NURS6501 Advanced Pathophysiology Midterm
Exam - Walden University MSN 2026-2027 |
Disease Processes & System Pathology
75 multiple-choice items | Bloom level coded (A = analysis/synthesis, P = application, R
= advanced recall)
MODULE 1 ‑ Cellular Basis of Disease (15 Qs)
Q1. A 55-year-old man with untreated hypertension is found to have a left-ventricular
wall thickness of 1.7 cm (normal ≤1.1 cm) with normal cavity size. Which
pathophysiologic process best explains this change?
A. Pathologic hyperplasia
B. Compensatory hypertrophy (P)
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Chronic pressure overload increases sarcomeres in parallel → concentric
hypertrophy (adaptive). Not hyperplasia (cell number), metaplasia (cell type), or
dysplasia (atypia).
,Q2. A 42-year-old woman with BRCA1 mutation undergoes prophylactic oophorectomy.
Pathology shows multiple microscopic ovarian cortical inclusion cysts lined by
tubal-type ciliated epithelium. This change is termed:
A. Apocrine metaplasia
B. Squamous metaplasia
C. Tubal metaplasia (P)
D. Dysplastic metaplasia
Correct Answer: C
Rationale: Ciliated tubal epithelium in ovary is tubal metaplasia—benign cell-type switch.
Not apocrine (breast), squamous, or dysplastic.
Q3. A 6-year-old boy ingests iron tablets. Serum markers show lipid peroxidation and
mitochondrial swelling. Which type of cellular injury predominates?
A. Apoptosis
B. Oxidative stress (P)
C. Autophagy
D. Chaperone-mediated proteolysis
Correct Answer: B
Rationale: Iron catalyzes Fenton reaction → ROS → membrane lipid
peroxidation—classic oxidative injury. Not programmed death or proteostasis.
,Q4. A 68-year-old smoker develops emphysema. Histology shows alveolar wall
apoptosis and decreased elastin. Which enzyme imbalance is most central?
A. Neutrophil elastase ↑ and α1-antitrypsin ↓ (A)
B. Collagenase ↑ and TIMP ↓
C. Xanthine oxidase ↑ and catalase ↓
D. Pancreatic lipase ↑ and lipoprotein lipase ↓
Correct Answer: A
Rationale: Smoking oxidizes α1-AT → uninhibited elastase → elastin degradation →
emphysema. Other choices relate to fibrosis, reperfusion, or fat metabolism.
Q5. A renal allograft biopsy 3 months post-transplant shows endothelialitis and
interstitial lymphocytic infiltrate. Which process is primarily responsible?
A. Hyperacute rejection
B. Acute cellular rejection (P)
C. Chronic rejection
D. Calcineurin inhibitor toxicity
Correct Answer: B
Rationale: Endothelialitis + T-cell infiltrate defines acute cellular rejection. Hyperacute is
minutes (pre-formed Ab), chronic is months-years fibrosis, CNI toxicity causes striped
fibrosis.
, Q6. A 30-year-old HIV-positive patient starts ART. Two weeks later CD4 count rises from
80 to 250 cells/µL but he develops fever, pulmonary infiltrates, and pleuritic pain. Which
immunopathologic mechanism explains these findings?
A. IRIS – immune reconstitution inflammatory syndrome (P)
B. Drug-induced hypersensitivity pneumonitis
C. Cytokine storm from ART
D. Latent HIV replication in alveoli
Correct Answer: A
Rationale: Rapid CD4 recovery → exuberant Th1 response to subclinical pathogens →
IRIS. Not direct drug toxicity or viral replication.
Q7. A 50-year-old woman has hereditary non-polyposis colon cancer (HNPCC). DNA
analysis reveals microsatellite instability. Which DNA repair pathway is defective?
A. Base-excision repair
B. Nucleotide-excision repair
C. Mismatch repair (R)
D. Homologous recombination
Correct Answer: C
Rationale: HNPCC involves germline mutation in MSH2/MLH1 → mismatch repair
failure → microsatellite instability.
Exam - Walden University MSN 2026-2027 |
Disease Processes & System Pathology
75 multiple-choice items | Bloom level coded (A = analysis/synthesis, P = application, R
= advanced recall)
MODULE 1 ‑ Cellular Basis of Disease (15 Qs)
Q1. A 55-year-old man with untreated hypertension is found to have a left-ventricular
wall thickness of 1.7 cm (normal ≤1.1 cm) with normal cavity size. Which
pathophysiologic process best explains this change?
A. Pathologic hyperplasia
B. Compensatory hypertrophy (P)
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Chronic pressure overload increases sarcomeres in parallel → concentric
hypertrophy (adaptive). Not hyperplasia (cell number), metaplasia (cell type), or
dysplasia (atypia).
,Q2. A 42-year-old woman with BRCA1 mutation undergoes prophylactic oophorectomy.
Pathology shows multiple microscopic ovarian cortical inclusion cysts lined by
tubal-type ciliated epithelium. This change is termed:
A. Apocrine metaplasia
B. Squamous metaplasia
C. Tubal metaplasia (P)
D. Dysplastic metaplasia
Correct Answer: C
Rationale: Ciliated tubal epithelium in ovary is tubal metaplasia—benign cell-type switch.
Not apocrine (breast), squamous, or dysplastic.
Q3. A 6-year-old boy ingests iron tablets. Serum markers show lipid peroxidation and
mitochondrial swelling. Which type of cellular injury predominates?
A. Apoptosis
B. Oxidative stress (P)
C. Autophagy
D. Chaperone-mediated proteolysis
Correct Answer: B
Rationale: Iron catalyzes Fenton reaction → ROS → membrane lipid
peroxidation—classic oxidative injury. Not programmed death or proteostasis.
,Q4. A 68-year-old smoker develops emphysema. Histology shows alveolar wall
apoptosis and decreased elastin. Which enzyme imbalance is most central?
A. Neutrophil elastase ↑ and α1-antitrypsin ↓ (A)
B. Collagenase ↑ and TIMP ↓
C. Xanthine oxidase ↑ and catalase ↓
D. Pancreatic lipase ↑ and lipoprotein lipase ↓
Correct Answer: A
Rationale: Smoking oxidizes α1-AT → uninhibited elastase → elastin degradation →
emphysema. Other choices relate to fibrosis, reperfusion, or fat metabolism.
Q5. A renal allograft biopsy 3 months post-transplant shows endothelialitis and
interstitial lymphocytic infiltrate. Which process is primarily responsible?
A. Hyperacute rejection
B. Acute cellular rejection (P)
C. Chronic rejection
D. Calcineurin inhibitor toxicity
Correct Answer: B
Rationale: Endothelialitis + T-cell infiltrate defines acute cellular rejection. Hyperacute is
minutes (pre-formed Ab), chronic is months-years fibrosis, CNI toxicity causes striped
fibrosis.
, Q6. A 30-year-old HIV-positive patient starts ART. Two weeks later CD4 count rises from
80 to 250 cells/µL but he develops fever, pulmonary infiltrates, and pleuritic pain. Which
immunopathologic mechanism explains these findings?
A. IRIS – immune reconstitution inflammatory syndrome (P)
B. Drug-induced hypersensitivity pneumonitis
C. Cytokine storm from ART
D. Latent HIV replication in alveoli
Correct Answer: A
Rationale: Rapid CD4 recovery → exuberant Th1 response to subclinical pathogens →
IRIS. Not direct drug toxicity or viral replication.
Q7. A 50-year-old woman has hereditary non-polyposis colon cancer (HNPCC). DNA
analysis reveals microsatellite instability. Which DNA repair pathway is defective?
A. Base-excision repair
B. Nucleotide-excision repair
C. Mismatch repair (R)
D. Homologous recombination
Correct Answer: C
Rationale: HNPCC involves germline mutation in MSH2/MLH1 → mismatch repair
failure → microsatellite instability.
