NSG 530 Exam 1 – Advanced
Pathophysiology (Wilkes University
2026/2027).
SECTION I: CELLULAR ADAPTATION, INJURY & DEATH (Q1–Q12)
Q1: A patient with long-standing hypertension develops left ventricular wall
thickening with no increase in chamber size. This cellular adaptation is best
described as:
A. Hyperplasia
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Correct because increased afterload from chronic hypertension
causes cardiac myocytes to increase in individual cell size (hypertrophy) through
enhanced protein synthesis and sarcomere addition, not an increase in cell
number (hyperplasia), which is the defining distinction between these adaptive
processes.
Q2: A 45-year-old smoker undergoes bronchoscopy, and biopsy of a bronchial
lesion reveals replacement of normal ciliated pseudostratified columnar
epithelium with stratified squamous epithelium. This reversible change is called:
A. Dysplasia
B. Anaplasia
C. Metaplasia [CORRECT]
D. Atrophy
Correct Answer: C
Rationale: Correct because metaplasia represents the reversible substitution of
one differentiated cell type for another in response to chronic irritation; smoking-
induced transformation of respiratory columnar epithelium to squamous
,epithelium is the classic pathophysiologic example of this protective yet
potentially preneoplastic adaptation.
Q3: A 72-year-old woman with severe malnutrition and prolonged immobilization
demonstrates bilateral quadriceps muscle mass reduction on examination. The
cellular mechanism underlying this finding is:
A. Apoptosis
B. Autophagy
C. Atrophy [CORRECT]
D. Hypertrophy
Correct Answer: C
Rationale: Correct because atrophy is a decrease in cell size resulting from
disuse, denervation, ischemia, malnutrition, or aging; the reduction in protein
synthesis and increase in protein degradation via the ubiquitin-proteasome
pathway leads to diminished cell mass and organ size without cell death.
Q4: A 55-year-old man with benign prostatic hyperplasia (BPH) has significant
lower urinary tract symptoms. The cellular basis of his prostate enlargement is:
A. Hypertrophy of smooth muscle cells
B. Hyperplasia of glandular and stromal cells [CORRECT]
C. Metaplasia of transitional epithelium
D. Dysplasia of prostatic ducts
Correct Answer: B
Rationale: Correct because benign prostatic hyperplasia is characterized by an
increase in cell number (hyperplasia) of both glandular epithelial and stromal
smooth muscle cells driven by dihydrotestosterone (DHT) and aging-related
hormonal changes, not merely an increase in individual cell size.
Q5: A 28-year-old woman with chronic gastroesophageal reflux disease
undergoes endoscopy. Biopsy of the distal esophagus shows intestinal-type
columnar epithelium with goblet cells replacing normal squamous mucosa. This
finding represents:
A. Dysplasia
B. Hyperplasia
, C. Metaplasia [CORRECT]
D. Carcinoma in situ
Correct Answer: C
Rationale: Correct because Barrett esophagus is the pathognomonic example of
metaplasia in which chronic acid exposure causes replacement of squamous
epithelium with columnar epithelium containing goblet cells; this adaptive change
is reversible if the inciting stimulus is removed but carries malignant potential if
dysplasia subsequently develops.
Q6: A 60-year-old man with a 40 pack-year smoking history has a lung biopsy
showing disordered growth of bronchial epithelium with loss of nuclear
uniformity, hyperchromasia, and nuclear pleomorphism extending from the
basement membrane to the lumen. This finding is best classified as:
A. Metaplasia
B. Anaplasia
C. Dysplasia [CORRECT]
D. Hypertrophy
Correct Answer: C
Rationale: Correct because dysplasia is defined by disordered cellular growth
with loss of uniformity, nuclear hyperchromasia, pleomorphism, and loss of
polarity; unlike metaplasia (which is adaptive and reversible), dysplasia is
preneoplastic and represents a pathologic continuum toward carcinoma in situ.
Q7: A patient who suffered a myocardial infarction 4 hours ago has an area of
myocardial tissue that appears firm and pale with preserved tissue architecture
visible on microscopic examination. This type of necrosis is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Correct because coagulative necrosis is the most common pattern of
ischemic injury in solid organs (heart, kidney, liver, spleen) and is characterized
by denaturation of structural and enzymatic proteins that preserves tissue
Pathophysiology (Wilkes University
2026/2027).
SECTION I: CELLULAR ADAPTATION, INJURY & DEATH (Q1–Q12)
Q1: A patient with long-standing hypertension develops left ventricular wall
thickening with no increase in chamber size. This cellular adaptation is best
described as:
A. Hyperplasia
B. Hypertrophy [CORRECT]
C. Metaplasia
D. Dysplasia
Correct Answer: B
Rationale: Correct because increased afterload from chronic hypertension
causes cardiac myocytes to increase in individual cell size (hypertrophy) through
enhanced protein synthesis and sarcomere addition, not an increase in cell
number (hyperplasia), which is the defining distinction between these adaptive
processes.
Q2: A 45-year-old smoker undergoes bronchoscopy, and biopsy of a bronchial
lesion reveals replacement of normal ciliated pseudostratified columnar
epithelium with stratified squamous epithelium. This reversible change is called:
A. Dysplasia
B. Anaplasia
C. Metaplasia [CORRECT]
D. Atrophy
Correct Answer: C
Rationale: Correct because metaplasia represents the reversible substitution of
one differentiated cell type for another in response to chronic irritation; smoking-
induced transformation of respiratory columnar epithelium to squamous
,epithelium is the classic pathophysiologic example of this protective yet
potentially preneoplastic adaptation.
Q3: A 72-year-old woman with severe malnutrition and prolonged immobilization
demonstrates bilateral quadriceps muscle mass reduction on examination. The
cellular mechanism underlying this finding is:
A. Apoptosis
B. Autophagy
C. Atrophy [CORRECT]
D. Hypertrophy
Correct Answer: C
Rationale: Correct because atrophy is a decrease in cell size resulting from
disuse, denervation, ischemia, malnutrition, or aging; the reduction in protein
synthesis and increase in protein degradation via the ubiquitin-proteasome
pathway leads to diminished cell mass and organ size without cell death.
Q4: A 55-year-old man with benign prostatic hyperplasia (BPH) has significant
lower urinary tract symptoms. The cellular basis of his prostate enlargement is:
A. Hypertrophy of smooth muscle cells
B. Hyperplasia of glandular and stromal cells [CORRECT]
C. Metaplasia of transitional epithelium
D. Dysplasia of prostatic ducts
Correct Answer: B
Rationale: Correct because benign prostatic hyperplasia is characterized by an
increase in cell number (hyperplasia) of both glandular epithelial and stromal
smooth muscle cells driven by dihydrotestosterone (DHT) and aging-related
hormonal changes, not merely an increase in individual cell size.
Q5: A 28-year-old woman with chronic gastroesophageal reflux disease
undergoes endoscopy. Biopsy of the distal esophagus shows intestinal-type
columnar epithelium with goblet cells replacing normal squamous mucosa. This
finding represents:
A. Dysplasia
B. Hyperplasia
, C. Metaplasia [CORRECT]
D. Carcinoma in situ
Correct Answer: C
Rationale: Correct because Barrett esophagus is the pathognomonic example of
metaplasia in which chronic acid exposure causes replacement of squamous
epithelium with columnar epithelium containing goblet cells; this adaptive change
is reversible if the inciting stimulus is removed but carries malignant potential if
dysplasia subsequently develops.
Q6: A 60-year-old man with a 40 pack-year smoking history has a lung biopsy
showing disordered growth of bronchial epithelium with loss of nuclear
uniformity, hyperchromasia, and nuclear pleomorphism extending from the
basement membrane to the lumen. This finding is best classified as:
A. Metaplasia
B. Anaplasia
C. Dysplasia [CORRECT]
D. Hypertrophy
Correct Answer: C
Rationale: Correct because dysplasia is defined by disordered cellular growth
with loss of uniformity, nuclear hyperchromasia, pleomorphism, and loss of
polarity; unlike metaplasia (which is adaptive and reversible), dysplasia is
preneoplastic and represents a pathologic continuum toward carcinoma in situ.
Q7: A patient who suffered a myocardial infarction 4 hours ago has an area of
myocardial tissue that appears firm and pale with preserved tissue architecture
visible on microscopic examination. This type of necrosis is:
A. Liquefactive necrosis
B. Caseous necrosis
C. Coagulative necrosis [CORRECT]
D. Fat necrosis
Correct Answer: C
Rationale: Correct because coagulative necrosis is the most common pattern of
ischemic injury in solid organs (heart, kidney, liver, spleen) and is characterized
by denaturation of structural and enzymatic proteins that preserves tissue
