MARYVILLE PATHO NURS 611 EXAM 3
PRACTICE QUESTIONS 2026/2027 AND
A NEW UPDATED STUDY GUIDE
COMPLETE
SECTION 1: CELLULAR ADAPTATION & INJURY
1. A 65-year-old man with a 40-pack-year smoking history presents with a non-
productive cough and weight loss. A lung biopsy reveals that the normal ciliated
pseudostratified columnar epithelium has been replaced by stratified squamous
epithelium. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C. Metaplasia
Rationale: Metaplasia is a reversible change in which one differentiated cell type
is replaced by another, often in response to chronic irritation. In this patient's
case, the chronic irritation from cigarette smoke has caused the normal columnar
epithelium of the airways to transform into stratified squamous epithelium. This
is a protective mechanism, but it also results in a loss of cilia and protective
mucus, impairing airway function. Hyperplasia (A) is an increase in the number of
cells; dysplasia (B) is disordered cell growth; anaplasia (D) is a loss of cellular
differentiation characteristic of malignancy .
2. A researcher exposes hepatocytes to a toxin that disrupts mitochondrial
electron transport, leading to a rapid depletion of intracellular ATP. Which of
,the following cellular events is most likely to occur FIRST as a direct
consequence of this ATP depletion?
A. Release of cytochrome c into the cytosol
B. Swelling of the cell due to failure of the sodium-potassium (Na+/K+) pump
C. Fragmentation of nuclear DNA into 180-200 base pair fragments
D. Formation of large, amorphous densities in the mitochondria
Correct Answer: B. Swelling of the cell due to failure of the sodium-potassium
(Na+/K+) pump
Rationale: ATP is essential for the function of the Na+/K+ ATPase pump. When
ATP levels drop, this pump fails, causing sodium to accumulate intracellularly. The
subsequent osmotic gradient draws water into the cell, leading to cellular swelling
and dilation of the endoplasmic reticulum. This is an early and reversible sign of
cell injury. The release of cytochrome c (A) and DNA fragmentation (C) are
hallmarks of apoptosis, which is a programmed process, not the immediate result
of ATP loss. The formation of amorphous densities (D) in mitochondria is a sign of
irreversible injury, which occurs later .
3. A 45-year-old woman with a history of hypertension and diabetes presents
with sudden-onset severe chest pain. An ECG shows ST-segment elevation, and
cardiac troponin levels are markedly elevated. Which of the following best
describes the primary mechanism of cell injury occurring in her myocardium?
A. Pressure overload leading to myocyte hypertrophy
B. Apoptosis mediated by death receptors
C. Reperfusion injury due to oxygen free radical generation
D. Direct toxicity from hyperglycemia-induced osmotic stress
Correct Answer: C. Reperfusion injury due to oxygen free radical generation
Rationale: The patient's presentation is classic for an acute myocardial infarction.
The primary mechanism of cell injury in the myocardium following ischemia is
reperfusion injury. When blood flow is restored to ischemic tissue, the sudden
reintroduction of oxygen leads to the generation of reactive oxygen species (free
radicals), which cause further cellular damage. While pressure overload (A) can
,lead to hypertrophy, it is a chronic process. Apoptosis (B) is a programmed cell
death, not the primary mechanism in acute MI. Hyperglycemia (D) contributes to
vascular damage over time but is not the acute mechanism .
4. Which of the following best describes the cellular change that occurs in
chronic hypertension leading to left ventricular hypertrophy?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C. Hypertrophy
Rationale: Hypertrophy is an increase in cell size due to increased functional
demand. In chronic hypertension, the left ventricle must pump against increased
afterload, causing individual myocytes to enlarge (hypertrophy) to generate
greater contractile force. This increases the overall muscle mass of the ventricle.
Hyperplasia (A) is an increase in cell number; metaplasia (B) is a change in cell
type; dysplasia (D) is disordered cell growth .
5. In a patient with prolonged hypotension leading to acute tubular necrosis in
the kidneys, which sequence of events most accurately describes the
progression to cell death?
A. Calcium influx → activation of endonucleases → DNA laddering → cell
shrinkage
B. ATP depletion → Na+/K+ pump failure → cell swelling → rupture of lysosomes
→ autolysis
C. Free radical damage → lipid peroxidation → membrane blebbing → apoptosis
D. Mitochondrial depolarization → cytochrome c release → caspase activation →
phagocytosis
Correct Answer: B. ATP depletion → Na+/K+ pump failure → cell swelling →
rupture of lysosomes → autolysis
, Rationale: In ischemic injury such as acute tubular necrosis, the lack of blood flow
leads to a depletion of oxygen and subsequently ATP. The failure of ATP-
dependent pumps, primarily the Na+/K+ pump, causes an influx of sodium and
water, leading to cell swelling. This is followed by damage to lysosomes, which
release their hydrolytic enzymes into the cytosol, a process known as autolysis.
This pathway is characteristic of necrosis. Options A and D describe apoptosis,
and option C describes necrosis due to free radicals .
6. A 60-year-old man with a history of chronic gastritis undergoes a gastric
biopsy. The pathologist reports a marked reduction in parietal cell numbers,
with the remaining cells showing enlarged nuclei and prominent nucleoli. This
cellular change in the remaining parietal cells is best described as:
A. Hyperplasia
B. Dysplasia
C. Atrophy
D. Hypertrophy
Correct Answer: D. Hypertrophy
Rationale: Hypertrophy is an increase in the size of cells due to an increased
functional demand. In this case, the remaining parietal cells are compensating for
the loss of their neighboring cells by enlarging and increasing their protein
synthesis, which is reflected in the enlarged nuclei and prominent nucleoli .
SECTION 2: HEMATOLOGIC DISORDERS
7. Which blood cells are the chief phagocytes involved in the early inflammation
process?
A. Neutrophils
B. Eosinophils
C. Monocytes
D. Erythrocytes
Correct Answer: A. Neutrophils
PRACTICE QUESTIONS 2026/2027 AND
A NEW UPDATED STUDY GUIDE
COMPLETE
SECTION 1: CELLULAR ADAPTATION & INJURY
1. A 65-year-old man with a 40-pack-year smoking history presents with a non-
productive cough and weight loss. A lung biopsy reveals that the normal ciliated
pseudostratified columnar epithelium has been replaced by stratified squamous
epithelium. This cellular adaptation is best described as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C. Metaplasia
Rationale: Metaplasia is a reversible change in which one differentiated cell type
is replaced by another, often in response to chronic irritation. In this patient's
case, the chronic irritation from cigarette smoke has caused the normal columnar
epithelium of the airways to transform into stratified squamous epithelium. This
is a protective mechanism, but it also results in a loss of cilia and protective
mucus, impairing airway function. Hyperplasia (A) is an increase in the number of
cells; dysplasia (B) is disordered cell growth; anaplasia (D) is a loss of cellular
differentiation characteristic of malignancy .
2. A researcher exposes hepatocytes to a toxin that disrupts mitochondrial
electron transport, leading to a rapid depletion of intracellular ATP. Which of
,the following cellular events is most likely to occur FIRST as a direct
consequence of this ATP depletion?
A. Release of cytochrome c into the cytosol
B. Swelling of the cell due to failure of the sodium-potassium (Na+/K+) pump
C. Fragmentation of nuclear DNA into 180-200 base pair fragments
D. Formation of large, amorphous densities in the mitochondria
Correct Answer: B. Swelling of the cell due to failure of the sodium-potassium
(Na+/K+) pump
Rationale: ATP is essential for the function of the Na+/K+ ATPase pump. When
ATP levels drop, this pump fails, causing sodium to accumulate intracellularly. The
subsequent osmotic gradient draws water into the cell, leading to cellular swelling
and dilation of the endoplasmic reticulum. This is an early and reversible sign of
cell injury. The release of cytochrome c (A) and DNA fragmentation (C) are
hallmarks of apoptosis, which is a programmed process, not the immediate result
of ATP loss. The formation of amorphous densities (D) in mitochondria is a sign of
irreversible injury, which occurs later .
3. A 45-year-old woman with a history of hypertension and diabetes presents
with sudden-onset severe chest pain. An ECG shows ST-segment elevation, and
cardiac troponin levels are markedly elevated. Which of the following best
describes the primary mechanism of cell injury occurring in her myocardium?
A. Pressure overload leading to myocyte hypertrophy
B. Apoptosis mediated by death receptors
C. Reperfusion injury due to oxygen free radical generation
D. Direct toxicity from hyperglycemia-induced osmotic stress
Correct Answer: C. Reperfusion injury due to oxygen free radical generation
Rationale: The patient's presentation is classic for an acute myocardial infarction.
The primary mechanism of cell injury in the myocardium following ischemia is
reperfusion injury. When blood flow is restored to ischemic tissue, the sudden
reintroduction of oxygen leads to the generation of reactive oxygen species (free
radicals), which cause further cellular damage. While pressure overload (A) can
,lead to hypertrophy, it is a chronic process. Apoptosis (B) is a programmed cell
death, not the primary mechanism in acute MI. Hyperglycemia (D) contributes to
vascular damage over time but is not the acute mechanism .
4. Which of the following best describes the cellular change that occurs in
chronic hypertension leading to left ventricular hypertrophy?
A. Hyperplasia
B. Metaplasia
C. Hypertrophy
D. Dysplasia
Correct Answer: C. Hypertrophy
Rationale: Hypertrophy is an increase in cell size due to increased functional
demand. In chronic hypertension, the left ventricle must pump against increased
afterload, causing individual myocytes to enlarge (hypertrophy) to generate
greater contractile force. This increases the overall muscle mass of the ventricle.
Hyperplasia (A) is an increase in cell number; metaplasia (B) is a change in cell
type; dysplasia (D) is disordered cell growth .
5. In a patient with prolonged hypotension leading to acute tubular necrosis in
the kidneys, which sequence of events most accurately describes the
progression to cell death?
A. Calcium influx → activation of endonucleases → DNA laddering → cell
shrinkage
B. ATP depletion → Na+/K+ pump failure → cell swelling → rupture of lysosomes
→ autolysis
C. Free radical damage → lipid peroxidation → membrane blebbing → apoptosis
D. Mitochondrial depolarization → cytochrome c release → caspase activation →
phagocytosis
Correct Answer: B. ATP depletion → Na+/K+ pump failure → cell swelling →
rupture of lysosomes → autolysis
, Rationale: In ischemic injury such as acute tubular necrosis, the lack of blood flow
leads to a depletion of oxygen and subsequently ATP. The failure of ATP-
dependent pumps, primarily the Na+/K+ pump, causes an influx of sodium and
water, leading to cell swelling. This is followed by damage to lysosomes, which
release their hydrolytic enzymes into the cytosol, a process known as autolysis.
This pathway is characteristic of necrosis. Options A and D describe apoptosis,
and option C describes necrosis due to free radicals .
6. A 60-year-old man with a history of chronic gastritis undergoes a gastric
biopsy. The pathologist reports a marked reduction in parietal cell numbers,
with the remaining cells showing enlarged nuclei and prominent nucleoli. This
cellular change in the remaining parietal cells is best described as:
A. Hyperplasia
B. Dysplasia
C. Atrophy
D. Hypertrophy
Correct Answer: D. Hypertrophy
Rationale: Hypertrophy is an increase in the size of cells due to an increased
functional demand. In this case, the remaining parietal cells are compensating for
the loss of their neighboring cells by enlarging and increasing their protein
synthesis, which is reflected in the enlarged nuclei and prominent nucleoli .
SECTION 2: HEMATOLOGIC DISORDERS
7. Which blood cells are the chief phagocytes involved in the early inflammation
process?
A. Neutrophils
B. Eosinophils
C. Monocytes
D. Erythrocytes
Correct Answer: A. Neutrophils
