1
NR507 / NR 507 Midterm Exam (New
2025/2026 Update) Advanced
Pathophysiology | Questions and
Verified Answers | 100% Correct | A
Grade – Chamberlain
Section 1: Cellular Injury (Questions 1-10)
Question 1: In reversible cellular injury, which mechanism primarily
leads to cellular swelling due to impaired ATP production?
• A. Nuclear pyknosis
• B. Mitochondrial dysfunction
• C. Plasma membrane rupture
• D. Lysosomal enzyme leakage
B Rationale: Mitochondrial dysfunction impairs ATP synthesis, leading
to failure of the Na+/K+ ATPase pump, causing sodium influx and
cellular swelling (hydropic change), which is reversible if restored early.
A is a feature of irreversible injury; C and D indicate necrosis.
Question 2: Which type of cellular adaptation occurs when hepatocytes
enlarge in response to chronic alcohol exposure?
• A. Atrophy
• B. Hypertrophy
• C. Hyperplasia
• D. Metaplasia
B Rationale: Hypertrophy involves increased cell size due to synthetic
demands, as in alcoholic liver disease where hepatocytes accumulate fat
, 2
and proteins. A is size reduction; C is cell number increase; D is cell
type change.
Question 3: Free radical injury in ischemia-reperfusion damage
primarily targets which cellular component?
• A. Nucleus
• B. Lipids in membranes
• C. Cytoskeleton
• D. Ribosomes
B Rationale: Free radicals cause lipid peroxidation in polyunsaturated
fatty acids of cell membranes, leading to membrane instability and
leakage. A, C, and D are secondary targets with less direct impact.
Question 4: The transition from reversible to irreversible cellular injury
is marked by?
• A. Glycogen depletion
• B. Mitochondrial permeability transition
• C. Endoplasmic reticulum dilation
• D. Cytoplasmic vacuolation
B Rationale: Mitochondrial permeability transition releases cytochrome
c, initiating apoptosis or necrosis, a key irreversible event. A, C, and D
are reversible changes.
Question 5: In hypoxic injury, the earliest ultrastructural change
observed is?
• A. Blebbing of the plasma membrane
• B. Swelling of the endoplasmic reticulum
• C. Chromatin clumping
• D. Karyorrhexis
, 3
B Rationale: ER swelling occurs first due to impaired protein folding
from ATP loss in hypoxia. A and C are later; D is irreversible nuclear
fragmentation.
Question 6: Which enzyme system detoxifies reactive oxygen species in
cellular injury?
• A. Cytochrome P450
• B. Superoxide dismutase
• C. Caspase-3
• D. DNA polymerase
B Rationale: Superoxide dismutase converts superoxide to hydrogen
peroxide, a primary antioxidant defense. A metabolizes xenobiotics; C
executes apoptosis; D repairs DNA.
Question 7: Calcific deposits in damaged cells (dystrophic calcification)
result from?
• A. Hypercalcemia
• B. Mitochondrial calcium overload
• C. Lysosomal phosphate release
• D. Extracellular matrix degradation
B Rationale: Damaged mitochondria sequester calcium, leading to
phosphate precipitation as calcium phosphate crystals. A is systemic; C
and D are unrelated.
Question 8: Apoptosis in cellular injury is triggered by which intrinsic
pathway activator?
• A. TNF-alpha
• B. Bax/Bak oligomerization
• C. Fas ligand
• D. Granzyme B
NR507 / NR 507 Midterm Exam (New
2025/2026 Update) Advanced
Pathophysiology | Questions and
Verified Answers | 100% Correct | A
Grade – Chamberlain
Section 1: Cellular Injury (Questions 1-10)
Question 1: In reversible cellular injury, which mechanism primarily
leads to cellular swelling due to impaired ATP production?
• A. Nuclear pyknosis
• B. Mitochondrial dysfunction
• C. Plasma membrane rupture
• D. Lysosomal enzyme leakage
B Rationale: Mitochondrial dysfunction impairs ATP synthesis, leading
to failure of the Na+/K+ ATPase pump, causing sodium influx and
cellular swelling (hydropic change), which is reversible if restored early.
A is a feature of irreversible injury; C and D indicate necrosis.
Question 2: Which type of cellular adaptation occurs when hepatocytes
enlarge in response to chronic alcohol exposure?
• A. Atrophy
• B. Hypertrophy
• C. Hyperplasia
• D. Metaplasia
B Rationale: Hypertrophy involves increased cell size due to synthetic
demands, as in alcoholic liver disease where hepatocytes accumulate fat
, 2
and proteins. A is size reduction; C is cell number increase; D is cell
type change.
Question 3: Free radical injury in ischemia-reperfusion damage
primarily targets which cellular component?
• A. Nucleus
• B. Lipids in membranes
• C. Cytoskeleton
• D. Ribosomes
B Rationale: Free radicals cause lipid peroxidation in polyunsaturated
fatty acids of cell membranes, leading to membrane instability and
leakage. A, C, and D are secondary targets with less direct impact.
Question 4: The transition from reversible to irreversible cellular injury
is marked by?
• A. Glycogen depletion
• B. Mitochondrial permeability transition
• C. Endoplasmic reticulum dilation
• D. Cytoplasmic vacuolation
B Rationale: Mitochondrial permeability transition releases cytochrome
c, initiating apoptosis or necrosis, a key irreversible event. A, C, and D
are reversible changes.
Question 5: In hypoxic injury, the earliest ultrastructural change
observed is?
• A. Blebbing of the plasma membrane
• B. Swelling of the endoplasmic reticulum
• C. Chromatin clumping
• D. Karyorrhexis
, 3
B Rationale: ER swelling occurs first due to impaired protein folding
from ATP loss in hypoxia. A and C are later; D is irreversible nuclear
fragmentation.
Question 6: Which enzyme system detoxifies reactive oxygen species in
cellular injury?
• A. Cytochrome P450
• B. Superoxide dismutase
• C. Caspase-3
• D. DNA polymerase
B Rationale: Superoxide dismutase converts superoxide to hydrogen
peroxide, a primary antioxidant defense. A metabolizes xenobiotics; C
executes apoptosis; D repairs DNA.
Question 7: Calcific deposits in damaged cells (dystrophic calcification)
result from?
• A. Hypercalcemia
• B. Mitochondrial calcium overload
• C. Lysosomal phosphate release
• D. Extracellular matrix degradation
B Rationale: Damaged mitochondria sequester calcium, leading to
phosphate precipitation as calcium phosphate crystals. A is systemic; C
and D are unrelated.
Question 8: Apoptosis in cellular injury is triggered by which intrinsic
pathway activator?
• A. TNF-alpha
• B. Bax/Bak oligomerization
• C. Fas ligand
• D. Granzyme B
