Adult-Gerontology CNS Test Advanced Pathophysiology 2 — Questions and Answers
Question 1: Systolic hypertension in older adults is largely attributed to:
- Increased cardiac output
- Arterial stiffening and decreased aortic compliance (Correct answer)
- Elevated renin-angiotensin activity
- Increased plasma volume
Correct answer: Arterial stiffening and decreased aortic compliance
Age-related loss of arterial elasticity increases pulse wave velocity and systolic pressure while diastolic pressure may remain stable or decrease.
Question 2: Osteoporosis is best defined pathophysiologically as:
- Failure of osteoblast recruitment only
- Imbalance between bone resorption and formation leading to decreased bone density and microarchitectural deterioration (Correct answer)
- Calcium and phosphate deposition defect
- Inflammatory destruction of cortical bone exclusively
Correct answer: Imbalance between bone resorption and formation leading to decreased bone density and microarchitectural deterioration
Osteoporosis results from an uncoupling of bone remodeling where osteoclast-mediated resorption exceeds osteoblast-mediated formation, reducing bone mass.
Question 3: Which mechanism explains the anemia commonly seen in chronic kidney disease?
- Iron sequestration by acute-phase proteins
- Reduced erythropoietin production by failing kidneys (Correct answer)
- Vitamin B12 malabsorption
- Hemolysis from uremic toxins primarily
Correct answer: Reduced erythropoietin production by failing kidneys
CKD impairs erythropoietin synthesis in peritubular fibroblasts, reducing the hormonal stimulus for red blood cell production in bone marrow.
Question 4: Pulmonary embolism causes hypoxemia primarily through:
- Diffusion impairment across thickened alveolar membranes
- Ventilation-perfusion mismatch and increased dead space (Correct answer)
- Hypoventilation from chest wall pain
- Left-to-right intracardiac shunting
Correct answer: Ventilation-perfusion mismatch and increased dead space
PE creates unperfused but ventilated alveoli (dead space), and reflex bronchoconstriction in infarcted regions adds VQ mismatch, impairing gas exchange.
Question 5: Delirium in hospitalized older adults is best understood as:
- A new psychiatric disorder triggered by hospitalization
- An acute neurological syndrome reflecting global cerebral dysfunction from predisposing and precipitating factors (Correct answer)
- A permanent cognitive change indicating new dementia
- Serotonin syndrome from polypharmacy
Correct answer: An acute neurological syndrome reflecting global cerebral dysfunction from predisposing and precipitating factors
Delirium arises from the interaction of baseline vulnerability (predisposing factors like age/dementia) with acute insults (precipitating factors like infection, medications, or pain).
Question 6: Hepatic encephalopathy in cirrhosis is primarily driven by:
- Hepatic arterial thrombosis
- Accumulation of ammonia and other neurotoxins due to impaired hepatic detoxification and portosystemic shunting (Correct answer)
- Bile salt toxicity to neurons
- Hypoalbuminemia causing cerebral edema
Correct answer: Accumulation of ammonia and other neurotoxins due to impaired hepatic detoxification and portosystemic shunting
Portal hypertension creates shunts that bypass hepatic detoxification, allowing gut-derived ammonia and neurotoxins to accumulate in the systemic circulation and brain.
Adult-Gerontology CNS Test Advanced Pathophysiology 2
Systolic hypertension in older adults is largely attributed to: