WGU D115 OA Advanced Pathophysiology Exam (Latest
) Actual Questions with Detailed Answers
and OA Readiness Practice Exam Test Bank with Study
Guide
SECTION I: CELLULAR INJURY, ADAPTATION, AND DEATH
1. A patient with chronic hypertension develops left ventricular hypertrophy.
Which cellular adaptation best describes this change?
A. Hyperplasia
B. Metaplasia
C. Atrophy
D. Dysplasia
E. Hypertrophy
Correct Answer: E. Hypertrophy
Rationale: Hypertrophy is an increase in cell size in response to increased
workload. Cardiac muscle cells are terminally differentiated and cannot divide;
therefore, they respond to chronic pressure overload from hypertension by
enlarging (hypertrophy). This leads to increased ventricular wall mass and is
initially compensatory but eventually becomes maladaptive, contributing to heart
failure. This is the classic example of pathologic hypertrophy .
2. A chronic smoker's bronchial epithelium shows replacement of normal
columnar ciliated cells with stratified squamous cells. This represents:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
E. Atrophy
, Correct Answer: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another. In chronic smokers, the respiratory epithelium undergoes
metaplasia from pseudostratified ciliated columnar epithelium to stratified
squamous epithelium. This change is adaptive because squamous epithelium is
more resistant to the chronic irritation from smoke. However, this adaptation
comes at a cost—the loss of ciliary function and mucus production impairs
mucociliary clearance, increasing infection risk .
3. A cell undergoing programmed, energy-dependent death without triggering
an inflammatory response is experiencing:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Apoptosis
E. Gangrenous necrosis
Correct Answer: D. Apoptosis
Rationale: Apoptosis is programmed cell death that is energy-dependent
(requires ATP), involves caspase activation, and results in DNA fragmentation and
formation of apoptotic bodies. The cell contents are packaged into membrane-
bound vesicles that are phagocytosed by macrophages without releasing
intracellular contents, thus avoiding inflammation. This is in contrast to necrosis,
which is unprogrammed cell death that triggers inflammation due to release of
cellular contents .
4. Following a myocardial infarction, the infarcted heart tissue maintains its
structural outline but the cells are dead. This type of necrosis is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Fat necrosis
,D. Caseous necrosis
E. Fibrinoid necrosis
Correct Answer: A. Coagulative necrosis
Rationale: Coagulative necrosis is the hallmark of ischemic injury in solid
organs such as the heart, kidney, and spleen. The structural architecture of the
dead tissue is preserved for several days because denatured proteins resist
proteolysis. The tissue appears pale and firm. This occurs because ischemia causes
rapid acidosis and denaturation of structural proteins, preventing complete
breakdown of the tissue architecture .
5. A patient with tuberculosis has a chest X-ray showing granulomatous lesions
with cheese-like material. This represents:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Correct Answer: C. Caseous necrosis
Rationale: Caseous necrosis is characteristic of tuberculosis and certain
fungal infections. The necrotic tissue appears grossly as soft, white, cheese-like
(caseous) debris. Histologically, it appears as amorphous granular material
surrounded by granulomatous inflammation. It represents a combination of
coagulative and liquefactive necrosis and is associated with cell-mediated
immune responses .
6. Which of the following is an early reversible sign of cell injury seen on
electron microscopy?
A. Nuclear pyknosis
B. Membrane rupture
C. Mitochondrial swelling
, D. Karyorrhexis
E. Karyolysis
Correct Answer: C. Mitochondrial swelling
Rationale: Early reversible cell injury is characterized by decreased ATP
production, leading to failure of the Na⁺/K⁺-ATPase pump, resulting in cellular
swelling and mitochondrial swelling. These changes are reversible if the injurious
stimulus is removed. Nuclear changes (pyknosis, karyorrhexis, karyolysis) and
membrane rupture indicate irreversible injury and are hallmarks of necrosis, not
reversible injury .
7. A patient sustained a cerebral infarct. The brain tissue becomes soft and
liquefied. This is consistent with:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Correct Answer: B. Liquefactive necrosis
Rationale: The brain undergoes liquefactive necrosis after ischemic injury
because it has a high lipid content and abundant hydrolytic enzymes. Neutrophils
and macrophages digest the dead tissue, producing a liquid cystic mass. This is
why brain infarcts eventually form cystic cavities. Unlike coagulative necrosis, the
tissue architecture is completely lost in liquefactive necrosis .
8. A patient with pancreatitis presents with areas of fat necrosis in the
abdomen. This is caused by:
A. Ischemia
B. Bacterial infection
C. Release of lipolytic enzymes
) Actual Questions with Detailed Answers
and OA Readiness Practice Exam Test Bank with Study
Guide
SECTION I: CELLULAR INJURY, ADAPTATION, AND DEATH
1. A patient with chronic hypertension develops left ventricular hypertrophy.
Which cellular adaptation best describes this change?
A. Hyperplasia
B. Metaplasia
C. Atrophy
D. Dysplasia
E. Hypertrophy
Correct Answer: E. Hypertrophy
Rationale: Hypertrophy is an increase in cell size in response to increased
workload. Cardiac muscle cells are terminally differentiated and cannot divide;
therefore, they respond to chronic pressure overload from hypertension by
enlarging (hypertrophy). This leads to increased ventricular wall mass and is
initially compensatory but eventually becomes maladaptive, contributing to heart
failure. This is the classic example of pathologic hypertrophy .
2. A chronic smoker's bronchial epithelium shows replacement of normal
columnar ciliated cells with stratified squamous cells. This represents:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
E. Atrophy
, Correct Answer: B. Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another. In chronic smokers, the respiratory epithelium undergoes
metaplasia from pseudostratified ciliated columnar epithelium to stratified
squamous epithelium. This change is adaptive because squamous epithelium is
more resistant to the chronic irritation from smoke. However, this adaptation
comes at a cost—the loss of ciliary function and mucus production impairs
mucociliary clearance, increasing infection risk .
3. A cell undergoing programmed, energy-dependent death without triggering
an inflammatory response is experiencing:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Apoptosis
E. Gangrenous necrosis
Correct Answer: D. Apoptosis
Rationale: Apoptosis is programmed cell death that is energy-dependent
(requires ATP), involves caspase activation, and results in DNA fragmentation and
formation of apoptotic bodies. The cell contents are packaged into membrane-
bound vesicles that are phagocytosed by macrophages without releasing
intracellular contents, thus avoiding inflammation. This is in contrast to necrosis,
which is unprogrammed cell death that triggers inflammation due to release of
cellular contents .
4. Following a myocardial infarction, the infarcted heart tissue maintains its
structural outline but the cells are dead. This type of necrosis is:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Fat necrosis
,D. Caseous necrosis
E. Fibrinoid necrosis
Correct Answer: A. Coagulative necrosis
Rationale: Coagulative necrosis is the hallmark of ischemic injury in solid
organs such as the heart, kidney, and spleen. The structural architecture of the
dead tissue is preserved for several days because denatured proteins resist
proteolysis. The tissue appears pale and firm. This occurs because ischemia causes
rapid acidosis and denaturation of structural proteins, preventing complete
breakdown of the tissue architecture .
5. A patient with tuberculosis has a chest X-ray showing granulomatous lesions
with cheese-like material. This represents:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Correct Answer: C. Caseous necrosis
Rationale: Caseous necrosis is characteristic of tuberculosis and certain
fungal infections. The necrotic tissue appears grossly as soft, white, cheese-like
(caseous) debris. Histologically, it appears as amorphous granular material
surrounded by granulomatous inflammation. It represents a combination of
coagulative and liquefactive necrosis and is associated with cell-mediated
immune responses .
6. Which of the following is an early reversible sign of cell injury seen on
electron microscopy?
A. Nuclear pyknosis
B. Membrane rupture
C. Mitochondrial swelling
, D. Karyorrhexis
E. Karyolysis
Correct Answer: C. Mitochondrial swelling
Rationale: Early reversible cell injury is characterized by decreased ATP
production, leading to failure of the Na⁺/K⁺-ATPase pump, resulting in cellular
swelling and mitochondrial swelling. These changes are reversible if the injurious
stimulus is removed. Nuclear changes (pyknosis, karyorrhexis, karyolysis) and
membrane rupture indicate irreversible injury and are hallmarks of necrosis, not
reversible injury .
7. A patient sustained a cerebral infarct. The brain tissue becomes soft and
liquefied. This is consistent with:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
E. Fibrinoid necrosis
Correct Answer: B. Liquefactive necrosis
Rationale: The brain undergoes liquefactive necrosis after ischemic injury
because it has a high lipid content and abundant hydrolytic enzymes. Neutrophils
and macrophages digest the dead tissue, producing a liquid cystic mass. This is
why brain infarcts eventually form cystic cavities. Unlike coagulative necrosis, the
tissue architecture is completely lost in liquefactive necrosis .
8. A patient with pancreatitis presents with areas of fat necrosis in the
abdomen. This is caused by:
A. Ischemia
B. Bacterial infection
C. Release of lipolytic enzymes
