NUR 376 Exam 1 – Applied Pathophysiology –
Official Blueprint Replica.
Q1: A patient with chronic alcoholism presents with low serum albumin and generalized
edema. Which pathophysiologic mechanism best explains the edema?
A. Increased capillary hydrostatic pressure
B. Decreased plasma oncotic pressure [CORRECT]
C. Increased interstitial osmotic pressure
D. Lymphatic obstruction
Correct Answer: B
Rationale: Correct because albumin is the primary plasma protein maintaining oncotic
pressure; decreased albumin reduces colloid osmotic pressure, allowing fluid to shift into
interstitial spaces.
Q2: A biopsy of skeletal muscle shows cells with enlarged nuclei, increased rough
endoplasmic reticulum, and no change in cell size. This adaptive response is best described as:
A. Hyperplasia
B. Atrophy
C. Hypertrophy [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Correct because hypertrophy involves an increase in cell size with augmented
protein synthesis and organelle content, matching the biopsy findings of enlarged nuclei and
increased RER.
Q3: During ischemia, a cell switches to anaerobic metabolism. Which consequence directly
results from this metabolic shift?
A. Increased ATP production
B. Decreased intracellular sodium
C. Accumulation of lactic acid [CORRECT]
,D. Alkalosis of the cytosol
Correct Answer: C
Rationale: Correct because anaerobic glycolysis produces pyruvate, which is converted to
lactic acid, leading to intracellular acidosis and reduced pH.
Q4: Which cellular change is reversible in the early stages of hypoxic injury?
A. Nuclear pyknosis
B. Plasma membrane blebbing [CORRECT]
C. Lysosomal rupture
D. Mitochondrial swelling with dense bodies
Correct Answer: B
Rationale: Correct because membrane blebbing occurs early during reversible cell injury and
can resolve if oxygen supply is restored before membrane integrity is permanently lost.
Q5: A patient is found to have elevated serum troponin following chest pain. This laboratory
finding indicates:
A. Reversible cell injury
B. Necrosis of cardiac myocytes [CORRECT]
C. Smooth muscle ischemia
D. Skeletal muscle damage
Correct Answer: B
Rationale: Correct because troponin is a regulatory protein specific to cardiac muscle that is
released into circulation when myocardial cells undergo irreversible injury and necrosis.
Q6: In reperfusion injury, which reactive oxygen species is most directly responsible for lipid
peroxidation of cell membranes?
A. Superoxide anion
B. Hydrogen peroxide
C. Hydroxyl radical [CORRECT]
D. Singlet oxygen
, Correct Answer: C
Rationale: Correct because the hydroxyl radical is highly reactive and initiates lipid
peroxidation, damaging membrane phospholipids during reperfusion.
Q7: A pathologist notes coagulative necrosis in a kidney specimen. This type of necrosis is
classically associated with:
A. Tuberculosis infection
B. Ischemic infarction [CORRECT]
C. Pancreatic enzyme release
D. Hypoxic injury to neuronal tissue
Correct Answer: B
Rationale: Correct because coagulative necrosis is the hallmark of ischemic necrosis in solid
organs such as the kidney and heart, where cell architecture is preserved initially.
Q8: Which of the following is an example of pathologic hyperplasia?
A. Liver regeneration following partial hepatectomy
B. Endometrial thickening during the menstrual cycle
C. Epidermal thickening over a callus
D. Benign prostatic hyperplasia [CORRECT]
Correct Answer: D
Rationale: Correct because benign prostatic hyperplasia is abnormal, excessive cell division in
response to hormonal stimulation, not a physiologic or compensatory process.
Q9: A patient with chronic anemia has pale, cool skin and fatigue. The cellular adaptation
occurring in her epidermal cells due to reduced oxygen delivery is:
A. Hyperplasia
B. Metaplasia
C. Atrophy [CORRECT]
D. Hypertrophy
Correct Answer: C
Official Blueprint Replica.
Q1: A patient with chronic alcoholism presents with low serum albumin and generalized
edema. Which pathophysiologic mechanism best explains the edema?
A. Increased capillary hydrostatic pressure
B. Decreased plasma oncotic pressure [CORRECT]
C. Increased interstitial osmotic pressure
D. Lymphatic obstruction
Correct Answer: B
Rationale: Correct because albumin is the primary plasma protein maintaining oncotic
pressure; decreased albumin reduces colloid osmotic pressure, allowing fluid to shift into
interstitial spaces.
Q2: A biopsy of skeletal muscle shows cells with enlarged nuclei, increased rough
endoplasmic reticulum, and no change in cell size. This adaptive response is best described as:
A. Hyperplasia
B. Atrophy
C. Hypertrophy [CORRECT]
D. Dysplasia
Correct Answer: C
Rationale: Correct because hypertrophy involves an increase in cell size with augmented
protein synthesis and organelle content, matching the biopsy findings of enlarged nuclei and
increased RER.
Q3: During ischemia, a cell switches to anaerobic metabolism. Which consequence directly
results from this metabolic shift?
A. Increased ATP production
B. Decreased intracellular sodium
C. Accumulation of lactic acid [CORRECT]
,D. Alkalosis of the cytosol
Correct Answer: C
Rationale: Correct because anaerobic glycolysis produces pyruvate, which is converted to
lactic acid, leading to intracellular acidosis and reduced pH.
Q4: Which cellular change is reversible in the early stages of hypoxic injury?
A. Nuclear pyknosis
B. Plasma membrane blebbing [CORRECT]
C. Lysosomal rupture
D. Mitochondrial swelling with dense bodies
Correct Answer: B
Rationale: Correct because membrane blebbing occurs early during reversible cell injury and
can resolve if oxygen supply is restored before membrane integrity is permanently lost.
Q5: A patient is found to have elevated serum troponin following chest pain. This laboratory
finding indicates:
A. Reversible cell injury
B. Necrosis of cardiac myocytes [CORRECT]
C. Smooth muscle ischemia
D. Skeletal muscle damage
Correct Answer: B
Rationale: Correct because troponin is a regulatory protein specific to cardiac muscle that is
released into circulation when myocardial cells undergo irreversible injury and necrosis.
Q6: In reperfusion injury, which reactive oxygen species is most directly responsible for lipid
peroxidation of cell membranes?
A. Superoxide anion
B. Hydrogen peroxide
C. Hydroxyl radical [CORRECT]
D. Singlet oxygen
, Correct Answer: C
Rationale: Correct because the hydroxyl radical is highly reactive and initiates lipid
peroxidation, damaging membrane phospholipids during reperfusion.
Q7: A pathologist notes coagulative necrosis in a kidney specimen. This type of necrosis is
classically associated with:
A. Tuberculosis infection
B. Ischemic infarction [CORRECT]
C. Pancreatic enzyme release
D. Hypoxic injury to neuronal tissue
Correct Answer: B
Rationale: Correct because coagulative necrosis is the hallmark of ischemic necrosis in solid
organs such as the kidney and heart, where cell architecture is preserved initially.
Q8: Which of the following is an example of pathologic hyperplasia?
A. Liver regeneration following partial hepatectomy
B. Endometrial thickening during the menstrual cycle
C. Epidermal thickening over a callus
D. Benign prostatic hyperplasia [CORRECT]
Correct Answer: D
Rationale: Correct because benign prostatic hyperplasia is abnormal, excessive cell division in
response to hormonal stimulation, not a physiologic or compensatory process.
Q9: A patient with chronic anemia has pale, cool skin and fatigue. The cellular adaptation
occurring in her epidermal cells due to reduced oxygen delivery is:
A. Hyperplasia
B. Metaplasia
C. Atrophy [CORRECT]
D. Hypertrophy
Correct Answer: C
