NSG 527 MIDTERM AND FINAL
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Question 1: A cell is deprived of oxygen. What is the first immediate cellular
response to this hypoxia?
A) Shift to aerobic metabolism
B) Shift to anaerobic glycolysis
C) Immediate cell lysis
D) Activation of apoptosis
Correct Answer: B
Rationale: When oxygen is depleted, the electron transport chain stops. The cell must
immediately shift to anaerobic glycolysis to generate the minimal ATP required to
maintain basic membrane function, though this produces lactic acid and far less ATP .
Question 2: What cellular structure contains digestive enzymes that, if ruptured,
cause autodigestion of the cell?
,A) Ribosome
B) Lysosome
C) Golgi apparatus
D) Endoplasmic reticulum
Correct Answer: B
Rationale: Lysosomes are membrane-bound vesicles containing acid hydrolases. If the
lysosomal membrane is damaged, these enzymes are released into the cytoplasm and
digest cellular components, leading to cell death .
Question 3: A patient has a myocardial infarction. The ischemic myocardial cells
show swollen, pale cytoplasm due to the influx of sodium and water. What is this
specific cellular injury called?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Hydropic swelling
D) Fatty change
Correct Answer: C
Rationale: Hydropic swelling (cloudy swelling) is the first manifestation of almost all
forms of cellular injury. It occurs because ATP depletion causes failure of the sodium-
potassium pump, allowing sodium and water to rush into the cell .
Question 4: Which type of necrosis is characterized by a firm, yellowish-cheesy
appearance and is most commonly seen in tuberculosis?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Correct Answer: C
Rationale: Caseous necrosis is a distinct form of necrosis associated with
granulomatous diseases like tuberculosis. It appears grossly as a soft, friable, cheese-like
material .
,Question 5: What role do histamine and bradykinin play in the acute inflammatory
response?
A) They promote vasoconstriction.
B) They cause vasodilation and increased vascular permeability.
C) They directly kill bacteria.
D) They activate the extrinsic coagulation pathway.
Correct Answer: B
Rationale: Both histamine (released from mast cells) and bradykinin are potent
inflammatory mediators. They cause arteriolar vasodilation (causing erythema and heat)
and contract endothelial cells to increase vascular permeability (causing edema) .
Question 6: A patient has a bacterial infection. Labs show an elevated white blood
cell count with a left shift. What does a left shift indicate?
A) Increased numbers of lymphocytes
B) Increased numbers of immature neutrophils (bands) in the blood
C) Decreased numbers of basophils
D) Increased numbers of erythrocytes
Correct Answer: B
Rationale: A left shift refers to the release of immature neutrophils (bands,
metamyelocytes) from the bone marrow into the peripheral blood. This indicates an
acute, severe inflammatory response where the demand for neutrophils outpaces their
production rate .
Question 7: Which complement fragment is the most potent anaphylatoxin,
meaning it directly stimulates mast cells to release histamine?
A) C3b
B) C5a
, C) C1q
D) C5b
Correct Answer: B
Rationale: C5a (along with C3a) is an anaphylatoxin. It binds to mast cells and basophils,
triggering degranulation and histamine release. C5a is also a powerful chemotactic
factor for neutrophils .
Question 8: What is the primary role of C3b in the complement system?
A) Vasodilation
B) Opsonization
C) Chemotaxis
D) Direct cell lysis
Correct Answer: B
Rationale: C3b binds to the surface of microbes. Macrophages and neutrophils have
complement receptors that recognize C3b. This coats the microbe (opsonization),
making it much easier for phagocytes to attach to and engulf it .
Question 9: What is the precise pathophysiologic mechanism of reperfusion injury?
A) The sudden influx of calcium causes immediate cell division, leading to aneurysm
formation.
B) Restoration of oxygen generates massive amounts of reactive oxygen species (ROS)
via the xanthine oxidase pathway, causing lipid peroxidation and mitochondrial
permeability transition pore (MPTP) opening.
C) Reperfusion causes an immediate shift to anaerobic metabolism, producing lethal
levels of lactic acid.
D) The sudden return of blood washes away all protective antioxidants from the tissue.
Correct Answer: B
Rationale: During ischemia, ATP breaks down to hypoxanthine, and xanthine
dehydrogenase is converted to xanthine oxidase. When oxygen is suddenly restored
(reperfusion), xanthine oxidase uses this new oxygen to convert hypoxanthine to uric
acid, unleashing a massive burst of superoxide free radicals (ROS). These ROS attack cell
EXAM PACKAGE DEAL 2026/2027 |
Wilkes University Complete Bundle
| Verified Q&A with Rationales |
Pass Guaranteed - A+ Graded
Question 1: A cell is deprived of oxygen. What is the first immediate cellular
response to this hypoxia?
A) Shift to aerobic metabolism
B) Shift to anaerobic glycolysis
C) Immediate cell lysis
D) Activation of apoptosis
Correct Answer: B
Rationale: When oxygen is depleted, the electron transport chain stops. The cell must
immediately shift to anaerobic glycolysis to generate the minimal ATP required to
maintain basic membrane function, though this produces lactic acid and far less ATP .
Question 2: What cellular structure contains digestive enzymes that, if ruptured,
cause autodigestion of the cell?
,A) Ribosome
B) Lysosome
C) Golgi apparatus
D) Endoplasmic reticulum
Correct Answer: B
Rationale: Lysosomes are membrane-bound vesicles containing acid hydrolases. If the
lysosomal membrane is damaged, these enzymes are released into the cytoplasm and
digest cellular components, leading to cell death .
Question 3: A patient has a myocardial infarction. The ischemic myocardial cells
show swollen, pale cytoplasm due to the influx of sodium and water. What is this
specific cellular injury called?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Hydropic swelling
D) Fatty change
Correct Answer: C
Rationale: Hydropic swelling (cloudy swelling) is the first manifestation of almost all
forms of cellular injury. It occurs because ATP depletion causes failure of the sodium-
potassium pump, allowing sodium and water to rush into the cell .
Question 4: Which type of necrosis is characterized by a firm, yellowish-cheesy
appearance and is most commonly seen in tuberculosis?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Correct Answer: C
Rationale: Caseous necrosis is a distinct form of necrosis associated with
granulomatous diseases like tuberculosis. It appears grossly as a soft, friable, cheese-like
material .
,Question 5: What role do histamine and bradykinin play in the acute inflammatory
response?
A) They promote vasoconstriction.
B) They cause vasodilation and increased vascular permeability.
C) They directly kill bacteria.
D) They activate the extrinsic coagulation pathway.
Correct Answer: B
Rationale: Both histamine (released from mast cells) and bradykinin are potent
inflammatory mediators. They cause arteriolar vasodilation (causing erythema and heat)
and contract endothelial cells to increase vascular permeability (causing edema) .
Question 6: A patient has a bacterial infection. Labs show an elevated white blood
cell count with a left shift. What does a left shift indicate?
A) Increased numbers of lymphocytes
B) Increased numbers of immature neutrophils (bands) in the blood
C) Decreased numbers of basophils
D) Increased numbers of erythrocytes
Correct Answer: B
Rationale: A left shift refers to the release of immature neutrophils (bands,
metamyelocytes) from the bone marrow into the peripheral blood. This indicates an
acute, severe inflammatory response where the demand for neutrophils outpaces their
production rate .
Question 7: Which complement fragment is the most potent anaphylatoxin,
meaning it directly stimulates mast cells to release histamine?
A) C3b
B) C5a
, C) C1q
D) C5b
Correct Answer: B
Rationale: C5a (along with C3a) is an anaphylatoxin. It binds to mast cells and basophils,
triggering degranulation and histamine release. C5a is also a powerful chemotactic
factor for neutrophils .
Question 8: What is the primary role of C3b in the complement system?
A) Vasodilation
B) Opsonization
C) Chemotaxis
D) Direct cell lysis
Correct Answer: B
Rationale: C3b binds to the surface of microbes. Macrophages and neutrophils have
complement receptors that recognize C3b. This coats the microbe (opsonization),
making it much easier for phagocytes to attach to and engulf it .
Question 9: What is the precise pathophysiologic mechanism of reperfusion injury?
A) The sudden influx of calcium causes immediate cell division, leading to aneurysm
formation.
B) Restoration of oxygen generates massive amounts of reactive oxygen species (ROS)
via the xanthine oxidase pathway, causing lipid peroxidation and mitochondrial
permeability transition pore (MPTP) opening.
C) Reperfusion causes an immediate shift to anaerobic metabolism, producing lethal
levels of lactic acid.
D) The sudden return of blood washes away all protective antioxidants from the tissue.
Correct Answer: B
Rationale: During ischemia, ATP breaks down to hypoxanthine, and xanthine
dehydrogenase is converted to xanthine oxidase. When oxygen is suddenly restored
(reperfusion), xanthine oxidase uses this new oxygen to convert hypoxanthine to uric
acid, unleashing a massive burst of superoxide free radicals (ROS). These ROS attack cell
