NURS 5433 Advanced Pathophysiology |
Chamberlain University | Academic Year
2026/2027
SECTION 1: Cellular Adaptation, Injury, and Genetics (Questions 1–20)
1. A 62-year-old male with long-standing hypertension develops left ventricular
enlargement. Which cellular adaptation best describes this change?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot
divide. In response to chronic pressure overload (hypertension), cardiomyocytes
increase in size (hypertrophy) to maintain wall tension. Hyperplasia involves an
increase in cell number, which is not possible in cardiac muscle. Atrophy is a
decrease in cell size, and metaplasia is the replacement of one mature cell type
with another.
2. A 55-year-old female with chronic gastroesophageal reflux disease undergoes
an endoscopy that reveals replacement of squamous epithelium with columnar
epithelium in the lower esophagus (Barrett's esophagus). This is an example of:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by
another, often in response to chronic irritation. In Barrett's esophagus, chronic
,acid exposure causes squamous cells to be replaced by columnar cells. Dysplasia
refers to disordered growth, hyperplasia is an increase in cell number, and
anaplasia is a lack of differentiation characteristic of malignancy.
3. Which of the following best describes the mechanism of apoptosis?
A. Programmed cell death involving caspase activation and cell shrinkage
B. Uncontrolled cell lysis with inflammatory response
C. Ischemic cell death with mitochondrial swelling
D. Coagulative necrosis due to protein denaturation
Rationale: Apoptosis is programmed cell death characterized by cell
shrinkage, chromatin condensation, and activation of caspases. It does not elicit
an inflammatory response. Necrosis, in contrast, involves cell swelling, lysis, and
inflammation.
4. A 48-year-old male with a 30-pack-year smoking history develops squamous cell
carcinoma of the lung. Which genetic alteration is most commonly associated with
this malignancy?
A. BRCA1 mutation
B. TP53 mutation
C. APC mutation
D. RET proto-oncogene mutation
Rationale: TP53 is the most frequently mutated tumor suppressor gene in
human cancers, including lung squamous cell carcinoma. BRCA1 is associated with
breast and ovarian cancer, APC with colorectal cancer, and RET with medullary
thyroid carcinoma.
5. Which of the following is an example of a labile cell population?
,A. Hepatocytes
B. Intestinal epithelial cells
C. Cardiac myocytes
D. Neurons
Rationale: Labile cells continuously divide and regenerate, such as intestinal
epithelial cells, skin, and hematopoietic cells. Hepatocytes are stable cells
(quiescent but can regenerate). Cardiac myocytes and neurons are permanent
cells that cannot divide.
6. A 35-year-old female presents with recurrent infections and is found to have
defective neutrophil oxidative burst. This condition is most consistent with:
A. Severe combined immunodeficiency (SCID)
B. Chronic granulomatous disease (CGD)
C. DiGeorge syndrome
D. Wiskott-Aldrich syndrome
Rationale: Chronic granulomatous disease is caused by a defect in NADPH
oxidase, which is responsible for the oxidative burst in phagocytes. This leads to
recurrent catalase-positive bacterial and fungal infections. SCID involves defective
T and B cell function, DiGeorge involves thymic hypoplasia, and Wiskott-Aldrich
involves impaired T cell function and platelet abnormalities.
7. Which type of hypersensitivity reaction is mediated by IgE antibodies?
A. Type II
B. Type III
C. Type I
D. Type IV
Rationale: Type I hypersensitivity is IgE-mediated and involves mast cell
degranulation, leading to allergic reactions such as anaphylaxis, allergic rhinitis,
, and asthma. Type II is antibody-mediated (IgG/IgM), Type III is immune complex-
mediated, and Type IV is T cell-mediated (delayed-type).
8. A 28-year-old female with systemic lupus erythematosus (SLE) has anti-nuclear
antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. Which
type of hypersensitivity reaction is primarily responsible for her tissue damage?
A. Type I
B. Type II
C. Type III
D. Type IV
Rationale: SLE is primarily a Type III hypersensitivity reaction, where immune
complexes (antigen-antibody) deposit in tissues, activate complement, and cause
inflammation. Anti-dsDNA antibodies form complexes that deposit in the
glomeruli, skin, and joints. Type II involves antibodies directed against tissue
antigens, and Type IV is cell-mediated.
9. Which of the following is a characteristic feature of malignant neoplasms?
A. Encapsulated and well-circumscribed
B. Ability to invade and metastasize
C. Slow growth rate
D. Cells resemble the tissue of origin
Rationale: Malignant neoplasms are characterized by invasion, metastasis,
rapid growth, and anaplasia (lack of differentiation). Benign neoplasms are
typically encapsulated, slow-growing, and resemble their tissue of origin.
10. A 45-year-old male with a family history of colorectal cancer is found to have a
mutation in the APC gene. This mutation is most associated with:
Chamberlain University | Academic Year
2026/2027
SECTION 1: Cellular Adaptation, Injury, and Genetics (Questions 1–20)
1. A 62-year-old male with long-standing hypertension develops left ventricular
enlargement. Which cellular adaptation best describes this change?
A. Hyperplasia
B. Atrophy
C. Metaplasia
D. Hypertrophy
Rationale: Cardiac muscle cells are terminally differentiated and cannot
divide. In response to chronic pressure overload (hypertension), cardiomyocytes
increase in size (hypertrophy) to maintain wall tension. Hyperplasia involves an
increase in cell number, which is not possible in cardiac muscle. Atrophy is a
decrease in cell size, and metaplasia is the replacement of one mature cell type
with another.
2. A 55-year-old female with chronic gastroesophageal reflux disease undergoes
an endoscopy that reveals replacement of squamous epithelium with columnar
epithelium in the lower esophagus (Barrett's esophagus). This is an example of:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Rationale: Metaplasia is the reversible replacement of one mature cell type by
another, often in response to chronic irritation. In Barrett's esophagus, chronic
,acid exposure causes squamous cells to be replaced by columnar cells. Dysplasia
refers to disordered growth, hyperplasia is an increase in cell number, and
anaplasia is a lack of differentiation characteristic of malignancy.
3. Which of the following best describes the mechanism of apoptosis?
A. Programmed cell death involving caspase activation and cell shrinkage
B. Uncontrolled cell lysis with inflammatory response
C. Ischemic cell death with mitochondrial swelling
D. Coagulative necrosis due to protein denaturation
Rationale: Apoptosis is programmed cell death characterized by cell
shrinkage, chromatin condensation, and activation of caspases. It does not elicit
an inflammatory response. Necrosis, in contrast, involves cell swelling, lysis, and
inflammation.
4. A 48-year-old male with a 30-pack-year smoking history develops squamous cell
carcinoma of the lung. Which genetic alteration is most commonly associated with
this malignancy?
A. BRCA1 mutation
B. TP53 mutation
C. APC mutation
D. RET proto-oncogene mutation
Rationale: TP53 is the most frequently mutated tumor suppressor gene in
human cancers, including lung squamous cell carcinoma. BRCA1 is associated with
breast and ovarian cancer, APC with colorectal cancer, and RET with medullary
thyroid carcinoma.
5. Which of the following is an example of a labile cell population?
,A. Hepatocytes
B. Intestinal epithelial cells
C. Cardiac myocytes
D. Neurons
Rationale: Labile cells continuously divide and regenerate, such as intestinal
epithelial cells, skin, and hematopoietic cells. Hepatocytes are stable cells
(quiescent but can regenerate). Cardiac myocytes and neurons are permanent
cells that cannot divide.
6. A 35-year-old female presents with recurrent infections and is found to have
defective neutrophil oxidative burst. This condition is most consistent with:
A. Severe combined immunodeficiency (SCID)
B. Chronic granulomatous disease (CGD)
C. DiGeorge syndrome
D. Wiskott-Aldrich syndrome
Rationale: Chronic granulomatous disease is caused by a defect in NADPH
oxidase, which is responsible for the oxidative burst in phagocytes. This leads to
recurrent catalase-positive bacterial and fungal infections. SCID involves defective
T and B cell function, DiGeorge involves thymic hypoplasia, and Wiskott-Aldrich
involves impaired T cell function and platelet abnormalities.
7. Which type of hypersensitivity reaction is mediated by IgE antibodies?
A. Type II
B. Type III
C. Type I
D. Type IV
Rationale: Type I hypersensitivity is IgE-mediated and involves mast cell
degranulation, leading to allergic reactions such as anaphylaxis, allergic rhinitis,
, and asthma. Type II is antibody-mediated (IgG/IgM), Type III is immune complex-
mediated, and Type IV is T cell-mediated (delayed-type).
8. A 28-year-old female with systemic lupus erythematosus (SLE) has anti-nuclear
antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. Which
type of hypersensitivity reaction is primarily responsible for her tissue damage?
A. Type I
B. Type II
C. Type III
D. Type IV
Rationale: SLE is primarily a Type III hypersensitivity reaction, where immune
complexes (antigen-antibody) deposit in tissues, activate complement, and cause
inflammation. Anti-dsDNA antibodies form complexes that deposit in the
glomeruli, skin, and joints. Type II involves antibodies directed against tissue
antigens, and Type IV is cell-mediated.
9. Which of the following is a characteristic feature of malignant neoplasms?
A. Encapsulated and well-circumscribed
B. Ability to invade and metastasize
C. Slow growth rate
D. Cells resemble the tissue of origin
Rationale: Malignant neoplasms are characterized by invasion, metastasis,
rapid growth, and anaplasia (lack of differentiation). Benign neoplasms are
typically encapsulated, slow-growing, and resemble their tissue of origin.
10. A 45-year-old male with a family history of colorectal cancer is found to have a
mutation in the APC gene. This mutation is most associated with:
