, WGU D236 Pathophysiology – Western Governors University –
Academic Year 2026/2027 – Objective Assessment
Comprehensive Examination with 100 Verified Questions and
Correct Answer Rationales .
DOMAIN 1: CELLULAR AND GENETIC ALTERATIONS (25 QUESTIONS)
Question 1
Which cellular adaptation is characterized by an increase in the number of cells in a tissue or
organ?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
CorreCt Answer: B ✓
rAtionAle: Hyperplasia is an increase in the number of cells resulting from increased
cellular division, commonly occurring in tissues capable of mitotic division. Hypertrophy (A) is an
increase in cell size; atrophy (C) is a decrease in cell size or number; metaplasia (D) is the
replacement of one cell type with another.
Question 2
A cell that has undergone irreversible injury and exhibits nuclear pyknosis, karyorrhexis, and
karyolysis is undergoing which process?
A. Apoptosis
B. Hypertrophy
C. Necrosis
D. Atrophy
CorreCt Answer: C ✓
rAtionAle: Nuclear changes of pyknosis (nuclear shrinkage), karyorrhexis (nuclear
fragmentation), and karyolysis (nuclear dissolution) are hallmark morphologic features
of necrosis, indicating irreversible cell death with loss of membrane integrity.
,Question 3
Which type of necrosis is typically associated with ischemic injury to the heart or kidney and
preserves tissue architecture initially?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
CorreCt Answer: C ✓
rAtionAle: Coagulative necrosis, common in ischemic infarcts of solid organs, results from
protein denaturation that preserves the general tissue outline for a period of time. Liquefactive
necrosis (A) occurs in the brain; caseous necrosis (B) occurs in tuberculosis; fat necrosis (D)
occurs in breast or pancreas.
Question 4
Metaplasia is best defined as:
A. An increase in cell size without an increase in cell number
B. Replacement of one differentiated cell type by another differentiated cell type
C. A decrease in cell size and function
D. Uncontrolled cellular proliferation with invasion
CorreCt Answer: B ✓
rAtionAle: Metaplasia is the reversible replacement of one differentiated cell type by
another, often in response to chronic irritation. Hypertrophy (A) is cell enlargement; atrophy (C)
is cell shrinkage; neoplasia (D) is uncontrolled proliferation.
Question 5
A 55-year-old patient with a history of chronic cigarette smoking is diagnosed with squamous
cell carcinoma of the lung. Which cellular alteration most likely preceded this malignancy?
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
CorreCt Answer: B ✓
rAtionAle: Dysplasia is disordered cellular growth that is often a precursor to malignancy. In
the respiratory tract, chronic irritation from smoking causes squamous metaplasia followed
by dysplasia, which can progress to carcinoma.
, Question 6
Which of the following is a characteristic of malignant tumors?
A. Encapsulated growth
B. Well-differentiated cells
C. Invasion of surrounding tissues
D. Low mitotic rate
CorreCt Answer: C ✓
rAtionAle: Invasion of surrounding tissues is a hallmark of malignancy. Benign tumors
are encapsulated (A), well-differentiated (B), and have a low mitotic rate (D). Malignant tumors
are poorly differentiated, invasive, and have a high mitotic rate.
Question 7
A patient with a genetic disorder has a mutation in the CFTR gene. This mutation leads to
defective transport of which ion?
A. Sodium
B. Potassium
C. Chloride
D. Calcium
CorreCt Answer: C ✓
rAtionAle: Cystic fibrosis is caused by a mutation in the CFTR (cystic fibrosis
transmembrane conductance regulator) gene, which encodes a chloride channel. Defective
chloride transport leads to thick, viscous secretions in the lungs, pancreas, and other organs.
Question 8
Which of the following is an autosomal dominant genetic disorder?
A. Cystic fibrosis
B. Huntington's disease
C. Sickle cell anemia
D. Hemophilia A
CorreCt Answer: B ✓
rAtionAle: Huntington's disease is an autosomal dominant disorder. Cystic fibrosis (A) and
sickle cell anemia (C) are autosomal recessive. Hemophilia A (D) is X-linked recessive.
Question 9
The presence of Reed-Sternberg cells is characteristic of which malignancy?
Academic Year 2026/2027 – Objective Assessment
Comprehensive Examination with 100 Verified Questions and
Correct Answer Rationales .
DOMAIN 1: CELLULAR AND GENETIC ALTERATIONS (25 QUESTIONS)
Question 1
Which cellular adaptation is characterized by an increase in the number of cells in a tissue or
organ?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
CorreCt Answer: B ✓
rAtionAle: Hyperplasia is an increase in the number of cells resulting from increased
cellular division, commonly occurring in tissues capable of mitotic division. Hypertrophy (A) is an
increase in cell size; atrophy (C) is a decrease in cell size or number; metaplasia (D) is the
replacement of one cell type with another.
Question 2
A cell that has undergone irreversible injury and exhibits nuclear pyknosis, karyorrhexis, and
karyolysis is undergoing which process?
A. Apoptosis
B. Hypertrophy
C. Necrosis
D. Atrophy
CorreCt Answer: C ✓
rAtionAle: Nuclear changes of pyknosis (nuclear shrinkage), karyorrhexis (nuclear
fragmentation), and karyolysis (nuclear dissolution) are hallmark morphologic features
of necrosis, indicating irreversible cell death with loss of membrane integrity.
,Question 3
Which type of necrosis is typically associated with ischemic injury to the heart or kidney and
preserves tissue architecture initially?
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis
D. Fat necrosis
CorreCt Answer: C ✓
rAtionAle: Coagulative necrosis, common in ischemic infarcts of solid organs, results from
protein denaturation that preserves the general tissue outline for a period of time. Liquefactive
necrosis (A) occurs in the brain; caseous necrosis (B) occurs in tuberculosis; fat necrosis (D)
occurs in breast or pancreas.
Question 4
Metaplasia is best defined as:
A. An increase in cell size without an increase in cell number
B. Replacement of one differentiated cell type by another differentiated cell type
C. A decrease in cell size and function
D. Uncontrolled cellular proliferation with invasion
CorreCt Answer: B ✓
rAtionAle: Metaplasia is the reversible replacement of one differentiated cell type by
another, often in response to chronic irritation. Hypertrophy (A) is cell enlargement; atrophy (C)
is cell shrinkage; neoplasia (D) is uncontrolled proliferation.
Question 5
A 55-year-old patient with a history of chronic cigarette smoking is diagnosed with squamous
cell carcinoma of the lung. Which cellular alteration most likely preceded this malignancy?
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Anaplasia
CorreCt Answer: B ✓
rAtionAle: Dysplasia is disordered cellular growth that is often a precursor to malignancy. In
the respiratory tract, chronic irritation from smoking causes squamous metaplasia followed
by dysplasia, which can progress to carcinoma.
, Question 6
Which of the following is a characteristic of malignant tumors?
A. Encapsulated growth
B. Well-differentiated cells
C. Invasion of surrounding tissues
D. Low mitotic rate
CorreCt Answer: C ✓
rAtionAle: Invasion of surrounding tissues is a hallmark of malignancy. Benign tumors
are encapsulated (A), well-differentiated (B), and have a low mitotic rate (D). Malignant tumors
are poorly differentiated, invasive, and have a high mitotic rate.
Question 7
A patient with a genetic disorder has a mutation in the CFTR gene. This mutation leads to
defective transport of which ion?
A. Sodium
B. Potassium
C. Chloride
D. Calcium
CorreCt Answer: C ✓
rAtionAle: Cystic fibrosis is caused by a mutation in the CFTR (cystic fibrosis
transmembrane conductance regulator) gene, which encodes a chloride channel. Defective
chloride transport leads to thick, viscous secretions in the lungs, pancreas, and other organs.
Question 8
Which of the following is an autosomal dominant genetic disorder?
A. Cystic fibrosis
B. Huntington's disease
C. Sickle cell anemia
D. Hemophilia A
CorreCt Answer: B ✓
rAtionAle: Huntington's disease is an autosomal dominant disorder. Cystic fibrosis (A) and
sickle cell anemia (C) are autosomal recessive. Hemophilia A (D) is X-linked recessive.
Question 9
The presence of Reed-Sternberg cells is characteristic of which malignancy?
