NIGHTINGALE COLLEGE PATHOPHYSIOLOGY
MIDTERM ACTUAL EXAM
2026/2027 Academic Year – Verified
Questions with ANSWERs and Rationales
SECTION 1: CELLULAR BIOLOGY, ADAPTATION, INJURY & DEATH
Question 1
A patient with chronic anemia develops an enlarged spleen. This represents which type of cellular
adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
E) Dysplasia
ANSWER: B – Hypertrophy
Rationale: Hypertrophy is an increase in cell size. In chronic anemia, the spleen works harder to remove
damaged RBCs, causing its reticuloendothelial cells to enlarge. Hyperplasia (A) is increased cell number;
atrophy (C) is shrinkage; metaplasia (D) is one cell type replacing another; dysplasia (E) is disordered
growth.
Question 2
,A client is diagnosed with Barrett's esophagus due to chronic acid reflux. The pathology report shows
that the normal stratified squamous epithelium has been replaced by columnar epithelium. This is an
example of:
A) Dysplasia
B) Neoplasia
C) Metaplasia
D) Anaplasia
ANSWER: C – Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another mature cell type
better suited to handle a harsh environment. Barrett's esophagus is columnar metaplasia of squamous
esophageal epithelium due to acid reflux. Dysplasia (A) is disordered growth; neoplasia (B) is new
abnormal growth; anaplasia (D) is loss of differentiation.
Question 3
A nurse is caring for a client with chronic hypertension. The increased workload on the left ventricle has
likely led to an increase in the size of myocardial cells. Which cellular adaptation is the nurse observing?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
ANSWER: B – Hypertrophy
Rationale: Hypertrophy is an increase in the size of cells (not the number) in response to increased
mechanical load or stress, common in cardiac muscle under pressure. Hyperplasia (A) is increased cell
number; atrophy (C) is decreased cell size; metaplasia (D) is replacement of one cell type by another.
Question 4
,A patient with prolonged ischemia shows irreversible cell injury. Which event most directly indicates
irreversibility?
A) Decreased ATP
B) Sodium-potassium pump dysfunction
C) Mitochondrial swelling
D) Severe membrane damage with lysosomal rupture
E) Anaerobic glycolysis
ANSWER: D – Severe membrane damage with lysosomal rupture
Rationale: Irreversible injury is marked by severe membrane damage (plasma, lysosomal, mitochondrial)
leading to enzyme leakage and cell death. Decreased ATP and pump dysfunction (A, B) are reversible
initially. Mitochondrial swelling (C) and anaerobic glycolysis (E) occur early and are reversible.
Question 5
A patient has atrophy of the left leg after a stroke. This is an example of:
A) Denervation atrophy
B) Disuse atrophy
C) Pressure atrophy
D) Ischemic atrophy
E) Endocrine atrophy
ANSWER: A – Denervation atrophy
Rationale: Loss of nerve supply (stroke causing paralysis) leads to denervation atrophy. Disuse atrophy
(B) occurs with immobilization but no nerve loss; pressure atrophy (C) from tumor; ischemic atrophy (D)
from blood flow loss; endocrine atrophy (E) from hormonal deficiency.
, Question 6
Which cellular change is a precursor to neoplasia but is reversible?
A) Anaplasia
B) Hyperplasia
C) Metaplasia
D) Dysplasia
E) Hypertrophy
ANSWER: D – Dysplasia
Rationale: Dysplasia (abnormal size/shape/organization) often precedes cancer (e.g., cervical dysplasia)
but can reverse if the cause is removed. Anaplasia (A) is an irreversible cancer marker; hyperplasia (B),
metaplasia (C), and hypertrophy (E) are not necessarily precursors to neoplasia.
Question 7
During apoptosis, which feature distinguishes it from necrosis?
A) Cell swelling
B) Inflammation
C) Preservation of membrane integrity until engulfment
D) Random DNA fragmentation
E) Release of DAMPs
ANSWER: C – Preservation of membrane integrity until engulfment
Rationale: Apoptosis is programmed cell death without inflammation. Necrosis causes cell swelling,
membrane rupture, and inflammation (B, E). In apoptosis, the cell membrane remains intact until the
cell is engulfed by phagocytes, preventing an inflammatory response.
MIDTERM ACTUAL EXAM
2026/2027 Academic Year – Verified
Questions with ANSWERs and Rationales
SECTION 1: CELLULAR BIOLOGY, ADAPTATION, INJURY & DEATH
Question 1
A patient with chronic anemia develops an enlarged spleen. This represents which type of cellular
adaptation?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
E) Dysplasia
ANSWER: B – Hypertrophy
Rationale: Hypertrophy is an increase in cell size. In chronic anemia, the spleen works harder to remove
damaged RBCs, causing its reticuloendothelial cells to enlarge. Hyperplasia (A) is increased cell number;
atrophy (C) is shrinkage; metaplasia (D) is one cell type replacing another; dysplasia (E) is disordered
growth.
Question 2
,A client is diagnosed with Barrett's esophagus due to chronic acid reflux. The pathology report shows
that the normal stratified squamous epithelium has been replaced by columnar epithelium. This is an
example of:
A) Dysplasia
B) Neoplasia
C) Metaplasia
D) Anaplasia
ANSWER: C – Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by another mature cell type
better suited to handle a harsh environment. Barrett's esophagus is columnar metaplasia of squamous
esophageal epithelium due to acid reflux. Dysplasia (A) is disordered growth; neoplasia (B) is new
abnormal growth; anaplasia (D) is loss of differentiation.
Question 3
A nurse is caring for a client with chronic hypertension. The increased workload on the left ventricle has
likely led to an increase in the size of myocardial cells. Which cellular adaptation is the nurse observing?
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
ANSWER: B – Hypertrophy
Rationale: Hypertrophy is an increase in the size of cells (not the number) in response to increased
mechanical load or stress, common in cardiac muscle under pressure. Hyperplasia (A) is increased cell
number; atrophy (C) is decreased cell size; metaplasia (D) is replacement of one cell type by another.
Question 4
,A patient with prolonged ischemia shows irreversible cell injury. Which event most directly indicates
irreversibility?
A) Decreased ATP
B) Sodium-potassium pump dysfunction
C) Mitochondrial swelling
D) Severe membrane damage with lysosomal rupture
E) Anaerobic glycolysis
ANSWER: D – Severe membrane damage with lysosomal rupture
Rationale: Irreversible injury is marked by severe membrane damage (plasma, lysosomal, mitochondrial)
leading to enzyme leakage and cell death. Decreased ATP and pump dysfunction (A, B) are reversible
initially. Mitochondrial swelling (C) and anaerobic glycolysis (E) occur early and are reversible.
Question 5
A patient has atrophy of the left leg after a stroke. This is an example of:
A) Denervation atrophy
B) Disuse atrophy
C) Pressure atrophy
D) Ischemic atrophy
E) Endocrine atrophy
ANSWER: A – Denervation atrophy
Rationale: Loss of nerve supply (stroke causing paralysis) leads to denervation atrophy. Disuse atrophy
(B) occurs with immobilization but no nerve loss; pressure atrophy (C) from tumor; ischemic atrophy (D)
from blood flow loss; endocrine atrophy (E) from hormonal deficiency.
, Question 6
Which cellular change is a precursor to neoplasia but is reversible?
A) Anaplasia
B) Hyperplasia
C) Metaplasia
D) Dysplasia
E) Hypertrophy
ANSWER: D – Dysplasia
Rationale: Dysplasia (abnormal size/shape/organization) often precedes cancer (e.g., cervical dysplasia)
but can reverse if the cause is removed. Anaplasia (A) is an irreversible cancer marker; hyperplasia (B),
metaplasia (C), and hypertrophy (E) are not necessarily precursors to neoplasia.
Question 7
During apoptosis, which feature distinguishes it from necrosis?
A) Cell swelling
B) Inflammation
C) Preservation of membrane integrity until engulfment
D) Random DNA fragmentation
E) Release of DAMPs
ANSWER: C – Preservation of membrane integrity until engulfment
Rationale: Apoptosis is programmed cell death without inflammation. Necrosis causes cell swelling,
membrane rupture, and inflammation (B, E). In apoptosis, the cell membrane remains intact until the
cell is engulfed by phagocytes, preventing an inflammatory response.
