Adult-Gerontology CNS Test Advanced Pathophysiology 1 — Questions and Answers
Question 1: Which pathophysiological mechanism primarily underlies type 2 diabetes mellitus in older adults?
- Autoimmune destruction of beta cells
- Insulin resistance combined with progressive beta-cell dysfunction (Correct answer)
- Absolute insulin deficiency
- Glucagon deficiency
Correct answer: Insulin resistance combined with progressive beta-cell dysfunction
Type 2 diabetes in older adults is driven by insulin resistance in peripheral tissues combined with progressive beta-cell failure to compensate.
Question 2: Atrial fibrillation increases stroke risk primarily by causing:
- Coronary artery spasm
- Cardioembolism from stasis-induced thrombus formation (Correct answer)
- Hypertensive encephalopathy
- Cerebral vasospasm
Correct answer: Cardioembolism from stasis-induced thrombus formation
Atrial fibrillation leads to blood stasis in the left atrial appendage, promoting thrombus formation that can embolize to the cerebral vasculature.
Question 3: In heart failure with reduced ejection fraction (HFrEF), the Frank-Starling mechanism initially compensates by:
- Decreasing preload to reduce wall stress
- Increasing stroke volume in response to elevated end-diastolic volume (Correct answer)
- Reducing afterload via vasodilation
- Stimulating cardiac hypertrophy immediately
Correct answer: Increasing stroke volume in response to elevated end-diastolic volume
The Frank-Starling mechanism compensates for reduced contractility by increasing stroke volume when the ventricle is stretched by a greater end-diastolic volume.
Question 4: Chronic kidney disease (CKD) in older adults most commonly progresses from:
- Glomerulonephritis alone
- Diabetic nephropathy and hypertensive nephrosclerosis (Correct answer)
- Obstructive uropathy
- Polycystic kidney disease
Correct answer: Diabetic nephropathy and hypertensive nephrosclerosis
Diabetic nephropathy and hypertensive nephrosclerosis are the two leading causes of CKD progression in the US adult population.
Question 5: The hallmark pathological feature of Alzheimer's disease is:
- Lewy body inclusions in cortical neurons
- Extracellular amyloid plaques and intracellular neurofibrillary tangles (Correct answer)
- Demyelination of white matter tracts
- Dopaminergic neuron loss in the substantia nigra
Correct answer: Extracellular amyloid plaques and intracellular neurofibrillary tangles
Alzheimer's disease is characterized by extracellular beta-amyloid plaques and intracellular tau-protein neurofibrillary tangles causing neuronal death.
Question 6: COPD is primarily characterized by which pathophysiological change?
- Reversible airway hyperresponsiveness
- Irreversible airflow limitation due to small airway disease and parenchymal destruction (Correct answer)
- Interstitial fibrosis with restrictive physiology
- Upper airway obstruction from mucosal edema
Correct answer: Irreversible airflow limitation due to small airway disease and parenchymal destruction
COPD involves progressive, largely irreversible airflow limitation caused by small airway inflammation/remodeling and emphysematous destruction of alveolar walls.
Adult-Gerontology CNS Test Advanced Pathophysiology 1
Which pathophysiological mechanism primarily underlies type 2 diabetes mellitus in older adults?