HARRISON'S PRINCIPLES OF INTERNAL MEDICINE,
22ND EDITION COMPREHENSIVE TEST BANK –
2026/2027 LATEST UPDATE
SECTION I: FOUNDATIONS OF CLINICAL PRACTICE AND
CARDINAL MANIFESTATIONS
1. A 68-year-old retired accountant presents to the internal medicine clinic with
increasing fatigue, exertional dyspnea, and bilateral knee pain over the past four
months. His medical history includes hypertension, type 2 diabetes mellitus, stage
3 chronic kidney disease, hyperlipidemia, and obesity. During the consultation, he
also reports poor sleep, occasional forgetfulness, urinary frequency, and concerns
about taking more than ten daily medications prescribed by different specialists.
Rather than addressing only his chief complaint, the internist reviews his chronic
illnesses, medications, vaccination status, cardiovascular risk, renal function,
functional capacity, and psychosocial concerns before developing a unified long-
term management plan. Which of the following BEST describes the role of the
internist in this scenario?
a. Focusing exclusively on the chief complaint to ensure efficient use of consultation
time
,b. Coordinating comprehensive, patient-centered care that integrates multiple chronic
conditions and psychosocial factors
c. Referring the patient to multiple specialists for each individual problem without
integration
d. Prioritizing medication reduction over clinical assessment to minimize polypharmacy
risks
ANS: B
Rationale: The internist's role encompasses comprehensive, longitudinal, patient-centered
care that integrates scientific evidence with patient values and preferences. Harrison's
emphasizes that internal medicine is a synthesis of evidence-based science and
individualized patient values, requiring the internist to consider the whole patient rather
than isolated organ systems.
2. A 45-year-old woman presents with a three-day history of subjective fever,
malaise, and a temperature of 38.9°C (102°F). She reports feeling cold and
shivering despite warm ambient temperature. Her husband notes that she has
been "bundling up" in blankets. On examination, her skin is warm and flushed.
Which of the following BEST explains the pathophysiological difference between
fever and hyperthermia in this patient?
a. In fever, the hypothalamic set point is increased; in hyperthermia, it remains
unchanged
b. In hyperthermia, the hypothalamic set point is increased; in fever, it remains
unchanged
c. Both fever and hyperthermia result from increased hypothalamic set point
d. Fever results from peripheral vasodilation, while hyperthermia results from
vasoconstriction
ANS: A
Rationale: Fever is characterized by an elevation in the hypothalamic temperature set
point, often due to pyrogens, leading to heat conservation behaviors (e.g., shivering,
,bundling up). In contrast, hyperthermia involves an unchanged hypothalamic set point
with uncontrolled heat gain or impaired heat loss, which does not respond to antipyretics.
3. A 72-year-old man with a 40-pack-year smoking history presents with
progressive dyspnea on exertion, chronic productive cough, and wheezing. He
reports that his symptoms have worsened over the past five years. On
examination, he has a barrel-shaped chest, prolonged expiration, and distant
breath sounds. Which of the following BEST describes the primary mechanism of
air "hunger" in this patient's dyspnea?
a. Peripheral chemoreceptors in the carotid body detect hypoxemia and signal the
medulla
b. Central chemoreceptors in the medulla respond to increased PaCO₂ and stimulate
ventilation
c. Stretch receptors in the lungs signal the brainstem to increase respiratory rate
d. The motor cortex directly stimulates respiratory muscles independent of chemical
stimuli
ANS: B
Rationale: In chronic obstructive pulmonary disease (COPD), air hunger is primarily driven
by central chemoreceptors in the medulla that respond to elevated PaCO₂ (hypercapnia).
This is a key compensatory mechanism in chronic respiratory failure.
4. A 55-year-old woman presents with a two-week history of progressive dyspnea,
orthopnea, and paroxysmal nocturnal dyspnea. She has a history of hypertension
and diabetes. On examination, crackles are heard at both lung bases, and jugular
venous distention is present. Which of the following BEST explains the mechanism
of dyspnea in this patient?
a. Stretch receptors in the lungs detect increased pulmonary capillary wedge pressure
b. Peripheral chemoreceptors detect decreased PaO₂ and stimulate the brainstem
, c. Central chemoreceptors detect increased PaCO₂ and stimulate ventilation
d. Motor cortex directly signals respiratory muscles to increase effort
ANS: A
Rationale: In left-sided heart failure, increased pulmonary capillary wedge pressure leads
to pulmonary congestion and stimulation of stretch receptors (J-receptors) in the lungs,
which signal the brainstem and produce dyspnea. Orthopnea and paroxysmal nocturnal
dyspnea are classic manifestations of this mechanism.
5. A 62-year-old man with type 2 diabetes mellitus presents for routine follow-up.
His most recent HbA1c is 8.5%. He reports increased urinary frequency, excessive
thirst, and unintentional weight loss over the past three months. Which of the
following pathophysiological mechanisms BEST explains his polyuria?
a. Increased glucose reabsorption in the proximal tubule
b. Osmotic diuresis due to glucose exceeding renal tubular reabsorption capacity
c. Decreased antidiuretic hormone secretion
d. Increased aldosterone secretion
ANS: B
Rationale: In uncontrolled diabetes mellitus, blood glucose exceeds the renal threshold for
reabsorption (approximately 180–200 mg/dL), leading to osmotic diuresis. Glucose in the
tubular fluid draws water into the urine, resulting in polyuria and subsequent polydipsia.
6. A 38-year-old woman presents with a 6-month history of fatigue, weight gain,
cold intolerance, and constipation. Her TSH is elevated, and free T4 is low. Which
of the following BEST describes the mechanism of her weight gain?
a. Increased basal metabolic rate leading to increased appetite
b. Decreased basal metabolic rate and fluid retention from myxedema
22ND EDITION COMPREHENSIVE TEST BANK –
2026/2027 LATEST UPDATE
SECTION I: FOUNDATIONS OF CLINICAL PRACTICE AND
CARDINAL MANIFESTATIONS
1. A 68-year-old retired accountant presents to the internal medicine clinic with
increasing fatigue, exertional dyspnea, and bilateral knee pain over the past four
months. His medical history includes hypertension, type 2 diabetes mellitus, stage
3 chronic kidney disease, hyperlipidemia, and obesity. During the consultation, he
also reports poor sleep, occasional forgetfulness, urinary frequency, and concerns
about taking more than ten daily medications prescribed by different specialists.
Rather than addressing only his chief complaint, the internist reviews his chronic
illnesses, medications, vaccination status, cardiovascular risk, renal function,
functional capacity, and psychosocial concerns before developing a unified long-
term management plan. Which of the following BEST describes the role of the
internist in this scenario?
a. Focusing exclusively on the chief complaint to ensure efficient use of consultation
time
,b. Coordinating comprehensive, patient-centered care that integrates multiple chronic
conditions and psychosocial factors
c. Referring the patient to multiple specialists for each individual problem without
integration
d. Prioritizing medication reduction over clinical assessment to minimize polypharmacy
risks
ANS: B
Rationale: The internist's role encompasses comprehensive, longitudinal, patient-centered
care that integrates scientific evidence with patient values and preferences. Harrison's
emphasizes that internal medicine is a synthesis of evidence-based science and
individualized patient values, requiring the internist to consider the whole patient rather
than isolated organ systems.
2. A 45-year-old woman presents with a three-day history of subjective fever,
malaise, and a temperature of 38.9°C (102°F). She reports feeling cold and
shivering despite warm ambient temperature. Her husband notes that she has
been "bundling up" in blankets. On examination, her skin is warm and flushed.
Which of the following BEST explains the pathophysiological difference between
fever and hyperthermia in this patient?
a. In fever, the hypothalamic set point is increased; in hyperthermia, it remains
unchanged
b. In hyperthermia, the hypothalamic set point is increased; in fever, it remains
unchanged
c. Both fever and hyperthermia result from increased hypothalamic set point
d. Fever results from peripheral vasodilation, while hyperthermia results from
vasoconstriction
ANS: A
Rationale: Fever is characterized by an elevation in the hypothalamic temperature set
point, often due to pyrogens, leading to heat conservation behaviors (e.g., shivering,
,bundling up). In contrast, hyperthermia involves an unchanged hypothalamic set point
with uncontrolled heat gain or impaired heat loss, which does not respond to antipyretics.
3. A 72-year-old man with a 40-pack-year smoking history presents with
progressive dyspnea on exertion, chronic productive cough, and wheezing. He
reports that his symptoms have worsened over the past five years. On
examination, he has a barrel-shaped chest, prolonged expiration, and distant
breath sounds. Which of the following BEST describes the primary mechanism of
air "hunger" in this patient's dyspnea?
a. Peripheral chemoreceptors in the carotid body detect hypoxemia and signal the
medulla
b. Central chemoreceptors in the medulla respond to increased PaCO₂ and stimulate
ventilation
c. Stretch receptors in the lungs signal the brainstem to increase respiratory rate
d. The motor cortex directly stimulates respiratory muscles independent of chemical
stimuli
ANS: B
Rationale: In chronic obstructive pulmonary disease (COPD), air hunger is primarily driven
by central chemoreceptors in the medulla that respond to elevated PaCO₂ (hypercapnia).
This is a key compensatory mechanism in chronic respiratory failure.
4. A 55-year-old woman presents with a two-week history of progressive dyspnea,
orthopnea, and paroxysmal nocturnal dyspnea. She has a history of hypertension
and diabetes. On examination, crackles are heard at both lung bases, and jugular
venous distention is present. Which of the following BEST explains the mechanism
of dyspnea in this patient?
a. Stretch receptors in the lungs detect increased pulmonary capillary wedge pressure
b. Peripheral chemoreceptors detect decreased PaO₂ and stimulate the brainstem
, c. Central chemoreceptors detect increased PaCO₂ and stimulate ventilation
d. Motor cortex directly signals respiratory muscles to increase effort
ANS: A
Rationale: In left-sided heart failure, increased pulmonary capillary wedge pressure leads
to pulmonary congestion and stimulation of stretch receptors (J-receptors) in the lungs,
which signal the brainstem and produce dyspnea. Orthopnea and paroxysmal nocturnal
dyspnea are classic manifestations of this mechanism.
5. A 62-year-old man with type 2 diabetes mellitus presents for routine follow-up.
His most recent HbA1c is 8.5%. He reports increased urinary frequency, excessive
thirst, and unintentional weight loss over the past three months. Which of the
following pathophysiological mechanisms BEST explains his polyuria?
a. Increased glucose reabsorption in the proximal tubule
b. Osmotic diuresis due to glucose exceeding renal tubular reabsorption capacity
c. Decreased antidiuretic hormone secretion
d. Increased aldosterone secretion
ANS: B
Rationale: In uncontrolled diabetes mellitus, blood glucose exceeds the renal threshold for
reabsorption (approximately 180–200 mg/dL), leading to osmotic diuresis. Glucose in the
tubular fluid draws water into the urine, resulting in polyuria and subsequent polydipsia.
6. A 38-year-old woman presents with a 6-month history of fatigue, weight gain,
cold intolerance, and constipation. Her TSH is elevated, and free T4 is low. Which
of the following BEST describes the mechanism of her weight gain?
a. Increased basal metabolic rate leading to increased appetite
b. Decreased basal metabolic rate and fluid retention from myxedema
