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 develops delirium after starting a high-dose
opioid for postoperative pain. Which pathophysiologic concept
best explains why this patient is more vulnerable to drug-
induced delirium than a younger adult?
Options
A. Age-related decrease in drug receptor numbers increases
drug sensitivity.
B. Reduced renal and hepatic clearance leading to higher
effective drug exposure.
,C. Increased blood–brain barrier permeability prevents central
nervous system drug entry.
D. Enhanced compensatory homeostatic mechanisms blunt
drug effects.
Correct Answer
B
Rationales
Correct: Aging commonly decreases hepatic metabolism and
renal excretion, which increases systemic exposure to drugs
(higher area under the curve) and raises the risk of central
adverse effects like delirium.
A (incorrect): While receptor changes occur with age, the
dominant clinical reason for increased drug sensitivity in this
context is reduced clearance rather than simple receptor
number changes.
C (incorrect): Blood–brain barrier permeability often changes
variably with age and disease, but increased permeability would
increase—not prevent—CNS entry; this statement is incorrect in
direction and not the primary reason.
D (incorrect): Aging typically reduces, not enhances, physiologic
reserve and compensatory mechanisms.
Teaching Point
Age-related renal/hepatic decline raises drug exposure and
adverse-event risk.
,Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
2.
Reference
Ch. 1 — Introduction
Question Stem
A clinician must decide whether a newly admitted patient’s
tachycardia is compensatory or primary pathology. According to
pathophysiologic reasoning, which piece of data best
distinguishes compensation from primary disease?
Options
A. Presence of an underlying reversible trigger (e.g., fever,
hemorrhage).
B. The absolute heart rate in beats per minute.
C. Patient’s age at symptom onset.
D. Presence of comorbid chronic disease.
Correct Answer
A
Rationales
Correct: Compensation is a response to an underlying stressor;
identifying a reversible trigger (fever, blood loss) supports a
compensatory mechanism rather than primary cardiac
pathology.
, B (incorrect): Absolute heart rate does not indicate mechanism
(compensation vs primary disease) without context.
C (incorrect): Age may influence disease prevalence but does
not by itself distinguish compensation from primary pathology.
D (incorrect): Comorbidities influence risk but don’t identify
whether the current tachycardia is compensatory.
Teaching Point
Identify reversible triggers to distinguish compensatory from
primary pathology.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3.
Reference
Ch. 1 — Introduction
Question Stem
A patient presents with progressive fatigue and microcytic
anemia. The clinician orders tests to determine whether
symptoms represent disease or an adaptive response. Which
concept from the chapter best frames the clinician’s reasoning?
Options
A. Disease equals any deviation from ideal laboratory values.
B. Adaptive responses that restore homeostasis may present
with abnormal labs but are not disease.
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 develops delirium after starting a high-dose
opioid for postoperative pain. Which pathophysiologic concept
best explains why this patient is more vulnerable to drug-
induced delirium than a younger adult?
Options
A. Age-related decrease in drug receptor numbers increases
drug sensitivity.
B. Reduced renal and hepatic clearance leading to higher
effective drug exposure.
,C. Increased blood–brain barrier permeability prevents central
nervous system drug entry.
D. Enhanced compensatory homeostatic mechanisms blunt
drug effects.
Correct Answer
B
Rationales
Correct: Aging commonly decreases hepatic metabolism and
renal excretion, which increases systemic exposure to drugs
(higher area under the curve) and raises the risk of central
adverse effects like delirium.
A (incorrect): While receptor changes occur with age, the
dominant clinical reason for increased drug sensitivity in this
context is reduced clearance rather than simple receptor
number changes.
C (incorrect): Blood–brain barrier permeability often changes
variably with age and disease, but increased permeability would
increase—not prevent—CNS entry; this statement is incorrect in
direction and not the primary reason.
D (incorrect): Aging typically reduces, not enhances, physiologic
reserve and compensatory mechanisms.
Teaching Point
Age-related renal/hepatic decline raises drug exposure and
adverse-event risk.
,Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
2.
Reference
Ch. 1 — Introduction
Question Stem
A clinician must decide whether a newly admitted patient’s
tachycardia is compensatory or primary pathology. According to
pathophysiologic reasoning, which piece of data best
distinguishes compensation from primary disease?
Options
A. Presence of an underlying reversible trigger (e.g., fever,
hemorrhage).
B. The absolute heart rate in beats per minute.
C. Patient’s age at symptom onset.
D. Presence of comorbid chronic disease.
Correct Answer
A
Rationales
Correct: Compensation is a response to an underlying stressor;
identifying a reversible trigger (fever, blood loss) supports a
compensatory mechanism rather than primary cardiac
pathology.
, B (incorrect): Absolute heart rate does not indicate mechanism
(compensation vs primary disease) without context.
C (incorrect): Age may influence disease prevalence but does
not by itself distinguish compensation from primary pathology.
D (incorrect): Comorbidities influence risk but don’t identify
whether the current tachycardia is compensatory.
Teaching Point
Identify reversible triggers to distinguish compensatory from
primary pathology.
Citation
Hammer & McPhee (2021). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3.
Reference
Ch. 1 — Introduction
Question Stem
A patient presents with progressive fatigue and microcytic
anemia. The clinician orders tests to determine whether
symptoms represent disease or an adaptive response. Which
concept from the chapter best frames the clinician’s reasoning?
Options
A. Disease equals any deviation from ideal laboratory values.
B. Adaptive responses that restore homeostasis may present
with abnormal labs but are not disease.
