NSG 5140 | Midterm Exam: Advanced
Pathophysiology- Questions with
CORRECT Answers | 2026 Latest update-
South College
1. A client presents with fatigue and pallor. A peripheral blood smear reveals
macrocytic red blood cells. This cellular adaptation is best described as:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells. In this case, the bone
marrow is attempting to compensate for anemia by increasing the production of
erythrocyte precursors, leading to larger (macrocytic) cells being released early. Atrophy
is a decrease in cell size, hypertrophy is an increase in cell size, and dysplasia is
abnormal cell growth.
2. The primary mechanism of cellular injury in ischemia is:
A. Direct membrane damage by toxins
B. Impaired ATP production leading to sodium-potassium pump failure
C. Activation of the complement cascade
D. Lysis by cytotoxic T cells
Correct Answer: B. Impaired ATP production leading to sodium-potassium pump
failure
Rationale: Ischemia is a lack of blood flow and oxygen. Without oxygen, oxidative
phosphorylation ceases, leading to a rapid drop in ATP. The ATP-dependent Na+/K+
pump fails, causing sodium to accumulate intracellularly, water to follow, and cellular
swelling.
3. Which cellular change is characteristic of irreversible cell injury and is visible
under a light microscope?
,A. Nuclear pyknosis
B. Cellular swelling
C. Ribosomal detachment
D. Loss of microvilli
Correct Answer: A. Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation), karyorrhexis
(fragmentation), and karyolysis (dissolution) are hallmarks of irreversible injury and
necrosis. Cellular swelling, ribosomal detachment, and loss of microvilli are reversible
changes seen in the early stages of cell injury.
4. The type of necrosis commonly associated with a lung infection caused by
Mycobacterium tuberculosis is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: C. Caseous necrosis
Rationale: Caseous necrosis, a combination of coagulative and liquefactive necrosis, is
characteristic of tuberculous infections. It results in a cheese-like, granular appearance.
5. A patient with chronic heart failure develops an enlarged heart. This cellular
adaptation is known as:
A. Atrophy
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is the increase in the size of individual cells. In response to
increased workload (e.g., increased pressure from heart failure), cardiac muscle cells
(which cannot divide) undergo hypertrophy to generate greater force.
6. The cellular component responsible for the production of ATP through oxidative
phosphorylation is the:
A. Ribosome
B. Endoplasmic reticulum
C. Mitochondrion
,D. Lysosome
Correct Answer: C. Mitochondrion
Rationale: The mitochondrion is the site of the electron transport chain and oxidative
phosphorylation, where the majority of ATP is generated. Ribosomes synthesize
proteins, the ER is involved in protein and lipid synthesis, and lysosomes are for
intracellular digestion.
7. Free radicals cause cellular damage primarily by:
A. Inhibiting protein synthesis
B. Disrupting the cell membrane and DNA through lipid peroxidation
C. Blocking receptor sites on the cell surface
D. Activating oncogenes
Correct Answer: B. Disrupting the cell membrane and DNA through lipid
peroxidation
Rationale: Free radicals are highly reactive molecules with unpaired electrons. They
cause damage by stealing electrons from other molecules, leading to lipid peroxidation
of cell membranes, protein modification, and DNA damage.
8. The process of programmed cell death that does not cause an inflammatory
response is called:
A. Necrosis
B. Gangrene
C. Apoptosis
D. Pyroptosis
Correct Answer: C. Apoptosis
Rationale: Apoptosis is an orderly, energy-dependent process of cellular self-
destruction. It is designed to eliminate unwanted cells without releasing cellular
contents that cause inflammation. Necrosis is an unregulated, inflammatory form of cell
death.
9. Barrett esophagus, where the normal stratified squamous epithelium is replaced
by columnar epithelium in response to acid reflux, is an example of:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Anaplasia
, Correct Answer: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another. It is an adaptive response to chronic irritation.
10. A cancer cell that demonstrates a lack of differentiation is said to be:
A. Anaplastic
B. Dysplastic
C. Metaplastic
D. Hyperplastic
Correct Answer: A. Anaplastic
Rationale: Anaplasia is a hallmark of malignancy and refers to the loss of cellular
differentiation and structure. Dysplasia implies disordered growth but is not necessarily
cancer, metaplasia is a reversible change, and hyperplasia is an increase in cell number.
11. The primary intracellular cation is:
A. Sodium
B. Chloride
C. Potassium
D. Calcium
Correct Answer: C. Potassium
Rationale: Potassium (K+) is the major cation in the intracellular fluid (ICF). Sodium
(Na+) is the primary extracellular cation.
12. A patient's lab results show a serum pH of 7.25. This indicates:
A. Alkalemia
B. Acidemia
C. Hypoxia
D. Hypercapnia
Correct Answer: B. Acidemia
Rationale: Normal arterial pH is 7.35-7.45. A pH of 7.25 is below the normal range,
indicating acidemia (blood is more acidic than normal). Alkalemia is a pH above 7.45.
13. A major mechanism for maintaining fluid balance between the intracellular
and extracellular compartments is:
A. Active transport
B. Osmosis
C. Filtration
Pathophysiology- Questions with
CORRECT Answers | 2026 Latest update-
South College
1. A client presents with fatigue and pallor. A peripheral blood smear reveals
macrocytic red blood cells. This cellular adaptation is best described as:
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Dysplasia
Correct Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in the number of cells. In this case, the bone
marrow is attempting to compensate for anemia by increasing the production of
erythrocyte precursors, leading to larger (macrocytic) cells being released early. Atrophy
is a decrease in cell size, hypertrophy is an increase in cell size, and dysplasia is
abnormal cell growth.
2. The primary mechanism of cellular injury in ischemia is:
A. Direct membrane damage by toxins
B. Impaired ATP production leading to sodium-potassium pump failure
C. Activation of the complement cascade
D. Lysis by cytotoxic T cells
Correct Answer: B. Impaired ATP production leading to sodium-potassium pump
failure
Rationale: Ischemia is a lack of blood flow and oxygen. Without oxygen, oxidative
phosphorylation ceases, leading to a rapid drop in ATP. The ATP-dependent Na+/K+
pump fails, causing sodium to accumulate intracellularly, water to follow, and cellular
swelling.
3. Which cellular change is characteristic of irreversible cell injury and is visible
under a light microscope?
,A. Nuclear pyknosis
B. Cellular swelling
C. Ribosomal detachment
D. Loss of microvilli
Correct Answer: A. Nuclear pyknosis
Rationale: Nuclear pyknosis (nuclear shrinkage and condensation), karyorrhexis
(fragmentation), and karyolysis (dissolution) are hallmarks of irreversible injury and
necrosis. Cellular swelling, ribosomal detachment, and loss of microvilli are reversible
changes seen in the early stages of cell injury.
4. The type of necrosis commonly associated with a lung infection caused by
Mycobacterium tuberculosis is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: C. Caseous necrosis
Rationale: Caseous necrosis, a combination of coagulative and liquefactive necrosis, is
characteristic of tuberculous infections. It results in a cheese-like, granular appearance.
5. A patient with chronic heart failure develops an enlarged heart. This cellular
adaptation is known as:
A. Atrophy
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B. Hypertrophy
Rationale: Hypertrophy is the increase in the size of individual cells. In response to
increased workload (e.g., increased pressure from heart failure), cardiac muscle cells
(which cannot divide) undergo hypertrophy to generate greater force.
6. The cellular component responsible for the production of ATP through oxidative
phosphorylation is the:
A. Ribosome
B. Endoplasmic reticulum
C. Mitochondrion
,D. Lysosome
Correct Answer: C. Mitochondrion
Rationale: The mitochondrion is the site of the electron transport chain and oxidative
phosphorylation, where the majority of ATP is generated. Ribosomes synthesize
proteins, the ER is involved in protein and lipid synthesis, and lysosomes are for
intracellular digestion.
7. Free radicals cause cellular damage primarily by:
A. Inhibiting protein synthesis
B. Disrupting the cell membrane and DNA through lipid peroxidation
C. Blocking receptor sites on the cell surface
D. Activating oncogenes
Correct Answer: B. Disrupting the cell membrane and DNA through lipid
peroxidation
Rationale: Free radicals are highly reactive molecules with unpaired electrons. They
cause damage by stealing electrons from other molecules, leading to lipid peroxidation
of cell membranes, protein modification, and DNA damage.
8. The process of programmed cell death that does not cause an inflammatory
response is called:
A. Necrosis
B. Gangrene
C. Apoptosis
D. Pyroptosis
Correct Answer: C. Apoptosis
Rationale: Apoptosis is an orderly, energy-dependent process of cellular self-
destruction. It is designed to eliminate unwanted cells without releasing cellular
contents that cause inflammation. Necrosis is an unregulated, inflammatory form of cell
death.
9. Barrett esophagus, where the normal stratified squamous epithelium is replaced
by columnar epithelium in response to acid reflux, is an example of:
A. Hypertrophy
B. Hyperplasia
C. Metaplasia
D. Anaplasia
, Correct Answer: C. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another. It is an adaptive response to chronic irritation.
10. A cancer cell that demonstrates a lack of differentiation is said to be:
A. Anaplastic
B. Dysplastic
C. Metaplastic
D. Hyperplastic
Correct Answer: A. Anaplastic
Rationale: Anaplasia is a hallmark of malignancy and refers to the loss of cellular
differentiation and structure. Dysplasia implies disordered growth but is not necessarily
cancer, metaplasia is a reversible change, and hyperplasia is an increase in cell number.
11. The primary intracellular cation is:
A. Sodium
B. Chloride
C. Potassium
D. Calcium
Correct Answer: C. Potassium
Rationale: Potassium (K+) is the major cation in the intracellular fluid (ICF). Sodium
(Na+) is the primary extracellular cation.
12. A patient's lab results show a serum pH of 7.25. This indicates:
A. Alkalemia
B. Acidemia
C. Hypoxia
D. Hypercapnia
Correct Answer: B. Acidemia
Rationale: Normal arterial pH is 7.35-7.45. A pH of 7.25 is below the normal range,
indicating acidemia (blood is more acidic than normal). Alkalemia is a pH above 7.45.
13. A major mechanism for maintaining fluid balance between the intracellular
and extracellular compartments is:
A. Active transport
B. Osmosis
C. Filtration
