,USU MSN 570 Week 3 APEA Quiz Bank | Advanced
Pathophysiology (2026) Q&A
1. A 55-year-old man with chronic hypertension presents with left ventricular hypertrophy on
echocardiogram. This cellular adaptation is best described as:
A) Atrophy from decreased workload
B) Hypertrophy from increased mechanical demand
C) Hyperplasia from hormonal stimulation
D) Metaplasia from chronic irritation
Correct Answer: B) Hypertrophy from increased mechanical demand
Rationale: Hypertrophy is an increase in cell size resulting in enlarged tissue mass, typically
from increased mechanical demand. Atrophy is a decrease in cell size, hyperplasia is an
increase in cell number, and metaplasia is a change from one differentiated cell type to
another.
2. In cellular injury, the "point of no return" is most closely associated with:
A) Depletion of ATP and cellular swelling
B) Massive calcium influx and activation of catabolic enzymes
C) Accumulation of fat vacuoles in the cytoplasm
D) Formation of apoptotic bodies
Correct Answer: B) Massive calcium influx and activation of catabolic enzymes
Rationale: Irreversible injury is marked by massive calcium influx, mitochondrial
dysfunction, and activation of phospholipases and proteases that destroy cellular membranes.
ATP depletion occurs early but calcium dysregulation marks irreversibility.
3. A patient with chronic bronchitis has hyperplasia of bronchial mucous glands. This is an
example of:
,A) Compensatory hyperplasia to replace damaged cells
B) Hormonal hyperplasia stimulated by growth factors
C) Pathologic hyperplasia due to chronic irritation
D) Neoplastic proliferation of glandular tissue
Correct Answer: C) Pathologic hyperplasia due to chronic irritation
Rationale: Pathologic hyperplasia is proliferation in response to chronic irritation or
hormonal stimulation beyond normal limits. Compensatory hyperplasia follows tissue loss,
and hormonal hyperplasia is physiologic.
4. The primary difference between necrosis and apoptosis is that:
A) Necrosis is programmed cell death; apoptosis is accidental
B) Apoptosis is energy-dependent and maintains membrane integrity; necrosis is accidental
with membrane rupture
C) Necrosis affects single cells; apoptosis affects groups of cells
D) Apoptosis causes inflammation; necrosis does not
Correct Answer: B) Apoptosis is energy-dependent and maintains membrane integrity;
necrosis is accidental with membrane rupture
Rationale: Apoptosis is programmed, energy-dependent cell death with intact membranes
and no inflammation. Necrosis is accidental cell death from injury, with membrane rupture
and inflammation.
5. During acute inflammation, the first response at the microcirculation level is:
A) Increased vascular permeability causing edema
B) Vasodilation and increased blood flow causing redness and heat
C) Leukocyte adhesion and transmigration
D) Fibrin deposition and clot formation
, Correct Answer: B) Vasodilation and increased blood flow causing redness and heat
Rationale: The vascular phase of acute inflammation begins with transient vasoconstriction
followed by vasodilation, causing increased blood flow. Increased permeability follows, then
leukocyte adhesion, and finally fibrin deposition.
6. Which of the following best explains the development of metabolic acidosis in a patient
with ethylene glycol poisoning?
A) Accumulation of glycolic acid and lactic acid due to alcohol dehydrogenase metabolism
B) Direct inhibition of the tricarboxylic acid cycle by ethylene glycol
C) Increased production of ketoacids from fatty acid oxidation
D) Hypoxia-induced lactic acidosis secondary to methemoglobinemia
Correct Answer: A) Accumulation of glycolic acid and lactic acid due to alcohol
dehydrogenase metabolism
Rationale: Ethylene glycol is metabolized by alcohol dehydrogenase to glycolic acid and
then to oxalic acid, causing a high anion gap metabolic acidosis. Lactic acid also accumulates
due to inhibition of the TCA cycle.
7. A 58-year-old male with type 2 diabetes mellitus reports burning foot pain that worsens at
night. Examination reveals diminished pinprick sensation distal to the ankles and absent
Achilles reflexes bilaterally. What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Correct Answer: C) Diabetic peripheral neuropathy
Rationale: Distal symmetric polyneuropathy is the most common complication of diabetes,
presenting with burning pain, nocturnal exacerbation, distal sensory loss, and areflexia.
Pathophysiology (2026) Q&A
1. A 55-year-old man with chronic hypertension presents with left ventricular hypertrophy on
echocardiogram. This cellular adaptation is best described as:
A) Atrophy from decreased workload
B) Hypertrophy from increased mechanical demand
C) Hyperplasia from hormonal stimulation
D) Metaplasia from chronic irritation
Correct Answer: B) Hypertrophy from increased mechanical demand
Rationale: Hypertrophy is an increase in cell size resulting in enlarged tissue mass, typically
from increased mechanical demand. Atrophy is a decrease in cell size, hyperplasia is an
increase in cell number, and metaplasia is a change from one differentiated cell type to
another.
2. In cellular injury, the "point of no return" is most closely associated with:
A) Depletion of ATP and cellular swelling
B) Massive calcium influx and activation of catabolic enzymes
C) Accumulation of fat vacuoles in the cytoplasm
D) Formation of apoptotic bodies
Correct Answer: B) Massive calcium influx and activation of catabolic enzymes
Rationale: Irreversible injury is marked by massive calcium influx, mitochondrial
dysfunction, and activation of phospholipases and proteases that destroy cellular membranes.
ATP depletion occurs early but calcium dysregulation marks irreversibility.
3. A patient with chronic bronchitis has hyperplasia of bronchial mucous glands. This is an
example of:
,A) Compensatory hyperplasia to replace damaged cells
B) Hormonal hyperplasia stimulated by growth factors
C) Pathologic hyperplasia due to chronic irritation
D) Neoplastic proliferation of glandular tissue
Correct Answer: C) Pathologic hyperplasia due to chronic irritation
Rationale: Pathologic hyperplasia is proliferation in response to chronic irritation or
hormonal stimulation beyond normal limits. Compensatory hyperplasia follows tissue loss,
and hormonal hyperplasia is physiologic.
4. The primary difference between necrosis and apoptosis is that:
A) Necrosis is programmed cell death; apoptosis is accidental
B) Apoptosis is energy-dependent and maintains membrane integrity; necrosis is accidental
with membrane rupture
C) Necrosis affects single cells; apoptosis affects groups of cells
D) Apoptosis causes inflammation; necrosis does not
Correct Answer: B) Apoptosis is energy-dependent and maintains membrane integrity;
necrosis is accidental with membrane rupture
Rationale: Apoptosis is programmed, energy-dependent cell death with intact membranes
and no inflammation. Necrosis is accidental cell death from injury, with membrane rupture
and inflammation.
5. During acute inflammation, the first response at the microcirculation level is:
A) Increased vascular permeability causing edema
B) Vasodilation and increased blood flow causing redness and heat
C) Leukocyte adhesion and transmigration
D) Fibrin deposition and clot formation
, Correct Answer: B) Vasodilation and increased blood flow causing redness and heat
Rationale: The vascular phase of acute inflammation begins with transient vasoconstriction
followed by vasodilation, causing increased blood flow. Increased permeability follows, then
leukocyte adhesion, and finally fibrin deposition.
6. Which of the following best explains the development of metabolic acidosis in a patient
with ethylene glycol poisoning?
A) Accumulation of glycolic acid and lactic acid due to alcohol dehydrogenase metabolism
B) Direct inhibition of the tricarboxylic acid cycle by ethylene glycol
C) Increased production of ketoacids from fatty acid oxidation
D) Hypoxia-induced lactic acidosis secondary to methemoglobinemia
Correct Answer: A) Accumulation of glycolic acid and lactic acid due to alcohol
dehydrogenase metabolism
Rationale: Ethylene glycol is metabolized by alcohol dehydrogenase to glycolic acid and
then to oxalic acid, causing a high anion gap metabolic acidosis. Lactic acid also accumulates
due to inhibition of the TCA cycle.
7. A 58-year-old male with type 2 diabetes mellitus reports burning foot pain that worsens at
night. Examination reveals diminished pinprick sensation distal to the ankles and absent
Achilles reflexes bilaterally. What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Correct Answer: C) Diabetic peripheral neuropathy
Rationale: Distal symmetric polyneuropathy is the most common complication of diabetes,
presenting with burning pain, nocturnal exacerbation, distal sensory loss, and areflexia.
