NSG 530 Exam 1 Actual Exam V2 | NSG 530 Advanced
Pathophysiology (NSG530 Exam 1) | Wilkes University
1. A 65-year-old male with a history of chronic hypertension presents with left ventricular
enlargement. Which cellular adaptation is most likely occurring in his myocardium?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
Answer: D
Rationale: Hypertrophy involves an increase in the size of cells rather than the number of
cells, which is common in tissues like the heart that cannot undergo mitotic division. In the
case of chronic hypertension, the left ventricle must pump against increased systemic
resistance, leading to the synthesis of more contractile proteins to handle the workload.
This structural change initially helps maintain cardiac output but can eventually lead to
heart failure if the underlying cause is not addressed.
2. A patient with a history of heavy smoking shows a change in the bronchial lining from
ciliated columnar epithelium to stratified squamous epithelium. What is this process called?
A. Metaplasia
B. Anaplasia
C. Dysplasia
D. Neoplasia
Answer: A
Rationale: Metaplasia is a reversible replacement of one mature cell type by another
mature cell type, often in response to chronic irritation or inflammation. In smokers, the
fragile ciliated columnar cells are replaced by tougher squamous cells to withstand the
smoke, though this results in the loss of the protective mucociliary escalator. This
adaptation is significant because while it protects the tissue, the loss of cilia increases the
risk of infection and the process can progress to dysplasia if the stimulus persists.
3. During hypoxic injury, what is the primary cause of cellular swelling?
A. Failure of the sodium-potassium pump
B. Increase in protein synthesis
C. Loss of genetic material
,D. Decreased intracellular osmotic pressure
Answer: A
Rationale: Hypoxia leads to a decrease in ATP production because the cell can no longer
perform efficient aerobic respiration. Without adequate ATP, the Na+/K+ ATPase pump
fails, allowing sodium to accumulate inside the cell and potassium to diffuse out. Water
follows the sodium into the cell due to osmotic pressure, leading to acute cellular swelling,
which is the first manifestation of almost all types of cell injury.
4. Which mechanism best describes the process of apoptosis?
A. Cell death triggered by inflammatory cytokines and membrane rupture
B. Cellular dissolution caused by lysosomal enzyme release following ischemia
C. Passive cell death resulting from external traumatic injury
D. Programmed cell death characterized by nuclear fragmentation and phagocytosis
without inflammation
Answer: D
Rationale: Apoptosis is a highly regulated, energy-dependent process of programmed cell
death used to eliminate unwanted or damaged cells. Unlike necrosis, it does not involve the
rupture of the plasma membrane, which prevents the release of intracellular contents and
the subsequent inflammatory response. Phagocytic cells quickly recognize and engulf the
apoptotic bodies, ensuring that the surrounding tissue remains healthy and undisturbed.
5. A biopsy of a cervical lesion reveals cells that are unequal in size, shape, and organization.
Which term best describes these findings?
A. Metaplasia
B. Hyperplasia
C. Atrophy
D. Dysplasia
Answer: D
Rationale: Dysplasia refers to abnormal changes in the size, shape, and organization of
mature cells and is often considered a pre-cancerous condition. It is frequently associated
with chronic irritation or inflammation, such as that caused by Human Papillomavirus
(HPV) in the cervix. While dysplasia is potentially reversible if the inciting stimulus is
removed, high-grade dysplasia often progresses to invasive carcinoma if left untreated.
6. A patient experiencing prolonged ischemia in the heart develops irreversible cell injury.
Which finding is most indicative of this transition?
A. Dilation of the endoplasmic reticulum
, B. Increase in glycolysis rate
C. Ribosome detachment
D. Mitochondrial swelling and membrane rupture
Answer: D
Rationale: Irreversible cell injury is marked by severe mitochondrial dysfunction and the
inability to restore ATP production even if oxygen is reintroduced. Large, flocculent
densities in the mitochondrial matrix and the rupture of lysosomal membranes signify that
the cell has passed the point of no return. These structural failures lead to the leakage of
enzymes and proteins into the bloodstream, which is why clinicians measure troponin
levels to diagnose a myocardial infarction.
7. What is the significance of the ‘left shift’ in a differential white blood cell count during an
acute infection?
A. An increase in the proportion of immature neutrophils (bands)
B. An increase in mature lymphocytes
C. A decrease in the total number of leukocytes
D. An increase in the number of eosinophils
Answer: A
Rationale: A ‘left shift’ indicates that the bone marrow is releasing immature neutrophils,
known as bands, into the circulation to keep up with the demand of an acute bacterial
infection. Normally, neutrophils mature fully in the marrow before release, but during
intense inflammation, the demand outpaces the supply of mature cells. This clinical finding
is a hallmark sign that the body is actively mounting a systemic response to a significant
infectious or inflammatory process.
8. Which mediator is primarily responsible for the pain associated with the inflammatory
response?
A. Complement C3b
B. Histamine
C. Bradykinin
D. Interferon
Answer: C
Rationale: Bradykinin is a potent plasma protein that acts along with prostaglandins to
stimulate nerve endings, resulting in the sensation of pain. It is part of the kinin system,
which is activated early in the inflammatory process to increase vascular permeability and
induce smooth muscle contraction. Understanding this helps clinicians manage
Pathophysiology (NSG530 Exam 1) | Wilkes University
1. A 65-year-old male with a history of chronic hypertension presents with left ventricular
enlargement. Which cellular adaptation is most likely occurring in his myocardium?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
Answer: D
Rationale: Hypertrophy involves an increase in the size of cells rather than the number of
cells, which is common in tissues like the heart that cannot undergo mitotic division. In the
case of chronic hypertension, the left ventricle must pump against increased systemic
resistance, leading to the synthesis of more contractile proteins to handle the workload.
This structural change initially helps maintain cardiac output but can eventually lead to
heart failure if the underlying cause is not addressed.
2. A patient with a history of heavy smoking shows a change in the bronchial lining from
ciliated columnar epithelium to stratified squamous epithelium. What is this process called?
A. Metaplasia
B. Anaplasia
C. Dysplasia
D. Neoplasia
Answer: A
Rationale: Metaplasia is a reversible replacement of one mature cell type by another
mature cell type, often in response to chronic irritation or inflammation. In smokers, the
fragile ciliated columnar cells are replaced by tougher squamous cells to withstand the
smoke, though this results in the loss of the protective mucociliary escalator. This
adaptation is significant because while it protects the tissue, the loss of cilia increases the
risk of infection and the process can progress to dysplasia if the stimulus persists.
3. During hypoxic injury, what is the primary cause of cellular swelling?
A. Failure of the sodium-potassium pump
B. Increase in protein synthesis
C. Loss of genetic material
,D. Decreased intracellular osmotic pressure
Answer: A
Rationale: Hypoxia leads to a decrease in ATP production because the cell can no longer
perform efficient aerobic respiration. Without adequate ATP, the Na+/K+ ATPase pump
fails, allowing sodium to accumulate inside the cell and potassium to diffuse out. Water
follows the sodium into the cell due to osmotic pressure, leading to acute cellular swelling,
which is the first manifestation of almost all types of cell injury.
4. Which mechanism best describes the process of apoptosis?
A. Cell death triggered by inflammatory cytokines and membrane rupture
B. Cellular dissolution caused by lysosomal enzyme release following ischemia
C. Passive cell death resulting from external traumatic injury
D. Programmed cell death characterized by nuclear fragmentation and phagocytosis
without inflammation
Answer: D
Rationale: Apoptosis is a highly regulated, energy-dependent process of programmed cell
death used to eliminate unwanted or damaged cells. Unlike necrosis, it does not involve the
rupture of the plasma membrane, which prevents the release of intracellular contents and
the subsequent inflammatory response. Phagocytic cells quickly recognize and engulf the
apoptotic bodies, ensuring that the surrounding tissue remains healthy and undisturbed.
5. A biopsy of a cervical lesion reveals cells that are unequal in size, shape, and organization.
Which term best describes these findings?
A. Metaplasia
B. Hyperplasia
C. Atrophy
D. Dysplasia
Answer: D
Rationale: Dysplasia refers to abnormal changes in the size, shape, and organization of
mature cells and is often considered a pre-cancerous condition. It is frequently associated
with chronic irritation or inflammation, such as that caused by Human Papillomavirus
(HPV) in the cervix. While dysplasia is potentially reversible if the inciting stimulus is
removed, high-grade dysplasia often progresses to invasive carcinoma if left untreated.
6. A patient experiencing prolonged ischemia in the heart develops irreversible cell injury.
Which finding is most indicative of this transition?
A. Dilation of the endoplasmic reticulum
, B. Increase in glycolysis rate
C. Ribosome detachment
D. Mitochondrial swelling and membrane rupture
Answer: D
Rationale: Irreversible cell injury is marked by severe mitochondrial dysfunction and the
inability to restore ATP production even if oxygen is reintroduced. Large, flocculent
densities in the mitochondrial matrix and the rupture of lysosomal membranes signify that
the cell has passed the point of no return. These structural failures lead to the leakage of
enzymes and proteins into the bloodstream, which is why clinicians measure troponin
levels to diagnose a myocardial infarction.
7. What is the significance of the ‘left shift’ in a differential white blood cell count during an
acute infection?
A. An increase in the proportion of immature neutrophils (bands)
B. An increase in mature lymphocytes
C. A decrease in the total number of leukocytes
D. An increase in the number of eosinophils
Answer: A
Rationale: A ‘left shift’ indicates that the bone marrow is releasing immature neutrophils,
known as bands, into the circulation to keep up with the demand of an acute bacterial
infection. Normally, neutrophils mature fully in the marrow before release, but during
intense inflammation, the demand outpaces the supply of mature cells. This clinical finding
is a hallmark sign that the body is actively mounting a systemic response to a significant
infectious or inflammatory process.
8. Which mediator is primarily responsible for the pain associated with the inflammatory
response?
A. Complement C3b
B. Histamine
C. Bradykinin
D. Interferon
Answer: C
Rationale: Bradykinin is a potent plasma protein that acts along with prostaglandins to
stimulate nerve endings, resulting in the sensation of pain. It is part of the kinin system,
which is activated early in the inflammatory process to increase vascular permeability and
induce smooth muscle contraction. Understanding this helps clinicians manage
