement of one cell type with another. Dysplasia refers to disordered growth with atypical
features, typically pre-malignant.
2. A 54-year-old male with a 30-year smoking history undergoes bronchoscopy that reveals replacement of
normal ciliated columnar epithelium with stratified squamous epithelium. This finding is best classified as:
A. Hyperplasia
B. Metaplasia
,C. Dysplasia
D. Anaplasia
Correct Answer: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated adult cell type with another, often as
an adaptive response to chronic irritation. In smokers, chronic exposure causes squamous metaplasia of the
bronchial epithelium. While metaplasia itself is not malignant, it is a precursor change that can progress to
dysplasia and ultimately carcinoma. Hyperplasia involves increased cell number without change in cell type.
Dysplasia shows disordered growth with atypical features. Anaplasia is lack of differentiation characteristic of
malignancy.
3. A 42-year-old female presents with fatigue and pallor. Labs reveal hemoglobin 8.2 g/dL, MCV 68 fL, and RDW
18%. Bone marrow shows microcytic hypochromic erythrocytes. The primary pathophysiologic mechanism is:
A. Impaired DNA synthesis due to vitamin B12 deficiency
B. Decreased heme synthesis due to iron deficiency
C. Autoimmune destruction of erythrocyte precursors
D. Defective globin chain synthesis
Correct Answer: B. Decreased heme synthesis due to iron deficiency
Rationale: Microcytic hypochromic anemia with elevated RDW is classic for iron deficiency anemia. Iron is
essential for heme synthesis; deficiency impairs hemoglobin production, resulting in smaller, paler red blood
cells. Impaired DNA synthesis causes megaloblastic anemia (macrocytic). Autoimmune destruction causes
hemolytic anemia. Defective globin chain synthesis occurs in thalassemias.
, 4. A 35-year-old male with recurrent bacterial infections is found to have a defect in the NADPH oxidase
enzyme system. This defect impairs the ability of phagocytes to:
A. Engulf and internalize bacteria
B. Produce reactive oxygen species for intracellular killing
C. Present antigens to T lymphocytes
D. Migrate to sites of infection
Correct Answer: B. Produce reactive oxygen species for intracellular killing
Rationale: Chronic granulomatous disease results from defective NADPH oxidase, which is required for the
respiratory burst that generates reactive oxygen species (superoxide, hydrogen peroxide) needed to kill
ingested pathogens. Phagocytosis itself remains intact, as does antigen presentation. The defect is specifically
in intracellular killing, not in engulfment or migration.
5. Which type of necrosis is most characteristic of ischemic injury to the heart and kidney?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis, characterized by protein denaturation with preservation of tissue architecture,
is the hallmark of ischemic injury in solid organs such as the heart and kidney. Liquefactive necrosis occurs in
the brain (ischemic stroke) and bacterial abscesses. Caseous necrosis is associated with tuberculosis. Fat
necrosis occurs in the pancreas and breast tissue.
— Comprehensive Review + Practice MCQs —
Walden University 2025/2026
1. A 68-year-old male with chronic hypertension develops left ventricular enlargement. Echocardiography
shows increased wall thickness without an increase in the number of cardiomyocytes. Which cellular
adaptation has occurred?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot undergo mitotic division. When faced
with increased workload (as in chronic hypertension), cardiomyocytes increase in size rather than number — a
process called hypertrophy. Hyperplasia (increase in cell number) cannot occur in cardiac muscle. Metaplasia
involves replacement of one cell type with another. Dysplasia refers to disordered growth with atypical
features, typically pre-malignant.
2. A 54-year-old male with a 30-year smoking history undergoes bronchoscopy that reveals replacement of
normal ciliated columnar epithelium with stratified squamous epithelium. This finding is best classified as:
A. Hyperplasia
B. Metaplasia
,C. Dysplasia
D. Anaplasia
Correct Answer: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated adult cell type with another, often as
an adaptive response to chronic irritation. In smokers, chronic exposure causes squamous metaplasia of the
bronchial epithelium. While metaplasia itself is not malignant, it is a precursor change that can progress to
dysplasia and ultimately carcinoma. Hyperplasia involves increased cell number without change in cell type.
Dysplasia shows disordered growth with atypical features. Anaplasia is lack of differentiation characteristic of
malignancy.
3. A 42-year-old female presents with fatigue and pallor. Labs reveal hemoglobin 8.2 g/dL, MCV 68 fL, and RDW
18%. Bone marrow shows microcytic hypochromic erythrocytes. The primary pathophysiologic mechanism is:
A. Impaired DNA synthesis due to vitamin B12 deficiency
B. Decreased heme synthesis due to iron deficiency
C. Autoimmune destruction of erythrocyte precursors
D. Defective globin chain synthesis
Correct Answer: B. Decreased heme synthesis due to iron deficiency
Rationale: Microcytic hypochromic anemia with elevated RDW is classic for iron deficiency anemia. Iron is
essential for heme synthesis; deficiency impairs hemoglobin production, resulting in smaller, paler red blood
cells. Impaired DNA synthesis causes megaloblastic anemia (macrocytic). Autoimmune destruction causes
hemolytic anemia. Defective globin chain synthesis occurs in thalassemias.
, 4. A 35-year-old male with recurrent bacterial infections is found to have a defect in the NADPH oxidase
enzyme system. This defect impairs the ability of phagocytes to:
A. Engulf and internalize bacteria
B. Produce reactive oxygen species for intracellular killing
C. Present antigens to T lymphocytes
D. Migrate to sites of infection
Correct Answer: B. Produce reactive oxygen species for intracellular killing
Rationale: Chronic granulomatous disease results from defective NADPH oxidase, which is required for the
respiratory burst that generates reactive oxygen species (superoxide, hydrogen peroxide) needed to kill
ingested pathogens. Phagocytosis itself remains intact, as does antigen presentation. The defect is specifically
in intracellular killing, not in engulfment or migration.
5. Which type of necrosis is most characteristic of ischemic injury to the heart and kidney?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C. Coagulative necrosis
Rationale: Coagulative necrosis, characterized by protein denaturation with preservation of tissue architecture,
is the hallmark of ischemic injury in solid organs such as the heart and kidney. Liquefactive necrosis occurs in
the brain (ischemic stroke) and bacterial abscesses. Caseous necrosis is associated with tuberculosis. Fat
necrosis occurs in the pancreas and breast tissue.
