NSG 530 Exam 1 Actual Exam V2 | NSG 530 Advanced
Pathophysiology (NSG530 Exam 1) [PDF] | Wilkes University
1. A 65-year-old male with a history of chronic untreated hypertension presents for a routine
checkup. An echocardiogram reveals significant thickening of the left ventricular wall. Which
cellular adaptation is most likely responsible for this finding?
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: C
Rationale: Hypertrophy refers to an increase in the size of cells, resulting in an increase in
the size of the organ. In this case, the cardiac myocytes increase in size to compensate for
the increased workload of pumping against high systemic pressure. This process involves
increased protein synthesis rather than the production of new cells.
2. A biopsy of the bronchial lining in a long-term smoker reveals that normal ciliated
columnar epithelium has been replaced by stratified squamous epithelium. This is an
example of:
A. Hyperplasia
B. Dysplasia
C. Anaplasia
D. Metaplasia
Answer: D
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type. In smokers, the fragile ciliated columnar cells are replaced by tougher
stratified squamous cells to withstand chronic irritation. While this provides protection, it
results in the loss of the vital mucociliary escalator function.
3. During an autopsy of a patient who died from a myocardial infarction, the pathologist
notes an area of the heart that is firm and opaque. Microscopic examination shows preserved
cell outlines but lost nuclei. What type of necrosis is this?
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis
,D. Fat necrosis
Answer: B
Rationale: Coagulative necrosis is characteristic of hypoxic injury in most organs except
the brain. It is characterized by protein denaturation, which prevents the cell from
digesting itself. This leaves a firm texture where the basic structural outline of the tissue is
preserved for several days.
4. A patient with acute pancreatitis presents with severe abdominal pain. Laboratory results
show elevated serum lipase. The necrosis occurring in the peripancreatic tissue is
characterized by the action of lipases on adipocytes, known as:
A. Coagulative necrosis
B. Fat necrosis
C. Caseous necrosis
D. Liquefactive necrosis
Answer: B
Rationale: Fat necrosis occurs when lipases are released into adipose tissue, breaking
down triglycerides into free fatty acids. These fatty acids then combine with calcium,
magnesium, and sodium ions to create soaps (saponification). The affected area typically
appears opaque and chalk-white on gross examination.
5. Which of the following processes is a regulated, energy-dependent form of cell death that
does not typically elicit an inflammatory response?
A. Necrosis
B. Autophagy
C. Pyoptosis
D. Apoptosis
Answer: D
Rationale: Apoptosis is a highly regulated process of programmed cell death used to
eliminate unwanted or damaged cells. Unlike necrosis, it involves the activation of caspases
and leads to cell shrinkage and DNA fragmentation without leaking cellular contents.
Because the cell membrane remains intact until phagocytosis, there is typically no
secondary inflammation.
6. A patient experiences a prolonged period of ischemia in the lower limb followed by sudden
restoration of blood flow. The patient then develops severe tissue damage. This phenomenon
is best explained by:
A. Apoptotic signaling
, B. Hypertrophic compensation
C. Metabolic alkalosis
D. Reperfusion injury
Answer: D
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic tissues,
leading to the massive production of reactive oxygen species (ROS). These ROS cause
further damage to cell membranes and mitochondria that were already stressed by
hypoxia. This can lead to systemic inflammation and additional local tissue destruction.
7. Which intracellular electrolyte imbalance is most directly responsible for the activation of
various enzymes that cause irreversible cell damage during ischemia?
A. Increased intracellular Sodium
B. Decreased intracellular Potassium
C. Decreased intracellular Magnesium
D. Increased intracellular Calcium
Answer: D
Rationale: Ischemia leads to ATP depletion, which causes the failure of calcium pumps and
the release of calcium from intracellular stores. The resulting increase in cytosolic calcium
activates proteases, endonucleases, and phospholipases that degrade the cell. This
enzymatic activation is a critical step in the transition from reversible to irreversible cell
injury.
8. A 45-year-old woman presents with a cervical biopsy showing abnormal changes in the
size, shape, and organization of mature cells. These findings are most indicative of:
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
Answer: A
Rationale: Dysplasia refers to abnormal changes in the size, shape, and organization of
mature cells and is often termed ‘atypical hyperplasia.’ It is frequently associated with
chronic irritation and is a strong precursor to cancerous changes. While it can be reversible
if the stimulus is removed, high-grade dysplasia often requires clinical intervention.
9. Carbon monoxide (CO) is toxic to cells primarily because it:
A. Causes direct DNA damage
Pathophysiology (NSG530 Exam 1) [PDF] | Wilkes University
1. A 65-year-old male with a history of chronic untreated hypertension presents for a routine
checkup. An echocardiogram reveals significant thickening of the left ventricular wall. Which
cellular adaptation is most likely responsible for this finding?
A. Hyperplasia
B. Atrophy
C. Hypertrophy
D. Metaplasia
Answer: C
Rationale: Hypertrophy refers to an increase in the size of cells, resulting in an increase in
the size of the organ. In this case, the cardiac myocytes increase in size to compensate for
the increased workload of pumping against high systemic pressure. This process involves
increased protein synthesis rather than the production of new cells.
2. A biopsy of the bronchial lining in a long-term smoker reveals that normal ciliated
columnar epithelium has been replaced by stratified squamous epithelium. This is an
example of:
A. Hyperplasia
B. Dysplasia
C. Anaplasia
D. Metaplasia
Answer: D
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
mature cell type. In smokers, the fragile ciliated columnar cells are replaced by tougher
stratified squamous cells to withstand chronic irritation. While this provides protection, it
results in the loss of the vital mucociliary escalator function.
3. During an autopsy of a patient who died from a myocardial infarction, the pathologist
notes an area of the heart that is firm and opaque. Microscopic examination shows preserved
cell outlines but lost nuclei. What type of necrosis is this?
A. Liquefactive necrosis
B. Coagulative necrosis
C. Caseous necrosis
,D. Fat necrosis
Answer: B
Rationale: Coagulative necrosis is characteristic of hypoxic injury in most organs except
the brain. It is characterized by protein denaturation, which prevents the cell from
digesting itself. This leaves a firm texture where the basic structural outline of the tissue is
preserved for several days.
4. A patient with acute pancreatitis presents with severe abdominal pain. Laboratory results
show elevated serum lipase. The necrosis occurring in the peripancreatic tissue is
characterized by the action of lipases on adipocytes, known as:
A. Coagulative necrosis
B. Fat necrosis
C. Caseous necrosis
D. Liquefactive necrosis
Answer: B
Rationale: Fat necrosis occurs when lipases are released into adipose tissue, breaking
down triglycerides into free fatty acids. These fatty acids then combine with calcium,
magnesium, and sodium ions to create soaps (saponification). The affected area typically
appears opaque and chalk-white on gross examination.
5. Which of the following processes is a regulated, energy-dependent form of cell death that
does not typically elicit an inflammatory response?
A. Necrosis
B. Autophagy
C. Pyoptosis
D. Apoptosis
Answer: D
Rationale: Apoptosis is a highly regulated process of programmed cell death used to
eliminate unwanted or damaged cells. Unlike necrosis, it involves the activation of caspases
and leads to cell shrinkage and DNA fragmentation without leaking cellular contents.
Because the cell membrane remains intact until phagocytosis, there is typically no
secondary inflammation.
6. A patient experiences a prolonged period of ischemia in the lower limb followed by sudden
restoration of blood flow. The patient then develops severe tissue damage. This phenomenon
is best explained by:
A. Apoptotic signaling
, B. Hypertrophic compensation
C. Metabolic alkalosis
D. Reperfusion injury
Answer: D
Rationale: Reperfusion injury occurs when oxygen is reintroduced to ischemic tissues,
leading to the massive production of reactive oxygen species (ROS). These ROS cause
further damage to cell membranes and mitochondria that were already stressed by
hypoxia. This can lead to systemic inflammation and additional local tissue destruction.
7. Which intracellular electrolyte imbalance is most directly responsible for the activation of
various enzymes that cause irreversible cell damage during ischemia?
A. Increased intracellular Sodium
B. Decreased intracellular Potassium
C. Decreased intracellular Magnesium
D. Increased intracellular Calcium
Answer: D
Rationale: Ischemia leads to ATP depletion, which causes the failure of calcium pumps and
the release of calcium from intracellular stores. The resulting increase in cytosolic calcium
activates proteases, endonucleases, and phospholipases that degrade the cell. This
enzymatic activation is a critical step in the transition from reversible to irreversible cell
injury.
8. A 45-year-old woman presents with a cervical biopsy showing abnormal changes in the
size, shape, and organization of mature cells. These findings are most indicative of:
A. Dysplasia
B. Metaplasia
C. Hypertrophy
D. Atrophy
Answer: A
Rationale: Dysplasia refers to abnormal changes in the size, shape, and organization of
mature cells and is often termed ‘atypical hyperplasia.’ It is frequently associated with
chronic irritation and is a strong precursor to cancerous changes. While it can be reversible
if the stimulus is removed, high-grade dysplasia often requires clinical intervention.
9. Carbon monoxide (CO) is toxic to cells primarily because it:
A. Causes direct DNA damage
