NR 507 Advanced Pathophysiology Week 8 Final Exam
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Cellular Adaptation, Injury & Neoplasia
Q1: A patient has been immobilized in a cast for 6 weeks following a femur fracture.
Upon removal of the cast, the affected limb shows a significant decrease in muscle
mass. Which cellular adaptation is responsible for this change?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in the size of cells, resulting in a reduction in tissue
mass; this occurs when there is a reduction in workload, use, or blood supply, as seen
with prolonged immobilization.
Q2: A 45-year-old male with a history of uncontrolled hypertension presents with left
ventricular hypertrophy. Which cellular mechanism is the primary cause of the increased
myocardial mass?
A. Hyperplasia
B. Hypertrophy
C. Dysplasia
D. Anaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in the size of individual cells (in this case, cardiac
myocytes) due to an increased workload, leading to increased organ mass without an
increase in cell number.
Q3: A chronic smoker undergoes a bronchoscopy, and a biopsy of the bronchial
epithelium reveals that the normal ciliated columnar cells have been replaced by
stratified squamous epithelium. This process is best described as:
A. Dysplasia
B. Metaplasia
,C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature cell type by another,
often in response to chronic irritation or stress, such as the replacement of ciliated
columnar cells with squamous cells due to tobacco smoke.
Q4: A pathologist is reviewing a biopsy and notes disordered cellular growth with
variations in cell size and shape, and loss of typical organization, but the changes are
confined to the epithelial layer and have not breached the basement membrane. This is
indicative of:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
Correct Answer: C
Rationale: Dysplasia refers to deranged cellular growth that is often reversible and
characterized by atypical cells; it is a pre-malignant change but does not invade the
basement membrane like cancer.
Q5: Which of the following statements best distinguishes apoptosis from necrosis?
A. Apoptosis is a pathological cell death caused by hypoxia, while necrosis is a
programmed cell death.
B. Apoptosis is programmed cell death that eliminates damaged cells without
inflammation, while necrosis is accidental cell death that triggers inflammation.
C. Necrosis is energy-dependent and occurs in single cells, while apoptosis is
energy-independent and affects large groups of cells.
D. Apoptosis results in cellular swelling, while necrosis results in cellular shrinkage.
Correct Answer: B
Rationale: Apoptosis is a controlled, energy-dependent process of cell suicide that
eliminates unwanted or damaged cells without inciting an inflammatory response,
whereas necrosis is unprogrammed cell death caused by injury that releases
intracellular contents, provoking inflammation.
Q6: A patient presents with a myocardial infarction. The ischemic area of the heart
muscle shows coagulative necrosis. What is the hallmark microscopic feature of this
type of necrosis?
A. Preservation of the basic cell outline but loss of the nucleus
B. Complete liquefaction of the tissue
,C. Formation of a cheesy, white debris
D. Accumulation of fat in the cells
Correct Answer: A
Rationale: Coagulative necrosis, typical of ischemic injury in most tissues (except the
brain), is characterized by the preservation of the basic tissue architecture but the death
of the cells (loss of nuclei).
Q7: In the context of cancer biology, which class of genes normally functions to inhibit
cell proliferation and prevent uncontrolled growth?
A. Proto-oncogenes
B. Tumor suppressor genes
C. Telomerase genes
D. DNA repair genes
Correct Answer: B
Rationale: Tumor suppressor genes, such as p53 and Rb, normally act as "brakes" on
cell division; when they are inactivated or mutated, uncontrolled cell growth can occur
leading to cancer.
Q8: A tumor is described as poorly differentiated, with cells that bear little resemblance
to the tissue of origin. This characteristic is used to determine the tumor's:
A. Stage
B. Grade
C. Size
D. Metastatic potential (directly)
Correct Answer: B
Rationale: The grade of a tumor refers to the degree of differentiation (how much the
cancer cells look like normal cells); poorly differentiated (anaplastic) tumors are high
grade.
Q9: A patient with a solid tumor is found to have high levels of vascular endothelial
growth factor (VEGF). What is the primary role of this factor in tumor pathophysiology?
A. It inhibits the immune response against the tumor.
B. It promotes angiogenesis to supply the tumor with nutrients.
C. It causes the breakdown of the extracellular matrix.
D. It triggers apoptosis in healthy surrounding tissue.
Correct Answer: B
, Rationale: Tumors cannot grow beyond 1-2mm without a blood supply; VEGF
stimulates the formation of new blood vessels (angiogenesis) to provide oxygen and
nutrients to the growing malignancy.
Q10: Which type of necrosis is most commonly associated with brain injuries, such as a
stroke, resulting from hypoxia?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis is characteristic of the central nervous system; the
lysosomal enzymes digest the dead cells, resulting in a liquid, pus-like substance.
Q11: A 60-year-old patient presents with back pain and hypercalcemia. A biopsy reveals
plasma cells. The bone destruction seen in this patient is driven by which mechanism?
A. Direct mechanical pressure of the tumor cells
B. Stimulation of osteoclasts by cytokines (RANKL)
C. Inhibition of osteoblast activity only
D. Auto-destruction of the bone matrix
Correct Answer: B
Rationale: In multiple myeloma, malignant plasma cells secrete cytokines like RANKL
(Receptor Activator of Nuclear Factor Kappa-B Ligand), which stimulate osteoclasts to
break down bone, causing lytic lesions and hypercalcemia.
Q12: A patient has a history of Barrett's esophagus. Which cellular change is the
greatest concern for this patient regarding malignant transformation?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Atrophy
Correct Answer: C
Rationale: While metaplasia (columnar epithelium replacing squamous) increases risk,
dysplasia (disordered growth arising from that metaplastic tissue) is the immediate
precursor to adenocarcinoma.
Fluids, Electrolytes, Acid-Base & Genetics
Actual Exam 2026/2027 Proctored via Examplify
Complete Questions & Detailed Rationales - Pass
Guaranteed - A+ Graded
Cellular Adaptation, Injury & Neoplasia
Q1: A patient has been immobilized in a cast for 6 weeks following a femur fracture.
Upon removal of the cast, the affected limb shows a significant decrease in muscle
mass. Which cellular adaptation is responsible for this change?
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C
Rationale: Atrophy is a decrease in the size of cells, resulting in a reduction in tissue
mass; this occurs when there is a reduction in workload, use, or blood supply, as seen
with prolonged immobilization.
Q2: A 45-year-old male with a history of uncontrolled hypertension presents with left
ventricular hypertrophy. Which cellular mechanism is the primary cause of the increased
myocardial mass?
A. Hyperplasia
B. Hypertrophy
C. Dysplasia
D. Anaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in the size of individual cells (in this case, cardiac
myocytes) due to an increased workload, leading to increased organ mass without an
increase in cell number.
Q3: A chronic smoker undergoes a bronchoscopy, and a biopsy of the bronchial
epithelium reveals that the normal ciliated columnar cells have been replaced by
stratified squamous epithelium. This process is best described as:
A. Dysplasia
B. Metaplasia
,C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature cell type by another,
often in response to chronic irritation or stress, such as the replacement of ciliated
columnar cells with squamous cells due to tobacco smoke.
Q4: A pathologist is reviewing a biopsy and notes disordered cellular growth with
variations in cell size and shape, and loss of typical organization, but the changes are
confined to the epithelial layer and have not breached the basement membrane. This is
indicative of:
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Neoplasia
Correct Answer: C
Rationale: Dysplasia refers to deranged cellular growth that is often reversible and
characterized by atypical cells; it is a pre-malignant change but does not invade the
basement membrane like cancer.
Q5: Which of the following statements best distinguishes apoptosis from necrosis?
A. Apoptosis is a pathological cell death caused by hypoxia, while necrosis is a
programmed cell death.
B. Apoptosis is programmed cell death that eliminates damaged cells without
inflammation, while necrosis is accidental cell death that triggers inflammation.
C. Necrosis is energy-dependent and occurs in single cells, while apoptosis is
energy-independent and affects large groups of cells.
D. Apoptosis results in cellular swelling, while necrosis results in cellular shrinkage.
Correct Answer: B
Rationale: Apoptosis is a controlled, energy-dependent process of cell suicide that
eliminates unwanted or damaged cells without inciting an inflammatory response,
whereas necrosis is unprogrammed cell death caused by injury that releases
intracellular contents, provoking inflammation.
Q6: A patient presents with a myocardial infarction. The ischemic area of the heart
muscle shows coagulative necrosis. What is the hallmark microscopic feature of this
type of necrosis?
A. Preservation of the basic cell outline but loss of the nucleus
B. Complete liquefaction of the tissue
,C. Formation of a cheesy, white debris
D. Accumulation of fat in the cells
Correct Answer: A
Rationale: Coagulative necrosis, typical of ischemic injury in most tissues (except the
brain), is characterized by the preservation of the basic tissue architecture but the death
of the cells (loss of nuclei).
Q7: In the context of cancer biology, which class of genes normally functions to inhibit
cell proliferation and prevent uncontrolled growth?
A. Proto-oncogenes
B. Tumor suppressor genes
C. Telomerase genes
D. DNA repair genes
Correct Answer: B
Rationale: Tumor suppressor genes, such as p53 and Rb, normally act as "brakes" on
cell division; when they are inactivated or mutated, uncontrolled cell growth can occur
leading to cancer.
Q8: A tumor is described as poorly differentiated, with cells that bear little resemblance
to the tissue of origin. This characteristic is used to determine the tumor's:
A. Stage
B. Grade
C. Size
D. Metastatic potential (directly)
Correct Answer: B
Rationale: The grade of a tumor refers to the degree of differentiation (how much the
cancer cells look like normal cells); poorly differentiated (anaplastic) tumors are high
grade.
Q9: A patient with a solid tumor is found to have high levels of vascular endothelial
growth factor (VEGF). What is the primary role of this factor in tumor pathophysiology?
A. It inhibits the immune response against the tumor.
B. It promotes angiogenesis to supply the tumor with nutrients.
C. It causes the breakdown of the extracellular matrix.
D. It triggers apoptosis in healthy surrounding tissue.
Correct Answer: B
, Rationale: Tumors cannot grow beyond 1-2mm without a blood supply; VEGF
stimulates the formation of new blood vessels (angiogenesis) to provide oxygen and
nutrients to the growing malignancy.
Q10: Which type of necrosis is most commonly associated with brain injuries, such as a
stroke, resulting from hypoxia?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Correct Answer: B
Rationale: Liquefactive necrosis is characteristic of the central nervous system; the
lysosomal enzymes digest the dead cells, resulting in a liquid, pus-like substance.
Q11: A 60-year-old patient presents with back pain and hypercalcemia. A biopsy reveals
plasma cells. The bone destruction seen in this patient is driven by which mechanism?
A. Direct mechanical pressure of the tumor cells
B. Stimulation of osteoclasts by cytokines (RANKL)
C. Inhibition of osteoblast activity only
D. Auto-destruction of the bone matrix
Correct Answer: B
Rationale: In multiple myeloma, malignant plasma cells secrete cytokines like RANKL
(Receptor Activator of Nuclear Factor Kappa-B Ligand), which stimulate osteoclasts to
break down bone, causing lytic lesions and hypercalcemia.
Q12: A patient has a history of Barrett's esophagus. Which cellular change is the
greatest concern for this patient regarding malignant transformation?
A. Hyperplasia
B. Metaplasia
C. Dysplasia
D. Atrophy
Correct Answer: C
Rationale: While metaplasia (columnar epithelium replacing squamous) increases risk,
dysplasia (disordered growth arising from that metaplastic tissue) is the immediate
precursor to adenocarcinoma.
Fluids, Electrolytes, Acid-Base & Genetics
