WALDEN UNIVERSITY – NURS 6501
ADVANCED PATHOPHYSIOLOGY MIDTERM –
QUESTIONS AND ANSWERS | 2026/2027
LATEST UPDATE
SECTION 1: CELLULAR BIOLOGY, ADAPTATION, AND CELLULAR INJURY
Questions 1–18
1. Which cellular adaptation involves an increase in the size of individual cells in response
to increased workload?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy increases individual cell size rather than cell number. It commonly
develops when cells experience increased functional demand, such as cardiac muscle
exposed to chronic pressure overload. Hyperplasia increases cell number, atrophy decreases
cellular size, and metaplasia involves replacement of one mature cell type with another.
2. A reduction in workload causes skeletal muscle fibers to become smaller over time.
Which adaptation explains this finding?
A) Hyperplasia
B) Atrophy
C) Hypertrophy
D) Dysplasia
Correct Answer: Atrophy
Rationale: Atrophy is a decrease in cell size caused by reduced workload, inadequate
nutrition, loss of nerve supply, or other factors. Disuse of skeletal muscle is a classic example.
Hyperplasia and hypertrophy represent increases in cell number and size, respectively, while
dysplasia describes abnormal cellular growth and organization.
3. What is the principal consequence of inadequate oxygen delivery to a cell?
A) Increased oxidative phosphorylation
,B) Increased mitochondrial ATP production
C) Reduced ATP generation
D) Accelerated protein synthesis
Correct Answer: Reduced ATP generation
Rationale: Oxygen is required for efficient mitochondrial oxidative phosphorylation. When
oxygen delivery falls, ATP production decreases, impairing energy-dependent membrane
pumps and cellular processes. Anaerobic metabolism can temporarily compensate, but it
produces substantially less ATP and contributes to lactate accumulation.
4. Which finding most strongly indicates that cellular injury has progressed from reversible
to irreversible damage?
A) Mild cellular swelling
B) Increased glycogen storage
C) Temporary fatty change
D) Severe membrane and mitochondrial damage with nuclear destruction
Correct Answer: Severe membrane and mitochondrial damage with nuclear destruction
Rationale: Irreversible cellular injury involves profound mitochondrial dysfunction, loss of
membrane integrity, calcium dysregulation, and nuclear changes such as pyknosis,
karyorrhexis, or karyolysis. Mild swelling and temporary metabolic changes may be
reversible when the underlying stress is corrected before critical cellular structures are
permanently damaged.
5. Which mechanism is most directly responsible for cellular swelling during early
reversible injury?
A) Failure of ATP-dependent ion pumps
B) Excessive DNA replication
C) Increased lysosomal synthesis
D) Enhanced oxidative phosphorylation
Correct Answer: Failure of ATP-dependent ion pumps
Rationale: ATP depletion impairs the sodium-potassium pump located in the plasma
membrane. Sodium accumulates intracellularly, causing water to enter the cell osmotically.
This produces cellular swelling, a characteristic early manifestation of reversible injury. The
other mechanisms do not directly explain the movement of water into injured cells.
6. Which characteristic best distinguishes apoptosis from necrosis?
A) Extensive surrounding inflammation
,B) Programmed cellular death with limited inflammation
C) Immediate rupture of every cellular membrane
D) Uncontrolled tissue destruction
Correct Answer: Programmed cellular death with limited inflammation
Rationale: Apoptosis is a regulated process of cellular elimination that generally produces
little surrounding inflammation because cellular fragments are efficiently removed. Necrosis
usually follows severe injury and involves membrane disruption, release of intracellular
contents, and inflammation. Apoptosis is therefore important in normal development as well
as disease.
7. A toxin increases production of unstable molecules that damage cellular lipids and
proteins. Which process is occurring?
A) Osmosis
B) Hyperplasia
C) Oxidative stress
D) Autophagy
Correct Answer: Oxidative stress
Rationale: Oxidative stress occurs when reactive oxygen species exceed the cell's antioxidant
defenses. Reactive molecules can damage membrane lipids, proteins, DNA, and organelles.
Although reactive oxygen species have normal signaling roles, excessive accumulation
contributes to cellular injury and several chronic disease processes.
8. Which cellular change is most closely associated with chronic irritation of respiratory
epithelium by cigarette smoke?
A) Physiologic hypertrophy
B) Atrophy
C) Hyperplasia only
D) Metaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is a reversible adaptation in which one differentiated cell type is
replaced by another better suited to withstand persistent stress. Chronic smoke exposure can
promote replacement of normal respiratory epithelium with squamous epithelium. Although
initially protective, persistent metaplastic change may increase the risk of dysplasia and
malignancy.
, 9. A tissue contains an abnormal proliferation of cells with disorganized architecture and
cellular atypia. Which term best describes this finding?
A) Dysplasia
B) Hypertrophy
C) Atrophy
D) Hyperplasia
Correct Answer: Dysplasia
Rationale: Dysplasia refers to abnormal cellular development characterized by variation in
cell size, shape, organization, and nuclear features. It may occur in chronically irritated
tissues and can represent a precursor to malignant transformation. Hyperplasia refers
primarily to increased cell number without necessarily having abnormal cellular architecture.
10. Which mechanism contributes directly to tissue injury caused by reperfusion after
prolonged ischemia?
A) Complete elimination of free radicals
B) Sudden production of reactive oxygen species
C) Permanent suppression of leukocytes
D) Increased cellular oxygen tolerance
Correct Answer: Sudden production of reactive oxygen species
Rationale: Reperfusion restores oxygen but can paradoxically worsen injury through
generation of reactive oxygen species. These molecules can damage membranes, proteins,
mitochondria, and DNA. Calcium influx and inflammatory activation may further contribute
to tissue damage after blood flow returns.
11. A cell activates a process in which damaged organelles are enclosed and delivered to
lysosomes for degradation. What is this process called?
A) Necrosis
B) Exocytosis
C) Autophagy
D) Pinocytosis
Correct Answer: Autophagy
Rationale: Autophagy is a regulated process that allows cells to degrade and recycle
damaged organelles and intracellular components. It can help cells survive during nutrient
deprivation or other stresses. Excessive or dysregulated autophagy, however, may contribute
to cellular dysfunction in certain diseases.
ADVANCED PATHOPHYSIOLOGY MIDTERM –
QUESTIONS AND ANSWERS | 2026/2027
LATEST UPDATE
SECTION 1: CELLULAR BIOLOGY, ADAPTATION, AND CELLULAR INJURY
Questions 1–18
1. Which cellular adaptation involves an increase in the size of individual cells in response
to increased workload?
A) Hypertrophy
B) Hyperplasia
C) Atrophy
D) Metaplasia
Correct Answer: Hypertrophy
Rationale: Hypertrophy increases individual cell size rather than cell number. It commonly
develops when cells experience increased functional demand, such as cardiac muscle
exposed to chronic pressure overload. Hyperplasia increases cell number, atrophy decreases
cellular size, and metaplasia involves replacement of one mature cell type with another.
2. A reduction in workload causes skeletal muscle fibers to become smaller over time.
Which adaptation explains this finding?
A) Hyperplasia
B) Atrophy
C) Hypertrophy
D) Dysplasia
Correct Answer: Atrophy
Rationale: Atrophy is a decrease in cell size caused by reduced workload, inadequate
nutrition, loss of nerve supply, or other factors. Disuse of skeletal muscle is a classic example.
Hyperplasia and hypertrophy represent increases in cell number and size, respectively, while
dysplasia describes abnormal cellular growth and organization.
3. What is the principal consequence of inadequate oxygen delivery to a cell?
A) Increased oxidative phosphorylation
,B) Increased mitochondrial ATP production
C) Reduced ATP generation
D) Accelerated protein synthesis
Correct Answer: Reduced ATP generation
Rationale: Oxygen is required for efficient mitochondrial oxidative phosphorylation. When
oxygen delivery falls, ATP production decreases, impairing energy-dependent membrane
pumps and cellular processes. Anaerobic metabolism can temporarily compensate, but it
produces substantially less ATP and contributes to lactate accumulation.
4. Which finding most strongly indicates that cellular injury has progressed from reversible
to irreversible damage?
A) Mild cellular swelling
B) Increased glycogen storage
C) Temporary fatty change
D) Severe membrane and mitochondrial damage with nuclear destruction
Correct Answer: Severe membrane and mitochondrial damage with nuclear destruction
Rationale: Irreversible cellular injury involves profound mitochondrial dysfunction, loss of
membrane integrity, calcium dysregulation, and nuclear changes such as pyknosis,
karyorrhexis, or karyolysis. Mild swelling and temporary metabolic changes may be
reversible when the underlying stress is corrected before critical cellular structures are
permanently damaged.
5. Which mechanism is most directly responsible for cellular swelling during early
reversible injury?
A) Failure of ATP-dependent ion pumps
B) Excessive DNA replication
C) Increased lysosomal synthesis
D) Enhanced oxidative phosphorylation
Correct Answer: Failure of ATP-dependent ion pumps
Rationale: ATP depletion impairs the sodium-potassium pump located in the plasma
membrane. Sodium accumulates intracellularly, causing water to enter the cell osmotically.
This produces cellular swelling, a characteristic early manifestation of reversible injury. The
other mechanisms do not directly explain the movement of water into injured cells.
6. Which characteristic best distinguishes apoptosis from necrosis?
A) Extensive surrounding inflammation
,B) Programmed cellular death with limited inflammation
C) Immediate rupture of every cellular membrane
D) Uncontrolled tissue destruction
Correct Answer: Programmed cellular death with limited inflammation
Rationale: Apoptosis is a regulated process of cellular elimination that generally produces
little surrounding inflammation because cellular fragments are efficiently removed. Necrosis
usually follows severe injury and involves membrane disruption, release of intracellular
contents, and inflammation. Apoptosis is therefore important in normal development as well
as disease.
7. A toxin increases production of unstable molecules that damage cellular lipids and
proteins. Which process is occurring?
A) Osmosis
B) Hyperplasia
C) Oxidative stress
D) Autophagy
Correct Answer: Oxidative stress
Rationale: Oxidative stress occurs when reactive oxygen species exceed the cell's antioxidant
defenses. Reactive molecules can damage membrane lipids, proteins, DNA, and organelles.
Although reactive oxygen species have normal signaling roles, excessive accumulation
contributes to cellular injury and several chronic disease processes.
8. Which cellular change is most closely associated with chronic irritation of respiratory
epithelium by cigarette smoke?
A) Physiologic hypertrophy
B) Atrophy
C) Hyperplasia only
D) Metaplasia
Correct Answer: Metaplasia
Rationale: Metaplasia is a reversible adaptation in which one differentiated cell type is
replaced by another better suited to withstand persistent stress. Chronic smoke exposure can
promote replacement of normal respiratory epithelium with squamous epithelium. Although
initially protective, persistent metaplastic change may increase the risk of dysplasia and
malignancy.
, 9. A tissue contains an abnormal proliferation of cells with disorganized architecture and
cellular atypia. Which term best describes this finding?
A) Dysplasia
B) Hypertrophy
C) Atrophy
D) Hyperplasia
Correct Answer: Dysplasia
Rationale: Dysplasia refers to abnormal cellular development characterized by variation in
cell size, shape, organization, and nuclear features. It may occur in chronically irritated
tissues and can represent a precursor to malignant transformation. Hyperplasia refers
primarily to increased cell number without necessarily having abnormal cellular architecture.
10. Which mechanism contributes directly to tissue injury caused by reperfusion after
prolonged ischemia?
A) Complete elimination of free radicals
B) Sudden production of reactive oxygen species
C) Permanent suppression of leukocytes
D) Increased cellular oxygen tolerance
Correct Answer: Sudden production of reactive oxygen species
Rationale: Reperfusion restores oxygen but can paradoxically worsen injury through
generation of reactive oxygen species. These molecules can damage membranes, proteins,
mitochondria, and DNA. Calcium influx and inflammatory activation may further contribute
to tissue damage after blood flow returns.
11. A cell activates a process in which damaged organelles are enclosed and delivered to
lysosomes for degradation. What is this process called?
A) Necrosis
B) Exocytosis
C) Autophagy
D) Pinocytosis
Correct Answer: Autophagy
Rationale: Autophagy is a regulated process that allows cells to degrade and recycle
damaged organelles and intracellular components. It can help cells survive during nutrient
deprivation or other stresses. Excessive or dysregulated autophagy, however, may contribute
to cellular dysfunction in certain diseases.
