HCR 240 Pathophysiology Final Exam: Complete Practice Question Bank with Actual Questions and
Detailed Rationales for Every Answer — Your A+ Study Guide.
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: Swelling (edema) occurs when fluid moves from the vascular space into the interstitium.
Sodium and water retention expands blood volume, increasing capillary hydrostatic pressure, which
forces fluid out. Decreased hydrostatic pressure (A) would reduce edema. Increased plasma proteins
(B) raise oncotic pressure, pulling fluid into vessels. Increased lymphatic flow (C) would help remove
interstitial 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 from a heart attack). It is
characterized by cell swelling, organelle breakdown, membrane rupture, and inflammation. Apoptosis
(A) is programmed, neat, and does not cause inflammation. Autophagy (B) is a lysosomal recycling
process. Metaplasia (C) is a reversible change from one cell type to another.
3. 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 a decrease in cell size and function due to reduced workload, denervation,
,ischemia, or hormonal loss. Hypertrophy (A) is an increase in cell size. Hyperplasia (B) is an increase in
cell number. Dysplasia (C) is abnormal cell growth (size, shape, organization).
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 (lack of differentiation) is a hallmark of malignancy. Anaplastic cells are primitive,
lack specialized structures, and often have large, hyperchromatic nuclei. This indicates high malignant
potential, rapid growth, and a high risk of metastasis. Benign tumors (A) are well-differentiated. Well-
differentiated cells (B) indicate low-grade malignancy. Anaplastic tumors have a 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 a classic example of metaplasia: the normal stratified squamous
epithelium of the lower esophagus is replaced by metaplastic columnar epithelium (similar to gastric
or intestinal mucosa) as an adaptive response to chronic acid reflux. This change can predispose to
adenocarcinoma. Hyperplasia (A) is increased cell number. Dysplasia (C) is disordered growth.
Anaplasia (D) is severe loss of differentiation in cancer.
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 (steatosis) is an accumulation of lipid droplets in the cytoplasm, typically in the
liver, heart, or kidney. It is reversible if the injurious agent (e.g., alcohol, hypoxia, toxins) is removed.
Coagulative necrosis (A), caseous necrosis (C), and gangrenous necrosis (D) are irreversible forms of
cell death.
7. 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 an increase in the number of normal-appearing
glandular and stromal cells, leading to prostate enlargement. Hypertrophy (A) is an increase in cell size.
Metaplasia (C) is a change in cell type. Dysplasia (D) is abnormal cell growth (not seen in BPH).
8. Which of the following best differentiates benign from malignant tumors?
A) Size of the tumor
B) Rate of growth
C) Metastasis
D) Pain on palpation
Answer: C
Rationale: Metastasis (spread to distant sites via blood or lymph) is the definitive feature that
distinguishes malignant from benign tumors. Benign tumors may grow rapidly (B) or become very
large (A), but they remain localized and do not metastasize. Pain (D) is not a reliable differentiator.
9. 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 the most common benign breast tumor in young women. It is typically
mobile, smooth, well-circumscribed, and non-invasive. Malignant tumors (B, C, D) are more likely to be
fixed, irregular, poorly defined, 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: Hepatitis B virus (HBV) is a biological carcinogen. It causes chronic inflammation and
integrates its DNA into the host genome, leading to mutations and hepatocellular carcinoma. Tumor
suppressors (A) are genes that prevent cancer (e.g., p53). Oncogenes (B) are mutated forms of proto-
oncogenes (D) that drive 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: they lose differentiation (specialized structure and function).
, They also lose cohesiveness (A), lack contact inhibition (B), and have high (not slow) mitotic rates (D).
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 gene that encodes a protein regulating cell cycle arrest,
DNA repair, and apoptosis. It is mutated in over 50% of human cancers. RAS (A), MYC (B), and SRC (D)
are proto-oncogenes; when mutated, they become 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 of the lung (strongly associated with smoking) characteristically
shows keratin pearls (whorls of squamous cells) and intercellular bridges. Small cell carcinoma (A) has
small, round cells with scant cytoplasm. Adenocarcinoma (C) shows glandular differentiation. Large cell
carcinoma (D) has large anaplastic cells without keratin or gland formation.
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, tightly regulated programmed cell death. It is characterized
by cell shrinkage, nuclear fragmentation, and formation of apoptotic bodies that are phagocytosed
without eliciting inflammation. Necrosis (A) and oncosis (D) cause inflammation. Pyroptosis (B) is a
pro-inflammatory form of programmed cell death (caspase-1 mediated).
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. Germline mutations significantly increase the risk
of breast cancer (up to 80% lifetime risk) and ovarian cancer (up to 40% lifetime risk). They also
increase risk for pancreatic cancer and, in men, prostate cancer, but breast and ovarian are the most
prominent.
Detailed Rationales for Every Answer — Your A+ Study Guide.
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: Swelling (edema) occurs when fluid moves from the vascular space into the interstitium.
Sodium and water retention expands blood volume, increasing capillary hydrostatic pressure, which
forces fluid out. Decreased hydrostatic pressure (A) would reduce edema. Increased plasma proteins
(B) raise oncotic pressure, pulling fluid into vessels. Increased lymphatic flow (C) would help remove
interstitial 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 from a heart attack). It is
characterized by cell swelling, organelle breakdown, membrane rupture, and inflammation. Apoptosis
(A) is programmed, neat, and does not cause inflammation. Autophagy (B) is a lysosomal recycling
process. Metaplasia (C) is a reversible change from one cell type to another.
3. 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 a decrease in cell size and function due to reduced workload, denervation,
,ischemia, or hormonal loss. Hypertrophy (A) is an increase in cell size. Hyperplasia (B) is an increase in
cell number. Dysplasia (C) is abnormal cell growth (size, shape, organization).
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 (lack of differentiation) is a hallmark of malignancy. Anaplastic cells are primitive,
lack specialized structures, and often have large, hyperchromatic nuclei. This indicates high malignant
potential, rapid growth, and a high risk of metastasis. Benign tumors (A) are well-differentiated. Well-
differentiated cells (B) indicate low-grade malignancy. Anaplastic tumors have a 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 a classic example of metaplasia: the normal stratified squamous
epithelium of the lower esophagus is replaced by metaplastic columnar epithelium (similar to gastric
or intestinal mucosa) as an adaptive response to chronic acid reflux. This change can predispose to
adenocarcinoma. Hyperplasia (A) is increased cell number. Dysplasia (C) is disordered growth.
Anaplasia (D) is severe loss of differentiation in cancer.
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 (steatosis) is an accumulation of lipid droplets in the cytoplasm, typically in the
liver, heart, or kidney. It is reversible if the injurious agent (e.g., alcohol, hypoxia, toxins) is removed.
Coagulative necrosis (A), caseous necrosis (C), and gangrenous necrosis (D) are irreversible forms of
cell death.
7. 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 an increase in the number of normal-appearing
glandular and stromal cells, leading to prostate enlargement. Hypertrophy (A) is an increase in cell size.
Metaplasia (C) is a change in cell type. Dysplasia (D) is abnormal cell growth (not seen in BPH).
8. Which of the following best differentiates benign from malignant tumors?
A) Size of the tumor
B) Rate of growth
C) Metastasis
D) Pain on palpation
Answer: C
Rationale: Metastasis (spread to distant sites via blood or lymph) is the definitive feature that
distinguishes malignant from benign tumors. Benign tumors may grow rapidly (B) or become very
large (A), but they remain localized and do not metastasize. Pain (D) is not a reliable differentiator.
9. 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 the most common benign breast tumor in young women. It is typically
mobile, smooth, well-circumscribed, and non-invasive. Malignant tumors (B, C, D) are more likely to be
fixed, irregular, poorly defined, 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: Hepatitis B virus (HBV) is a biological carcinogen. It causes chronic inflammation and
integrates its DNA into the host genome, leading to mutations and hepatocellular carcinoma. Tumor
suppressors (A) are genes that prevent cancer (e.g., p53). Oncogenes (B) are mutated forms of proto-
oncogenes (D) that drive 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: they lose differentiation (specialized structure and function).
, They also lose cohesiveness (A), lack contact inhibition (B), and have high (not slow) mitotic rates (D).
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 gene that encodes a protein regulating cell cycle arrest,
DNA repair, and apoptosis. It is mutated in over 50% of human cancers. RAS (A), MYC (B), and SRC (D)
are proto-oncogenes; when mutated, they become 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 of the lung (strongly associated with smoking) characteristically
shows keratin pearls (whorls of squamous cells) and intercellular bridges. Small cell carcinoma (A) has
small, round cells with scant cytoplasm. Adenocarcinoma (C) shows glandular differentiation. Large cell
carcinoma (D) has large anaplastic cells without keratin or gland formation.
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, tightly regulated programmed cell death. It is characterized
by cell shrinkage, nuclear fragmentation, and formation of apoptotic bodies that are phagocytosed
without eliciting inflammation. Necrosis (A) and oncosis (D) cause inflammation. Pyroptosis (B) is a
pro-inflammatory form of programmed cell death (caspase-1 mediated).
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. Germline mutations significantly increase the risk
of breast cancer (up to 80% lifetime risk) and ovarian cancer (up to 40% lifetime risk). They also
increase risk for pancreatic cancer and, in men, prostate cancer, but breast and ovarian are the most
prominent.
