FPGEE Pathophysiology 2

Question 1

In cirrhosis, which mechanism is most responsible for the development of ascites?

Accepted Answer

Portal hypertension combined with hypoalbuminemia reducing oncotic pressure

Answer

Increased lymphatic flow from the thoracic duct

Answer

Excess aldosterone independent of portal hypertension

Answer

Renal tubular acidosis causing sodium loss into the peritoneum

Question 2

A patient with an acute MI develops a new holosystolic murmur at the left sternal border 4 days post-infarct. Which complication is most likely?

Accepted Answer

Ventricular septal rupture causing a left-to-right shunt

Answer

Mitral stenosis from papillary muscle scarring

Answer

Aortic regurgitation from root dilation

Answer

Pericarditis causing a friction rub misidentified as a murmur

Question 3

Which pathophysiological change is responsible for the elevated serum creatinine in pre-renal azotemia?

Accepted Answer

Decreased renal perfusion reducing GFR without intrinsic tubular damage

Answer

Glomerular inflammation reducing filtration surface area

Answer

Obstructive nephropathy increasing back-pressure on nephrons

Answer

Tubular necrosis impairing creatinine secretion

Question 4

In Graves' disease, the hyperthyroidism is caused by:

Accepted Answer

IgG autoantibodies that stimulate the TSH receptor

Answer

Excessive TSH secretion by a pituitary adenoma

Answer

Follicular destruction releasing stored thyroid hormone

Answer

Dietary iodine excess triggering thyroid autonomy

Question 5

A patient with COPD has a PaCO2 of 55 mmHg and HCO3- of 30 mEq/L. What pathophysiological adaptation is reflected by the elevated bicarbonate?

Accepted Answer

Renal compensation for chronic respiratory acidosis by retaining bicarbonate

Answer

Acute metabolic alkalosis from diuretic use

Answer

Respiratory compensation for metabolic alkalosis

Answer

Acute respiratory alkalosis with secondary metabolic acidosis

Question 6

Which mechanism underlies the thrombocytopenia in heparin-induced thrombocytopenia (HIT)?

Accepted Answer

IgG antibodies against heparin-PF4 complexes activating platelets and causing consumption

Answer

Heparin directly lysing platelets by complement activation

Answer

Heparin chelating calcium needed for platelet aggregation

Answer

Antiplatelet antibodies cross-reacting with glycoprotein IIb/IIIa

Question 7

In septic shock, the refractory hypotension is primarily due to:

Accepted Answer

Massive vasodilation driven by excess nitric oxide from bacterial endotoxins

Answer

Cardiac tamponade from bacterial pericarditis

Answer

Severe anemia reducing oxygen delivery capacity

Answer

Adrenal insufficiency causing cortisol deficiency in all patients