HCR 240 Pathophysiology Final Exam: Actual Questions and Answers with Detailed Rationales for
Every Question — The Complete Practice Test Bank to Help You Pass and Earn Your A+ Grade.
Questions 1–150 with Multiple Answers & Detailed Rationales
Section 1: Cellular Adaptation, Injury, and Neoplasia (Q1–20)
Q1. A 55-year-old male has swelling of the feet. Which of the following aided in the development of
swelling?
A) Decreased capillary hydrostatic pressure
B) Increased plasma proteins
C) Increased lymphatic flow
D) Sodium and water retention
Answer: D
Rationale: Sodium and water retention expands blood volume, increasing capillary hydrostatic
pressure, which forces fluid into interstitial spaces (edema). Decreased hydrostatic pressure (A) reduces
edema. Increased plasma proteins (B) increase oncotic pressure, pulling fluid into vessels. Increased
lymphatic flow (C) would drain edema, not cause it.
Q2. A patient has a heart attack that leads to progressive cell injury causing cell death with severe
cell swelling and breakdown of organelles. What term defines this process?
A) Apoptosis
B) Autophagy
C) Metaplasia
D) Necrosis
Answer: D
Rationale: Necrosis is pathological cell death caused by injury (e.g., ischemia), characterized by cell
swelling, organelle breakdown, and inflammation. Apoptosis (A) is programmed, neat, and non-
inflammatory. Autophagy (B) is lysosomal recycling of damaged components. Metaplasia (C) is a
reversible change from one cell type to another.
Q3. Which term describes the reduction in cell size as a result of decreased workload or stimulus?
A) Hypertrophy
B) Hyperplasia
C) Dysplasia
D) Atrophy
Answer: D
Rationale: Atrophy is decreased cell size caused by disuse, denervation, ischemia, or hormonal loss.
Hypertrophy (A) is increased cell size. Hyperplasia (B) is increased cell number. Dysplasia (C) is
abnormal cell growth.
,Q4. A 60-year-old smoker has a lung mass. Biopsy shows anaplasia. What does this indicate?
A) Benign tumor
B) Well-differentiated cells
C) Malignant potential
D) No metastasis risk
Answer: C
Rationale: Anaplasia means lack of differentiation, a hallmark of malignancy, associated with rapid
growth and high metastatic potential. Benign tumors (A) are well-differentiated. Well-differentiated
cells (B) indicate low-grade malignancy, not anaplasia. Anaplastic tumors have high metastasis risk (D
false).
Q5. A 45-year-old with chronic GERD has Barrett esophagus. This is an example of:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Answer: B
Rationale: Barrett esophagus is replacement of normal squamous epithelium with metaplastic
columnar epithelium due to chronic acid reflux — a protective metaplastic change. Hyperplasia (A) is
increased cell number. Dysplasia (C) is disordered growth. Anaplasia (D) is malignancy.
Q6. Which of the following is a reversible cell injury?
A) Coagulative necrosis
B) Fatty change (steatosis)
C) Caseous necrosis
D) Gangrenous necrosis
Answer: B
Rationale: Fatty change (lipid accumulation in liver, heart, or kidney) is reversible if the insult is
removed. All necrosis types (A, C, D) are irreversible.
Q7. A 70-year-old has an enlarged prostate. Microscopy shows increased numbers of normal-
appearing glandular cells. This is:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: B
Rationale: Benign prostatic hyperplasia (BPH) is increased number of normal cells. Hypertrophy (A) is
cell size increase. Metaplasia (C) is cell type change. Dysplasia (D) is abnormal cells.
Q8. Which of the following best differentiates benign from malignant tumors?
A) Size of tumor
B) Rate of growth
C) Metastasis
D) Pain on palpation
Answer: C
,Rationale: Only malignant tumors metastasize (spread to distant sites). Benign tumors may grow
rapidly (B) or be large (A), but they remain localized. Pain (D) is not reliable.
Q9. A 30-year-old female has a breast lump that is mobile, smooth, and non-invasive. Most likely
diagnosis:
A) Fibroadenoma (benign)
B) Invasive ductal carcinoma
C) Inflammatory breast cancer
D) Paget disease of the breast
Answer: A
Rationale: Fibroadenoma is a benign breast tumor that is mobile, smooth, and non-invasive.
Malignant tumors (B, C, D) are often fixed, irregular, and invasive.
Q10. A patient with chronic hepatitis B develops liver cancer. The hepatitis B virus is a(n):
A) Tumor suppressor gene
B) Oncogene
C) Carcinogen
D) Proto-oncogene
Answer: C
Rationale: HBV is a biological carcinogen — it causes cancer by integrating into host DNA. Oncogenes
(B) are mutated proto-oncogenes (D). Tumor suppressor genes (A) are inactivated in cancer.
Q11. Which of the following is a characteristic of malignant cells?
A) Cohesive adherence
B) Contact inhibition
C) Loss of differentiation
D) Slow mitotic rate
Answer: C
Rationale: Malignant cells are anaplastic (loss of differentiation). They lack cohesiveness (A), lack
contact inhibition (B), and have high mitotic rates (D false).
Q12. A tumor suppressor gene that is mutated in many cancers is:
A) RAS
B) MYC
C) TP53
D) SRC
Answer: C
Rationale: TP53 (p53) is a tumor suppressor; mutations allow damaged cells to survive and proliferate.
RAS (A), MYC (B), and SRC (D) are proto-oncogenes.
Q13. A 65-year-old smoker has a lung mass with keratin pearls on biopsy. This is most likely:
A) Small cell carcinoma
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Large cell carcinoma
Answer: B
Rationale: Squamous cell carcinoma (strongly linked to smoking) shows keratin pearls and intercellular
, bridges. Small cell (A) has small round cells with scant cytoplasm. Adenocarcinoma (C) has gland
formation. Large cell (D) has large anaplastic cells.
Q14. Which term refers to programmed cell death without inflammation?
A) Necrosis
B) Pyroptosis
C) Apoptosis
D) Oncosis
Answer: C
Rationale: Apoptosis is energy-dependent, neat, and non-inflammatory. Necrosis (A) causes
inflammation. Pyroptosis (B) is inflammatory programmed death (caspase-1 mediated). Oncosis (D) is
pre-necrotic swelling.
Q15. A 50-year-old with BRCA1 mutation has high risk for:
A) Lung cancer
B) Colon cancer
C) Breast and ovarian cancer
D) Prostate cancer
Answer: C
Rationale: BRCA1 and BRCA2 are DNA repair genes; mutations increase risk for breast, ovarian, and
pancreatic cancers — not primarily lung (A), colon (B), or prostate (D) alone.
Q16. A 40-year-old has cervical dysplasia on Pap smear. This means:
A) Invasive cancer is present
B) Reversible abnormal cell growth
C) Metastasis has occurred
D) Benign tumor is present
Answer: B
Rationale: Dysplasia is disordered but potentially reversible cell growth (pre-cancerous). Invasive
cancer (A) would show invasion beyond basement membrane. Dysplasia is not metastatic (C) nor a
benign tumor (D).
Q17. Which of the following is a systemic effect of cancer?
A) Cachexia
B) Pain at primary site
C) Local swelling
D) Palpable mass
Answer: A
Rationale: Cachexia (weight loss, muscle wasting, anorexia) is a paraneoplastic systemic effect. Pain (B),
swelling (C), and mass (D) are local effects.
Q18. Which of the following best describes caseous necrosis?
A) Seen in brain infarcts
B) Associated with tuberculosis
C) Caused by fat digestion
D) Results from ischemia of limbs
Answer: B
Every Question — The Complete Practice Test Bank to Help You Pass and Earn Your A+ Grade.
Questions 1–150 with Multiple Answers & Detailed Rationales
Section 1: Cellular Adaptation, Injury, and Neoplasia (Q1–20)
Q1. A 55-year-old male has swelling of the feet. Which of the following aided in the development of
swelling?
A) Decreased capillary hydrostatic pressure
B) Increased plasma proteins
C) Increased lymphatic flow
D) Sodium and water retention
Answer: D
Rationale: Sodium and water retention expands blood volume, increasing capillary hydrostatic
pressure, which forces fluid into interstitial spaces (edema). Decreased hydrostatic pressure (A) reduces
edema. Increased plasma proteins (B) increase oncotic pressure, pulling fluid into vessels. Increased
lymphatic flow (C) would drain edema, not cause it.
Q2. A patient has a heart attack that leads to progressive cell injury causing cell death with severe
cell swelling and breakdown of organelles. What term defines this process?
A) Apoptosis
B) Autophagy
C) Metaplasia
D) Necrosis
Answer: D
Rationale: Necrosis is pathological cell death caused by injury (e.g., ischemia), characterized by cell
swelling, organelle breakdown, and inflammation. Apoptosis (A) is programmed, neat, and non-
inflammatory. Autophagy (B) is lysosomal recycling of damaged components. Metaplasia (C) is a
reversible change from one cell type to another.
Q3. Which term describes the reduction in cell size as a result of decreased workload or stimulus?
A) Hypertrophy
B) Hyperplasia
C) Dysplasia
D) Atrophy
Answer: D
Rationale: Atrophy is decreased cell size caused by disuse, denervation, ischemia, or hormonal loss.
Hypertrophy (A) is increased cell size. Hyperplasia (B) is increased cell number. Dysplasia (C) is
abnormal cell growth.
,Q4. A 60-year-old smoker has a lung mass. Biopsy shows anaplasia. What does this indicate?
A) Benign tumor
B) Well-differentiated cells
C) Malignant potential
D) No metastasis risk
Answer: C
Rationale: Anaplasia means lack of differentiation, a hallmark of malignancy, associated with rapid
growth and high metastatic potential. Benign tumors (A) are well-differentiated. Well-differentiated
cells (B) indicate low-grade malignancy, not anaplasia. Anaplastic tumors have high metastasis risk (D
false).
Q5. A 45-year-old with chronic GERD has Barrett esophagus. This is an example of:
A) Hyperplasia
B) Metaplasia
C) Dysplasia
D) Anaplasia
Answer: B
Rationale: Barrett esophagus is replacement of normal squamous epithelium with metaplastic
columnar epithelium due to chronic acid reflux — a protective metaplastic change. Hyperplasia (A) is
increased cell number. Dysplasia (C) is disordered growth. Anaplasia (D) is malignancy.
Q6. Which of the following is a reversible cell injury?
A) Coagulative necrosis
B) Fatty change (steatosis)
C) Caseous necrosis
D) Gangrenous necrosis
Answer: B
Rationale: Fatty change (lipid accumulation in liver, heart, or kidney) is reversible if the insult is
removed. All necrosis types (A, C, D) are irreversible.
Q7. A 70-year-old has an enlarged prostate. Microscopy shows increased numbers of normal-
appearing glandular cells. This is:
A) Hypertrophy
B) Hyperplasia
C) Metaplasia
D) Dysplasia
Answer: B
Rationale: Benign prostatic hyperplasia (BPH) is increased number of normal cells. Hypertrophy (A) is
cell size increase. Metaplasia (C) is cell type change. Dysplasia (D) is abnormal cells.
Q8. Which of the following best differentiates benign from malignant tumors?
A) Size of tumor
B) Rate of growth
C) Metastasis
D) Pain on palpation
Answer: C
,Rationale: Only malignant tumors metastasize (spread to distant sites). Benign tumors may grow
rapidly (B) or be large (A), but they remain localized. Pain (D) is not reliable.
Q9. A 30-year-old female has a breast lump that is mobile, smooth, and non-invasive. Most likely
diagnosis:
A) Fibroadenoma (benign)
B) Invasive ductal carcinoma
C) Inflammatory breast cancer
D) Paget disease of the breast
Answer: A
Rationale: Fibroadenoma is a benign breast tumor that is mobile, smooth, and non-invasive.
Malignant tumors (B, C, D) are often fixed, irregular, and invasive.
Q10. A patient with chronic hepatitis B develops liver cancer. The hepatitis B virus is a(n):
A) Tumor suppressor gene
B) Oncogene
C) Carcinogen
D) Proto-oncogene
Answer: C
Rationale: HBV is a biological carcinogen — it causes cancer by integrating into host DNA. Oncogenes
(B) are mutated proto-oncogenes (D). Tumor suppressor genes (A) are inactivated in cancer.
Q11. Which of the following is a characteristic of malignant cells?
A) Cohesive adherence
B) Contact inhibition
C) Loss of differentiation
D) Slow mitotic rate
Answer: C
Rationale: Malignant cells are anaplastic (loss of differentiation). They lack cohesiveness (A), lack
contact inhibition (B), and have high mitotic rates (D false).
Q12. A tumor suppressor gene that is mutated in many cancers is:
A) RAS
B) MYC
C) TP53
D) SRC
Answer: C
Rationale: TP53 (p53) is a tumor suppressor; mutations allow damaged cells to survive and proliferate.
RAS (A), MYC (B), and SRC (D) are proto-oncogenes.
Q13. A 65-year-old smoker has a lung mass with keratin pearls on biopsy. This is most likely:
A) Small cell carcinoma
B) Squamous cell carcinoma
C) Adenocarcinoma
D) Large cell carcinoma
Answer: B
Rationale: Squamous cell carcinoma (strongly linked to smoking) shows keratin pearls and intercellular
, bridges. Small cell (A) has small round cells with scant cytoplasm. Adenocarcinoma (C) has gland
formation. Large cell (D) has large anaplastic cells.
Q14. Which term refers to programmed cell death without inflammation?
A) Necrosis
B) Pyroptosis
C) Apoptosis
D) Oncosis
Answer: C
Rationale: Apoptosis is energy-dependent, neat, and non-inflammatory. Necrosis (A) causes
inflammation. Pyroptosis (B) is inflammatory programmed death (caspase-1 mediated). Oncosis (D) is
pre-necrotic swelling.
Q15. A 50-year-old with BRCA1 mutation has high risk for:
A) Lung cancer
B) Colon cancer
C) Breast and ovarian cancer
D) Prostate cancer
Answer: C
Rationale: BRCA1 and BRCA2 are DNA repair genes; mutations increase risk for breast, ovarian, and
pancreatic cancers — not primarily lung (A), colon (B), or prostate (D) alone.
Q16. A 40-year-old has cervical dysplasia on Pap smear. This means:
A) Invasive cancer is present
B) Reversible abnormal cell growth
C) Metastasis has occurred
D) Benign tumor is present
Answer: B
Rationale: Dysplasia is disordered but potentially reversible cell growth (pre-cancerous). Invasive
cancer (A) would show invasion beyond basement membrane. Dysplasia is not metastatic (C) nor a
benign tumor (D).
Q17. Which of the following is a systemic effect of cancer?
A) Cachexia
B) Pain at primary site
C) Local swelling
D) Palpable mass
Answer: A
Rationale: Cachexia (weight loss, muscle wasting, anorexia) is a paraneoplastic systemic effect. Pain (B),
swelling (C), and mass (D) are local effects.
Q18. Which of the following best describes caseous necrosis?
A) Seen in brain infarcts
B) Associated with tuberculosis
C) Caused by fat digestion
D) Results from ischemia of limbs
Answer: B
