1
NR507-NP Midterm Exam: Advanced
Pathophysiology Actual Exam Questions
& Verified Answers | Nurse Practitioner
Certification Prep
Section 1: Cellular Injury, Adaptation & Neoplasia
Q1: A 58-year-old woman with lobular carcinoma in situ (LCIS) is informed her condition
carries a 30 % lifetime risk of invasive cancer. Which hallmark of neoplasia best explains this
field-effect predisposition?
A. Genomic instability
B. Sustained proliferative signaling
C. Evading immune destruction
D. Activating invasion & metastasis
Answer: A
Verified Rationale: Genomic instability generates cumulative mutations across entire epithelial
fields, explaining the multifocal and bilateral cancer risk seen with LCIS.
Q2: Which cellular adaptation is characterized by an increase in the NUMBER of cells in an
organ or tissue, typically in response to hormonal stimulation or increased functional demand?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: A
Verified Rationale: Hyperplasia is defined as a reversible increase in cell number while
individual cell size remains normal.
Q3: The development of Barrett esophagus, where stratified squamous epithelium is replaced by
intestinal-type columnar epithelium, is an example of:
A. Dysplasia
B. Metaplasia
,2
C. Anaplasia
D. Hyperplasia
Answer: B
Verified Rationale: Metaplasia is the reversible substitution of one differentiated cell type by
another better able to withstand an adverse environment.
Q4: A renal transplant recipient with rising creatinine shows endothelial cell swelling, bleb
formation, and loss of microvilli on electron microscopy. These ultrastructural changes are most
consistent with which form of reversible injury?
A. Hydropic change
B. Coagulative necrosis
C. Apoptosis
D. Caseous necrosis
Answer: A
Verified Rationale: Hydropic (vacuolar) change represents early, reversible ATP-depletion–
induced Na+/K+ pump failure with influx of water.
Q5: Which of the following is the most reliable cytologic feature distinguishing malignant from
benign cells in a fine-needle aspirate?
A. Large cytoplasmic glycogen vacuoles
B. Hyperchromatic nuclei with irregular nuclear contours
C. Binucleation in mesothelial cells
D. Perinuclear halo in plasma cells
Answer: B
Verified Rationale: Irregular, hyperchromatic nuclei reflect cumulative genetic damage and are a
cardinal sign of malignancy.
Q6: A 45-year-old woman with HER2-positive breast cancer receives trastuzumab. The drug’s
antineoplastic effect is primarily mediated by inhibition of which hallmark capability?
A. Inducing angiogenesis
B. Sustained proliferative signaling
C. Evading growth suppressors
D. Resisting cell death
Answer: B
Verified Rationale: Trastuzumab blocks HER2 receptor tyrosine kinase signaling, thereby
interrupting constitutive proliferative signaling.
Q7: Which cell type relies MOST heavily on the unfolded protein response (UPR) to prevent
injury from accumulation of misfolded immunoglobulins?
A. Pancreatic acinar cell
, 3
B. Plasma cell
C. Keratinocyte
D. Adipocyte
Answer: B
Verified Rationale: Plasma cells synthesize abundant secretory immunoglobulins, making them
highly dependent on UPR quality-control pathways.
Q8: Select ALL that apply. Which of the following are mechanisms by which normal cells evade
apoptosis? (Select 2)
A. Phosphorylation of p53 by DNA-damage sensors
B. Activation of PI3K/Akt pathway leading to BAD phosphorylation
C. Overexpression of Bcl-2
D. Caspase 8 activation via Fas receptor
Answer: B, C
Verified Rationale: Both PI3K/Akt-mediated BAD phosphorylation and Bcl-2 overexpression
block mitochondrial cytochrome-c release, thereby inhibiting apoptosis.
Q9: A 62-year-old smoker has a chest CT showing a 2-cm spiculated mass. Biopsy reveals
keratin pearls and intercellular bridges. Which grade and stage information is MOST critical for
predicting 5-year survival?
A. Nuclear grade and mitotic count
B. Depth of invasion and nodal status
C. Tumor doubling time
D. Presence of necrosis
Answer: B
Verified Rationale: TNM staging (depth/nodal spread) remains the strongest predictor of survival
in solid tumors.
Q10: A 70-year-old man develops therapy-related myelodysplastic syndrome 5 years after
chemotherapy for non-Hodgkin lymphoma. Which class of chemotherapy agents is MOST
implicated in this secondary neoplasm?
A. Antimicrotubule agents
B. Topoisomerase II inhibitors
C. Alkylating agents
D. Monoclonal antibodies
Answer: C
Verified Rationale: Alkylating agents cause DNA cross-links that lead to TP53 mutations and
secondary leukemias/myelodysplasia.
Section 2: Cardiovascular Pathophysiology
NR507-NP Midterm Exam: Advanced
Pathophysiology Actual Exam Questions
& Verified Answers | Nurse Practitioner
Certification Prep
Section 1: Cellular Injury, Adaptation & Neoplasia
Q1: A 58-year-old woman with lobular carcinoma in situ (LCIS) is informed her condition
carries a 30 % lifetime risk of invasive cancer. Which hallmark of neoplasia best explains this
field-effect predisposition?
A. Genomic instability
B. Sustained proliferative signaling
C. Evading immune destruction
D. Activating invasion & metastasis
Answer: A
Verified Rationale: Genomic instability generates cumulative mutations across entire epithelial
fields, explaining the multifocal and bilateral cancer risk seen with LCIS.
Q2: Which cellular adaptation is characterized by an increase in the NUMBER of cells in an
organ or tissue, typically in response to hormonal stimulation or increased functional demand?
A. Hyperplasia
B. Hypertrophy
C. Atrophy
D. Metaplasia
Answer: A
Verified Rationale: Hyperplasia is defined as a reversible increase in cell number while
individual cell size remains normal.
Q3: The development of Barrett esophagus, where stratified squamous epithelium is replaced by
intestinal-type columnar epithelium, is an example of:
A. Dysplasia
B. Metaplasia
,2
C. Anaplasia
D. Hyperplasia
Answer: B
Verified Rationale: Metaplasia is the reversible substitution of one differentiated cell type by
another better able to withstand an adverse environment.
Q4: A renal transplant recipient with rising creatinine shows endothelial cell swelling, bleb
formation, and loss of microvilli on electron microscopy. These ultrastructural changes are most
consistent with which form of reversible injury?
A. Hydropic change
B. Coagulative necrosis
C. Apoptosis
D. Caseous necrosis
Answer: A
Verified Rationale: Hydropic (vacuolar) change represents early, reversible ATP-depletion–
induced Na+/K+ pump failure with influx of water.
Q5: Which of the following is the most reliable cytologic feature distinguishing malignant from
benign cells in a fine-needle aspirate?
A. Large cytoplasmic glycogen vacuoles
B. Hyperchromatic nuclei with irregular nuclear contours
C. Binucleation in mesothelial cells
D. Perinuclear halo in plasma cells
Answer: B
Verified Rationale: Irregular, hyperchromatic nuclei reflect cumulative genetic damage and are a
cardinal sign of malignancy.
Q6: A 45-year-old woman with HER2-positive breast cancer receives trastuzumab. The drug’s
antineoplastic effect is primarily mediated by inhibition of which hallmark capability?
A. Inducing angiogenesis
B. Sustained proliferative signaling
C. Evading growth suppressors
D. Resisting cell death
Answer: B
Verified Rationale: Trastuzumab blocks HER2 receptor tyrosine kinase signaling, thereby
interrupting constitutive proliferative signaling.
Q7: Which cell type relies MOST heavily on the unfolded protein response (UPR) to prevent
injury from accumulation of misfolded immunoglobulins?
A. Pancreatic acinar cell
, 3
B. Plasma cell
C. Keratinocyte
D. Adipocyte
Answer: B
Verified Rationale: Plasma cells synthesize abundant secretory immunoglobulins, making them
highly dependent on UPR quality-control pathways.
Q8: Select ALL that apply. Which of the following are mechanisms by which normal cells evade
apoptosis? (Select 2)
A. Phosphorylation of p53 by DNA-damage sensors
B. Activation of PI3K/Akt pathway leading to BAD phosphorylation
C. Overexpression of Bcl-2
D. Caspase 8 activation via Fas receptor
Answer: B, C
Verified Rationale: Both PI3K/Akt-mediated BAD phosphorylation and Bcl-2 overexpression
block mitochondrial cytochrome-c release, thereby inhibiting apoptosis.
Q9: A 62-year-old smoker has a chest CT showing a 2-cm spiculated mass. Biopsy reveals
keratin pearls and intercellular bridges. Which grade and stage information is MOST critical for
predicting 5-year survival?
A. Nuclear grade and mitotic count
B. Depth of invasion and nodal status
C. Tumor doubling time
D. Presence of necrosis
Answer: B
Verified Rationale: TNM staging (depth/nodal spread) remains the strongest predictor of survival
in solid tumors.
Q10: A 70-year-old man develops therapy-related myelodysplastic syndrome 5 years after
chemotherapy for non-Hodgkin lymphoma. Which class of chemotherapy agents is MOST
implicated in this secondary neoplasm?
A. Antimicrotubule agents
B. Topoisomerase II inhibitors
C. Alkylating agents
D. Monoclonal antibodies
Answer: C
Verified Rationale: Alkylating agents cause DNA cross-links that lead to TP53 mutations and
secondary leukemias/myelodysplasia.
Section 2: Cardiovascular Pathophysiology
