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 62-year-old man presents with fatigue and new onset weight
loss. His clinician explains that symptoms represent a loss of
physiologic reserve and failure of compensatory mechanisms.
Which pathophysiologic principle best explains why older adults
manifest disease with subtler signs but faster decompensation?
Options
A. Disease always manifests with the same signs regardless of
age because pathologic processes are identical.
B. Reduced homeostatic reserve and decreased ability to mount
adaptive responses.
C. Increased baseline inflammatory signaling that masks new
pathology.
,D. Higher metabolic rate in older adults accelerates disease
expression.
Correct Answer
B
Rationales
Correct (B): The concept of diminished physiologic
(homeostatic) reserve with aging explains subtler early signs
and more rapid decompensation when stressors overwhelm
adaptive mechanisms.
A: Incorrect — disease manifestations vary with host reserve;
pathologic processes are not identically expressed across ages.
C: Incorrect — while chronic inflammation can occur with age,
the primary principle is loss of compensatory reserve, not
masking.
D: Incorrect — older adults typically have lower, not higher,
basal metabolic rates; that does not explain the pattern
described.
Teaching Point
Aging reduces physiologic reserve, limiting adaptive responses
to stressors.
Citation
Hammer & McPhee (2018). Pathophysiology of Disease (8th
Ed.). Ch. 1.
2.
,Reference — Ch. 1 — Introduction
Question Stem
A nurse is prioritizing care for two patients: one with acute
hypovolemia and one with chronic compensated heart failure.
Applying pathophysiologic reasoning from the introduction,
which assessment finding best predicts imminent collapse in
the acutely hypovolemic patient?
Options
A. Mild ankle edema and normal blood pressure.
B. Rapid narrow pulse pressure with tachycardia and delayed
capillary refill.
C. Chronic jugular venous distention at baseline.
D. Long-standing elevated BNP without acute symptoms.
Correct Answer
B
Rationales
Correct (B): In acute hypovolemia, narrow pulse pressure,
tachycardia, and delayed capillary refill indicate reduced
effective circulating volume and impending cardiovascular
collapse.
A: Incorrect — mild edema with normal BP suggests chronic
compensation, not acute collapse.
C: Incorrect — chronic JVD suggests right-sided failure, not
acute hypovolemia.
D: Incorrect — chronically elevated BNP suggests chronic heart
, failure; it is less specific for acute decompensation than
hemodynamic signs.
Teaching Point
Acute circulatory failure presents with narrow pulse pressure
and poor perfusion signs.
Citation
Hammer & McPhee (2018). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3.
Reference — Ch. 2 — Genetic Disease
Question Stem
A 28-year-old woman with a family history of early-onset breast
cancer requests genetic testing. Her pedigree shows multiple
first-degree relatives affected before age 50. Which principle
from genetics best supports prioritized testing for high-
penetrance genes (e.g., BRCA1/2) in this family?
Options
A. Multifactorial inheritance means single genes rarely explain
familial clustering.
B. Strong familial clustering and early onset suggest autosomal
dominant inheritance with high penetrance.
C. Late-onset disease in relatives would indicate an X-linked
pattern.
INTRODUCTION TO CLINICAL MEDICINE
8TH EDITION
AUTHOR(S)GARY D. HAMMER; STEPHEN J.
MCPHEE
TEST BANK
Reference — Ch. 1 — Introduction
Question Stem
A 62-year-old man presents with fatigue and new onset weight
loss. His clinician explains that symptoms represent a loss of
physiologic reserve and failure of compensatory mechanisms.
Which pathophysiologic principle best explains why older adults
manifest disease with subtler signs but faster decompensation?
Options
A. Disease always manifests with the same signs regardless of
age because pathologic processes are identical.
B. Reduced homeostatic reserve and decreased ability to mount
adaptive responses.
C. Increased baseline inflammatory signaling that masks new
pathology.
,D. Higher metabolic rate in older adults accelerates disease
expression.
Correct Answer
B
Rationales
Correct (B): The concept of diminished physiologic
(homeostatic) reserve with aging explains subtler early signs
and more rapid decompensation when stressors overwhelm
adaptive mechanisms.
A: Incorrect — disease manifestations vary with host reserve;
pathologic processes are not identically expressed across ages.
C: Incorrect — while chronic inflammation can occur with age,
the primary principle is loss of compensatory reserve, not
masking.
D: Incorrect — older adults typically have lower, not higher,
basal metabolic rates; that does not explain the pattern
described.
Teaching Point
Aging reduces physiologic reserve, limiting adaptive responses
to stressors.
Citation
Hammer & McPhee (2018). Pathophysiology of Disease (8th
Ed.). Ch. 1.
2.
,Reference — Ch. 1 — Introduction
Question Stem
A nurse is prioritizing care for two patients: one with acute
hypovolemia and one with chronic compensated heart failure.
Applying pathophysiologic reasoning from the introduction,
which assessment finding best predicts imminent collapse in
the acutely hypovolemic patient?
Options
A. Mild ankle edema and normal blood pressure.
B. Rapid narrow pulse pressure with tachycardia and delayed
capillary refill.
C. Chronic jugular venous distention at baseline.
D. Long-standing elevated BNP without acute symptoms.
Correct Answer
B
Rationales
Correct (B): In acute hypovolemia, narrow pulse pressure,
tachycardia, and delayed capillary refill indicate reduced
effective circulating volume and impending cardiovascular
collapse.
A: Incorrect — mild edema with normal BP suggests chronic
compensation, not acute collapse.
C: Incorrect — chronic JVD suggests right-sided failure, not
acute hypovolemia.
D: Incorrect — chronically elevated BNP suggests chronic heart
, failure; it is less specific for acute decompensation than
hemodynamic signs.
Teaching Point
Acute circulatory failure presents with narrow pulse pressure
and poor perfusion signs.
Citation
Hammer & McPhee (2018). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3.
Reference — Ch. 2 — Genetic Disease
Question Stem
A 28-year-old woman with a family history of early-onset breast
cancer requests genetic testing. Her pedigree shows multiple
first-degree relatives affected before age 50. Which principle
from genetics best supports prioritized testing for high-
penetrance genes (e.g., BRCA1/2) in this family?
Options
A. Multifactorial inheritance means single genes rarely explain
familial clustering.
B. Strong familial clustering and early onset suggest autosomal
dominant inheritance with high penetrance.
C. Late-onset disease in relatives would indicate an X-linked
pattern.
