NSG5140 ADVANCED PATHOPHYSIOLOGY
WEEK 5 MIDTERM — 250 ORIGINAL PRACTICE QUESTIONS
& ANSWERS
Study guide • Exam-style multiple choice • Correct answers marked with a large green tick
Important: This is an original practice resource, not a copy of a live/proctored exam or a claim of access to confidential exam questions.
Public web listings describe NSG5140 practice materials covering cellular injury, inflammation, hemodynamics, renal/respiratory
pathophysiology and neoplasia; this guide uses those high-yield domains while writing its questions independently.
CORE PATHOPHYSIOLOGY MAP
→ Cell stress → adaptation → reversible injury → irreversible injury
→ Innate immune activation → endothelial changes → leukocyte recruitment → resolution/repair
→ Endothelial injury + abnormal flow + hypercoagulability → thrombosis
→ Perfusion failure → cellular hypoxia → ATP depletion → organ dysfunction
→ Genomic instability + altered growth signaling → neoplasia → invasion/metastasis
ACID–BASE QUICK MAP
→ Metabolic acidosis → ↓HCO3− → respiratory compensation: ↓PaCO2
→ Metabolic alkalosis → ↑HCO3− → respiratory compensation: ↑PaCO2
→ Respiratory acidosis → ↑PaCO2 → renal compensation: ↑HCO3−
→ Respiratory alkalosis → ↓PaCO2 → renal compensation: ↓HCO3−
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 1
, 1. A patient with long-standing hypertension develops increased left ventricular wall thickness. Which
cellular adaptation is most likely?
Hypertrophy from increased workload
Hyperplasia from increased workload
Metaplasia of cardiomyocytes
Dysplasia from chronic inflammation
Rationale: Cardiac myocytes enlarge in response to chronic pressure overload; they do not normally divide to produce
hyperplasia.
2. A cell exposed to mild, reversible hypoxia develops swelling. What is the earliest major biochemical
event?
Failure of oxidative phosphorylation with ATP depletion
Immediate nuclear fragmentation
Massive DNA replication
Permanent membrane rupture
Rationale: ATP depletion impairs ATP-dependent ion pumps, causing sodium and water accumulation.
3. Which finding most strongly indicates irreversible cellular injury?
Mild cellular swelling
Fatty change
Severe membrane damage with inability to reverse mitochondrial dysfunction
Transient ribosomal detachment
Rationale: Severe membrane and mitochondrial injury are hallmarks of irreversible injury.
4. Why does intracellular calcium rise during severe cell injury?
Membrane damage and failure of calcium pumps
Increased DNA replication
Reduced extracellular calcium
Increased lysosomal synthesis
Rationale: Loss of membrane integrity and ATP-dependent calcium transport allows intracellular calcium accumulation.
5. Which reactive oxygen species is converted by superoxide dismutase into hydrogen peroxide?
Superoxide anion
Hydroxyl radical
Nitric oxide
Peroxynitrite
Rationale: Superoxide dismutase converts superoxide to hydrogen peroxide.
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 2
, 6. A patient has chronic gastroesophageal reflux and develops replacement of esophageal squamous
epithelium by columnar epithelium. This is best classified as:
Hyperplasia
Metaplasia
Hypertrophy
Anaplasia
Rationale: Metaplasia is a reversible substitution of one mature cell type for another in response to chronic stress.
7. Which process is characterized by programmed, energy-dependent cell death with minimal
inflammation?
Necrosis
Apoptosis
Gangrene
Autolysis
Rationale: Apoptosis is regulated cell death and usually does not provoke the inflammation typical of necrosis.
8. What is the main role of BCL-2 in apoptosis?
Promote mitochondrial outer-membrane permeabilization
Inhibit apoptosis by preserving mitochondrial integrity
Activate neutrophil migration
Increase lysosomal rupture
Rationale: BCL-2 is anti-apoptotic and helps preserve mitochondrial membrane integrity.
9. Which caspase is a major executioner caspase in apoptosis?
Caspase-3
Caspase-1
Caspase-8 only
Caspase-12 only
Rationale: Caspase-3 is a key executioner caspase that cleaves cellular substrates.
10. A tissue exposed to chronic irritation develops enlarged cells without an increase in cell number.
Which adaptation is present?
Hypertrophy
Hyperplasia
Metaplasia
Dysplasia
Rationale: Hypertrophy means increased cell size, commonly caused by increased workload.
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 3
, 11. Which mechanism best explains cellular swelling during early reversible injury?
Na+/K+-ATPase failure with intracellular sodium and water accumulation
Immediate DNA cross-linking
Increased protein degradation by caspases
Increased extracellular potassium uptake
Rationale: ATP depletion impairs the Na+/K+-ATPase, causing sodium and water to enter the cell.
12. Which organelle is especially vulnerable to calcium overload during severe cell injury?
Mitochondria
Golgi apparatus only
Nucleolus only
Centrioles
Rationale: Mitochondrial calcium overload promotes permeability transition and loss of ATP production.
13. What is a major consequence of lipid peroxidation?
Membrane damage
Increased DNA repair
Improved mitochondrial coupling
Reduced free-radical formation
Rationale: Reactive oxygen species attack membrane lipids, compromising membrane integrity.
14. Which adaptation commonly occurs in skeletal muscle after increased workload?
Hypertrophy
Metaplasia
Atrophy
Anaplasia
Rationale: Skeletal muscle fibers enlarge with increased workload.
15. Which condition is most likely to cause physiologic hypertrophy?
Regular resistance training
Chronic ischemia
Prolonged starvation
Severe denervation
Rationale: Exercise can produce adaptive enlargement of skeletal and cardiac muscle.
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 4
WEEK 5 MIDTERM — 250 ORIGINAL PRACTICE QUESTIONS
& ANSWERS
Study guide • Exam-style multiple choice • Correct answers marked with a large green tick
Important: This is an original practice resource, not a copy of a live/proctored exam or a claim of access to confidential exam questions.
Public web listings describe NSG5140 practice materials covering cellular injury, inflammation, hemodynamics, renal/respiratory
pathophysiology and neoplasia; this guide uses those high-yield domains while writing its questions independently.
CORE PATHOPHYSIOLOGY MAP
→ Cell stress → adaptation → reversible injury → irreversible injury
→ Innate immune activation → endothelial changes → leukocyte recruitment → resolution/repair
→ Endothelial injury + abnormal flow + hypercoagulability → thrombosis
→ Perfusion failure → cellular hypoxia → ATP depletion → organ dysfunction
→ Genomic instability + altered growth signaling → neoplasia → invasion/metastasis
ACID–BASE QUICK MAP
→ Metabolic acidosis → ↓HCO3− → respiratory compensation: ↓PaCO2
→ Metabolic alkalosis → ↑HCO3− → respiratory compensation: ↑PaCO2
→ Respiratory acidosis → ↑PaCO2 → renal compensation: ↑HCO3−
→ Respiratory alkalosis → ↓PaCO2 → renal compensation: ↓HCO3−
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 1
, 1. A patient with long-standing hypertension develops increased left ventricular wall thickness. Which
cellular adaptation is most likely?
Hypertrophy from increased workload
Hyperplasia from increased workload
Metaplasia of cardiomyocytes
Dysplasia from chronic inflammation
Rationale: Cardiac myocytes enlarge in response to chronic pressure overload; they do not normally divide to produce
hyperplasia.
2. A cell exposed to mild, reversible hypoxia develops swelling. What is the earliest major biochemical
event?
Failure of oxidative phosphorylation with ATP depletion
Immediate nuclear fragmentation
Massive DNA replication
Permanent membrane rupture
Rationale: ATP depletion impairs ATP-dependent ion pumps, causing sodium and water accumulation.
3. Which finding most strongly indicates irreversible cellular injury?
Mild cellular swelling
Fatty change
Severe membrane damage with inability to reverse mitochondrial dysfunction
Transient ribosomal detachment
Rationale: Severe membrane and mitochondrial injury are hallmarks of irreversible injury.
4. Why does intracellular calcium rise during severe cell injury?
Membrane damage and failure of calcium pumps
Increased DNA replication
Reduced extracellular calcium
Increased lysosomal synthesis
Rationale: Loss of membrane integrity and ATP-dependent calcium transport allows intracellular calcium accumulation.
5. Which reactive oxygen species is converted by superoxide dismutase into hydrogen peroxide?
Superoxide anion
Hydroxyl radical
Nitric oxide
Peroxynitrite
Rationale: Superoxide dismutase converts superoxide to hydrogen peroxide.
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 2
, 6. A patient has chronic gastroesophageal reflux and develops replacement of esophageal squamous
epithelium by columnar epithelium. This is best classified as:
Hyperplasia
Metaplasia
Hypertrophy
Anaplasia
Rationale: Metaplasia is a reversible substitution of one mature cell type for another in response to chronic stress.
7. Which process is characterized by programmed, energy-dependent cell death with minimal
inflammation?
Necrosis
Apoptosis
Gangrene
Autolysis
Rationale: Apoptosis is regulated cell death and usually does not provoke the inflammation typical of necrosis.
8. What is the main role of BCL-2 in apoptosis?
Promote mitochondrial outer-membrane permeabilization
Inhibit apoptosis by preserving mitochondrial integrity
Activate neutrophil migration
Increase lysosomal rupture
Rationale: BCL-2 is anti-apoptotic and helps preserve mitochondrial membrane integrity.
9. Which caspase is a major executioner caspase in apoptosis?
Caspase-3
Caspase-1
Caspase-8 only
Caspase-12 only
Rationale: Caspase-3 is a key executioner caspase that cleaves cellular substrates.
10. A tissue exposed to chronic irritation develops enlarged cells without an increase in cell number.
Which adaptation is present?
Hypertrophy
Hyperplasia
Metaplasia
Dysplasia
Rationale: Hypertrophy means increased cell size, commonly caused by increased workload.
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 3
, 11. Which mechanism best explains cellular swelling during early reversible injury?
Na+/K+-ATPase failure with intracellular sodium and water accumulation
Immediate DNA cross-linking
Increased protein degradation by caspases
Increased extracellular potassium uptake
Rationale: ATP depletion impairs the Na+/K+-ATPase, causing sodium and water to enter the cell.
12. Which organelle is especially vulnerable to calcium overload during severe cell injury?
Mitochondria
Golgi apparatus only
Nucleolus only
Centrioles
Rationale: Mitochondrial calcium overload promotes permeability transition and loss of ATP production.
13. What is a major consequence of lipid peroxidation?
Membrane damage
Increased DNA repair
Improved mitochondrial coupling
Reduced free-radical formation
Rationale: Reactive oxygen species attack membrane lipids, compromising membrane integrity.
14. Which adaptation commonly occurs in skeletal muscle after increased workload?
Hypertrophy
Metaplasia
Atrophy
Anaplasia
Rationale: Skeletal muscle fibers enlarge with increased workload.
15. Which condition is most likely to cause physiologic hypertrophy?
Regular resistance training
Chronic ischemia
Prolonged starvation
Severe denervation
Rationale: Exercise can produce adaptive enlargement of skeletal and cardiac muscle.
NSG5140 Advanced Pathophysiology — Original Practice Resource Page 4
