NSG 527 MIDTERM EXAM LATEST 2026 \2027 QUESTIONS AND
ANSWERS WITH VERIFIED RATIONALES 100 PERCENT
GUARANTEE PASS WILKES UNIVERSITY
1. A cell is deprived of oxygen. What is the first immediate cellular response to this hypoxia?
A. Shift to aerobic metabolism
B. Shift to anaerobic glycolysis
C. Immediate cell lysis
D. Activation of apoptosis
Answer: B
Rationale: When oxygen is depleted, the electron transport chain stops. The cell must immediately
shift to anaerobic glycolysis to generate the minimal ATP required to maintain basic membrane
function, though this produces lactic acid and far less ATP.
2. What cellular structure contains digestive enzymes that, if ruptured, cause autodigestion of the
cell?
A. Ribosome
B. Lysosome
C. Golgi apparatus
D. Endoplasmic reticulum
Answer: B
,Rationale: Lysosomes are membrane-bound vesicles containing acid hydrolases. If the lysosomal
membrane is damaged, these enzymes are released into the cytoplasm and digest cellular
components, leading to cell death.
3. A patient has a myocardial infarction. The ischemic myocardial cells show swollen, pale
cytoplasm due to the influx of sodium and water. What is this specific cellular injury called?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Hydropic swelling
D. Fatty change
Answer: C
Rationale: Hydropic swelling (cloudy swelling) is the first manifestation of almost all forms of
cellular injury. It occurs because ATP depletion causes failure of the sodium-potassium pump,
allowing sodium and water to rush into the cell.
4. Which type of necrosis is characterized by a firm, yellowish-cheesy appearance and is most
commonly seen in tuberculosis?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: C
Rationale: Caseous necrosis is a distinct form of necrosis associated with granulomatous diseases
like tuberculosis. It appears grossly as a soft, friable, cheese-like material.
5. A patient with chronic alcoholism develops liver enlargement. Biopsy shows large lipid vacuoles
displacing the nucleus to the periphery of the hepatocytes. What is this cellular adaptation?
A. Atrophy
B. Hypertrophy
,C. Hyperplasia
D. Fatty change (Steatosis)
Answer: D
Rationale: Fatty change, or steatosis, occurs when lipids accumulate in parenchymal cells, most
commonly hepatocytes. Alcohol alters mitochondrial and microsomal function, leading to decreased
lipid oxidation and increased triglyceride synthesis.
6. A patient with a chronic peptic ulcer has the normal stratified squamous epithelium of the
esophagus replaced by columnar epithelium containing goblet cells. What is this called?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another. In
this case, chronic acid exposure causes the esophageal squamous cells to change to intestinal-type
columnar cells (Barrett esophagus) to better withstand the acid.
7. What is the primary intracellular trigger that activates the apoptotic pathway in a cell with
damaged DNA?
A. Release of cytochrome c from mitochondria
B. Influx of calcium
C. Activation of caspase-8
D. Complement activation
Answer: A
Rationale: The intrinsic pathway of apoptosis is triggered by cellular stress like DNA damage.
Proteins like p53 signal the mitochondria to release cytochrome c into the cytosol, which then
activates caspases to execute cell death.
, 8. Unlike necrosis, apoptosis does not cause inflammation. Why?
A. Apoptotic cells are phagocytized by macrophages before they rupture and leak cellular contents.
B. Apoptosis only occurs in sterile body cavities.
C. Apoptotic cells release anti-inflammatory cytokines.
D. Apoptosis does not involve cell death, only shrinkage.
Answer: A
Rationale: During apoptosis, the cell membrane remains intact, and the cell breaks into apoptotic
bodies. These bodies express signals that prompt macrophages to phagocytose them before they
can spill pro-inflammatory intracellular contents into the tissue.
9. A patient is exposed to high levels of radiation. What is the primary mechanism by which
radiation causes cellular injury?
A. Directly altering DNA sequences
B. Generating reactive oxygen species (free radicals) that damage lipids, proteins, and DNA
C. Activating complement
D. Causing massive histamine release
Answer: B
Rationale: Ionizing radiation interacts with water in the body to produce hydroxyl radicals, which
are highly reactive oxygen species. These free radicals cause oxidative damage to cellular
membranes (lipid peroxidation), proteins, and DNA.
10. Which cellular organelle is most susceptible to injury from ischemia due to its high calcium
concentration and lipid content?
A. Nucleus
B. Mitochondria
C. Lysosome
D. Ribosome
Answer: B
ANSWERS WITH VERIFIED RATIONALES 100 PERCENT
GUARANTEE PASS WILKES UNIVERSITY
1. A cell is deprived of oxygen. What is the first immediate cellular response to this hypoxia?
A. Shift to aerobic metabolism
B. Shift to anaerobic glycolysis
C. Immediate cell lysis
D. Activation of apoptosis
Answer: B
Rationale: When oxygen is depleted, the electron transport chain stops. The cell must immediately
shift to anaerobic glycolysis to generate the minimal ATP required to maintain basic membrane
function, though this produces lactic acid and far less ATP.
2. What cellular structure contains digestive enzymes that, if ruptured, cause autodigestion of the
cell?
A. Ribosome
B. Lysosome
C. Golgi apparatus
D. Endoplasmic reticulum
Answer: B
,Rationale: Lysosomes are membrane-bound vesicles containing acid hydrolases. If the lysosomal
membrane is damaged, these enzymes are released into the cytoplasm and digest cellular
components, leading to cell death.
3. A patient has a myocardial infarction. The ischemic myocardial cells show swollen, pale
cytoplasm due to the influx of sodium and water. What is this specific cellular injury called?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Hydropic swelling
D. Fatty change
Answer: C
Rationale: Hydropic swelling (cloudy swelling) is the first manifestation of almost all forms of
cellular injury. It occurs because ATP depletion causes failure of the sodium-potassium pump,
allowing sodium and water to rush into the cell.
4. Which type of necrosis is characterized by a firm, yellowish-cheesy appearance and is most
commonly seen in tuberculosis?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
Answer: C
Rationale: Caseous necrosis is a distinct form of necrosis associated with granulomatous diseases
like tuberculosis. It appears grossly as a soft, friable, cheese-like material.
5. A patient with chronic alcoholism develops liver enlargement. Biopsy shows large lipid vacuoles
displacing the nucleus to the periphery of the hepatocytes. What is this cellular adaptation?
A. Atrophy
B. Hypertrophy
,C. Hyperplasia
D. Fatty change (Steatosis)
Answer: D
Rationale: Fatty change, or steatosis, occurs when lipids accumulate in parenchymal cells, most
commonly hepatocytes. Alcohol alters mitochondrial and microsomal function, leading to decreased
lipid oxidation and increased triglyceride synthesis.
6. A patient with a chronic peptic ulcer has the normal stratified squamous epithelium of the
esophagus replaced by columnar epithelium containing goblet cells. What is this called?
A. Dysplasia
B. Metaplasia
C. Anaplasia
D. Hyperplasia
Answer: B
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with another. In
this case, chronic acid exposure causes the esophageal squamous cells to change to intestinal-type
columnar cells (Barrett esophagus) to better withstand the acid.
7. What is the primary intracellular trigger that activates the apoptotic pathway in a cell with
damaged DNA?
A. Release of cytochrome c from mitochondria
B. Influx of calcium
C. Activation of caspase-8
D. Complement activation
Answer: A
Rationale: The intrinsic pathway of apoptosis is triggered by cellular stress like DNA damage.
Proteins like p53 signal the mitochondria to release cytochrome c into the cytosol, which then
activates caspases to execute cell death.
, 8. Unlike necrosis, apoptosis does not cause inflammation. Why?
A. Apoptotic cells are phagocytized by macrophages before they rupture and leak cellular contents.
B. Apoptosis only occurs in sterile body cavities.
C. Apoptotic cells release anti-inflammatory cytokines.
D. Apoptosis does not involve cell death, only shrinkage.
Answer: A
Rationale: During apoptosis, the cell membrane remains intact, and the cell breaks into apoptotic
bodies. These bodies express signals that prompt macrophages to phagocytose them before they
can spill pro-inflammatory intracellular contents into the tissue.
9. A patient is exposed to high levels of radiation. What is the primary mechanism by which
radiation causes cellular injury?
A. Directly altering DNA sequences
B. Generating reactive oxygen species (free radicals) that damage lipids, proteins, and DNA
C. Activating complement
D. Causing massive histamine release
Answer: B
Rationale: Ionizing radiation interacts with water in the body to produce hydroxyl radicals, which
are highly reactive oxygen species. These free radicals cause oxidative damage to cellular
membranes (lipid peroxidation), proteins, and DNA.
10. Which cellular organelle is most susceptible to injury from ischemia due to its high calcium
concentration and lipid content?
A. Nucleus
B. Mitochondria
C. Lysosome
D. Ribosome
Answer: B
