HCR 240 Final Exam Actual Questions and Answers: A Complete Practice Test Bank with Detailed
Rationales for Every Question to Help You Pass Pathophysiology and Earn Your A+ Grade on the
First Attempt.
Questions 1–150 with Multiple Answers & Detailed Rationales
Cellular Adaptation, Injury, and Neoplasia (Questions 1–20)
1. 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 increases blood volume and capillary hydrostatic pressure,
forcing fluid into interstitial spaces (edema). Decreased hydrostatic pressure (a) would reduce edema.
Increased plasma proteins (b) would pull fluid into vessels. Increased lymphatic flow (c) would drain
fluid, not cause swelling.
2. A patient had a heart attack leading to progressive cell injury 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), featuring cell swelling,
organelle breakdown, and inflammation. Apoptosis (a) is programmed, neat, and non-inflammatory.
Autophagy (b) is lysosomal recycling. Metaplasia (c) is reversible cell type change.
3. Which term describes reduction in cell size due to decreased workload or stimulus?
a) Hypertrophy
b) Hyperplasia
c) Dysplasia
d) Atrophy
Answer: d
Rationale: Atrophy is decreased cell size from disuse, denervation, ischemia, or hormonal loss.
Hypertrophy (a) is increased cell size. Hyperplasia (b) is increased cell number. Dysplasia (c) is
abnormal cell growth.
4. 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 metastasis. Benign tumors (a) are well-differentiated. Well-differentiated (b) would be low
grade. Anaplastic tumors have high metastasis risk (d false).
5. 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 squamous epithelium with columnar epithelium due to
acid reflux—a protective metaplastic change. Hyperplasia (a) is increased number. Dysplasia (c) is
disordered growth. Anaplasia (d) is malignancy.
6. 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, kidney) is reversible if the insult is removed.
All necrosis types (a, c, d) are irreversible.
7. A 70-year-old has an enlarged prostate. Under microscope, there are increased numbers of
normal-appearing glandular cells. This is:
a) Hypertrophy
b) Hyperplasia
c) Metaplasia
d) Dysplasia
Answer: b
Rationale: Benign prostatic hyperplasia is increased number of normal cells. Hypertrophy (a) is cell size
increase. Metaplasia (c) is cell type change. Dysplasia (d) is abnormal cells.
8. 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.
,9. A 30-year-old female has a breast lump that is mobile, smooth, and non-invasive. Most likely:
a) Fibroadenoma (benign)
b) Invasive ductal carcinoma
c) Inflammatory breast cancer
d) Paget disease
Answer: a
Rationale: Fibroadenoma is a benign breast tumor, mobile, smooth, and non-invasive. Malignant
tumors (b, c, d) are often fixed, irregular, and invasive.
10. 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 (causes cancer by integrating into host DNA). Oncogenes (b)
are mutated proto-oncogenes (d). Tumor suppressor genes (a) are inactivated in cancer.
11. 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).
12. 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.
13. 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 (often from smoking) shows keratin pearls and intercellular
bridges. Small cell (a) has small round cells. Adenocarcinoma (c) has glands. Large cell (d) has large
anaplastic cells.
, 14. 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. Oncosis (d) is pre-necrotic swelling.
15. 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.
16. A 40-year-old has cervical dysplasia on Pap smear. This means:
a) Invasive cancer present
b) Reversible abnormal cell growth
c) Metastasis has occurred
d) Benign tumor
Answer: b
Rationale: Dysplasia is disordered but potentially reversible cell growth (pre-cancerous). Invasive
cancer (a) would show invasion. Dysplasia is not metastatic (c) nor benign tumor (d).
17. 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.
18. 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
Rationale: Caseous necrosis (cheese-like) is characteristic of tuberculosis. Brain infarcts (a) show
liquefactive necrosis. Fat necrosis (c) from pancreatitis. Gangrene (d) from limb ischemia.
19. A 55-year-old has chronic heartburn. Long-term acid exposure can lead to which esophageal
change?
Rationales for Every Question to Help You Pass Pathophysiology and Earn Your A+ Grade on the
First Attempt.
Questions 1–150 with Multiple Answers & Detailed Rationales
Cellular Adaptation, Injury, and Neoplasia (Questions 1–20)
1. 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 increases blood volume and capillary hydrostatic pressure,
forcing fluid into interstitial spaces (edema). Decreased hydrostatic pressure (a) would reduce edema.
Increased plasma proteins (b) would pull fluid into vessels. Increased lymphatic flow (c) would drain
fluid, not cause swelling.
2. A patient had a heart attack leading to progressive cell injury 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), featuring cell swelling,
organelle breakdown, and inflammation. Apoptosis (a) is programmed, neat, and non-inflammatory.
Autophagy (b) is lysosomal recycling. Metaplasia (c) is reversible cell type change.
3. Which term describes reduction in cell size due to decreased workload or stimulus?
a) Hypertrophy
b) Hyperplasia
c) Dysplasia
d) Atrophy
Answer: d
Rationale: Atrophy is decreased cell size from disuse, denervation, ischemia, or hormonal loss.
Hypertrophy (a) is increased cell size. Hyperplasia (b) is increased cell number. Dysplasia (c) is
abnormal cell growth.
4. 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 metastasis. Benign tumors (a) are well-differentiated. Well-differentiated (b) would be low
grade. Anaplastic tumors have high metastasis risk (d false).
5. 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 squamous epithelium with columnar epithelium due to
acid reflux—a protective metaplastic change. Hyperplasia (a) is increased number. Dysplasia (c) is
disordered growth. Anaplasia (d) is malignancy.
6. 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, kidney) is reversible if the insult is removed.
All necrosis types (a, c, d) are irreversible.
7. A 70-year-old has an enlarged prostate. Under microscope, there are increased numbers of
normal-appearing glandular cells. This is:
a) Hypertrophy
b) Hyperplasia
c) Metaplasia
d) Dysplasia
Answer: b
Rationale: Benign prostatic hyperplasia is increased number of normal cells. Hypertrophy (a) is cell size
increase. Metaplasia (c) is cell type change. Dysplasia (d) is abnormal cells.
8. 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.
,9. A 30-year-old female has a breast lump that is mobile, smooth, and non-invasive. Most likely:
a) Fibroadenoma (benign)
b) Invasive ductal carcinoma
c) Inflammatory breast cancer
d) Paget disease
Answer: a
Rationale: Fibroadenoma is a benign breast tumor, mobile, smooth, and non-invasive. Malignant
tumors (b, c, d) are often fixed, irregular, and invasive.
10. 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 (causes cancer by integrating into host DNA). Oncogenes (b)
are mutated proto-oncogenes (d). Tumor suppressor genes (a) are inactivated in cancer.
11. 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).
12. 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.
13. 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 (often from smoking) shows keratin pearls and intercellular
bridges. Small cell (a) has small round cells. Adenocarcinoma (c) has glands. Large cell (d) has large
anaplastic cells.
, 14. 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. Oncosis (d) is pre-necrotic swelling.
15. 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.
16. A 40-year-old has cervical dysplasia on Pap smear. This means:
a) Invasive cancer present
b) Reversible abnormal cell growth
c) Metastasis has occurred
d) Benign tumor
Answer: b
Rationale: Dysplasia is disordered but potentially reversible cell growth (pre-cancerous). Invasive
cancer (a) would show invasion. Dysplasia is not metastatic (c) nor benign tumor (d).
17. 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.
18. 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
Rationale: Caseous necrosis (cheese-like) is characteristic of tuberculosis. Brain infarcts (a) show
liquefactive necrosis. Fat necrosis (c) from pancreatitis. Gangrene (d) from limb ischemia.
19. A 55-year-old has chronic heartburn. Long-term acid exposure can lead to which esophageal
change?
