ANATOMICAL CHART COMPANY ATLAS
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
Reference: Part I — Cellular Adaptation — Hypertrophy vs.
Hyperplasia
Stem: A 64-year-old male with long-standing uncontrolled
hypertension presents with exertional dyspnea.
Echocardiogram shows left ventricular wall thickening with
preserved chamber size. Which cellular adaptation best explains
this patient's myocardial changes?
A. Cellular hyperplasia due to increased cardiomyocyte mitosis
B. Cellular hypertrophy from increased synthesis of contractile
,proteins
C. Cellular metaplasia resulting from chronic ischemia
D. Cellular atrophy caused by decreased workload
Correct Answer: B
Rationale — Correct: Chronic pressure overload (hypertension)
causes cardiomyocytes to increase size by synthesizing more
contractile proteins (actin/myosin), resulting in hypertrophy and
thicker ventricular walls. This adaptation increases workload
capacity initially.
Rationale — Incorrect:
A. Cardiomyocytes are terminally differentiated; hyperplasia
(increased cell number) is not the typical response in adult
myocardium.
C. Metaplasia is replacement of one mature cell type by
another (e.g., in epithelium), not the mechanism for ventricular
wall thickening.
D. Atrophy is decreased cell size from reduced workload or
nutrients; this patient has increased workload, not decreased.
Teaching Point: Pressure overload → myocardial hypertrophy
via increased contractile protein synthesis.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Part I.
2)
Reference: Part I — Cell Injury — Reversible vs. Irreversible
Injury
,Stem: A 55-year-old woman with chest pain arrives 90 minutes
after symptom onset. Cardiac cells exposed to ischemia display
cellular swelling, blebbing, and decreased ATP production on
biopsy. Which description best categorizes these changes?
A. Irreversible cell injury with nuclear pyknosis
B. Reversible cell injury due to impaired ATP-dependent ion
pumps
C. Apoptotic cell death mediated by caspase activation
D. Autophagic cell survival with increased lysosomal digestion
Correct Answer: B
Rationale — Correct: Early ischemic injury causes decreased
ATP, failure of Na⁺/K⁺ pumps, cellular swelling, and membrane
blebs — features of reversible injury if blood flow is restored
promptly.
Rationale — Incorrect:
A. Nuclear pyknosis and rupture indicate irreversible
injury/necrosis; not described here.
C. Apoptosis is programmed and shows cell shrinkage and
chromatin condensation rather than swelling/blebbing from
ATP loss.
D. While autophagy may occur, the hallmark here is pump
failure and reversible swelling.
Teaching Point: ATP depletion → pump failure → reversible cell
swelling early after ischemia.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Part I.
, 3)
Reference: Part I — Hypoxia and Ischemia — Mechanisms of
Injury
Stem: A patient with severe anemia develops confusion and
lactic acidosis. Tissue biopsy shows increased glycolysis and
lactate accumulation. Which pathophysiologic process primarily
explains these findings?
A. Increased oxidative phosphorylation due to excess O₂
B. Shift to anaerobic metabolism from inadequate oxygen
delivery
C. Mitochondrial hyperactivity increasing ATP production
D. Enhanced fatty acid oxidation producing ketones
Correct Answer: B
Rationale — Correct: In anemia, reduced oxygen delivery forces
cells to rely on anaerobic glycolysis, producing lactate and
causing lactic acidosis and decreased ATP efficiency.
Rationale — Incorrect:
A. Oxidative phosphorylation decreases with hypoxia, not
increases.
C. Mitochondrial dysfunction occurs during hypoxia, reducing
ATP, not increasing it.
D. Fatty acid oxidation requires oxygen; hypoxia inhibits it and
does not primarily cause lactate build-up.
Teaching Point: Reduced O₂ delivery → anaerobic glycolysis →
lactate accumulation and acidosis.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Part I.
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
Reference: Part I — Cellular Adaptation — Hypertrophy vs.
Hyperplasia
Stem: A 64-year-old male with long-standing uncontrolled
hypertension presents with exertional dyspnea.
Echocardiogram shows left ventricular wall thickening with
preserved chamber size. Which cellular adaptation best explains
this patient's myocardial changes?
A. Cellular hyperplasia due to increased cardiomyocyte mitosis
B. Cellular hypertrophy from increased synthesis of contractile
,proteins
C. Cellular metaplasia resulting from chronic ischemia
D. Cellular atrophy caused by decreased workload
Correct Answer: B
Rationale — Correct: Chronic pressure overload (hypertension)
causes cardiomyocytes to increase size by synthesizing more
contractile proteins (actin/myosin), resulting in hypertrophy and
thicker ventricular walls. This adaptation increases workload
capacity initially.
Rationale — Incorrect:
A. Cardiomyocytes are terminally differentiated; hyperplasia
(increased cell number) is not the typical response in adult
myocardium.
C. Metaplasia is replacement of one mature cell type by
another (e.g., in epithelium), not the mechanism for ventricular
wall thickening.
D. Atrophy is decreased cell size from reduced workload or
nutrients; this patient has increased workload, not decreased.
Teaching Point: Pressure overload → myocardial hypertrophy
via increased contractile protein synthesis.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Part I.
2)
Reference: Part I — Cell Injury — Reversible vs. Irreversible
Injury
,Stem: A 55-year-old woman with chest pain arrives 90 minutes
after symptom onset. Cardiac cells exposed to ischemia display
cellular swelling, blebbing, and decreased ATP production on
biopsy. Which description best categorizes these changes?
A. Irreversible cell injury with nuclear pyknosis
B. Reversible cell injury due to impaired ATP-dependent ion
pumps
C. Apoptotic cell death mediated by caspase activation
D. Autophagic cell survival with increased lysosomal digestion
Correct Answer: B
Rationale — Correct: Early ischemic injury causes decreased
ATP, failure of Na⁺/K⁺ pumps, cellular swelling, and membrane
blebs — features of reversible injury if blood flow is restored
promptly.
Rationale — Incorrect:
A. Nuclear pyknosis and rupture indicate irreversible
injury/necrosis; not described here.
C. Apoptosis is programmed and shows cell shrinkage and
chromatin condensation rather than swelling/blebbing from
ATP loss.
D. While autophagy may occur, the hallmark here is pump
failure and reversible swelling.
Teaching Point: ATP depletion → pump failure → reversible cell
swelling early after ischemia.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Part I.
, 3)
Reference: Part I — Hypoxia and Ischemia — Mechanisms of
Injury
Stem: A patient with severe anemia develops confusion and
lactic acidosis. Tissue biopsy shows increased glycolysis and
lactate accumulation. Which pathophysiologic process primarily
explains these findings?
A. Increased oxidative phosphorylation due to excess O₂
B. Shift to anaerobic metabolism from inadequate oxygen
delivery
C. Mitochondrial hyperactivity increasing ATP production
D. Enhanced fatty acid oxidation producing ketones
Correct Answer: B
Rationale — Correct: In anemia, reduced oxygen delivery forces
cells to rely on anaerobic glycolysis, producing lactate and
causing lactic acidosis and decreased ATP efficiency.
Rationale — Incorrect:
A. Oxidative phosphorylation decreases with hypoxia, not
increases.
C. Mitochondrial dysfunction occurs during hypoxia, reducing
ATP, not increasing it.
D. Fatty acid oxidation requires oxygen; hypoxia inhibits it and
does not primarily cause lactate build-up.
Teaching Point: Reduced O₂ delivery → anaerobic glycolysis →
lactate accumulation and acidosis.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Part I.
