N212 Pathophysiology – Full Practice Exam
SECTION 1: Cellular Adaptation & Injury
(Questions 1-15)
Q1. A 62-year-old male with a 30-year history of poorly controlled
hypertension shows echocardiographic evidence of left ventricular
wall thickening. What is the primary cellular mechanism driving this
change?
• A) Hyperplasia due to increased mitotic division
• B) Hypertrophy due to increased protein synthesis
• C) Metaplasia due to chronic mechanical stress
• D) Dysplasia due to genetic mutations in myocytes
Answer: B – Myocardial cells are permanent cells and cannot undergo
mitosis (ruling out hyperplasia). When faced with a chronic increase in
afterload (hypertension), the myocytes adapt via hypertrophy, which
involves an increase in cell size driven by enhanced protein synthesis and
the addition of sarcomeres .
Q2. A 45-year-old female with chronic gastroesophageal reflux disease
develops replacement of the normal squamous epithelium of the lower
esophagus with columnar epithelium. This cellular adaptation is best
described as:
• A) Hypertrophy
• B) Hyperplasia
• C) Metaplasia
• D) Dysplasia
,Answer: C – Metaplasia is the reversible replacement of one differentiated
cell type with another. In Barrett's esophagus, the normal squamous
epithelium is replaced by columnar epithelium as an adaptive response to
chronic acid exposure .
Q3. A weightlifter's enlarged skeletal muscles are an example of:
• A) Hyperplasia
• B) Metaplasia
• C) Hypertrophy
• D) Dysplasia
Answer: C – Increased workload causes an increase in individual muscle
cell size (hypertrophy), not cell number. This is a physiologic adaptation .
Q4. Which of the following describes physiologic atrophy?
• A) Thymus shrinking in adulthood
• B) Loss of muscle mass in a casted limb
• C) Brain atrophy in Alzheimer's disease
• D) Endometrial atrophy after menopause
Answer: A – Physiologic atrophy is a normal, age-related process. Thymus
involution is expected with aging; the others are pathologic .
Q5. A patient with a tumor is noted to have cells that are poorly
differentiated and resemble primitive, undifferentiated cells. This
process is best described as:
• A) Anaplasia
• B) Metaplasia
• C) Hyperplasia
, • D) Hypertrophy
Answer: A – Anaplasia refers to the loss of differentiation and the reversion
of cells to a more primitive, undifferentiated state. It is a hallmark of
malignant tumors and is associated with increased cellular atypia and
aggressive behavior .
Q6. A 50-year-old female presents with a Pap smear showing dysplastic
cells. Which of the following best describes dysplasia?
• A) An increase in the number of cells
• B) A decrease in cell size
• C) Abnormal changes in cell size, shape, and organization
• D) Replacement of one cell type with another
Answer: C – Dysplasia is characterized by abnormal changes in cell size,
shape, and organization. It is often a precursor to malignancy and is
commonly detected in cervical Pap smears .
Q7. A patient experiences ischemia-reperfusion injury following a
myocardial infarction. Which of the following mechanisms is primarily
responsible for reperfusion injury?
• A) Increased ATP production
• B) Generation of reactive oxygen species (free radicals)
• C) Decreased calcium influx
• D) Inhibition of inflammatory mediators
Answer: B – Reperfusion injury occurs when blood flow is restored to
ischemic tissue, leading to the generation of reactive oxygen species (free
radicals) that cause additional cellular damage. This is a key concept in
understanding myocardial infarction outcomes .
, Q8. Which type of cell death is characterized by cellular swelling,
rupture of the cell membrane, and an inflammatory response?
• A) Apoptosis
• B) Necrosis
• C) Autophagy
• D) Atrophy
Answer: B – Necrosis is a form of cell death characterized by cellular
swelling, rupture of the cell membrane, and leakage of cellular contents,
which triggers an inflammatory response. Apoptosis is programmed cell
death that does not elicit inflammation .
Q9. A patient with chronic hypoxia develops increased production of
red blood cells. This is an example of:
• A) Physiologic hyperplasia
• B) Pathologic hyperplasia
• C) Compensatory hyperplasia
• D) Hormonal hyperplasia
Answer: C – Compensatory hyperplasia occurs when the body increases
cell production to compensate for a deficiency. In chronic hypoxia, the
kidneys release erythropoietin, which stimulates the bone marrow to
produce more red blood cells to increase oxygen-carrying capacity .
Q10. A patient with chronic alcoholism develops liver cirrhosis. The
liver cells show evidence of fatty change. This is an example of:
• A) Cellular adaptation
• B) Cellular injury
• C) Cellular death
• D) Cellular aging
SECTION 1: Cellular Adaptation & Injury
(Questions 1-15)
Q1. A 62-year-old male with a 30-year history of poorly controlled
hypertension shows echocardiographic evidence of left ventricular
wall thickening. What is the primary cellular mechanism driving this
change?
• A) Hyperplasia due to increased mitotic division
• B) Hypertrophy due to increased protein synthesis
• C) Metaplasia due to chronic mechanical stress
• D) Dysplasia due to genetic mutations in myocytes
Answer: B – Myocardial cells are permanent cells and cannot undergo
mitosis (ruling out hyperplasia). When faced with a chronic increase in
afterload (hypertension), the myocytes adapt via hypertrophy, which
involves an increase in cell size driven by enhanced protein synthesis and
the addition of sarcomeres .
Q2. A 45-year-old female with chronic gastroesophageal reflux disease
develops replacement of the normal squamous epithelium of the lower
esophagus with columnar epithelium. This cellular adaptation is best
described as:
• A) Hypertrophy
• B) Hyperplasia
• C) Metaplasia
• D) Dysplasia
,Answer: C – Metaplasia is the reversible replacement of one differentiated
cell type with another. In Barrett's esophagus, the normal squamous
epithelium is replaced by columnar epithelium as an adaptive response to
chronic acid exposure .
Q3. A weightlifter's enlarged skeletal muscles are an example of:
• A) Hyperplasia
• B) Metaplasia
• C) Hypertrophy
• D) Dysplasia
Answer: C – Increased workload causes an increase in individual muscle
cell size (hypertrophy), not cell number. This is a physiologic adaptation .
Q4. Which of the following describes physiologic atrophy?
• A) Thymus shrinking in adulthood
• B) Loss of muscle mass in a casted limb
• C) Brain atrophy in Alzheimer's disease
• D) Endometrial atrophy after menopause
Answer: A – Physiologic atrophy is a normal, age-related process. Thymus
involution is expected with aging; the others are pathologic .
Q5. A patient with a tumor is noted to have cells that are poorly
differentiated and resemble primitive, undifferentiated cells. This
process is best described as:
• A) Anaplasia
• B) Metaplasia
• C) Hyperplasia
, • D) Hypertrophy
Answer: A – Anaplasia refers to the loss of differentiation and the reversion
of cells to a more primitive, undifferentiated state. It is a hallmark of
malignant tumors and is associated with increased cellular atypia and
aggressive behavior .
Q6. A 50-year-old female presents with a Pap smear showing dysplastic
cells. Which of the following best describes dysplasia?
• A) An increase in the number of cells
• B) A decrease in cell size
• C) Abnormal changes in cell size, shape, and organization
• D) Replacement of one cell type with another
Answer: C – Dysplasia is characterized by abnormal changes in cell size,
shape, and organization. It is often a precursor to malignancy and is
commonly detected in cervical Pap smears .
Q7. A patient experiences ischemia-reperfusion injury following a
myocardial infarction. Which of the following mechanisms is primarily
responsible for reperfusion injury?
• A) Increased ATP production
• B) Generation of reactive oxygen species (free radicals)
• C) Decreased calcium influx
• D) Inhibition of inflammatory mediators
Answer: B – Reperfusion injury occurs when blood flow is restored to
ischemic tissue, leading to the generation of reactive oxygen species (free
radicals) that cause additional cellular damage. This is a key concept in
understanding myocardial infarction outcomes .
, Q8. Which type of cell death is characterized by cellular swelling,
rupture of the cell membrane, and an inflammatory response?
• A) Apoptosis
• B) Necrosis
• C) Autophagy
• D) Atrophy
Answer: B – Necrosis is a form of cell death characterized by cellular
swelling, rupture of the cell membrane, and leakage of cellular contents,
which triggers an inflammatory response. Apoptosis is programmed cell
death that does not elicit inflammation .
Q9. A patient with chronic hypoxia develops increased production of
red blood cells. This is an example of:
• A) Physiologic hyperplasia
• B) Pathologic hyperplasia
• C) Compensatory hyperplasia
• D) Hormonal hyperplasia
Answer: C – Compensatory hyperplasia occurs when the body increases
cell production to compensate for a deficiency. In chronic hypoxia, the
kidneys release erythropoietin, which stimulates the bone marrow to
produce more red blood cells to increase oxygen-carrying capacity .
Q10. A patient with chronic alcoholism develops liver cirrhosis. The
liver cells show evidence of fatty change. This is an example of:
• A) Cellular adaptation
• B) Cellular injury
• C) Cellular death
• D) Cellular aging
