WGU D115 Advanced Pathophysiology OA
Exam 2025/2026 – Complete Exam
Questions and Answers
Section 1: Cellular Adaptation, Injury & Death (Questions 1–20)
1. A 62-year-old patient with chronic hypertension has developed left ventricular hypertrophy.
Which cellular adaptation best describes this change?
A) Hyperplasia — increase in cell number
B) Metaplasia — replacement of one cell type with another
C) Hypertrophy — increase in cell size
D) Dysplasia — abnormal cell growth and organization
Correct Answer: C) Hypertrophy — increase in cell size
Rationale: Hypertrophy is an increase in cell size in response to increased workload.
Chronic hypertension increases afterload on the left ventricle, causing myocardial cells to
hypertrophy to meet the increased demand. This is a compensatory adaptation that can
eventually become pathologic.
2. A smoker's bronchial epithelium transitions from columnar to squamous cells over time.
This cellular change is called:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Correct Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with another.
In smokers, chronic irritation causes columnar bronchial epithelium to convert to squamous
epithelium, which is more resistant to irritation but loses ciliary function.
,3. A cell undergoes programmed, energy-dependent death without triggering inflammation.
This process is:
A) Liquefactive necrosis
B) Apoptosis
C) Coagulative necrosis
D) Caseous necrosis
Correct Answer: B) Apoptosis
Rationale: Apoptosis is programmed cell death involving caspase activation, DNA
fragmentation, and formation of apoptotic bodies. It does not trigger inflammation because
contents are contained within membrane-bound vesicles and cleared by phagocytes.
4. Following a myocardial infarction, the infarcted tissue maintains its structural outline but
cells are dead. This type of necrosis is:
A) Fat necrosis
B) Liquefactive necrosis
C) Coagulative necrosis
D) Fibrinoid necrosis
Correct Answer: C) Coagulative necrosis
Rationale: Coagulative necrosis preserves the structural architecture of dead tissue for
days because denatured proteins resist proteolysis. It is the hallmark of ischemic injury in
solid organs such as the heart and kidney.
5. A patient with tuberculosis has a chest X-ray showing cheese-like necrotic material in the
lung. This finding represents:
A) Coagulative necrosis
B) Caseous necrosis
C) Fat necrosis
D) Gangrenous necrosis
Correct Answer: B) Caseous necrosis
,Rationale: Caseous necrosis is characteristic of tuberculosis and fungal infections.
Histologically it appears as amorphous, granular, cheese-like debris surrounded by
granulomatous inflammation. It is a combination of coagulative and liquefactive necrosis.
6. Which of the following is an early reversible sign of cell injury seen on electron microscopy?
A) Nuclear pyknosis
B) Membrane rupture
C) Mitochondrial swelling
D) Karyorrhexis
Correct Answer: C) Mitochondrial swelling
Rationale: Early reversible cell injury causes decreased ATP production, leading to failure
of the Na⁺/K⁺-ATPase pump, cellular swelling, and mitochondrial swelling. These changes are
reversible if the injurious stimulus is removed early. Nuclear changes (pyknosis, karyorrhexis,
karyolysis) indicate irreversible injury.
7. A patient sustained a brain infarct. The necrotic tissue becomes soft and liquefied. This is
consistent with:
A) Coagulative necrosis
B) Caseous necrosis
C) Liquefactive necrosis
D) Fat necrosis
Correct Answer: C) Liquefactive necrosis
Rationale: The brain undergoes liquefactive necrosis after ischemic injury because it has a
high lipid content and abundant hydrolytic enzymes. Neutrophils and macrophages digest the
dead tissue, producing a liquid cystic mass.
8. A 45-year-old male with chronic alcohol use disorder has a liver biopsy showing
accumulation of fat droplets within hepatocytes. This cellular change is best described as:
A) Necrosis
B) Apoptosis
, C) Steatosis
D) Fibrosis
Correct Answer: C) Steatosis
Rationale: Steatosis is the accumulation of triglycerides within hepatocytes, commonly
seen in fatty liver disease caused by chronic alcohol consumption, malnutrition, or metabolic
disorders. The condition is reversible if the causative agent is removed. Necrosis is cell death
with inflammatory response, apoptosis is programmed cell death, and fibrosis is connective
tissue proliferation.
9. Which of the following best characterizes reversible cellular injury?
A) Loss of mitochondrial function and cell membrane integrity
B) Maintenance of cell membrane integrity and reversible biochemical changes
C) Permanent denaturation of nuclear proteins
D) Complete dissolution of the cell nucleus
Correct Answer: B) Maintenance of cell membrane integrity and reversible biochemical
changes
Rationale: Reversible cellular injury is characterized by preservation of cell membrane
integrity and biochemical changes that can be corrected if the offending stimulus is removed.
When ATP production is compromised, the Na⁺/K⁺-ATPase fails, leading to cellular swelling
(hydropic change). However, if the injury is mild and brief, these changes can resolve.
10. An 8-year-old child presents with recurrent respiratory infections. Chest imaging reveals
bronchiectasis with columnar to cuboidal epithelium replacing the normal ciliated
pseudostratified columnar epithelium in the bronchi. This represents:
A) Dysplasia
B) Anaplasia
C) Hyperplasia
D) Metaplasia
Correct Answer: D) Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another, usually in response to chronic irritation or inflammation. In this case, ciliated
Exam 2025/2026 – Complete Exam
Questions and Answers
Section 1: Cellular Adaptation, Injury & Death (Questions 1–20)
1. A 62-year-old patient with chronic hypertension has developed left ventricular hypertrophy.
Which cellular adaptation best describes this change?
A) Hyperplasia — increase in cell number
B) Metaplasia — replacement of one cell type with another
C) Hypertrophy — increase in cell size
D) Dysplasia — abnormal cell growth and organization
Correct Answer: C) Hypertrophy — increase in cell size
Rationale: Hypertrophy is an increase in cell size in response to increased workload.
Chronic hypertension increases afterload on the left ventricle, causing myocardial cells to
hypertrophy to meet the increased demand. This is a compensatory adaptation that can
eventually become pathologic.
2. A smoker's bronchial epithelium transitions from columnar to squamous cells over time.
This cellular change is called:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Correct Answer: B) Metaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type with another.
In smokers, chronic irritation causes columnar bronchial epithelium to convert to squamous
epithelium, which is more resistant to irritation but loses ciliary function.
,3. A cell undergoes programmed, energy-dependent death without triggering inflammation.
This process is:
A) Liquefactive necrosis
B) Apoptosis
C) Coagulative necrosis
D) Caseous necrosis
Correct Answer: B) Apoptosis
Rationale: Apoptosis is programmed cell death involving caspase activation, DNA
fragmentation, and formation of apoptotic bodies. It does not trigger inflammation because
contents are contained within membrane-bound vesicles and cleared by phagocytes.
4. Following a myocardial infarction, the infarcted tissue maintains its structural outline but
cells are dead. This type of necrosis is:
A) Fat necrosis
B) Liquefactive necrosis
C) Coagulative necrosis
D) Fibrinoid necrosis
Correct Answer: C) Coagulative necrosis
Rationale: Coagulative necrosis preserves the structural architecture of dead tissue for
days because denatured proteins resist proteolysis. It is the hallmark of ischemic injury in
solid organs such as the heart and kidney.
5. A patient with tuberculosis has a chest X-ray showing cheese-like necrotic material in the
lung. This finding represents:
A) Coagulative necrosis
B) Caseous necrosis
C) Fat necrosis
D) Gangrenous necrosis
Correct Answer: B) Caseous necrosis
,Rationale: Caseous necrosis is characteristic of tuberculosis and fungal infections.
Histologically it appears as amorphous, granular, cheese-like debris surrounded by
granulomatous inflammation. It is a combination of coagulative and liquefactive necrosis.
6. Which of the following is an early reversible sign of cell injury seen on electron microscopy?
A) Nuclear pyknosis
B) Membrane rupture
C) Mitochondrial swelling
D) Karyorrhexis
Correct Answer: C) Mitochondrial swelling
Rationale: Early reversible cell injury causes decreased ATP production, leading to failure
of the Na⁺/K⁺-ATPase pump, cellular swelling, and mitochondrial swelling. These changes are
reversible if the injurious stimulus is removed early. Nuclear changes (pyknosis, karyorrhexis,
karyolysis) indicate irreversible injury.
7. A patient sustained a brain infarct. The necrotic tissue becomes soft and liquefied. This is
consistent with:
A) Coagulative necrosis
B) Caseous necrosis
C) Liquefactive necrosis
D) Fat necrosis
Correct Answer: C) Liquefactive necrosis
Rationale: The brain undergoes liquefactive necrosis after ischemic injury because it has a
high lipid content and abundant hydrolytic enzymes. Neutrophils and macrophages digest the
dead tissue, producing a liquid cystic mass.
8. A 45-year-old male with chronic alcohol use disorder has a liver biopsy showing
accumulation of fat droplets within hepatocytes. This cellular change is best described as:
A) Necrosis
B) Apoptosis
, C) Steatosis
D) Fibrosis
Correct Answer: C) Steatosis
Rationale: Steatosis is the accumulation of triglycerides within hepatocytes, commonly
seen in fatty liver disease caused by chronic alcohol consumption, malnutrition, or metabolic
disorders. The condition is reversible if the causative agent is removed. Necrosis is cell death
with inflammatory response, apoptosis is programmed cell death, and fibrosis is connective
tissue proliferation.
9. Which of the following best characterizes reversible cellular injury?
A) Loss of mitochondrial function and cell membrane integrity
B) Maintenance of cell membrane integrity and reversible biochemical changes
C) Permanent denaturation of nuclear proteins
D) Complete dissolution of the cell nucleus
Correct Answer: B) Maintenance of cell membrane integrity and reversible biochemical
changes
Rationale: Reversible cellular injury is characterized by preservation of cell membrane
integrity and biochemical changes that can be corrected if the offending stimulus is removed.
When ATP production is compromised, the Na⁺/K⁺-ATPase fails, leading to cellular swelling
(hydropic change). However, if the injury is mild and brief, these changes can resolve.
10. An 8-year-old child presents with recurrent respiratory infections. Chest imaging reveals
bronchiectasis with columnar to cuboidal epithelium replacing the normal ciliated
pseudostratified columnar epithelium in the bronchi. This represents:
A) Dysplasia
B) Anaplasia
C) Hyperplasia
D) Metaplasia
Correct Answer: D) Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another, usually in response to chronic irritation or inflammation. In this case, ciliated
