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 56-year-old man presents with progressive fatigue and pallor.
Lab tests show normocytic anemia. When considering
pathophysiologic mechanisms, which step most directly links a
patient’s symptoms to impaired oxygen delivery at the tissue
level?
Options
A. Increased circulating cytokines producing anorexia
B. Reduced hemoglobin concentration in blood
,C. Decreased renal erythropoietin production due to age
D. Iron sequestration in macrophages from chronic disease
Correct Answer
B
Rationales
• Correct (B): Reduced hemoglobin lowers the blood’s
oxygen-carrying capacity, which directly impairs tissue
oxygen delivery and explains fatigue and pallor.
• Incorrect (A): Cytokine-mediated anorexia may contribute
to chronic illness but does not directly lower oxygen
delivery.
• Incorrect (C): Decreased erythropoietin can cause anemia
but is a proximate cause of reduced hemoglobin rather
than the direct link to tissue hypoxia.
• Incorrect (D): Iron sequestration causes a type of anemia
(functional iron deficiency) but the immediate mechanism
producing fatigue is reduced hemoglobin concentration.
Teaching Point
Hemoglobin concentration is the primary determinant of
oxygen-carrying capacity.
Citation (Simplified APA)
Hammer & McPhee (2019). Pathophysiology of Disease (8th
Ed.). Ch. 1.
,2
Reference
Ch. 1 — Introduction
Question Stem
A nurse interprets a diagnostic test result: a screening test with
high sensitivity is negative. Which is the best clinical inference
about the likelihood of disease in this context?
Options
A. The negative result rules out disease (low false-negative
rate).
B. The negative result confirms disease (few false positives).
C. The negative result is uninterpretable without specificity.
D. The negative result suggests the disease is likely present.
Correct Answer
A
Rationales
• Correct (A): High sensitivity means the test detects most
people with disease; a negative result makes disease
unlikely (SnNout principle).
• Incorrect (B): Confirmation of disease requires high
specificity, not sensitivity.
• Incorrect (C): While specificity helps interpret positives, a
negative high-sensitivity test provides clinically useful
exclusion.
, • Incorrect (D): A negative high-sensitivity test argues
against, not for, disease.
Teaching Point
A highly sensitive test with a negative result effectively rules out
disease (SnNout).
Citation (Simplified APA)
Hammer & McPhee (2019). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3
Reference
Ch. 1 — Introduction
Question Stem
A 28-year-old woman has an acute myocardial infarction. Which
pathophysiologic concept best explains why myocardial necrosis
produces elevated serum cardiac troponin?
Options
A. Increased synthesis of contractile proteins after ischemia
B. Loss of membrane integrity allowing intracellular proteins to
leak into blood
C. Upregulation of hepatic production of cardiac proteins
D. Deposition of immune complexes in the myocardium
Correct Answer
B
INTRODUCTION TO CLINICAL MEDICINE
8TH EDITION
AUTHOR(S)GARY D. HAMMER; STEPHEN J.
MCPHEE
TEST BANK
1
Reference
Ch. 1 — Introduction
Question Stem
A 56-year-old man presents with progressive fatigue and pallor.
Lab tests show normocytic anemia. When considering
pathophysiologic mechanisms, which step most directly links a
patient’s symptoms to impaired oxygen delivery at the tissue
level?
Options
A. Increased circulating cytokines producing anorexia
B. Reduced hemoglobin concentration in blood
,C. Decreased renal erythropoietin production due to age
D. Iron sequestration in macrophages from chronic disease
Correct Answer
B
Rationales
• Correct (B): Reduced hemoglobin lowers the blood’s
oxygen-carrying capacity, which directly impairs tissue
oxygen delivery and explains fatigue and pallor.
• Incorrect (A): Cytokine-mediated anorexia may contribute
to chronic illness but does not directly lower oxygen
delivery.
• Incorrect (C): Decreased erythropoietin can cause anemia
but is a proximate cause of reduced hemoglobin rather
than the direct link to tissue hypoxia.
• Incorrect (D): Iron sequestration causes a type of anemia
(functional iron deficiency) but the immediate mechanism
producing fatigue is reduced hemoglobin concentration.
Teaching Point
Hemoglobin concentration is the primary determinant of
oxygen-carrying capacity.
Citation (Simplified APA)
Hammer & McPhee (2019). Pathophysiology of Disease (8th
Ed.). Ch. 1.
,2
Reference
Ch. 1 — Introduction
Question Stem
A nurse interprets a diagnostic test result: a screening test with
high sensitivity is negative. Which is the best clinical inference
about the likelihood of disease in this context?
Options
A. The negative result rules out disease (low false-negative
rate).
B. The negative result confirms disease (few false positives).
C. The negative result is uninterpretable without specificity.
D. The negative result suggests the disease is likely present.
Correct Answer
A
Rationales
• Correct (A): High sensitivity means the test detects most
people with disease; a negative result makes disease
unlikely (SnNout principle).
• Incorrect (B): Confirmation of disease requires high
specificity, not sensitivity.
• Incorrect (C): While specificity helps interpret positives, a
negative high-sensitivity test provides clinically useful
exclusion.
, • Incorrect (D): A negative high-sensitivity test argues
against, not for, disease.
Teaching Point
A highly sensitive test with a negative result effectively rules out
disease (SnNout).
Citation (Simplified APA)
Hammer & McPhee (2019). Pathophysiology of Disease (8th
Ed.). Ch. 1.
3
Reference
Ch. 1 — Introduction
Question Stem
A 28-year-old woman has an acute myocardial infarction. Which
pathophysiologic concept best explains why myocardial necrosis
produces elevated serum cardiac troponin?
Options
A. Increased synthesis of contractile proteins after ischemia
B. Loss of membrane integrity allowing intracellular proteins to
leak into blood
C. Upregulation of hepatic production of cardiac proteins
D. Deposition of immune complexes in the myocardium
Correct Answer
B
