NR507 Advanced Pathophysiology Midterm Exam -
Chamberlain University 2026-2027 | Disease
Processes & System Disorders
65 Items | Grade A
All items are applied clinical vignettes that require mechanism-level reasoning.
Domain 1 — Cellular Foundations & Adaptive Responses (16 Qs)
Q1
A 65-year-old male with 50-pack-year smoking history has chronic cough. Bronchoscopy
shows ciliated columnar epithelium replaced by stratified squamous epithelium. This
change is:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct: B (Metaplasia)
Rationale: Reversible substitution of one differentiated cell type by another (columnar →
squamous) in response to chronic irritation. Protective but loses mucus-clearing
function. Hyperplasia = ↑ cell number; dysplasia = disordered growth; anaplasia = loss
of differentiation (malignant).
,Q2
A 30-year-old woman with BRCA1 mutation undergoes breast biopsy showing ductal
epithelium with loss of polarity, nuclear pleomorphism, and increased mitoses but intact
myoepithelial layer. This is:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Carcinoma in situ
Correct: C (Dysplasia)
Rationale: Disordered growth with cytologic atypia confined within basement
membrane. Represents pre-neoplastic change. Not invasive (D) or simple hyperplasia
(A).
Q3
A 55-year-old man with COPD has barrel chest and flattened diaphragm on CXR. These
changes result from:
A. Type I alveolar cell apoptosis
B. Centrilobular emphysema with loss of elastic recoil → air trapping
C. Bronchial smooth muscle hyperplasia
D. Mucus gland hypertrophy
Correct: B
,Rationale: Emphysema destroys alveolar walls → loss of elastic recoil → air trapping →
barrel chest/flat diaphragm. Other options describe different COPD pathologies
(bronchitis, asthma).
Q4
A 70-year-old man with CHF has bilateral pitting edema to knees. Which Starling force
change is primary?
A. ↑ plasma oncotic pressure
B. ↑ interstitial hydrostatic pressure
C. ↑ capillary hydrostatic pressure
D. ↓ capillary oncotic pressure
Correct: C
Rationale: Heart failure → ↑ venous pressure → ↑ capillary hydrostatic pressure → fluid
filtration > reabsorption → edema. Not ↓ oncotic (D) or ↑ interstitial pressure (B).
Q5
A 25-year-old man with acute appendicitis has RLQ pain, fever, and neutrophilia. Which
inflammatory mediator is most responsible for neutrophil margination?
A. IL-1
B. Histamine
C. C5a
D. Bradykinin
, Correct: C (C5a)
Rationale: Complement fragment C5a is potent chemoattractant and causes neutrophil
margination and chemotaxis. IL-1 (A) causes fever and acute phase response;
histamine (B) vasodilation; bradykinin (D) pain.
Q6
A 60-year-old woman with RA has pannus formation on hand X-ray. Pannus consists of:
A. Granulation tissue with fibroblasts and neovessels invading cartilage
B. Caseating necrosis with multinucleated giant cells
C. Fibrinoid necrosis of vessel walls
D. Amyloid deposition in synovium
Correct: A
Rationale: Pannus = inflammatory granulation tissue (fibroblasts, neovessels,
inflammatory cells) that erodes cartilage and bone. Not caseating (B) or amyloid (D).
Q7
A 45-year-old woman with SLE has photosensitive rash and anti-dsDNA antibodies.
Which type of hypersensitivity is primary in SLE?
A. Type I (IgE-mediated)
B. Type II (cytotoxic antibody)
C. Type III (immune complex)
D. Type IV (delayed T-cell)
Chamberlain University 2026-2027 | Disease
Processes & System Disorders
65 Items | Grade A
All items are applied clinical vignettes that require mechanism-level reasoning.
Domain 1 — Cellular Foundations & Adaptive Responses (16 Qs)
Q1
A 65-year-old male with 50-pack-year smoking history has chronic cough. Bronchoscopy
shows ciliated columnar epithelium replaced by stratified squamous epithelium. This
change is:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Anaplasia
Correct: B (Metaplasia)
Rationale: Reversible substitution of one differentiated cell type by another (columnar →
squamous) in response to chronic irritation. Protective but loses mucus-clearing
function. Hyperplasia = ↑ cell number; dysplasia = disordered growth; anaplasia = loss
of differentiation (malignant).
,Q2
A 30-year-old woman with BRCA1 mutation undergoes breast biopsy showing ductal
epithelium with loss of polarity, nuclear pleomorphism, and increased mitoses but intact
myoepithelial layer. This is:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Carcinoma in situ
Correct: C (Dysplasia)
Rationale: Disordered growth with cytologic atypia confined within basement
membrane. Represents pre-neoplastic change. Not invasive (D) or simple hyperplasia
(A).
Q3
A 55-year-old man with COPD has barrel chest and flattened diaphragm on CXR. These
changes result from:
A. Type I alveolar cell apoptosis
B. Centrilobular emphysema with loss of elastic recoil → air trapping
C. Bronchial smooth muscle hyperplasia
D. Mucus gland hypertrophy
Correct: B
,Rationale: Emphysema destroys alveolar walls → loss of elastic recoil → air trapping →
barrel chest/flat diaphragm. Other options describe different COPD pathologies
(bronchitis, asthma).
Q4
A 70-year-old man with CHF has bilateral pitting edema to knees. Which Starling force
change is primary?
A. ↑ plasma oncotic pressure
B. ↑ interstitial hydrostatic pressure
C. ↑ capillary hydrostatic pressure
D. ↓ capillary oncotic pressure
Correct: C
Rationale: Heart failure → ↑ venous pressure → ↑ capillary hydrostatic pressure → fluid
filtration > reabsorption → edema. Not ↓ oncotic (D) or ↑ interstitial pressure (B).
Q5
A 25-year-old man with acute appendicitis has RLQ pain, fever, and neutrophilia. Which
inflammatory mediator is most responsible for neutrophil margination?
A. IL-1
B. Histamine
C. C5a
D. Bradykinin
, Correct: C (C5a)
Rationale: Complement fragment C5a is potent chemoattractant and causes neutrophil
margination and chemotaxis. IL-1 (A) causes fever and acute phase response;
histamine (B) vasodilation; bradykinin (D) pain.
Q6
A 60-year-old woman with RA has pannus formation on hand X-ray. Pannus consists of:
A. Granulation tissue with fibroblasts and neovessels invading cartilage
B. Caseating necrosis with multinucleated giant cells
C. Fibrinoid necrosis of vessel walls
D. Amyloid deposition in synovium
Correct: A
Rationale: Pannus = inflammatory granulation tissue (fibroblasts, neovessels,
inflammatory cells) that erodes cartilage and bone. Not caseating (B) or amyloid (D).
Q7
A 45-year-old woman with SLE has photosensitive rash and anti-dsDNA antibodies.
Which type of hypersensitivity is primary in SLE?
A. Type I (IgE-mediated)
B. Type II (cytotoxic antibody)
C. Type III (immune complex)
D. Type IV (delayed T-cell)
