WGU D236 PATHOPHYSIOLOGY PRE-ASSESSMENT EXAM
2026/2027 | Grade A Verified | PA Practice Test | Pass
Guaranteed - A+ Graded
Section 1: Cellular Adaptation, Injury & Neoplasia (Q1-10)
Q1. A 78-year-old patient has been bedridden for 3 months after hip surgery. Muscle
biopsy shows decreased cell size with increased lipofuscin pigment. This cellular
adaptation is:
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C. Atrophy [CORRECT]
Rationale: Atrophy is the decrease in cell size due to reduced workload, innervation, or
blood supply, as seen in disuse muscle wasting. Hypertrophy is increased cell size;
hyperplasia is increased cell number; metaplasia is replacement of one cell type by
another.
Q2. A 25-year-old female athlete has enlarged skeletal muscle mass in her quadriceps
after 6 months of resistance training. This adaptation results from:
A. Hyperplasia of muscle fibers
B. Hypertrophy of individual muscle cells
C. Metaplasia of connective tissue
D. Dysplasia of myocytes
Correct Answer: B. Hypertrophy of individual muscle cells [CORRECT]
,Rationale: Skeletal muscle enlargement from exercise occurs through hypertrophy
(increase in size of existing muscle fibers), not hyperplasia (which is more characteristic
of uterine smooth muscle). Metaplasia and dysplasia are pathologic processes, not
exercise adaptations.
Q3. A patient with chronic gastroesophageal reflux has Barrett esophagus on
endoscopy. The columnar epithelium replacing squamous epithelium represents:
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C. Metaplasia [CORRECT]
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, as when chronic acid exposure causes squamous-to-columnar epithelial
change in Barrett esophagus. Dysplasia involves disordered growth; anaplasia indicates
loss of differentiation in malignancy.
Q4. A patient with hypoxic injury shows cellular swelling, fatty change, and loss of
microvilli. These changes represent:
A. Apoptosis
B. Reversible cell injury
C. Coagulative necrosis
D. Caseous necrosis
Correct Answer: B. Reversible cell injury [CORRECT]
Rationale: Cellular swelling, fatty change, and organelle damage characterize reversible
cell injury that can resolve if the insult is removed. Apoptosis is programmed cell death;
coagulative and caseous necrosis are irreversible patterns of cell death with
architectural destruction.
,Q5. A patient receiving chemotherapy has widespread programmed cell death without
inflammation. This process is:
A. Liquefactive necrosis
B. Apoptosis
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B. Apoptosis [CORRECT]
Rationale: Apoptosis is energy-dependent programmed cell death characterized by cell
shrinkage, chromatin condensation, and formation of apoptotic bodies without
inflammation—common in chemotherapy-induced cell death. Necrosis involves cell
swelling, membrane rupture, and inflammatory response.
Q6. A patient with an acute myocardial infarction shows preserved tissue architecture
with loss of nuclei and eosinophilic cytoplasm. This pattern is:
A. Liquefactive necrosis
B. Coagulative necrosis
C. Fat necrosis
D. Fibrinoid necrosis
Correct Answer: B. Coagulative necrosis [CORRECT]
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs
(heart, kidney, spleen) where tissue architecture is preserved but cells lose nuclei and
stain eosinophilic. Liquefactive necrosis occurs in brain and abscesses; fat necrosis
occurs in pancreas/breast; fibrinoid necrosis occurs in vessels.
Q7. A patient with tuberculosis has granulomas containing amorphous granular debris
with no preserved architecture. This describes:
A. Coagulative necrosis
B. Caseous necrosis
, C. Liquefactive necrosis
D. Gangrenous necrosis
Correct Answer: B. Caseous necrosis [CORRECT]
Rationale: Caseous necrosis is a distinctive form seen in tuberculosis, featuring
amorphous, cheese-like granular debris without preserved tissue architecture,
surrounded by granulomatous inflammation. It represents a hybrid of coagulative and
liquefactive patterns.
Q8. A breast lump is well-circumscribed, mobile, and composed of uniform cells with
low mitotic activity. These features suggest:
A. Malignant tumor with metastasis
B. Benign tumor
C. Pre-malignant dysplasia
D. Carcinoma in situ
Correct Answer: B. Benign tumor [CORRECT]
Rationale: Benign tumors are typically well-circumscribed, mobile, slow-growing, and
composed of well-differentiated cells with low mitotic activity. Malignant tumors are
invasive, poorly circumscribed, and show pleomorphism with high mitotic activity.
Q9. A patient with breast cancer develops a lesion in the vertebral bodies. The most
likely route of metastasis to bone is:
A. Lymphatic spread
B. Hematogenous spread
C. Seeding of body cavities
D. Direct extension
Correct Answer: B. Hematogenous spread [CORRECT]
2026/2027 | Grade A Verified | PA Practice Test | Pass
Guaranteed - A+ Graded
Section 1: Cellular Adaptation, Injury & Neoplasia (Q1-10)
Q1. A 78-year-old patient has been bedridden for 3 months after hip surgery. Muscle
biopsy shows decreased cell size with increased lipofuscin pigment. This cellular
adaptation is:
A. Hypertrophy
B. Hyperplasia
C. Atrophy
D. Metaplasia
Correct Answer: C. Atrophy [CORRECT]
Rationale: Atrophy is the decrease in cell size due to reduced workload, innervation, or
blood supply, as seen in disuse muscle wasting. Hypertrophy is increased cell size;
hyperplasia is increased cell number; metaplasia is replacement of one cell type by
another.
Q2. A 25-year-old female athlete has enlarged skeletal muscle mass in her quadriceps
after 6 months of resistance training. This adaptation results from:
A. Hyperplasia of muscle fibers
B. Hypertrophy of individual muscle cells
C. Metaplasia of connective tissue
D. Dysplasia of myocytes
Correct Answer: B. Hypertrophy of individual muscle cells [CORRECT]
,Rationale: Skeletal muscle enlargement from exercise occurs through hypertrophy
(increase in size of existing muscle fibers), not hyperplasia (which is more characteristic
of uterine smooth muscle). Metaplasia and dysplasia are pathologic processes, not
exercise adaptations.
Q3. A patient with chronic gastroesophageal reflux has Barrett esophagus on
endoscopy. The columnar epithelium replacing squamous epithelium represents:
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Anaplasia
Correct Answer: C. Metaplasia [CORRECT]
Rationale: Metaplasia is the reversible replacement of one differentiated cell type by
another, as when chronic acid exposure causes squamous-to-columnar epithelial
change in Barrett esophagus. Dysplasia involves disordered growth; anaplasia indicates
loss of differentiation in malignancy.
Q4. A patient with hypoxic injury shows cellular swelling, fatty change, and loss of
microvilli. These changes represent:
A. Apoptosis
B. Reversible cell injury
C. Coagulative necrosis
D. Caseous necrosis
Correct Answer: B. Reversible cell injury [CORRECT]
Rationale: Cellular swelling, fatty change, and organelle damage characterize reversible
cell injury that can resolve if the insult is removed. Apoptosis is programmed cell death;
coagulative and caseous necrosis are irreversible patterns of cell death with
architectural destruction.
,Q5. A patient receiving chemotherapy has widespread programmed cell death without
inflammation. This process is:
A. Liquefactive necrosis
B. Apoptosis
C. Caseous necrosis
D. Gangrenous necrosis
Correct Answer: B. Apoptosis [CORRECT]
Rationale: Apoptosis is energy-dependent programmed cell death characterized by cell
shrinkage, chromatin condensation, and formation of apoptotic bodies without
inflammation—common in chemotherapy-induced cell death. Necrosis involves cell
swelling, membrane rupture, and inflammatory response.
Q6. A patient with an acute myocardial infarction shows preserved tissue architecture
with loss of nuclei and eosinophilic cytoplasm. This pattern is:
A. Liquefactive necrosis
B. Coagulative necrosis
C. Fat necrosis
D. Fibrinoid necrosis
Correct Answer: B. Coagulative necrosis [CORRECT]
Rationale: Coagulative necrosis is characteristic of ischemic injury in solid organs
(heart, kidney, spleen) where tissue architecture is preserved but cells lose nuclei and
stain eosinophilic. Liquefactive necrosis occurs in brain and abscesses; fat necrosis
occurs in pancreas/breast; fibrinoid necrosis occurs in vessels.
Q7. A patient with tuberculosis has granulomas containing amorphous granular debris
with no preserved architecture. This describes:
A. Coagulative necrosis
B. Caseous necrosis
, C. Liquefactive necrosis
D. Gangrenous necrosis
Correct Answer: B. Caseous necrosis [CORRECT]
Rationale: Caseous necrosis is a distinctive form seen in tuberculosis, featuring
amorphous, cheese-like granular debris without preserved tissue architecture,
surrounded by granulomatous inflammation. It represents a hybrid of coagulative and
liquefactive patterns.
Q8. A breast lump is well-circumscribed, mobile, and composed of uniform cells with
low mitotic activity. These features suggest:
A. Malignant tumor with metastasis
B. Benign tumor
C. Pre-malignant dysplasia
D. Carcinoma in situ
Correct Answer: B. Benign tumor [CORRECT]
Rationale: Benign tumors are typically well-circumscribed, mobile, slow-growing, and
composed of well-differentiated cells with low mitotic activity. Malignant tumors are
invasive, poorly circumscribed, and show pleomorphism with high mitotic activity.
Q9. A patient with breast cancer develops a lesion in the vertebral bodies. The most
likely route of metastasis to bone is:
A. Lymphatic spread
B. Hematogenous spread
C. Seeding of body cavities
D. Direct extension
Correct Answer: B. Hematogenous spread [CORRECT]
