Pathophysiology of Disease: An Introduction to
Clinical Medicine
8th Edition
Author(s)Gary D. Hammer; Stephen J. McPhee
TEST BANK
Ch. 1 — Introduction
1.
Reference: Ch. 1 — Introduction
Question Stem: A 68-year-old man presents
with progressive exertional dyspnea and lower-
extremity edema. You suspect chronic heart
failure as the clinical syndrome. Which
pathophysiologic interpretation best explains
why his fatigue worsens during exertion?
,Options:
A. Decreased cardiac output during exertion
limits oxygen delivery to skeletal muscle.
B. Increased venous return during exertion
causes pulmonary vascular congestion.
C. Exercise-induced tachycardia leads to
myocardial ischemia in all patients with heart
failure.
D. Heightened inflammatory cytokine release
during exertion causes muscle catabolism.
Correct Answer: A
Rationales:
Correct: Decreased cardiac reserve in heart
failure prevents appropriate rise in cardiac
output with activity, reducing oxygen delivery
to working muscle and producing exertional
fatigue.
A (incorrect as distractor removed): N/A
B: Increased venous return may worsen
pulmonary congestion in some patients, but it is
,not the central reason exertion causes systemic
muscle fatigue from reduced perfusion.
C: Tachycardia can provoke ischemia in
coronary disease, but not all heart-failure
patients develop exercise-induced ischemia;
reduced forward output is the primary
mechanism.
D: Systemic inflammation may contribute to
chronic fatigue over time, but acute worsening
with exertion is explained by hemodynamic
limitation, not immediate cytokine-mediated
catabolism.
Teaching Point: Exercise intolerance in heart
failure reflects limited cardiac reserve and
impaired oxygen delivery.
Citation: Hammer & McPhee (2021).
Pathophysiology of Disease (8th Ed.). Ch. 1.
2.
, Reference: Ch. 1 — Introduction
Question Stem: During admission triage, a
patient reports chest pain (symptom) while the
nurse documents an S4 gallop on exam (sign).
Why is distinguishing signs from symptoms
important for clinical pathophysiologic
reasoning?
Options:
A. Signs are subjective and less reliable than
symptoms for diagnosis.
B. Symptoms reflect patient experience; signs
provide objective evidence to constrain
pathophysiologic hypotheses.
C. Only signs should guide diagnostic testing
because symptoms are often psychosomatic.
D. Symptoms and signs are interchangeable in
determining disease mechanisms.
Correct Answer: B
Clinical Medicine
8th Edition
Author(s)Gary D. Hammer; Stephen J. McPhee
TEST BANK
Ch. 1 — Introduction
1.
Reference: Ch. 1 — Introduction
Question Stem: A 68-year-old man presents
with progressive exertional dyspnea and lower-
extremity edema. You suspect chronic heart
failure as the clinical syndrome. Which
pathophysiologic interpretation best explains
why his fatigue worsens during exertion?
,Options:
A. Decreased cardiac output during exertion
limits oxygen delivery to skeletal muscle.
B. Increased venous return during exertion
causes pulmonary vascular congestion.
C. Exercise-induced tachycardia leads to
myocardial ischemia in all patients with heart
failure.
D. Heightened inflammatory cytokine release
during exertion causes muscle catabolism.
Correct Answer: A
Rationales:
Correct: Decreased cardiac reserve in heart
failure prevents appropriate rise in cardiac
output with activity, reducing oxygen delivery
to working muscle and producing exertional
fatigue.
A (incorrect as distractor removed): N/A
B: Increased venous return may worsen
pulmonary congestion in some patients, but it is
,not the central reason exertion causes systemic
muscle fatigue from reduced perfusion.
C: Tachycardia can provoke ischemia in
coronary disease, but not all heart-failure
patients develop exercise-induced ischemia;
reduced forward output is the primary
mechanism.
D: Systemic inflammation may contribute to
chronic fatigue over time, but acute worsening
with exertion is explained by hemodynamic
limitation, not immediate cytokine-mediated
catabolism.
Teaching Point: Exercise intolerance in heart
failure reflects limited cardiac reserve and
impaired oxygen delivery.
Citation: Hammer & McPhee (2021).
Pathophysiology of Disease (8th Ed.). Ch. 1.
2.
, Reference: Ch. 1 — Introduction
Question Stem: During admission triage, a
patient reports chest pain (symptom) while the
nurse documents an S4 gallop on exam (sign).
Why is distinguishing signs from symptoms
important for clinical pathophysiologic
reasoning?
Options:
A. Signs are subjective and less reliable than
symptoms for diagnosis.
B. Symptoms reflect patient experience; signs
provide objective evidence to constrain
pathophysiologic hypotheses.
C. Only signs should guide diagnostic testing
because symptoms are often psychosomatic.
D. Symptoms and signs are interchangeable in
determining disease mechanisms.
Correct Answer: B
