,NR 507 Midterm Exam | Advanced Pathophysiology
(2026) Actual Q&A PDF | Chamberlain
1. A 68-year-old male with long-standing hypertension has an echocardiogram
demonstrating increased left ventricular wall thickness without chamber dilation. Which
cellular adaptation is primarily responsible for this finding?
A) Hyperplasia of cardiac myocytes
B) Hypertrophy of cardiac myocytes
C) Metaplasia of cardiac tissue
D) Atrophy of ventricular myocardium
Correct Answer: Hypertrophy of cardiac myocytes
Rationale: Chronic pressure overload from hypertension stimulates an increase in
individual myocyte size, known as hypertrophy, which thickens the ventricular wall
without increasing cell number. Hyperplasia is limited in terminally differentiated cardiac
cells, while metaplasia and atrophy do not characterize this compensatory response to
pressure overload.
2. During an acute myocardial infarction, a region of irreversibly injured myocardium
exhibits disrupted cell membranes, mitochondrial swelling, and calcium influx. Which
form of cell death is primarily occurring?
A) Apoptosis with orderly DNA fragmentation
B) Autophagy with lysosomal recycling
,C) Necrosis with inflammatory sequelae
D) Senescence with permanent cell-cycle arrest
Correct Answer: Necrosis with inflammatory sequelae
Rationale: Ischemic necrosis is characterized by loss of membrane integrity, organelle
swelling, and subsequent inflammation, which distinguishes it from the energy-
dependent and non-inflammatory process of apoptosis. Autophagy and senescence are
distinct cellular processes not primarily defining acute infarct zones.
3. A patient with chronic gastroesophageal reflux disease develops replacement of the
normal esophageal squamous epithelium with columnar epithelium. This adaptive
change is best classified as which process?
A) Metaplasia driven by chronic injury
B) Hyperplasia of residual squamous cells
C) Dysplasia with disordered maturation
D) Neoplastic transformation to adenocarcinoma
Correct Answer: Metaplasia driven by chronic injury
Rationale: Barrett esophagus exemplifies metaplasia, a reversible change in which one
differentiated cell type is replaced by another better suited to withstand the chronic acid
exposure. While dysplasia and adenocarcinoma may later arise from this change, the
defining adaptive step is metaplasia.
, 4. A pathologist examining a cervical biopsy notes cells with abnormal size, shape, and
organization, but the basement membrane remains intact. This finding is most
consistent with which classification?
A) Metaplasia
B) Hyperplasia
C) Dysplasia
D) Anaplasia
Correct Answer: Dysplasia
Rationale: Dysplasia refers to disorganized growth with abnormal cell morphology
and loss of cellular polarity, yet the basement membrane is intact, distinguishing it from
invasive carcinoma. It is considered a preneoplastic condition, graded from mild to
severe, whereas anaplasia is a loss of differentiation characteristic of malignancy.
5. Which type of cellular adaptation involves an increase in the number of cells in
response to hormonal stimulation or increased functional demand?
A) Hypertrophy
B) Atrophy
C) Metaplasia
D) Hyperplasia
Correct Answer: Hyperplasia
(2026) Actual Q&A PDF | Chamberlain
1. A 68-year-old male with long-standing hypertension has an echocardiogram
demonstrating increased left ventricular wall thickness without chamber dilation. Which
cellular adaptation is primarily responsible for this finding?
A) Hyperplasia of cardiac myocytes
B) Hypertrophy of cardiac myocytes
C) Metaplasia of cardiac tissue
D) Atrophy of ventricular myocardium
Correct Answer: Hypertrophy of cardiac myocytes
Rationale: Chronic pressure overload from hypertension stimulates an increase in
individual myocyte size, known as hypertrophy, which thickens the ventricular wall
without increasing cell number. Hyperplasia is limited in terminally differentiated cardiac
cells, while metaplasia and atrophy do not characterize this compensatory response to
pressure overload.
2. During an acute myocardial infarction, a region of irreversibly injured myocardium
exhibits disrupted cell membranes, mitochondrial swelling, and calcium influx. Which
form of cell death is primarily occurring?
A) Apoptosis with orderly DNA fragmentation
B) Autophagy with lysosomal recycling
,C) Necrosis with inflammatory sequelae
D) Senescence with permanent cell-cycle arrest
Correct Answer: Necrosis with inflammatory sequelae
Rationale: Ischemic necrosis is characterized by loss of membrane integrity, organelle
swelling, and subsequent inflammation, which distinguishes it from the energy-
dependent and non-inflammatory process of apoptosis. Autophagy and senescence are
distinct cellular processes not primarily defining acute infarct zones.
3. A patient with chronic gastroesophageal reflux disease develops replacement of the
normal esophageal squamous epithelium with columnar epithelium. This adaptive
change is best classified as which process?
A) Metaplasia driven by chronic injury
B) Hyperplasia of residual squamous cells
C) Dysplasia with disordered maturation
D) Neoplastic transformation to adenocarcinoma
Correct Answer: Metaplasia driven by chronic injury
Rationale: Barrett esophagus exemplifies metaplasia, a reversible change in which one
differentiated cell type is replaced by another better suited to withstand the chronic acid
exposure. While dysplasia and adenocarcinoma may later arise from this change, the
defining adaptive step is metaplasia.
, 4. A pathologist examining a cervical biopsy notes cells with abnormal size, shape, and
organization, but the basement membrane remains intact. This finding is most
consistent with which classification?
A) Metaplasia
B) Hyperplasia
C) Dysplasia
D) Anaplasia
Correct Answer: Dysplasia
Rationale: Dysplasia refers to disorganized growth with abnormal cell morphology
and loss of cellular polarity, yet the basement membrane is intact, distinguishing it from
invasive carcinoma. It is considered a preneoplastic condition, graded from mild to
severe, whereas anaplasia is a loss of differentiation characteristic of malignancy.
5. Which type of cellular adaptation involves an increase in the number of cells in
response to hormonal stimulation or increased functional demand?
A) Hypertrophy
B) Atrophy
C) Metaplasia
D) Hyperplasia
Correct Answer: Hyperplasia
