1|Page
NSG 5140 Advanced Pathophysiology
Comprehensive Midterm Exam Review - Set
2 200 Multiple-Choice Questions with
Answers and Rationales
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-
30)
Question 1: A 62-year-old male with chronic hypertension develops left ventricular
hypertrophy. Initially, this adaptation serves to:
A) Increase cardiac output
B) Decrease wall stress
C) Increase myocardial oxygen demand
D) Decrease contractility
Answer: B
Rationale: Concentric LV hypertrophy is an adaptive response to chronic pressure
overload (hypertension). By increasing wall thickness, wall stress is reduced (LaPlace's
law: stress = pressure × radius / (2 × wall thickness)). This maintains cardiac function
initially. Over time, however, it becomes maladaptive with diastolic dysfunction and
increased oxygen demand.
Question 2: A 55-year-old male with chronic alcoholism presents with
hepatomegaly. Liver biopsy shows macrovesicular steatosis. Which mechanism is
primarily responsible?
A) Increased fatty acid oxidation
B) Decreased fatty acid synthesis
C) Accumulation of triglycerides in hepatocytes
D) Increased protein synthesis
,2|Page
Answer: C
Rationale: Alcoholic liver disease causes fatty liver (steatosis) through accumulation of
triglycerides within hepatocytes. Mechanisms include increased fatty acid synthesis,
decreased fatty acid oxidation, impaired lipoprotein export, and increased peripheral
fat mobilization. This is an example of injury due to accumulation of endogenous
substances.
Figure 1: Cellular Adaptation Types
text
┌─────────────────────────────────────────────────────────────────────┐
│ TYPES OF CELLULAR ADAPTATION │
├─────────────────────────────────────────────────────────────────────┤
│ │
│ NORMAL CELL ◄─────────────────────────────────────────────────► │
│ ┌─────────┐ │
│ │ Normal │ │
│ │ Size │ │
│ └─────────┘ │
│ │ │
│ ├───────────────────┬───────────────────┬─────────────────┐ │
│ ▼ ▼ ▼ ▼ │
│ ┌─────────┐ ┌─────────┐ ┌─────────┐ ┌─────────┐│
│ │ ATROPHY │ │HYPERTRO│ │HYPER- │ │METAPLAS││
│ │ Smaller │ │PHY │ │PLASIA │ │IA ││
│ │ Size │ │Larger │ │More │ │Change ││
│ │ │ │Size │ │Cells │ │Type ││
│ └─────────┘ └─────────┘ └─────────┘ └─────────┘│
│ │
│ Atrophy: Decreased cell size (disuse, denervation, ischemia) │
│ Hypertrophy: Increased cell size (workload, hormones) │
│ Hyperplasia: Increased cell number (hormonal, compensatory) │
│ Metaplasia: Change in cell type (chronic irritation) │
└─────────────────────────────────────────────────────────────────────┘
,3|Page
Question 3: A 78-year-old patient with Alzheimer disease has accumulation of
amyloid plaques in the brain. This type of cellular injury is classified as:
A) Hypoxic injury
B) Immunologic injury
C) Accumulation of abnormal substances
D) Physical injury
Answer: C
Rationale: Alzheimer disease is characterized by accumulation of abnormal proteins—
specifically amyloid-beta plaques (extracellular) and neurofibrillary tangles composed
of hyperphosphorylated tau protein (intracellular). This represents injury due to
accumulation of abnormal substances, which includes Parkinson disease (Lewy bodies)
and prion diseases.
Question 4: During an ischemic event, ATP depletion leads to cellular swelling
primarily through:
A) Failure of the Na⁺/K⁺ ATPase pump
B) Mitochondrial membrane depolarization
C) Increased protein synthesis
D) Activation of lysosomal enzymes
Answer: A
Rationale: ATP is required for the Na⁺/K⁺ ATPase pump to maintain the
electrochemical gradient. When ATP is depleted, the pump fails, causing sodium to
accumulate intracellularly, followed by water influx due to osmotic pressure, resulting
in cellular swelling. This is a hallmark of reversible cell injury.
Question 5: A 35-year-old pregnant female has increased size of her uterine
myometrium. This adaptation is best described as:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
, 4|Page
Answer: B
Rationale: During pregnancy, the uterine smooth muscle undergoes hyperplasia
(increase in cell number) due to estrogen stimulation. This is a physiologic adaptation.
Hypertrophy (increase in cell size) occurs in cardiac muscle in response to increased
workload, as cardiac myocytes are terminally differentiated and cannot divide.
Question 6: A 65-year-old patient with prostate cancer undergoes androgen
deprivation therapy. The prostate tissue shrinks due to:
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Answer: C
Rationale: Atrophy is the decrease in cell size and organ size due to decreased
workload, loss of hormonal stimulation, or other factors. Androgen deprivation removes
the hormonal stimulus for prostate cell growth, leading to prostate atrophy. This is a
reversible change that can be restored with renewed hormonal stimulation.
Question 7: A 50-year-old patient with chronic hepatitis B infection develops liver
cirrhosis. The mechanism of liver injury involves:
A) Direct hepatocyte destruction by the virus
B) Immune-mediated injury to hepatocytes
C) Accumulation of fat in hepatocytes
D) Genetic mutation in hepatocytes
Answer: B
Rationale: Hepatitis B virus causes liver injury primarily through immune-mediated
mechanisms. The host immune response targets virus-infected hepatocytes, leading to
cell death, inflammation, and eventually fibrosis and cirrhosis. The virus itself does not
directly destroy cells in most cases.
NSG 5140 Advanced Pathophysiology
Comprehensive Midterm Exam Review - Set
2 200 Multiple-Choice Questions with
Answers and Rationales
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-
30)
Question 1: A 62-year-old male with chronic hypertension develops left ventricular
hypertrophy. Initially, this adaptation serves to:
A) Increase cardiac output
B) Decrease wall stress
C) Increase myocardial oxygen demand
D) Decrease contractility
Answer: B
Rationale: Concentric LV hypertrophy is an adaptive response to chronic pressure
overload (hypertension). By increasing wall thickness, wall stress is reduced (LaPlace's
law: stress = pressure × radius / (2 × wall thickness)). This maintains cardiac function
initially. Over time, however, it becomes maladaptive with diastolic dysfunction and
increased oxygen demand.
Question 2: A 55-year-old male with chronic alcoholism presents with
hepatomegaly. Liver biopsy shows macrovesicular steatosis. Which mechanism is
primarily responsible?
A) Increased fatty acid oxidation
B) Decreased fatty acid synthesis
C) Accumulation of triglycerides in hepatocytes
D) Increased protein synthesis
,2|Page
Answer: C
Rationale: Alcoholic liver disease causes fatty liver (steatosis) through accumulation of
triglycerides within hepatocytes. Mechanisms include increased fatty acid synthesis,
decreased fatty acid oxidation, impaired lipoprotein export, and increased peripheral
fat mobilization. This is an example of injury due to accumulation of endogenous
substances.
Figure 1: Cellular Adaptation Types
text
┌─────────────────────────────────────────────────────────────────────┐
│ TYPES OF CELLULAR ADAPTATION │
├─────────────────────────────────────────────────────────────────────┤
│ │
│ NORMAL CELL ◄─────────────────────────────────────────────────► │
│ ┌─────────┐ │
│ │ Normal │ │
│ │ Size │ │
│ └─────────┘ │
│ │ │
│ ├───────────────────┬───────────────────┬─────────────────┐ │
│ ▼ ▼ ▼ ▼ │
│ ┌─────────┐ ┌─────────┐ ┌─────────┐ ┌─────────┐│
│ │ ATROPHY │ │HYPERTRO│ │HYPER- │ │METAPLAS││
│ │ Smaller │ │PHY │ │PLASIA │ │IA ││
│ │ Size │ │Larger │ │More │ │Change ││
│ │ │ │Size │ │Cells │ │Type ││
│ └─────────┘ └─────────┘ └─────────┘ └─────────┘│
│ │
│ Atrophy: Decreased cell size (disuse, denervation, ischemia) │
│ Hypertrophy: Increased cell size (workload, hormones) │
│ Hyperplasia: Increased cell number (hormonal, compensatory) │
│ Metaplasia: Change in cell type (chronic irritation) │
└─────────────────────────────────────────────────────────────────────┘
,3|Page
Question 3: A 78-year-old patient with Alzheimer disease has accumulation of
amyloid plaques in the brain. This type of cellular injury is classified as:
A) Hypoxic injury
B) Immunologic injury
C) Accumulation of abnormal substances
D) Physical injury
Answer: C
Rationale: Alzheimer disease is characterized by accumulation of abnormal proteins—
specifically amyloid-beta plaques (extracellular) and neurofibrillary tangles composed
of hyperphosphorylated tau protein (intracellular). This represents injury due to
accumulation of abnormal substances, which includes Parkinson disease (Lewy bodies)
and prion diseases.
Question 4: During an ischemic event, ATP depletion leads to cellular swelling
primarily through:
A) Failure of the Na⁺/K⁺ ATPase pump
B) Mitochondrial membrane depolarization
C) Increased protein synthesis
D) Activation of lysosomal enzymes
Answer: A
Rationale: ATP is required for the Na⁺/K⁺ ATPase pump to maintain the
electrochemical gradient. When ATP is depleted, the pump fails, causing sodium to
accumulate intracellularly, followed by water influx due to osmotic pressure, resulting
in cellular swelling. This is a hallmark of reversible cell injury.
Question 5: A 35-year-old pregnant female has increased size of her uterine
myometrium. This adaptation is best described as:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
, 4|Page
Answer: B
Rationale: During pregnancy, the uterine smooth muscle undergoes hyperplasia
(increase in cell number) due to estrogen stimulation. This is a physiologic adaptation.
Hypertrophy (increase in cell size) occurs in cardiac muscle in response to increased
workload, as cardiac myocytes are terminally differentiated and cannot divide.
Question 6: A 65-year-old patient with prostate cancer undergoes androgen
deprivation therapy. The prostate tissue shrinks due to:
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Answer: C
Rationale: Atrophy is the decrease in cell size and organ size due to decreased
workload, loss of hormonal stimulation, or other factors. Androgen deprivation removes
the hormonal stimulus for prostate cell growth, leading to prostate atrophy. This is a
reversible change that can be restored with renewed hormonal stimulation.
Question 7: A 50-year-old patient with chronic hepatitis B infection develops liver
cirrhosis. The mechanism of liver injury involves:
A) Direct hepatocyte destruction by the virus
B) Immune-mediated injury to hepatocytes
C) Accumulation of fat in hepatocytes
D) Genetic mutation in hepatocytes
Answer: B
Rationale: Hepatitis B virus causes liver injury primarily through immune-mediated
mechanisms. The host immune response targets virus-infected hepatocytes, leading to
cell death, inflammation, and eventually fibrosis and cirrhosis. The virus itself does not
directly destroy cells in most cases.
