Chamberlain NR 507 Midterm Exam
Advanced Pathophysiology
2026/2027
Section 1: Cellular Adaptation, Injury, and Neoplasia
1. A 55-year-old male with chronic heart failure develops marked peripheral
edema. Which cellular adaptation occurs in his myocardium due to increased
workload?
A) Atrophy
B) Hyperplasia
C) Hypertrophy
D) Metaplasia
Answer: C) Hypertrophy
Expert Rationale: Hypertrophy is an increase in individual cell size due to
increased mechanical demand or stimulation. In heart failure, the cardiac myocytes
enlarge to compensate for the increased workload.
2. Barrett esophagus involves replacement of normal squamous epithelium with
columnar epithelium. This is an example of:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Neoplasia
Answer: B) Metaplasia
Expert Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another, often in response to chronic irritation like GERD.
3. Neuronal loss in Alzheimer disease occurs via:
A) Apoptosis
B) Necrosis
C) Autophagy
D) Ischemic injury
,Answer: A) Apoptosis
Expert Rationale: Alzheimer disease involves programmed cell death (apoptosis).
Necrosis is unprogrammed cell death due to acute injury.
4. Which finding indicates reversible cell injury?
A) Pyknosis
B) Karyorrhexis
C) Cellular swelling
D) Karyolysis
Answer: C) Cellular swelling
Expert Rationale: Cellular swelling (hydropic change) and fatty change are
reversible. Pyknosis, karyorrhexis, and karyolysis are signs of irreversible necrosis.
5. The primary cellular target of ionizing radiation is:
A) Plasma membrane
B) Mitochondria
C) DNA
D) Ribosomes
Answer: C) DNA
Expert Rationale: DNA is the primary target; radiation causes DNA strand breaks
and chromosomal damage.
6. A well-differentiated tumor resembling normal tissue is likely:
A) Malignant, Grade 1
B) Malignant, Grade 4
C) Benign
D) Anaplastic
Answer: A) Malignant, Grade 1
Expert Rationale: Well-differentiated malignant tumors are Grade 1. Anaplastic is
poorly differentiated (Grade 4).
7. Activation of which gene type drives uncontrolled proliferation?
A) Tumor suppressor genes
B) Proto-oncogenes
C) Apoptosis genes
D) DNA repair genes
Answer: B) Proto-oncogenes
Expert Rationale: Proto-oncogenes promote normal cell growth; mutation
converts them to oncogenes that drive proliferation.
, 8. Li-Fraumeni syndrome is associated with mutation in:
A) BRCA1
B) APC
C) TP53
D) RET
Answer: C) TP53
Expert Rationale: Li-Fraumeni syndrome is caused by germline TP53 mutations,
increasing risk for sarcomas, breast cancer, and other tumors.
9. The APC gene is classified as a:
A) Proto-oncogene
B) Tumor suppressor gene
C) DNA repair gene
D) Apoptosis gene
Answer: B) Tumor suppressor gene
Expert Rationale: APC is a tumor suppressor; mutation leads to familial
adenomatous polyposis and colorectal cancer.
10. Which feature distinguishes malignant from benign tumors?
A) Well-differentiated cells
B) Encapsulation
C) Metastasis
D) Slow growth
Answer: C) Metastasis
Expert Rationale: Metastasis is the defining feature of malignancy. Benign
tumors may be well-differentiated but do not metastasize.
Section 2: Inflammation and Immunity
11. First responders of the innate immune system:
A) Macrophages
B) Lymphocytes
C) Neutrophils
D) Eosinophils
Answer: C) Neutrophils
Expert Rationale: Neutrophils appear first in any immune response.
Advanced Pathophysiology
2026/2027
Section 1: Cellular Adaptation, Injury, and Neoplasia
1. A 55-year-old male with chronic heart failure develops marked peripheral
edema. Which cellular adaptation occurs in his myocardium due to increased
workload?
A) Atrophy
B) Hyperplasia
C) Hypertrophy
D) Metaplasia
Answer: C) Hypertrophy
Expert Rationale: Hypertrophy is an increase in individual cell size due to
increased mechanical demand or stimulation. In heart failure, the cardiac myocytes
enlarge to compensate for the increased workload.
2. Barrett esophagus involves replacement of normal squamous epithelium with
columnar epithelium. This is an example of:
A) Dysplasia
B) Metaplasia
C) Anaplasia
D) Neoplasia
Answer: B) Metaplasia
Expert Rationale: Metaplasia is the reversible replacement of one differentiated
cell type with another, often in response to chronic irritation like GERD.
3. Neuronal loss in Alzheimer disease occurs via:
A) Apoptosis
B) Necrosis
C) Autophagy
D) Ischemic injury
,Answer: A) Apoptosis
Expert Rationale: Alzheimer disease involves programmed cell death (apoptosis).
Necrosis is unprogrammed cell death due to acute injury.
4. Which finding indicates reversible cell injury?
A) Pyknosis
B) Karyorrhexis
C) Cellular swelling
D) Karyolysis
Answer: C) Cellular swelling
Expert Rationale: Cellular swelling (hydropic change) and fatty change are
reversible. Pyknosis, karyorrhexis, and karyolysis are signs of irreversible necrosis.
5. The primary cellular target of ionizing radiation is:
A) Plasma membrane
B) Mitochondria
C) DNA
D) Ribosomes
Answer: C) DNA
Expert Rationale: DNA is the primary target; radiation causes DNA strand breaks
and chromosomal damage.
6. A well-differentiated tumor resembling normal tissue is likely:
A) Malignant, Grade 1
B) Malignant, Grade 4
C) Benign
D) Anaplastic
Answer: A) Malignant, Grade 1
Expert Rationale: Well-differentiated malignant tumors are Grade 1. Anaplastic is
poorly differentiated (Grade 4).
7. Activation of which gene type drives uncontrolled proliferation?
A) Tumor suppressor genes
B) Proto-oncogenes
C) Apoptosis genes
D) DNA repair genes
Answer: B) Proto-oncogenes
Expert Rationale: Proto-oncogenes promote normal cell growth; mutation
converts them to oncogenes that drive proliferation.
, 8. Li-Fraumeni syndrome is associated with mutation in:
A) BRCA1
B) APC
C) TP53
D) RET
Answer: C) TP53
Expert Rationale: Li-Fraumeni syndrome is caused by germline TP53 mutations,
increasing risk for sarcomas, breast cancer, and other tumors.
9. The APC gene is classified as a:
A) Proto-oncogene
B) Tumor suppressor gene
C) DNA repair gene
D) Apoptosis gene
Answer: B) Tumor suppressor gene
Expert Rationale: APC is a tumor suppressor; mutation leads to familial
adenomatous polyposis and colorectal cancer.
10. Which feature distinguishes malignant from benign tumors?
A) Well-differentiated cells
B) Encapsulation
C) Metastasis
D) Slow growth
Answer: C) Metastasis
Expert Rationale: Metastasis is the defining feature of malignancy. Benign
tumors may be well-differentiated but do not metastasize.
Section 2: Inflammation and Immunity
11. First responders of the innate immune system:
A) Macrophages
B) Lymphocytes
C) Neutrophils
D) Eosinophils
Answer: C) Neutrophils
Expert Rationale: Neutrophils appear first in any immune response.
