WGU D115 Advanced Pathophysiology OA
Exam 2025/2026 – Complete Exam Questions
and Answers
1. A 62-year-old patient with chronic hypertension develops left ventricular hypertrophy. Which
cellular adaptation best describes this change?
A) Hyperplasia — increase in cell number
B) Metaplasia — replacement of one cell type with another
C) Hypertrophy — increase in cell size
D) Dysplasia — abnormal cell growth and organization
Correct Answer: C) Hypertrophy — increase in cell size
Rationale: Hypertrophy is an increase in cell size in response to increased workload. Chronic
hypertension increases afterload on the left ventricle, causing myocardial cells to hypertrophy to
meet the increased demand. Because cardiac myocytes cannot significantly divide, the heart
compensates by increasing cell size rather than cell number .
2. A researcher studying a cell line that lost the ability to undergo apoptosis after DNA damage
finds absent p53 protein expression. Loss of p53 function most directly affects which cellular
process?
A) Ras protein GTPase activity
B) Cyclin D-CDK4 complex formation
C) Activation of pro-apoptotic Bax and Bak proteins
D) Telomerase reverse transcriptase expression
Correct Answer: C) Activation of pro-apoptotic Bax and Bak proteins
Rationale: p53 activates the intrinsic apoptotic pathway by upregulating pro-apoptotic Bax
and Bak while suppressing anti-apoptotic Bcl-2. Loss of p53 function prevents apoptosis of cells
with DNA damage, allowing potentially malignant cells to survive and proliferate .
3. A patient with COPD develops squamous metaplasia in the bronchial epithelium. Which
statement best describes this cellular change?
,A) An increase in cell size
B) A reversible replacement of one differentiated cell type with another
C) An increase in the number of cells
D) A decrease in cell size
Correct Answer: B) A reversible replacement of one differentiated cell type with another
Rationale: Metaplasia is a reversible change in which one differentiated cell type is replaced
by another. In COPD, chronic irritation from smoking causes the normal ciliated columnar
epithelium of the bronchi to be replaced by stratified squamous epithelium, which is more
resilient but loses protective functions .
4. Which statement accurately describes the difference between necrosis and apoptosis?
A) Necrosis is programmed cell death; apoptosis is unregulated
B) Necrosis triggers an inflammatory response; apoptosis does not
C) Apoptosis always leads to cell swelling; necrosis does not
D) Necrosis is energy-dependent; apoptosis is not
Correct Answer: B) Necrosis triggers an inflammatory response; apoptosis does not
Rationale: Necrosis is unregulated cell death that triggers inflammation due to the release
of cellular contents. Apoptosis is a highly regulated, energy-dependent process that does not
elicit an inflammatory response .
5. The cellular adaptation characterized by a decrease in cell size and function in response to
decreased workload is called:
A) Hypertrophy
B) Atrophy
C) Hyperplasia
D) Metaplasia
Correct Answer: B) Atrophy
Rationale: Atrophy is a decrease in cell size due to reduced workload, disuse, denervation,
or decreased blood supply. It is a common adaptation in immobilized muscles or aging tissues .
6. Ischemia causes cellular injury primarily through which mechanism?
,A) Excess ATP production
B) Decreased oxygen delivery leading to anaerobic metabolism and lactic acidosis
C) Hyperkalemia from cell rupture
D) Increased protein synthesis
Correct Answer: B) Decreased oxygen delivery leading to anaerobic metabolism and lactic
acidosis
Rationale: Ischemia reduces oxygen delivery to cells. This forces the cell into anaerobic
metabolism, which produces lactic acid and decreases ATP production, leading to cell swelling
and injury .
7. Free radicals cause cellular damage by which mechanism?
A) Promoting DNA repair
B) Stealing electrons from cellular structures like DNA, lipids, and proteins
C) Increasing ATP production
D) Activating apoptosis pathways only
Correct Answer: B) Stealing electrons from cellular structures like DNA, lipids, and
proteins
Rationale: Free radicals are highly reactive molecules with unpaired electrons. They cause
oxidative stress by stealing electrons from cellular structures, leading to DNA damage, lipid
peroxidation, and protein dysfunction .
8. A patient with prolonged immobilization is at risk for which cellular adaptation in skeletal
muscle?
A) Hypertrophy
B) Hyperplasia
C) Disuse atrophy
D) Metaplasia
Correct Answer: C) Disuse atrophy
Rationale: Disuse atrophy occurs in skeletal muscle when there is decreased workload from
prolonged immobility, resulting in decreased muscle mass and function .
, 9. Which of the following is an example of pathologic hyperplasia?
A) Breast tissue enlargement during pregnancy
B) Endometrial hyperplasia from unopposed estrogen
C) Liver regeneration after partial hepatectomy
D) Erythrocyte production in high altitude
Correct Answer: B) Endometrial hyperplasia from unopposed estrogen
Rationale: Endometrial hyperplasia from unopposed estrogen is a pathologic hyperplasia
that increases the risk of endometrial cancer. The others are physiologic responses to normal
stimuli .
10. The hallmark of irreversible cellular injury is:
A) Cellular swelling
B) Fatty change
C) Mitochondrial amorphous densities
D) Membrane blebbing
Correct Answer: C) Mitochondrial amorphous densities
Rationale: Flocculent densities in the mitochondrial matrix are an irreversible marker of cell
death, indicating severe membrane damage. This is the "point of no return" where cell death is
inevitable even if the stressor is removed .
11. What is the earliest reversible morphologic sign of cell injury?
A) Nuclear pyknosis
B) Cellular swelling (hydropic change)
C) Fatty change
D) Karyolysis
Correct Answer: B) Cellular swelling (hydropic change)
Rationale: Cellular swelling is the earliest reversible sign of cell injury, caused by ATP
depletion leading to failure of the Na⁺/K⁺ pump and subsequent water influx. This is followed by
fatty change in some organs .
Exam 2025/2026 – Complete Exam Questions
and Answers
1. A 62-year-old patient with chronic hypertension develops left ventricular hypertrophy. Which
cellular adaptation best describes this change?
A) Hyperplasia — increase in cell number
B) Metaplasia — replacement of one cell type with another
C) Hypertrophy — increase in cell size
D) Dysplasia — abnormal cell growth and organization
Correct Answer: C) Hypertrophy — increase in cell size
Rationale: Hypertrophy is an increase in cell size in response to increased workload. Chronic
hypertension increases afterload on the left ventricle, causing myocardial cells to hypertrophy to
meet the increased demand. Because cardiac myocytes cannot significantly divide, the heart
compensates by increasing cell size rather than cell number .
2. A researcher studying a cell line that lost the ability to undergo apoptosis after DNA damage
finds absent p53 protein expression. Loss of p53 function most directly affects which cellular
process?
A) Ras protein GTPase activity
B) Cyclin D-CDK4 complex formation
C) Activation of pro-apoptotic Bax and Bak proteins
D) Telomerase reverse transcriptase expression
Correct Answer: C) Activation of pro-apoptotic Bax and Bak proteins
Rationale: p53 activates the intrinsic apoptotic pathway by upregulating pro-apoptotic Bax
and Bak while suppressing anti-apoptotic Bcl-2. Loss of p53 function prevents apoptosis of cells
with DNA damage, allowing potentially malignant cells to survive and proliferate .
3. A patient with COPD develops squamous metaplasia in the bronchial epithelium. Which
statement best describes this cellular change?
,A) An increase in cell size
B) A reversible replacement of one differentiated cell type with another
C) An increase in the number of cells
D) A decrease in cell size
Correct Answer: B) A reversible replacement of one differentiated cell type with another
Rationale: Metaplasia is a reversible change in which one differentiated cell type is replaced
by another. In COPD, chronic irritation from smoking causes the normal ciliated columnar
epithelium of the bronchi to be replaced by stratified squamous epithelium, which is more
resilient but loses protective functions .
4. Which statement accurately describes the difference between necrosis and apoptosis?
A) Necrosis is programmed cell death; apoptosis is unregulated
B) Necrosis triggers an inflammatory response; apoptosis does not
C) Apoptosis always leads to cell swelling; necrosis does not
D) Necrosis is energy-dependent; apoptosis is not
Correct Answer: B) Necrosis triggers an inflammatory response; apoptosis does not
Rationale: Necrosis is unregulated cell death that triggers inflammation due to the release
of cellular contents. Apoptosis is a highly regulated, energy-dependent process that does not
elicit an inflammatory response .
5. The cellular adaptation characterized by a decrease in cell size and function in response to
decreased workload is called:
A) Hypertrophy
B) Atrophy
C) Hyperplasia
D) Metaplasia
Correct Answer: B) Atrophy
Rationale: Atrophy is a decrease in cell size due to reduced workload, disuse, denervation,
or decreased blood supply. It is a common adaptation in immobilized muscles or aging tissues .
6. Ischemia causes cellular injury primarily through which mechanism?
,A) Excess ATP production
B) Decreased oxygen delivery leading to anaerobic metabolism and lactic acidosis
C) Hyperkalemia from cell rupture
D) Increased protein synthesis
Correct Answer: B) Decreased oxygen delivery leading to anaerobic metabolism and lactic
acidosis
Rationale: Ischemia reduces oxygen delivery to cells. This forces the cell into anaerobic
metabolism, which produces lactic acid and decreases ATP production, leading to cell swelling
and injury .
7. Free radicals cause cellular damage by which mechanism?
A) Promoting DNA repair
B) Stealing electrons from cellular structures like DNA, lipids, and proteins
C) Increasing ATP production
D) Activating apoptosis pathways only
Correct Answer: B) Stealing electrons from cellular structures like DNA, lipids, and
proteins
Rationale: Free radicals are highly reactive molecules with unpaired electrons. They cause
oxidative stress by stealing electrons from cellular structures, leading to DNA damage, lipid
peroxidation, and protein dysfunction .
8. A patient with prolonged immobilization is at risk for which cellular adaptation in skeletal
muscle?
A) Hypertrophy
B) Hyperplasia
C) Disuse atrophy
D) Metaplasia
Correct Answer: C) Disuse atrophy
Rationale: Disuse atrophy occurs in skeletal muscle when there is decreased workload from
prolonged immobility, resulting in decreased muscle mass and function .
, 9. Which of the following is an example of pathologic hyperplasia?
A) Breast tissue enlargement during pregnancy
B) Endometrial hyperplasia from unopposed estrogen
C) Liver regeneration after partial hepatectomy
D) Erythrocyte production in high altitude
Correct Answer: B) Endometrial hyperplasia from unopposed estrogen
Rationale: Endometrial hyperplasia from unopposed estrogen is a pathologic hyperplasia
that increases the risk of endometrial cancer. The others are physiologic responses to normal
stimuli .
10. The hallmark of irreversible cellular injury is:
A) Cellular swelling
B) Fatty change
C) Mitochondrial amorphous densities
D) Membrane blebbing
Correct Answer: C) Mitochondrial amorphous densities
Rationale: Flocculent densities in the mitochondrial matrix are an irreversible marker of cell
death, indicating severe membrane damage. This is the "point of no return" where cell death is
inevitable even if the stressor is removed .
11. What is the earliest reversible morphologic sign of cell injury?
A) Nuclear pyknosis
B) Cellular swelling (hydropic change)
C) Fatty change
D) Karyolysis
Correct Answer: B) Cellular swelling (hydropic change)
Rationale: Cellular swelling is the earliest reversible sign of cell injury, caused by ATP
depletion leading to failure of the Na⁺/K⁺ pump and subsequent water influx. This is followed by
fatty change in some organs .
