NU606 | NU606 Advanced Pathophysiology Exam 1
Version 1 | Questions with Correct Answers and Expert
Explanation for Each Question
Section 1: Cellular Adaptation & Injury (Q1–10)
Q1. A patient with chronic alcohol use develops a small, firm liver. This is an example of:
• A. Hypertrophy
• B. Hyperplasia
• C. Atrophy
• D. Metaplasia
Expert Explanation: Chronic alcohol exposure leads to hepatocyte death and fibrosis.
The remaining cells shrink (atrophy) due to reduced demand and toxins. Atrophy =
decrease in cell size and organ size.
Q2. A post-menopausal woman develops endometrial hyperplasia. This is most likely
due to:
• A. Increased estrogen without opposing progesterone
• B. Decreased estrogen
• C. Chronic ischemia
• D. Viral infection
Expert Explanation: Unopposed estrogen (from anovulation, obesity, or HRT without
progesterone) stimulates endometrial cell division → hyperplasia. This is pathologic and
can progress to cancer.
Q3. Reperfusion injury after a myocardial infarction is primarily caused by:
• A. Continued hypoxia
, • B. Oxidative stress from reactive oxygen species
• C. Apoptosis inhibition
• D. Hypercalcemia
Expert Explanation: When oxygen returns to ischemic tissue, it triggers massive ROS
production (superoxide, hydrogen peroxide, hydroxyl radicals) that damage cell
membranes, DNA, and proteins.
Q4. Which type of necrosis is most commonly seen in the brain after a stroke?
• A. Coagulative
• B. Caseous
• C. Liquefactive
• D. Fat
Expert Explanation: Brain tissue has abundant lipids and few connective tissue fibers.
Enzymes from microglia and neutrophils liquefy dead tissue → cyst formation.
Q5. A patient with tuberculosis develops caseous necrosis in the lung. The gross
appearance of this necrosis is:
• A. Firm and pale
• B. Soft, friable, and cheese-like
• C. Oily and yellow
• D. Hard and black
Expert Explanation: Caseous necrosis (from TB, fungi) has a friable, yellow-white,
"cottage cheese" appearance due to a combination of coagulative and liquefactive
necrosis with granulomatous inflammation.
Q6. Which of the following is an example of physiologic hypertrophy?
, • A. Left ventricular thickening in hypertension
• B. Skeletal muscle enlargement in a weightlifter
• C. Uterine enlargement in fibroids
• D. Prostate enlargement in older men
Expert Explanation: Physiologic hypertrophy occurs in response to normal increased
workload (exercise, pregnancy). Pathologic hypertrophy results from disease
(hypertension, valve disease).
Q7. Metaplasia increases cancer risk because:
• A. It directly causes DNA mutations
• B. Metaplastic epithelium is often less differentiated and may undergo
dysplasia
• C. It activates oncogenes
• D. It suppresses p53
Expert Explanation: Metaplasia replaces one cell type with another (e.g., Barrett's
esophagus). While reversible, chronic irritation can lead to dysplasia (abnormal growth)
and eventually carcinoma.
Q8. Which cellular change is reversible?
• A. Karyorrhexis
• B. Fatty change (steatosis)
• C. Karyolysis
• D. Pyknosis
Expert Explanation: Fatty change (lipid vacuoles in liver cells) is reversible if the cause
(alcohol, toxins, diabetes) is removed. Pyknosis, karyorrhexis, and karyolysis are nuclear
changes indicating irreversible cell death.
, Q9. A patient with carbon monoxide poisoning presents with cherry-red skin and
confusion. The mechanism of cellular injury is:
• A. Free radical damage
• B. Hypoxia due to CO binding to hemoglobin
• C. Direct mitochondrial toxin
• D. Calcium overload
Expert Explanation: CO binds to hemoglobin with 200× greater affinity than O₂,
reducing oxygen-carrying capacity → histotoxic hypoxia despite normal PaO₂.
Q10. Dystrophic calcification is characterized by:
• A. Hypercalcemia
• B. Calcium deposition in dead or damaged tissue with normal serum calcium
• C. Calcium deposition in normal tissue
• D. Reversible injury
Expert Explanation: Dystrophic calcification occurs in atherosclerotic plaques, damaged
heart valves, or caseous lesions. Serum calcium remains normal. Metastatic calcification
occurs with hypercalcemia.
Section 2: Inflammation & Immunity (Q11–20)
Q11. Which of the following correctly orders the vascular changes in acute
inflammation?
• A. Increased permeability → vasoconstriction → vasodilation
• B. Vasodilation → increased permeability → stasis → leukocyte adhesion
• C. Leukocyte emigration → vasodilation → stasis
• D. Stasis → vasodilation → increased permeability
Version 1 | Questions with Correct Answers and Expert
Explanation for Each Question
Section 1: Cellular Adaptation & Injury (Q1–10)
Q1. A patient with chronic alcohol use develops a small, firm liver. This is an example of:
• A. Hypertrophy
• B. Hyperplasia
• C. Atrophy
• D. Metaplasia
Expert Explanation: Chronic alcohol exposure leads to hepatocyte death and fibrosis.
The remaining cells shrink (atrophy) due to reduced demand and toxins. Atrophy =
decrease in cell size and organ size.
Q2. A post-menopausal woman develops endometrial hyperplasia. This is most likely
due to:
• A. Increased estrogen without opposing progesterone
• B. Decreased estrogen
• C. Chronic ischemia
• D. Viral infection
Expert Explanation: Unopposed estrogen (from anovulation, obesity, or HRT without
progesterone) stimulates endometrial cell division → hyperplasia. This is pathologic and
can progress to cancer.
Q3. Reperfusion injury after a myocardial infarction is primarily caused by:
• A. Continued hypoxia
, • B. Oxidative stress from reactive oxygen species
• C. Apoptosis inhibition
• D. Hypercalcemia
Expert Explanation: When oxygen returns to ischemic tissue, it triggers massive ROS
production (superoxide, hydrogen peroxide, hydroxyl radicals) that damage cell
membranes, DNA, and proteins.
Q4. Which type of necrosis is most commonly seen in the brain after a stroke?
• A. Coagulative
• B. Caseous
• C. Liquefactive
• D. Fat
Expert Explanation: Brain tissue has abundant lipids and few connective tissue fibers.
Enzymes from microglia and neutrophils liquefy dead tissue → cyst formation.
Q5. A patient with tuberculosis develops caseous necrosis in the lung. The gross
appearance of this necrosis is:
• A. Firm and pale
• B. Soft, friable, and cheese-like
• C. Oily and yellow
• D. Hard and black
Expert Explanation: Caseous necrosis (from TB, fungi) has a friable, yellow-white,
"cottage cheese" appearance due to a combination of coagulative and liquefactive
necrosis with granulomatous inflammation.
Q6. Which of the following is an example of physiologic hypertrophy?
, • A. Left ventricular thickening in hypertension
• B. Skeletal muscle enlargement in a weightlifter
• C. Uterine enlargement in fibroids
• D. Prostate enlargement in older men
Expert Explanation: Physiologic hypertrophy occurs in response to normal increased
workload (exercise, pregnancy). Pathologic hypertrophy results from disease
(hypertension, valve disease).
Q7. Metaplasia increases cancer risk because:
• A. It directly causes DNA mutations
• B. Metaplastic epithelium is often less differentiated and may undergo
dysplasia
• C. It activates oncogenes
• D. It suppresses p53
Expert Explanation: Metaplasia replaces one cell type with another (e.g., Barrett's
esophagus). While reversible, chronic irritation can lead to dysplasia (abnormal growth)
and eventually carcinoma.
Q8. Which cellular change is reversible?
• A. Karyorrhexis
• B. Fatty change (steatosis)
• C. Karyolysis
• D. Pyknosis
Expert Explanation: Fatty change (lipid vacuoles in liver cells) is reversible if the cause
(alcohol, toxins, diabetes) is removed. Pyknosis, karyorrhexis, and karyolysis are nuclear
changes indicating irreversible cell death.
, Q9. A patient with carbon monoxide poisoning presents with cherry-red skin and
confusion. The mechanism of cellular injury is:
• A. Free radical damage
• B. Hypoxia due to CO binding to hemoglobin
• C. Direct mitochondrial toxin
• D. Calcium overload
Expert Explanation: CO binds to hemoglobin with 200× greater affinity than O₂,
reducing oxygen-carrying capacity → histotoxic hypoxia despite normal PaO₂.
Q10. Dystrophic calcification is characterized by:
• A. Hypercalcemia
• B. Calcium deposition in dead or damaged tissue with normal serum calcium
• C. Calcium deposition in normal tissue
• D. Reversible injury
Expert Explanation: Dystrophic calcification occurs in atherosclerotic plaques, damaged
heart valves, or caseous lesions. Serum calcium remains normal. Metastatic calcification
occurs with hypercalcemia.
Section 2: Inflammation & Immunity (Q11–20)
Q11. Which of the following correctly orders the vascular changes in acute
inflammation?
• A. Increased permeability → vasoconstriction → vasodilation
• B. Vasodilation → increased permeability → stasis → leukocyte adhesion
• C. Leukocyte emigration → vasodilation → stasis
• D. Stasis → vasodilation → increased permeability
