# NSG 5140 Week 5 Midterm Exam – Practice Questions &
Answers
## Section 1: Cellular Adaptation, Injury, and Death (Questions 1-12)
**1. A 62-year-old male with chronic heart failure presents with worsening dyspnea, jugular venous
distension, and peripheral edema. Which cellular adaptation is most likely occurring in his
myocardium as a compensatory mechanism?**
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
**Answer: C**
*Rationale:* Hypertrophy is an increase in cell size due to increased workload. Cardiac myocytes are
terminally differentiated and respond to increased workload from chronic hypertension by enlarging,
resulting in left ventricular wall thickening .
**2. During ischemia, the switch from aerobic to anaerobic metabolism leads to which immediate
intracellular change?**
A) Increased ATP production
B) Increased intracellular pH
C) Accumulation of lactic acid
D) Decreased intracellular sodium
**Answer: C**
*Rationale:* Ischemia causes decreased oxygen supply, leading to anaerobic metabolism which
produces lactic acid as a byproduct, causing intracellular acidosis and cellular injury .
**3. Hypoxia initially disrupts which cellular process?**
A) DNA replication
B) Protein synthesis
C) Oxidative phosphorylation
D) Lysosomal activity
,**Answer: C**
*Rationale:* Oxygen is required for oxidative phosphorylation and ATP generation within
mitochondria. Hypoxia limits this process, leading to decreased ATP production .
**4. Which mechanism most directly leads to irreversible cell injury?**
A) Decreased ATP production
B) Cellular swelling
C) Mitochondrial membrane damage
D) Ribosomal detachment
**Answer: C**
*Rationale:* Mitochondrial membrane damage is considered the point of no return in cell injury,
triggering either apoptosis or necrosis .
**5. Which cellular change is characteristic of reversible cell injury?**
A) Nuclear pyknosis
B) Failure of ion pumps leading to cell swelling
C) Membrane rupture
D) Lysosomal enzyme release
**Answer: B**
*Rationale:* Reversible injury involves cellular swelling due to ion pump failure. If the insult is
removed, the cell can recover. Irreversible injury involves membrane damage and nuclear changes
such as pyknosis .
**6. A chronic smoker develops persistent cough and mucus hypersecretion due to an increased
number of mucus-secreting cells replacing normal ciliated columnar epithelium. This cellular change is
best described as:**
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
**Answer: C**
, *Rationale:* Metaplasia is a reversible replacement of one differentiated cell type by another. In
chronic smokers, ciliated columnar epithelium is replaced by squamous or mucus-secreting cells as an
adaptive response to chronic irritation .
**7. A researcher observes that sustained mechanical stretch of cardiac myocytes leads to increased
protein synthesis and cell enlargement. Which intracellular signaling pathway is most directly
responsible for this adaptive response?**
A) Activation of the PI3K/Akt/mTOR pathway leading to increased translation
B) Induction of p53-mediated cell cycle arrest and senescence
C) Upregulation of caspases and initiation of apoptosis
D) Activation of the unfolded protein response due to ER stress
**Answer: A**
*Rationale:* Cardiac myocytes respond to increased workload by undergoing hypertrophy, driven by
the PI3K/Akt/mTOR pathway that enhances protein synthesis .
**8. A patient's biopsy reveals dysplastic cells. This finding indicates:**
A) Normal cellular appearance
B) Fully differentiated cells
C) Disordered cellular growth
D) Reversible cellular adaptation
**Answer: C**
*Rationale:* Dysplasia indicates abnormal cell growth with disordered differentiation. While it can be
a precursor to cancer, it may be reversible if the irritant is removed .
**9. Which organelle is known as the "powerhouse" of the cell due to its role in oxidative
phosphorylation and ATP generation?**
A) Nucleus
B) Golgi apparatus
C) Mitochondria
D) Ribosomes
**Answer: C**
Answers
## Section 1: Cellular Adaptation, Injury, and Death (Questions 1-12)
**1. A 62-year-old male with chronic heart failure presents with worsening dyspnea, jugular venous
distension, and peripheral edema. Which cellular adaptation is most likely occurring in his
myocardium as a compensatory mechanism?**
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
**Answer: C**
*Rationale:* Hypertrophy is an increase in cell size due to increased workload. Cardiac myocytes are
terminally differentiated and respond to increased workload from chronic hypertension by enlarging,
resulting in left ventricular wall thickening .
**2. During ischemia, the switch from aerobic to anaerobic metabolism leads to which immediate
intracellular change?**
A) Increased ATP production
B) Increased intracellular pH
C) Accumulation of lactic acid
D) Decreased intracellular sodium
**Answer: C**
*Rationale:* Ischemia causes decreased oxygen supply, leading to anaerobic metabolism which
produces lactic acid as a byproduct, causing intracellular acidosis and cellular injury .
**3. Hypoxia initially disrupts which cellular process?**
A) DNA replication
B) Protein synthesis
C) Oxidative phosphorylation
D) Lysosomal activity
,**Answer: C**
*Rationale:* Oxygen is required for oxidative phosphorylation and ATP generation within
mitochondria. Hypoxia limits this process, leading to decreased ATP production .
**4. Which mechanism most directly leads to irreversible cell injury?**
A) Decreased ATP production
B) Cellular swelling
C) Mitochondrial membrane damage
D) Ribosomal detachment
**Answer: C**
*Rationale:* Mitochondrial membrane damage is considered the point of no return in cell injury,
triggering either apoptosis or necrosis .
**5. Which cellular change is characteristic of reversible cell injury?**
A) Nuclear pyknosis
B) Failure of ion pumps leading to cell swelling
C) Membrane rupture
D) Lysosomal enzyme release
**Answer: B**
*Rationale:* Reversible injury involves cellular swelling due to ion pump failure. If the insult is
removed, the cell can recover. Irreversible injury involves membrane damage and nuclear changes
such as pyknosis .
**6. A chronic smoker develops persistent cough and mucus hypersecretion due to an increased
number of mucus-secreting cells replacing normal ciliated columnar epithelium. This cellular change is
best described as:**
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
**Answer: C**
, *Rationale:* Metaplasia is a reversible replacement of one differentiated cell type by another. In
chronic smokers, ciliated columnar epithelium is replaced by squamous or mucus-secreting cells as an
adaptive response to chronic irritation .
**7. A researcher observes that sustained mechanical stretch of cardiac myocytes leads to increased
protein synthesis and cell enlargement. Which intracellular signaling pathway is most directly
responsible for this adaptive response?**
A) Activation of the PI3K/Akt/mTOR pathway leading to increased translation
B) Induction of p53-mediated cell cycle arrest and senescence
C) Upregulation of caspases and initiation of apoptosis
D) Activation of the unfolded protein response due to ER stress
**Answer: A**
*Rationale:* Cardiac myocytes respond to increased workload by undergoing hypertrophy, driven by
the PI3K/Akt/mTOR pathway that enhances protein synthesis .
**8. A patient's biopsy reveals dysplastic cells. This finding indicates:**
A) Normal cellular appearance
B) Fully differentiated cells
C) Disordered cellular growth
D) Reversible cellular adaptation
**Answer: C**
*Rationale:* Dysplasia indicates abnormal cell growth with disordered differentiation. While it can be
a precursor to cancer, it may be reversible if the irritant is removed .
**9. Which organelle is known as the "powerhouse" of the cell due to its role in oxidative
phosphorylation and ATP generation?**
A) Nucleus
B) Golgi apparatus
C) Mitochondria
D) Ribosomes
**Answer: C**
