Pathophysiology of Disease: An Introduction to
Clinical Medicine
8th Edition
Author(s)Gary D. Hammer; Stephen J. McPhee
TEST BANK
5
Reference
Ch. 1 — Introduction
Question Stem
A patient’s biopsy shows tissue hypoxia with increased lactate
production but preserved cell membrane integrity. Which stage
of cellular injury does this represent and what is the primary
metabolic change?
Options
A. Irreversible injury — oxidative phosphorylation is intact.
B. Reversible injury — shift from aerobic to anaerobic glycolysis.
,C. Apoptosis — increased mitochondrial ATP synthesis.
D. Necrosis — loss of glycolytic enzymes.
Correct Answer
B
Rationales
• Correct (B): Reversible injury from hypoxia leads to
decreased aerobic respiration and compensatory
anaerobic glycolysis, increasing lactate while membranes
remain intact.
• A (incorrect): Irreversible injury implies membrane
damage and death; oxidative phosphorylation would be
impaired.
• C (incorrect): Apoptosis involves programmed cell death
with energy-dependent steps, not increased ATP synthesis.
• D (incorrect): Necrosis follows irreversible injury and
membrane rupture, not simply increased lactate with
preserved membranes.
Teaching Point
Reversible hypoxic injury shifts cells to anaerobic glycolysis and
lactate accumulation.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
,6
Reference
Ch. 1 — Introduction
Question Stem
A clinician must choose a biomarker to detect early myocardial
injury. Which property makes a protein biomarker most useful
for early detection of tissue-specific injury?
Options
A. High intracellular abundance and rapid release after cell
membrane disruption.
B. Exclusive expression in all cell types for systemic sensitivity.
C. Short plasma half-life to avoid detection.
D. Expression only during fetal development.
Correct Answer
A
Rationales
• Correct (A): A useful tissue-specific biomarker is abundant
intracellularly and rapidly released when cell membranes
are damaged, allowing early detection.
• B (incorrect): Ubiquitous expression reduces tissue
specificity and diagnostic value.
• C (incorrect): Very short half-life may reduce detectability
during the diagnostic window.
, • D (incorrect): Fetal-only expression is irrelevant for
detecting adult myocardial injury.
Teaching Point
Ideal biomarkers are tissue-specific, abundant, and rapidly
released after injury.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
7
Reference
Ch. 2 — Genetic Disease
Question Stem
A 28-year-old woman with a family history of an autosomal
dominant disease wants genetic counseling. Which statement
best explains why a parent with the pathogenic variant may
show variable severity among affected relatives?
Options
A. Variable expressivity and modifier genes alter phenotypic
severity.
B. Autosomal dominant traits always produce identical
phenotypes in all carriers.
C. Mitochondrial heteroplasmy explains variable severity in
autosomal dominant diseases.
D. X-inactivation in males causes variable expressivity.
Clinical Medicine
8th Edition
Author(s)Gary D. Hammer; Stephen J. McPhee
TEST BANK
5
Reference
Ch. 1 — Introduction
Question Stem
A patient’s biopsy shows tissue hypoxia with increased lactate
production but preserved cell membrane integrity. Which stage
of cellular injury does this represent and what is the primary
metabolic change?
Options
A. Irreversible injury — oxidative phosphorylation is intact.
B. Reversible injury — shift from aerobic to anaerobic glycolysis.
,C. Apoptosis — increased mitochondrial ATP synthesis.
D. Necrosis — loss of glycolytic enzymes.
Correct Answer
B
Rationales
• Correct (B): Reversible injury from hypoxia leads to
decreased aerobic respiration and compensatory
anaerobic glycolysis, increasing lactate while membranes
remain intact.
• A (incorrect): Irreversible injury implies membrane
damage and death; oxidative phosphorylation would be
impaired.
• C (incorrect): Apoptosis involves programmed cell death
with energy-dependent steps, not increased ATP synthesis.
• D (incorrect): Necrosis follows irreversible injury and
membrane rupture, not simply increased lactate with
preserved membranes.
Teaching Point
Reversible hypoxic injury shifts cells to anaerobic glycolysis and
lactate accumulation.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
,6
Reference
Ch. 1 — Introduction
Question Stem
A clinician must choose a biomarker to detect early myocardial
injury. Which property makes a protein biomarker most useful
for early detection of tissue-specific injury?
Options
A. High intracellular abundance and rapid release after cell
membrane disruption.
B. Exclusive expression in all cell types for systemic sensitivity.
C. Short plasma half-life to avoid detection.
D. Expression only during fetal development.
Correct Answer
A
Rationales
• Correct (A): A useful tissue-specific biomarker is abundant
intracellularly and rapidly released when cell membranes
are damaged, allowing early detection.
• B (incorrect): Ubiquitous expression reduces tissue
specificity and diagnostic value.
• C (incorrect): Very short half-life may reduce detectability
during the diagnostic window.
, • D (incorrect): Fetal-only expression is irrelevant for
detecting adult myocardial injury.
Teaching Point
Ideal biomarkers are tissue-specific, abundant, and rapidly
released after injury.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
7
Reference
Ch. 2 — Genetic Disease
Question Stem
A 28-year-old woman with a family history of an autosomal
dominant disease wants genetic counseling. Which statement
best explains why a parent with the pathogenic variant may
show variable severity among affected relatives?
Options
A. Variable expressivity and modifier genes alter phenotypic
severity.
B. Autosomal dominant traits always produce identical
phenotypes in all carriers.
C. Mitochondrial heteroplasmy explains variable severity in
autosomal dominant diseases.
D. X-inactivation in males causes variable expressivity.
