NR 507 Advanced Pathophysiology
NR 507 Advanced Pathophysiology Midterm
Exam 2025/2026 – 200 Practice Questions with
Rationales (Alternate Set)
Table of Contents
1. Cellular Adaptation & Injury – Q1–15
2. Genetics & Neoplasia – Q16–30
3. Inflammation & Immunity – Q31–45
4. Fluid, Electrolyte & Acid-Base – Q46–60
5. Cardiovascular – Q61–75
6. Respiratory – Q76–90
7. Renal & Urinary – Q91–105
8. Endocrine – Q106–125
9. Neurologic & Musculoskeletal – Q126–140
10. Hematologic – Q141–155
11. Gastrointestinal & Hepatobiliary – Q156–170
12. Multisystem & Infectious Disease – Q171–185
13. General & Miscellaneous – Q186–200
Topic 1: Cellular Adaptation & Injury
1. A pathologist notes that the size of individual cardiac myocytes has
increased in response to chronic hypertension. This adaptive change is
called:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: B. Hypertrophy
Rationale: Increased workload leads to an increase in cell size (hypertrophy) in
non-dividing cells like cardiac muscle.
2. Which type of necrosis is most commonly seen in the brain after a
stroke?
A. Coagulative
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
, NR 507 Advanced Pathophysiology
B. Liquefactive
C. Caseous
D. Fat necrosis
Answer: B. Liquefactive
Rationale: The brain has high lipid content and lacks a strong connective tissue
framework, so dead tissue liquefies.
3. Reversible cell injury is characterized by all EXCEPT:
A. Cellular swelling
B. Fatty change
C. Nuclear pyknosis
D. Loss of microvilli
Answer: C. Nuclear pyknosis
Rationale: Pyknosis (nuclear shrinkage) indicates irreversible injury. The others
can be reversible if the insult is removed.
4. A 60-year-old smoker has a bronchial biopsy showing replacement of
normal ciliated columnar epithelium with stratified squamous epithelium.
This change is:
A. Dysplasia
B. Anaplasia
C. Metaplasia
D. Hyperplasia
Answer: C. Metaplasia
Rationale: This is a classic example of squamous metaplasia from chronic
irritation (smoking).
5. Dystrophic calcification is most likely to occur in:
A. Normal tissue with hypercalcemia
B. Damaged or necrotic tissue
C. The lungs of a patient with sarcoidosis
D. The kidneys of a patient with multiple myeloma
Answer: B. Damaged or necrotic tissue
Rationale: Dystrophic calcification occurs in injured tissue despite normal serum
calcium levels.
6. Which of the following is a characteristic of apoptosis?
A. Inflammation is typically present.
B. It results in cell swelling and lysis.
C. It is a programmed, energy-dependent process.
D. It always occurs pathologically.
Answer: C. It is a programmed, energy-dependent process.
Rationale: Apoptosis is tightly regulated, requires ATP, and does not trigger
inflammation.
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
, NR 507 Advanced Pathophysiology
7. A patient with chronic GERD develops Barrett's esophagus. This is an
example of:
A. Squamous metaplasia
B. Intestinal metaplasia
C. Hyperplasia
D. Dysplasia
Answer: B. Intestinal metaplasia
Rationale: Barrett's esophagus is replacement of normal squamous epithelium
with intestinal-type columnar epithelium.
8. The most common type of necrosis associated with pulmonary
tuberculosis is:
A. Coagulative
B. Liquefactive
C. Caseous
D. Gangrenous
Answer: C. Caseous
Rationale: Caseous necrosis is characteristic of TB, with a cheese-like, granular
appearance.
9. A patient with prolonged ischemia to the lower leg develops dry
gangrene. This is a form of:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Fat necrosis
D. Fibrinoid necrosis
Answer: A. Coagulative necrosis
Rationale: Dry gangrene results from coagulative necrosis due to chronic
ischemia.
10. All of the following are causes of cellular injury EXCEPT:
A. Hypoxia
B. Free radicals
C. Apoptosis
D. Physical trauma
Answer: C. Apoptosis
Rationale: Apoptosis is a programmed process, not an injurious cause. The
others are causes of cell injury.
11. A patient with acute pancreatitis develops chalky white areas in the
peripancreatic fat. This is most consistent with:
A. Caseous necrosis
B. Fat necrosis
C. Coagulative necrosis
D. Fibrinoid necrosis
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
, NR 507 Advanced Pathophysiology
Answer: B. Fat necrosis
Rationale: Pancreatic enzymes (lipase) break down triglycerides into fatty acids,
which bind calcium and appear as white deposits.
12. Which cellular adaptation is characterized by an increase in the number
of cells in an organ?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Metaplasia
Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in cell number, while hypertrophy is
increased cell size.
13. A patient with chronic hepatitis C develops a shrunken, nodular liver.
This end-stage change is:
A. Cirrhosis
B. Fibrosis
C. Steatosis
D. Cholestasis
Answer: A. Cirrhosis
Rationale: Cirrhosis is diffuse fibrosis with regenerative nodules, the end result
of chronic liver injury.
14. Which of the following is an example of physiologic hypertrophy?
A. Left ventricular hypertrophy in hypertension
B. Skeletal muscle enlargement in bodybuilders
C. Cardiac enlargement in aortic stenosis
D. Uterine hypertrophy during pregnancy
Answer: D. Uterine hypertrophy during pregnancy
Rationale: Physiologic hypertrophy is a normal response to increased demand
(hormonal or mechanical). Uterine growth in pregnancy involves both
hypertrophy and hyperplasia. Option B is also physiologic but often considered
adaptive; D is the most classic example.
15. The finding of "flocculent densities" in mitochondria on electron
microscopy indicates:
A. Reversible cell injury
B. Irreversible cell injury
C. Normal mitochondrial function
D. Apoptosis
Answer: B. Irreversible cell injury
Rationale: Flocculent densities are a hallmark of irreversible mitochondrial
damage.
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
NR 507 Advanced Pathophysiology Midterm
Exam 2025/2026 – 200 Practice Questions with
Rationales (Alternate Set)
Table of Contents
1. Cellular Adaptation & Injury – Q1–15
2. Genetics & Neoplasia – Q16–30
3. Inflammation & Immunity – Q31–45
4. Fluid, Electrolyte & Acid-Base – Q46–60
5. Cardiovascular – Q61–75
6. Respiratory – Q76–90
7. Renal & Urinary – Q91–105
8. Endocrine – Q106–125
9. Neurologic & Musculoskeletal – Q126–140
10. Hematologic – Q141–155
11. Gastrointestinal & Hepatobiliary – Q156–170
12. Multisystem & Infectious Disease – Q171–185
13. General & Miscellaneous – Q186–200
Topic 1: Cellular Adaptation & Injury
1. A pathologist notes that the size of individual cardiac myocytes has
increased in response to chronic hypertension. This adaptive change is
called:
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Answer: B. Hypertrophy
Rationale: Increased workload leads to an increase in cell size (hypertrophy) in
non-dividing cells like cardiac muscle.
2. Which type of necrosis is most commonly seen in the brain after a
stroke?
A. Coagulative
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
, NR 507 Advanced Pathophysiology
B. Liquefactive
C. Caseous
D. Fat necrosis
Answer: B. Liquefactive
Rationale: The brain has high lipid content and lacks a strong connective tissue
framework, so dead tissue liquefies.
3. Reversible cell injury is characterized by all EXCEPT:
A. Cellular swelling
B. Fatty change
C. Nuclear pyknosis
D. Loss of microvilli
Answer: C. Nuclear pyknosis
Rationale: Pyknosis (nuclear shrinkage) indicates irreversible injury. The others
can be reversible if the insult is removed.
4. A 60-year-old smoker has a bronchial biopsy showing replacement of
normal ciliated columnar epithelium with stratified squamous epithelium.
This change is:
A. Dysplasia
B. Anaplasia
C. Metaplasia
D. Hyperplasia
Answer: C. Metaplasia
Rationale: This is a classic example of squamous metaplasia from chronic
irritation (smoking).
5. Dystrophic calcification is most likely to occur in:
A. Normal tissue with hypercalcemia
B. Damaged or necrotic tissue
C. The lungs of a patient with sarcoidosis
D. The kidneys of a patient with multiple myeloma
Answer: B. Damaged or necrotic tissue
Rationale: Dystrophic calcification occurs in injured tissue despite normal serum
calcium levels.
6. Which of the following is a characteristic of apoptosis?
A. Inflammation is typically present.
B. It results in cell swelling and lysis.
C. It is a programmed, energy-dependent process.
D. It always occurs pathologically.
Answer: C. It is a programmed, energy-dependent process.
Rationale: Apoptosis is tightly regulated, requires ATP, and does not trigger
inflammation.
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
, NR 507 Advanced Pathophysiology
7. A patient with chronic GERD develops Barrett's esophagus. This is an
example of:
A. Squamous metaplasia
B. Intestinal metaplasia
C. Hyperplasia
D. Dysplasia
Answer: B. Intestinal metaplasia
Rationale: Barrett's esophagus is replacement of normal squamous epithelium
with intestinal-type columnar epithelium.
8. The most common type of necrosis associated with pulmonary
tuberculosis is:
A. Coagulative
B. Liquefactive
C. Caseous
D. Gangrenous
Answer: C. Caseous
Rationale: Caseous necrosis is characteristic of TB, with a cheese-like, granular
appearance.
9. A patient with prolonged ischemia to the lower leg develops dry
gangrene. This is a form of:
A. Coagulative necrosis
B. Liquefactive necrosis
C. Fat necrosis
D. Fibrinoid necrosis
Answer: A. Coagulative necrosis
Rationale: Dry gangrene results from coagulative necrosis due to chronic
ischemia.
10. All of the following are causes of cellular injury EXCEPT:
A. Hypoxia
B. Free radicals
C. Apoptosis
D. Physical trauma
Answer: C. Apoptosis
Rationale: Apoptosis is a programmed process, not an injurious cause. The
others are causes of cell injury.
11. A patient with acute pancreatitis develops chalky white areas in the
peripancreatic fat. This is most consistent with:
A. Caseous necrosis
B. Fat necrosis
C. Coagulative necrosis
D. Fibrinoid necrosis
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
, NR 507 Advanced Pathophysiology
Answer: B. Fat necrosis
Rationale: Pancreatic enzymes (lipase) break down triglycerides into fatty acids,
which bind calcium and appear as white deposits.
12. Which cellular adaptation is characterized by an increase in the number
of cells in an organ?
A. Hypertrophy
B. Atrophy
C. Hyperplasia
D. Metaplasia
Answer: C. Hyperplasia
Rationale: Hyperplasia is an increase in cell number, while hypertrophy is
increased cell size.
13. A patient with chronic hepatitis C develops a shrunken, nodular liver.
This end-stage change is:
A. Cirrhosis
B. Fibrosis
C. Steatosis
D. Cholestasis
Answer: A. Cirrhosis
Rationale: Cirrhosis is diffuse fibrosis with regenerative nodules, the end result
of chronic liver injury.
14. Which of the following is an example of physiologic hypertrophy?
A. Left ventricular hypertrophy in hypertension
B. Skeletal muscle enlargement in bodybuilders
C. Cardiac enlargement in aortic stenosis
D. Uterine hypertrophy during pregnancy
Answer: D. Uterine hypertrophy during pregnancy
Rationale: Physiologic hypertrophy is a normal response to increased demand
(hormonal or mechanical). Uterine growth in pregnancy involves both
hypertrophy and hyperplasia. Option B is also physiologic but often considered
adaptive; D is the most classic example.
15. The finding of "flocculent densities" in mitochondria on electron
microscopy indicates:
A. Reversible cell injury
B. Irreversible cell injury
C. Normal mitochondrial function
D. Apoptosis
Answer: B. Irreversible cell injury
Rationale: Flocculent densities are a hallmark of irreversible mitochondrial
damage.
© NR 507 Advanced Pathophysiology Study Resource – 2025/2026 Edition
