NURS 611 EXAM 1 PATHO ACTUAL EXAM
TEST BANK 2024/2026 Complete 350+
Questions and Correct Detailed Answers with
Rationales Maryville University – Graded A+
Section 1: Cellular Biology & Adaptation (Questions 1-25)
1. A patient with chronic hypertension develops left ventricular hypertrophy.
This is an example of which cellular adaptation?
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Hypertrophy
Rationale:- Hypertrophy is an increase in cell size without cell division. In chronic
hypertension, cardiac myocytes enlarge to generate more force against increased
systemic vascular resistance, leading to ventricular wall thickening.
2. During a myocardial infarction, prolonged ischemia leads to irreversible
cell injury characterized by:
A) Mitochondrial swelling and chromatin clumping
B) Lysosomal rupture and autodigestion
C) Cellular swelling and fatty change
D) Nuclear pyknosis and plasma membrane breakdown
Rationale:- Irreversible injury markers include nuclear changes (pyknosis,
karyorrhexis, karyolysis) and profound plasma membrane damage. Mitochondrial
and lysosomal changes occur earlier but are reversible initially.
3. A patient with α1-antitrypsin deficiency develops panacinar emphysema.
This is primarily caused by:
A) Uncontrolled neutrophil elastase activity
B) Excessive collagen deposition
C) Free radical-mediated lipid peroxidation
D) Accumulation of misfolded proteins in hepatocytes
*Rationale:- α1-antitrypsin is a protease inhibitor. Its deficiency allows neutrophil
,elastase to degrade alveolar elastin unchecked, leading to loss of alveolar walls and
emphysema.*
4. In hypoxic cell injury, the switch from aerobic to anaerobic metabolism
results in:
A) Increased ATP production
B) Accumulation of lactic acid and decreased pH
C) Enhanced oxidative phosphorylation
D) Preservation of intracellular glycogen stores
Rationale:- Anaerobic glycolysis yields only 2 ATP per glucose (vs 36 aerobically)
and produces lactic acid, causing intracellular acidosis, which inhibits enzyme
function and worsens cellular injury.
5. Apoptosis differs from necrosis in that apoptosis:
A) Always causes inflammation
B) Involves cell swelling and membrane rupture
C) Is a regulated, energy-dependent process
D) Results from accidental cell injury
Rationale:- Apoptosis is programmed cell death characterized by cell shrinkage,
DNA fragmentation, and formation of apoptotic bodies without inflammation.
Necrosis is unregulated, causes inflammation, and results from severe injury.
6. A patient with chronic GERD develops Barrett esophagus, where squamous
epithelium is replaced by columnar epithelium. This is an example of:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Anaplasia
Rationale:- Metaplasia is the reversible replacement of one differentiated cell type
by another. In Barrett esophagus, acid reflux causes adaptive change from
squamous to intestinal-type columnar epithelium.
7. Which finding is characteristic of reversible cell injury?
A) Calcification of mitochondria
B) Blebbing of the plasma membrane
C) Disappearance of ribosomes
D) Disruption of lysosomal membranes
Rationale:- Cell membrane blebbing is an early, potentially reversible change.
,Mitochondrial calcification, ribosome loss, and lysosomal disruption indicate
irreversible injury.
8. A researcher observes intracellular accumulation of lipofuscin in
myocardial cells of an elderly patient. This "wear-and-tear" pigment
represents:
A) Hemosiderin from RBC breakdown
B) Undigested residues from autophagy
C) Calcium phosphate deposits
D) Glycogen granules
Rationale:- Lipofuscin is an insoluble lipid-protein complex from peroxidation of
unsaturated lipids in organelle membranes. It accumulates with age as lysosomes
cannot degrade it.
9. A patient with sickle cell anemia develops leg ulcers and retinopathy. These
complications result primarily from:
A) Chronic inflammatory response
B) Recurrent vaso-occlusive crises
C) Autoantibody formation
D) Complement system deficiency
Rationale:- Sickled RBCs obstruct microvasculature, causing ischemic injury and
infarction in various tissues, leading to chronic complications like ulcers and
retinopathy.
10. The Warburg effect in cancer cells refers to:
A) Increased oxidative phosphorylation
B) Preferential use of glycolysis even in oxygen presence
C) Enhanced fatty acid oxidation
D) Impaired glucose uptake
Rationale:- Cancer cells often rely on aerobic glycolysis (Warburg effect) to
generate ATP and metabolic intermediates for rapid growth, despite having
functional mitochondria.
11. A patient with chronic alcohol use disorder develops liver steatosis (fatty
liver). This is an example of:
A) Pathologic atrophy
B) Reversible cellular accumulation
C) Irreversible necrosis
D) Dysplastic change
, Rationale:- Fatty liver from alcohol is a reversible accumulation of triglycerides
within hepatocytes. With abstinence, fat is metabolized and liver returns to normal.
12. Which cellular organelle is the primary site of ATP production?
A) Golgi apparatus
B) Rough endoplasmic reticulum
C) Mitochondria
D) Lysosomes
Rationale:- Mitochondria generate ATP via oxidative phosphorylation. Damage to
mitochondria is a key event in irreversible cell injury.
13. A biopsy of a breast mass shows increased numbers of normal-appearing
glandular cells. This is termed:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Rationale:- Hyperplasia is increased cell number due to increased division,
resulting in enlarged tissue mass but normal cell appearance.
14. Caseous necrosis is most characteristic of which condition?
A) Ischemic myocardial infarction
B) Tuberculosis
C) Acute pancreatitis
D) Venous infarction of testis
Rationale:- Caseous necrosis (cheese-like appearance) is pathognomonic for
tuberculosis. It is a form of coagulative necrosis with a granulomatous
inflammatory response.
15. Which of the following is an example of physiologic atrophy?
A) Thymus gland involution in adulthood
B) Atrophy of a fractured limb muscle
C) Brain atrophy in Alzheimer's disease
D) Vaginal epithelial atrophy after menopause
Rationale:- Thymic involution after puberty is normal physiologic atrophy. The
others are pathologic.
16. A patient's heart shows brown atrophy. What pigment is responsible for
this color?
A) Hemosiderin
TEST BANK 2024/2026 Complete 350+
Questions and Correct Detailed Answers with
Rationales Maryville University – Graded A+
Section 1: Cellular Biology & Adaptation (Questions 1-25)
1. A patient with chronic hypertension develops left ventricular hypertrophy.
This is an example of which cellular adaptation?
A) Atrophy
B) Hyperplasia
C) Metaplasia
D) Hypertrophy
Rationale:- Hypertrophy is an increase in cell size without cell division. In chronic
hypertension, cardiac myocytes enlarge to generate more force against increased
systemic vascular resistance, leading to ventricular wall thickening.
2. During a myocardial infarction, prolonged ischemia leads to irreversible
cell injury characterized by:
A) Mitochondrial swelling and chromatin clumping
B) Lysosomal rupture and autodigestion
C) Cellular swelling and fatty change
D) Nuclear pyknosis and plasma membrane breakdown
Rationale:- Irreversible injury markers include nuclear changes (pyknosis,
karyorrhexis, karyolysis) and profound plasma membrane damage. Mitochondrial
and lysosomal changes occur earlier but are reversible initially.
3. A patient with α1-antitrypsin deficiency develops panacinar emphysema.
This is primarily caused by:
A) Uncontrolled neutrophil elastase activity
B) Excessive collagen deposition
C) Free radical-mediated lipid peroxidation
D) Accumulation of misfolded proteins in hepatocytes
*Rationale:- α1-antitrypsin is a protease inhibitor. Its deficiency allows neutrophil
,elastase to degrade alveolar elastin unchecked, leading to loss of alveolar walls and
emphysema.*
4. In hypoxic cell injury, the switch from aerobic to anaerobic metabolism
results in:
A) Increased ATP production
B) Accumulation of lactic acid and decreased pH
C) Enhanced oxidative phosphorylation
D) Preservation of intracellular glycogen stores
Rationale:- Anaerobic glycolysis yields only 2 ATP per glucose (vs 36 aerobically)
and produces lactic acid, causing intracellular acidosis, which inhibits enzyme
function and worsens cellular injury.
5. Apoptosis differs from necrosis in that apoptosis:
A) Always causes inflammation
B) Involves cell swelling and membrane rupture
C) Is a regulated, energy-dependent process
D) Results from accidental cell injury
Rationale:- Apoptosis is programmed cell death characterized by cell shrinkage,
DNA fragmentation, and formation of apoptotic bodies without inflammation.
Necrosis is unregulated, causes inflammation, and results from severe injury.
6. A patient with chronic GERD develops Barrett esophagus, where squamous
epithelium is replaced by columnar epithelium. This is an example of:
A) Dysplasia
B) Metaplasia
C) Hyperplasia
D) Anaplasia
Rationale:- Metaplasia is the reversible replacement of one differentiated cell type
by another. In Barrett esophagus, acid reflux causes adaptive change from
squamous to intestinal-type columnar epithelium.
7. Which finding is characteristic of reversible cell injury?
A) Calcification of mitochondria
B) Blebbing of the plasma membrane
C) Disappearance of ribosomes
D) Disruption of lysosomal membranes
Rationale:- Cell membrane blebbing is an early, potentially reversible change.
,Mitochondrial calcification, ribosome loss, and lysosomal disruption indicate
irreversible injury.
8. A researcher observes intracellular accumulation of lipofuscin in
myocardial cells of an elderly patient. This "wear-and-tear" pigment
represents:
A) Hemosiderin from RBC breakdown
B) Undigested residues from autophagy
C) Calcium phosphate deposits
D) Glycogen granules
Rationale:- Lipofuscin is an insoluble lipid-protein complex from peroxidation of
unsaturated lipids in organelle membranes. It accumulates with age as lysosomes
cannot degrade it.
9. A patient with sickle cell anemia develops leg ulcers and retinopathy. These
complications result primarily from:
A) Chronic inflammatory response
B) Recurrent vaso-occlusive crises
C) Autoantibody formation
D) Complement system deficiency
Rationale:- Sickled RBCs obstruct microvasculature, causing ischemic injury and
infarction in various tissues, leading to chronic complications like ulcers and
retinopathy.
10. The Warburg effect in cancer cells refers to:
A) Increased oxidative phosphorylation
B) Preferential use of glycolysis even in oxygen presence
C) Enhanced fatty acid oxidation
D) Impaired glucose uptake
Rationale:- Cancer cells often rely on aerobic glycolysis (Warburg effect) to
generate ATP and metabolic intermediates for rapid growth, despite having
functional mitochondria.
11. A patient with chronic alcohol use disorder develops liver steatosis (fatty
liver). This is an example of:
A) Pathologic atrophy
B) Reversible cellular accumulation
C) Irreversible necrosis
D) Dysplastic change
, Rationale:- Fatty liver from alcohol is a reversible accumulation of triglycerides
within hepatocytes. With abstinence, fat is metabolized and liver returns to normal.
12. Which cellular organelle is the primary site of ATP production?
A) Golgi apparatus
B) Rough endoplasmic reticulum
C) Mitochondria
D) Lysosomes
Rationale:- Mitochondria generate ATP via oxidative phosphorylation. Damage to
mitochondria is a key event in irreversible cell injury.
13. A biopsy of a breast mass shows increased numbers of normal-appearing
glandular cells. This is termed:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Rationale:- Hyperplasia is increased cell number due to increased division,
resulting in enlarged tissue mass but normal cell appearance.
14. Caseous necrosis is most characteristic of which condition?
A) Ischemic myocardial infarction
B) Tuberculosis
C) Acute pancreatitis
D) Venous infarction of testis
Rationale:- Caseous necrosis (cheese-like appearance) is pathognomonic for
tuberculosis. It is a form of coagulative necrosis with a granulomatous
inflammatory response.
15. Which of the following is an example of physiologic atrophy?
A) Thymus gland involution in adulthood
B) Atrophy of a fractured limb muscle
C) Brain atrophy in Alzheimer's disease
D) Vaginal epithelial atrophy after menopause
Rationale:- Thymic involution after puberty is normal physiologic atrophy. The
others are pathologic.
16. A patient's heart shows brown atrophy. What pigment is responsible for
this color?
A) Hemosiderin
