NURS 611: Advanced Pathophysiology - Cellular Injury & Adaptation
2026 |Maryville
1. A 55-year-old male smoker undergoes a biopsy of his bronchial epithelium.
The pathology report indicates that the normal ciliated columnar epithelium has
been replaced by stratified squamous epithelium. This is an example of:
A. Hyperplasia
B. Dysplasia
C. Atrophy
D. Metaplasia
Answer: D
Rationale: Metaplasia is the reversible replacement of one mature cell type by another,
often as an adaptation to chronic irritation or inflammation.
2. What is the primary mechanism of cellular swelling during hypoxic injury?
A. Increased intracellular potassium levels
B. Failure of the Na+/K+ ATPase pump
C. Decrease in osmotic pressure within the cell
D. Activation of protein kinase C
Answer: B
Rationale: Hypoxia leads to ATP depletion, which causes the failure of the sodium-
potassium pump. This results in sodium moving into the cell, followed by water, causing
oncosis (swelling).
,3. Which of the following describes ‘dysplasia’?
A. A decrease in cell size
B. The replacement of one cell type with another
C. Abnormal changes in the size, shape, and organization of mature cells
D. An increase in the number of cells in an organ
Answer: C
Rationale: Dysplasia, often called atypical hyperplasia, refers to abnormal changes in cell
morphology and is frequently a precursor to cancer.
4. During reperfusion injury, the restoration of oxygen can lead to further
damage due to the formation of:
A. Lactic acid
B. Pyruvate
C. Reactive oxygen species (ROS)
D. Magnesium ions
Answer: C
Rationale: Reperfusion injury occurs when oxygen is restored to ischemic tissues, leading
to the burst of free radicals (ROS) that cause membrane damage and calcium overload.
5. Caseous necrosis is most commonly associated with which of the following
infections?
A. Staphylococcus aureus
B. Mycobacterium tuberculosis
C. Escherichia coli
D. Clostridium perfringens
Answer: B
Rationale: Caseous necrosis, which looks like ‘clumped cheese,’ is a combination of
coagulative and liquefactive necrosis characteristic of tuberculosis.
, 6. In the process of apoptosis, what role do caspases play?
A. They inhibit cell death by stabilizing the mitochondria
B. They prevent DNA fragmentation
C. They increase the production of ATP
D. They are enzymes that initiate and execute cellular self-destruction
Answer: D
Rationale: Caspases are proteases that are activated in a cascade to dismantle the cell’s
components during apoptosis.
7. Which type of necrosis is typically found in the brain following ischemic
injury?
A. Coagulative necrosis
B. Fat necrosis
C. Liquefactive necrosis
D. Fibrinoid necrosis
Answer: C
Rationale: Liquefactive necrosis occurs in the brain because brain cells are rich in
digestive hydrolytic enzymes and lipids.
8. A patient with chronic hypertension develops a thickened left ventricular
wall. This cellular adaptation is known as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Hypertrophy
Answer: D
Rationale: Hypertrophy is an increase in the size of cells (not number), common in
myocardial cells in response to increased workload.
2026 |Maryville
1. A 55-year-old male smoker undergoes a biopsy of his bronchial epithelium.
The pathology report indicates that the normal ciliated columnar epithelium has
been replaced by stratified squamous epithelium. This is an example of:
A. Hyperplasia
B. Dysplasia
C. Atrophy
D. Metaplasia
Answer: D
Rationale: Metaplasia is the reversible replacement of one mature cell type by another,
often as an adaptation to chronic irritation or inflammation.
2. What is the primary mechanism of cellular swelling during hypoxic injury?
A. Increased intracellular potassium levels
B. Failure of the Na+/K+ ATPase pump
C. Decrease in osmotic pressure within the cell
D. Activation of protein kinase C
Answer: B
Rationale: Hypoxia leads to ATP depletion, which causes the failure of the sodium-
potassium pump. This results in sodium moving into the cell, followed by water, causing
oncosis (swelling).
,3. Which of the following describes ‘dysplasia’?
A. A decrease in cell size
B. The replacement of one cell type with another
C. Abnormal changes in the size, shape, and organization of mature cells
D. An increase in the number of cells in an organ
Answer: C
Rationale: Dysplasia, often called atypical hyperplasia, refers to abnormal changes in cell
morphology and is frequently a precursor to cancer.
4. During reperfusion injury, the restoration of oxygen can lead to further
damage due to the formation of:
A. Lactic acid
B. Pyruvate
C. Reactive oxygen species (ROS)
D. Magnesium ions
Answer: C
Rationale: Reperfusion injury occurs when oxygen is restored to ischemic tissues, leading
to the burst of free radicals (ROS) that cause membrane damage and calcium overload.
5. Caseous necrosis is most commonly associated with which of the following
infections?
A. Staphylococcus aureus
B. Mycobacterium tuberculosis
C. Escherichia coli
D. Clostridium perfringens
Answer: B
Rationale: Caseous necrosis, which looks like ‘clumped cheese,’ is a combination of
coagulative and liquefactive necrosis characteristic of tuberculosis.
, 6. In the process of apoptosis, what role do caspases play?
A. They inhibit cell death by stabilizing the mitochondria
B. They prevent DNA fragmentation
C. They increase the production of ATP
D. They are enzymes that initiate and execute cellular self-destruction
Answer: D
Rationale: Caspases are proteases that are activated in a cascade to dismantle the cell’s
components during apoptosis.
7. Which type of necrosis is typically found in the brain following ischemic
injury?
A. Coagulative necrosis
B. Fat necrosis
C. Liquefactive necrosis
D. Fibrinoid necrosis
Answer: C
Rationale: Liquefactive necrosis occurs in the brain because brain cells are rich in
digestive hydrolytic enzymes and lipids.
8. A patient with chronic hypertension develops a thickened left ventricular
wall. This cellular adaptation is known as:
A. Hyperplasia
B. Dysplasia
C. Metaplasia
D. Hypertrophy
Answer: D
Rationale: Hypertrophy is an increase in the size of cells (not number), common in
myocardial cells in response to increased workload.
