NURS6501 ADVANCED PATHOPHYSIOLOGY
MIDTERM 2026/2027 Actual Exam – Complete
Questions & Detailed Rationales – Pass Guaranteed
– A+ Graded
TABLE OF CONTENTS
Section 1 | Cellular Adaptation & Injury | Q1 – Q10
Section 2 | Inflammation, Immunity & Infection | Q11 – Q20
Section 3 | Fluid, Electrolyte & Acid-Base Balance | Q21 – Q30
Section 4 | Genetics & Neoplasia | Q31 – Q40
Section 5 | Integumentary & Musculoskeletal Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
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SECTION 1: CELLULAR ADAPTATION & INJURY Q1 – Q10
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Question 1 of 50
A 58-year-old male smoker with a chronic productive cough undergoes bronchoscopy.
Biopsy of the bronchial mucosa reveals that ciliated columnar epithelium has been
replaced by stratified squamous epithelium.
A. Metaplasia, a reversible replacement of one differentiated cell type by another in
response to chronic irritation ✓ CORRECT
B. Dysplasia with disordered growth and nuclear atypia throughout the epithelium
C. Hyperplasia characterized by an increased number of normal ciliated columnar cells
D. Hypertrophy involving enlargement of individual ciliated columnar cells
Correct Answer: A
Rationale: Metaplasia is the reversible substitution of one mature cell type for another,
commonly seen in respiratory epithelium exposed to chronic cigarette smoke. Dysplasia
,implies disordered growth with cytologic atypia that is not described in this adaptive
change. If smoking ceases, this change can revert to normal columnar epithelium.
Question 2 of 50
A 62-year-old male with long-standing hypertension presents with dyspnea on exertion.
Echocardiography shows concentric left ventricular thickening. Endomyocardial biopsy
demonstrates myocardial cells with increased size and greater mitochondrial density.
A. Hyperplasia from replication of cardiac myocytes in response to hemodynamic
stress
B. Hypertrophy, an increase in cell size without cell division in terminally differentiated
tissue ✓ CORRECT
C. Metaplasia with replacement of cardiac myocytes by fibroblastic tissue
D. Dysplasia with disordered arrangement of myofibrils and nuclear pleomorphism
Correct Answer: B
Rationale: Hypertrophy is defined by an increase in cell size and organelle content
producing larger tissue mass without cell division, which is the adaptive response of
adult cardiac muscle to pressure overload. Cardiac myocytes are terminally
differentiated and do not undergo hyperplasia under normal conditions. Pathologic
hypertrophy initially compensates for increased afterload but can progress to systolic
dysfunction.
Question 3 of 50
A 34-year-old woman with an abnormal Pap smear undergoes colposcopy. Histology of
the cervical epithelium shows disordered maturation, nuclear hyperchromasia, and loss
of normal basal-to-superficial polarity.
A. Metaplasia with replacement of squamous epithelium by glandular columnar cells
B. Hypertrophy involving enlargement of basal layer cells without nuclear changes
C. Dysplasia, a pre-neoplastic disordered growth with cytologic atypia and loss of
maturation ✓ CORRECT
,D. Anaplasia representing complete loss of differentiation and invasive potential
Correct Answer: C
Rationale: Dysplasia is characterized by disordered epithelial maturation, nuclear
pleomorphism, and loss of polarity, representing a reversible pre-neoplastic change
when mild to moderate. Metaplasia involves replacement by a different normal cell type
without cytologic atypia. High-risk HPV persistence is the primary driver of cervical
dysplasia progression.
Question 4 of 50
A 28-year-old male is extricated after being trapped under rubble for four hours
following a building collapse. Serum creatine kinase is 45,000 U/L. Muscle biopsy
shows swollen myocytes with loss of membrane integrity, mitochondrial amorphous
densities, and cytoplasmic vacuolization.
A. Reversible cellular swelling with intact plasma membranes that will normalize with
reperfusion
B. Apoptosis with cell shrinkage, chromatin condensation, and maintenance of
membrane integrity
C. Metaplasia from pressure-induced cellular adaptation to ischemic conditions
D. Irreversible injury with membrane phospholipid loss and massive calcium influx
causing cell death ✓ CORRECT
Correct Answer: D
Rationale: Prolonged ischemia causes ATP depletion, loss of membrane phospholipids,
and massive calcium influx that are hallmarks of irreversible cell injury. Reversible injury
would show only cellular swelling and fatty change without membrane rupture.
Rhabdomyolysis from crush injury exemplifies coagulative necrosis in skeletal muscle
and requires aggressive fluid resuscitation to prevent acute kidney injury.
Question 5 of 50
, A 50-year-old alcoholic with elevated liver enzymes undergoes percutaneous liver
biopsy. Histology shows hepatocytes containing large clear vacuoles that displace the
nucleus to the periphery of the cell.
A. Fatty change from impaired lipoprotein transport and excessive free fatty acid
accumulation ✓ CORRECT
B. Hydropic change involving water accumulation producing small intracellular vacuoles
C. Hyaline change with proteinaceous accumulation in hepatocyte cytoplasm
D. Glycogen accumulation producing diffuse cytoplasmic clearing without nuclear
displacement
Correct Answer: A
Rationale: Fatty change results from impaired lipoprotein synthesis and excessive free
fatty acid influx, producing large triglyceride vacuoles that displace the nucleus to the
periphery. Hydropic change involves water accumulation producing small clear
vacuoles, not large fat vacuoles. Alcohol-induced steatosis is reversible with abstinence
but can progress to steatohepatitis and cirrhosis.
Question 6 of 50
A 70-year-old woman with severe aortic stenosis dies after declining surgery. Autopsy
reveals a heart weight of 550 g. Histology of the left ventricle shows enlarged myocytes
with bizarre polyploid nuclei but normal cellular differentiation.
A. Hyperplasia of cardiac fibroblasts causing reactive fibrosis in the myocardium
B. Hypertrophy with nuclear atypia mimicking malignancy but representing benign
adaptive change ✓ CORRECT
C. Anaplastic transformation of cardiac myocytes into a primary cardiac sarcoma
D. Dysplastic change from hemodynamic stress with loss of cellular differentiation
Correct Answer: B
Rationale: Chronic pressure overload produces pathologic hypertrophy where myocytes
enlarge and may develop polyploidy with bizarre nuclei, but this remains a benign
MIDTERM 2026/2027 Actual Exam – Complete
Questions & Detailed Rationales – Pass Guaranteed
– A+ Graded
TABLE OF CONTENTS
Section 1 | Cellular Adaptation & Injury | Q1 – Q10
Section 2 | Inflammation, Immunity & Infection | Q11 – Q20
Section 3 | Fluid, Electrolyte & Acid-Base Balance | Q21 – Q30
Section 4 | Genetics & Neoplasia | Q31 – Q40
Section 5 | Integumentary & Musculoskeletal Disorders | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: CELLULAR ADAPTATION & INJURY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old male smoker with a chronic productive cough undergoes bronchoscopy.
Biopsy of the bronchial mucosa reveals that ciliated columnar epithelium has been
replaced by stratified squamous epithelium.
A. Metaplasia, a reversible replacement of one differentiated cell type by another in
response to chronic irritation ✓ CORRECT
B. Dysplasia with disordered growth and nuclear atypia throughout the epithelium
C. Hyperplasia characterized by an increased number of normal ciliated columnar cells
D. Hypertrophy involving enlargement of individual ciliated columnar cells
Correct Answer: A
Rationale: Metaplasia is the reversible substitution of one mature cell type for another,
commonly seen in respiratory epithelium exposed to chronic cigarette smoke. Dysplasia
,implies disordered growth with cytologic atypia that is not described in this adaptive
change. If smoking ceases, this change can revert to normal columnar epithelium.
Question 2 of 50
A 62-year-old male with long-standing hypertension presents with dyspnea on exertion.
Echocardiography shows concentric left ventricular thickening. Endomyocardial biopsy
demonstrates myocardial cells with increased size and greater mitochondrial density.
A. Hyperplasia from replication of cardiac myocytes in response to hemodynamic
stress
B. Hypertrophy, an increase in cell size without cell division in terminally differentiated
tissue ✓ CORRECT
C. Metaplasia with replacement of cardiac myocytes by fibroblastic tissue
D. Dysplasia with disordered arrangement of myofibrils and nuclear pleomorphism
Correct Answer: B
Rationale: Hypertrophy is defined by an increase in cell size and organelle content
producing larger tissue mass without cell division, which is the adaptive response of
adult cardiac muscle to pressure overload. Cardiac myocytes are terminally
differentiated and do not undergo hyperplasia under normal conditions. Pathologic
hypertrophy initially compensates for increased afterload but can progress to systolic
dysfunction.
Question 3 of 50
A 34-year-old woman with an abnormal Pap smear undergoes colposcopy. Histology of
the cervical epithelium shows disordered maturation, nuclear hyperchromasia, and loss
of normal basal-to-superficial polarity.
A. Metaplasia with replacement of squamous epithelium by glandular columnar cells
B. Hypertrophy involving enlargement of basal layer cells without nuclear changes
C. Dysplasia, a pre-neoplastic disordered growth with cytologic atypia and loss of
maturation ✓ CORRECT
,D. Anaplasia representing complete loss of differentiation and invasive potential
Correct Answer: C
Rationale: Dysplasia is characterized by disordered epithelial maturation, nuclear
pleomorphism, and loss of polarity, representing a reversible pre-neoplastic change
when mild to moderate. Metaplasia involves replacement by a different normal cell type
without cytologic atypia. High-risk HPV persistence is the primary driver of cervical
dysplasia progression.
Question 4 of 50
A 28-year-old male is extricated after being trapped under rubble for four hours
following a building collapse. Serum creatine kinase is 45,000 U/L. Muscle biopsy
shows swollen myocytes with loss of membrane integrity, mitochondrial amorphous
densities, and cytoplasmic vacuolization.
A. Reversible cellular swelling with intact plasma membranes that will normalize with
reperfusion
B. Apoptosis with cell shrinkage, chromatin condensation, and maintenance of
membrane integrity
C. Metaplasia from pressure-induced cellular adaptation to ischemic conditions
D. Irreversible injury with membrane phospholipid loss and massive calcium influx
causing cell death ✓ CORRECT
Correct Answer: D
Rationale: Prolonged ischemia causes ATP depletion, loss of membrane phospholipids,
and massive calcium influx that are hallmarks of irreversible cell injury. Reversible injury
would show only cellular swelling and fatty change without membrane rupture.
Rhabdomyolysis from crush injury exemplifies coagulative necrosis in skeletal muscle
and requires aggressive fluid resuscitation to prevent acute kidney injury.
Question 5 of 50
, A 50-year-old alcoholic with elevated liver enzymes undergoes percutaneous liver
biopsy. Histology shows hepatocytes containing large clear vacuoles that displace the
nucleus to the periphery of the cell.
A. Fatty change from impaired lipoprotein transport and excessive free fatty acid
accumulation ✓ CORRECT
B. Hydropic change involving water accumulation producing small intracellular vacuoles
C. Hyaline change with proteinaceous accumulation in hepatocyte cytoplasm
D. Glycogen accumulation producing diffuse cytoplasmic clearing without nuclear
displacement
Correct Answer: A
Rationale: Fatty change results from impaired lipoprotein synthesis and excessive free
fatty acid influx, producing large triglyceride vacuoles that displace the nucleus to the
periphery. Hydropic change involves water accumulation producing small clear
vacuoles, not large fat vacuoles. Alcohol-induced steatosis is reversible with abstinence
but can progress to steatohepatitis and cirrhosis.
Question 6 of 50
A 70-year-old woman with severe aortic stenosis dies after declining surgery. Autopsy
reveals a heart weight of 550 g. Histology of the left ventricle shows enlarged myocytes
with bizarre polyploid nuclei but normal cellular differentiation.
A. Hyperplasia of cardiac fibroblasts causing reactive fibrosis in the myocardium
B. Hypertrophy with nuclear atypia mimicking malignancy but representing benign
adaptive change ✓ CORRECT
C. Anaplastic transformation of cardiac myocytes into a primary cardiac sarcoma
D. Dysplastic change from hemodynamic stress with loss of cellular differentiation
Correct Answer: B
Rationale: Chronic pressure overload produces pathologic hypertrophy where myocytes
enlarge and may develop polyploidy with bizarre nuclei, but this remains a benign
