NSG 5140 Advanced Pathophysiology
Midterm Exam Review 2 | South College
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-
30)
Question 1: A 55-year-old male with a 30-pack-year smoking history develops a
persistent cough and undergoes a bronchial biopsy showing replacement of normal
ciliated columnar epithelium with stratified squamous epithelium. This cellular
change is BEST described as:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type by another in response to chronic irritation. In smokers, the respiratory
epithelium undergoes squamous metaplasia as an adaptive response to chronic
injury. This is considered a protective mechanism but predisposes to
malignancy. Dysplasia involves abnormal cellular changes; hyperplasia is
increased cell number; anaplasia is loss of differentiation seen in cancer.
Question 2: During ischemia, depletion of ATP leads to cellular swelling primarily
because:
A) The sodium-potassium pump fails, causing intracellular sodium accumulation
B) Mitochondrial ATP synthase is overactivated
C) The cell membrane becomes impermeable to water
D) Potassium rushes into the cell
,Answer: A
Rationale: ATP is required for the Na⁺/K⁺ ATPase pump to maintain the
electrochemical gradient. When ATP is depleted, the pump fails, causing sodium
to accumulate intracellularly, followed by water influx due to osmotic pressure,
resulting in cellular swelling. This is a hallmark of reversible cell injury.
Mitochondrial dysfunction and membrane permeability changes occur later in
irreversible injury.
Question 3: Which of the following is a characteristic feature of apoptosis that
distinguishes it from necrosis?
A) Cell swelling and membrane rupture
B) Extensive inflammatory response
C) Energy-dependent programmed cell death
D) Random DNA fragmentation
Answer: C
Rationale: Apoptosis is a highly regulated, energy-dependent (requiring ATP)
form of programmed cell death. It involves cellular shrinkage, membrane
blebbing, and formation of apoptotic bodies that are phagocytosed without
triggering inflammation. Necrosis is uncontrolled, passive cell death that causes
inflammation, cell swelling, and membrane rupture.
Question 4: A patient with chronic gastroesophageal reflux disease develops
replacement of the normal squamous epithelium of the esophagus with columnar
epithelium. This condition is known as:
A) Barrett esophagus
B) Esophageal varices
C) Esophageal stricture
D) Achalasia
Answer: A
Rationale: Barrett esophagus is a metaplastic change in which the normal
stratified squamous epithelium of the distal esophagus is replaced by
specialized intestinal-type columnar epithelium in response to chronic acid
,exposure from GERD. This is a premalignant condition that increases the risk of
esophageal adenocarcinoma.
Question 5: Which of the following cellular changes is considered reversible?
A) Pyknosis
B) Karyorrhexis
C) Cellular swelling
D) Karyolysis
Answer: C
Rationale: Cellular swelling (hydropic change) is a reversible change
characterized by accumulation of water within the cell due to failure of ion
pumps. Pyknosis (nuclear condensation), karyorrhexis (nuclear fragmentation),
and karyolysis (nuclear dissolution) are all features of irreversible injury and
cell death.
Question 6: A 70-year-old patient with Alzheimer disease is found to have
accumulation of abnormal proteins in the brain. This type of cellular injury is
classified as:
A) Hypoxic injury
B) Immunologic injury
C) Genetic injury
D) Accumulation of abnormal substances
Answer: D
Rationale: Alzheimer disease is characterized by accumulation of abnormal
proteins—specifically amyloid-beta plaques and neurofibrillary tangles
composed of hyperphosphorylated tau protein. This represents injury due to
accumulation of abnormal substances, a category of cellular injury that also
includes diseases like Parkinson disease (Lewy bodies) and prion diseases.
Question 7: Prolonged ischemia leading to irreversible cell injury is characterized by:
, A) Restoration of ATP production
B) Reversal of mitochondrial swelling
C) Loss of plasma membrane integrity
D) Decreased intracellular calcium
Answer: C
Rationale: Loss of plasma membrane integrity is a hallmark of irreversible cell
injury. When the cell membrane is damaged beyond repair, cellular contents
leak out, and the cell cannot recover. This is accompanied by mitochondrial
dysfunction with calcium influx, lysosomal rupture, and release of proteolytic
enzymes. ATP production cannot be restored, and cell death is inevitable.
Question 8: A 45-year-old female develops increased size of her uterine
myometrium during pregnancy. This adaptation is BEST described as:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: B
Rationale: During pregnancy, the uterine smooth muscle undergoes hyperplasia
(increase in cell number) due to estrogen stimulation. This is a physiologic
adaptation. Hypertrophy (increase in cell size) occurs in cardiac muscle in
response to increased workload, as cardiac myocytes cannot divide. Metaplasia
and dysplasia are pathologic changes.
Question 9: Which cellular organelle is primarily responsible for generating ATP
through oxidative phosphorylation?
A) Endoplasmic reticulum
B) Golgi apparatus
C) Mitochondria
D) Lysosomes
Answer: C
Midterm Exam Review 2 | South College
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
SECTION 1: CELLULAR ADAPTATION AND INJURY (Questions 1-
30)
Question 1: A 55-year-old male with a 30-pack-year smoking history develops a
persistent cough and undergoes a bronchial biopsy showing replacement of normal
ciliated columnar epithelium with stratified squamous epithelium. This cellular
change is BEST described as:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
Answer: C
Rationale: Metaplasia is the reversible replacement of one differentiated cell
type by another in response to chronic irritation. In smokers, the respiratory
epithelium undergoes squamous metaplasia as an adaptive response to chronic
injury. This is considered a protective mechanism but predisposes to
malignancy. Dysplasia involves abnormal cellular changes; hyperplasia is
increased cell number; anaplasia is loss of differentiation seen in cancer.
Question 2: During ischemia, depletion of ATP leads to cellular swelling primarily
because:
A) The sodium-potassium pump fails, causing intracellular sodium accumulation
B) Mitochondrial ATP synthase is overactivated
C) The cell membrane becomes impermeable to water
D) Potassium rushes into the cell
,Answer: A
Rationale: ATP is required for the Na⁺/K⁺ ATPase pump to maintain the
electrochemical gradient. When ATP is depleted, the pump fails, causing sodium
to accumulate intracellularly, followed by water influx due to osmotic pressure,
resulting in cellular swelling. This is a hallmark of reversible cell injury.
Mitochondrial dysfunction and membrane permeability changes occur later in
irreversible injury.
Question 3: Which of the following is a characteristic feature of apoptosis that
distinguishes it from necrosis?
A) Cell swelling and membrane rupture
B) Extensive inflammatory response
C) Energy-dependent programmed cell death
D) Random DNA fragmentation
Answer: C
Rationale: Apoptosis is a highly regulated, energy-dependent (requiring ATP)
form of programmed cell death. It involves cellular shrinkage, membrane
blebbing, and formation of apoptotic bodies that are phagocytosed without
triggering inflammation. Necrosis is uncontrolled, passive cell death that causes
inflammation, cell swelling, and membrane rupture.
Question 4: A patient with chronic gastroesophageal reflux disease develops
replacement of the normal squamous epithelium of the esophagus with columnar
epithelium. This condition is known as:
A) Barrett esophagus
B) Esophageal varices
C) Esophageal stricture
D) Achalasia
Answer: A
Rationale: Barrett esophagus is a metaplastic change in which the normal
stratified squamous epithelium of the distal esophagus is replaced by
specialized intestinal-type columnar epithelium in response to chronic acid
,exposure from GERD. This is a premalignant condition that increases the risk of
esophageal adenocarcinoma.
Question 5: Which of the following cellular changes is considered reversible?
A) Pyknosis
B) Karyorrhexis
C) Cellular swelling
D) Karyolysis
Answer: C
Rationale: Cellular swelling (hydropic change) is a reversible change
characterized by accumulation of water within the cell due to failure of ion
pumps. Pyknosis (nuclear condensation), karyorrhexis (nuclear fragmentation),
and karyolysis (nuclear dissolution) are all features of irreversible injury and
cell death.
Question 6: A 70-year-old patient with Alzheimer disease is found to have
accumulation of abnormal proteins in the brain. This type of cellular injury is
classified as:
A) Hypoxic injury
B) Immunologic injury
C) Genetic injury
D) Accumulation of abnormal substances
Answer: D
Rationale: Alzheimer disease is characterized by accumulation of abnormal
proteins—specifically amyloid-beta plaques and neurofibrillary tangles
composed of hyperphosphorylated tau protein. This represents injury due to
accumulation of abnormal substances, a category of cellular injury that also
includes diseases like Parkinson disease (Lewy bodies) and prion diseases.
Question 7: Prolonged ischemia leading to irreversible cell injury is characterized by:
, A) Restoration of ATP production
B) Reversal of mitochondrial swelling
C) Loss of plasma membrane integrity
D) Decreased intracellular calcium
Answer: C
Rationale: Loss of plasma membrane integrity is a hallmark of irreversible cell
injury. When the cell membrane is damaged beyond repair, cellular contents
leak out, and the cell cannot recover. This is accompanied by mitochondrial
dysfunction with calcium influx, lysosomal rupture, and release of proteolytic
enzymes. ATP production cannot be restored, and cell death is inevitable.
Question 8: A 45-year-old female develops increased size of her uterine
myometrium during pregnancy. This adaptation is BEST described as:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: B
Rationale: During pregnancy, the uterine smooth muscle undergoes hyperplasia
(increase in cell number) due to estrogen stimulation. This is a physiologic
adaptation. Hypertrophy (increase in cell size) occurs in cardiac muscle in
response to increased workload, as cardiac myocytes cannot divide. Metaplasia
and dysplasia are pathologic changes.
Question 9: Which cellular organelle is primarily responsible for generating ATP
through oxidative phosphorylation?
A) Endoplasmic reticulum
B) Golgi apparatus
C) Mitochondria
D) Lysosomes
Answer: C
