NUR 631 Advanced Physiology and
Pathophysiology Midterm & Final Exam Prep
Test Bank 1 – Practice Exam | 150 Questions &
Correct Answers (Verified) Plus Rationales | 2026
Q&A
Instructions: Select the best answer for each question. This practice
exam is designed to prepare you for graduate-level pathophysiology
assessments.
SECTION 1: CELLULAR ADAPTATION, INJURY, & DEATH
(Questions 1–15)
Question 1 of 150
A patient with chronic gastroesophageal reflux disease (GERD) develops metaplasia in
the lower esophagus. Which of the following cellular adaptations has occurred?
• A. Hyperplasia
• B. Hypertrophy
• C. Metaplasia
• D. Dysplasia
Correct Answer: C – Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another. In GERD, the normal stratified squamous epithelium of the lower esophagus is
,replaced by columnar epithelium (Barrett esophagus) to better withstand the acidic
environment. Dysplasia is disordered cellular growth; hyperplasia is increased cell number;
hypertrophy is increased cell size.
Question 2 of 150
A patient with chronic hypertension develops left ventricular thickening. This is an
example of:
• A. Hyperplasia
• B. Hypertrophy
• C. Atrophy
• D. Metaplasia
Correct Answer: B – Hypertrophy
Rationale: Hypertrophy is an increase in cell size, leading to organ enlargement. Cardiac
myocytes cannot divide (they are terminally differentiated), so they respond to increased
workload (chronic hypertension) by increasing in size (hypertrophy).
Question 3 of 150
Which of the following is a characteristic of irreversible cell injury?
• A. Cellular swelling
• B. Fatty change
• C. Nuclear pyknosis
• D. Loss of microvilli
,Correct Answer: C – Nuclear pyknosis
Rationale: Irreversible cell injury is marked by nuclear changes: pyknosis (nuclear
shrinkage and condensation), karyorrhexis (fragmentation), and karyolysis (dissolution).
Cellular swelling, fatty change, and loss of microvilli are reversible changes.
Question 4 of 150
A patient with a myocardial infarction (MI) develops coagulation necrosis. Which of the
following describes the microscopic appearance of coagulation necrosis?
• A. Tissue becomes soft and liquefied
• B. Tissue architecture is preserved but cells are anucleate
• C. Cheese-like appearance with calcium deposition
• D. Fat saponification with chalky white areas
Correct Answer: B – Tissue architecture is preserved but cells are anucleate
Rationale: Coagulation necrosis (common in MI, kidney, liver) preserves tissue architecture
for days because proteases are denatured by ischemia. Cells become anucleate with
preserved cell outlines. Liquefactive necrosis occurs in brain. Caseous necrosis occurs in TB.
Fat necrosis occurs in pancreatitis.
Question 5 of 150
A patient with a stroke develops liquefactive necrosis in the brain. Which of the
following is the mechanism of this type of necrosis?
• A. Ischemia with preservation of tissue architecture
• B. Release of lysosomal enzymes causing tissue digestion
, • C. Deposition of calcium in dead tissue
• D. Formation of a cheese-like granuloma
Correct Answer: B – Release of lysosomal enzymes causing tissue digestion
Rationale: In liquefactive necrosis (brain, spinal cord), dead tissue is digested by lysosomal
enzymes from neutrophils and microglia, forming a liquid viscous mass. Tissue
architecture is not preserved.
Question 6 of 150
A patient with tuberculosis develops caseous necrosis in a lung granuloma. Which of the
following describes the gross appearance of caseous necrosis?
• A. Liquid, creamy material
• B. Firm, pink tissue
• C. Soft, yellow-white, cheese-like material
• D. Hard, calcified tissue
Correct Answer: C – Soft, yellow-white, cheese-like material
Rationale: Caseous necrosis (TB, fungal infections) has a soft, friable, yellow-white, cheese-
like appearance. It is a combination of coagulation necrosis and granulomatous
inflammation.
Question 7 of 150
A patient with acute pancreatitis develops fat necrosis in the abdomen. Which
laboratory finding is most likely?
Pathophysiology Midterm & Final Exam Prep
Test Bank 1 – Practice Exam | 150 Questions &
Correct Answers (Verified) Plus Rationales | 2026
Q&A
Instructions: Select the best answer for each question. This practice
exam is designed to prepare you for graduate-level pathophysiology
assessments.
SECTION 1: CELLULAR ADAPTATION, INJURY, & DEATH
(Questions 1–15)
Question 1 of 150
A patient with chronic gastroesophageal reflux disease (GERD) develops metaplasia in
the lower esophagus. Which of the following cellular adaptations has occurred?
• A. Hyperplasia
• B. Hypertrophy
• C. Metaplasia
• D. Dysplasia
Correct Answer: C – Metaplasia
Rationale: Metaplasia is the reversible replacement of one differentiated cell type with
another. In GERD, the normal stratified squamous epithelium of the lower esophagus is
,replaced by columnar epithelium (Barrett esophagus) to better withstand the acidic
environment. Dysplasia is disordered cellular growth; hyperplasia is increased cell number;
hypertrophy is increased cell size.
Question 2 of 150
A patient with chronic hypertension develops left ventricular thickening. This is an
example of:
• A. Hyperplasia
• B. Hypertrophy
• C. Atrophy
• D. Metaplasia
Correct Answer: B – Hypertrophy
Rationale: Hypertrophy is an increase in cell size, leading to organ enlargement. Cardiac
myocytes cannot divide (they are terminally differentiated), so they respond to increased
workload (chronic hypertension) by increasing in size (hypertrophy).
Question 3 of 150
Which of the following is a characteristic of irreversible cell injury?
• A. Cellular swelling
• B. Fatty change
• C. Nuclear pyknosis
• D. Loss of microvilli
,Correct Answer: C – Nuclear pyknosis
Rationale: Irreversible cell injury is marked by nuclear changes: pyknosis (nuclear
shrinkage and condensation), karyorrhexis (fragmentation), and karyolysis (dissolution).
Cellular swelling, fatty change, and loss of microvilli are reversible changes.
Question 4 of 150
A patient with a myocardial infarction (MI) develops coagulation necrosis. Which of the
following describes the microscopic appearance of coagulation necrosis?
• A. Tissue becomes soft and liquefied
• B. Tissue architecture is preserved but cells are anucleate
• C. Cheese-like appearance with calcium deposition
• D. Fat saponification with chalky white areas
Correct Answer: B – Tissue architecture is preserved but cells are anucleate
Rationale: Coagulation necrosis (common in MI, kidney, liver) preserves tissue architecture
for days because proteases are denatured by ischemia. Cells become anucleate with
preserved cell outlines. Liquefactive necrosis occurs in brain. Caseous necrosis occurs in TB.
Fat necrosis occurs in pancreatitis.
Question 5 of 150
A patient with a stroke develops liquefactive necrosis in the brain. Which of the
following is the mechanism of this type of necrosis?
• A. Ischemia with preservation of tissue architecture
• B. Release of lysosomal enzymes causing tissue digestion
, • C. Deposition of calcium in dead tissue
• D. Formation of a cheese-like granuloma
Correct Answer: B – Release of lysosomal enzymes causing tissue digestion
Rationale: In liquefactive necrosis (brain, spinal cord), dead tissue is digested by lysosomal
enzymes from neutrophils and microglia, forming a liquid viscous mass. Tissue
architecture is not preserved.
Question 6 of 150
A patient with tuberculosis develops caseous necrosis in a lung granuloma. Which of the
following describes the gross appearance of caseous necrosis?
• A. Liquid, creamy material
• B. Firm, pink tissue
• C. Soft, yellow-white, cheese-like material
• D. Hard, calcified tissue
Correct Answer: C – Soft, yellow-white, cheese-like material
Rationale: Caseous necrosis (TB, fungal infections) has a soft, friable, yellow-white, cheese-
like appearance. It is a combination of coagulation necrosis and granulomatous
inflammation.
Question 7 of 150
A patient with acute pancreatitis develops fat necrosis in the abdomen. Which
laboratory finding is most likely?
