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
Question Stem
A 68-year-old man with coronary artery disease develops tissue
hypoxia during a prolonged episode of hypotension. Which
cellular event best explains the earliest reversible change in this
patient’s affected myocardial cells?
Options
A. Mitochondrial membrane rupture releasing cytochrome c
B. Loss of ATP leading to failure of Na⁺/K⁺ ATPase and cell
swelling
C. Extensive nuclear chromatin clumping with karyolysis
,D. Lysosomal membrane rupture with autodigestion of
cytoplasm
Correct Answer
B
Rationales
Correct: Reduced perfusion lowers ATP production; Na⁺/K⁺
ATPase fails, causing intracellular Na⁺ and water accumulation
and reversible cell swelling.
A (incorrect): Mitochondrial membrane rupture with
cytochrome c release is characteristic of irreversible injury and
apoptosis, not the earliest reversible change.
C (incorrect): Karyolysis and profound nuclear changes indicate
irreversible cell death.
D (incorrect): Lysosomal rupture and autodigestion occur later
and signify irreversible injury.
Teaching Point
ATP depletion → Na⁺/K⁺ pump failure → reversible cell swelling.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
2)
Reference
Ch. 1 — Introduction
,Question Stem
A nurse reviews lab and clinical data for a patient with acute
hepatic ischemia. Which laboratory finding most specifically
indicates irreversible cell injury has occurred?
Options
A. Elevated lactate due to anaerobic metabolism
B. Rising serum transaminases (ALT/AST) with persistent
elevation
C. Decreased intracellular ATP in hepatocytes
D. Mildly prolonged prothrombin time
Correct Answer
B
Rationales
Correct: Persistent large increases in ALT/AST reflect cell
membrane rupture and release of intracellular enzymes—
markers of irreversible hepatocellular injury.
A (incorrect): Elevated lactate occurs early with hypoxia and is
not specific for irreversible injury.
C (incorrect): ATP depletion is an early, potentially reversible
event.
D (incorrect): Prolonged PT suggests synthetic dysfunction but is
less specific for timing of irreversible cell death.
Teaching Point
Persistent enzyme leakage (ALT/AST) signals hepatocyte
membrane rupture and irreversible injury.
, Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3)
Reference
Ch. 1 — Introduction
Question Stem
A patient’s tissues are exposed to a high load of reactive oxygen
species (ROS). Which adaptive/repair mechanism is MOST
directly responsible for neutralizing ROS and protecting cells?
Options
A. Activation of caspases to remove damaged cells
B. Upregulation of antioxidant enzymes like superoxide
dismutase and glutathione peroxidase
C. Increased expression of pro-inflammatory cytokines
D. Enhanced lysosomal enzyme release
Correct Answer
B
Rationales
Correct: Antioxidant enzymes (SOD, catalase, glutathione
peroxidase) directly detoxify ROS and limit oxidative injury.
A (incorrect): Caspase activation leads to apoptosis, not ROS
neutralization.
C (incorrect): Pro-inflammatory cytokines may amplify injury,
INTRODUCTION TO CLINICAL MEDICINE
8TH EDITION
AUTHOR(S)GARY D. HAMMER; STEPHEN J.
MCPHEE
TEST BANK
1)
Reference
Ch. 1 — Introduction
Question Stem
A 68-year-old man with coronary artery disease develops tissue
hypoxia during a prolonged episode of hypotension. Which
cellular event best explains the earliest reversible change in this
patient’s affected myocardial cells?
Options
A. Mitochondrial membrane rupture releasing cytochrome c
B. Loss of ATP leading to failure of Na⁺/K⁺ ATPase and cell
swelling
C. Extensive nuclear chromatin clumping with karyolysis
,D. Lysosomal membrane rupture with autodigestion of
cytoplasm
Correct Answer
B
Rationales
Correct: Reduced perfusion lowers ATP production; Na⁺/K⁺
ATPase fails, causing intracellular Na⁺ and water accumulation
and reversible cell swelling.
A (incorrect): Mitochondrial membrane rupture with
cytochrome c release is characteristic of irreversible injury and
apoptosis, not the earliest reversible change.
C (incorrect): Karyolysis and profound nuclear changes indicate
irreversible cell death.
D (incorrect): Lysosomal rupture and autodigestion occur later
and signify irreversible injury.
Teaching Point
ATP depletion → Na⁺/K⁺ pump failure → reversible cell swelling.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
2)
Reference
Ch. 1 — Introduction
,Question Stem
A nurse reviews lab and clinical data for a patient with acute
hepatic ischemia. Which laboratory finding most specifically
indicates irreversible cell injury has occurred?
Options
A. Elevated lactate due to anaerobic metabolism
B. Rising serum transaminases (ALT/AST) with persistent
elevation
C. Decreased intracellular ATP in hepatocytes
D. Mildly prolonged prothrombin time
Correct Answer
B
Rationales
Correct: Persistent large increases in ALT/AST reflect cell
membrane rupture and release of intracellular enzymes—
markers of irreversible hepatocellular injury.
A (incorrect): Elevated lactate occurs early with hypoxia and is
not specific for irreversible injury.
C (incorrect): ATP depletion is an early, potentially reversible
event.
D (incorrect): Prolonged PT suggests synthetic dysfunction but is
less specific for timing of irreversible cell death.
Teaching Point
Persistent enzyme leakage (ALT/AST) signals hepatocyte
membrane rupture and irreversible injury.
, Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3)
Reference
Ch. 1 — Introduction
Question Stem
A patient’s tissues are exposed to a high load of reactive oxygen
species (ROS). Which adaptive/repair mechanism is MOST
directly responsible for neutralizing ROS and protecting cells?
Options
A. Activation of caspases to remove damaged cells
B. Upregulation of antioxidant enzymes like superoxide
dismutase and glutathione peroxidase
C. Increased expression of pro-inflammatory cytokines
D. Enhanced lysosomal enzyme release
Correct Answer
B
Rationales
Correct: Antioxidant enzymes (SOD, catalase, glutathione
peroxidase) directly detoxify ROS and limit oxidative injury.
A (incorrect): Caspase activation leads to apoptosis, not ROS
neutralization.
C (incorrect): Pro-inflammatory cytokines may amplify injury,
