ANATOMICAL CHART COMPANY ATLAS
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
Reference
Part I — Cells, Homeostasis, and Disease — Cellular Atrophy
(Adaptive Responses)
Stem
A 68-year-old man was admitted after a hip fracture and placed
on prolonged bed rest. Over two weeks the nurse notes
decreased muscle bulk and reduced strength in the affected
limb despite normal sensation and perfusion. Which
,pathophysiologic process best explains the observed muscle
changes?
A. Increased apoptosis of muscle cells due to ischemia
B. Disuse atrophy from decreased workload and reduced
protein synthesis
C. Denervation atrophy from peripheral nerve injury
D. Hypertrophy of type I fibers replacing type II fibers
Correct Answer: B
Rationale — Correct (B)
Disuse atrophy occurs when reduced workload decreases
protein synthesis and increases proteasomal degradation,
causing loss of muscle mass without cell death. The scenario of
immobilization fits decreased metabolic demand and reversible
reduction in cell size.
Rationale — Incorrect
A. Apoptosis due to ischemia would show cellular death
features; perfusion is normal.
C. Denervation atrophy follows nerve injury and presents with
loss of reflexes and sensation.
D. Hypertrophy involves increased cell size, not the decreased
bulk described.
Teaching Point:
Disuse reduces protein synthesis → reversible cellular atrophy;
encourage early mobilization.
,Citation:
Stewart, J. (4th ed.). Anatomical Chart Company Atlas of
Pathophysiology. Part I.
2
Reference
Part I — Cells, Homeostasis, and Disease — Cellular
Hypertrophy (Adaptive Responses)
Stem
A 55-year-old woman with long-standing uncontrolled
hypertension reports increasing exertional dyspnea.
Echocardiography shows concentric left ventricular thickening
with preserved chamber size. The nurse interprets this as which
cellular adaptation?
A. Hyperplasia of myocardial fibers producing more cells
B. Hypertrophy of cardiac myocytes due to increased workload
C. Dysplastic change of myocardial tissue predisposing to
arrhythmia
D. Metaplasia with replacement of myocardium by fibroblasts
Correct Answer: B
Rationale — Correct (B)
Chronic pressure overload (hypertension) stimulates cardiac
myocyte hypertrophy—cells enlarge to increase contractile
force resulting in concentric LV hypertrophy. This is an adaptive
increase in cell size, not cell number.
, Rationale — Incorrect
A. Cardiac myocytes are terminally differentiated—hyperplasia
is not the primary response.
C. Dysplasia is disordered growth usually in epithelial tissues,
not concentric hypertrophy.
D. Metaplasia implies cell type change; fibroblast replacement
describes fibrosis, not adaptive hypertrophy.
Teaching Point:
Chronic pressure overload → myocyte hypertrophy; monitor for
eventual heart failure.
Citation:
Stewart, J. (4th ed.). Anatomical Chart Company Atlas of
Pathophysiology. Part I.
3
Reference
Part I — Cells, Homeostasis, and Disease — Hyperplasia and
Hormonal Stimulation
Stem
A 34-year-old woman on combined oral contraceptives presents
with prolonged, heavy menstrual bleeding. Endometrial biopsy
reveals increased glandular tissue without atypia. Which
mechanism most likely produced this histologic change?
A. Estrogen-driven endometrial hyperplasia (increased cell
proliferation)
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
Reference
Part I — Cells, Homeostasis, and Disease — Cellular Atrophy
(Adaptive Responses)
Stem
A 68-year-old man was admitted after a hip fracture and placed
on prolonged bed rest. Over two weeks the nurse notes
decreased muscle bulk and reduced strength in the affected
limb despite normal sensation and perfusion. Which
,pathophysiologic process best explains the observed muscle
changes?
A. Increased apoptosis of muscle cells due to ischemia
B. Disuse atrophy from decreased workload and reduced
protein synthesis
C. Denervation atrophy from peripheral nerve injury
D. Hypertrophy of type I fibers replacing type II fibers
Correct Answer: B
Rationale — Correct (B)
Disuse atrophy occurs when reduced workload decreases
protein synthesis and increases proteasomal degradation,
causing loss of muscle mass without cell death. The scenario of
immobilization fits decreased metabolic demand and reversible
reduction in cell size.
Rationale — Incorrect
A. Apoptosis due to ischemia would show cellular death
features; perfusion is normal.
C. Denervation atrophy follows nerve injury and presents with
loss of reflexes and sensation.
D. Hypertrophy involves increased cell size, not the decreased
bulk described.
Teaching Point:
Disuse reduces protein synthesis → reversible cellular atrophy;
encourage early mobilization.
,Citation:
Stewart, J. (4th ed.). Anatomical Chart Company Atlas of
Pathophysiology. Part I.
2
Reference
Part I — Cells, Homeostasis, and Disease — Cellular
Hypertrophy (Adaptive Responses)
Stem
A 55-year-old woman with long-standing uncontrolled
hypertension reports increasing exertional dyspnea.
Echocardiography shows concentric left ventricular thickening
with preserved chamber size. The nurse interprets this as which
cellular adaptation?
A. Hyperplasia of myocardial fibers producing more cells
B. Hypertrophy of cardiac myocytes due to increased workload
C. Dysplastic change of myocardial tissue predisposing to
arrhythmia
D. Metaplasia with replacement of myocardium by fibroblasts
Correct Answer: B
Rationale — Correct (B)
Chronic pressure overload (hypertension) stimulates cardiac
myocyte hypertrophy—cells enlarge to increase contractile
force resulting in concentric LV hypertrophy. This is an adaptive
increase in cell size, not cell number.
, Rationale — Incorrect
A. Cardiac myocytes are terminally differentiated—hyperplasia
is not the primary response.
C. Dysplasia is disordered growth usually in epithelial tissues,
not concentric hypertrophy.
D. Metaplasia implies cell type change; fibroblast replacement
describes fibrosis, not adaptive hypertrophy.
Teaching Point:
Chronic pressure overload → myocyte hypertrophy; monitor for
eventual heart failure.
Citation:
Stewart, J. (4th ed.). Anatomical Chart Company Atlas of
Pathophysiology. Part I.
3
Reference
Part I — Cells, Homeostasis, and Disease — Hyperplasia and
Hormonal Stimulation
Stem
A 34-year-old woman on combined oral contraceptives presents
with prolonged, heavy menstrual bleeding. Endometrial biopsy
reveals increased glandular tissue without atypia. Which
mechanism most likely produced this histologic change?
A. Estrogen-driven endometrial hyperplasia (increased cell
proliferation)
