NR507 Advanced Pathophysiology
Midterm Exam: Comprehensive Q&A
with Rationales for Weeks 1–4
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–
25)
1. A client presents with enlargement of the left ventricle due
to long-standing hypertension. This is an example of which
type of cellular adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size leading to organ
enlargement. The left ventricle enlarges in response to increased
workload (hypertension) because cardiac muscle cells are
terminally differentiated and cannot undergo hyperplasia (mitotic
division).
,2. A patient who smokes heavily develops thickening of the
bronchial epithelium, changing from columnar to squamous
cells. This is an example of:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Answer: C) Metaplasia
Rationale: Metaplasia is the reversible replacement of one
differentiated cell type with another, often as an adaptive
response to chronic irritation. Chronic smoking causes bronchial
epithelium to transform into stratified squamous epithelium,
which is more protective but less functional.
3. A 48-year-old female with chronic GERD undergoes
endoscopy revealing replacement of normal squamous
esophageal epithelium with columnar epithelium (Barrett's
esophagus). This cellular change BEST represents:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Coagulative necrosis
Answer: C) Metaplasia
,Rationale: Barrett's esophagus is squamous-to-columnar
metaplasia caused by chronic acid exposure. The new epithelium
is more resistant to acid but carries a risk of adenocarcinoma.
Metaplasia is reversible if the stimulus is removed.
4. A weightlifter's skeletal muscle cells increase in size due to
resistance training. This best represents:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size without an
increase in cell number, commonly seen in skeletal and cardiac
muscle in response to increased workload.
5. Following prolonged immobilization, a patient's calf
muscle decreases in mass. This is best described as:
A) Necrosis
B) Hypertrophy
C) Metaplasia
D) Atrophy
, Answer: D) Atrophy
Rationale: Atrophy results from decreased workload, denervation,
or reduced nutrition, causing a decrease in cell size and organ
mass.
6. Uterine smooth muscle cells increasing in number during
pregnancy is an example of:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: B) Hyperplasia
Rationale: Hyperplasia is an increase in cell number due to
increased demand or hormonal stimulation; it is reversible.
7. Dysplasia differs from metaplasia primarily because
dysplasia involves:
A) A change in cell type
B) A decrease in cell number
C) Atypical changes in cell size, shape, and organization
D) Programmed cell death
Midterm Exam: Comprehensive Q&A
with Rationales for Weeks 1–4
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–
25)
1. A client presents with enlargement of the left ventricle due
to long-standing hypertension. This is an example of which
type of cellular adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size leading to organ
enlargement. The left ventricle enlarges in response to increased
workload (hypertension) because cardiac muscle cells are
terminally differentiated and cannot undergo hyperplasia (mitotic
division).
,2. A patient who smokes heavily develops thickening of the
bronchial epithelium, changing from columnar to squamous
cells. This is an example of:
A) Hyperplasia
B) Hypertrophy
C) Metaplasia
D) Dysplasia
Answer: C) Metaplasia
Rationale: Metaplasia is the reversible replacement of one
differentiated cell type with another, often as an adaptive
response to chronic irritation. Chronic smoking causes bronchial
epithelium to transform into stratified squamous epithelium,
which is more protective but less functional.
3. A 48-year-old female with chronic GERD undergoes
endoscopy revealing replacement of normal squamous
esophageal epithelium with columnar epithelium (Barrett's
esophagus). This cellular change BEST represents:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Coagulative necrosis
Answer: C) Metaplasia
,Rationale: Barrett's esophagus is squamous-to-columnar
metaplasia caused by chronic acid exposure. The new epithelium
is more resistant to acid but carries a risk of adenocarcinoma.
Metaplasia is reversible if the stimulus is removed.
4. A weightlifter's skeletal muscle cells increase in size due to
resistance training. This best represents:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Answer: B) Hypertrophy
Rationale: Hypertrophy is an increase in cell size without an
increase in cell number, commonly seen in skeletal and cardiac
muscle in response to increased workload.
5. Following prolonged immobilization, a patient's calf
muscle decreases in mass. This is best described as:
A) Necrosis
B) Hypertrophy
C) Metaplasia
D) Atrophy
, Answer: D) Atrophy
Rationale: Atrophy results from decreased workload, denervation,
or reduced nutrition, causing a decrease in cell size and organ
mass.
6. Uterine smooth muscle cells increasing in number during
pregnancy is an example of:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: B) Hyperplasia
Rationale: Hyperplasia is an increase in cell number due to
increased demand or hormonal stimulation; it is reversible.
7. Dysplasia differs from metaplasia primarily because
dysplasia involves:
A) A change in cell type
B) A decrease in cell number
C) Atypical changes in cell size, shape, and organization
D) Programmed cell death
