NURS 5315 Advanced Pathophysiology
Comprehensive Examination (Exams 1–5) – 180
Questions with Verified Answers & Detailed
Rationales (2026 Edition)
Question 1
A microscopic image of cardiac muscle shows irregularly distributed,
small, dense basophilic granules within the cytoplasm of myocytes.
These granules are most likely composed of:
A. Glycogen
B. Hemosiderin
C. Lipofuscin
D. Lipid droplets
✔Correct Answer: C
Rationale: Lipofuscin is an insoluble "wear-and-tear" pigment from lipid
peroxidation, appearing yellow-brown to dark basophilic on H&E stain.
Glycogen appears as clear vacuoles. Hemosiderin is golden-brown. Lipid
droplets dissolve during processing, leaving clear spaces.
,Question 2
A 68-year-old with chronic heart failure develops peripheral edema,
jugular venous distension, and hepatomegaly. The cellular mechanism
most directly responsible for these findings is:
A. Increased hydrostatic pressure
B. Decreased plasma oncotic pressure
C. Lymphatic obstruction
D. Sodium retention alone
✔Correct Answer: A
Rationale: Chronic heart failure → increased venous hydrostatic
pressure → fluid movement from capillaries into interstitium.
Decreased oncotic pressure occurs in nephrotic syndrome. Lymphatic
obstruction causes localized edema. Sodium retention is secondary to
low perfusion but not the direct mechanism.
Question 3
A kidney biopsy from an atrophic kidney shows cells with shrunken
nuclei and condensed chromatin. This morphologic change is
characteristic of:
A. Necrosis
B. Apoptosis
,C. Metaplasia
D. Dysplasia
✔Correct Answer: B
Rationale: Apoptosis features cell shrinkage, nuclear condensation
(pyknosis), and chromatin clumping without inflammation. Necrosis
shows cell swelling, karyolysis, and inflammation.
Question 4
Which cellular adaptation is considered irreversible and a precursor to
malignancy?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Hypertrophy
✔Correct Answer: C
Rationale: Dysplasia is disordered cellular growth; while often
reversible, it can progress to carcinoma-in-situ and invasive cancer.
Hyperplasia, metaplasia, and hypertrophy are reversible adaptations.
, Question 5
During ischemia, the switch from aerobic to anaerobic metabolism
leads directly to:
A. Increased ATP production
B. Decreased intracellular pH
C. Increased oxidative phosphorylation
D. Increased intracellular calcium efflux
✔Correct Answer: B
Rationale: Anaerobic glycolysis produces lactic acid → accumulates →
decreased intracellular pH → enzyme dysfunction and chromatin
clumping. ATP production decreases. Oxidative phosphorylation stops.
Calcium influx (not efflux) increases.
Question 6
Reperfusion injury after myocardial infarction is primarily mediated by:
A. Increased oxygen delivery
B. Reactive oxygen species (ROS)
C. Adenosine release
D. Heat shock proteins
✔Correct Answer: B
Rationale: ROS (superoxide, hydroxyl radical, hydrogen peroxide) form
Comprehensive Examination (Exams 1–5) – 180
Questions with Verified Answers & Detailed
Rationales (2026 Edition)
Question 1
A microscopic image of cardiac muscle shows irregularly distributed,
small, dense basophilic granules within the cytoplasm of myocytes.
These granules are most likely composed of:
A. Glycogen
B. Hemosiderin
C. Lipofuscin
D. Lipid droplets
✔Correct Answer: C
Rationale: Lipofuscin is an insoluble "wear-and-tear" pigment from lipid
peroxidation, appearing yellow-brown to dark basophilic on H&E stain.
Glycogen appears as clear vacuoles. Hemosiderin is golden-brown. Lipid
droplets dissolve during processing, leaving clear spaces.
,Question 2
A 68-year-old with chronic heart failure develops peripheral edema,
jugular venous distension, and hepatomegaly. The cellular mechanism
most directly responsible for these findings is:
A. Increased hydrostatic pressure
B. Decreased plasma oncotic pressure
C. Lymphatic obstruction
D. Sodium retention alone
✔Correct Answer: A
Rationale: Chronic heart failure → increased venous hydrostatic
pressure → fluid movement from capillaries into interstitium.
Decreased oncotic pressure occurs in nephrotic syndrome. Lymphatic
obstruction causes localized edema. Sodium retention is secondary to
low perfusion but not the direct mechanism.
Question 3
A kidney biopsy from an atrophic kidney shows cells with shrunken
nuclei and condensed chromatin. This morphologic change is
characteristic of:
A. Necrosis
B. Apoptosis
,C. Metaplasia
D. Dysplasia
✔Correct Answer: B
Rationale: Apoptosis features cell shrinkage, nuclear condensation
(pyknosis), and chromatin clumping without inflammation. Necrosis
shows cell swelling, karyolysis, and inflammation.
Question 4
Which cellular adaptation is considered irreversible and a precursor to
malignancy?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Hypertrophy
✔Correct Answer: C
Rationale: Dysplasia is disordered cellular growth; while often
reversible, it can progress to carcinoma-in-situ and invasive cancer.
Hyperplasia, metaplasia, and hypertrophy are reversible adaptations.
, Question 5
During ischemia, the switch from aerobic to anaerobic metabolism
leads directly to:
A. Increased ATP production
B. Decreased intracellular pH
C. Increased oxidative phosphorylation
D. Increased intracellular calcium efflux
✔Correct Answer: B
Rationale: Anaerobic glycolysis produces lactic acid → accumulates →
decreased intracellular pH → enzyme dysfunction and chromatin
clumping. ATP production decreases. Oxidative phosphorylation stops.
Calcium influx (not efflux) increases.
Question 6
Reperfusion injury after myocardial infarction is primarily mediated by:
A. Increased oxygen delivery
B. Reactive oxygen species (ROS)
C. Adenosine release
D. Heat shock proteins
✔Correct Answer: B
Rationale: ROS (superoxide, hydroxyl radical, hydrogen peroxide) form
