GOULD'S PATHOPHYSIOLOGY FOR THE
HEALTH PROFESSIONS
7TH EDITION
• AUTHOR(S)KARIN C. VANMETER;
ROBERT J. HUBERT
TEST BANK
1
Reference
Ch. 1 — Introduction to Pathophysiology — What Is
Pathophysiology and Why Study It?
Stem
A 58-year-old nurse notices that a patient with chronic reduced
perfusion to a limb has a visibly smaller calf muscle on the
affected side. Integrating cellular adaptation concepts, which
process best explains the decrease in muscle mass and why it
occurs?
Options
A. Hypertrophy due to increased workload on remaining muscle
,fibers
B. Hyperplasia from increased satellite cell proliferation
C. Atrophy from reduced workload and decreased protein
synthesis
D. Metaplasia from phenotypic change in muscle cells
Correct Answer
C
Rationale — Correct (3–4 sentences)
Atrophy represents a reduction in cell size and function from
decreased workload, insufficient nutrients, or diminished blood
supply, driven by decreased protein synthesis and increased
proteasomal degradation. In chronic reduced perfusion, muscle
cells downregulate energy-consuming processes, causing loss of
myofibrils and cell shrinkage. This mechanism explains the
smaller calf muscle without new cell types forming. (Aligns with
Gould’s pathophysiology description of atrophy.)
Rationale — Incorrect
A. Hypertrophy increases cell size and would enlarge, not
shrink, muscle.
B. Hyperplasia increases cell number and is uncommon in
mature skeletal muscle.
D. Metaplasia is change of one differentiated cell type to
another, not reduction in size.
Teaching Point
Atrophy = decreased cell size from reduced workload, nutrition,
or perfusion.
,Citation
VanMeter, K. C., & Hubert, R. J. (2024). Gould’s Pathophysiology
for the Health Professions (7th ed.). Ch. 1.
2
Reference
Ch. 1 — Introduction to Pathophysiology — Introduction to
Cellular Changes
Stem
A patient’s biopsy shows replacement of normal bronchial
pseudostratified epithelium with stratified squamous
epithelium after years of cigarette smoke exposure. Which
mechanistic explanation best accounts for this histologic
change?
Options
A. Adaptive hypertrophy to increase metabolic capacity
B. Reversible cell injury causing necrosis and fibrosis
C. Metaplasia due to chronic irritant driving reprogramming of
stem cells
D. Oncogenic transformation producing dysplastic epithelium
Correct Answer
C
Rationale — Correct (3–4 sentences)
Metaplasia is an adaptive substitution of one differentiated cell
type for another better suited to withstand chronic stress;
, cigarette smoke induces reprogramming of basal
stem/progenitor cells to produce squamous epithelium. This
change is protective initially but can impair mucociliary
clearance and predispose to further injury. Gould emphasizes
metaplasia as a reversible, adaptive response to persistent
irritation.
Rationale — Incorrect
A. Hypertrophy increases cell size, not change cell phenotype.
B. Reversible injury does not produce organized replacement of
cell type.
D. Dysplasia and oncogenic transformation are different
processes; metaplasia precedes but is not equivalent to
malignant change.
Teaching Point
Metaplasia = adaptive phenotype change from chronic
irritation; stems from progenitor cell reprogramming.
Citation
VanMeter, K. C., & Hubert, R. J. (2024). Gould’s Pathophysiology
for the Health Professions (7th ed.). Ch. 1.
3
Reference
Ch. 1 — Introduction to Pathophysiology — Introduction to
Cellular Changes
HEALTH PROFESSIONS
7TH EDITION
• AUTHOR(S)KARIN C. VANMETER;
ROBERT J. HUBERT
TEST BANK
1
Reference
Ch. 1 — Introduction to Pathophysiology — What Is
Pathophysiology and Why Study It?
Stem
A 58-year-old nurse notices that a patient with chronic reduced
perfusion to a limb has a visibly smaller calf muscle on the
affected side. Integrating cellular adaptation concepts, which
process best explains the decrease in muscle mass and why it
occurs?
Options
A. Hypertrophy due to increased workload on remaining muscle
,fibers
B. Hyperplasia from increased satellite cell proliferation
C. Atrophy from reduced workload and decreased protein
synthesis
D. Metaplasia from phenotypic change in muscle cells
Correct Answer
C
Rationale — Correct (3–4 sentences)
Atrophy represents a reduction in cell size and function from
decreased workload, insufficient nutrients, or diminished blood
supply, driven by decreased protein synthesis and increased
proteasomal degradation. In chronic reduced perfusion, muscle
cells downregulate energy-consuming processes, causing loss of
myofibrils and cell shrinkage. This mechanism explains the
smaller calf muscle without new cell types forming. (Aligns with
Gould’s pathophysiology description of atrophy.)
Rationale — Incorrect
A. Hypertrophy increases cell size and would enlarge, not
shrink, muscle.
B. Hyperplasia increases cell number and is uncommon in
mature skeletal muscle.
D. Metaplasia is change of one differentiated cell type to
another, not reduction in size.
Teaching Point
Atrophy = decreased cell size from reduced workload, nutrition,
or perfusion.
,Citation
VanMeter, K. C., & Hubert, R. J. (2024). Gould’s Pathophysiology
for the Health Professions (7th ed.). Ch. 1.
2
Reference
Ch. 1 — Introduction to Pathophysiology — Introduction to
Cellular Changes
Stem
A patient’s biopsy shows replacement of normal bronchial
pseudostratified epithelium with stratified squamous
epithelium after years of cigarette smoke exposure. Which
mechanistic explanation best accounts for this histologic
change?
Options
A. Adaptive hypertrophy to increase metabolic capacity
B. Reversible cell injury causing necrosis and fibrosis
C. Metaplasia due to chronic irritant driving reprogramming of
stem cells
D. Oncogenic transformation producing dysplastic epithelium
Correct Answer
C
Rationale — Correct (3–4 sentences)
Metaplasia is an adaptive substitution of one differentiated cell
type for another better suited to withstand chronic stress;
, cigarette smoke induces reprogramming of basal
stem/progenitor cells to produce squamous epithelium. This
change is protective initially but can impair mucociliary
clearance and predispose to further injury. Gould emphasizes
metaplasia as a reversible, adaptive response to persistent
irritation.
Rationale — Incorrect
A. Hypertrophy increases cell size, not change cell phenotype.
B. Reversible injury does not produce organized replacement of
cell type.
D. Dysplasia and oncogenic transformation are different
processes; metaplasia precedes but is not equivalent to
malignant change.
Teaching Point
Metaplasia = adaptive phenotype change from chronic
irritation; stems from progenitor cell reprogramming.
Citation
VanMeter, K. C., & Hubert, R. J. (2024). Gould’s Pathophysiology
for the Health Professions (7th ed.). Ch. 1.
3
Reference
Ch. 1 — Introduction to Pathophysiology — Introduction to
Cellular Changes
