NUR 546/NUR546 Exam 4 V3 | Advanced
Pathophysiology Q&A with Rationale |
William Paterson University
1. A 45-year-old female presents with fatigue, cold intolerance, and weight gain despite a
decreased appetite. Laboratory results show an elevated TSH and low free T4. Which
condition is most likely?
A. Grave’s Disease
B. Hashimoto’s Thyroiditis
C. Secondary Hyperthyroidism
D. Pheochromocytoma
Answer: B
Rationale: Hashimoto’s thyroiditis is the most common cause of primary hypothyroidism
in iodine-sufficient areas. An elevated TSH combined with a low free T4 indicates that the
thyroid gland is failing to produce enough hormone despite stimulation from the pituitary.
This autoimmune destruction leads to the classic symptoms of metabolic slowing such as
weight gain and fatigue.
2. Which of the following describes the Somogyi effect in patients with Diabetes Mellitus?
A. Early morning hyperglycemia due to GH release without preceding hypoglycemia
B. Post-prandial glucose spikes following a high-carbohydrate meal
,C. Hypoglycemia followed by rebound hyperglycemia due to counter-regulatory hormones
D. A decrease in insulin sensitivity due to chronic infection
Answer: C
Rationale: The Somogyi effect is characterized by a drop in blood glucose levels during the
night, which triggers the release of stress hormones like cortisol and glucagon. These
counter-regulatory hormones cause a rebound spike in glucose by the morning. It is
distinct from the Dawn phenomenon, which does not involve a preceding hypoglycemic
event.
3. A patient with Small Cell Lung Cancer presents with hyponatremia and very concentrated
urine. What is the most likely pathophysiological mechanism?
A. Excessive secretion of Antidiuretic Hormone (SIADH)
B. Inhibition of Antidiuretic Hormone (ADH)
C. Destruction of the posterior pituitary gland
D. Renal resistance to vasopressin
Answer: A
Rationale: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is frequently
associated with ectopic hormone production by small cell lung cancers. The excess ADH
causes the kidneys to reabsorb too much water, leading to dilutional hyponatremia.
Patients typically exhibit high urine osmolarity despite having low serum osmolarity.
, 4. What is the primary underlying cause of Type 1 Diabetes Mellitus?
A. Peripheral insulin resistance and beta-cell exhaustion
B. Autoimmune destruction of pancreatic beta cells
C. Excessive glucagon production by alpha cells
D. Inability of the liver to store glycogen
Answer: B
Rationale: Type 1 Diabetes Mellitus is characterized by an absolute insulin deficiency due
to the autoimmune-mediated destruction of pancreatic beta cells. T-cells and
autoantibodies target the insulin-producing cells, leading to a total loss of insulin secretion.
This differs from Type 2 DM, which is primarily driven by insulin resistance and relative
deficiency.
5. A patient presents with truncal obesity, a ‘moon face,’ and purple striae on the abdomen.
Which laboratory finding would support a diagnosis of Cushing Syndrome?
A. Low serum cortisol
B. Hypoglycemia
C. Elevated urinary free cortisol
D. Hyperkalemia
Answer: C
Pathophysiology Q&A with Rationale |
William Paterson University
1. A 45-year-old female presents with fatigue, cold intolerance, and weight gain despite a
decreased appetite. Laboratory results show an elevated TSH and low free T4. Which
condition is most likely?
A. Grave’s Disease
B. Hashimoto’s Thyroiditis
C. Secondary Hyperthyroidism
D. Pheochromocytoma
Answer: B
Rationale: Hashimoto’s thyroiditis is the most common cause of primary hypothyroidism
in iodine-sufficient areas. An elevated TSH combined with a low free T4 indicates that the
thyroid gland is failing to produce enough hormone despite stimulation from the pituitary.
This autoimmune destruction leads to the classic symptoms of metabolic slowing such as
weight gain and fatigue.
2. Which of the following describes the Somogyi effect in patients with Diabetes Mellitus?
A. Early morning hyperglycemia due to GH release without preceding hypoglycemia
B. Post-prandial glucose spikes following a high-carbohydrate meal
,C. Hypoglycemia followed by rebound hyperglycemia due to counter-regulatory hormones
D. A decrease in insulin sensitivity due to chronic infection
Answer: C
Rationale: The Somogyi effect is characterized by a drop in blood glucose levels during the
night, which triggers the release of stress hormones like cortisol and glucagon. These
counter-regulatory hormones cause a rebound spike in glucose by the morning. It is
distinct from the Dawn phenomenon, which does not involve a preceding hypoglycemic
event.
3. A patient with Small Cell Lung Cancer presents with hyponatremia and very concentrated
urine. What is the most likely pathophysiological mechanism?
A. Excessive secretion of Antidiuretic Hormone (SIADH)
B. Inhibition of Antidiuretic Hormone (ADH)
C. Destruction of the posterior pituitary gland
D. Renal resistance to vasopressin
Answer: A
Rationale: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is frequently
associated with ectopic hormone production by small cell lung cancers. The excess ADH
causes the kidneys to reabsorb too much water, leading to dilutional hyponatremia.
Patients typically exhibit high urine osmolarity despite having low serum osmolarity.
, 4. What is the primary underlying cause of Type 1 Diabetes Mellitus?
A. Peripheral insulin resistance and beta-cell exhaustion
B. Autoimmune destruction of pancreatic beta cells
C. Excessive glucagon production by alpha cells
D. Inability of the liver to store glycogen
Answer: B
Rationale: Type 1 Diabetes Mellitus is characterized by an absolute insulin deficiency due
to the autoimmune-mediated destruction of pancreatic beta cells. T-cells and
autoantibodies target the insulin-producing cells, leading to a total loss of insulin secretion.
This differs from Type 2 DM, which is primarily driven by insulin resistance and relative
deficiency.
5. A patient presents with truncal obesity, a ‘moon face,’ and purple striae on the abdomen.
Which laboratory finding would support a diagnosis of Cushing Syndrome?
A. Low serum cortisol
B. Hypoglycemia
C. Elevated urinary free cortisol
D. Hyperkalemia
Answer: C
