NR507 Midterm Exam Advanced Pathophysiology
Chamberlain College Actual Exam 2026/2027 – Complete 75
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
SECTION A: Cellular Biology, Adaptation, Injury & Death (Q1–Q12)
Q1: A 42-year-old man's right leg is placed in a cast for 8 weeks following a fracture.
When the cast is removed, the right calf measures 3 cm smaller in circumference than
the left. This change represents which cellular adaptation?
A. Atrophy — decreased cell size from reduced workload [CORRECT]
B. Hypertrophy — increased cell size from increased workload
C. Hyperplasia — increased cell number
D. Metaplasia — replacement of one cell type by another
Correct Answer: A
Rationale: Disuse atrophy occurs when immobilization reduces workload, causing cells
to shrink and decrease protein synthesis. Hypertrophy and hyperplasia increase cell
size/number, and metaplasia involves cell-type substitution, none of which describe
immobilization-related loss of muscle bulk.
Q2: An autopsy specimen from a patient with long-standing, untreated hypertension
shows markedly thickened left ventricular walls with enlarged individual cardiac muscle
cells. This change is BEST classified as:
A. Pathologic hyperplasia
B. Pathologic hypertrophy of myocardial cells [CORRECT]
C. Atrophy of cardiac muscle
D. Dysplasia of cardiac tissue
Correct Answer: B
Rationale: Cardiac muscle cannot undergo hyperplasia (it is a permanent tissue), so
chronic pressure overload from hypertension enlarges individual myocytes — pathologic
hypertrophy. Hyperplasia is impossible here, atrophy is shrinking, and dysplasia refers to
disordered cellular maturation.
,Q3: A postmenopausal woman taking unopposed estrogen develops abnormally
thickened endometrium; biopsy shows an increased NUMBER of endometrial glandular
cells with normal-appearing architecture. This is:
A. Hypertrophy
B. Metaplasia
C. Hyperplasia [CORRECT]
D. Apoptosis
Correct Answer: C
Rationale: Hormonal stimulation increased the number of endometrial cells, defining
hyperplasia — a process that raises endometrial cancer risk when unopposed.
Hypertrophy increases cell size, metaplasia changes cell type, and apoptosis is cell
death.
Q4: A 55-year-old chronic smoker undergoes bronchoscopy; the normal ciliated
columnar epithelium of his bronchi has been replaced by stratified squamous
epithelium that can better withstand smoke irritation but has lost cilia and mucus
secretion. This adaptive change is:
A. Dysplasia
B. Hyperplasia
C. Atrophy
D. Metaplasia [CORRECT]
Correct Answer: D
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
better able to tolerate the adverse environment — here, squamous epithelium replacing
columnar cells in response to smoking. Dysplasia adds disordered growth, and
hyperplasia only increases cell numbers without changing type.
Q5: A Pap smear shows cervical epithelial cells with increased mitotic activity, variation
in size and shape, and loss of normal organization. The provider explains this is a
precancerous change that may be REVERSIBLE if the irritating stimulus
(HPV-associated changes) is removed. This is:
A. Dysplasia [CORRECT]
B. Physiologic hypertrophy
C. Normal hyperplasia
D. Caseous necrosis
Correct Answer: A
Rationale: Dysplasia is disordered cellular growth with atypia and lost organization that
can regress if the irritant is eliminated or progress to carcinoma in situ. Normal
adaptations preserve architecture, and necrosis is cell death, not disordered maturation.
, Q6: A patient in hypovolemic shock develops cellular injury; because ATP is depleted,
the Na⁺/K⁺ pump fails, sodium and water enter cells, and the cells swell. This early
change is:
A. Irreversible coagulative necrosis
B. Reversible cellular swelling (hydropic degeneration) [CORRECT]
C. Apoptotic fragmentation
D. Fat necrosis with saponification
Correct Answer: B
Rationale: Failure of energy-dependent pumps causes osmotic cell swelling — the first
manifestation of most injuries and still REVERSIBLE if perfusion is restored. Necrosis
and apoptotic fragmentation represent later, different events, and fat necrosis occurs in
specific contexts such as pancreatic injury.
Q7: During complete ischemia, which event occurs FIRST in the cascade of hypoxic
injury?
A. Cell membrane rupture with enzyme leakage
B. Random DNA degradation
C. Decreased ATP production causing failure of the Na⁺/K⁺ pump and cellular swelling
[CORRECT]
D. Coagulative necrosis with scar formation
Correct Answer: C
Rationale: Hypoxia stops oxidative phosphorylation, and ATP depletion promptly
disables membrane pumps, producing swelling before irreversible events. Membrane
rupture, random DNA destruction, and necrosis mark later, irreversible stages.
Q8: A patient dies 5 days after a massive myocardial infarction. Autopsy reveals an area
of dead myocardium in which the cell architecture is preserved as "ghost outlines," with
protein coagulation and loss of nuclei. This type of necrosis is:
A. Liquefactive necrosis
B. Fat necrosis
C. Caseous necrosis
D. Coagulative necrosis [CORRECT]
Correct Answer: D
Rationale: Coagulative necrosis — caused by ischemia in solid organs such as heart,
kidney, and spleen — preserves tissue architecture for days as proteins denature.
Liquefactive necrosis transforms tissue into liquid (brain, abscesses), caseous necrosis
occurs in tuberculosis, and fat necrosis accompanies lipase-release injury.
Q9: A chest X-ray and sputum studies of an immigrant patient with chronic cough reveal
a granulomatous lung lesion; biopsy shows crumbly, "cheese-like" debris combining
Chamberlain College Actual Exam 2026/2027 – Complete 75
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
SECTION A: Cellular Biology, Adaptation, Injury & Death (Q1–Q12)
Q1: A 42-year-old man's right leg is placed in a cast for 8 weeks following a fracture.
When the cast is removed, the right calf measures 3 cm smaller in circumference than
the left. This change represents which cellular adaptation?
A. Atrophy — decreased cell size from reduced workload [CORRECT]
B. Hypertrophy — increased cell size from increased workload
C. Hyperplasia — increased cell number
D. Metaplasia — replacement of one cell type by another
Correct Answer: A
Rationale: Disuse atrophy occurs when immobilization reduces workload, causing cells
to shrink and decrease protein synthesis. Hypertrophy and hyperplasia increase cell
size/number, and metaplasia involves cell-type substitution, none of which describe
immobilization-related loss of muscle bulk.
Q2: An autopsy specimen from a patient with long-standing, untreated hypertension
shows markedly thickened left ventricular walls with enlarged individual cardiac muscle
cells. This change is BEST classified as:
A. Pathologic hyperplasia
B. Pathologic hypertrophy of myocardial cells [CORRECT]
C. Atrophy of cardiac muscle
D. Dysplasia of cardiac tissue
Correct Answer: B
Rationale: Cardiac muscle cannot undergo hyperplasia (it is a permanent tissue), so
chronic pressure overload from hypertension enlarges individual myocytes — pathologic
hypertrophy. Hyperplasia is impossible here, atrophy is shrinking, and dysplasia refers to
disordered cellular maturation.
,Q3: A postmenopausal woman taking unopposed estrogen develops abnormally
thickened endometrium; biopsy shows an increased NUMBER of endometrial glandular
cells with normal-appearing architecture. This is:
A. Hypertrophy
B. Metaplasia
C. Hyperplasia [CORRECT]
D. Apoptosis
Correct Answer: C
Rationale: Hormonal stimulation increased the number of endometrial cells, defining
hyperplasia — a process that raises endometrial cancer risk when unopposed.
Hypertrophy increases cell size, metaplasia changes cell type, and apoptosis is cell
death.
Q4: A 55-year-old chronic smoker undergoes bronchoscopy; the normal ciliated
columnar epithelium of his bronchi has been replaced by stratified squamous
epithelium that can better withstand smoke irritation but has lost cilia and mucus
secretion. This adaptive change is:
A. Dysplasia
B. Hyperplasia
C. Atrophy
D. Metaplasia [CORRECT]
Correct Answer: D
Rationale: Metaplasia is the reversible replacement of one mature cell type by another
better able to tolerate the adverse environment — here, squamous epithelium replacing
columnar cells in response to smoking. Dysplasia adds disordered growth, and
hyperplasia only increases cell numbers without changing type.
Q5: A Pap smear shows cervical epithelial cells with increased mitotic activity, variation
in size and shape, and loss of normal organization. The provider explains this is a
precancerous change that may be REVERSIBLE if the irritating stimulus
(HPV-associated changes) is removed. This is:
A. Dysplasia [CORRECT]
B. Physiologic hypertrophy
C. Normal hyperplasia
D. Caseous necrosis
Correct Answer: A
Rationale: Dysplasia is disordered cellular growth with atypia and lost organization that
can regress if the irritant is eliminated or progress to carcinoma in situ. Normal
adaptations preserve architecture, and necrosis is cell death, not disordered maturation.
, Q6: A patient in hypovolemic shock develops cellular injury; because ATP is depleted,
the Na⁺/K⁺ pump fails, sodium and water enter cells, and the cells swell. This early
change is:
A. Irreversible coagulative necrosis
B. Reversible cellular swelling (hydropic degeneration) [CORRECT]
C. Apoptotic fragmentation
D. Fat necrosis with saponification
Correct Answer: B
Rationale: Failure of energy-dependent pumps causes osmotic cell swelling — the first
manifestation of most injuries and still REVERSIBLE if perfusion is restored. Necrosis
and apoptotic fragmentation represent later, different events, and fat necrosis occurs in
specific contexts such as pancreatic injury.
Q7: During complete ischemia, which event occurs FIRST in the cascade of hypoxic
injury?
A. Cell membrane rupture with enzyme leakage
B. Random DNA degradation
C. Decreased ATP production causing failure of the Na⁺/K⁺ pump and cellular swelling
[CORRECT]
D. Coagulative necrosis with scar formation
Correct Answer: C
Rationale: Hypoxia stops oxidative phosphorylation, and ATP depletion promptly
disables membrane pumps, producing swelling before irreversible events. Membrane
rupture, random DNA destruction, and necrosis mark later, irreversible stages.
Q8: A patient dies 5 days after a massive myocardial infarction. Autopsy reveals an area
of dead myocardium in which the cell architecture is preserved as "ghost outlines," with
protein coagulation and loss of nuclei. This type of necrosis is:
A. Liquefactive necrosis
B. Fat necrosis
C. Caseous necrosis
D. Coagulative necrosis [CORRECT]
Correct Answer: D
Rationale: Coagulative necrosis — caused by ischemia in solid organs such as heart,
kidney, and spleen — preserves tissue architecture for days as proteins denature.
Liquefactive necrosis transforms tissue into liquid (brain, abscesses), caseous necrosis
occurs in tuberculosis, and fat necrosis accompanies lipase-release injury.
Q9: A chest X-ray and sputum studies of an immigrant patient with chronic cough reveal
a granulomatous lung lesion; biopsy shows crumbly, "cheese-like" debris combining
