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 — Homeostasis and Disease Continuum
Clinical Stem
A 58-year-old man with poorly controlled type 2 diabetes
presents with gradual peripheral neuropathy and episodic
dizziness. Laboratory tests show chronic hyperglycemia (HbA1c
9.5%) and microalbuminuria. Which pathophysiologic concept
best explains why his nervous system and kidneys show
progressive dysfunction before acute decompensation?
,A. Threshold model — organs maintain function until a critical
injury threshold is crossed, then suddenly fail.
B. Continuum model — homeostatic compensation causes
gradual subclinical damage that progresses to clinical disease.
C. Binary disease model — disease presence is all-or-none and
determined by a single causative factor.
D. Sporadic injury model — random insults produce abrupt,
unconnected organ injuries over time.
Correct Answer
B
Rationale — Correct (B)
The continuum model describes how chronic stress
(hyperglycemia) provokes compensatory changes (e.g.,
metabolic adaptation, microvascular remodeling) that produce
gradual, subclinical structural and functional damage in high-
flow organs (nerve, kidney) before overt failure. Hammer &
McPhee emphasize gradual loss of homeostasis and progressive
disease along a spectrum rather than abrupt onset.
Rationales — Incorrect
A. Threshold model implies abrupt failure after compensation
fails; this doesn’t match gradual neuropathy/microalbuminuria.
C. Binary model ignores multifactorial, progressive mechanisms
in chronic metabolic disease.
D. Sporadic injury model fails to account for the persistent,
cumulative metabolic insult causing predictable organ-specific
changes.
,Teaching Point
Chronic stress produces progressive, compensatory damage —
disease often lies along a continuum before acute failure.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
2)
Reference
Ch. 1 — Introduction — Risk Factors, Causation, and
Multifactorial Disease
Clinical Stem
In a community study, smoking and occupational silica exposure
independently increase COPD risk. A 60-year-old miner who
smokes has severe airflow limitation. Which concept best
explains how smoking and silica combined produced more
severe lung disease than either alone?
A. Additive causation — effects simply sum without interacting.
B. Synergistic interaction — exposures amplify each other’s
damaging effect.
C. Confounding — apparent interaction is due to an
unmeasured third factor.
D. Effect modification by age — age is the main determinant of
severity.
, Correct Answer
B
Rationale — Correct (B)
Synergistic interaction occurs when two exposures interact
biologically to produce a greater-than-additive effect (e.g.,
smoking impairs mucociliary clearance and silica promotes
inflammation/fibrosis), leading to amplified lung injury. Chapter
1 discusses multifactorial causation and interaction between
risk factors.
Rationales — Incorrect
A. Additive models underestimate combined effects when
biological interaction exists.
C. Confounding suggests a spurious association; here
occupational and smoking exposures plausibly interact.
D. While age modifies risk, it doesn’t explain a biological
amplification between silica and smoke.
Teaching Point
Multiple exposures can interact synergistically, producing
greater-than-additive disease risk.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
3)
INTRODUCTION TO CLINICAL MEDICINE
8TH EDITION
AUTHOR(S)GARY D. HAMMER; STEPHEN J.
MCPHEE
TEST BANK
1)
Reference
Ch. 1 — Introduction — Homeostasis and Disease Continuum
Clinical Stem
A 58-year-old man with poorly controlled type 2 diabetes
presents with gradual peripheral neuropathy and episodic
dizziness. Laboratory tests show chronic hyperglycemia (HbA1c
9.5%) and microalbuminuria. Which pathophysiologic concept
best explains why his nervous system and kidneys show
progressive dysfunction before acute decompensation?
,A. Threshold model — organs maintain function until a critical
injury threshold is crossed, then suddenly fail.
B. Continuum model — homeostatic compensation causes
gradual subclinical damage that progresses to clinical disease.
C. Binary disease model — disease presence is all-or-none and
determined by a single causative factor.
D. Sporadic injury model — random insults produce abrupt,
unconnected organ injuries over time.
Correct Answer
B
Rationale — Correct (B)
The continuum model describes how chronic stress
(hyperglycemia) provokes compensatory changes (e.g.,
metabolic adaptation, microvascular remodeling) that produce
gradual, subclinical structural and functional damage in high-
flow organs (nerve, kidney) before overt failure. Hammer &
McPhee emphasize gradual loss of homeostasis and progressive
disease along a spectrum rather than abrupt onset.
Rationales — Incorrect
A. Threshold model implies abrupt failure after compensation
fails; this doesn’t match gradual neuropathy/microalbuminuria.
C. Binary model ignores multifactorial, progressive mechanisms
in chronic metabolic disease.
D. Sporadic injury model fails to account for the persistent,
cumulative metabolic insult causing predictable organ-specific
changes.
,Teaching Point
Chronic stress produces progressive, compensatory damage —
disease often lies along a continuum before acute failure.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
2)
Reference
Ch. 1 — Introduction — Risk Factors, Causation, and
Multifactorial Disease
Clinical Stem
In a community study, smoking and occupational silica exposure
independently increase COPD risk. A 60-year-old miner who
smokes has severe airflow limitation. Which concept best
explains how smoking and silica combined produced more
severe lung disease than either alone?
A. Additive causation — effects simply sum without interacting.
B. Synergistic interaction — exposures amplify each other’s
damaging effect.
C. Confounding — apparent interaction is due to an
unmeasured third factor.
D. Effect modification by age — age is the main determinant of
severity.
, Correct Answer
B
Rationale — Correct (B)
Synergistic interaction occurs when two exposures interact
biologically to produce a greater-than-additive effect (e.g.,
smoking impairs mucociliary clearance and silica promotes
inflammation/fibrosis), leading to amplified lung injury. Chapter
1 discusses multifactorial causation and interaction between
risk factors.
Rationales — Incorrect
A. Additive models underestimate combined effects when
biological interaction exists.
C. Confounding suggests a spurious association; here
occupational and smoking exposures plausibly interact.
D. While age modifies risk, it doesn’t explain a biological
amplification between silica and smoke.
Teaching Point
Multiple exposures can interact synergistically, producing
greater-than-additive disease risk.
Citation
Hammer, G. D., & McPhee, S. J. (2025). Pathophysiology of
Disease (8th ed.). Chapter 1.
3)
