NSG 5140 Midterm Exam Review: Advanced Pathophysiology –
South College (150 Practice Questions & Answers) LATEST
UPDATE THIS YEAR. PDF
EXAM OVERVIEW:
This comprehensive midterm examination is designed to evaluate mastery of advanced
pathophysiology concepts essential for clinical practice in the NSG 5140 course at South
College . The assessment covers foundational theory, applied clinical reasoning, and
regulatory knowledge across ten core domains . The exam emphasizes clinical reasoning,
differential diagnosis, and evidence-based management . Detailed rationales are provided
for each answer to reinforce learning and support exam readiness .
EXAM FORMAT & SCOPE
Feature Detail
Course NSG 5140 – Advanced Pathophysiology
Institution South College
Exam Type Midterm Examination
Question Multiple-choice, scenario-based clinical vignettes
Format
Core Cellular Adaptation/Injury, Inflammation/Immunity, Genetics,
Domains Fluid/Electrolyte/Acid-Base, Neuro, Cardiovascular, Pulmonary, Renal,
Endocrine, GI/Hepatobiliary
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-15)
Q1. A 65-year-old male with chronic heart failure presents with worsening dyspnea
and peripheral edema. Which cellular adaptation is most likely occurring in his
myocardial tissue in response to prolonged pressure overload?
Answer: Hypertrophy
,Rationale: Hypertrophy is an increase in individual cell size due to increased workload, as
seen in myocardial cells responding to chronic pressure overload (e.g., hypertension, valve
disease). Hyperplasia is increased cell number, rare in cardiac muscle. Atrophy is
decreased cell size from disuse or denervation. Metaplasia is replacement of one
differentiated cell type with another .
Q2. A pathologist examines a biopsy from the bronchial epithelium of a chronic
smoker. The normal pseudostratified ciliated columnar epithelium is replaced by
stratified squamous epithelium. Which molecular event is most likely initiating this
change?
Answer: Reprogramming of stem cells due to chronic irritation and altered transcription
factor signaling
Rationale: Metaplasia, the replacement of one differentiated cell type by another, results
from reprogramming of tissue-resident stem cells or undifferentiated cells in response to
chronic stress, often involving changes in transcription factors (e.g., Sox2, p63). Increased
Bcl-2 would inhibit apoptosis, not cause metaplasia. p53 mutation is associated with
dysplasia/cancer, not metaplasia. E-cadherin silencing is more related to invasion in
carcinoma .
Q3. In a patient with prolonged ischemia due to renal artery stenosis, proximal
tubular epithelial cells exhibit swelling of mitochondria and dilation of the
endoplasmic reticulum on electron microscopy. Which phase of cell injury does this
morphology represent, and what is the primary underlying biochemical defect?
Answer: Reversible injury; depletion of ATP leading to failure of ion pumps
Rationale: Cellular swelling with mitochondrial and ER changes is characteristic of
reversible injury, primarily due to ATP depletion causing failure of Na⁺/K⁺ ATPase and
subsequent intracellular edema. Calcium influx and mitochondrial damage are features of
irreversible injury. Necroptosis and apoptosis involve distinct pathways and are not seen in
reversible injury .
,Q4. A liver biopsy from a patient with nonalcoholic steatohepatitis (NASH) shows
hepatocytes with large fat vacuoles displacing the nucleus to the periphery. Which
cellular adaptation is most directly responsible for this histological finding?
Answer: Intracellular accumulation of triglycerides secondary to impaired fatty acid
oxidation
Rationale: Steatosis (fatty change) is an abnormal intracellular accumulation of
triglycerides, not a true adaptation like hypertrophy or hyperplasia. It results from
imbalances in lipid metabolism, such as increased influx or decreased oxidation.
Hepatocytes do not undergo metaplasia to adipocytes; the fat is stored within existing
hepatocytes .
Q5. A 55-year-old smoker develops hemoptysis and weight loss. Lung biopsy shows
atypical epithelial cells with loss of normal stratification and increased mitotic figures
but no invasion through basement membrane. This finding is best described as:
Answer: Carcinoma in situ
Rationale: Carcinoma in situ shows neoplastic cells confined to the epithelium without
basement membrane invasion. Dysplasia is disordered growth without full neoplastic
transformation. Metaplasia is reversible cell type change. Anaplasia describes poorly
differentiated malignant cells .
Q6. A 58-year-old male with chronic alcoholism presents with abdominal pain and
jaundice. Laboratory findings show elevated AST, ALT, and prolonged prothrombin
time. Hepatocyte swelling with intracellular fat accumulation is noted on biopsy.
Which cellular adaptation is primarily responsible for this finding?
Answer: Steatosis
Rationale: Steatosis (fatty change) is the abnormal accumulation of triglycerides within
hepatocytes, commonly caused by alcohol toxicity. Hyperplasia is increased cell number.
Metaplasia is replacement of one cell type with another. Hypertrophy is increased cell size
without fat accumulation .
Q7. Which type of necrosis is most commonly associated with myocardial infarction?
Answer: Coagulative necrosis
, Rationale: Coagulative necrosis preserves tissue architecture for several days and is
typical of ischemic injury in solid organs such as the heart .
Q8. Which type of necrosis is most often seen in hypoxic injury in the brain?
Answer: Liquefactive necrosis
Rationale: In the brain, ischemic injury leads to enzymatic digestion of dead cells resulting
in liquefactive necrosis .
Q9. Which of the following best describes apoptosis?
Answer: Programmed cell death with minimal inflammation
Rationale: Apoptosis is a controlled, energy-dependent process of cell death that removes
damaged or unnecessary cells without eliciting a significant inflammatory response .
Q10. Which cellular adaptation is seen in Barrett's esophagus?
Answer: Metaplasia
Rationale: Chronic acid exposure in the esophagus causes squamous epithelium to
transform into columnar epithelium .
Q11. A patient with chronic hypertension experiences left ventricular hypertrophy.
This is an example of:
Answer: Hypertrophy
Rationale: Hypertrophy refers to an increase in cell size, often in response to increased
workload, as seen in left ventricular hypertrophy due to hypertension .
Q12. What is the primary mechanism of cellular injury in hypoxia?
Answer: ATP depletion
Rationale: Hypoxia primarily causes injury by reducing oxygen delivery, which decreases
ATP production, leading to failure of ion pumps, cell swelling, and eventual cell death .
South College (150 Practice Questions & Answers) LATEST
UPDATE THIS YEAR. PDF
EXAM OVERVIEW:
This comprehensive midterm examination is designed to evaluate mastery of advanced
pathophysiology concepts essential for clinical practice in the NSG 5140 course at South
College . The assessment covers foundational theory, applied clinical reasoning, and
regulatory knowledge across ten core domains . The exam emphasizes clinical reasoning,
differential diagnosis, and evidence-based management . Detailed rationales are provided
for each answer to reinforce learning and support exam readiness .
EXAM FORMAT & SCOPE
Feature Detail
Course NSG 5140 – Advanced Pathophysiology
Institution South College
Exam Type Midterm Examination
Question Multiple-choice, scenario-based clinical vignettes
Format
Core Cellular Adaptation/Injury, Inflammation/Immunity, Genetics,
Domains Fluid/Electrolyte/Acid-Base, Neuro, Cardiovascular, Pulmonary, Renal,
Endocrine, GI/Hepatobiliary
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-15)
Q1. A 65-year-old male with chronic heart failure presents with worsening dyspnea
and peripheral edema. Which cellular adaptation is most likely occurring in his
myocardial tissue in response to prolonged pressure overload?
Answer: Hypertrophy
,Rationale: Hypertrophy is an increase in individual cell size due to increased workload, as
seen in myocardial cells responding to chronic pressure overload (e.g., hypertension, valve
disease). Hyperplasia is increased cell number, rare in cardiac muscle. Atrophy is
decreased cell size from disuse or denervation. Metaplasia is replacement of one
differentiated cell type with another .
Q2. A pathologist examines a biopsy from the bronchial epithelium of a chronic
smoker. The normal pseudostratified ciliated columnar epithelium is replaced by
stratified squamous epithelium. Which molecular event is most likely initiating this
change?
Answer: Reprogramming of stem cells due to chronic irritation and altered transcription
factor signaling
Rationale: Metaplasia, the replacement of one differentiated cell type by another, results
from reprogramming of tissue-resident stem cells or undifferentiated cells in response to
chronic stress, often involving changes in transcription factors (e.g., Sox2, p63). Increased
Bcl-2 would inhibit apoptosis, not cause metaplasia. p53 mutation is associated with
dysplasia/cancer, not metaplasia. E-cadherin silencing is more related to invasion in
carcinoma .
Q3. In a patient with prolonged ischemia due to renal artery stenosis, proximal
tubular epithelial cells exhibit swelling of mitochondria and dilation of the
endoplasmic reticulum on electron microscopy. Which phase of cell injury does this
morphology represent, and what is the primary underlying biochemical defect?
Answer: Reversible injury; depletion of ATP leading to failure of ion pumps
Rationale: Cellular swelling with mitochondrial and ER changes is characteristic of
reversible injury, primarily due to ATP depletion causing failure of Na⁺/K⁺ ATPase and
subsequent intracellular edema. Calcium influx and mitochondrial damage are features of
irreversible injury. Necroptosis and apoptosis involve distinct pathways and are not seen in
reversible injury .
,Q4. A liver biopsy from a patient with nonalcoholic steatohepatitis (NASH) shows
hepatocytes with large fat vacuoles displacing the nucleus to the periphery. Which
cellular adaptation is most directly responsible for this histological finding?
Answer: Intracellular accumulation of triglycerides secondary to impaired fatty acid
oxidation
Rationale: Steatosis (fatty change) is an abnormal intracellular accumulation of
triglycerides, not a true adaptation like hypertrophy or hyperplasia. It results from
imbalances in lipid metabolism, such as increased influx or decreased oxidation.
Hepatocytes do not undergo metaplasia to adipocytes; the fat is stored within existing
hepatocytes .
Q5. A 55-year-old smoker develops hemoptysis and weight loss. Lung biopsy shows
atypical epithelial cells with loss of normal stratification and increased mitotic figures
but no invasion through basement membrane. This finding is best described as:
Answer: Carcinoma in situ
Rationale: Carcinoma in situ shows neoplastic cells confined to the epithelium without
basement membrane invasion. Dysplasia is disordered growth without full neoplastic
transformation. Metaplasia is reversible cell type change. Anaplasia describes poorly
differentiated malignant cells .
Q6. A 58-year-old male with chronic alcoholism presents with abdominal pain and
jaundice. Laboratory findings show elevated AST, ALT, and prolonged prothrombin
time. Hepatocyte swelling with intracellular fat accumulation is noted on biopsy.
Which cellular adaptation is primarily responsible for this finding?
Answer: Steatosis
Rationale: Steatosis (fatty change) is the abnormal accumulation of triglycerides within
hepatocytes, commonly caused by alcohol toxicity. Hyperplasia is increased cell number.
Metaplasia is replacement of one cell type with another. Hypertrophy is increased cell size
without fat accumulation .
Q7. Which type of necrosis is most commonly associated with myocardial infarction?
Answer: Coagulative necrosis
, Rationale: Coagulative necrosis preserves tissue architecture for several days and is
typical of ischemic injury in solid organs such as the heart .
Q8. Which type of necrosis is most often seen in hypoxic injury in the brain?
Answer: Liquefactive necrosis
Rationale: In the brain, ischemic injury leads to enzymatic digestion of dead cells resulting
in liquefactive necrosis .
Q9. Which of the following best describes apoptosis?
Answer: Programmed cell death with minimal inflammation
Rationale: Apoptosis is a controlled, energy-dependent process of cell death that removes
damaged or unnecessary cells without eliciting a significant inflammatory response .
Q10. Which cellular adaptation is seen in Barrett's esophagus?
Answer: Metaplasia
Rationale: Chronic acid exposure in the esophagus causes squamous epithelium to
transform into columnar epithelium .
Q11. A patient with chronic hypertension experiences left ventricular hypertrophy.
This is an example of:
Answer: Hypertrophy
Rationale: Hypertrophy refers to an increase in cell size, often in response to increased
workload, as seen in left ventricular hypertrophy due to hypertension .
Q12. What is the primary mechanism of cellular injury in hypoxia?
Answer: ATP depletion
Rationale: Hypoxia primarily causes injury by reducing oxygen delivery, which decreases
ATP production, leading to failure of ion pumps, cell swelling, and eventual cell death .
