Pathophysiology of Disease: An Introduction to
Clinical Medicine
8th Edition
Author(s)Gary D. Hammer; Stephen J. McPhee
TEST BANK
Reference: Ch. 1 — Introduction
Question Stem:
A 68-year-old man with chronic hypertension
presents with progressive exertional dyspnea.
You must explain how long-standing pressure
overload leads to preserved systolic function
initially but later to heart failure. Which
pathophysiologic process best accounts for
initial compensation in the myocardium?
,Options:
A. Cardiomyocyte hyperplasia increasing
contractile units
B. Increased myocardial capillary density
reducing afterload
C. Concentric hypertrophy via myocyte
sarcomere addition in parallel
D. Diffuse myocardial fibrosis causing increased
compliance
Correct Answer:
C
Rationales:
Correct: Concentric hypertrophy results from
parallel addition of sarcomeres in response to
pressure overload, increasing wall thickness
and maintaining systolic function temporarily.
A (incorrect): Cardiomyocyte hyperplasia does
not occur appreciably in adult human
myocardium; adaptation is primarily by
hypertrophy.
,B (incorrect): Increased capillary density does
not typically accompany pathological pressure
overload and would not reduce afterload.
D (incorrect): Diffuse fibrosis reduces
compliance and contributes to diastolic
dysfunction rather than initial compensation.
Teaching Point:
Pressure overload induces concentric
hypertrophy by adding sarcomeres in parallel.
Citation (Simplified APA):
Hammer & McPhee (2021). Pathophysiology of
Disease (8th Ed.). Ch. 1.
Reference: Ch. 1 — Introduction
Question Stem:
A patient’s lab shows persistent lactic acidosis
after a period of hypotension. As the clinician,
which explanation best links cellular ATP
depletion to this biochemical finding?
, Options:
A. ATP depletion activates mitochondrial
oxidative phosphorylation increasing lactate.
B. Reduced ATP impairs Na⁺/K⁺-ATPase, causing
membrane depolarization and lactic release.
C. Low ATP shifts pyruvate metabolism toward
lactate via increased anaerobic glycolysis.
D. ATP depletion directly converts pyruvate to
lactate through an ATP-dependent enzyme.
Correct Answer:
C
Rationales:
Correct: When ATP is low due to impaired
oxidative phosphorylation, cells rely on
anaerobic glycolysis, converting pyruvate to
lactate to regenerate NAD⁺.
A (incorrect): Oxidative phosphorylation
produces ATP and does not increase lactate
production.
B (incorrect): Na⁺/K⁺-ATPase impairment causes
Clinical Medicine
8th Edition
Author(s)Gary D. Hammer; Stephen J. McPhee
TEST BANK
Reference: Ch. 1 — Introduction
Question Stem:
A 68-year-old man with chronic hypertension
presents with progressive exertional dyspnea.
You must explain how long-standing pressure
overload leads to preserved systolic function
initially but later to heart failure. Which
pathophysiologic process best accounts for
initial compensation in the myocardium?
,Options:
A. Cardiomyocyte hyperplasia increasing
contractile units
B. Increased myocardial capillary density
reducing afterload
C. Concentric hypertrophy via myocyte
sarcomere addition in parallel
D. Diffuse myocardial fibrosis causing increased
compliance
Correct Answer:
C
Rationales:
Correct: Concentric hypertrophy results from
parallel addition of sarcomeres in response to
pressure overload, increasing wall thickness
and maintaining systolic function temporarily.
A (incorrect): Cardiomyocyte hyperplasia does
not occur appreciably in adult human
myocardium; adaptation is primarily by
hypertrophy.
,B (incorrect): Increased capillary density does
not typically accompany pathological pressure
overload and would not reduce afterload.
D (incorrect): Diffuse fibrosis reduces
compliance and contributes to diastolic
dysfunction rather than initial compensation.
Teaching Point:
Pressure overload induces concentric
hypertrophy by adding sarcomeres in parallel.
Citation (Simplified APA):
Hammer & McPhee (2021). Pathophysiology of
Disease (8th Ed.). Ch. 1.
Reference: Ch. 1 — Introduction
Question Stem:
A patient’s lab shows persistent lactic acidosis
after a period of hypotension. As the clinician,
which explanation best links cellular ATP
depletion to this biochemical finding?
, Options:
A. ATP depletion activates mitochondrial
oxidative phosphorylation increasing lactate.
B. Reduced ATP impairs Na⁺/K⁺-ATPase, causing
membrane depolarization and lactic release.
C. Low ATP shifts pyruvate metabolism toward
lactate via increased anaerobic glycolysis.
D. ATP depletion directly converts pyruvate to
lactate through an ATP-dependent enzyme.
Correct Answer:
C
Rationales:
Correct: When ATP is low due to impaired
oxidative phosphorylation, cells rely on
anaerobic glycolysis, converting pyruvate to
lactate to regenerate NAD⁺.
A (incorrect): Oxidative phosphorylation
produces ATP and does not increase lactate
production.
B (incorrect): Na⁺/K⁺-ATPase impairment causes
