NURS 231 Pathophysiology Final
Exam - Portage Learning
Section 1: Cellular Adaptation, Injury & Death
1. Which of the following best describes the cellular adaptation seen in a
bodybuilder’s skeletal muscle following chronic resistance training?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size, commonly seen in
skeletal muscle in response to increased workload. Hyperplasia (A) involves an
increase in cell number and is less relevant in skeletal muscle. Atrophy (C) is a
decrease in cell size. Metaplasia (D) is the reversible replacement of one mature
cell type with another .
2. A biopsy of the lower esophagus in a patient with chronic GERD reveals
columnar epithelium replacing the normal stratified squamous epithelium.
This finding is most consistent with:
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C
Rationale: Barrett esophagus is the classic example of metaplasia, where
chronic acid exposure causes a change from squamous to columnar epithelium.
Dysplasia (A) refers to disordered growth and is a preneoplastic change, not a
change in mature cell type. Hyperplasia (B) is an increase in cell number.
Anaplasia (D) is a lack of differentiation seen in malignancy .
3. Which of the following is the single most common cause of cellular injury
and cell death in clinical medicine?
,A. Physical trauma
B. Hypoxia
C. Chemical toxins
D. Infectious agents
Correct Answer: B
Rationale: Hypoxia (oxygen deprivation) is the most common cause of
cellular injury. It may result from ischemia, respiratory failure, or anemia. While
trauma, toxins, and infections cause injury, hypoxia is the most frequent final
common pathway to cell death .
4. A patient with a myocardial infarction has a region of dead heart tissue. The
type of necrosis most characteristic of this ischemic injury is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid
organs (heart, kidney, spleen), where architectural outlines are preserved due to
protein denaturation. Liquefactive necrosis (A) occurs in brain infarcts and
abscesses. Caseous necrosis (B) is seen in tuberculosis. Fat necrosis (D) occurs in
pancreatitis or breast trauma .
5. Which of the following best distinguishes apoptosis from necrosis?
A. Apoptosis causes cell swelling and membrane rupture
B. Apoptosis triggers a robust inflammatory response
C. Apoptosis is energy-dependent and does not incite inflammation
D. Apoptosis results in the release of intracellular contents
Correct Answer: C
Rationale: Apoptosis is programmed cell death that is energy-dependent
(ATP-requiring), results in cell shrinkage and apoptotic body formation, and does
not trigger inflammation. Necrosis (A, B, D) involves cell swelling, membrane
rupture, release of contents, and inflammation .
,6. The intrinsic pathway of apoptosis is triggered by which of the following
events?
A. Binding of Fas ligand to the Fas receptor
B. Cytochrome c release from mitochondria and apoptosome formation
C. Activation of caspase-8 by the death-inducing signaling complex
D. Perforin and granzyme B entry from cytotoxic T cells
Correct Answer: B
Rationale: The intrinsic (mitochondrial) pathway is initiated by cellular
stress, leading to cytochrome c release, apoptosome formation, and caspase-9
activation. Fas ligand (A) and caspase-8 (C) are part of the extrinsic pathway.
Granzyme B (D) is a mechanism used by cytotoxic T cells to induce apoptosis .
7. A 72-year-old patient with long-standing hypertension develops left
ventricular hypertrophy. This is best classified as:
A. Physiologic hypertrophy
B. Pathologic hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Rationale: Ventricular hypertrophy in response to chronic pressure
overload (hypertension) is pathologic hypertrophy. Physiologic hypertrophy (A)
occurs with exercise. Hyperplasia (C) is an increase in cell number. Metaplasia
(D) is a change in cell type .
8. Which of the following is a classic example of liquefactive necrosis?
A. Myocardial infarction
B. Cerebral infarction
C. Tuberculosis granuloma
D. Pancreatic fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs in the brain following ischemic
injury, where enzymatic digestion leads to a liquid mass. Myocardial infarction (A)
causes coagulative necrosis. Tuberculosis (C) causes caseous necrosis. Pancreatic
injury (D) causes fat necrosis .
, 9. Dystrophic calcification is best described as:
A. Calcium deposition in normal tissues due to hypercalcemia
B. Calcium deposition in damaged or dying tissues with normal serum calcium
C. Calcium deposition in the kidneys due to renal failure
D. Calcium deposition in the lungs due to metastatic disease
Correct Answer: B
Rationale: Dystrophic calcification occurs in injured, dying, or dead tissues
despite normal serum calcium levels. Metastatic calcification (A) occurs in normal
tissues in the setting of hypercalcemia .
10. A patient with severe malnutrition shows significant muscle wasting. This
adaptation is termed:
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: B
Rationale: Atrophy is a decrease in cell size due to decreased workload,
nutrient deprivation, or other stressors. Hypertrophy (A) is an increase in size.
Hyperplasia (C) is an increase in number. Dysplasia (D) is disordered growth .
11. Which of the following is TRUE regarding metaplasia?
A. It is an irreversible change that always progresses to cancer
B. It is a reversible change from one mature cell type to another
C. It involves an increase in cell number
D. It is synonymous with dysplasia
Correct Answer: B
Rationale: Metaplasia is a reversible replacement of one mature cell type
by another in response to stress. While persistent metaplasia can predispose to
dysplasia, it is not always irreversible or inevitably malignant (A). It does not
involve an increase in cell number (C) and is not the same as dysplasia (D) .
12. Free radicals cause cellular injury primarily through:
A. ATP production
B. Oxidative damage to lipids, proteins, and DNA
Exam - Portage Learning
Section 1: Cellular Adaptation, Injury & Death
1. Which of the following best describes the cellular adaptation seen in a
bodybuilder’s skeletal muscle following chronic resistance training?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size, commonly seen in
skeletal muscle in response to increased workload. Hyperplasia (A) involves an
increase in cell number and is less relevant in skeletal muscle. Atrophy (C) is a
decrease in cell size. Metaplasia (D) is the reversible replacement of one mature
cell type with another .
2. A biopsy of the lower esophagus in a patient with chronic GERD reveals
columnar epithelium replacing the normal stratified squamous epithelium.
This finding is most consistent with:
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C
Rationale: Barrett esophagus is the classic example of metaplasia, where
chronic acid exposure causes a change from squamous to columnar epithelium.
Dysplasia (A) refers to disordered growth and is a preneoplastic change, not a
change in mature cell type. Hyperplasia (B) is an increase in cell number.
Anaplasia (D) is a lack of differentiation seen in malignancy .
3. Which of the following is the single most common cause of cellular injury
and cell death in clinical medicine?
,A. Physical trauma
B. Hypoxia
C. Chemical toxins
D. Infectious agents
Correct Answer: B
Rationale: Hypoxia (oxygen deprivation) is the most common cause of
cellular injury. It may result from ischemia, respiratory failure, or anemia. While
trauma, toxins, and infections cause injury, hypoxia is the most frequent final
common pathway to cell death .
4. A patient with a myocardial infarction has a region of dead heart tissue. The
type of necrosis most characteristic of this ischemic injury is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
Correct Answer: C
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid
organs (heart, kidney, spleen), where architectural outlines are preserved due to
protein denaturation. Liquefactive necrosis (A) occurs in brain infarcts and
abscesses. Caseous necrosis (B) is seen in tuberculosis. Fat necrosis (D) occurs in
pancreatitis or breast trauma .
5. Which of the following best distinguishes apoptosis from necrosis?
A. Apoptosis causes cell swelling and membrane rupture
B. Apoptosis triggers a robust inflammatory response
C. Apoptosis is energy-dependent and does not incite inflammation
D. Apoptosis results in the release of intracellular contents
Correct Answer: C
Rationale: Apoptosis is programmed cell death that is energy-dependent
(ATP-requiring), results in cell shrinkage and apoptotic body formation, and does
not trigger inflammation. Necrosis (A, B, D) involves cell swelling, membrane
rupture, release of contents, and inflammation .
,6. The intrinsic pathway of apoptosis is triggered by which of the following
events?
A. Binding of Fas ligand to the Fas receptor
B. Cytochrome c release from mitochondria and apoptosome formation
C. Activation of caspase-8 by the death-inducing signaling complex
D. Perforin and granzyme B entry from cytotoxic T cells
Correct Answer: B
Rationale: The intrinsic (mitochondrial) pathway is initiated by cellular
stress, leading to cytochrome c release, apoptosome formation, and caspase-9
activation. Fas ligand (A) and caspase-8 (C) are part of the extrinsic pathway.
Granzyme B (D) is a mechanism used by cytotoxic T cells to induce apoptosis .
7. A 72-year-old patient with long-standing hypertension develops left
ventricular hypertrophy. This is best classified as:
A. Physiologic hypertrophy
B. Pathologic hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Rationale: Ventricular hypertrophy in response to chronic pressure
overload (hypertension) is pathologic hypertrophy. Physiologic hypertrophy (A)
occurs with exercise. Hyperplasia (C) is an increase in cell number. Metaplasia
(D) is a change in cell type .
8. Which of the following is a classic example of liquefactive necrosis?
A. Myocardial infarction
B. Cerebral infarction
C. Tuberculosis granuloma
D. Pancreatic fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs in the brain following ischemic
injury, where enzymatic digestion leads to a liquid mass. Myocardial infarction (A)
causes coagulative necrosis. Tuberculosis (C) causes caseous necrosis. Pancreatic
injury (D) causes fat necrosis .
, 9. Dystrophic calcification is best described as:
A. Calcium deposition in normal tissues due to hypercalcemia
B. Calcium deposition in damaged or dying tissues with normal serum calcium
C. Calcium deposition in the kidneys due to renal failure
D. Calcium deposition in the lungs due to metastatic disease
Correct Answer: B
Rationale: Dystrophic calcification occurs in injured, dying, or dead tissues
despite normal serum calcium levels. Metastatic calcification (A) occurs in normal
tissues in the setting of hypercalcemia .
10. A patient with severe malnutrition shows significant muscle wasting. This
adaptation is termed:
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: B
Rationale: Atrophy is a decrease in cell size due to decreased workload,
nutrient deprivation, or other stressors. Hypertrophy (A) is an increase in size.
Hyperplasia (C) is an increase in number. Dysplasia (D) is disordered growth .
11. Which of the following is TRUE regarding metaplasia?
A. It is an irreversible change that always progresses to cancer
B. It is a reversible change from one mature cell type to another
C. It involves an increase in cell number
D. It is synonymous with dysplasia
Correct Answer: B
Rationale: Metaplasia is a reversible replacement of one mature cell type
by another in response to stress. While persistent metaplasia can predispose to
dysplasia, it is not always irreversible or inevitably malignant (A). It does not
involve an increase in cell number (C) and is not the same as dysplasia (D) .
12. Free radicals cause cellular injury primarily through:
A. ATP production
B. Oxidative damage to lipids, proteins, and DNA
