,D236 Pathophysiology Exam Prep —
Comprehensive Review + Practice
MCQs — Western Governors University
2025/2026
1. A patient with chronic obstructive pulmonary disease (COPD) has persistent hypoxemia over several years.
Bronchial biopsy reveals a decrease in cell size and metabolic activity in the epithelial lining. Which cellular
adaptation does this represent?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in cell size and function that occurs when cells are subjected to reduced
oxygen or nutrient supply, disuse, or chronic stress. In chronic hypoxia from COPD, cells reduce their size and
metabolic demands to conserve energy and remain viable .
2. A patient with chronic hypertension develops thickening of the left ventricular wall. Which cellular
adaptation best explains this finding?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
,Correct Answer: B
Rationale: Hypertrophy is an increase in cell size, not cell number. Cardiac muscle cells cannot undergo mitotic
division (hyperplasia), so they enlarge in response to increased workload. Chronic hypertension increases
afterload on the left ventricle, causing compensatory hypertrophy .
3. A smoker with chronic bronchitis undergoes bronchial biopsy that shows normal ciliated columnar
epithelium replaced by stratified squamous epithelium. This change is best classified as:
A. Atrophy
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type by another, more resistant cell
type in response to chronic irritation. In smokers, ciliated columnar epithelium is replaced by stratified
squamous epithelium, which can better withstand the irritant but loses ciliary clearance function .
4. A cervical Pap smear shows abnormal cellular proliferation with variation in cell size and shape,
hyperchromatic nuclei, and disordered arrangement, but no invasion of the basement membrane. This finding
is best classified as:
A. Metaplasia
B. Dysplasia
C. Anaplasia
, D. Hyperplasia
Correct Answer: B
Rationale: Dysplasia is characterized by disordered growth with cellular atypia (pleomorphism, hyperchromatic
nuclei, increased mitotic figures) but without basement membrane invasion. It is considered a premalignant
change that may regress or progress to carcinoma in situ .
5. During ischemia, ATP depletion causes failure of the sodium-potassium pump. Which consequence directly
results from this pump failure?
A. Cellular shrinkage
B. Cellular swelling
C. Apoptosis
D. Autophagy
Correct Answer: B
Rationale: ATP depletion impairs the Na⁺/K⁺ ATPase pump, causing sodium to accumulate intracellularly. Water
follows sodium osmotically, leading to cellular swelling (edema). This is a hallmark of reversible cellular injury .
6. A lung biopsy from a patient with tuberculosis shows a cheese-like, white, granular area of necrosis. Which
type of necrosis is this?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
Comprehensive Review + Practice
MCQs — Western Governors University
2025/2026
1. A patient with chronic obstructive pulmonary disease (COPD) has persistent hypoxemia over several years.
Bronchial biopsy reveals a decrease in cell size and metabolic activity in the epithelial lining. Which cellular
adaptation does this represent?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in cell size and function that occurs when cells are subjected to reduced
oxygen or nutrient supply, disuse, or chronic stress. In chronic hypoxia from COPD, cells reduce their size and
metabolic demands to conserve energy and remain viable .
2. A patient with chronic hypertension develops thickening of the left ventricular wall. Which cellular
adaptation best explains this finding?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
,Correct Answer: B
Rationale: Hypertrophy is an increase in cell size, not cell number. Cardiac muscle cells cannot undergo mitotic
division (hyperplasia), so they enlarge in response to increased workload. Chronic hypertension increases
afterload on the left ventricle, causing compensatory hypertrophy .
3. A smoker with chronic bronchitis undergoes bronchial biopsy that shows normal ciliated columnar
epithelium replaced by stratified squamous epithelium. This change is best classified as:
A. Atrophy
B. Dysplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type by another, more resistant cell
type in response to chronic irritation. In smokers, ciliated columnar epithelium is replaced by stratified
squamous epithelium, which can better withstand the irritant but loses ciliary clearance function .
4. A cervical Pap smear shows abnormal cellular proliferation with variation in cell size and shape,
hyperchromatic nuclei, and disordered arrangement, but no invasion of the basement membrane. This finding
is best classified as:
A. Metaplasia
B. Dysplasia
C. Anaplasia
, D. Hyperplasia
Correct Answer: B
Rationale: Dysplasia is characterized by disordered growth with cellular atypia (pleomorphism, hyperchromatic
nuclei, increased mitotic figures) but without basement membrane invasion. It is considered a premalignant
change that may regress or progress to carcinoma in situ .
5. During ischemia, ATP depletion causes failure of the sodium-potassium pump. Which consequence directly
results from this pump failure?
A. Cellular shrinkage
B. Cellular swelling
C. Apoptosis
D. Autophagy
Correct Answer: B
Rationale: ATP depletion impairs the Na⁺/K⁺ ATPase pump, causing sodium to accumulate intracellularly. Water
follows sodium osmotically, leading to cellular swelling (edema). This is a hallmark of reversible cellular injury .
6. A lung biopsy from a patient with tuberculosis shows a cheese-like, white, granular area of necrosis. Which
type of necrosis is this?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
