ANATOMICAL CHART COMPANY ATLAS
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
1
Reference: Ch. 1 — Cellular Membrane Function & Ion
Transport
Stem: A 68-year-old man with prolonged hypotension presents
with confusion and oliguria after an episode of sepsis.
Laboratory studies show hyponatremia and rising serum
creatinine. Which pathophysiologic process best explains the
patient’s acute cellular dysfunction in renal tubular cells?
,A. Increased Na⁺/K⁺-ATPase activity causing intracellular
hypernatremia
B. Loss of ATP leading to failure of ion pumps and cell swelling
C. Increased aerobic metabolism with enhanced mitochondrial
function
D. Apoptosis mediated via intrinsic mitochondrial cytochrome-c
release
Correct answer: B
Rationale — Correct (B): Hypotension and sepsis reduce tissue
perfusion and oxygen delivery, causing decreased ATP
production. ATP-dependent Na⁺/K⁺ pumps fail, sodium
accumulates intracellularly and osmotic water influx causes cell
swelling — classic reversible cell injury in renal tubular cells.
Rationale — Incorrect:
• A: Increased Na⁺/K⁺-ATPase activity would maintain ionic
gradients; not expected with ATP depletion.
• C: Aerobic metabolism is impaired in hypoperfusion;
mitochondrial dysfunction, not enhancement, occurs.
• D: Apoptosis is energy-dependent programmed death;
acute ischemic tubular necrosis is primarily necrosis from
ATP loss.
Teaching point: ATP depletion → Na⁺/K⁺ pump failure → cellular
swelling is hallmark of reversible cell injury.
,Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Ch. 1.
2
Reference: Ch. 2 — Cellular Adaptation: Atrophy, Hypertrophy,
Hyperplasia, Metaplasia
Stem: A 55-year-old female smoker develops chronic cough.
Bronchoscopic biopsy shows replacement of normal
pseudostratified ciliated columnar epithelium by stratified
squamous epithelium. Which adaptive mechanism and risk
does this represent?
A. Dysplasia; immediate progression to carcinoma is certain
B. Metaplasia; adaptive change that increases squamous
carcinoma risk if stimulus persists
C. Hyperplasia; reversible with no increased cancer risk
D. Hypertrophy; increased cell size protecting against toxins
Correct answer: B
Rationale — Correct (B): Chronic cigarette smoke causes
persistent irritation; columnar epithelium transforms to
stratified squamous (metaplasia) as an adaptive, reversible
response. Persistent injury increases risk of dysplasia and
malignant transformation (squamous cell carcinoma).
Rationale — Incorrect:
, • A: Dysplasia is disordered growth with atypia; metaplasia
precedes dysplasia.
• C: Hyperplasia is increased cell number (e.g., endometrial);
not the epithelial replacement described.
• D: Hypertrophy is increased cell size, not epithelial type
change.
Teaching point: Metaplasia is adaptive but predisposes to
dysplasia/cancer if injurious stimulus continues.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Ch. 2.
3
Reference: Ch. 3 — Hypoxic and Ischemic Cellular Injury;
Reperfusion Injury
Stem: A 60-year-old man had a 90-minute myocardial ischemic
episode followed by reperfusion therapy. Over the next 24
hours, markers of oxidative injury increase. Which mechanism
best explains reperfusion-related cell damage?
A. Restoration of ATP prevents any further injury
B. Reperfusion generates reactive oxygen species that damage
cell membranes
C. Increased anaerobic glycolysis during reperfusion causes
lactic acidosis and cell swelling
OF PATHOPHYSIOLOGY
4TH EDITION
• AUTHOR(S)JULIE STEWART
TEST BANK
1
Reference: Ch. 1 — Cellular Membrane Function & Ion
Transport
Stem: A 68-year-old man with prolonged hypotension presents
with confusion and oliguria after an episode of sepsis.
Laboratory studies show hyponatremia and rising serum
creatinine. Which pathophysiologic process best explains the
patient’s acute cellular dysfunction in renal tubular cells?
,A. Increased Na⁺/K⁺-ATPase activity causing intracellular
hypernatremia
B. Loss of ATP leading to failure of ion pumps and cell swelling
C. Increased aerobic metabolism with enhanced mitochondrial
function
D. Apoptosis mediated via intrinsic mitochondrial cytochrome-c
release
Correct answer: B
Rationale — Correct (B): Hypotension and sepsis reduce tissue
perfusion and oxygen delivery, causing decreased ATP
production. ATP-dependent Na⁺/K⁺ pumps fail, sodium
accumulates intracellularly and osmotic water influx causes cell
swelling — classic reversible cell injury in renal tubular cells.
Rationale — Incorrect:
• A: Increased Na⁺/K⁺-ATPase activity would maintain ionic
gradients; not expected with ATP depletion.
• C: Aerobic metabolism is impaired in hypoperfusion;
mitochondrial dysfunction, not enhancement, occurs.
• D: Apoptosis is energy-dependent programmed death;
acute ischemic tubular necrosis is primarily necrosis from
ATP loss.
Teaching point: ATP depletion → Na⁺/K⁺ pump failure → cellular
swelling is hallmark of reversible cell injury.
,Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Ch. 1.
2
Reference: Ch. 2 — Cellular Adaptation: Atrophy, Hypertrophy,
Hyperplasia, Metaplasia
Stem: A 55-year-old female smoker develops chronic cough.
Bronchoscopic biopsy shows replacement of normal
pseudostratified ciliated columnar epithelium by stratified
squamous epithelium. Which adaptive mechanism and risk
does this represent?
A. Dysplasia; immediate progression to carcinoma is certain
B. Metaplasia; adaptive change that increases squamous
carcinoma risk if stimulus persists
C. Hyperplasia; reversible with no increased cancer risk
D. Hypertrophy; increased cell size protecting against toxins
Correct answer: B
Rationale — Correct (B): Chronic cigarette smoke causes
persistent irritation; columnar epithelium transforms to
stratified squamous (metaplasia) as an adaptive, reversible
response. Persistent injury increases risk of dysplasia and
malignant transformation (squamous cell carcinoma).
Rationale — Incorrect:
, • A: Dysplasia is disordered growth with atypia; metaplasia
precedes dysplasia.
• C: Hyperplasia is increased cell number (e.g., endometrial);
not the epithelial replacement described.
• D: Hypertrophy is increased cell size, not epithelial type
change.
Teaching point: Metaplasia is adaptive but predisposes to
dysplasia/cancer if injurious stimulus continues.
Citation: Stewart, J. (4th ed.). Anatomical Chart Company Atlas
of Pathophysiology. Ch. 2.
3
Reference: Ch. 3 — Hypoxic and Ischemic Cellular Injury;
Reperfusion Injury
Stem: A 60-year-old man had a 90-minute myocardial ischemic
episode followed by reperfusion therapy. Over the next 24
hours, markers of oxidative injury increase. Which mechanism
best explains reperfusion-related cell damage?
A. Restoration of ATP prevents any further injury
B. Reperfusion generates reactive oxygen species that damage
cell membranes
C. Increased anaerobic glycolysis during reperfusion causes
lactic acidosis and cell swelling
