NURS 5315 Advanced Pathophysiology Tests 1-4 Bundle UTA Actual Exam
2026/2027 – Complete 120 Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
SECTION A: Test 1 – Cellular Biology, Genetics & Inflammation (Q1–Q30)
Q1: A 58-year-old man with a 30-pack-year smoking history undergoes bronchoscopy.
Biopsy of the bronchial epithelium reveals that the normal ciliated pseudostratified
columnar epithelium has been replaced by stratified squamous epithelium. Which
cellular adaptation does this finding represent?
A. Atrophy of the bronchial lining
B. Hyperplasia of the airway epithelium
C. Metaplasia of the bronchial epithelium [CORRECT]
D. Dysplasia of the basal cell layer
Correct Answer: C
Rationale: Metaplasia is the reversible substitution of one adult cell type for another
better suited to survive chronic irritation, such as squamous replacement of columnar
epithelium in smokers. Atrophy decreases cell size, hyperplasia increases cell number,
and dysplasia is disordered atypical growth.
Q2: Chronic hypertension has caused a patient's left ventricular wall to thicken and
become more muscular. Which cellular adaptation explains this finding in cardiac
myocytes?
A. Hyperplasia, because cardiocytes increase in number under pressure load
B. Hypertrophy, because terminally differentiated myocytes increase in size [CORRECT]
C. Metaplasia, because myocytes transform to smooth muscle
D. Neoplasia, because new growth of cardiac tissue has occurred
Correct Answer: B
Rationale: Cardiac myocytes are terminally differentiated and cannot divide, so
increased workload causes cell enlargement (hypertrophy). Hyperplasia requires cell
division, which does not occur in cardiac muscle.
Q3: During embryologic development, the cells forming the webbing between the fingers
die and are removed without any surrounding inflammation or scar formation. Which
mechanism of cell death explains this finding?
A. Coagulative necrosis with an inflammatory response
,B. Liquefactive necrosis releasing lysosomal enzymes
C. Caspase-independent mitochondrial swelling and rupture
D. Apoptosis, an ATP-dependent programmed cell death mechanism [CORRECT]
Correct Answer: D
Rationale: Apoptosis is programmed cell death mediated by caspase enzymes that
eliminates cells without triggering inflammation or scarring, as in embryonic digit
separation. Necrosis always incites an inflammatory response due to membrane
rupture and enzyme leakage.
Q4: A renal artery occlusion produces a wedge-shaped area of pale, firm tissue with
preserved cellular architecture ("tombstone" appearance) on histology. Which type of
necrosis is this?
A. Coagulative necrosis [CORRECT]
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis results from ischemia in solid organs, where denatured
proteins preserve tissue outline while cells die. Liquefactive necrosis digests tissue
(brain, abscess), and caseous and fat necrosis have distinct cheese-like and chalky
appearances.
Q5: An autopsy of a patient who died of an ischemic stroke shows a 10-day-old cerebral
infarct with soft, liquefied tissue and early cavity formation. Which type of necrosis
occurred in the brain?
A. Coagulative necrosis from protein denaturation
B. Caseous necrosis from mycobacterial infection
C. Liquefactive necrosis from enzymatic digestion [CORRECT]
D. Gangrenous necrosis from mixed ischemic injury
Correct Answer: C
Rationale: The brain lacks substantial stromal collagen, so ischemic tissue undergoes
liquefaction by lysosomal enzymes with cystic cavity formation. Coagulative necrosis is
the pattern in most other solid organs.
Q6: A lung biopsy from a patient with tuberculosis shows a granuloma with a central
amorphous, cheese-like, friable necrotic zone. Which type of necrosis is present?
A. Fibrinoid necrosis of vessel walls
B. Caseous necrosis [CORRECT]
C. Enzymatic fat necrosis of parenchyma
D. Coagulative necrosis of alveolar septa
,Correct Answer: B
Rationale: Caseous necrosis is a distinctive form of coagulative necrosis seen with TB
and fungal infections, producing friable, white-cheese-like debris enclosed by a
granuloma. The other patterns occur in immune vessel injury, pancreatic fat injury, and
ischemic tissue, respectively.
Q7: A patient experiences successful reperfusion of an occluded coronary artery, but
myocardial injury paradoxically worsens over the next several hours. Which mechanism
most directly mediates this reperfusion injury?
A. Complement activation destroying myocytes by membrane attack complexes
B. Rapid restoration of ATP with mitochondrial calcium overload only
C. Increased protein synthesis overwhelmed by oxygen delivery
D. Oxygen-derived free radicals causing lipid peroxidation of membranes [CORRECT]
Correct Answer: D
Rationale: Reintroduced oxygen fuels xanthine oxidase and mitochondrial electron leak,
generating reactive oxygen species that peroxidize cell membranes and worsen injury
when antioxidant reserves are depleted. The paradox is oxidative, not nutritional or
synthetic, in origin.
Q8: A renal tubular cell subjected to acute hypoxia swells, with cytoplasmic
vacuolization and dilated endoplasmic reticulum. Which subcellular event is the earliest
critical mechanism producing this swelling?
A. Depleted ATP causing failure of the sodium–potassium pump [CORRECT]
B. Increased potassium influx causing hyperosmotic swelling
C. Active extrusion of cytosolic calcium into the cytosol
D. Accelerated transcription of stress-response proteins
Correct Answer: A
Rationale: Hypoxia halts oxidative phosphorylation, ATP falls, and the Na⁺/K⁺-ATPase
fails, allowing sodium and water to accumulate intracellularly with resultant hydropic
swelling. Potassium loss, not gain, accompanies pump failure, and protein synthesis
declines rather than accelerates.
Q9: A cervical biopsy in a 31-year-old woman with HPV infection shows disordered,
atypical epithelial cells with enlarged, hyperchromatic nuclei and loss of normal polarity.
Which cellular change is described, and what is its clinical significance?
A. Metaplasia that is fully reversible with no malignant potential
B. Hyperplasia that always progresses to invasive carcinoma
C. Dysplasia, a premalignant change that may regress or progress [CORRECT]
D. Anaplasia, which defines the lesion as invasive cancer
Correct Answer: C
, Rationale: Dysplasia (cervical intraepithelial neoplasia) is disordered proliferative atypia
that is potentially reversible but may progress to carcinoma if untreated. Anaplasia
defines malignancy, metaplasia is substitution of cell type, and hyperplasia is orderly
increased cell number.
Q10: A 24-year-old athlete's arm is immobilized in a cast for 8 weeks after a fracture.
Upon cast removal, the forearm muscles appear visibly smaller and weaker. Which
adaptation accounts for this finding?
A. Denervation-induced cell death of myocytes
B. Atrophy from decreased workload and metabolic demand [CORRECT]
C. Compression-induced metaplasia of muscle fibers
D. Apoptosis from irreversible ischemic injury
Correct Answer: B
Rationale: Disuse atrophy is the decrease in cell size that occurs when workload,
innervation, or nutrition is reduced, and it is largely reversible with resumed use. It is
adaptation, not irreversible cell death.
Q11: A newborn displays hypotonia, a flat facial profile, and a single palmar crease.
Karyotyping reveals 47,XX,+21. Which chromosomal mechanism produced this
disorder?
A. A reciprocal translocation between chromosomes 14 and 21
B. A mitotic nondisjunction producing mosaicism of two cell lines
C. A deletion of the distal long arm of chromosome 21
D. A meiotic nondisjunction of chromosome 21 homologues [CORRECT]
Correct Answer: D
Rationale: About 95% of Down syndrome results from meiotic nondisjunction, producing
a full trisomy 21 (47 chromosomes). Translocation Down syndrome involves
Robertsonian translocation, mosaicism arises from mitotic error, and deletion
syndromes involve chromosome loss, not gain.
Q12: A 29-year-old man whose father died of Huntington disease at age 52 asks about
his risk of inheriting the condition. Which inheritance pattern applies, and what is his
chance of developing the disease?
A. Autosomal dominant with a 50% risk [CORRECT]
B. Autosomal recessive with a 25% risk if only one parent is affected
C. X-linked dominant with a 50% risk only if male
D. Autosomal dominant with a 25% risk due to incomplete penetrance
Correct Answer: A
Rationale: Huntington disease is autosomal dominant, so each child of an affected
heterozygous parent has a 50% chance regardless of sex. Incomplete penetrance is not
2026/2027 – Complete 120 Questions with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
SECTION A: Test 1 – Cellular Biology, Genetics & Inflammation (Q1–Q30)
Q1: A 58-year-old man with a 30-pack-year smoking history undergoes bronchoscopy.
Biopsy of the bronchial epithelium reveals that the normal ciliated pseudostratified
columnar epithelium has been replaced by stratified squamous epithelium. Which
cellular adaptation does this finding represent?
A. Atrophy of the bronchial lining
B. Hyperplasia of the airway epithelium
C. Metaplasia of the bronchial epithelium [CORRECT]
D. Dysplasia of the basal cell layer
Correct Answer: C
Rationale: Metaplasia is the reversible substitution of one adult cell type for another
better suited to survive chronic irritation, such as squamous replacement of columnar
epithelium in smokers. Atrophy decreases cell size, hyperplasia increases cell number,
and dysplasia is disordered atypical growth.
Q2: Chronic hypertension has caused a patient's left ventricular wall to thicken and
become more muscular. Which cellular adaptation explains this finding in cardiac
myocytes?
A. Hyperplasia, because cardiocytes increase in number under pressure load
B. Hypertrophy, because terminally differentiated myocytes increase in size [CORRECT]
C. Metaplasia, because myocytes transform to smooth muscle
D. Neoplasia, because new growth of cardiac tissue has occurred
Correct Answer: B
Rationale: Cardiac myocytes are terminally differentiated and cannot divide, so
increased workload causes cell enlargement (hypertrophy). Hyperplasia requires cell
division, which does not occur in cardiac muscle.
Q3: During embryologic development, the cells forming the webbing between the fingers
die and are removed without any surrounding inflammation or scar formation. Which
mechanism of cell death explains this finding?
A. Coagulative necrosis with an inflammatory response
,B. Liquefactive necrosis releasing lysosomal enzymes
C. Caspase-independent mitochondrial swelling and rupture
D. Apoptosis, an ATP-dependent programmed cell death mechanism [CORRECT]
Correct Answer: D
Rationale: Apoptosis is programmed cell death mediated by caspase enzymes that
eliminates cells without triggering inflammation or scarring, as in embryonic digit
separation. Necrosis always incites an inflammatory response due to membrane
rupture and enzyme leakage.
Q4: A renal artery occlusion produces a wedge-shaped area of pale, firm tissue with
preserved cellular architecture ("tombstone" appearance) on histology. Which type of
necrosis is this?
A. Coagulative necrosis [CORRECT]
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis results from ischemia in solid organs, where denatured
proteins preserve tissue outline while cells die. Liquefactive necrosis digests tissue
(brain, abscess), and caseous and fat necrosis have distinct cheese-like and chalky
appearances.
Q5: An autopsy of a patient who died of an ischemic stroke shows a 10-day-old cerebral
infarct with soft, liquefied tissue and early cavity formation. Which type of necrosis
occurred in the brain?
A. Coagulative necrosis from protein denaturation
B. Caseous necrosis from mycobacterial infection
C. Liquefactive necrosis from enzymatic digestion [CORRECT]
D. Gangrenous necrosis from mixed ischemic injury
Correct Answer: C
Rationale: The brain lacks substantial stromal collagen, so ischemic tissue undergoes
liquefaction by lysosomal enzymes with cystic cavity formation. Coagulative necrosis is
the pattern in most other solid organs.
Q6: A lung biopsy from a patient with tuberculosis shows a granuloma with a central
amorphous, cheese-like, friable necrotic zone. Which type of necrosis is present?
A. Fibrinoid necrosis of vessel walls
B. Caseous necrosis [CORRECT]
C. Enzymatic fat necrosis of parenchyma
D. Coagulative necrosis of alveolar septa
,Correct Answer: B
Rationale: Caseous necrosis is a distinctive form of coagulative necrosis seen with TB
and fungal infections, producing friable, white-cheese-like debris enclosed by a
granuloma. The other patterns occur in immune vessel injury, pancreatic fat injury, and
ischemic tissue, respectively.
Q7: A patient experiences successful reperfusion of an occluded coronary artery, but
myocardial injury paradoxically worsens over the next several hours. Which mechanism
most directly mediates this reperfusion injury?
A. Complement activation destroying myocytes by membrane attack complexes
B. Rapid restoration of ATP with mitochondrial calcium overload only
C. Increased protein synthesis overwhelmed by oxygen delivery
D. Oxygen-derived free radicals causing lipid peroxidation of membranes [CORRECT]
Correct Answer: D
Rationale: Reintroduced oxygen fuels xanthine oxidase and mitochondrial electron leak,
generating reactive oxygen species that peroxidize cell membranes and worsen injury
when antioxidant reserves are depleted. The paradox is oxidative, not nutritional or
synthetic, in origin.
Q8: A renal tubular cell subjected to acute hypoxia swells, with cytoplasmic
vacuolization and dilated endoplasmic reticulum. Which subcellular event is the earliest
critical mechanism producing this swelling?
A. Depleted ATP causing failure of the sodium–potassium pump [CORRECT]
B. Increased potassium influx causing hyperosmotic swelling
C. Active extrusion of cytosolic calcium into the cytosol
D. Accelerated transcription of stress-response proteins
Correct Answer: A
Rationale: Hypoxia halts oxidative phosphorylation, ATP falls, and the Na⁺/K⁺-ATPase
fails, allowing sodium and water to accumulate intracellularly with resultant hydropic
swelling. Potassium loss, not gain, accompanies pump failure, and protein synthesis
declines rather than accelerates.
Q9: A cervical biopsy in a 31-year-old woman with HPV infection shows disordered,
atypical epithelial cells with enlarged, hyperchromatic nuclei and loss of normal polarity.
Which cellular change is described, and what is its clinical significance?
A. Metaplasia that is fully reversible with no malignant potential
B. Hyperplasia that always progresses to invasive carcinoma
C. Dysplasia, a premalignant change that may regress or progress [CORRECT]
D. Anaplasia, which defines the lesion as invasive cancer
Correct Answer: C
, Rationale: Dysplasia (cervical intraepithelial neoplasia) is disordered proliferative atypia
that is potentially reversible but may progress to carcinoma if untreated. Anaplasia
defines malignancy, metaplasia is substitution of cell type, and hyperplasia is orderly
increased cell number.
Q10: A 24-year-old athlete's arm is immobilized in a cast for 8 weeks after a fracture.
Upon cast removal, the forearm muscles appear visibly smaller and weaker. Which
adaptation accounts for this finding?
A. Denervation-induced cell death of myocytes
B. Atrophy from decreased workload and metabolic demand [CORRECT]
C. Compression-induced metaplasia of muscle fibers
D. Apoptosis from irreversible ischemic injury
Correct Answer: B
Rationale: Disuse atrophy is the decrease in cell size that occurs when workload,
innervation, or nutrition is reduced, and it is largely reversible with resumed use. It is
adaptation, not irreversible cell death.
Q11: A newborn displays hypotonia, a flat facial profile, and a single palmar crease.
Karyotyping reveals 47,XX,+21. Which chromosomal mechanism produced this
disorder?
A. A reciprocal translocation between chromosomes 14 and 21
B. A mitotic nondisjunction producing mosaicism of two cell lines
C. A deletion of the distal long arm of chromosome 21
D. A meiotic nondisjunction of chromosome 21 homologues [CORRECT]
Correct Answer: D
Rationale: About 95% of Down syndrome results from meiotic nondisjunction, producing
a full trisomy 21 (47 chromosomes). Translocation Down syndrome involves
Robertsonian translocation, mosaicism arises from mitotic error, and deletion
syndromes involve chromosome loss, not gain.
Q12: A 29-year-old man whose father died of Huntington disease at age 52 asks about
his risk of inheriting the condition. Which inheritance pattern applies, and what is his
chance of developing the disease?
A. Autosomal dominant with a 50% risk [CORRECT]
B. Autosomal recessive with a 25% risk if only one parent is affected
C. X-linked dominant with a 50% risk only if male
D. Autosomal dominant with a 25% risk due to incomplete penetrance
Correct Answer: A
Rationale: Huntington disease is autosomal dominant, so each child of an affected
heterozygous parent has a 50% chance regardless of sex. Incomplete penetrance is not
