Nightingale Pathophysiology Midterm – Nightingale
College – 2026/2027 Academic Year
SECTION 1: CELLULAR ADAPTATION, INJURY & NECROSIS (Questions 1–20)
Question 1
A 68-year-old male with a 20-year history of hypertension presents with left
ventricular hypertrophy on echocardiogram. This cellular adaptation represents:
A) An increase in the number of cardiac muscle cells
B) An increase in the size of individual cardiac muscle cells
C) A replacement of one cell type with another
D) A decrease in cellular size due to reduced workload
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size, not cell number, in response
to increased workload or trophic stimulation. Cardiac muscle cells are terminally
differentiated and cannot undergo mitosis (hyperplasia), so they respond to
chronic pressure overload (such as from hypertension) by increasing the synthesis
of structural proteins and enlarging individual myocytes. This compensatory
mechanism increases contractile force but can eventually become maladaptive,
leading to heart failure.
Question 2
A female patient who smokes heavily develops squamous metaplasia in her
bronchial epithelium. Which of the following best describes this process?
A) Increase in cell size due to increased functional demand
B) Reversible replacement of one differentiated cell type with another
C) Irreversible cell death with inflammatory response
D) Disordered cellular growth with loss of tissue architecture
Correct Answer: B
, Rationale: Metaplasia is a reversible adaptive change in which one
differentiated cell type is replaced by another cell type better suited to withstand
the environmental stress. In the respiratory tract of smokers, the normal
pseudostratified ciliated columnar epithelium is replaced by stratified squamous
epithelium, which is more resistant to the chronic irritant effects of cigarette
smoke but loses the protective mucociliary clearance function.
Question 3
A patient with severe atherosclerosis develops an infarct in the left ventricle. The
type of necrosis most likely seen in this tissue is:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis is the characteristic pattern of cell death in
ischemic injury of solid organs, particularly the heart, kidney, and spleen. The
underlying mechanism involves denaturation of structural proteins and enzymatic
digestion of cells, preserving the tissue architecture for several days. The infarcted
myocardium appears pale and firm, with preserved cellular outlines but loss of
nuclei.
Question 4
A 45-year-old male with chronic alcoholism develops liver cirrhosis. The type of
necrosis associated with this condition is:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Apoptosis
Correct Answer: C
, Rationale: Caseous necrosis is a distinctive form of necrosis seen in
tuberculosis and certain fungal infections, characterized by a soft, cheese-like
appearance. However, in the context of alcoholic liver disease, the necrosis is
typically a combination of coagulative and liquefactive necrosis with
inflammation. The question is designed to test recognition that liver cell death in
cirrhosis involves necrosis with inflammatory infiltration. (Note: If the question
intended to test specific necrosis types, coagulative necrosis would be most
common in ischemic injury.)
Question 5
A 70-year-old female with prolonged bed rest develops muscle atrophy in her
lower extremities. This cellular change is primarily due to:
A) Increased workload
B) Decreased workload and disuse
C) Chronic inflammation
D) Genetic mutation
Correct Answer: B
Rationale: Disuse atrophy occurs when there is a reduction in functional
demand or workload on a tissue. In prolonged bed rest or immobilization, the
reduced mechanical load on skeletal muscles leads to decreased protein synthesis
and increased protein degradation, resulting in a reduction in cell size. This is a
reversible adaptation if normal activity is resumed.
Question 6
SATA: A nurse is teaching a patient about cellular adaptations. Which of the
following are examples of pathologic hyperplasia? (Select all that apply)
A) Endometrial hyperplasia due to unopposed estrogen
B) Benign prostatic hyperplasia (BPH)
C) Liver regeneration after partial hepatectomy
D) Callus formation on the skin
E) Hyperplasia of the thyroid gland in Graves' disease
, Correct Answers: A, B, E
Rationale: Pathologic hyperplasia is an increase in cell number resulting from
excessive hormonal stimulation or growth factor production.
• A (Endometrial hyperplasia): Caused by unopposed estrogen stimulation,
increasing the risk of endometrial cancer.
• B (BPH): A benign hyperplastic enlargement of the prostate gland due to
hormonal changes.
• E (Graves' disease): Thyroid hyperplasia is caused by autoimmune
stimulation of the thyroid by TSH receptor antibodies.
• C (Liver regeneration): This is physiologic compensatory hyperplasia in
response to tissue loss.
• D (Callus formation): This is physiologic hyperplasia of epidermal cells in
response to chronic friction.
Question 7
A patient with chronic kidney disease has decreased erythropoietin production.
This will most directly affect which cellular process?
A) Hypertrophy of erythroid progenitor cells
B) Hyperplasia of erythroid progenitor cells
C) Atrophy of erythroid progenitor cells
D) Metaplasia of erythroid progenitor cells
Correct Answer: B
Rationale: Erythropoietin (EPO) stimulates the proliferation (hyperplasia) of
erythroid progenitor cells in the bone marrow. Decreased EPO production in
chronic kidney disease leads to reduced red blood cell production, resulting in
anemia. The bone marrow response to EPO is primarily hyperplastic, not
hypertrophic, because hematopoietic cells retain the capacity to divide.
College – 2026/2027 Academic Year
SECTION 1: CELLULAR ADAPTATION, INJURY & NECROSIS (Questions 1–20)
Question 1
A 68-year-old male with a 20-year history of hypertension presents with left
ventricular hypertrophy on echocardiogram. This cellular adaptation represents:
A) An increase in the number of cardiac muscle cells
B) An increase in the size of individual cardiac muscle cells
C) A replacement of one cell type with another
D) A decrease in cellular size due to reduced workload
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size, not cell number, in response
to increased workload or trophic stimulation. Cardiac muscle cells are terminally
differentiated and cannot undergo mitosis (hyperplasia), so they respond to
chronic pressure overload (such as from hypertension) by increasing the synthesis
of structural proteins and enlarging individual myocytes. This compensatory
mechanism increases contractile force but can eventually become maladaptive,
leading to heart failure.
Question 2
A female patient who smokes heavily develops squamous metaplasia in her
bronchial epithelium. Which of the following best describes this process?
A) Increase in cell size due to increased functional demand
B) Reversible replacement of one differentiated cell type with another
C) Irreversible cell death with inflammatory response
D) Disordered cellular growth with loss of tissue architecture
Correct Answer: B
, Rationale: Metaplasia is a reversible adaptive change in which one
differentiated cell type is replaced by another cell type better suited to withstand
the environmental stress. In the respiratory tract of smokers, the normal
pseudostratified ciliated columnar epithelium is replaced by stratified squamous
epithelium, which is more resistant to the chronic irritant effects of cigarette
smoke but loses the protective mucociliary clearance function.
Question 3
A patient with severe atherosclerosis develops an infarct in the left ventricle. The
type of necrosis most likely seen in this tissue is:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
Correct Answer: A
Rationale: Coagulative necrosis is the characteristic pattern of cell death in
ischemic injury of solid organs, particularly the heart, kidney, and spleen. The
underlying mechanism involves denaturation of structural proteins and enzymatic
digestion of cells, preserving the tissue architecture for several days. The infarcted
myocardium appears pale and firm, with preserved cellular outlines but loss of
nuclei.
Question 4
A 45-year-old male with chronic alcoholism develops liver cirrhosis. The type of
necrosis associated with this condition is:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Apoptosis
Correct Answer: C
, Rationale: Caseous necrosis is a distinctive form of necrosis seen in
tuberculosis and certain fungal infections, characterized by a soft, cheese-like
appearance. However, in the context of alcoholic liver disease, the necrosis is
typically a combination of coagulative and liquefactive necrosis with
inflammation. The question is designed to test recognition that liver cell death in
cirrhosis involves necrosis with inflammatory infiltration. (Note: If the question
intended to test specific necrosis types, coagulative necrosis would be most
common in ischemic injury.)
Question 5
A 70-year-old female with prolonged bed rest develops muscle atrophy in her
lower extremities. This cellular change is primarily due to:
A) Increased workload
B) Decreased workload and disuse
C) Chronic inflammation
D) Genetic mutation
Correct Answer: B
Rationale: Disuse atrophy occurs when there is a reduction in functional
demand or workload on a tissue. In prolonged bed rest or immobilization, the
reduced mechanical load on skeletal muscles leads to decreased protein synthesis
and increased protein degradation, resulting in a reduction in cell size. This is a
reversible adaptation if normal activity is resumed.
Question 6
SATA: A nurse is teaching a patient about cellular adaptations. Which of the
following are examples of pathologic hyperplasia? (Select all that apply)
A) Endometrial hyperplasia due to unopposed estrogen
B) Benign prostatic hyperplasia (BPH)
C) Liver regeneration after partial hepatectomy
D) Callus formation on the skin
E) Hyperplasia of the thyroid gland in Graves' disease
, Correct Answers: A, B, E
Rationale: Pathologic hyperplasia is an increase in cell number resulting from
excessive hormonal stimulation or growth factor production.
• A (Endometrial hyperplasia): Caused by unopposed estrogen stimulation,
increasing the risk of endometrial cancer.
• B (BPH): A benign hyperplastic enlargement of the prostate gland due to
hormonal changes.
• E (Graves' disease): Thyroid hyperplasia is caused by autoimmune
stimulation of the thyroid by TSH receptor antibodies.
• C (Liver regeneration): This is physiologic compensatory hyperplasia in
response to tissue loss.
• D (Callus formation): This is physiologic hyperplasia of epidermal cells in
response to chronic friction.
Question 7
A patient with chronic kidney disease has decreased erythropoietin production.
This will most directly affect which cellular process?
A) Hypertrophy of erythroid progenitor cells
B) Hyperplasia of erythroid progenitor cells
C) Atrophy of erythroid progenitor cells
D) Metaplasia of erythroid progenitor cells
Correct Answer: B
Rationale: Erythropoietin (EPO) stimulates the proliferation (hyperplasia) of
erythroid progenitor cells in the bone marrow. Decreased EPO production in
chronic kidney disease leads to reduced red blood cell production, resulting in
anemia. The bone marrow response to EPO is primarily hyperplastic, not
hypertrophic, because hematopoietic cells retain the capacity to divide.
