NSG5140 Week 5 Midterm Exam –
Advanced Pathophysiology
Complete Practice Examination
Due: 30th September
Total Questions: 150
Format: Multiple Choice
Time Allowed: 3 Hours
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1–35)
Question 1
A patient with chronic hypertension develops left ventricular wall thickening. Which mechanism BEST
explains this adaptation?
A) Hyperplasia of cardiac muscle cells
B) Hypertrophy of cardiac muscle cells
C) Metaplasia of cardiac tissue
D) Dysplasia of the myocardium
ANSWER: B) Hypertrophy of cardiac muscle cells
Rationale: Hypertension increases the workload on the left ventricle, leading to hypertrophy—an
increase in cell size without an increase in cell number. Cardiac muscle cells are terminally differentiated
,and cannot undergo hyperplasia (increase in cell number). Metaplasia is the replacement of one
differentiated cell type with another, and dysplasia refers to abnormal cellular growth, both of which are
not adaptive responses in the heart.
Question 2
Which cellular organelle is primarily responsible for ATP production through oxidative phosphorylation?
A) Ribosome
B) Golgi apparatus
C) Mitochondria
D) Endoplasmic reticulum
ANSWER: C) Mitochondria
Rationale: Mitochondria are the primary site of ATP production through oxidative phosphorylation. They
contain the electron transport chain and ATP synthase, which generate ATP from ADP and inorganic
phosphate. Ribosomes are responsible for protein synthesis, the Golgi apparatus modifies and packages
proteins, and the endoplasmic reticulum is involved in protein synthesis and lipid metabolism.
Question 3
Which of the following is the primary mechanism of cellular injury in hypoxic conditions?
A) DNA mutation
B) ATP depletion leading to loss of ion homeostasis
C) Free radical formation
D) Protein misfolding
ANSWER: B) ATP depletion leading to loss of ion homeostasis
,Rationale: Hypoxia limits oxidative phosphorylation, leading to decreased ATP production. The Na⁺/K⁺
ATPase pump requires ATP to maintain ion gradients; failure of this pump causes intracellular sodium
accumulation, water influx, and cellular swelling. This is the hallmark of hypoxic cellular injury.
Question 4
Chronic exposure to gastric acid in the lower esophagus causes the normal stratified squamous
epithelium to change to columnar epithelium. This change is called:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Neoplasia
ANSWER: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another.
Barrett's esophagus is a classic example where squamous epithelium transforms to columnar epithelium
in response to chronic acid exposure.
Question 5
A pathologist examining a myocardial infarction under the microscope notes preserved tissue
architecture with loss of nuclei and eosinophilic cytoplasm. This type of necrosis is:
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
ANSWER: B) Coagulative necrosis
, Rationale: Coagulative necrosis is typical of ischemic injury in solid organs like the heart, kidney, and
liver. It preserves tissue outlines but shows nuclear loss and increased cytoplasmic eosinophilia.
Question 6
Which process best describes programmed cell death that occurs in scattered single cells without
triggering inflammation?
A) Necrosis
B) Apoptosis
C) Autophagy
D) Gangrene
ANSWER: B) Apoptosis
Rationale: Apoptosis is a highly regulated, energy-dependent process of programmed cell death
affecting scattered individual cells. It is characterized by cell shrinkage, chromatin condensation, and
formation of apoptotic bodies without triggering inflammation.
Question 7
What is the hallmark of reversible cellular injury?
A) Nuclear pyknosis
B) Failure of ion pumps leading to cell swelling
C) Membrane rupture
D) Lysosomal enzyme release
ANSWER: B) Failure of ion pumps leading to cell swelling
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.
Advanced Pathophysiology
Complete Practice Examination
Due: 30th September
Total Questions: 150
Format: Multiple Choice
Time Allowed: 3 Hours
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1–35)
Question 1
A patient with chronic hypertension develops left ventricular wall thickening. Which mechanism BEST
explains this adaptation?
A) Hyperplasia of cardiac muscle cells
B) Hypertrophy of cardiac muscle cells
C) Metaplasia of cardiac tissue
D) Dysplasia of the myocardium
ANSWER: B) Hypertrophy of cardiac muscle cells
Rationale: Hypertension increases the workload on the left ventricle, leading to hypertrophy—an
increase in cell size without an increase in cell number. Cardiac muscle cells are terminally differentiated
,and cannot undergo hyperplasia (increase in cell number). Metaplasia is the replacement of one
differentiated cell type with another, and dysplasia refers to abnormal cellular growth, both of which are
not adaptive responses in the heart.
Question 2
Which cellular organelle is primarily responsible for ATP production through oxidative phosphorylation?
A) Ribosome
B) Golgi apparatus
C) Mitochondria
D) Endoplasmic reticulum
ANSWER: C) Mitochondria
Rationale: Mitochondria are the primary site of ATP production through oxidative phosphorylation. They
contain the electron transport chain and ATP synthase, which generate ATP from ADP and inorganic
phosphate. Ribosomes are responsible for protein synthesis, the Golgi apparatus modifies and packages
proteins, and the endoplasmic reticulum is involved in protein synthesis and lipid metabolism.
Question 3
Which of the following is the primary mechanism of cellular injury in hypoxic conditions?
A) DNA mutation
B) ATP depletion leading to loss of ion homeostasis
C) Free radical formation
D) Protein misfolding
ANSWER: B) ATP depletion leading to loss of ion homeostasis
,Rationale: Hypoxia limits oxidative phosphorylation, leading to decreased ATP production. The Na⁺/K⁺
ATPase pump requires ATP to maintain ion gradients; failure of this pump causes intracellular sodium
accumulation, water influx, and cellular swelling. This is the hallmark of hypoxic cellular injury.
Question 4
Chronic exposure to gastric acid in the lower esophagus causes the normal stratified squamous
epithelium to change to columnar epithelium. This change is called:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Neoplasia
ANSWER: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another.
Barrett's esophagus is a classic example where squamous epithelium transforms to columnar epithelium
in response to chronic acid exposure.
Question 5
A pathologist examining a myocardial infarction under the microscope notes preserved tissue
architecture with loss of nuclei and eosinophilic cytoplasm. This type of necrosis is:
A) Liquefactive necrosis
B) Coagulative necrosis
C) Caseous necrosis
D) Fat necrosis
ANSWER: B) Coagulative necrosis
, Rationale: Coagulative necrosis is typical of ischemic injury in solid organs like the heart, kidney, and
liver. It preserves tissue outlines but shows nuclear loss and increased cytoplasmic eosinophilia.
Question 6
Which process best describes programmed cell death that occurs in scattered single cells without
triggering inflammation?
A) Necrosis
B) Apoptosis
C) Autophagy
D) Gangrene
ANSWER: B) Apoptosis
Rationale: Apoptosis is a highly regulated, energy-dependent process of programmed cell death
affecting scattered individual cells. It is characterized by cell shrinkage, chromatin condensation, and
formation of apoptotic bodies without triggering inflammation.
Question 7
What is the hallmark of reversible cellular injury?
A) Nuclear pyknosis
B) Failure of ion pumps leading to cell swelling
C) Membrane rupture
D) Lysosomal enzyme release
ANSWER: B) Failure of ion pumps leading to cell swelling
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.
