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

Portal hypertension increases hydrostatic pressure in the splanchnic bed while hypoalbuminemia (from hepatic synthetic failure) lowers colloid oncotic pressure, together driving fluid into the peritoneal cavity.

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

Myocardial necrosis can cause rupture of the interventricular septum 3–5 days post-MI, creating an acute ventricular septal defect with a left-to-right shunt heard as a harsh holosystolic 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

Pre-renal azotemia results from reduced renal blood flow (e.g., dehydration, heart failure), which lowers GFR and creatinine clearance without structural kidney damage, making it rapidly reversible.

Question 4

In Graves' disease, the hyperthyroidism is caused by:

Accepted Answer

IgG autoantibodies that stimulate the TSH receptor

Answer

Graves' disease involves thyroid-stimulating immunoglobulins (TSI/TRAb) that bind and continuously activate TSH receptors, driving unregulated thyroid hormone synthesis independent of pituitary TSH.

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

In chronic hypercapnia, the kidneys compensate by excreting more H+ and retaining HCO3-, raising serum bicarbonate to partially normalize arterial pH.

FPGEE Exam Practice Test

FPGEE Exam Practice Test

FPGEE Pathophysiology 2