Adaptive changes – dysplasia MCQs With Answer

Adaptive changes – dysplasia MCQs With Answer

Understanding adaptive changes and dysplasia is essential for B.Pharm students preparing for pathology and clinical pharmacy roles. This concise, Student-friendly post covers cellular adaptation, epithelial dysplasia, histopathology features, molecular markers (p53, Ki-67, p16), and clinical implications including screening (Pap smear, HPV testing) and progression to carcinoma. Emphasis on reversible versus irreversible changes, grading criteria (mild, moderate, severe, carcinoma in situ), and tissue-specific examples will strengthen pharmacology and therapeutics decision-making. These targeted dysplasia MCQs aid exam readiness and practical application in patient care and drug safety. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary definition of dysplasia in pathology?

• Reversible cell size decrease due to decreased workload
• Disordered growth with loss of cellular uniformity and architecture
• Replacement of one differentiated cell type with another
• Uncontrolled clonal proliferation with invasion

Correct Answer: Disordered growth with loss of cellular uniformity and architecture

Q2. Which of the following features is most characteristic of epithelial dysplasia on histology?

• Increased glycogen storage
• Preserved stratified squamous polarity
• Nuclear pleomorphism and increased mitotic figures
• Granulation tissue formation

Correct Answer: Nuclear pleomorphism and increased mitotic figures

Q3. Dysplasia differs from hyperplasia primarily because dysplasia involves:

• Organ enlargement via increased cell size
• Normal tissue architecture with increased cell number
• Disordered cell growth and atypia
• Adaptation by decreasing cell number

Correct Answer: Disordered cell growth and atypia

Q4. Which molecular marker is commonly used to indicate high-risk HPV-related cervical dysplasia?

• HER2
• p16
• Albumin
• BRCA1

Correct Answer: p16

Q5. Carcinoma in situ is best described as:

• Dysplastic epithelium that has breached the basement membrane
• Severe dysplasia occupying full thickness of epithelium without invasion
• Mild epithelial hyperplasia
• Necrotic tissue lacking cellular detail

Correct Answer: Severe dysplasia occupying full thickness of epithelium without invasion

Q6. Which staining or test is most useful in screening cervical dysplasia?

• Serum PSA
• Papanicolaou (Pap) smear cytology
• Chest X-ray
• Urinalysis dipstick

Correct Answer: Papanicolaou (Pap) smear cytology

Q7. Loss of polarity in epithelial cells indicates which process?

• Normal differentiation
• Dysplastic change
• Apoptosis
• Keratinization only

Correct Answer: Dysplastic change

Q8. Which of the following best distinguishes metaplasia from dysplasia?

• Metaplasia is malignant; dysplasia is always benign
• Metaplasia is a reversible substitution of cell type; dysplasia includes atypia and disordered growth
• Dysplasia involves replacement by connective tissue
• Metaplasia always progresses to cancer

Correct Answer: Metaplasia is a reversible substitution of cell type; dysplasia includes atypia and disordered growth

Q9. Which cellular change is considered reversible and part of adaptive changes rather than dysplasia?

• Severe nuclear atypia
• Cell swelling (hydropic change)
• Loss of basement membrane
• Invasive growth

Correct Answer: Cell swelling (hydropic change)

Q10. An increase in Ki-67 labeling index in epithelial tissue suggests:

• Reduced proliferation
• Increased cell proliferation often seen in dysplasia
• Enhanced apoptosis only
• Improved tissue repair with normal architecture

Correct Answer: Increased cell proliferation often seen in dysplasia

Q11. Which risk factor is most strongly associated with cervical epithelial dysplasia?

• High-sodium diet
• High-risk human papillomavirus (HPV) infection
• Exposure to UV light
• Excessive vitamin C intake

Correct Answer: High-risk human papillomavirus (HPV) infection

Q12. Dysplastic changes in bronchial epithelium from chronic smoking typically progress through which sequence?

• Atrophy → necrosis → regeneration
• Metaplasia → dysplasia → carcinoma in situ → invasive carcinoma
• Hyperplasia → fibrosis → cirrhosis
• Apoptosis → autophagy → healing

Correct Answer: Metaplasia → dysplasia → carcinoma in situ → invasive carcinoma

Q13. The presence of atypical mitoses is an indicator of:

• Normal cell turnover
• Benign reactive change only
• Severe dysplasia or neoplastic transformation
• Mitochondrial dysfunction without proliferation

Correct Answer: Severe dysplasia or neoplastic transformation

Q14. In grading epithelial dysplasia, mild dysplasia usually involves which portion of the epithelium?

• Basal one-third
• Full thickness
• Superficial one-third only
• Entire mucosa and submucosa

Correct Answer: Basal one-third

Q15. Which pharmacological agent is strongly linked to epithelial dysplasia of the oral mucosa when used as a drug abuse substance?

• Topical corticosteroids
• Betel nut (areca nut) chewing products (containing alkaloids)
• Topical antiseptics
• Inhaled bronchodilators

Correct Answer: Betel nut (areca nut) chewing products (containing alkaloids)

Q16. Which intracellular change is commonly seen in dysplastic cells?

• Uniform small nuclei
• Hyperchromatic enlarged nuclei
• Decreased nuclear-cytoplasmic ratio
• Abundant lipid vacuoles only

Correct Answer: Hyperchromatic enlarged nuclei

Q17. Which finding on a Pap smear indicates high-grade squamous intraepithelial lesion (HSIL)?

• Cells with minimal atypia and abundant cytoplasm
• Markedly abnormal nuclei, high N:C ratio, and coarse chromatin
• Mature superficial squamous cells only
• Polymicrobial infection without nuclear atypia

Correct Answer: Markedly abnormal nuclei, high N:C ratio, and coarse chromatin

Q18. p53 mutation in dysplastic lesions primarily affects which cellular process?

• Protein glycosylation in the Golgi
• DNA damage response and cell cycle arrest/apoptosis
• Fatty acid synthesis
• Extracellular matrix deposition

Correct Answer: DNA damage response and cell cycle arrest/apoptosis

Q19. Which term best describes reversible replacement of columnar epithelium by stratified squamous epithelium in the respiratory tract?

• Dysplasia
• Metaplasia
• Neoplasia
• Anaplasia

Correct Answer: Metaplasia

Q20. Dysplasia in Barrett esophagus typically involves which cell lineage change?

• Squamous epithelium to columnar epithelium with intestinal metaplasia, then dysplasia
• Columnar to transitional epithelium only
• Connective tissue replacing epithelium
• Neural tissue appearing in the mucosa

Correct Answer: Squamous epithelium to columnar epithelium with intestinal metaplasia, then dysplasia

Q21. Which biomarker combination is most useful for triaging equivocal cervical cytology?

• Hemoglobin and hematocrit
• HPV DNA testing and p16 immunostaining
• Serum creatinine and urea
• CRP and ESR

Correct Answer: HPV DNA testing and p16 immunostaining

Q22. The concept of “field cancerization” in dysplasia refers to:

• Isolated single dysplastic cell only
• Widespread epithelial molecular alterations predisposing to multifocal dysplasia and cancer
• Tumor metastasis to distant organs
• Immune clearance of dysplastic cells

Correct Answer: Widespread epithelial molecular alterations predisposing to multifocal dysplasia and cancer

Q23. In liver pathology, a dysplastic nodule is most relevant to which disease context?

• Acute viral hepatitis only
• Regenerative nodules in cirrhosis with potential progression to hepatocellular carcinoma
• Fatty liver without fibrosis
• Autoimmune pancreatitis

Correct Answer: Regenerative nodules in cirrhosis with potential progression to hepatocellular carcinoma

Q24. Which feature suggests that dysplasia may be reversible rather than progressed to invasive cancer?

• Invasion through basement membrane
• Removal of the injurious stimulus leading to regression
• Extensive stromal desmoplasia
• Metastatic spread

Correct Answer: Removal of the injurious stimulus leading to regression

Q25. Which histologic change differentiates carcinoma in situ from invasive carcinoma?

• Cellular atypia
• Presence of mitotic figures
• Disruption and penetration of the basement membrane
• Loss of polarity

Correct Answer: Disruption and penetration of the basement membrane

Q26. Atypia limited to the basal third of the epithelium corresponds to which dysplasia grade?

• Severe dysplasia
• Mild dysplasia
• Carcinoma in situ
• No dysplasia

Correct Answer: Mild dysplasia

Q27. Which cellular pathway alteration often contributes to progression from dysplasia to carcinoma?

• Upregulation of DNA repair and apoptosis
• Accumulation of genetic mutations in oncogenes and tumor suppressor genes
• Enhanced collagen deposition only
• Complete restoration of normal gene expression

Correct Answer: Accumulation of genetic mutations in oncogenes and tumor suppressor genes

Q28. Which of these is NOT a typical histologic sign of dysplasia?

• Increased nuclear-cytoplasmic ratio
• Basal cell hyperplasia with maintained polarity
• Abnormal mitotic figures above basal layers
• Loss of cellular cohesion

Correct Answer: Basal cell hyperplasia with maintained polarity

Q29. In oral pathology, erythroplakia with dysplasia is clinically significant because:

• It is always benign and self-resolving
• It has a higher risk of severe dysplasia or carcinoma compared to leukoplakia
• It indicates fungal infection only
• It is unrelated to tobacco use

Correct Answer: It has a higher risk of severe dysplasia or carcinoma compared to leukoplakia

Q30. Which cell-cycle regulator, when overexpressed, is often linked to increased proliferation in dysplastic lesions?

• p27 (CDK inhibitor)
• Ki-67 (proliferation marker)
• Albumin
• Cytochrome c

Correct Answer: Ki-67 (proliferation marker)

Q31. Which diagnostic procedure provides tissue architecture to confirm dysplasia rather than cytology alone?

• Fine needle aspiration cytology
• Excisional or incisional biopsy with histopathology
• Serum tumor markers only
• Plain radiograph

Correct Answer: Excisional or incisional biopsy with histopathology

Q32. Which of the following best describes “anaplasia” compared to dysplasia?

• Anaplasia refers to reversible cell adaptation
• Anaplasia indicates extreme cellular dedifferentiation associated with malignant tumors, more severe than dysplasia
• Anaplasia is specific to liver cells
• Anaplasia is synonymous with metaplasia

Correct Answer: Anaplasia indicates extreme cellular dedifferentiation associated with malignant tumors, more severe than dysplasia

Q33. Which environmental exposure is classically associated with dysplastic changes in bronchial epithelium?

• Periodic fasting
• Cigarette smoke
• Low noise levels
• High-altitude hypoxia only

Correct Answer: Cigarette smoke

Q34. When reporting dysplasia, pathologists often use which three-tier or two-tier grading system?

• Grade I–IV or binary aseptic system
• Mild, moderate, severe (three-tier) or low-grade vs high-grade (two-tier)
• Acute, subacute, chronic
• Type A, Type B, Type C, Type D

Correct Answer: Mild, moderate, severe (three-tier) or low-grade vs high-grade (two-tier)

Q35. Which therapeutic strategy is commonly used for high-grade dysplasia in the cervix?

• Observation only without follow-up
• Excisional treatment such as LEEP or cone biopsy
• Topical antifungals exclusively
• High-dose systemic antibiotics

Correct Answer: Excisional treatment such as LEEP or cone biopsy

Q36. Which histochemical or immunohistochemical marker suggests disrupted cell cycle control in dysplasia?

• p16 overexpression
• Insulin positivity
• Albumin staining
• Collagen IV only

Correct Answer: p16 overexpression

Q37. Which statement about progression rates of low-grade cervical dysplasia is most accurate?

• All low-grade lesions quickly progress to invasive cancer within weeks
• Many low-grade lesions regress spontaneously, while a subset may persist or progress
• Low-grade lesions never regress
• Progression is immediate and unavoidable

Correct Answer: Many low-grade lesions regress spontaneously, while a subset may persist or progress

Q38. Dysplasia in which tissue is typically assessed using endoscopic biopsy rather than surface cytology?

• Cervix
• Esophagus (Barrett esophagus)
• Skin
• Peripheral blood smear

Correct Answer: Esophagus (Barrett esophagus)

Q39. Which therapeutic implication is important for pharmacists regarding dysplasia?

• All dysplasia requires immediate chemotherapy
• Understanding drug-induced mucosal injury and counsel on carcinogenic exposures, screening, and medication risks
• Pharmacists have no role in dysplasia management
• Only surgical teams manage dysplasia without medication considerations

Correct Answer: Understanding drug-induced mucosal injury and counsel on carcinogenic exposures, screening, and medication risks

Q40. Atypical cells with perinuclear clearing and koilocytosis on cytology indicate:

• Fungal infection
• HPV effect associated with possible dysplasia
• Vitamin deficiency
• Bacterial vaginosis

Correct Answer: HPV effect associated with possible dysplasia

Q41. In dysplastic epithelium, failure of terminal differentiation is reflected by:

• Increased surface maturation
• Persistence of immature basal-type cells across superficial layers
• Complete loss of basal layer only
• Enhanced mucus secretion only

Correct Answer: Persistence of immature basal-type cells across superficial layers

Q42. Which process can directly promote epithelial dysplasia via chronic inflammation?

• Intermittent exercise
• Persistent H. pylori infection in the stomach
• Short-term antibiotic use
• Vaccination

Correct Answer: Persistent H. pylori infection in the stomach

Q43. Which ultrastructural change is often seen in dysplastic cells under electron microscopy?

• Abundant, well-formed desmosomes and normal polarity
• Nuclear membrane irregularities and prominent nucleoli
• Complete absence of mitochondria only
• Excessive secretory granules indicating normal function

Correct Answer: Nuclear membrane irregularities and prominent nucleoli

Q44. For pharmacology students, why is knowledge of dysplasia important when considering drug safety?

• Drugs never influence epithelial morphology
• Some drugs and chemicals are carcinogenic or promote dysplasia; pharmacists must counsel for risk reduction and monitor adverse effects
• Only physicians need to know about dysplasia
• Dysplasia is irrelevant to clinical therapeutics

Correct Answer: Some drugs and chemicals are carcinogenic or promote dysplasia; pharmacists must counsel for risk reduction and monitor adverse effects

Q45. Which cell junction alteration contributes to loss of cohesion seen in dysplasia?

• Strengthening of tight junctions
• Reduction or dysfunction of desmosomes and adherens junctions
• Increase in gap junction communication
• Enhanced basement membrane protein synthesis

Correct Answer: Reduction or dysfunction of desmosomes and adherens junctions

Q46. Dysplasia is most likely to be described as reversible under what condition?

• When genetic mutations are permanent and numerous
• When inciting stimulus is removed early and cellular changes are not fixed by mutation
• When stromal invasion has occurred
• When metastasis is present

Correct Answer: When inciting stimulus is removed early and cellular changes are not fixed by mutation

Q47. Which imaging modality is most useful to detect invasive carcinoma after a biopsy-proven high-grade dysplasia?

• Ultrasound for all epithelial cancers
• Appropriate cross-sectional imaging (MRI/CT) depending on organ and clinical suspicion
• ECG
• Basic visual inspection always suffices

Correct Answer: Appropriate cross-sectional imaging (MRI/CT) depending on organ and clinical suspicion

Q48. In the context of dysplasia, “loss of heterozygosity” (LOH) refers to:

• Complete restoration of both gene alleles
• Loss of one allele of a gene, often tumor suppressor, contributing to progression toward malignancy
• Increased heterozygous genetic diversity protecting cells
• Loss of mitochondrial DNA only

Correct Answer: Loss of one allele of a gene, often tumor suppressor, contributing to progression toward malignancy

Q49. Which preventive strategy reduces the incidence of cervical dysplasia at the population level?

• HPV vaccination in adolescents and young adults
• Daily vitamin E supplements alone
• Universal antibiotic prophylaxis
• Elimination of routine screening

Correct Answer: HPV vaccination in adolescents and young adults

Q50. Which statement is true regarding management decisions for dysplasia?

• All dysplasia should be treated the same regardless of grade or site
• Management is individualized based on dysplasia grade, tissue site, patient factors, and risk of progression
• Follow-up is unnecessary after detecting dysplasia
• Surgical excision is never indicated for dysplasia

Correct Answer: Management is individualized based on dysplasia grade, tissue site, patient factors, and risk of progression

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com