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Question 1
A patient with long-standing diabetes presents with burning foot pain worse at night. Which
pathophysiologic mechanism is most responsible
A Microvascular ischemia causing Schwann cell apoptosis
B Immune-mediated demyelination
C NMDA receptor hyperactivation in dorsal horn neurons
D Sodium channel mutation in peripheral nerves
Answer A
Diabetic neuropathy is primarily caused by microvascular ischemia leading to Schwann cell
apoptosis and axonal degeneration. Chronic hyperglycemia damages small blood vessels
supplying peripheral nerves. Immune-mediated demyelination or channelopathies are not
typical in diabetic neuropathy.
Question 2
A patient on ACE inhibitors develops persistent cough. What is the underlying mechanism
A Increased prostaglandin synthesis
B Decreased angiotensin II
C Bradykinin accumulation
D Alveolar irritation from metabolites
Answer C
ACE breaks down bradykinin. Inhibition leads to bradykinin accumulation, which irritates
the airway and produces a dry, persistent cough.
Question 3
Which lab best differentiates SIADH from cerebral salt wasting
A Serum sodium
B Urine osmolality
C Serum uric acid
D Plasma ADH
Answer C
SIADH presents with low serum uric acid due to dilutional effects and renal excretion,
whereas cerebral salt wasting typically shows normal or high uric acid because of volume
depletion.
Question 4
An elderly patient on warfarin is started on trimethoprim-sulfamethoxazole. INR rises
dramatically. What is the mechanism
A CYP2C9 inhibition
B Increased vitamin K synthesis
C Increased albumin binding
D Reduced hepatic clearance via CYP3A4
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Answer A
TMP-SMX inhibits CYP2C9, the enzyme responsible for warfarin metabolism, causing
accumulation and supratherapeutic INR.
Question 5
Most accurate early indicator of acute kidney injury
A Serum creatinine
B BUN
C Urine output
D GFR
Answer C
Urine output declines before serum creatinine rises because creatinine may lag hours to days
behind the injury. Early oliguria is the most sensitive early indicator.
Question 6
A patient with metabolic acidosis has Kussmaul respirations. What is the purpose
A Increase PaCO₂
B Increase oxygen delivery
C Blow off CO₂ to raise pH
D Compensate for hypokalemia
Answer C
Kussmaul respirations are a respiratory compensatory mechanism to decrease PaCO₂ and
raise blood pH in metabolic acidosis, commonly seen in diabetic ketoacidosis.
Question 7
Which drug class is contraindicated in pregnancy due to fetal renal agenesis
A Beta-blockers
B ACE inhibitors
C Calcium channel blockers
D Thiazides
Answer B
ACE inhibitors block fetal renin-angiotensin system, leading to oligohydramnios and renal
agenesis.
Question 8
Which condition causes widened pulse pressure
A Aortic stenosis
B Cardiac tamponade
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C Aortic regurgitation
D Pulmonary embolism
Answer C
Aortic regurgitation leads to high systolic and low diastolic pressure, producing a wide pulse
pressure.
Question 9
A patient with Graves disease has tachycardia and tremors. Best initial drug
A Methimazole
B Propylthiouracil
C Propranolol
D Radioactive iodine
Answer C
Beta-blockers control adrenergic symptoms immediately. Antithyroid drugs take days to
weeks to reduce hormone levels.
Question 10
Most sensitive test for early diabetic ketoacidosis
A Serum glucose
B Urine ketones
C Serum beta-hydroxybutyrate
D ABG pH
Answer C
Beta-hydroxybutyrate is the predominant ketone in DKA and rises before urine ketones or pH
changes.
Question 11
A patient with chronic hypertension develops concentric left ventricular hypertrophy. Which
molecular mechanism is responsible
A Increased preload causing sarcomere lengthening
B Pressure overload causing parallel sarcomere replication
C RAAS suppression decreasing myocyte size
D Increased intracellular calcium causing eccentric dilation
Answer B
Pressure overload stimulates parallel sarcomere replication, resulting in concentric
hypertrophy. Volume overload causes sarcomeres in series leading to eccentric hypertrophy.
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Question 1
A patient with long-standing diabetes presents with burning foot pain worse at night. Which
pathophysiologic mechanism is most responsible
A Microvascular ischemia causing Schwann cell apoptosis
B Immune-mediated demyelination
C NMDA receptor hyperactivation in dorsal horn neurons
D Sodium channel mutation in peripheral nerves
Answer A
Diabetic neuropathy is primarily caused by microvascular ischemia leading to Schwann cell
apoptosis and axonal degeneration. Chronic hyperglycemia damages small blood vessels
supplying peripheral nerves. Immune-mediated demyelination or channelopathies are not
typical in diabetic neuropathy.
Question 2
A patient on ACE inhibitors develops persistent cough. What is the underlying mechanism
A Increased prostaglandin synthesis
B Decreased angiotensin II
C Bradykinin accumulation
D Alveolar irritation from metabolites
Answer C
ACE breaks down bradykinin. Inhibition leads to bradykinin accumulation, which irritates
the airway and produces a dry, persistent cough.
Question 3
Which lab best differentiates SIADH from cerebral salt wasting
A Serum sodium
B Urine osmolality
C Serum uric acid
D Plasma ADH
Answer C
SIADH presents with low serum uric acid due to dilutional effects and renal excretion,
whereas cerebral salt wasting typically shows normal or high uric acid because of volume
depletion.
Question 4
An elderly patient on warfarin is started on trimethoprim-sulfamethoxazole. INR rises
dramatically. What is the mechanism
A CYP2C9 inhibition
B Increased vitamin K synthesis
C Increased albumin binding
D Reduced hepatic clearance via CYP3A4
,3|Page
Answer A
TMP-SMX inhibits CYP2C9, the enzyme responsible for warfarin metabolism, causing
accumulation and supratherapeutic INR.
Question 5
Most accurate early indicator of acute kidney injury
A Serum creatinine
B BUN
C Urine output
D GFR
Answer C
Urine output declines before serum creatinine rises because creatinine may lag hours to days
behind the injury. Early oliguria is the most sensitive early indicator.
Question 6
A patient with metabolic acidosis has Kussmaul respirations. What is the purpose
A Increase PaCO₂
B Increase oxygen delivery
C Blow off CO₂ to raise pH
D Compensate for hypokalemia
Answer C
Kussmaul respirations are a respiratory compensatory mechanism to decrease PaCO₂ and
raise blood pH in metabolic acidosis, commonly seen in diabetic ketoacidosis.
Question 7
Which drug class is contraindicated in pregnancy due to fetal renal agenesis
A Beta-blockers
B ACE inhibitors
C Calcium channel blockers
D Thiazides
Answer B
ACE inhibitors block fetal renin-angiotensin system, leading to oligohydramnios and renal
agenesis.
Question 8
Which condition causes widened pulse pressure
A Aortic stenosis
B Cardiac tamponade
, 4|Page
C Aortic regurgitation
D Pulmonary embolism
Answer C
Aortic regurgitation leads to high systolic and low diastolic pressure, producing a wide pulse
pressure.
Question 9
A patient with Graves disease has tachycardia and tremors. Best initial drug
A Methimazole
B Propylthiouracil
C Propranolol
D Radioactive iodine
Answer C
Beta-blockers control adrenergic symptoms immediately. Antithyroid drugs take days to
weeks to reduce hormone levels.
Question 10
Most sensitive test for early diabetic ketoacidosis
A Serum glucose
B Urine ketones
C Serum beta-hydroxybutyrate
D ABG pH
Answer C
Beta-hydroxybutyrate is the predominant ketone in DKA and rises before urine ketones or pH
changes.
Question 11
A patient with chronic hypertension develops concentric left ventricular hypertrophy. Which
molecular mechanism is responsible
A Increased preload causing sarcomere lengthening
B Pressure overload causing parallel sarcomere replication
C RAAS suppression decreasing myocyte size
D Increased intracellular calcium causing eccentric dilation
Answer B
Pressure overload stimulates parallel sarcomere replication, resulting in concentric
hypertrophy. Volume overload causes sarcomeres in series leading to eccentric hypertrophy.
