SOLUTION MANUAL FOR PATHOPHYSIOLOGY
PRACTICAL APPROACH 4TH EDITION BY LACHEL
STORY TEST BANK CHAPTERS 1 - 14 UPDATED
2026
Chapter 1 Summary: Cellular Function
Question 1
A patient with chronic hypertension has an enlarged left ventricular wall on
echocardiogram. This cardiac change is an example of which cellular
adaptation?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: B
Rationale: Hypertrophy is the increase in the size of cells in response to
increased workload. The left ventricular muscle cells enlarge to pump against
elevated systemic pressure, leading to a thicker heart wall.
Question 2
Which of the following is the most common cause of cellular injury?
A) Chemical toxins
B) Physical trauma
C) Hypoxia
D) Infectious agents
Answer: C
Rationale: Hypoxia, or inadequate oxygen delivery to cells, is the most
common cause of cellular injury. It impairs aerobic metabolism, leading to a
cascade of dysfunction, often due to ischemia (loss of blood flow).
Question 3
A patient with chronic gastroesophageal reflux disease (GERD) has a biopsy
showing that the normal squamous epithelium in the lower esophagus has been
replaced by columnar epithelium. This change is termed:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
,Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type by
another, often in response to chronic irritation. In GERD, the acid-resistant
columnar cells replace squamous cells as an adaptive, though abnormal,
response.
Question 4
The irreversible loss of function that occurs when cells are unable to maintain
homeostasis, characterized by nuclear changes like pyknosis and karyorrhexis,
is defined as:
A) Adaptation
B) Apoptosis
C) Necrosis
D) Ischemia
Answer: C
Rationale: Necrosis is the pathologic death of cells and living tissue,
characterized by cell swelling, rupture, and nuclear disintegration (pyknosis,
karyorrhexis, karyolysis). It triggers inflammation.
Question 5
Which type of cellular adaptation is characterized by an increase in
the number of cells in an organ or tissue?
A) Hypertrophy
B) Atrophy
C) Hyperplasia
D) Metaplasia
Answer: C
Rationale: Hyperplasia is an increase in the number of cells. This can be
physiologic (e.g., breast tissue during pregnancy) or pathologic (e.g.,
endometrial hyperplasia).
Question 6
Free radicals cause cellular injury primarily by:
A) Depleting cellular glycogen stores
B) Damaging cell membranes via lipid peroxidation
C) Blocking protein synthesis
D) Increasing intracellular pH
Answer: B
Rationale: Free radicals are unstable molecules with an unpaired electron. They
cause injury by stealing electrons from stable molecules, particularly lipids in
,cell membranes, through a process called lipid peroxidation, which disrupts
membrane integrity.
Question 7
A patient with prolonged bed rest experiences a decrease in muscle mass and
strength. This is an example of:
A) Hypertrophy
B) Disuse atrophy
C) Pathologic hyperplasia
D) Metaplasia
Answer: B
Rationale: Atrophy is a decrease in cell size. Disuse atrophy occurs from a lack
of workload or stimulation, such as immobility from bed rest, leading to
reduced muscle protein synthesis and increased degradation.
Question 8
Programmed cell death that is a normal, controlled process for eliminating
unwanted or damaged cells without causing inflammation is called:
A) Necrosis
B) Autophagy
C) Apoptosis
D) Gangrene
Answer: C
Rationale: Apoptosis is a programmed, energy-dependent ("suicide") process
for physiologic cell deletion (e.g., embryonic development, shedding of
intestinal lining). Cells fragment into apoptotic bodies that are phagocytized,
preventing inflammation.
Question 9
A skin biopsy from a sun-exposed area reveals disordered cell growth with
variation in cell size, shape, and nuclear appearance. This is most indicative of:
A) Compensatory hyperplasia
B) Metaplasia
C) Dysplasia
D) Hypertrophy
Answer: C
Rationale: Dysplasia is an abnormal change in the size, shape, and organization
of mature cells. It is often a precursor to cancer (pre-neoplastic) and is
commonly seen with chronic irritation or infection, such as from UV radiation.
Question 10
The phase of the cell cycle where DNA replication occurs is:
, A) G1 (Gap 1)
B) S (Synthesis)
C) G2 (Gap 2)
D) M (Mitosis)
Answer: B
Rationale: The S phase (Synthesis) is when DNA is replicated, resulting in two
identical sets of chromosomes. This must occur accurately before the cell can
proceed to mitosis (M phase).
Question 11
Ischemia-reperfusion injury often causes more severe cellular damage because:
A) Blood flow restoration increases oxygen, leading to a burst of free radical
production.
B) It prevents inflammatory cells from reaching the site.
C) It immediately reverses all ATP depletion.
D) It promotes rapid apoptosis of all injured cells.
Answer: A
Rationale: When blood flow (and oxygen) is restored to previously ischemic
tissue, it fuels the generation of a large number of damaging free radicals
through oxidative metabolism, paradoxically increasing injury beyond the initial
ischemic damage.
Question 12
A patient presents with gangrene of the foot following prolonged frostbite. This
necrotic tissue is best described as:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Dry gangrene
Answer: D
Rationale: Dry gangrene is a form of coagulative necrosis that occurs when
tissue dies and dries out, typically from a gradual loss of blood supply
(ischemia) as seen in frostbite, diabetes, or arterial insufficiency. It appears dry,
shrunken, and black.
Question 13
Which organelle is responsible for producing adenosine triphosphate (ATP)
through oxidative phosphorylation?
A) Golgi apparatus
B) Lysosome
C) Mitochondrion
PRACTICAL APPROACH 4TH EDITION BY LACHEL
STORY TEST BANK CHAPTERS 1 - 14 UPDATED
2026
Chapter 1 Summary: Cellular Function
Question 1
A patient with chronic hypertension has an enlarged left ventricular wall on
echocardiogram. This cardiac change is an example of which cellular
adaptation?
A) Atrophy
B) Hypertrophy
C) Hyperplasia
D) Metaplasia
Answer: B
Rationale: Hypertrophy is the increase in the size of cells in response to
increased workload. The left ventricular muscle cells enlarge to pump against
elevated systemic pressure, leading to a thicker heart wall.
Question 2
Which of the following is the most common cause of cellular injury?
A) Chemical toxins
B) Physical trauma
C) Hypoxia
D) Infectious agents
Answer: C
Rationale: Hypoxia, or inadequate oxygen delivery to cells, is the most
common cause of cellular injury. It impairs aerobic metabolism, leading to a
cascade of dysfunction, often due to ischemia (loss of blood flow).
Question 3
A patient with chronic gastroesophageal reflux disease (GERD) has a biopsy
showing that the normal squamous epithelium in the lower esophagus has been
replaced by columnar epithelium. This change is termed:
A) Dysplasia
B) Hyperplasia
C) Metaplasia
D) Anaplasia
,Answer: C
Rationale: Metaplasia is the reversible replacement of one mature cell type by
another, often in response to chronic irritation. In GERD, the acid-resistant
columnar cells replace squamous cells as an adaptive, though abnormal,
response.
Question 4
The irreversible loss of function that occurs when cells are unable to maintain
homeostasis, characterized by nuclear changes like pyknosis and karyorrhexis,
is defined as:
A) Adaptation
B) Apoptosis
C) Necrosis
D) Ischemia
Answer: C
Rationale: Necrosis is the pathologic death of cells and living tissue,
characterized by cell swelling, rupture, and nuclear disintegration (pyknosis,
karyorrhexis, karyolysis). It triggers inflammation.
Question 5
Which type of cellular adaptation is characterized by an increase in
the number of cells in an organ or tissue?
A) Hypertrophy
B) Atrophy
C) Hyperplasia
D) Metaplasia
Answer: C
Rationale: Hyperplasia is an increase in the number of cells. This can be
physiologic (e.g., breast tissue during pregnancy) or pathologic (e.g.,
endometrial hyperplasia).
Question 6
Free radicals cause cellular injury primarily by:
A) Depleting cellular glycogen stores
B) Damaging cell membranes via lipid peroxidation
C) Blocking protein synthesis
D) Increasing intracellular pH
Answer: B
Rationale: Free radicals are unstable molecules with an unpaired electron. They
cause injury by stealing electrons from stable molecules, particularly lipids in
,cell membranes, through a process called lipid peroxidation, which disrupts
membrane integrity.
Question 7
A patient with prolonged bed rest experiences a decrease in muscle mass and
strength. This is an example of:
A) Hypertrophy
B) Disuse atrophy
C) Pathologic hyperplasia
D) Metaplasia
Answer: B
Rationale: Atrophy is a decrease in cell size. Disuse atrophy occurs from a lack
of workload or stimulation, such as immobility from bed rest, leading to
reduced muscle protein synthesis and increased degradation.
Question 8
Programmed cell death that is a normal, controlled process for eliminating
unwanted or damaged cells without causing inflammation is called:
A) Necrosis
B) Autophagy
C) Apoptosis
D) Gangrene
Answer: C
Rationale: Apoptosis is a programmed, energy-dependent ("suicide") process
for physiologic cell deletion (e.g., embryonic development, shedding of
intestinal lining). Cells fragment into apoptotic bodies that are phagocytized,
preventing inflammation.
Question 9
A skin biopsy from a sun-exposed area reveals disordered cell growth with
variation in cell size, shape, and nuclear appearance. This is most indicative of:
A) Compensatory hyperplasia
B) Metaplasia
C) Dysplasia
D) Hypertrophy
Answer: C
Rationale: Dysplasia is an abnormal change in the size, shape, and organization
of mature cells. It is often a precursor to cancer (pre-neoplastic) and is
commonly seen with chronic irritation or infection, such as from UV radiation.
Question 10
The phase of the cell cycle where DNA replication occurs is:
, A) G1 (Gap 1)
B) S (Synthesis)
C) G2 (Gap 2)
D) M (Mitosis)
Answer: B
Rationale: The S phase (Synthesis) is when DNA is replicated, resulting in two
identical sets of chromosomes. This must occur accurately before the cell can
proceed to mitosis (M phase).
Question 11
Ischemia-reperfusion injury often causes more severe cellular damage because:
A) Blood flow restoration increases oxygen, leading to a burst of free radical
production.
B) It prevents inflammatory cells from reaching the site.
C) It immediately reverses all ATP depletion.
D) It promotes rapid apoptosis of all injured cells.
Answer: A
Rationale: When blood flow (and oxygen) is restored to previously ischemic
tissue, it fuels the generation of a large number of damaging free radicals
through oxidative metabolism, paradoxically increasing injury beyond the initial
ischemic damage.
Question 12
A patient presents with gangrene of the foot following prolonged frostbite. This
necrotic tissue is best described as:
A) Coagulative necrosis
B) Liquefactive necrosis
C) Caseous necrosis
D) Dry gangrene
Answer: D
Rationale: Dry gangrene is a form of coagulative necrosis that occurs when
tissue dies and dries out, typically from a gradual loss of blood supply
(ischemia) as seen in frostbite, diabetes, or arterial insufficiency. It appears dry,
shrunken, and black.
Question 13
Which organelle is responsible for producing adenosine triphosphate (ATP)
through oxidative phosphorylation?
A) Golgi apparatus
B) Lysosome
C) Mitochondrion
