NR507 / NR 507 Advanced Pathophysiology
Midterm Exam (Latest 2026-2027) – Complete
Review, Practice Questions & Study Guide |
Guaranteed Pass
SECTION 1: CELLULAR INJURY, ADAPTATION & DEATH
Q1. In GERD, the distal esophageal squamous epithelium is replaced by acid-resistant
columnar mucosa. This change is:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Correct: B
Rationale: Chronic acid irritation drives transcription-factor reprogramming (CDX-2 ↑) →
phenotypic switch to columnar cells; reversible if irritant removed.
Q2. SATA. Which events characterize irreversible ischemic cell injury? (Select all.)
A) Lysosomal rupture
B) Clumping of nuclear chromatin
,C) Ca²⁺ influx activating phospholipases
D) Detachment of ribosomes from RER
E) Mitochondrial permeability-transition-pore opening
Correct: A, C, E
Rationale: Nuclear clumping (B) and ribosomal detachment (D) occur in reversible
injury; MPT-pore, Ca²⁺-activated enzymes, and enzyme leakage denote necrosis.
Q3. A 45-year-old with emphysema shows apoptosis of alveolar endothelial cells. Which
intracellular mediator activates executioner caspases?
A) Cytochrome-c / Apaf-1 / caspase-9 complex
B) NF-κB translocation
C) HIF-1α stabilization
D) p53 phosphorylation
Correct: A
Rationale: Intrinsic apoptotic pathway: cigarette-smoke oxidants → mitochondrial
outer-membrane permeabilization → apoptosome formation → caspase-3 activation.
Q4. Ordered Response. Arrange the sequence of oxidative cell damage during
reperfusion.
1. NADPH-oxidase activation
2. Superoxide formation
3. Hydroxyl-radical generation via Haber-Weiss
4. Lipid peroxidation of membranes
, 5. DNA-strand breaks
Correct: 1-2-3-4-5
Rationale: ROS cascade; iron-catalyzed conversion of O₂⁻ + H₂O₂ → •OH causes ultimate
damage.
Q5. A biopsy shows cells with markedly enlarged, pleomorphic nuclei and loss of
polarity but intact basement membrane. This is:
A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Anaplasia
Correct: B
Rationale: Dysplasia = disordered growth, premalignant, basement membrane intact;
anaplasia implies invasive cancer.
SECTION 2: GENETIC & EPIGENETIC MECHANISMS
Q6. A missense mutation in BRCA1 predisposes to breast cancer primarily by:
A) Creating a stop codon
B) Impairing homologous recombination repair
C) Activating a proto-oncogene
D) Causing genomic imprinting
Midterm Exam (Latest 2026-2027) – Complete
Review, Practice Questions & Study Guide |
Guaranteed Pass
SECTION 1: CELLULAR INJURY, ADAPTATION & DEATH
Q1. In GERD, the distal esophageal squamous epithelium is replaced by acid-resistant
columnar mucosa. This change is:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Correct: B
Rationale: Chronic acid irritation drives transcription-factor reprogramming (CDX-2 ↑) →
phenotypic switch to columnar cells; reversible if irritant removed.
Q2. SATA. Which events characterize irreversible ischemic cell injury? (Select all.)
A) Lysosomal rupture
B) Clumping of nuclear chromatin
,C) Ca²⁺ influx activating phospholipases
D) Detachment of ribosomes from RER
E) Mitochondrial permeability-transition-pore opening
Correct: A, C, E
Rationale: Nuclear clumping (B) and ribosomal detachment (D) occur in reversible
injury; MPT-pore, Ca²⁺-activated enzymes, and enzyme leakage denote necrosis.
Q3. A 45-year-old with emphysema shows apoptosis of alveolar endothelial cells. Which
intracellular mediator activates executioner caspases?
A) Cytochrome-c / Apaf-1 / caspase-9 complex
B) NF-κB translocation
C) HIF-1α stabilization
D) p53 phosphorylation
Correct: A
Rationale: Intrinsic apoptotic pathway: cigarette-smoke oxidants → mitochondrial
outer-membrane permeabilization → apoptosome formation → caspase-3 activation.
Q4. Ordered Response. Arrange the sequence of oxidative cell damage during
reperfusion.
1. NADPH-oxidase activation
2. Superoxide formation
3. Hydroxyl-radical generation via Haber-Weiss
4. Lipid peroxidation of membranes
, 5. DNA-strand breaks
Correct: 1-2-3-4-5
Rationale: ROS cascade; iron-catalyzed conversion of O₂⁻ + H₂O₂ → •OH causes ultimate
damage.
Q5. A biopsy shows cells with markedly enlarged, pleomorphic nuclei and loss of
polarity but intact basement membrane. This is:
A) Metaplasia
B) Dysplasia
C) Hyperplasia
D) Anaplasia
Correct: B
Rationale: Dysplasia = disordered growth, premalignant, basement membrane intact;
anaplasia implies invasive cancer.
SECTION 2: GENETIC & EPIGENETIC MECHANISMS
Q6. A missense mutation in BRCA1 predisposes to breast cancer primarily by:
A) Creating a stop codon
B) Impairing homologous recombination repair
C) Activating a proto-oncogene
D) Causing genomic imprinting
