NURS 611 Pathophysiology Test 1 Actual Exam
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Section A: Cellular & Tissue Injury — Adaptation, Injury, & Death
Q1: A 45-year-old male with a 30 pack-year smoking history undergoes bronchoscopy
with biopsy. Histology reveals that the normal pseudostratified ciliated columnar
epithelium has been replaced by stratified squamous epithelium. This cellular
adaptation is BEST described as:
A. Atrophy
B. Hypertrophy
C. Metaplasia [CORRECT]
D. Hyperplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated mature cell
type with another, typically in response to chronic irritation. Smoking-induced chronic
irritation commonly causes squamous metaplasia in respiratory epithelium. Atrophy
involves decreased cell size, hypertrophy involves increased cell size, and hyperplasia
involves increased cell number.
,Q2: A patient suffers an acute myocardial infarction. Histologic examination of the
affected myocardium reveals preserved tissue architecture, loss of nuclei, and intensely
eosinophilic cytoplasm. This pattern of cell death is classified as:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs such
as the heart, kidney, and spleen, where the denaturation of structural proteins preserves
tissue architecture temporarily. Liquefactive necrosis occurs in the brain and with
bacterial infection, caseous necrosis is seen in tuberculosis, and fat necrosis occurs in
pancreatic injury.
Q3: A patient with carbon tetrachloride poisoning develops severe centrilobular hepatic
necrosis. The primary mechanism of cellular injury involves reactive oxygen species
causing peroxidation of membrane lipids. The cell's primary enzymatic defense system
against free radical injury includes:
A. Lysosomal hydrolases and proteasomes
B. Ribosomal RNA polymerases
C. Superoxide dismutase, catalase, and glutathione peroxidase [CORRECT]
D. DNA polymerases and helicases
, Correct Answer: C
Rationale: Superoxide dismutase converts superoxide to hydrogen peroxide, catalase
converts hydrogen peroxide to water and oxygen, and glutathione peroxidase reduces
hydrogen peroxide and lipid peroxides. These enzymes constitute the primary
antioxidant defense against free radical-mediated cellular injury.
Q4: During programmed cell death, a cell demonstrates chromatin condensation,
cytoplasmic shrinkage, membrane blebbing, and fragmentation into membrane-bound
apoptotic bodies that are phagocytosed without inciting inflammation. The execution of
apoptosis is primarily mediated by which enzyme family?
A. Matrix metalloproteinases
B. Caspases [CORRECT]
C. Cyclooxygenases
D. Phospholipases
Correct Answer: B
Rationale: Caspases are cysteine-aspartic proteases that function as the central
executioners of apoptosis by cleaving cellular substrates. Initiator caspases (e.g.,
caspase-8, -9) activate executioner caspases (e.g., caspase-3, -6, -7), leading to the
characteristic morphologic changes of apoptosis.
Q5: A 68-year-old patient with long-standing peripheral arterial disease develops a dry,
shrunken, blackened great toe with a clear line of demarcation from viable tissue. There
is no purulent drainage or foul odor. This is BEST described as:
2026/2027 – Comprehensive Test Bank
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
Section A: Cellular & Tissue Injury — Adaptation, Injury, & Death
Q1: A 45-year-old male with a 30 pack-year smoking history undergoes bronchoscopy
with biopsy. Histology reveals that the normal pseudostratified ciliated columnar
epithelium has been replaced by stratified squamous epithelium. This cellular
adaptation is BEST described as:
A. Atrophy
B. Hypertrophy
C. Metaplasia [CORRECT]
D. Hyperplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated mature cell
type with another, typically in response to chronic irritation. Smoking-induced chronic
irritation commonly causes squamous metaplasia in respiratory epithelium. Atrophy
involves decreased cell size, hypertrophy involves increased cell size, and hyperplasia
involves increased cell number.
,Q2: A patient suffers an acute myocardial infarction. Histologic examination of the
affected myocardium reveals preserved tissue architecture, loss of nuclei, and intensely
eosinophilic cytoplasm. This pattern of cell death is classified as:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs such
as the heart, kidney, and spleen, where the denaturation of structural proteins preserves
tissue architecture temporarily. Liquefactive necrosis occurs in the brain and with
bacterial infection, caseous necrosis is seen in tuberculosis, and fat necrosis occurs in
pancreatic injury.
Q3: A patient with carbon tetrachloride poisoning develops severe centrilobular hepatic
necrosis. The primary mechanism of cellular injury involves reactive oxygen species
causing peroxidation of membrane lipids. The cell's primary enzymatic defense system
against free radical injury includes:
A. Lysosomal hydrolases and proteasomes
B. Ribosomal RNA polymerases
C. Superoxide dismutase, catalase, and glutathione peroxidase [CORRECT]
D. DNA polymerases and helicases
, Correct Answer: C
Rationale: Superoxide dismutase converts superoxide to hydrogen peroxide, catalase
converts hydrogen peroxide to water and oxygen, and glutathione peroxidase reduces
hydrogen peroxide and lipid peroxides. These enzymes constitute the primary
antioxidant defense against free radical-mediated cellular injury.
Q4: During programmed cell death, a cell demonstrates chromatin condensation,
cytoplasmic shrinkage, membrane blebbing, and fragmentation into membrane-bound
apoptotic bodies that are phagocytosed without inciting inflammation. The execution of
apoptosis is primarily mediated by which enzyme family?
A. Matrix metalloproteinases
B. Caspases [CORRECT]
C. Cyclooxygenases
D. Phospholipases
Correct Answer: B
Rationale: Caspases are cysteine-aspartic proteases that function as the central
executioners of apoptosis by cleaving cellular substrates. Initiator caspases (e.g.,
caspase-8, -9) activate executioner caspases (e.g., caspase-3, -6, -7), leading to the
characteristic morphologic changes of apoptosis.
Q5: A 68-year-old patient with long-standing peripheral arterial disease develops a dry,
shrunken, blackened great toe with a clear line of demarcation from viable tissue. There
is no purulent drainage or foul odor. This is BEST described as:
