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NURS 6501N / NURS6501 Advanced Pathophysiology
Midterm Examination
Comprehensive Question Bank – 200 Multiple-Choice Questions
with Answers and Explanations
VERSION 1: Questions 1–100
Cellular Adaptation, Injury, and Death
Question 1
What is the single most common cause of cellular injury?
A) Chemical injury
B) Hypoxic injury
C) Infectious injury
D) Mechanical injury
Valid answer: B) Hypoxic injury
Explanation: Hypoxic injury is the most common cause of cellular injury,
resulting from inadequate oxygen delivery to tissues. This can occur due to
ischemia, anemia, or respiratory failure. Hypoxia leads to decreased ATP
production, failure of the sodium-potassium pump, cellular swelling, and
ultimately cell death if not corrected.
Question 2
The early dilation (swelling) of the cell's endoplasmic reticulum results in:
A) Increased protein synthesis
B) Reduced protein synthesis
C) Enhanced cellular metabolism
D) Improved membrane stability
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Valid answer: B) Reduced protein synthesis
Explanation: Early dilation of the endoplasmic reticulum is a hallmark of
reversible cell injury. This swelling interferes with the organelle's normal function,
particularly protein synthesis and folding, leading to reduced production of
essential proteins.
Question 3
Which of the following is a hallmark of reversible cell injury?
A) Karyolysis
B) Cell membrane rupture
C) Cellular swelling
D) Mitochondrial calcification
Valid answer: C) Cellular swelling
Explanation: Cellular swelling is a classic hallmark of reversible cell injury,
caused by failure of ion pumps in the plasma membrane. This results in
accumulation of intracellular sodium and water. Karyolysis, membrane rupture,
and mitochondrial calcification are features of irreversible injury and cell death.
Question 4
Sodium and water accumulation in an injured cell are a direct result of:
A) Increased ATP production
B) Decreased ATP production
C) Enhanced sodium pump activity
D) Increased protein synthesis
Valid answer: B) Decreased ATP production
Explanation: When cellular ATP production decreases due to hypoxia or other
insults, the sodium-potassium ATPase pump fails. This leads to intracellular
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sodium accumulation, which draws water into the cell, causing cellular swelling
and edema.
Question 5
A patient with a history of atherosclerosis presents with chest pain. The
underlying cellular mechanism most likely involves:
A) Hyperplasia
B) Metaplasia
C) Ischemic injury
D) Hypertrophy
Valid answer: C) Ischemic injury
Explanation: Atherosclerosis causes narrowing of coronary arteries, leading to
reduced blood flow and ischemic injury to myocardial cells. This results in
decreased oxygen delivery, ATP depletion, and cellular dysfunction or death if
prolonged.
Question 6
A patient receiving chemotherapy for breast cancer develops nausea, vomiting,
and jaundice. The most likely cause of these symptoms is:
A) Hypoxic injury
B) Chemical injury
C) Physical injury
D) Immunologic injury
Valid answer: B) Chemical injury
Explanation: Chemotherapeutic agents are chemical substances that can cause
cellular injury, particularly to rapidly dividing cells in the liver, gastrointestinal
tract, and bone marrow. The jaundice indicates hepatotoxicity, while nausea and
vomiting reflect gastrointestinal epithelial damage.
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Question 7
Which cellular adaptation involves an increase in cell size in response to increased
workload?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Valid answer: B) Hypertrophy
Explanation: Hypertrophy is an increase in cell size, often in response to
increased workload or trophic stimulation. Examples include cardiac muscle
hypertrophy in hypertension and skeletal muscle hypertrophy with exercise.
Question 8
Metaplasia refers to:
A) An increase in cell number
B) A decrease in cell size
C) The replacement of one differentiated cell type with another
D) Uncontrolled cell division
Valid answer: C) The replacement of one differentiated cell type with another
Explanation: Metaplasia is a reversible change in which one adult cell type is
replaced by another cell type, often in response to chronic irritation or
inflammation. An example is the replacement of columnar epithelium with
squamous epithelium in the respiratory tract of smokers.
Question 9
Ischemia is best defined as:
A) Decreased blood flow to a tissue
NURS 6501N / NURS6501 Advanced Pathophysiology
Midterm Examination
Comprehensive Question Bank – 200 Multiple-Choice Questions
with Answers and Explanations
VERSION 1: Questions 1–100
Cellular Adaptation, Injury, and Death
Question 1
What is the single most common cause of cellular injury?
A) Chemical injury
B) Hypoxic injury
C) Infectious injury
D) Mechanical injury
Valid answer: B) Hypoxic injury
Explanation: Hypoxic injury is the most common cause of cellular injury,
resulting from inadequate oxygen delivery to tissues. This can occur due to
ischemia, anemia, or respiratory failure. Hypoxia leads to decreased ATP
production, failure of the sodium-potassium pump, cellular swelling, and
ultimately cell death if not corrected.
Question 2
The early dilation (swelling) of the cell's endoplasmic reticulum results in:
A) Increased protein synthesis
B) Reduced protein synthesis
C) Enhanced cellular metabolism
D) Improved membrane stability
, 2
Valid answer: B) Reduced protein synthesis
Explanation: Early dilation of the endoplasmic reticulum is a hallmark of
reversible cell injury. This swelling interferes with the organelle's normal function,
particularly protein synthesis and folding, leading to reduced production of
essential proteins.
Question 3
Which of the following is a hallmark of reversible cell injury?
A) Karyolysis
B) Cell membrane rupture
C) Cellular swelling
D) Mitochondrial calcification
Valid answer: C) Cellular swelling
Explanation: Cellular swelling is a classic hallmark of reversible cell injury,
caused by failure of ion pumps in the plasma membrane. This results in
accumulation of intracellular sodium and water. Karyolysis, membrane rupture,
and mitochondrial calcification are features of irreversible injury and cell death.
Question 4
Sodium and water accumulation in an injured cell are a direct result of:
A) Increased ATP production
B) Decreased ATP production
C) Enhanced sodium pump activity
D) Increased protein synthesis
Valid answer: B) Decreased ATP production
Explanation: When cellular ATP production decreases due to hypoxia or other
insults, the sodium-potassium ATPase pump fails. This leads to intracellular
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sodium accumulation, which draws water into the cell, causing cellular swelling
and edema.
Question 5
A patient with a history of atherosclerosis presents with chest pain. The
underlying cellular mechanism most likely involves:
A) Hyperplasia
B) Metaplasia
C) Ischemic injury
D) Hypertrophy
Valid answer: C) Ischemic injury
Explanation: Atherosclerosis causes narrowing of coronary arteries, leading to
reduced blood flow and ischemic injury to myocardial cells. This results in
decreased oxygen delivery, ATP depletion, and cellular dysfunction or death if
prolonged.
Question 6
A patient receiving chemotherapy for breast cancer develops nausea, vomiting,
and jaundice. The most likely cause of these symptoms is:
A) Hypoxic injury
B) Chemical injury
C) Physical injury
D) Immunologic injury
Valid answer: B) Chemical injury
Explanation: Chemotherapeutic agents are chemical substances that can cause
cellular injury, particularly to rapidly dividing cells in the liver, gastrointestinal
tract, and bone marrow. The jaundice indicates hepatotoxicity, while nausea and
vomiting reflect gastrointestinal epithelial damage.
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Question 7
Which cellular adaptation involves an increase in cell size in response to increased
workload?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
Valid answer: B) Hypertrophy
Explanation: Hypertrophy is an increase in cell size, often in response to
increased workload or trophic stimulation. Examples include cardiac muscle
hypertrophy in hypertension and skeletal muscle hypertrophy with exercise.
Question 8
Metaplasia refers to:
A) An increase in cell number
B) A decrease in cell size
C) The replacement of one differentiated cell type with another
D) Uncontrolled cell division
Valid answer: C) The replacement of one differentiated cell type with another
Explanation: Metaplasia is a reversible change in which one adult cell type is
replaced by another cell type, often in response to chronic irritation or
inflammation. An example is the replacement of columnar epithelium with
squamous epithelium in the respiratory tract of smokers.
Question 9
Ischemia is best defined as:
A) Decreased blood flow to a tissue
