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NURS 6501 ADVANCED PATHOPHYSIOLOGY
WALDEN UNIVERSITY MIDTERM EXAM
2026/2027 Complete Questions and Verified Answers
Pass Guaranteed - A+ Graded
SECTION 1: CELLULAR ADAPTATION, INJURY, AND DEATH
Q1: A 65-year-old male with a history of smoking presents with a chronic cough. A bronchial
biopsy reveals that the normal ciliated pseudostratified columnar epithelial cells have been
replaced by stratified squamous epithelial cells. This change is best described as:
A. Hyperplasia
B. Metaplasia. [CORRECT]
C. Dysplasia
D. Anaplasia
Rationale: Metaplasia is a reversible change in which one differentiated cell type is replaced by
another cell type better able to withstand environmental stress. In smokers, the normal ciliated
columnar epithelium of the airways undergoes metaplasia to stratified squamous epithelium (B).
Hyperplasia (A) is increased cell number. Dysplasia (C) is abnormal cell growth and
differentiation. Anaplasia (D) is loss of differentiation seen in cancer.
Q2: A 45-year-old female has a uterine fibroid (leiomyoma) causing significant enlargement of
her uterus. Microscopic examination reveals enlarged smooth muscle cells with increased
cytoplasmic organelles. This cellular adaptation is:
A. Atrophy
B. Hypertrophy. [CORRECT]
C. Hyperplasia
D. Metaplasia
Rationale: Hypertrophy refers to an increase in cell size resulting in enlarged tissue mass. The
uterine smooth muscle cells in leiomyomas undergo hypertrophy (B) with increased cytoplasmic
organelles to support the larger cell volume. Atrophy (A) is decreased cell size. Hyperplasia (C)
involves increased cell number. Metaplasia (D) involves cell type conversion.
,2
Q3: A 28-year-old male with chronic gastroesophageal reflux disease undergoes endoscopy.
Biopsy of the distal esophagus reveals columnar epithelium with goblet cells replacing the
normal squamous epithelium. This adaptation is:
A. Dysplasia
B. Metaplasia. [CORRECT]
C. Hyperplasia
D. Neoplasia
Rationale: Barrett's esophagus represents metaplasia (B), where chronic acid exposure causes
the normal squamous epithelium to be replaced by intestinal-type columnar epithelium with
goblet cells. This is a protective adaptation that unfortunately increases cancer risk. Dysplasia
(A) would show abnormal cell maturation. Hyperplasia (C) is increased cell number. Neoplasia
(D) indicates new, uncontrolled growth.
Q4: A patient with prolonged immobilization of a limb develops decreased muscle mass and cell
size. This process is best described as:
A. Hypertrophy
B. Hyperplasia
C. Atrophy. [CORRECT]
D. Metaplasia
Rationale: Atrophy (C) is the decrease in cell size due to reduced workload, loss of innervation,
or inadequate nutrition. Disuse atrophy results in decreased protein synthesis and increased
protein degradation, leading to smaller muscle cells. Hypertrophy (A) and hyperplasia (B)
represent increases in tissue mass. Metaplasia (D) involves cell type change.
Q5: A 55-year-old female with endometrial hyperplasia shows increased glandular tissue with
abnormal cellular architecture but intact basement membrane. This represents:
A. Metaplasia
B. Dysplasia. [CORRECT]
C. Anaplasia
D. Hypertrophy
Rationale: Dysplasia (B) is characterized by abnormal cell growth with loss of normal tissue
architecture and cellular pleomorphism, representing a pre-neoplastic change. The basement
membrane remains intact, distinguishing it from invasive cancer. Metaplasia (A) is reversible cell
type replacement. Anaplasia (C) indicates complete loss of differentiation in malignant cells.
Hypertrophy (D) is increased cell size.
,3
Q6: A patient suffers myocardial infarction. The affected cardiac muscle cells show preservation
of cellular outline with loss of nuclei and increased eosinophilia. This pattern of necrosis is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis. [CORRECT]
D. Fat necrosis
Rationale: Coagulative necrosis (C) is characteristic of ischemic injury in solid organs like the
heart, where protein denaturation preserves cellular architecture temporarily, creating "ghost"
cells with preserved outlines but lost nuclei. Liquefactive necrosis (A) occurs in brain infarcts
and abscesses. Caseous necrosis (B) is seen in tuberculosis. Fat necrosis (D) occurs in pancreatic
injury or breast tissue.
Q7: A 60-year-old male with atherosclerotic disease develops acute limb ischemia. Upon
reperfusion, the tissue damage paradoxically worsens due to:
A. Decreased ATP production
B. Calcium overload and free radical generation. [CORRECT]
C. Protein synthesis failure
D. Lysosomal enzyme leakage
Rationale: Reperfusion injury (B) occurs when oxygen reintroduced to ischemic tissue generates
reactive oxygen species through xanthine oxidase activity and mitochondrial electron transport
chain disruption. Calcium overload activates proteases and phospholipases. While ATP depletion
(A) occurs during ischemia, the worsening after reperfusion specifically involves free radical-
mediated damage.
Q8: A patient with meningococcal sepsis develops bilateral adrenal hemorrhage and acute
adrenal insufficiency. The adrenal tissue shows enzymatic fat necrosis with calcium deposits.
This type of necrosis is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis. [CORRECT]
Rationale: Fat necrosis (D) occurs when lipases (activated in acute pancreatitis or released from
damaged adipose tissue) break down triglycerides into fatty acids, which combine with calcium
, 4
to form soap-like deposits (saponification). This is characteristic of Waterhouse-Friderichsen
syndrome. The other necrosis types do not involve fat saponification.
Q9: Programmed cell death characterized by cell shrinkage, chromatin condensation, membrane
blebbing, and formation of apoptotic bodies without inflammation is:
A. Necrosis
B. Autophagy
C. Apoptosis. [CORRECT]
D. Pyroptosis
Rationale: Apoptosis (C) is energy-dependent programmed cell death that maintains membrane
integrity, preventing inflammation. Key features include cell shrinkage, pyknosis (nuclear
condensation), and karyorrhexis (fragmentation). Necrosis (A) involves membrane rupture and
inflammation. Autophagy (B) involves lysosomal degradation of cellular components. Pyroptosis
(D) is inflammatory programmed cell death.
Q10: A 70-year-old patient with chronic granulomatous disease develops necrotic tissue
surrounded by a granulomatous inflammatory response. The necrotic center appears soft, white,
and "cheese-like." This represents:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis. [CORRECT]
D. Gangrenous necrosis
Rationale: Caseous necrosis (C) is characteristic of tuberculosis and fungal infections, featuring
amorphous, eosinophilic debris without preserved cellular outlines, surrounded by
granulomatous inflammation. The "cheese-like" appearance is pathognomonic. Coagulative
necrosis (A) preserves tissue architecture. Liquefactive necrosis (B) forms liquid pus.
Gangrenous necrosis (D) refers to ischemic necrosis with putrefaction.
Q11: A patient ingests a toxic dose of acetaminophen. The centrilobular hepatocytes show
cytoplasmic vacuolization, mitochondrial swelling, and plasma membrane blebs. This represents:
A. Apoptosis
B. Oncosis (hydropic change). [CORRECT]
C. Metaplasia
D. Hypertrophy
NURS 6501 ADVANCED PATHOPHYSIOLOGY
WALDEN UNIVERSITY MIDTERM EXAM
2026/2027 Complete Questions and Verified Answers
Pass Guaranteed - A+ Graded
SECTION 1: CELLULAR ADAPTATION, INJURY, AND DEATH
Q1: A 65-year-old male with a history of smoking presents with a chronic cough. A bronchial
biopsy reveals that the normal ciliated pseudostratified columnar epithelial cells have been
replaced by stratified squamous epithelial cells. This change is best described as:
A. Hyperplasia
B. Metaplasia. [CORRECT]
C. Dysplasia
D. Anaplasia
Rationale: Metaplasia is a reversible change in which one differentiated cell type is replaced by
another cell type better able to withstand environmental stress. In smokers, the normal ciliated
columnar epithelium of the airways undergoes metaplasia to stratified squamous epithelium (B).
Hyperplasia (A) is increased cell number. Dysplasia (C) is abnormal cell growth and
differentiation. Anaplasia (D) is loss of differentiation seen in cancer.
Q2: A 45-year-old female has a uterine fibroid (leiomyoma) causing significant enlargement of
her uterus. Microscopic examination reveals enlarged smooth muscle cells with increased
cytoplasmic organelles. This cellular adaptation is:
A. Atrophy
B. Hypertrophy. [CORRECT]
C. Hyperplasia
D. Metaplasia
Rationale: Hypertrophy refers to an increase in cell size resulting in enlarged tissue mass. The
uterine smooth muscle cells in leiomyomas undergo hypertrophy (B) with increased cytoplasmic
organelles to support the larger cell volume. Atrophy (A) is decreased cell size. Hyperplasia (C)
involves increased cell number. Metaplasia (D) involves cell type conversion.
,2
Q3: A 28-year-old male with chronic gastroesophageal reflux disease undergoes endoscopy.
Biopsy of the distal esophagus reveals columnar epithelium with goblet cells replacing the
normal squamous epithelium. This adaptation is:
A. Dysplasia
B. Metaplasia. [CORRECT]
C. Hyperplasia
D. Neoplasia
Rationale: Barrett's esophagus represents metaplasia (B), where chronic acid exposure causes
the normal squamous epithelium to be replaced by intestinal-type columnar epithelium with
goblet cells. This is a protective adaptation that unfortunately increases cancer risk. Dysplasia
(A) would show abnormal cell maturation. Hyperplasia (C) is increased cell number. Neoplasia
(D) indicates new, uncontrolled growth.
Q4: A patient with prolonged immobilization of a limb develops decreased muscle mass and cell
size. This process is best described as:
A. Hypertrophy
B. Hyperplasia
C. Atrophy. [CORRECT]
D. Metaplasia
Rationale: Atrophy (C) is the decrease in cell size due to reduced workload, loss of innervation,
or inadequate nutrition. Disuse atrophy results in decreased protein synthesis and increased
protein degradation, leading to smaller muscle cells. Hypertrophy (A) and hyperplasia (B)
represent increases in tissue mass. Metaplasia (D) involves cell type change.
Q5: A 55-year-old female with endometrial hyperplasia shows increased glandular tissue with
abnormal cellular architecture but intact basement membrane. This represents:
A. Metaplasia
B. Dysplasia. [CORRECT]
C. Anaplasia
D. Hypertrophy
Rationale: Dysplasia (B) is characterized by abnormal cell growth with loss of normal tissue
architecture and cellular pleomorphism, representing a pre-neoplastic change. The basement
membrane remains intact, distinguishing it from invasive cancer. Metaplasia (A) is reversible cell
type replacement. Anaplasia (C) indicates complete loss of differentiation in malignant cells.
Hypertrophy (D) is increased cell size.
,3
Q6: A patient suffers myocardial infarction. The affected cardiac muscle cells show preservation
of cellular outline with loss of nuclei and increased eosinophilia. This pattern of necrosis is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis. [CORRECT]
D. Fat necrosis
Rationale: Coagulative necrosis (C) is characteristic of ischemic injury in solid organs like the
heart, where protein denaturation preserves cellular architecture temporarily, creating "ghost"
cells with preserved outlines but lost nuclei. Liquefactive necrosis (A) occurs in brain infarcts
and abscesses. Caseous necrosis (B) is seen in tuberculosis. Fat necrosis (D) occurs in pancreatic
injury or breast tissue.
Q7: A 60-year-old male with atherosclerotic disease develops acute limb ischemia. Upon
reperfusion, the tissue damage paradoxically worsens due to:
A. Decreased ATP production
B. Calcium overload and free radical generation. [CORRECT]
C. Protein synthesis failure
D. Lysosomal enzyme leakage
Rationale: Reperfusion injury (B) occurs when oxygen reintroduced to ischemic tissue generates
reactive oxygen species through xanthine oxidase activity and mitochondrial electron transport
chain disruption. Calcium overload activates proteases and phospholipases. While ATP depletion
(A) occurs during ischemia, the worsening after reperfusion specifically involves free radical-
mediated damage.
Q8: A patient with meningococcal sepsis develops bilateral adrenal hemorrhage and acute
adrenal insufficiency. The adrenal tissue shows enzymatic fat necrosis with calcium deposits.
This type of necrosis is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis. [CORRECT]
Rationale: Fat necrosis (D) occurs when lipases (activated in acute pancreatitis or released from
damaged adipose tissue) break down triglycerides into fatty acids, which combine with calcium
, 4
to form soap-like deposits (saponification). This is characteristic of Waterhouse-Friderichsen
syndrome. The other necrosis types do not involve fat saponification.
Q9: Programmed cell death characterized by cell shrinkage, chromatin condensation, membrane
blebbing, and formation of apoptotic bodies without inflammation is:
A. Necrosis
B. Autophagy
C. Apoptosis. [CORRECT]
D. Pyroptosis
Rationale: Apoptosis (C) is energy-dependent programmed cell death that maintains membrane
integrity, preventing inflammation. Key features include cell shrinkage, pyknosis (nuclear
condensation), and karyorrhexis (fragmentation). Necrosis (A) involves membrane rupture and
inflammation. Autophagy (B) involves lysosomal degradation of cellular components. Pyroptosis
(D) is inflammatory programmed cell death.
Q10: A 70-year-old patient with chronic granulomatous disease develops necrotic tissue
surrounded by a granulomatous inflammatory response. The necrotic center appears soft, white,
and "cheese-like." This represents:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis. [CORRECT]
D. Gangrenous necrosis
Rationale: Caseous necrosis (C) is characteristic of tuberculosis and fungal infections, featuring
amorphous, eosinophilic debris without preserved cellular outlines, surrounded by
granulomatous inflammation. The "cheese-like" appearance is pathognomonic. Coagulative
necrosis (A) preserves tissue architecture. Liquefactive necrosis (B) forms liquid pus.
Gangrenous necrosis (D) refers to ischemic necrosis with putrefaction.
Q11: A patient ingests a toxic dose of acetaminophen. The centrilobular hepatocytes show
cytoplasmic vacuolization, mitochondrial swelling, and plasma membrane blebs. This represents:
A. Apoptosis
B. Oncosis (hydropic change). [CORRECT]
C. Metaplasia
D. Hypertrophy
