WGU D236 PATHOPHYSIOLOGY EXAM REVIEW
2026/2027 | Complete Guide | 100% Correct Mastery |
Verified Q&A | Pass Guaranteed - A+ Graded
Section 1: Cellular Adaptation, Injury & Neoplasia Mastery (Q1-
22)
Q1. A 45-year-old male with a 30 pack-year smoking history develops metaplasia of
the bronchial epithelium. Which of the following best describes this cellular
adaptation?
A. Increase in cell number resulting in tissue enlargement
B. Decrease in cell size due to reduced workload
C. Replacement of one differentiated cell type by another [CORRECT]
D. Increase in cell size due to increased functional demand
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, often in response to chronic irritation. A describes hyperplasia; B describes
atrophy; D describes hypertrophy.
Correct Answer: C
Q2. A patient presents with chronic hypertension. Biopsy of the left ventricle reveals
enlarged cardiac myocytes with increased nuclear size. This cellular adaptation is best
classified as:
A. Hyperplasia
B. Hypertrophy [CORRECT]
,C. Atrophy
D. Dysplasia
Rationale: Hypertrophy is an increase in cell size (not number) in response to
increased workload, such as pressure overload from hypertension. Hyperplasia
involves increased cell number; atrophy is decreased size; dysplasia is disordered
growth.
Correct Answer: B
Q3. Which of the following is the FIRST biochemical event to occur during cellular
hypoxic injury?
A. Decreased ATP synthesis [CORRECT]
B. Cell membrane rupture
C. Nuclear pyknosis
D. Lysosomal enzyme release
Rationale: Hypoxic injury begins with decreased oxidative phosphorylation and ATP
synthesis. Membrane rupture, nuclear pyknosis, and lysosomal enzyme release are
later events in the injury cascade.
Correct Answer: A
Q4. A 62-year-old patient with severe atherosclerosis develops acute myocardial
infarction. The initial mechanism of myocardial cell death is best described as:
A. Apoptosis
B. Coagulative necrosis [CORRECT]
C. Liquefactive necrosis
D. Caseous necrosis
Rationale: Ischemic injury to the myocardium produces coagulative necrosis,
characterized by preserved tissue architecture with loss of nuclei. Apoptosis is
programmed cell death; liquefactive necrosis occurs in brain infarcts; caseous
,necrosis is seen in tuberculosis.
Correct Answer: B
Q5. Reperfusion injury following restoration of blood flow to ischemic tissue is
primarily mediated by:
A. Increased intracellular calcium only
B. Generation of reactive oxygen species (free radicals) [CORRECT]
C. Decreased intracellular pH only
D. Inhibition of protein synthesis
Rationale: Reperfusion injury is primarily caused by reactive oxygen species (free
radicals) generated when oxygen is reintroduced to ischemic tissue. While calcium
overload and acidosis contribute, free radical-mediated damage is the primary
mechanism.
Correct Answer: B
Q6. A patient with chronic alcohol abuse develops hepatic steatosis. The primary
mechanism of fatty change (steatosis) in hepatocytes is:
A. Increased beta-oxidation of fatty acids
B. Decreased synthesis of apolipoproteins [CORRECT]
C. Increased bile acid production
D. Decreased glycogen storage
Rationale: Hepatic steatosis results from impaired export of triglycerides due to
decreased synthesis of apolipoproteins (needed for VLDL formation). Beta-oxidation
is decreased, not increased, in alcohol-induced liver disease.
Correct Answer: B
, Q7. Which of the following cellular accumulations is MOST characteristic of Wilson
disease?
A. Hemosiderin
B. Copper [CORRECT]
C. Glycogen
D. Cholesterol
Rationale: Wilson disease is an autosomal recessive disorder of copper metabolism
causing copper accumulation in the liver, brain, and cornea. Hemosiderin
accumulates in hemochromatosis; glycogen in glycogen storage diseases; cholesterol
in atherosclerosis.
Correct Answer: B
Q8. A 55-year-old woman presents with jaundice, dark urine, and pruritus. Liver
biopsy reveals brown granular pigment in hepatocytes. This pigment is most likely:
A. Lipofuscin
B. Bilirubin [CORRECT]
C. Hemosiderin
D. Melanin
Rationale: The clinical presentation of jaundice with dark urine indicates conjugated
hyperbilirubinemia; brown granular pigment in hepatocytes represents bilirubin.
Lipofuscin is "wear-and-tear" pigment; hemosiderin is iron-containing; melanin is
found in skin.
Correct Answer: B
Q9. The sequence of neoplastic progression from normal to malignant is best
described as:
A. Dysplasia → Metaplasia → Hyperplasia → Carcinoma in situ → Invasive carcinoma
B. Hyperplasia → Metaplasia → Dysplasia → Carcinoma in situ → Invasive carcinoma
[CORRECT]
2026/2027 | Complete Guide | 100% Correct Mastery |
Verified Q&A | Pass Guaranteed - A+ Graded
Section 1: Cellular Adaptation, Injury & Neoplasia Mastery (Q1-
22)
Q1. A 45-year-old male with a 30 pack-year smoking history develops metaplasia of
the bronchial epithelium. Which of the following best describes this cellular
adaptation?
A. Increase in cell number resulting in tissue enlargement
B. Decrease in cell size due to reduced workload
C. Replacement of one differentiated cell type by another [CORRECT]
D. Increase in cell size due to increased functional demand
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, often in response to chronic irritation. A describes hyperplasia; B describes
atrophy; D describes hypertrophy.
Correct Answer: C
Q2. A patient presents with chronic hypertension. Biopsy of the left ventricle reveals
enlarged cardiac myocytes with increased nuclear size. This cellular adaptation is best
classified as:
A. Hyperplasia
B. Hypertrophy [CORRECT]
,C. Atrophy
D. Dysplasia
Rationale: Hypertrophy is an increase in cell size (not number) in response to
increased workload, such as pressure overload from hypertension. Hyperplasia
involves increased cell number; atrophy is decreased size; dysplasia is disordered
growth.
Correct Answer: B
Q3. Which of the following is the FIRST biochemical event to occur during cellular
hypoxic injury?
A. Decreased ATP synthesis [CORRECT]
B. Cell membrane rupture
C. Nuclear pyknosis
D. Lysosomal enzyme release
Rationale: Hypoxic injury begins with decreased oxidative phosphorylation and ATP
synthesis. Membrane rupture, nuclear pyknosis, and lysosomal enzyme release are
later events in the injury cascade.
Correct Answer: A
Q4. A 62-year-old patient with severe atherosclerosis develops acute myocardial
infarction. The initial mechanism of myocardial cell death is best described as:
A. Apoptosis
B. Coagulative necrosis [CORRECT]
C. Liquefactive necrosis
D. Caseous necrosis
Rationale: Ischemic injury to the myocardium produces coagulative necrosis,
characterized by preserved tissue architecture with loss of nuclei. Apoptosis is
programmed cell death; liquefactive necrosis occurs in brain infarcts; caseous
,necrosis is seen in tuberculosis.
Correct Answer: B
Q5. Reperfusion injury following restoration of blood flow to ischemic tissue is
primarily mediated by:
A. Increased intracellular calcium only
B. Generation of reactive oxygen species (free radicals) [CORRECT]
C. Decreased intracellular pH only
D. Inhibition of protein synthesis
Rationale: Reperfusion injury is primarily caused by reactive oxygen species (free
radicals) generated when oxygen is reintroduced to ischemic tissue. While calcium
overload and acidosis contribute, free radical-mediated damage is the primary
mechanism.
Correct Answer: B
Q6. A patient with chronic alcohol abuse develops hepatic steatosis. The primary
mechanism of fatty change (steatosis) in hepatocytes is:
A. Increased beta-oxidation of fatty acids
B. Decreased synthesis of apolipoproteins [CORRECT]
C. Increased bile acid production
D. Decreased glycogen storage
Rationale: Hepatic steatosis results from impaired export of triglycerides due to
decreased synthesis of apolipoproteins (needed for VLDL formation). Beta-oxidation
is decreased, not increased, in alcohol-induced liver disease.
Correct Answer: B
, Q7. Which of the following cellular accumulations is MOST characteristic of Wilson
disease?
A. Hemosiderin
B. Copper [CORRECT]
C. Glycogen
D. Cholesterol
Rationale: Wilson disease is an autosomal recessive disorder of copper metabolism
causing copper accumulation in the liver, brain, and cornea. Hemosiderin
accumulates in hemochromatosis; glycogen in glycogen storage diseases; cholesterol
in atherosclerosis.
Correct Answer: B
Q8. A 55-year-old woman presents with jaundice, dark urine, and pruritus. Liver
biopsy reveals brown granular pigment in hepatocytes. This pigment is most likely:
A. Lipofuscin
B. Bilirubin [CORRECT]
C. Hemosiderin
D. Melanin
Rationale: The clinical presentation of jaundice with dark urine indicates conjugated
hyperbilirubinemia; brown granular pigment in hepatocytes represents bilirubin.
Lipofuscin is "wear-and-tear" pigment; hemosiderin is iron-containing; melanin is
found in skin.
Correct Answer: B
Q9. The sequence of neoplastic progression from normal to malignant is best
described as:
A. Dysplasia → Metaplasia → Hyperplasia → Carcinoma in situ → Invasive carcinoma
B. Hyperplasia → Metaplasia → Dysplasia → Carcinoma in situ → Invasive carcinoma
[CORRECT]
