PATHOPHYSIOLOGY OF DISEASE: AN
INTRODUCTION TO CLINICAL MEDICINE
8TH EDITION
AUTHOR(S)GARY D. HAMMER; STEPHEN J.
MCPHEE
TEST BANK
1
Reference
Ch. 1 — Introduction — Disease pathogenesis and homeostasis
Stem
A 58-year-old man with longstanding hypertension is discovered
to have left ventricular hypertrophy (LVH) on echocardiography
despite no symptoms. Which pathophysiologic principle best
explains the development of LVH in this patient as an adaptive
response that later predisposes to heart failure?
,A. Irreversible cellular injury due to ischemia leading to
replacement fibrosis
B. Compensatory hypertrophy from increased mechanical
workload with preserved cell number
C. Hyperplasia of cardiomyocytes mediated by activation of
stem cells
D. Metaplasia of myocardial tissue into fibrocartilaginous tissue
Correct answer
B
Rationale — Correct (B)
Hypertension increases afterload, producing chronic mechanical
stress that stimulates cardiomyocyte hypertrophy (increase in
cell size) as an adaptive response to normalize wall stress. This
is a compensatory, often initially reversible process that
preserves function but later contributes to diastolic dysfunction
and heart failure. This reflects structure–function adaptation
described in the Introduction.
Rationale — Incorrect
A. Irreversible ischemic injury and replacement fibrosis occur
after severe cell death, not as the initial adaptive hypertrophic
response.
C. Adult cardiomyocytes undergo hypertrophy rather than
hyperplasia; proliferation via stem cells is not the principal
mechanism.
D. Metaplasia is change in differentiated cell type (e.g.,
epithelium), not a myocardial transformation to fibrocartilage.
,Teaching point
Chronic hemodynamic overload → cardiomyocyte hypertrophy
(increased cell size), then dysfunction.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
2
Reference
Ch. 1 — Introduction — Reversible versus irreversible cell injury
Stem
A 45-year-old woman presents with an acute toxic ingestion.
Early muscle biopsy shows cell swelling, blebbing, and
mitochondrial swelling but intact nuclei. Three days later tissue
demonstrates karyolysis and loss of architecture. The earliest
morphologic changes correspond to which biochemical
disturbance?
A. DNA fragmentation and cross-linking
B. Persistent ATP depletion with loss of membrane ion pump
function
C. Caspase-mediated internucleosomal cleavage
D. Lysosomal rupture causing immediate enzymatic digestion
Correct answer
B
, Rationale — Correct (B)
Cell swelling, membrane blebbing, and mitochondrial swelling
are hallmarks of reversible injury caused primarily by ATP
depletion that impairs membrane ion pumps (Na⁺/K⁺ ATPase),
leading to ionic imbalance and water influx. Progression to
irreversible injury with karyolysis follows persistent ATP loss and
collapse of membrane integrity.
Rationale — Incorrect
A. DNA fragmentation is a later event in irreversible
injury/apoptosis, not the earliest reversible changes.
C. Caspase-mediated cleavage is characteristic of apoptosis,
which has distinct morphological features from early reversible
injury.
D. Lysosomal rupture contributes to necrosis but is downstream
of membrane failure, not the initiating biochemical disturbance
in reversible injury.
Teaching point
ATP depletion → ion pump failure → cellular swelling: reversible
stage before necrosis.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
3
INTRODUCTION TO CLINICAL MEDICINE
8TH EDITION
AUTHOR(S)GARY D. HAMMER; STEPHEN J.
MCPHEE
TEST BANK
1
Reference
Ch. 1 — Introduction — Disease pathogenesis and homeostasis
Stem
A 58-year-old man with longstanding hypertension is discovered
to have left ventricular hypertrophy (LVH) on echocardiography
despite no symptoms. Which pathophysiologic principle best
explains the development of LVH in this patient as an adaptive
response that later predisposes to heart failure?
,A. Irreversible cellular injury due to ischemia leading to
replacement fibrosis
B. Compensatory hypertrophy from increased mechanical
workload with preserved cell number
C. Hyperplasia of cardiomyocytes mediated by activation of
stem cells
D. Metaplasia of myocardial tissue into fibrocartilaginous tissue
Correct answer
B
Rationale — Correct (B)
Hypertension increases afterload, producing chronic mechanical
stress that stimulates cardiomyocyte hypertrophy (increase in
cell size) as an adaptive response to normalize wall stress. This
is a compensatory, often initially reversible process that
preserves function but later contributes to diastolic dysfunction
and heart failure. This reflects structure–function adaptation
described in the Introduction.
Rationale — Incorrect
A. Irreversible ischemic injury and replacement fibrosis occur
after severe cell death, not as the initial adaptive hypertrophic
response.
C. Adult cardiomyocytes undergo hypertrophy rather than
hyperplasia; proliferation via stem cells is not the principal
mechanism.
D. Metaplasia is change in differentiated cell type (e.g.,
epithelium), not a myocardial transformation to fibrocartilage.
,Teaching point
Chronic hemodynamic overload → cardiomyocyte hypertrophy
(increased cell size), then dysfunction.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
2
Reference
Ch. 1 — Introduction — Reversible versus irreversible cell injury
Stem
A 45-year-old woman presents with an acute toxic ingestion.
Early muscle biopsy shows cell swelling, blebbing, and
mitochondrial swelling but intact nuclei. Three days later tissue
demonstrates karyolysis and loss of architecture. The earliest
morphologic changes correspond to which biochemical
disturbance?
A. DNA fragmentation and cross-linking
B. Persistent ATP depletion with loss of membrane ion pump
function
C. Caspase-mediated internucleosomal cleavage
D. Lysosomal rupture causing immediate enzymatic digestion
Correct answer
B
, Rationale — Correct (B)
Cell swelling, membrane blebbing, and mitochondrial swelling
are hallmarks of reversible injury caused primarily by ATP
depletion that impairs membrane ion pumps (Na⁺/K⁺ ATPase),
leading to ionic imbalance and water influx. Progression to
irreversible injury with karyolysis follows persistent ATP loss and
collapse of membrane integrity.
Rationale — Incorrect
A. DNA fragmentation is a later event in irreversible
injury/apoptosis, not the earliest reversible changes.
C. Caspase-mediated cleavage is characteristic of apoptosis,
which has distinct morphological features from early reversible
injury.
D. Lysosomal rupture contributes to necrosis but is downstream
of membrane failure, not the initiating biochemical disturbance
in reversible injury.
Teaching point
ATP depletion → ion pump failure → cellular swelling: reversible
stage before necrosis.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
3
