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NSG 5140 Advanced Pathophysiology
Comprehensive Midterm Exam Review 400
Multiple-Choice Questions with Answers and
Rationales
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-
50)
Question 1: A 58-year-old male with a 35-pack-year smoking history presents with a
chronic cough. Bronchial biopsy reveals replacement of normal pseudostratified
ciliated columnar epithelium with stratified squamous epithelium. Which term best
describes this cellular change?
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
Answer: C
Rationale: Metaplasia is a reversible adaptive change where one differentiated cell type
replaces another in response to chronic irritation. In smokers, chronic irritation causes
squamous metaplasia of respiratory epithelium, which is protective initially but
predisposes to dysplasia and malignancy. Dysplasia involves abnormal cellular
architecture; hyperplasia is increased cell number; anaplasia is loss of differentiation
seen in cancer.
Question 2: A 72-year-old patient with chronic kidney disease has a hemoglobin of
9.2 g/dL. Laboratory studies show normocytic, normochromic anemia with low
reticulocyte count. Which mechanism best explains this anemia?
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A) Decreased red blood cell lifespan
B) Decreased erythropoietin production
C) Iron deficiency from poor absorption
D) Vitamin B12 deficiency
Answer: B
Rationale: The kidneys produce erythropoietin (EPO) in response to hypoxia. In chronic
kidney disease, EPO production decreases, leading to normocytic, normochromic
anemia. RBC lifespan is normal, iron studies are typically normal (unless coexisting
deficiency), and B12 deficiency causes macrocytic anemia.
Table 1: Comparison of Reversible vs. Irreversible Cell Injury
Feature Reversible Injury Irreversible Injury
ATP Levels Decreased but recoverable Depleted, cannot recover
Mitochondria Swelling, dense bodies absent Swelling with dense bodies (calciu
Membrane Integrity Intact Disrupted
Nuclear Changes Chromatin clumping Pyknosis, karyorrhexis, karyolysis
Calcium Influx Mild Massive
Recovery Possible Yes, with restoration of blood flow No
Question 3: A 45-year-old female with breast cancer receives doxorubicin
chemotherapy. She develops symptoms of heart failure. Which mechanism of cellular
injury is most likely responsible?
A) Ischemic injury
B) Direct mitochondrial toxicity
C) Immune-mediated injury
D) Oxidative stress from free radicals
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Answer: B
Rationale: Doxorubicin (Adriamycin) causes cardiotoxicity through direct mitochondrial
injury and disruption of the electron transport chain, leading to ATP depletion and cell
death. The damage is dose-dependent and can result in dilated cardiomyopathy. Free
radical generation also occurs but mitochondrial toxicity is the primary mechanism.
Question 4: A 62-year-old male with hypertension develops concentric 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 5: 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
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.
, 4|Page
Question 6: 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 7: 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 8: A 35-year-old pregnant female has increased size of her uterine
myometrium. This adaptation is best described as:
A) Hypertrophy
B) Hyperplasia
NSG 5140 Advanced Pathophysiology
Comprehensive Midterm Exam Review 400
Multiple-Choice Questions with Answers and
Rationales
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-
50)
Question 1: A 58-year-old male with a 35-pack-year smoking history presents with a
chronic cough. Bronchial biopsy reveals replacement of normal pseudostratified
ciliated columnar epithelium with stratified squamous epithelium. Which term best
describes this cellular change?
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
Answer: C
Rationale: Metaplasia is a reversible adaptive change where one differentiated cell type
replaces another in response to chronic irritation. In smokers, chronic irritation causes
squamous metaplasia of respiratory epithelium, which is protective initially but
predisposes to dysplasia and malignancy. Dysplasia involves abnormal cellular
architecture; hyperplasia is increased cell number; anaplasia is loss of differentiation
seen in cancer.
Question 2: A 72-year-old patient with chronic kidney disease has a hemoglobin of
9.2 g/dL. Laboratory studies show normocytic, normochromic anemia with low
reticulocyte count. Which mechanism best explains this anemia?
,2|Page
A) Decreased red blood cell lifespan
B) Decreased erythropoietin production
C) Iron deficiency from poor absorption
D) Vitamin B12 deficiency
Answer: B
Rationale: The kidneys produce erythropoietin (EPO) in response to hypoxia. In chronic
kidney disease, EPO production decreases, leading to normocytic, normochromic
anemia. RBC lifespan is normal, iron studies are typically normal (unless coexisting
deficiency), and B12 deficiency causes macrocytic anemia.
Table 1: Comparison of Reversible vs. Irreversible Cell Injury
Feature Reversible Injury Irreversible Injury
ATP Levels Decreased but recoverable Depleted, cannot recover
Mitochondria Swelling, dense bodies absent Swelling with dense bodies (calciu
Membrane Integrity Intact Disrupted
Nuclear Changes Chromatin clumping Pyknosis, karyorrhexis, karyolysis
Calcium Influx Mild Massive
Recovery Possible Yes, with restoration of blood flow No
Question 3: A 45-year-old female with breast cancer receives doxorubicin
chemotherapy. She develops symptoms of heart failure. Which mechanism of cellular
injury is most likely responsible?
A) Ischemic injury
B) Direct mitochondrial toxicity
C) Immune-mediated injury
D) Oxidative stress from free radicals
,3|Page
Answer: B
Rationale: Doxorubicin (Adriamycin) causes cardiotoxicity through direct mitochondrial
injury and disruption of the electron transport chain, leading to ATP depletion and cell
death. The damage is dose-dependent and can result in dilated cardiomyopathy. Free
radical generation also occurs but mitochondrial toxicity is the primary mechanism.
Question 4: A 62-year-old male with hypertension develops concentric 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 5: 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
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.
, 4|Page
Question 6: 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 7: 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 8: A 35-year-old pregnant female has increased size of her uterine
myometrium. This adaptation is best described as:
A) Hypertrophy
B) Hyperplasia
