NURS 231 Final Exam (2026/2027) Pathophysiology
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Examination 150 Questions and Verified Answers,
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Section 1: Cellular Adaptation, Injury & Death (Questions 1–15)
Q1. A cardiac myocyte enlarges in response to chronic hypertension. This
adaptation is called:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
✓ Correct Answer: B – Hypertrophy
Rationale: Hypertrophy = increase in cell size due to increased workload.
Hypertension increases afterload, causing left ventricular hypertrophy.
Hyperplasia = increased cell number. Atrophy = decreased size. Metaplasia = one
cell type replaces another.
Q2. Which of the following is an example of physiologic hyperplasia?
A) Endometrial hyperplasia
B) Benign prostatic hyperplasia (BPH)
C) Liver regeneration after partial hepatectomy
D) Psoriasis
✓ Correct Answer: C – Liver regeneration
Rationale: Physiologic hyperplasia is normal and controlled (liver regeneration,
breast/uterine enlargement during pregnancy). Endometrial hyperplasia and BPH
are pathologic but hormonally driven. Psoriasis = pathologic hyperplasia.
Q3. A pathologist notes nuclear pyknosis, karyorrhexis, and karyolysis in a tissue
sample. These findings indicate:
A) Reversible cell injury
B) Irreversible cell injury (necrosis)
,C) Apoptosis
D) Normal mitotic activity
✓ Correct Answer: B – Irreversible cell injury (necrosis)
Rationale: Pyknosis (nuclear condensation), karyorrhexis (fragmentation), and
karyolysis (dissolution) are hallmarks of irreversible injury/necrosis. Reversible
injury shows cellular swelling and fatty change.
Q4. Which type of necrosis is most characteristic of the brain after a stroke?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
✓ Correct Answer: B – Liquefactive necrosis
Rationale: Brain infarcts undergo liquefactive necrosis due to abundant lysosomal
enzymes and lack of connective tissue framework. Coagulative necrosis = kidney,
heart, liver (except brain). Caseous = TB. Fat = pancreas, breast.
Q5. A patient with tuberculosis has a lung lesion with "cheese-like" appearance.
This is:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Gangrenous necrosis
✓ Correct Answer: C – Caseous necrosis
Rationale: Caseous necrosis (TB) = granular, friable, cheese-like material with
granulomas and Langhans giant cells. Coagulative = firm. Liquefactive = liquid.
Q6. A 65-year-old smoker has a non-healing ulcer on the left great toe. The toe
is black, dry, and shriveled. This is:
A) Wet gangrene
B) Dry gangrene
C) Gas gangrene
D) Necrotizing fasciitis
,✓ Correct Answer: B – Dry gangrene
Rationale: Dry gangrene = coagulative necrosis from chronic ischemia (PAD,
diabetes). Black, dry, mummified. Wet gangrene = infection + ischemia, foul-
smelling. Gas gangrene = Clostridium.
Q7. Which statement best describes apoptosis?
A) Uncontrolled cell death causing inflammation
B) Programmed cell death without inflammation
C) Cell death due to trauma
D) Cell death due to hypoxia
✓ Correct Answer: B – Programmed cell death without inflammation
Rationale: Apoptosis is genetically programmed, energy-dependent (ATP), and
does NOT trigger inflammation. Necrosis is pathologic, unregulated, and causes
inflammation.
Q8. A pathologist notes "fat necrosis" with saponification (white, chalky areas)
in the abdomen. Most likely cause:
A) Myocardial infarction
B) Acute pancreatitis
C) Tuberculosis
D) Stroke
✓ Correct Answer: B – Acute pancreatitis
Rationale: Pancreatic lipases digest peripancreatic fat → fatty acids + calcium →
calcium soaps (saponification) = fat necrosis. Also seen in breast trauma.
Q9. Squamous metaplasia of the bronchial epithelium is most commonly caused
by:
A) Viral infection
B) Cigarette smoking
C) Bacterial pneumonia
D) Asbestos exposure
✓ Correct Answer: B – Cigarette smoking
Rationale: Chronic irritation (smoking) → ciliated columnar epithelium replaced
by stratified squamous epithelium (metaplasia). Reversible if smoking stops. May
progress to dysplasia/cancer.
, Q10. Which intracellular change is reversible?
A) Fatty change (steatosis)
B) Nuclear pyknosis
C) Membrane rupture
D) Lysosomal enzyme leakage
✓ Correct Answer: A – Fatty change (steatosis)
Rationale: Fatty change (lipid vacuoles in liver/heart) is reversible if the insult
(alcohol, obesity) is removed. Pyknosis, membrane rupture, and lysosomal
leakage indicate irreversible injury.
Q11. A patient with chronic alcohol use has an enlarged, yellow, greasy liver.
Microscopy shows hepatocytes with large fat vacuoles. This is:
A) Cirrhosis
B) Hepatic steatosis
C) Hepatitis
D) Hepatocellular carcinoma
✓ Correct Answer: B – Hepatic steatosis
Rationale: Fatty liver (steatosis) = reversible accumulation of triglycerides.
Cirrhosis is irreversible fibrosis. Steatosis can progress to steatohepatitis, then
cirrhosis.
Q12. Which type of necrosis is associated with Mycobacterium tuberculosis
infection?
A) Coagulative
B) Liquefactive
C) Caseous
D) Fat
✓ Correct Answer: C – Caseous
Rationale: Tuberculosis = caseous necrosis with granulomas (epithelioid
histiocytes, Langhans giant cells, peripheral lymphocytes). Central caseation is
characteristic.
Q13. A patient with a myocardial infarction has a pale, firm area of dead tissue.
This is:
A) Liquefactive necrosis
Portage Learning | Comprehensive Final
Examination 150 Questions and Verified Answers,
100% Guarantee Pass
Section 1: Cellular Adaptation, Injury & Death (Questions 1–15)
Q1. A cardiac myocyte enlarges in response to chronic hypertension. This
adaptation is called:
A) Hyperplasia
B) Hypertrophy
C) Atrophy
D) Metaplasia
✓ Correct Answer: B – Hypertrophy
Rationale: Hypertrophy = increase in cell size due to increased workload.
Hypertension increases afterload, causing left ventricular hypertrophy.
Hyperplasia = increased cell number. Atrophy = decreased size. Metaplasia = one
cell type replaces another.
Q2. Which of the following is an example of physiologic hyperplasia?
A) Endometrial hyperplasia
B) Benign prostatic hyperplasia (BPH)
C) Liver regeneration after partial hepatectomy
D) Psoriasis
✓ Correct Answer: C – Liver regeneration
Rationale: Physiologic hyperplasia is normal and controlled (liver regeneration,
breast/uterine enlargement during pregnancy). Endometrial hyperplasia and BPH
are pathologic but hormonally driven. Psoriasis = pathologic hyperplasia.
Q3. A pathologist notes nuclear pyknosis, karyorrhexis, and karyolysis in a tissue
sample. These findings indicate:
A) Reversible cell injury
B) Irreversible cell injury (necrosis)
,C) Apoptosis
D) Normal mitotic activity
✓ Correct Answer: B – Irreversible cell injury (necrosis)
Rationale: Pyknosis (nuclear condensation), karyorrhexis (fragmentation), and
karyolysis (dissolution) are hallmarks of irreversible injury/necrosis. Reversible
injury shows cellular swelling and fatty change.
Q4. Which type of necrosis is most characteristic of the brain after a stroke?
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Fat necrosis
✓ Correct Answer: B – Liquefactive necrosis
Rationale: Brain infarcts undergo liquefactive necrosis due to abundant lysosomal
enzymes and lack of connective tissue framework. Coagulative necrosis = kidney,
heart, liver (except brain). Caseous = TB. Fat = pancreas, breast.
Q5. A patient with tuberculosis has a lung lesion with "cheese-like" appearance.
This is:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Gangrenous necrosis
✓ Correct Answer: C – Caseous necrosis
Rationale: Caseous necrosis (TB) = granular, friable, cheese-like material with
granulomas and Langhans giant cells. Coagulative = firm. Liquefactive = liquid.
Q6. A 65-year-old smoker has a non-healing ulcer on the left great toe. The toe
is black, dry, and shriveled. This is:
A) Wet gangrene
B) Dry gangrene
C) Gas gangrene
D) Necrotizing fasciitis
,✓ Correct Answer: B – Dry gangrene
Rationale: Dry gangrene = coagulative necrosis from chronic ischemia (PAD,
diabetes). Black, dry, mummified. Wet gangrene = infection + ischemia, foul-
smelling. Gas gangrene = Clostridium.
Q7. Which statement best describes apoptosis?
A) Uncontrolled cell death causing inflammation
B) Programmed cell death without inflammation
C) Cell death due to trauma
D) Cell death due to hypoxia
✓ Correct Answer: B – Programmed cell death without inflammation
Rationale: Apoptosis is genetically programmed, energy-dependent (ATP), and
does NOT trigger inflammation. Necrosis is pathologic, unregulated, and causes
inflammation.
Q8. A pathologist notes "fat necrosis" with saponification (white, chalky areas)
in the abdomen. Most likely cause:
A) Myocardial infarction
B) Acute pancreatitis
C) Tuberculosis
D) Stroke
✓ Correct Answer: B – Acute pancreatitis
Rationale: Pancreatic lipases digest peripancreatic fat → fatty acids + calcium →
calcium soaps (saponification) = fat necrosis. Also seen in breast trauma.
Q9. Squamous metaplasia of the bronchial epithelium is most commonly caused
by:
A) Viral infection
B) Cigarette smoking
C) Bacterial pneumonia
D) Asbestos exposure
✓ Correct Answer: B – Cigarette smoking
Rationale: Chronic irritation (smoking) → ciliated columnar epithelium replaced
by stratified squamous epithelium (metaplasia). Reversible if smoking stops. May
progress to dysplasia/cancer.
, Q10. Which intracellular change is reversible?
A) Fatty change (steatosis)
B) Nuclear pyknosis
C) Membrane rupture
D) Lysosomal enzyme leakage
✓ Correct Answer: A – Fatty change (steatosis)
Rationale: Fatty change (lipid vacuoles in liver/heart) is reversible if the insult
(alcohol, obesity) is removed. Pyknosis, membrane rupture, and lysosomal
leakage indicate irreversible injury.
Q11. A patient with chronic alcohol use has an enlarged, yellow, greasy liver.
Microscopy shows hepatocytes with large fat vacuoles. This is:
A) Cirrhosis
B) Hepatic steatosis
C) Hepatitis
D) Hepatocellular carcinoma
✓ Correct Answer: B – Hepatic steatosis
Rationale: Fatty liver (steatosis) = reversible accumulation of triglycerides.
Cirrhosis is irreversible fibrosis. Steatosis can progress to steatohepatitis, then
cirrhosis.
Q12. Which type of necrosis is associated with Mycobacterium tuberculosis
infection?
A) Coagulative
B) Liquefactive
C) Caseous
D) Fat
✓ Correct Answer: C – Caseous
Rationale: Tuberculosis = caseous necrosis with granulomas (epithelioid
histiocytes, Langhans giant cells, peripheral lymphocytes). Central caseation is
characteristic.
Q13. A patient with a myocardial infarction has a pale, firm area of dead tissue.
This is:
A) Liquefactive necrosis
