NSG 530 Advanced Pathophysiology – Wilkes University Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
Exam 1: Foundations of Pathophysiology
Total questions: 85 (75 multiple-choice, 5 select-all-that-apply, 5 ordered-response)
Time allowed: 90 minutes
Difficulty distribution: Easy 30% (26), Moderate 50% (42), Difficult 20% (17)
1
A 58-year-old male with a 40 pack-year smoking history presents with a non-healing
ulcer on the lateral tongue. Biopsy reveals squamous cell carcinoma. Which cellular
adaptation most likely preceded malignant transformation in the adjacent epithelium?
A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Hypertrophy
Correct Answer: B
Rationale: Dysplasia is a disordered, pre-neoplastic cellular adaptation characterized by
loss of uniformity and architectural organization; it frequently precedes carcinoma in
situ and invasive cancer. Metaplasia (A) is a reversible change of one differentiated cell
type to another and is not itself pre-malignant, though it can be a precursor to dysplasia.
Hyperplasia (C) is an increase in cell number that remains regulated. Hypertrophy (D) is
an increase in cell size without neoplastic potential.
,2
A patient with chronic gastroesophageal reflux disease develops Barrett esophagus.
The pathologist notes columnar epithelium replacing stratified squamous epithelium.
This change represents which adaptive response?
A. Atrophy
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible substitution of one differentiated cell type for
another, often in response to chronic irritation; Barrett esophagus is the classic
example. Atrophy (A) is a decrease in cell size or number. Hyperplasia (C) is increased
cell proliferation. Anaplasia (D) is a loss of differentiation seen in malignant tumors, not
an adaptive response.
3
During an ischemic event, a myocardial cell demonstrates cytoplasmic vacuolization,
mitochondrial swelling, and decreased ATP production but intact plasma membrane.
Which term best describes this stage of cell injury?
A. Reversible injury
B. Irreversible injury
C. Apoptosis
D. Necrosis
Correct Answer: A
Rationale: Reversible cellular injury is characterized by cellular swelling, fatty change,
and organelle dysfunction with an intact plasma membrane; restoration of blood flow
permits recovery. Irreversible injury (B) involves plasma membrane disruption and
,nuclear changes. Apoptosis (C) is programmed cell death with cell shrinkage and
chromatin condensation. Necrosis (D) is unregulated cell death with membrane rupture
and inflammation.
4
A 45-year-old woman presents with progressive fatigue and hepatomegaly. Liver biopsy
reveals abundant clear cytoplasmic vacuoles displacing the nucleus peripherally. Which
mechanism is primarily responsible for this morphologic finding?
A. Accumulation of triglycerides
B. Accumulation of glycogen
C. Accumulation of water
D. Accumulation of cholesterol
Correct Answer: A
Rationale: Macrovesicular steatosis (fatty change) is characterized by large lipid
vacuoles that displace the nucleus to the periphery, reflecting triglyceride accumulation
due to impaired lipoprotein export or increased free fatty acid delivery. Glycogen
accumulation (B) produces diffuse cytoplasmic clearing without peripheral nuclear
displacement. Water accumulation (C) causes hydropic change with diffuse swelling.
Cholesterol accumulation (D) typically forms crystalline clefts or foam cells.
5
A patient receiving high-dose corticosteroids for systemic lupus erythematosus
develops proximal muscle weakness. Muscle biopsy shows decreased fiber size
without inflammation. Which process best explains this finding?
A. Disuse atrophy
B. Denervation atrophy
C. Endocrine atrophy
D. Ischemic atrophy
, Correct Answer: C
Rationale: Exogenous corticosteroids produce endocrine atrophy by stimulating protein
catabolism and inhibiting protein synthesis, leading to type II fiber atrophy and proximal
muscle weakness. Disuse atrophy (A) follows immobilization. Denervation atrophy (B)
shows grouped fiber atrophy and reinnervation changes. Ischemic atrophy (D) results
from chronic hypoperfusion.
6
A 62-year-old man with chronic hypertension has a left ventricular wall thickness of 14
mm (normal ≤11 mm) on echocardiography. Myocardial biopsy reveals enlarged
myocytes with enlarged nuclei. Which cellular process is demonstrated?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size (not number) in response to
mechanical stress, producing enlarged myocytes with enlarged nuclei; chronic pressure
overload in hypertension is the classic stimulus. Hyperplasia (A) is an increase in cell
number, which does not occur in terminally differentiated cardiac myocytes. Metaplasia
(C) is a change in cell type. Dysplasia (D) is pre-neoplastic disordered growth.
7
A patient with chronic obstructive pulmonary disease has hyperinflated lungs on chest
radiograph. Histology reveals enlarged alveolar spaces with destruction of alveolar
walls but no fibrosis. Which pathologic process is present?
A. Compensatory emphysema
B. Panacinar emphysema
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
Exam 1: Foundations of Pathophysiology
Total questions: 85 (75 multiple-choice, 5 select-all-that-apply, 5 ordered-response)
Time allowed: 90 minutes
Difficulty distribution: Easy 30% (26), Moderate 50% (42), Difficult 20% (17)
1
A 58-year-old male with a 40 pack-year smoking history presents with a non-healing
ulcer on the lateral tongue. Biopsy reveals squamous cell carcinoma. Which cellular
adaptation most likely preceded malignant transformation in the adjacent epithelium?
A. Metaplasia
B. Dysplasia
C. Hyperplasia
D. Hypertrophy
Correct Answer: B
Rationale: Dysplasia is a disordered, pre-neoplastic cellular adaptation characterized by
loss of uniformity and architectural organization; it frequently precedes carcinoma in
situ and invasive cancer. Metaplasia (A) is a reversible change of one differentiated cell
type to another and is not itself pre-malignant, though it can be a precursor to dysplasia.
Hyperplasia (C) is an increase in cell number that remains regulated. Hypertrophy (D) is
an increase in cell size without neoplastic potential.
,2
A patient with chronic gastroesophageal reflux disease develops Barrett esophagus.
The pathologist notes columnar epithelium replacing stratified squamous epithelium.
This change represents which adaptive response?
A. Atrophy
B. Metaplasia
C. Hyperplasia
D. Anaplasia
Correct Answer: B
Rationale: Metaplasia is the reversible substitution of one differentiated cell type for
another, often in response to chronic irritation; Barrett esophagus is the classic
example. Atrophy (A) is a decrease in cell size or number. Hyperplasia (C) is increased
cell proliferation. Anaplasia (D) is a loss of differentiation seen in malignant tumors, not
an adaptive response.
3
During an ischemic event, a myocardial cell demonstrates cytoplasmic vacuolization,
mitochondrial swelling, and decreased ATP production but intact plasma membrane.
Which term best describes this stage of cell injury?
A. Reversible injury
B. Irreversible injury
C. Apoptosis
D. Necrosis
Correct Answer: A
Rationale: Reversible cellular injury is characterized by cellular swelling, fatty change,
and organelle dysfunction with an intact plasma membrane; restoration of blood flow
permits recovery. Irreversible injury (B) involves plasma membrane disruption and
,nuclear changes. Apoptosis (C) is programmed cell death with cell shrinkage and
chromatin condensation. Necrosis (D) is unregulated cell death with membrane rupture
and inflammation.
4
A 45-year-old woman presents with progressive fatigue and hepatomegaly. Liver biopsy
reveals abundant clear cytoplasmic vacuoles displacing the nucleus peripherally. Which
mechanism is primarily responsible for this morphologic finding?
A. Accumulation of triglycerides
B. Accumulation of glycogen
C. Accumulation of water
D. Accumulation of cholesterol
Correct Answer: A
Rationale: Macrovesicular steatosis (fatty change) is characterized by large lipid
vacuoles that displace the nucleus to the periphery, reflecting triglyceride accumulation
due to impaired lipoprotein export or increased free fatty acid delivery. Glycogen
accumulation (B) produces diffuse cytoplasmic clearing without peripheral nuclear
displacement. Water accumulation (C) causes hydropic change with diffuse swelling.
Cholesterol accumulation (D) typically forms crystalline clefts or foam cells.
5
A patient receiving high-dose corticosteroids for systemic lupus erythematosus
develops proximal muscle weakness. Muscle biopsy shows decreased fiber size
without inflammation. Which process best explains this finding?
A. Disuse atrophy
B. Denervation atrophy
C. Endocrine atrophy
D. Ischemic atrophy
, Correct Answer: C
Rationale: Exogenous corticosteroids produce endocrine atrophy by stimulating protein
catabolism and inhibiting protein synthesis, leading to type II fiber atrophy and proximal
muscle weakness. Disuse atrophy (A) follows immobilization. Denervation atrophy (B)
shows grouped fiber atrophy and reinnervation changes. Ischemic atrophy (D) results
from chronic hypoperfusion.
6
A 62-year-old man with chronic hypertension has a left ventricular wall thickness of 14
mm (normal ≤11 mm) on echocardiography. Myocardial biopsy reveals enlarged
myocytes with enlarged nuclei. Which cellular process is demonstrated?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Hypertrophy is an increase in cell size (not number) in response to
mechanical stress, producing enlarged myocytes with enlarged nuclei; chronic pressure
overload in hypertension is the classic stimulus. Hyperplasia (A) is an increase in cell
number, which does not occur in terminally differentiated cardiac myocytes. Metaplasia
(C) is a change in cell type. Dysplasia (D) is pre-neoplastic disordered growth.
7
A patient with chronic obstructive pulmonary disease has hyperinflated lungs on chest
radiograph. Histology reveals enlarged alveolar spaces with destruction of alveolar
walls but no fibrosis. Which pathologic process is present?
A. Compensatory emphysema
B. Panacinar emphysema
