ANATOMICAL CHART COMPANY ATLAS
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
Ch. 1 — Cell Membrane Integrity and Ion Transport
Stem: A 68-year-old man with recent onset of confusion and
muscle weakness is admitted after vomiting and poor oral
intake for 4 days. Labs show serum Na⁺ 128 mEq/L and K⁺ 3.0
mEq/L. The nurse recognizes that membrane pump
dysfunction is most likely responsible for which immediate
cellular disturbance?
,A. Increased intracellular Na⁺ with cellular swelling
B. Increased intracellular K⁺ with hyperpolarization
C. Activation of caspase-mediated apoptosis
D. Increased mitochondrial ATP production
Correct Answer: A
Rationale — Correct (A): Prolonged hypovolemia and
electrolyte loss impair Na⁺/K⁺-ATPase activity, causing
intracellular Na⁺ accumulation, osmotic water influx, and
cellular swelling. This reflects membrane pump failure due to
decreased ATP or electrolyte imbalance.
Rationale — Incorrect:
B. Intracellular K⁺ usually falls when Na⁺/K⁺-ATPase fails;
hyperpolarization is unlikely.
C. Caspase-mediated apoptosis is a programmed death
pathway, not the immediate result of pump failure.
D. Mitochondrial ATP production decreases with
ischemia/electrolyte disturbance, not increases.
Teaching point: Na⁺/K⁺-ATPase failure → intracellular Na⁺ rise
→ water influx → cellular swelling.
Citation: Stewart, J. Anatomical Chart Company Atlas of
Pathophysiology. Ch. 1.
2) Reference
Ch. 1 — Hypoxia and Ischemic Cell Injury
,Stem: A 72-year-old woman with atrial fibrillation stops
anticoagulation and develops sudden unilateral weakness. CT
shows ischemic stroke. At the cellular level, which early event
best explains neuronal dysfunction within minutes of cerebral
ischemia?
A. Loss of ATP causing failure of ion pumps and glutamate
release
B. Induction of DNA repair enzymes preventing necrosis
C. Activation of slow, caspase-dependent apoptosis only after
days
D. Chronic hypertrophy of neurons to increase perfusion
Correct Answer: A
Rationale — Correct (A): Acute ischemia rapidly depletes ATP,
disabling ion pumps, causing depolarization and excessive
glutamate release — excitotoxicity — which quickly injures
neurons. This sequence explains immediate neuronal
dysfunction.
Rationale — Incorrect:
B. DNA repair enzymes are not protective in the immediate
ATP-depleted phase; necrosis predominates early.
C. Apoptosis may occur later or in penumbra zones, but early
minutes are dominated by necrotic/excitotoxic injury.
D. Neuronal hypertrophy is not an acute adaptive response to
ischemia.
, Teaching point: Acute ischemia → ATP loss → ion pump failure
→ excitotoxic neuronal injury.
Citation: Stewart, J. Anatomical Chart Company Atlas of
Pathophysiology. Ch. 1.
3) Reference
Ch. 2 — Reversible vs. Irreversible Cell Injury; Necrosis Types
Stem: A 55-year-old man with prolonged small-bowel
obstruction becomes febrile and has severe abdominal pain.
Surgical findings reveal pale, friable intestinal segments.
Histology shows loss of nuclei and increased eosinophilia of
cytoplasm. Which form of cell death does this pattern
indicate?
A. Coagulative necrosis due to ischemia
B. Liquefactive necrosis due to enzymatic digestion
C. Caseous necrosis from granulomatous inflammation
D. Fat necrosis due to lipase activity
Correct Answer: B
Rationale — Correct (B): In ischemic bowel with bacterial
invasion and digestive enzyme activity, liquefactive necrosis
occurs: tissues become soft, with loss of structure and
enzymatic digestion producing the friable appearance
described. (In CNS ischemia liquefactive is classic; bowel can
also liquefy with infection/enzymes.)
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
Ch. 1 — Cell Membrane Integrity and Ion Transport
Stem: A 68-year-old man with recent onset of confusion and
muscle weakness is admitted after vomiting and poor oral
intake for 4 days. Labs show serum Na⁺ 128 mEq/L and K⁺ 3.0
mEq/L. The nurse recognizes that membrane pump
dysfunction is most likely responsible for which immediate
cellular disturbance?
,A. Increased intracellular Na⁺ with cellular swelling
B. Increased intracellular K⁺ with hyperpolarization
C. Activation of caspase-mediated apoptosis
D. Increased mitochondrial ATP production
Correct Answer: A
Rationale — Correct (A): Prolonged hypovolemia and
electrolyte loss impair Na⁺/K⁺-ATPase activity, causing
intracellular Na⁺ accumulation, osmotic water influx, and
cellular swelling. This reflects membrane pump failure due to
decreased ATP or electrolyte imbalance.
Rationale — Incorrect:
B. Intracellular K⁺ usually falls when Na⁺/K⁺-ATPase fails;
hyperpolarization is unlikely.
C. Caspase-mediated apoptosis is a programmed death
pathway, not the immediate result of pump failure.
D. Mitochondrial ATP production decreases with
ischemia/electrolyte disturbance, not increases.
Teaching point: Na⁺/K⁺-ATPase failure → intracellular Na⁺ rise
→ water influx → cellular swelling.
Citation: Stewart, J. Anatomical Chart Company Atlas of
Pathophysiology. Ch. 1.
2) Reference
Ch. 1 — Hypoxia and Ischemic Cell Injury
,Stem: A 72-year-old woman with atrial fibrillation stops
anticoagulation and develops sudden unilateral weakness. CT
shows ischemic stroke. At the cellular level, which early event
best explains neuronal dysfunction within minutes of cerebral
ischemia?
A. Loss of ATP causing failure of ion pumps and glutamate
release
B. Induction of DNA repair enzymes preventing necrosis
C. Activation of slow, caspase-dependent apoptosis only after
days
D. Chronic hypertrophy of neurons to increase perfusion
Correct Answer: A
Rationale — Correct (A): Acute ischemia rapidly depletes ATP,
disabling ion pumps, causing depolarization and excessive
glutamate release — excitotoxicity — which quickly injures
neurons. This sequence explains immediate neuronal
dysfunction.
Rationale — Incorrect:
B. DNA repair enzymes are not protective in the immediate
ATP-depleted phase; necrosis predominates early.
C. Apoptosis may occur later or in penumbra zones, but early
minutes are dominated by necrotic/excitotoxic injury.
D. Neuronal hypertrophy is not an acute adaptive response to
ischemia.
, Teaching point: Acute ischemia → ATP loss → ion pump failure
→ excitotoxic neuronal injury.
Citation: Stewart, J. Anatomical Chart Company Atlas of
Pathophysiology. Ch. 1.
3) Reference
Ch. 2 — Reversible vs. Irreversible Cell Injury; Necrosis Types
Stem: A 55-year-old man with prolonged small-bowel
obstruction becomes febrile and has severe abdominal pain.
Surgical findings reveal pale, friable intestinal segments.
Histology shows loss of nuclei and increased eosinophilia of
cytoplasm. Which form of cell death does this pattern
indicate?
A. Coagulative necrosis due to ischemia
B. Liquefactive necrosis due to enzymatic digestion
C. Caseous necrosis from granulomatous inflammation
D. Fat necrosis due to lipase activity
Correct Answer: B
Rationale — Correct (B): In ischemic bowel with bacterial
invasion and digestive enzyme activity, liquefactive necrosis
occurs: tissues become soft, with loss of structure and
enzymatic digestion producing the friable appearance
described. (In CNS ischemia liquefactive is classic; bowel can
also liquefy with infection/enzymes.)
