Apea Pathophysiology Actual Exam
Review 2026 — Comprehensive Study
Guide With Verified Answers & Complete
Rationales
**1. A patient with chronic hypertension develops increased left
ventricular wall thickness. Which cellular adaptation does this
represent?**
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
**Correct answer:** B. Hypertrophy
**Rationale:** Hypertrophy is an increase in cell size, not cell
number. Cardiac muscle cells are terminally differentiated and
cannot divide; therefore, they enlarge in response to chronic
pressure overload from hypertension to maintain cardiac
output. Hyperplasia involves an increase in cell number,
metaplasia is the reversible replacement of one cell type with
another, and atrophy is shrinkage of cells .
,**2. A chronic smoker undergoes a biopsy showing
replacement of bronchial columnar epithelium with stratified
squamous epithelium. This change is best classified as:**
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Neoplasia
**Correct answer:** B. Metaplasia
**Rationale:** Metaplasia is the reversible substitution of one
mature, differentiated cell type with another that is better able to
survive the adverse environment. In smokers, chronic irritation
causes columnar epithelium to convert to squamous epithelium,
which is more resistant but loses ciliary function. Dysplasia
refers to disordered growth with atypical cells, anaplasia
denotes lack of differentiation seen in malignancy, and
neoplasia refers to new uncontrolled growth .
**3. A cell undergoes programmed, energy-dependent death
without triggering an inflammatory response. This process is
called:**
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis
, D. Caseous necrosis
**Correct answer:** C. Apoptosis
**Rationale:** Apoptosis is genetically programmed cell death
involving caspase activation, DNA fragmentation, and formation
of apoptotic bodies that are phagocytosed without
inflammation. Necrosis, by contrast, involves cell swelling,
membrane rupture, and inflammation. Coagulative, liquefactive,
and caseous necrosis are all forms of necrosis associated with
inflammatory responses .
**4. Following a myocardial infarction, the infarcted tissue
maintains its structural outline but the cells are dead. Which
type of necrosis is this?**
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis
D. Fat necrosis
**Correct answer:** B. Coagulative necrosis
**Rationale:** Coagulative necrosis preserves the structural
architecture of dead tissue for days because denatured
proteins resist proteolysis. It is the hallmark of ischemic injury in
solid organs such as the heart, kidney, and spleen. Liquefactive
Review 2026 — Comprehensive Study
Guide With Verified Answers & Complete
Rationales
**1. A patient with chronic hypertension develops increased left
ventricular wall thickness. Which cellular adaptation does this
represent?**
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Atrophy
**Correct answer:** B. Hypertrophy
**Rationale:** Hypertrophy is an increase in cell size, not cell
number. Cardiac muscle cells are terminally differentiated and
cannot divide; therefore, they enlarge in response to chronic
pressure overload from hypertension to maintain cardiac
output. Hyperplasia involves an increase in cell number,
metaplasia is the reversible replacement of one cell type with
another, and atrophy is shrinkage of cells .
,**2. A chronic smoker undergoes a biopsy showing
replacement of bronchial columnar epithelium with stratified
squamous epithelium. This change is best classified as:**
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Neoplasia
**Correct answer:** B. Metaplasia
**Rationale:** Metaplasia is the reversible substitution of one
mature, differentiated cell type with another that is better able to
survive the adverse environment. In smokers, chronic irritation
causes columnar epithelium to convert to squamous epithelium,
which is more resistant but loses ciliary function. Dysplasia
refers to disordered growth with atypical cells, anaplasia
denotes lack of differentiation seen in malignancy, and
neoplasia refers to new uncontrolled growth .
**3. A cell undergoes programmed, energy-dependent death
without triggering an inflammatory response. This process is
called:**
A. Coagulative necrosis
B. Liquefactive necrosis
C. Apoptosis
, D. Caseous necrosis
**Correct answer:** C. Apoptosis
**Rationale:** Apoptosis is genetically programmed cell death
involving caspase activation, DNA fragmentation, and formation
of apoptotic bodies that are phagocytosed without
inflammation. Necrosis, by contrast, involves cell swelling,
membrane rupture, and inflammation. Coagulative, liquefactive,
and caseous necrosis are all forms of necrosis associated with
inflammatory responses .
**4. Following a myocardial infarction, the infarcted tissue
maintains its structural outline but the cells are dead. Which
type of necrosis is this?**
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis
D. Fat necrosis
**Correct answer:** B. Coagulative necrosis
**Rationale:** Coagulative necrosis preserves the structural
architecture of dead tissue for days because denatured
proteins resist proteolysis. It is the hallmark of ischemic injury in
solid organs such as the heart, kidney, and spleen. Liquefactive
