NR 507 MIDTERM EXAM ACTUAL 2026/2027 |
ADVANCED PATHOPHYSIOLOGY | VERIFIED Q&A
| CHAMBERLAIN
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–50)
Question 1
A client presents with enlargement of the left ventricle due to longstanding
hypertension. This is an example of which type of cellular adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Correct 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 cannot divide (hyperplasia).
,Question 2
A client who smokes has a change in the bronchial epithelium from ciliated
columnar to stratified squamous. This is an example of:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Correct Answer: D) Metaplasia
Rationale: Metaplasia is a reversible replacement of one differentiated cell
type with another. Smoking causes chronic irritation, leading to squamous
metaplasia of the bronchial epithelium as an adaptive response.
Question 3
A 55yearold male construction worker develops increased muscle mass in his
dominant arm after years of heavy manual labor. A biopsy would MOST likely
reveal which cellular change?
A) Increased number of muscle cells
B) Increased size of individual muscle cells with more myofibrils and
mitochondria
C) Replacement of muscle cells with fibrous tissue
D) Abnormal muscle cell morphology with nuclear pleomorphism
,Correct Answer: B) Increased size of individual muscle cells with more
myofibrils and mitochondria
Rationale: Skeletal muscle cells are terminally differentiated and cannot
divide. They respond to increased workload through hypertrophy—increased
cell size with more myofibrils, mitochondria, and sarcoplasmic reticulum.
Question 4
A 48yearold female with chronic gastroesophageal reflux disease (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
Correct Answer: C) Metaplasia
Rationale: Barrett's esophagus is squamoustocolumnar metaplasia caused by
chronic acid exposure. The new epithelium is more resistant to acid but
carries risk of adenocarcinoma. Metaplasia is reversible if the stimulus is
removed.
, Question 5
During myocardial ischemia, which of the following FIRST occurs at the
cellular level?
A) Nuclear chromatin margination and karyorrhexis
B) Lysosomal membrane rupture releasing digestive enzymes
C) Failure of Na⁺/K⁺ ATPase causing cellular swelling and calcium influx
D) Mitochondrial membrane rupture releasing cytochrome c
Correct Answer: C) Failure of Na⁺/K⁺ ATPase causing cellular swelling and
calcium influx
Rationale: ATP depletion during ischemia first causes Na⁺/K⁺ ATPase pump
failure → intracellular sodium accumulation → osmotic water entry → cellular
swelling (earliest reversible change). Calcium influx activates destructive
enzymes.
Question 6
A pathologist examining tissue from a patient who died of a stroke finds
liquefied brain tissue with a fluidfilled cavity. This type of necrosis occurred
because:
A) The brain has high protein content that denatures during ischemia
B) The brain has high lipid content and abundant hydrolytic enzymes that
completely digest necrotic tissue
C) Bacterial infection caused enzymatic dissolution of brain tissue
D) Caseous material accumulated due to granulomatous inflammation
ADVANCED PATHOPHYSIOLOGY | VERIFIED Q&A
| CHAMBERLAIN
SECTION 1: CELLULAR ADAPTATION & INJURY (Questions 1–50)
Question 1
A client presents with enlargement of the left ventricle due to longstanding
hypertension. This is an example of which type of cellular adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Correct 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 cannot divide (hyperplasia).
,Question 2
A client who smokes has a change in the bronchial epithelium from ciliated
columnar to stratified squamous. This is an example of:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Correct Answer: D) Metaplasia
Rationale: Metaplasia is a reversible replacement of one differentiated cell
type with another. Smoking causes chronic irritation, leading to squamous
metaplasia of the bronchial epithelium as an adaptive response.
Question 3
A 55yearold male construction worker develops increased muscle mass in his
dominant arm after years of heavy manual labor. A biopsy would MOST likely
reveal which cellular change?
A) Increased number of muscle cells
B) Increased size of individual muscle cells with more myofibrils and
mitochondria
C) Replacement of muscle cells with fibrous tissue
D) Abnormal muscle cell morphology with nuclear pleomorphism
,Correct Answer: B) Increased size of individual muscle cells with more
myofibrils and mitochondria
Rationale: Skeletal muscle cells are terminally differentiated and cannot
divide. They respond to increased workload through hypertrophy—increased
cell size with more myofibrils, mitochondria, and sarcoplasmic reticulum.
Question 4
A 48yearold female with chronic gastroesophageal reflux disease (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
Correct Answer: C) Metaplasia
Rationale: Barrett's esophagus is squamoustocolumnar metaplasia caused by
chronic acid exposure. The new epithelium is more resistant to acid but
carries risk of adenocarcinoma. Metaplasia is reversible if the stimulus is
removed.
, Question 5
During myocardial ischemia, which of the following FIRST occurs at the
cellular level?
A) Nuclear chromatin margination and karyorrhexis
B) Lysosomal membrane rupture releasing digestive enzymes
C) Failure of Na⁺/K⁺ ATPase causing cellular swelling and calcium influx
D) Mitochondrial membrane rupture releasing cytochrome c
Correct Answer: C) Failure of Na⁺/K⁺ ATPase causing cellular swelling and
calcium influx
Rationale: ATP depletion during ischemia first causes Na⁺/K⁺ ATPase pump
failure → intracellular sodium accumulation → osmotic water entry → cellular
swelling (earliest reversible change). Calcium influx activates destructive
enzymes.
Question 6
A pathologist examining tissue from a patient who died of a stroke finds
liquefied brain tissue with a fluidfilled cavity. This type of necrosis occurred
because:
A) The brain has high protein content that denatures during ischemia
B) The brain has high lipid content and abundant hydrolytic enzymes that
completely digest necrotic tissue
C) Bacterial infection caused enzymatic dissolution of brain tissue
D) Caseous material accumulated due to granulomatous inflammation
