Page 1 of 234
NR507: ADVANCED
PATHOPHYSIOLOGY | MIDTERM
EXAMINATION QUESTION BANK
Table of Contents
1. **Section 1: Cellular Adaptation, Injury & Death** (Questions 1–35) – Page 5
2. **Section 2: Fluid, Electrolyte & Acid-Base Imbalances** (Questions 36–65) – Page 18
3. **Section 3: Inflammation, Infection & Immunity** (Questions 66–100) – Page 32
4. **Section 4: Genetic Disorders & Neoplasia** (Questions 101–130) – Page 47
5. **Section 5: Cardiovascular Pathophysiology** (Questions 131–160) – Page 60
6. **Section 6: Respiratory Pathophysiology** (Questions 161–185) – Page 73
7. **Section 7: Renal & Urological Pathophysiology** (Questions 186–210) – Page 84
Section 1: Cellular Adaptation, Injury & Death
Questions 1–35
Question 1
Topic: Cellular Adaptation
Learning Objective: Identify the primary mechanism of cellular atrophy
Difficulty: Easy
,Page 2 of 234
A 72-year-old patient experiences significant muscle wasting after six weeks of immobilization
following a hip fracture. Which mechanism best explains this cellular change?
A. Increased protein synthesis with cellular swelling
B. Decreased protein synthesis with increased autophagy
C. Increased cell division with tissue hyperplasia
D. Transformation of muscle cells to connective tissue
Correct answer: B. Decreased protein synthesis with increased autophagy
Detailed rationale: Atrophy represents a reduction in cell size through decreased protein
synthesis and increased degradation of cellular components via autophagy and the ubiquitin-
proteasome system. When muscle is immobilized, the lack of mechanical stimulation and
reduced metabolic demand triggers this adaptive response. The cells remain viable but smaller,
allowing for potential recovery if the stimulus is removed.
Why the other options are incorrect:
- A: Increased protein synthesis with swelling describes hypertrophy, not atrophy.
- C: Increased cell division describes hyperplasia, which does not occur in skeletal muscle (a
permanent tissue).
- D: Transformation to connective tissue describes fibrosis or metaplasia, not simple atrophy.
Exam tip: Remember that atrophy involves "use it or lose it" – decreased workload leads to
decreased cell size through enhanced protein degradation pathways.
---
**Question 2**
,Page 3 of 234
**Topic:** Cellular Adaptation
**Learning Objective:** Differentiate types of cellular adaptation
**Difficulty:** Easy
A woman with chronic cervical irritation undergoes a Pap smear that reveals columnar epithelial
cells have been replaced by squamous epithelial cells. This cellular change represents:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
**Correct answer:** C. Metaplasia
**Detailed rationale:** Metaplasia is the reversible replacement of one mature cell type with
another mature cell type that is better able to survive the adverse environment. In the cervix,
chronic irritation causes columnar epithelium to be replaced by more robust stratified
squamous epithelium. While this adaptation is protective, it may increase risk of malignant
transformation if the stimulus persists.
**Why the other options are incorrect:**
- A: Hyperplasia involves an increase in cell number, not a change in cell type.
- B: Hypertrophy involves an increase in cell size, not a change in cell type.
- D: Dysplasia involves disordered growth with abnormal cell appearance, representing a more
concerning pre-malignant change.
**Exam tip:** Metaplasia = "meta" (change) + "plasia" (growth) = change from one mature cell
type to another. It is reversible but can progress to dysplasia.
, Page 4 of 234
---
**Question 3**
**Topic:** Cellular Adaptation
**Learning Objective:** Distinguish between physiologic and pathologic hypertrophy
**Difficulty:** Easy
Which of the following represents physiologic hypertrophy?
A. Cardiac muscle enlargement in response to chronic hypertension
B. Skeletal muscle enlargement in response to resistance training
C. Prostate gland enlargement in benign prostatic hyperplasia
D. Endometrial thickening during the menstrual cycle
**Correct answer:** B. Skeletal muscle enlargement in response to resistance training
**Detailed rationale:** Physiologic hypertrophy occurs in response to normal stimuli such as
exercise, resulting in increased muscle mass without pathologic consequences. Resistance
training causes skeletal muscle fibers to increase in size due to increased protein synthesis and
sarcomere addition. This adaptation improves function and is reversible when training ceases.
**Why the other options are incorrect:**
- A: Cardiac hypertrophy from hypertension is pathologic, often leading to heart failure.
- C: Benign prostatic hyperplasia involves hyperplasia (increased cell number), not hypertrophy.
- D: Endometrial thickening involves hyperplasia stimulated by hormones, not hypertrophy.
NR507: ADVANCED
PATHOPHYSIOLOGY | MIDTERM
EXAMINATION QUESTION BANK
Table of Contents
1. **Section 1: Cellular Adaptation, Injury & Death** (Questions 1–35) – Page 5
2. **Section 2: Fluid, Electrolyte & Acid-Base Imbalances** (Questions 36–65) – Page 18
3. **Section 3: Inflammation, Infection & Immunity** (Questions 66–100) – Page 32
4. **Section 4: Genetic Disorders & Neoplasia** (Questions 101–130) – Page 47
5. **Section 5: Cardiovascular Pathophysiology** (Questions 131–160) – Page 60
6. **Section 6: Respiratory Pathophysiology** (Questions 161–185) – Page 73
7. **Section 7: Renal & Urological Pathophysiology** (Questions 186–210) – Page 84
Section 1: Cellular Adaptation, Injury & Death
Questions 1–35
Question 1
Topic: Cellular Adaptation
Learning Objective: Identify the primary mechanism of cellular atrophy
Difficulty: Easy
,Page 2 of 234
A 72-year-old patient experiences significant muscle wasting after six weeks of immobilization
following a hip fracture. Which mechanism best explains this cellular change?
A. Increased protein synthesis with cellular swelling
B. Decreased protein synthesis with increased autophagy
C. Increased cell division with tissue hyperplasia
D. Transformation of muscle cells to connective tissue
Correct answer: B. Decreased protein synthesis with increased autophagy
Detailed rationale: Atrophy represents a reduction in cell size through decreased protein
synthesis and increased degradation of cellular components via autophagy and the ubiquitin-
proteasome system. When muscle is immobilized, the lack of mechanical stimulation and
reduced metabolic demand triggers this adaptive response. The cells remain viable but smaller,
allowing for potential recovery if the stimulus is removed.
Why the other options are incorrect:
- A: Increased protein synthesis with swelling describes hypertrophy, not atrophy.
- C: Increased cell division describes hyperplasia, which does not occur in skeletal muscle (a
permanent tissue).
- D: Transformation to connective tissue describes fibrosis or metaplasia, not simple atrophy.
Exam tip: Remember that atrophy involves "use it or lose it" – decreased workload leads to
decreased cell size through enhanced protein degradation pathways.
---
**Question 2**
,Page 3 of 234
**Topic:** Cellular Adaptation
**Learning Objective:** Differentiate types of cellular adaptation
**Difficulty:** Easy
A woman with chronic cervical irritation undergoes a Pap smear that reveals columnar epithelial
cells have been replaced by squamous epithelial cells. This cellular change represents:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
**Correct answer:** C. Metaplasia
**Detailed rationale:** Metaplasia is the reversible replacement of one mature cell type with
another mature cell type that is better able to survive the adverse environment. In the cervix,
chronic irritation causes columnar epithelium to be replaced by more robust stratified
squamous epithelium. While this adaptation is protective, it may increase risk of malignant
transformation if the stimulus persists.
**Why the other options are incorrect:**
- A: Hyperplasia involves an increase in cell number, not a change in cell type.
- B: Hypertrophy involves an increase in cell size, not a change in cell type.
- D: Dysplasia involves disordered growth with abnormal cell appearance, representing a more
concerning pre-malignant change.
**Exam tip:** Metaplasia = "meta" (change) + "plasia" (growth) = change from one mature cell
type to another. It is reversible but can progress to dysplasia.
, Page 4 of 234
---
**Question 3**
**Topic:** Cellular Adaptation
**Learning Objective:** Distinguish between physiologic and pathologic hypertrophy
**Difficulty:** Easy
Which of the following represents physiologic hypertrophy?
A. Cardiac muscle enlargement in response to chronic hypertension
B. Skeletal muscle enlargement in response to resistance training
C. Prostate gland enlargement in benign prostatic hyperplasia
D. Endometrial thickening during the menstrual cycle
**Correct answer:** B. Skeletal muscle enlargement in response to resistance training
**Detailed rationale:** Physiologic hypertrophy occurs in response to normal stimuli such as
exercise, resulting in increased muscle mass without pathologic consequences. Resistance
training causes skeletal muscle fibers to increase in size due to increased protein synthesis and
sarcomere addition. This adaptation improves function and is reversible when training ceases.
**Why the other options are incorrect:**
- A: Cardiac hypertrophy from hypertension is pathologic, often leading to heart failure.
- C: Benign prostatic hyperplasia involves hyperplasia (increased cell number), not hypertrophy.
- D: Endometrial thickening involves hyperplasia stimulated by hormones, not hypertrophy.
