NSG 120 PATHOPHYSIOLOGY HESI
EXAM 1 TOTAL QUESTIONS: 210
ANSWER KEY WITH RATIONALES
INCLUDED
SECTION 1: CELLULAR ADAPTATION & INJURY (20 questions)
1. A patient has an enlarged heart due to long-standing hypertension. This is an
example of:
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Answer: C – Hypertrophy (increased cell size due to increased workload, not
cell number).
2. Chronic acid reflux causes esophageal lining cells to change from squamous to
columnar epithelium. This is:
A) Atrophy
B) Metaplasia
C) Anaplasia
D) Hyperplasia
,Answer: B – Metaplasia (reversible replacement of one differentiated cell type
with another).
3. During ischemia, the first loss of cellular function is due to:
A) ATP depletion
B) Calcium overload
C) Free radical damage
D) Lysosomal rupture
Answer: A – ATP depletion impairs Na+/K+ pump, causing cell swelling.
4. Irreversible cell injury is marked by:
A) Nuclear pyknosis
B) Loss of cell membrane integrity
C) Decreased ATP
D) Mitochondrial swelling
Answer: B – Loss of membrane integrity leads to enzyme leakage and necrosis.
5. Coagulative necrosis is most commonly seen in:
A) Brain
B) Lungs
C) Heart (MI)
D) Pancreas
Answer: C – Heart, kidney, liver (preserves tissue structure for days).
6. Caseous necrosis is characteristic of:
A) Tuberculosis
B) Gangrene
C) Fat necrosis
D) Ischemic stroke
Answer: A – Tuberculosis (cheese-like, granulomatous inflammation).
7. Liquefactive necrosis occurs in:
A) Myocardium
B) Brain (stroke)
,C) Skeletal muscle
D) Liver
Answer: B – Brain (digested by enzymes, forms cystic space).
8. Which of the following is a hallmark of apoptosis?
A) Inflammation
B) Cell swelling
C) Chromatin condensation
D) Rupture of lysosomes
Answer: C – Apoptosis: programmed cell death, no inflammation, chromatin
condensation, nuclear fragmentation.
9. Which cellular adaptation is potentially reversible if the stimulus is removed?
A) Dysplasia
B) Neoplasia
C) Hypertrophy
D) Metaplasia
Answer: D – Metaplasia (often reversible; dysplasia may also reverse, but
neoplasia generally irreversible).
10. Free radical injury is prevented by:
A) Catalase
B) Cytochrome C
C) Calcium ATPase
D) Lactic acid
Answer: A – Catalase, superoxide dismutase, glutathione peroxidase are
antioxidants.
11. A patient with chronic hepatitis develops liver atrophy. This is likely due to:
A) Decreased workload
B) Loss of innervation
C) Decreased blood flow/nutrients
D) Hormonal changes
, Answer: C – Ischemia/nutritional deficiency leads to atrophy in chronic
disease.
12. Anaplasia is a feature of:
A) Benign tumors
B) Malignant tumors
C) Hypertrophic cardiomyopathy
D) Metaplastic epithelium
Answer: B – Anaplasia = lack of differentiation, hallmark of malignancy.
13. Hypoxia-induced cell injury primarily disrupts:
A) DNA synthesis
B) Aerobic respiration
C) Protein synthesis
D) Lipid synthesis
Answer: B – Aerobic respiration stops → anaerobic glycolysis → lactic acidosis.
14. In reperfusion injury, the main damaging agents are:
A) Oxygen free radicals
B) Clotting factors
C) Leukotrienes
D) Histamine
Answer: A – Reactive oxygen species (ROS) form when oxygen returns.
15. Which lab finding indicates hepatocyte necrosis?
A) Elevated ALT/AST
B) Elevated BNP
C) Elevated troponin
D) Elevated creatinine
Answer: A – ALT/AST (liver enzymes) released with hepatocellular injury.
16. A Pap smear shows abnormal, disorganized cervical cells but no invasion. This
is:
A) Anaplasia
EXAM 1 TOTAL QUESTIONS: 210
ANSWER KEY WITH RATIONALES
INCLUDED
SECTION 1: CELLULAR ADAPTATION & INJURY (20 questions)
1. A patient has an enlarged heart due to long-standing hypertension. This is an
example of:
A) Hyperplasia
B) Metaplasia
C) Hypertrophy
D) Dysplasia
Answer: C – Hypertrophy (increased cell size due to increased workload, not
cell number).
2. Chronic acid reflux causes esophageal lining cells to change from squamous to
columnar epithelium. This is:
A) Atrophy
B) Metaplasia
C) Anaplasia
D) Hyperplasia
,Answer: B – Metaplasia (reversible replacement of one differentiated cell type
with another).
3. During ischemia, the first loss of cellular function is due to:
A) ATP depletion
B) Calcium overload
C) Free radical damage
D) Lysosomal rupture
Answer: A – ATP depletion impairs Na+/K+ pump, causing cell swelling.
4. Irreversible cell injury is marked by:
A) Nuclear pyknosis
B) Loss of cell membrane integrity
C) Decreased ATP
D) Mitochondrial swelling
Answer: B – Loss of membrane integrity leads to enzyme leakage and necrosis.
5. Coagulative necrosis is most commonly seen in:
A) Brain
B) Lungs
C) Heart (MI)
D) Pancreas
Answer: C – Heart, kidney, liver (preserves tissue structure for days).
6. Caseous necrosis is characteristic of:
A) Tuberculosis
B) Gangrene
C) Fat necrosis
D) Ischemic stroke
Answer: A – Tuberculosis (cheese-like, granulomatous inflammation).
7. Liquefactive necrosis occurs in:
A) Myocardium
B) Brain (stroke)
,C) Skeletal muscle
D) Liver
Answer: B – Brain (digested by enzymes, forms cystic space).
8. Which of the following is a hallmark of apoptosis?
A) Inflammation
B) Cell swelling
C) Chromatin condensation
D) Rupture of lysosomes
Answer: C – Apoptosis: programmed cell death, no inflammation, chromatin
condensation, nuclear fragmentation.
9. Which cellular adaptation is potentially reversible if the stimulus is removed?
A) Dysplasia
B) Neoplasia
C) Hypertrophy
D) Metaplasia
Answer: D – Metaplasia (often reversible; dysplasia may also reverse, but
neoplasia generally irreversible).
10. Free radical injury is prevented by:
A) Catalase
B) Cytochrome C
C) Calcium ATPase
D) Lactic acid
Answer: A – Catalase, superoxide dismutase, glutathione peroxidase are
antioxidants.
11. A patient with chronic hepatitis develops liver atrophy. This is likely due to:
A) Decreased workload
B) Loss of innervation
C) Decreased blood flow/nutrients
D) Hormonal changes
, Answer: C – Ischemia/nutritional deficiency leads to atrophy in chronic
disease.
12. Anaplasia is a feature of:
A) Benign tumors
B) Malignant tumors
C) Hypertrophic cardiomyopathy
D) Metaplastic epithelium
Answer: B – Anaplasia = lack of differentiation, hallmark of malignancy.
13. Hypoxia-induced cell injury primarily disrupts:
A) DNA synthesis
B) Aerobic respiration
C) Protein synthesis
D) Lipid synthesis
Answer: B – Aerobic respiration stops → anaerobic glycolysis → lactic acidosis.
14. In reperfusion injury, the main damaging agents are:
A) Oxygen free radicals
B) Clotting factors
C) Leukotrienes
D) Histamine
Answer: A – Reactive oxygen species (ROS) form when oxygen returns.
15. Which lab finding indicates hepatocyte necrosis?
A) Elevated ALT/AST
B) Elevated BNP
C) Elevated troponin
D) Elevated creatinine
Answer: A – ALT/AST (liver enzymes) released with hepatocellular injury.
16. A Pap smear shows abnormal, disorganized cervical cells but no invasion. This
is:
A) Anaplasia
