FPGEE Pathophysiology 3

Question 1

In rheumatoid arthritis, the chronic joint destruction is primarily mediated by:

Accepted Answer

Pannus formation driven by synovial fibroblasts and macrophages secreting destructive cytokines

Answer

Uric acid crystal deposition activating neutrophils in synovial fluid

Answer

Cartilage wear from mechanical overload in weight-bearing joints

Answer

Anti-dsDNA antibodies depositing immune complexes in the joint space

Question 2

A patient with acute pancreatitis develops hypocalcemia. Which mechanism is most responsible?

Accepted Answer

Saponification of peripancreatic fat by lipases binding calcium

Answer

Increased renal calcium excretion due to loop diuretic therapy

Answer

Hypoparathyroidism triggered by pancreatic enzyme activation

Answer

Vitamin D deficiency from pancreatic exocrine insufficiency

Question 3

Which pathophysiological event triggers the cascade of cellular injury in ischemia-reperfusion injury?

Accepted Answer

Rapid restoration of oxygen leading to reactive oxygen species generation and cellular damage

Answer

Sustained ATP depletion preventing membrane pump recovery

Answer

Persistent vasoconstriction after reperfusion preventing oxygen delivery

Answer

Inflammatory cytokine release during ischemia before reperfusion

Question 4

In nephrotic syndrome, the edema forms primarily because:

Accepted Answer

Massive proteinuria lowers plasma oncotic pressure, allowing fluid to shift into interstitial spaces

Answer

Increased ADH secretion causes water retention in the collecting duct

Answer

Aldosterone excess causes renal sodium retention as the primary event

Answer

Lymphatic obstruction prevents protein return to the circulation

Question 5

Pernicious anemia is caused by:

Accepted Answer

Autoimmune destruction of gastric parietal cells impairing intrinsic factor production

Answer

Dietary deficiency of cobalamin due to strict veganism

Answer

Ileal Crohn's disease preventing cobalamin absorption

Answer

Metformin therapy blocking intestinal cobalamin uptake receptors

Question 6

Which pathophysiological mechanism explains the Somogyi effect in diabetes management?

Accepted Answer

Nocturnal hypoglycemia triggering counter-regulatory hormone release causing rebound morning hyperglycemia

Answer

Insufficient insulin at bedtime causing morning hyperglycemia

Answer

Dawn phenomenon from growth hormone surges at 4–8 AM independent of prior hypoglycemia

Answer

Post-meal insulin resistance causing persistent overnight hyperglycemia

Question 7

In systemic lupus erythematosus (SLE), glomerulonephritis is primarily caused by:

Accepted Answer

Deposition of anti-dsDNA immune complexes in the glomerular basement membrane activating complement

Answer

T-cell mediated cytotoxic attack on podocytes

Answer

Eosinophilic infiltration of the mesangium from type I hypersensitivity

Answer

Direct binding of antinuclear antibodies to glomerular type IV collagen