Test Bank Applied Pathophysiology For Advanced Practice,2nd
Edition By Lucie Dlugasch & Lachel Story ISBN 9781284255614,
All Chapters(1-14, Latest 2025-2026)
1. A 45-year-old man presents with muscle enlargement after starting a weightlifting program.
Histologic examination reveals increased synthesis of contractile proteins without an
, increase in cell number. Which adaptive process explains this change?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Rationale: Hypertrophy results from increased synthesis of proteins and organelles within
cells, allowing them to meet greater functional demands. In non-dividing tissues like
skeletal and cardiac muscle, this is the primary adaptive mechanism.
2. A 32-year-old smoker shows squamous epithelial replacement of the normal columnar cells in
her bronchial mucosa. What adaptive process is responsible?
A. Dysplasia
B. Metaplasia
C. Atrophy
D. Hyperplasia
Rationale: Metaplasia is the reversible substitution of one mature cell type for another better
suited to withstand chronic irritation. Here, the columnar ciliated epithelium is replaced by
squamous epithelium in response to smoke exposure.
3. A patient with hypertension develops thickened ventricular walls and normal chamber size.
Which process underlies this change?
A. Hyperplasia of myocytes
B. Increased synthesis of contractile proteins
C. Fibrotic deposition
D. Increased mitotic activity
Rationale: Cardiac myocytes cannot divide, so they respond to increased workload through
hypertrophy by synthesizing more structural proteins and organelles.
,4. A patient’s leg has been immobilized in a cast for six weeks. Upon removal, the muscles appear
smaller and weaker. Which process occurred?
A. Atrophy due to decreased workload
B. Hypertrophy due to disuse
C. Hyperplasia of muscle fibers
D. Metaplasia due to stress
Rationale: Disuse atrophy results from reduced protein synthesis and increased protein
degradation as the cell adjusts its metabolism to reduced functional demand.
5. During myocardial ischemia, which cellular event occurs first?
A. Nuclear fragmentation
B. Decrease in ATP synthesis
C. Lysosomal rupture
D. Cell membrane rupture
Rationale: Oxygen deprivation immediately halts oxidative phosphorylation, leading to ATP
depletion. This precedes other downstream events such as ion pump failure and cell swelling.
6. Which change best characterizes a reversible cell injury?
A. Nuclear pyknosis
B. Cellular swelling
C. Membrane rupture
D. Karyorrhexis
Rationale: Reversible injury is marked by hydropic swelling due to ATP loss and Na⁺/K⁺ pump
failure. If the nucleus remains intact and the membrane is not disrupted, recovery is possible.
7. A liver biopsy from a man exposed to carbon tetrachloride shows dilated rough endoplasmic
reticulum and ribosome detachment. What does this represent?
A. Impaired protein synthesis due to ER stress
B. Increased translational activity
C. Lysosomal activation
D. Nuclear fragmentation
, Rationale: Toxic metabolites disrupt ribosomal binding to the ER, impairing protein synthesis and
leading to ER dilation—an early, reversible form of cell injury.
8. Which organelle is the primary site of ATP production in aerobic metabolism?
A. Lysosome
B. Golgi apparatus
C. Mitochondrion
D. Endoplasmic reticulum
Rationale: Mitochondria produce ATP through oxidative phosphorylation. Loss of mitochondrial
membrane potential is a key feature of irreversible cell injury.
9. After a myocardial infarction, reperfusion of the ischemic tissue paradoxically increases cellular
injury. Why?
A. Persistent hypoxia
B. Rapid ROS formation upon reoxygenation
C. Decreased neutrophil infiltration
D. pH normalization
Rationale: Reintroduction of oxygen generates reactive oxygen species and inflammatory
mediators that exacerbate tissue damage beyond that of initial ischemia.
10. A patient with hypoxia from severe anemia shows mitochondrial swelling. What intracellular
event caused this?
A. DNA fragmentation
B. Loss of mitochondrial membrane potential and calcium overload
C. Increased ATP synthesis
D. Enhanced glycolysis
Rationale: Hypoxia inhibits oxidative phosphorylation, allowing calcium entry and mitochondrial
swelling, a hallmark of early irreversible injury.
11. Which enzyme catalyzes the conversion of superoxide radicals into hydrogen peroxide?
A. Superoxide dismutase
B. Catalase
C. Glutathione peroxidase
Edition By Lucie Dlugasch & Lachel Story ISBN 9781284255614,
All Chapters(1-14, Latest 2025-2026)
1. A 45-year-old man presents with muscle enlargement after starting a weightlifting program.
Histologic examination reveals increased synthesis of contractile proteins without an
, increase in cell number. Which adaptive process explains this change?
A. Hyperplasia
B. Hypertrophy
C. Metaplasia
D. Dysplasia
Rationale: Hypertrophy results from increased synthesis of proteins and organelles within
cells, allowing them to meet greater functional demands. In non-dividing tissues like
skeletal and cardiac muscle, this is the primary adaptive mechanism.
2. A 32-year-old smoker shows squamous epithelial replacement of the normal columnar cells in
her bronchial mucosa. What adaptive process is responsible?
A. Dysplasia
B. Metaplasia
C. Atrophy
D. Hyperplasia
Rationale: Metaplasia is the reversible substitution of one mature cell type for another better
suited to withstand chronic irritation. Here, the columnar ciliated epithelium is replaced by
squamous epithelium in response to smoke exposure.
3. A patient with hypertension develops thickened ventricular walls and normal chamber size.
Which process underlies this change?
A. Hyperplasia of myocytes
B. Increased synthesis of contractile proteins
C. Fibrotic deposition
D. Increased mitotic activity
Rationale: Cardiac myocytes cannot divide, so they respond to increased workload through
hypertrophy by synthesizing more structural proteins and organelles.
,4. A patient’s leg has been immobilized in a cast for six weeks. Upon removal, the muscles appear
smaller and weaker. Which process occurred?
A. Atrophy due to decreased workload
B. Hypertrophy due to disuse
C. Hyperplasia of muscle fibers
D. Metaplasia due to stress
Rationale: Disuse atrophy results from reduced protein synthesis and increased protein
degradation as the cell adjusts its metabolism to reduced functional demand.
5. During myocardial ischemia, which cellular event occurs first?
A. Nuclear fragmentation
B. Decrease in ATP synthesis
C. Lysosomal rupture
D. Cell membrane rupture
Rationale: Oxygen deprivation immediately halts oxidative phosphorylation, leading to ATP
depletion. This precedes other downstream events such as ion pump failure and cell swelling.
6. Which change best characterizes a reversible cell injury?
A. Nuclear pyknosis
B. Cellular swelling
C. Membrane rupture
D. Karyorrhexis
Rationale: Reversible injury is marked by hydropic swelling due to ATP loss and Na⁺/K⁺ pump
failure. If the nucleus remains intact and the membrane is not disrupted, recovery is possible.
7. A liver biopsy from a man exposed to carbon tetrachloride shows dilated rough endoplasmic
reticulum and ribosome detachment. What does this represent?
A. Impaired protein synthesis due to ER stress
B. Increased translational activity
C. Lysosomal activation
D. Nuclear fragmentation
, Rationale: Toxic metabolites disrupt ribosomal binding to the ER, impairing protein synthesis and
leading to ER dilation—an early, reversible form of cell injury.
8. Which organelle is the primary site of ATP production in aerobic metabolism?
A. Lysosome
B. Golgi apparatus
C. Mitochondrion
D. Endoplasmic reticulum
Rationale: Mitochondria produce ATP through oxidative phosphorylation. Loss of mitochondrial
membrane potential is a key feature of irreversible cell injury.
9. After a myocardial infarction, reperfusion of the ischemic tissue paradoxically increases cellular
injury. Why?
A. Persistent hypoxia
B. Rapid ROS formation upon reoxygenation
C. Decreased neutrophil infiltration
D. pH normalization
Rationale: Reintroduction of oxygen generates reactive oxygen species and inflammatory
mediators that exacerbate tissue damage beyond that of initial ischemia.
10. A patient with hypoxia from severe anemia shows mitochondrial swelling. What intracellular
event caused this?
A. DNA fragmentation
B. Loss of mitochondrial membrane potential and calcium overload
C. Increased ATP synthesis
D. Enhanced glycolysis
Rationale: Hypoxia inhibits oxidative phosphorylation, allowing calcium entry and mitochondrial
swelling, a hallmark of early irreversible injury.
11. Which enzyme catalyzes the conversion of superoxide radicals into hydrogen peroxide?
A. Superoxide dismutase
B. Catalase
C. Glutathione peroxidase
