West Coast University
College of Nursing
PATHOPHYSIOLOGY
MIDTERM EXAMINATION
2026/2027 Academic Year
Total Questions: 60 Multiple-Choice Questions (MCQ)
Testing Time: 90 Minutes
Format: Computer-Based, Proctored
Passing Score: 75–80% (45–48/60 Correct)
Question Types: Standard MCQ, SATA, Clinical Vignettes, Mechanism-to-Manifestation
Aligned With: AACN Essentials & Graduate Nursing Competency Standards
, EXAMINATION INSTRUCTIONS
1. This examination consists of 60 multiple-choice questions covering foundational and intermediate
disease mechanism principles in pathophysiology.
2. Each question has four answer options (A, B, C, D). Select the single best answer unless the
question is explicitly marked as Select-All-That-Apply (SATA).
3. Questions are presented in bold. Correct answers are indicated in bold purple. Detailed rationales
are provided in italic font with a lavender background.
4. The exam is organized into the following core domains: Cellular Biology & Genetic Foundations,
Immune & Inflammatory Pathophysiology, Neurologic Pathophysiology, Endocrine & Metabolic
Disorders, Cardiovascular & Pulmonary Pathophysiology, Renal/Gastrointestinal/Hematologic
Mechanisms, Clinical Correlation & Diagnostic Reasoning, and Scenario-Based Application.
5. Focus on evidence-based disease mechanism principles, cellular/molecular pathway integration,
and advanced clinical judgment aligned with AACN Essentials.
6. Pace yourself to complete all questions within the 90-minute testing period.
7. A passing score of 75–80% (45–48 correct answers out of 60) is typically required per WCU
nursing program policy.
Domain Distribution:
Cellular Biology & Genetic Foundations (Q1–Q8): 8 Questions
Immune & Inflammatory Pathophysiology (Q9–Q16): 8 Questions
Neurologic Pathophysiology (Q17–Q24): 8 Questions
Endocrine & Metabolic Disorders (Q25–Q32): 8 Questions
Cardiovascular & Pulmonary Pathophysiology (Q33–Q41): 9 Questions
Renal, Gastrointestinal & Hematologic Mechanisms (Q42–Q50): 9 Questions
Clinical Correlation & Diagnostic Reasoning (Q51–Q55): 5 Questions
Scenario-Based Application (Q56–Q60): 5 Questions
, Cellular Biology & Genetic Foundations
Q1. A 68-year-old male with chronic ischemic heart disease presents with gradually
worsening exercise intolerance. Echocardiography reveals left ventricular wall thickening
with no increase in myocyte number. Which cellular adaptation best explains this finding?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size due to increased functional demand or hormonal
stimulation. In cardiac muscle, which is composed of terminally differentiated cells incapable of
division, the primary adaptive response to increased workload (such as chronic pressure overload from
ischemic heart disease) is hypertrophy. Atrophy would involve cell shrinkage, hyperplasia requires cell
division (not possible in cardiac myocytes), and metaplasia involves replacement of one differentiated
cell type with another.
Q2. A long-term cigarette smoker undergoes bronchoscopic biopsy revealing replacement
of normal ciliated columnar epithelium with stratified squamous epithelium in the
tracheobronchial tree. This change is best classified as:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Neoplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature cell type with another mature cell
type, often as an adaptive response to chronic stress. In smokers, chronic exposure to toxic irritants
triggers the substitution of ciliated columnar epithelium with more resilient stratified squamous
epithelium. While this change is initially adaptive and potentially reversible, it represents a
premalignant condition. Dysplasia refers to disordered growth with atypical cells, hyperplasia is an
increase in cell number, and neoplasia indicates uncontrolled, autonomous new growth.
Q3. Which cellular change represents an irreversible injury characterized by progressive
decline in protein synthesis, membrane damage, and nuclear pyknosis?
A. Cellular swelling
B. Fatty change
C. Coagulative necrosis
D. Endoplasmic reticulum dilation
Correct Answer: C
Rationale: Coagulative necrosis represents irreversible cell injury characterized by protein
denaturation, preservation of tissue architecture (ghost outlines), nuclear pyknosis (shrinkage),
karyorrhexis (fragmentation), and karyolysis (dissolution). Cellular swelling and endoplasmic
reticulum dilation are features of reversible injury. Fatty change, while it can be associated with
reversible or irreversible injury depending on severity, does not inherently represent the hallmark
features of irreversible necrosis described in the question stem.
Q4. A researcher is studying programmed cell death in developing embryonic tissue.
Which pathway is primarily mediated by caspase activation, requires ATP, and does not
elicit an inflammatory response?
A. Coagulative necrosis
B. Liquefactive necrosis
College of Nursing
PATHOPHYSIOLOGY
MIDTERM EXAMINATION
2026/2027 Academic Year
Total Questions: 60 Multiple-Choice Questions (MCQ)
Testing Time: 90 Minutes
Format: Computer-Based, Proctored
Passing Score: 75–80% (45–48/60 Correct)
Question Types: Standard MCQ, SATA, Clinical Vignettes, Mechanism-to-Manifestation
Aligned With: AACN Essentials & Graduate Nursing Competency Standards
, EXAMINATION INSTRUCTIONS
1. This examination consists of 60 multiple-choice questions covering foundational and intermediate
disease mechanism principles in pathophysiology.
2. Each question has four answer options (A, B, C, D). Select the single best answer unless the
question is explicitly marked as Select-All-That-Apply (SATA).
3. Questions are presented in bold. Correct answers are indicated in bold purple. Detailed rationales
are provided in italic font with a lavender background.
4. The exam is organized into the following core domains: Cellular Biology & Genetic Foundations,
Immune & Inflammatory Pathophysiology, Neurologic Pathophysiology, Endocrine & Metabolic
Disorders, Cardiovascular & Pulmonary Pathophysiology, Renal/Gastrointestinal/Hematologic
Mechanisms, Clinical Correlation & Diagnostic Reasoning, and Scenario-Based Application.
5. Focus on evidence-based disease mechanism principles, cellular/molecular pathway integration,
and advanced clinical judgment aligned with AACN Essentials.
6. Pace yourself to complete all questions within the 90-minute testing period.
7. A passing score of 75–80% (45–48 correct answers out of 60) is typically required per WCU
nursing program policy.
Domain Distribution:
Cellular Biology & Genetic Foundations (Q1–Q8): 8 Questions
Immune & Inflammatory Pathophysiology (Q9–Q16): 8 Questions
Neurologic Pathophysiology (Q17–Q24): 8 Questions
Endocrine & Metabolic Disorders (Q25–Q32): 8 Questions
Cardiovascular & Pulmonary Pathophysiology (Q33–Q41): 9 Questions
Renal, Gastrointestinal & Hematologic Mechanisms (Q42–Q50): 9 Questions
Clinical Correlation & Diagnostic Reasoning (Q51–Q55): 5 Questions
Scenario-Based Application (Q56–Q60): 5 Questions
, Cellular Biology & Genetic Foundations
Q1. A 68-year-old male with chronic ischemic heart disease presents with gradually
worsening exercise intolerance. Echocardiography reveals left ventricular wall thickening
with no increase in myocyte number. Which cellular adaptation best explains this finding?
A. Atrophy
B. Hypertrophy
C. Hyperplasia
D. Metaplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size due to increased functional demand or hormonal
stimulation. In cardiac muscle, which is composed of terminally differentiated cells incapable of
division, the primary adaptive response to increased workload (such as chronic pressure overload from
ischemic heart disease) is hypertrophy. Atrophy would involve cell shrinkage, hyperplasia requires cell
division (not possible in cardiac myocytes), and metaplasia involves replacement of one differentiated
cell type with another.
Q2. A long-term cigarette smoker undergoes bronchoscopic biopsy revealing replacement
of normal ciliated columnar epithelium with stratified squamous epithelium in the
tracheobronchial tree. This change is best classified as:
A. Dysplasia
B. Metaplasia
C. Hyperplasia
D. Neoplasia
Correct Answer: B
Rationale: Metaplasia is the reversible replacement of one mature cell type with another mature cell
type, often as an adaptive response to chronic stress. In smokers, chronic exposure to toxic irritants
triggers the substitution of ciliated columnar epithelium with more resilient stratified squamous
epithelium. While this change is initially adaptive and potentially reversible, it represents a
premalignant condition. Dysplasia refers to disordered growth with atypical cells, hyperplasia is an
increase in cell number, and neoplasia indicates uncontrolled, autonomous new growth.
Q3. Which cellular change represents an irreversible injury characterized by progressive
decline in protein synthesis, membrane damage, and nuclear pyknosis?
A. Cellular swelling
B. Fatty change
C. Coagulative necrosis
D. Endoplasmic reticulum dilation
Correct Answer: C
Rationale: Coagulative necrosis represents irreversible cell injury characterized by protein
denaturation, preservation of tissue architecture (ghost outlines), nuclear pyknosis (shrinkage),
karyorrhexis (fragmentation), and karyolysis (dissolution). Cellular swelling and endoplasmic
reticulum dilation are features of reversible injury. Fatty change, while it can be associated with
reversible or irreversible injury depending on severity, does not inherently represent the hallmark
features of irreversible necrosis described in the question stem.
Q4. A researcher is studying programmed cell death in developing embryonic tissue.
Which pathway is primarily mediated by caspase activation, requires ATP, and does not
elicit an inflammatory response?
A. Coagulative necrosis
B. Liquefactive necrosis
