PORTAGE NURS 231 PATHOPHYSIOLOGY ALL EXAMS
2026/2027 | Modules 1-10 with Final Review | Latest
Update | Pass Guaranteed - A+ Graded
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (35
Questions)
Q1: A 68-year-old male with a history of benign prostatic hyperplasia presents with
urinary retention. Microscopic examination reveals enlarged prostate cells with
increased cytoplasmic organelles. Which cellular adaptation is demonstrated?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size resulting in enlarged tissue mass,
characterized by increased cytoplasmic organelles and protein synthesis. Hyperplasia
(A) involves increased cell number, not cell size. Atrophy (C) is decreased cell size.
Metaplasia (D) is replacement of one differentiated cell type with another.
Q2: A 45-year-old female smoker has chronic bronchitis. Bronchial biopsy reveals
stratified squamous epithelium replacing normal pseudostratified ciliated columnar
epithelium. This change is classified as:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, often in response to chronic irritation (smoking). Dysplasia (A) is disordered
,cell growth with nuclear atypia. Hyperplasia (C) is increased cell number. Anaplasia (D)
is loss of cellular differentiation, characteristic of malignancy.
Q3: A 55-year-old male with chronic hypertension has left ventricular wall thickening on
echocardiography. The cardiomyocytes demonstrate increased myofibrils and
mitochondria. This represents:
A. Physiologic hyperplasia
B. Pathologic hypertrophy
C. Compensatory atrophy
D. Reversible dysplasia
Correct Answer: B
Rationale: Pathologic hypertrophy occurs in response to increased workload (afterload)
from hypertension, resulting in increased cell size with more organelles. Physiologic
hyperplasia (A) occurs in normal tissues like breast tissue during pregnancy. Atrophy
(C) is decreased size. Dysplasia (D) is pre-neoplastic disordered growth.
Q4: A 70-year-old female on prolonged bed rest shows decreased muscle mass and
bone density. Muscle biopsy reveals smaller myocytes with reduced organelle numbers.
This cellular adaptation is:
A. Disuse atrophy
B. Denervation atrophy
C. Ischemic atrophy
D. Endocrine atrophy
Correct Answer: A
Rationale: Disuse atrophy results from decreased workload or immobilization, causing
reduced protein synthesis and increased protein degradation. Denervation atrophy (B)
follows nerve damage. Ischemic atrophy (C) results from inadequate blood supply.
Endocrine atrophy (D) follows hormone deficiency.
Q5: A 35-year-old female with chronic gastroesophageal reflux disease has Barrett
esophagus on endoscopy. Histology shows intestinal-type columnar epithelium
replacing squamous epithelium. This is best described as:
A. Metaplasia with malignant potential
B. Benign hyperplasia
C. Reversible dysplasia
,D. Physiologic adaptation
Correct Answer: A
Rationale: Barrett esophagus is intestinal metaplasia of the distal esophagus due to
chronic acid exposure, representing a premalignant condition with increased risk for
adenocarcinoma. It is not hyperplasia (B) or physiologic (D). Dysplasia (C) would show
nuclear atypia and disordered maturation.
Q6: A pathologist examines liver tissue from a patient with hepatitis and notes
Councilman bodies (apoptotic hepatocytes). Apoptosis differs from necrosis in that
apoptosis:
A. Causes significant inflammatory response
B. Is always pathologic and harmful
C. Involves cell shrinkage with intact plasma membrane
D. Results in cellular swelling and membrane rupture
Correct Answer: C
Rationale: Apoptosis is programmed cell death characterized by cell shrinkage,
chromatin condensation, membrane blebbing without rupture, and formation of
apoptotic bodies. Necrosis (D) involves cellular swelling, membrane rupture, and
inflammation. Apoptosis can be physiologic (embryogenesis) and does not trigger
significant inflammation (A).
Q7: A 42-year-old male presents with severe crushing chest pain. Cardiac enzymes are
elevated. ECG shows ST-elevation in leads V1-V4. The myocardial tissue will most likely
demonstrate:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs
(heart, kidney, spleen) except the brain, preserving tissue architecture initially due to
denaturation of structural proteins. Liquefactive necrosis (B) occurs in brain infarcts
and abscesses. Caseous necrosis (C) is seen in tuberculosis. Fat necrosis (D) occurs in
pancreatic trauma or breast tissue.
, Q8: A 28-year-old male with HIV develops cerebral toxoplasmosis. Brain biopsy shows
tissue destruction with cystic spaces. The type of necrosis present is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs in the brain due to ischemic injury or infections
(abscesses) because brain tissue lacks substantial connective tissue framework and
contains high lipid content, leading to enzymatic digestion and softening. Coagulative
necrosis (A) occurs in other solid organs. Caseous necrosis (C) is cheese-like, seen in
TB.
Q9: A patient with poorly controlled diabetes develops a black, dry foot ulcer with clear
demarcation from viable tissue. This represents:
A. Wet gangrene
B. Dry gangrene
C. Gas gangrene
D. Liquefactive necrosis
Correct Answer: B
Rationale: Dry gangrene is coagulative necrosis in ischemic tissue (often diabetic
peripheral vascular disease) with slow onset, allowing tissue dehydration and
mummification without significant bacterial infection. Wet gangrene (A) involves
liquefactive necrosis with bacterial infection and pus. Gas gangrene (C) is caused by
Clostridium perfringens with gas formation.
Q10: A 30-year-old female with lupus presents with painful digital ulcers following cold
exposure. The fingertips show sharply demarcated blackened tissue. This is classified
as:
A. Dry gangrene
B. Wet gangrene
C. Gas gangrene
D. Coagulative necrosis only
Correct Answer: A
2026/2027 | Modules 1-10 with Final Review | Latest
Update | Pass Guaranteed - A+ Graded
SECTION 1: CELLULAR ADAPTATION, INJURY & DEATH (35
Questions)
Q1: A 68-year-old male with a history of benign prostatic hyperplasia presents with
urinary retention. Microscopic examination reveals enlarged prostate cells with
increased cytoplasmic organelles. Which cellular adaptation is demonstrated?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size resulting in enlarged tissue mass,
characterized by increased cytoplasmic organelles and protein synthesis. Hyperplasia
(A) involves increased cell number, not cell size. Atrophy (C) is decreased cell size.
Metaplasia (D) is replacement of one differentiated cell type with another.
Q2: A 45-year-old female smoker has chronic bronchitis. Bronchial biopsy reveals
stratified squamous epithelium replacing normal pseudostratified ciliated columnar
epithelium. This change is classified as:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, often in response to chronic irritation (smoking). Dysplasia (A) is disordered
,cell growth with nuclear atypia. Hyperplasia (C) is increased cell number. Anaplasia (D)
is loss of cellular differentiation, characteristic of malignancy.
Q3: A 55-year-old male with chronic hypertension has left ventricular wall thickening on
echocardiography. The cardiomyocytes demonstrate increased myofibrils and
mitochondria. This represents:
A. Physiologic hyperplasia
B. Pathologic hypertrophy
C. Compensatory atrophy
D. Reversible dysplasia
Correct Answer: B
Rationale: Pathologic hypertrophy occurs in response to increased workload (afterload)
from hypertension, resulting in increased cell size with more organelles. Physiologic
hyperplasia (A) occurs in normal tissues like breast tissue during pregnancy. Atrophy
(C) is decreased size. Dysplasia (D) is pre-neoplastic disordered growth.
Q4: A 70-year-old female on prolonged bed rest shows decreased muscle mass and
bone density. Muscle biopsy reveals smaller myocytes with reduced organelle numbers.
This cellular adaptation is:
A. Disuse atrophy
B. Denervation atrophy
C. Ischemic atrophy
D. Endocrine atrophy
Correct Answer: A
Rationale: Disuse atrophy results from decreased workload or immobilization, causing
reduced protein synthesis and increased protein degradation. Denervation atrophy (B)
follows nerve damage. Ischemic atrophy (C) results from inadequate blood supply.
Endocrine atrophy (D) follows hormone deficiency.
Q5: A 35-year-old female with chronic gastroesophageal reflux disease has Barrett
esophagus on endoscopy. Histology shows intestinal-type columnar epithelium
replacing squamous epithelium. This is best described as:
A. Metaplasia with malignant potential
B. Benign hyperplasia
C. Reversible dysplasia
,D. Physiologic adaptation
Correct Answer: A
Rationale: Barrett esophagus is intestinal metaplasia of the distal esophagus due to
chronic acid exposure, representing a premalignant condition with increased risk for
adenocarcinoma. It is not hyperplasia (B) or physiologic (D). Dysplasia (C) would show
nuclear atypia and disordered maturation.
Q6: A pathologist examines liver tissue from a patient with hepatitis and notes
Councilman bodies (apoptotic hepatocytes). Apoptosis differs from necrosis in that
apoptosis:
A. Causes significant inflammatory response
B. Is always pathologic and harmful
C. Involves cell shrinkage with intact plasma membrane
D. Results in cellular swelling and membrane rupture
Correct Answer: C
Rationale: Apoptosis is programmed cell death characterized by cell shrinkage,
chromatin condensation, membrane blebbing without rupture, and formation of
apoptotic bodies. Necrosis (D) involves cellular swelling, membrane rupture, and
inflammation. Apoptosis can be physiologic (embryogenesis) and does not trigger
significant inflammation (A).
Q7: A 42-year-old male presents with severe crushing chest pain. Cardiac enzymes are
elevated. ECG shows ST-elevation in leads V1-V4. The myocardial tissue will most likely
demonstrate:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs
(heart, kidney, spleen) except the brain, preserving tissue architecture initially due to
denaturation of structural proteins. Liquefactive necrosis (B) occurs in brain infarcts
and abscesses. Caseous necrosis (C) is seen in tuberculosis. Fat necrosis (D) occurs in
pancreatic trauma or breast tissue.
, Q8: A 28-year-old male with HIV develops cerebral toxoplasmosis. Brain biopsy shows
tissue destruction with cystic spaces. The type of necrosis present is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B
Rationale: Liquefactive necrosis occurs in the brain due to ischemic injury or infections
(abscesses) because brain tissue lacks substantial connective tissue framework and
contains high lipid content, leading to enzymatic digestion and softening. Coagulative
necrosis (A) occurs in other solid organs. Caseous necrosis (C) is cheese-like, seen in
TB.
Q9: A patient with poorly controlled diabetes develops a black, dry foot ulcer with clear
demarcation from viable tissue. This represents:
A. Wet gangrene
B. Dry gangrene
C. Gas gangrene
D. Liquefactive necrosis
Correct Answer: B
Rationale: Dry gangrene is coagulative necrosis in ischemic tissue (often diabetic
peripheral vascular disease) with slow onset, allowing tissue dehydration and
mummification without significant bacterial infection. Wet gangrene (A) involves
liquefactive necrosis with bacterial infection and pus. Gas gangrene (C) is caused by
Clostridium perfringens with gas formation.
Q10: A 30-year-old female with lupus presents with painful digital ulcers following cold
exposure. The fingertips show sharply demarcated blackened tissue. This is classified
as:
A. Dry gangrene
B. Wet gangrene
C. Gas gangrene
D. Coagulative necrosis only
Correct Answer: A
