NURS 611 EXAM 1:
PATHOPHYSIOLOGY MARYVILLE
UNIVERSITY LATEST VERSION /
GRADED A+
SECTION I: CELLULAR BIOLOGY & ADAPTATION
1. A patient is diagnosed with cardiac ischemia. At a cellular level, what is the most likely primary
mechanism of injury?
a) Hypoxic injury due to inadequate blood flow
b) Free radical injury from reperfusion
c) Chemical injury from lipid accumulation
d) Apoptosis from genetic programming
Answer: a) Hypoxic injury due to inadequate blood flow
Rationale: Ischemia is the most common cause of hypoxia, resulting from reduced blood flow (oxygen
delivery) to tissues. While reperfusion injury (b) can occur when flow is restored, the primary
mechanism of injury during ischemia is hypoxia.
2. A pathologist notes that the heart of a patient with long-standing hypertension shows an increased
muscle mass with larger myocytes. This is best described as:
a) Hyperplasia
b) Metaplasia
c) Hypertrophy
d) Dysplasia
Answer: c) Hypertrophy
Rationale: Hypertrophy refers to an increase in the size of cells, leading to an increase in the size of the
organ. In hypertension, cardiac myocytes enlarge to compensate for increased workload. Hyperplasia (a)
is an increase in cell number.
,3. Which cellular adaptation is considered irreversible and is a hallmark of high-grade squamous
intraepithelial lesions (HSIL) in the cervix?
a) Atrophy
b) Metaplasia
c) Dysplasia
d) Anaplasia
Answer: c) Dysplasia
Rationale: Dysplasia is disordered cellular growth, often characterized by variations in size, shape, and
organization. While it is often reversible if the irritating stimulus is removed, high-grade dysplasia is
considered a pre-malignant, irreversible state in clinical practice (though pathologically it is technically
reversible until it becomes carcinoma in situ).
4. A patient with chronic gastroesophageal reflux disease (GERD) has the normal stratified squamous
epithelium of the lower esophagus replaced by columnar epithelium. This process is known as:
a) Dysplasia
b) Barrett metaplasia
c) Hypertrophy
d) Neoplasia
Answer: b) Barrett metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another. In
GERD, the esophagus undergoes metaplasia to columnar epithelium (Barrett esophagus) to better
withstand the acidic environment.
5. During cellular injury, what happens to sodium (Na+) and water due to failure of the Na+/K+
ATPase pump?
a) Sodium moves out of the cell; water follows, causing cell shrinkage
b) Sodium moves into the cell; water follows, causing cellular swelling
c) Potassium moves into the cell; water follows, causing cellular swelling
d) Sodium and potassium equilibrium is maintained by passive diffusion
Answer: b) Sodium moves into the cell; water follows, causing cellular swelling
Rationale: The Na+/K+ ATPase pump maintains high intracellular K+ and low intracellular Na+. When
ATP is depleted (hypoxia), the pump fails. Na+ accumulates intracellularly, increasing osmotic pressure,
drawing water into the cell, causing hydropic swelling (the earliest sign of cellular injury).
6. Which mechanism of cell death is characterized by cell shrinkage, chromatin condensation, and
formation of apoptotic bodies without triggering inflammation?
a) Necrosis
b) Pyroptosis
, c) Apoptosis
d) Coagulative necrosis
Answer: c) Apoptosis
Rationale: Apoptosis is programmed cell death. It is a highly regulated, energy-dependent process that
eliminates damaged or senescent cells without releasing cellular contents into the interstitium, thus
avoiding an inflammatory response. Necrosis (a) is unregulated and inflammatory.
7. Caseous necrosis, characterized by a soft, "cheese-like" appearance, is most commonly associated
with which type of infection?
a) Streptococcal pneumonia
b) Tuberculosis
c) Clostridium infection
d) Viral hepatitis
Answer: b) Tuberculosis
Rationale: Caseous necrosis is a distinct form of coagulative necrosis most often seen in tuberculosis.
The center of the granuloma has a friable, yellow-white appearance (like cottage cheese) due to the
breakdown of tissue and immune cells.
SECTION II: GENETICS & GENOMICS
8. A child is born with a deletion on chromosome 15 inherited from the father, resulting in Prader-
Willi syndrome. The same deletion inherited from the mother results in Angelman syndrome. This
phenomenon is known as:
a) Penetrance
b) Genomic imprinting
c) Trinucleotide repeat expansion
d) Uniparental disomy
Answer: b) Genomic imprinting
Rationale: Genomic imprinting is an epigenetic phenomenon where the expression of a gene depends
on whether it is inherited from the mother or the father. Different syndromes result from the same
deletion depending on parental origin.
9. A patient presents with multiple café-au-lait spots, axillary freckling, and a neurofibroma on the
forearm. This autosomal dominant disorder is most likely:
a) Marfan syndrome
b) Huntington disease
c) Neurofibromatosis type 1 (NF-1)
d) Cystic fibrosis
PATHOPHYSIOLOGY MARYVILLE
UNIVERSITY LATEST VERSION /
GRADED A+
SECTION I: CELLULAR BIOLOGY & ADAPTATION
1. A patient is diagnosed with cardiac ischemia. At a cellular level, what is the most likely primary
mechanism of injury?
a) Hypoxic injury due to inadequate blood flow
b) Free radical injury from reperfusion
c) Chemical injury from lipid accumulation
d) Apoptosis from genetic programming
Answer: a) Hypoxic injury due to inadequate blood flow
Rationale: Ischemia is the most common cause of hypoxia, resulting from reduced blood flow (oxygen
delivery) to tissues. While reperfusion injury (b) can occur when flow is restored, the primary
mechanism of injury during ischemia is hypoxia.
2. A pathologist notes that the heart of a patient with long-standing hypertension shows an increased
muscle mass with larger myocytes. This is best described as:
a) Hyperplasia
b) Metaplasia
c) Hypertrophy
d) Dysplasia
Answer: c) Hypertrophy
Rationale: Hypertrophy refers to an increase in the size of cells, leading to an increase in the size of the
organ. In hypertension, cardiac myocytes enlarge to compensate for increased workload. Hyperplasia (a)
is an increase in cell number.
,3. Which cellular adaptation is considered irreversible and is a hallmark of high-grade squamous
intraepithelial lesions (HSIL) in the cervix?
a) Atrophy
b) Metaplasia
c) Dysplasia
d) Anaplasia
Answer: c) Dysplasia
Rationale: Dysplasia is disordered cellular growth, often characterized by variations in size, shape, and
organization. While it is often reversible if the irritating stimulus is removed, high-grade dysplasia is
considered a pre-malignant, irreversible state in clinical practice (though pathologically it is technically
reversible until it becomes carcinoma in situ).
4. A patient with chronic gastroesophageal reflux disease (GERD) has the normal stratified squamous
epithelium of the lower esophagus replaced by columnar epithelium. This process is known as:
a) Dysplasia
b) Barrett metaplasia
c) Hypertrophy
d) Neoplasia
Answer: b) Barrett metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another. In
GERD, the esophagus undergoes metaplasia to columnar epithelium (Barrett esophagus) to better
withstand the acidic environment.
5. During cellular injury, what happens to sodium (Na+) and water due to failure of the Na+/K+
ATPase pump?
a) Sodium moves out of the cell; water follows, causing cell shrinkage
b) Sodium moves into the cell; water follows, causing cellular swelling
c) Potassium moves into the cell; water follows, causing cellular swelling
d) Sodium and potassium equilibrium is maintained by passive diffusion
Answer: b) Sodium moves into the cell; water follows, causing cellular swelling
Rationale: The Na+/K+ ATPase pump maintains high intracellular K+ and low intracellular Na+. When
ATP is depleted (hypoxia), the pump fails. Na+ accumulates intracellularly, increasing osmotic pressure,
drawing water into the cell, causing hydropic swelling (the earliest sign of cellular injury).
6. Which mechanism of cell death is characterized by cell shrinkage, chromatin condensation, and
formation of apoptotic bodies without triggering inflammation?
a) Necrosis
b) Pyroptosis
, c) Apoptosis
d) Coagulative necrosis
Answer: c) Apoptosis
Rationale: Apoptosis is programmed cell death. It is a highly regulated, energy-dependent process that
eliminates damaged or senescent cells without releasing cellular contents into the interstitium, thus
avoiding an inflammatory response. Necrosis (a) is unregulated and inflammatory.
7. Caseous necrosis, characterized by a soft, "cheese-like" appearance, is most commonly associated
with which type of infection?
a) Streptococcal pneumonia
b) Tuberculosis
c) Clostridium infection
d) Viral hepatitis
Answer: b) Tuberculosis
Rationale: Caseous necrosis is a distinct form of coagulative necrosis most often seen in tuberculosis.
The center of the granuloma has a friable, yellow-white appearance (like cottage cheese) due to the
breakdown of tissue and immune cells.
SECTION II: GENETICS & GENOMICS
8. A child is born with a deletion on chromosome 15 inherited from the father, resulting in Prader-
Willi syndrome. The same deletion inherited from the mother results in Angelman syndrome. This
phenomenon is known as:
a) Penetrance
b) Genomic imprinting
c) Trinucleotide repeat expansion
d) Uniparental disomy
Answer: b) Genomic imprinting
Rationale: Genomic imprinting is an epigenetic phenomenon where the expression of a gene depends
on whether it is inherited from the mother or the father. Different syndromes result from the same
deletion depending on parental origin.
9. A patient presents with multiple café-au-lait spots, axillary freckling, and a neurofibroma on the
forearm. This autosomal dominant disorder is most likely:
a) Marfan syndrome
b) Huntington disease
c) Neurofibromatosis type 1 (NF-1)
d) Cystic fibrosis
