1. Which of the following is the most likely cause of metabolic acidosis
in a patient with diabetic ketoacidosis (DKA)?
A) Increased production of hydrogen ions (H+) B) Decreased renal
excretion of hydrogen ions (H+) C) Increased bicarbonate (HCO₃-) levels
D) Increased respiratory rate leading to excessive CO₂ loss
Answer: A) Increased production of hydrogen ions (H+)
Rationale: In DKA, the breakdown of fatty acids leads to the production
of ketone bodies, such as acetoacetate and β-hydroxybutyrate. These
ketone bodies release hydrogen ions, leading to metabolic acidosis. The
kidneys attempt to compensate by excreting more H+, but the acidosis
persists due to excessive ketone production.
2. In chronic obstructive pulmonary disease (COPD), which of the
following is the primary mechanism responsible for airflow limitation?
A) Inflammation of the small airways B) Bronchoconstriction C) Loss of
elastic recoil D) Impaired mucociliary clearance
Answer: C) Loss of elastic recoil
Rationale: COPD is characterized by a loss of elastic recoil due to
destruction of the alveolar walls and the alveolar-capillary membrane
(emphysema). This loss of elasticity leads to airway collapse during
expiration, limiting airflow. Chronic inflammation and
bronchoconstriction are also present but are secondary to the primary
problem of decreased elastic recoil.
3. A patient presents with tachycardia, tremors, and heat intolerance.
Lab results show decreased TSH and increased free T4. What is the
most likely diagnosis?
,A) Hypothyroidism B) Hyperthyroidism C) Adrenal insufficiency D)
Pheochromocytoma
Answer: B) Hyperthyroidism
Rationale: The clinical signs (tachycardia, tremors, heat intolerance) and
lab results (decreased TSH and increased T4) suggest hyperthyroidism.
The low TSH indicates that the thyroid gland is overactive and producing
excess thyroid hormone. This leads to increased metabolism and
symptoms such as tremors, heat intolerance, and tachycardia.
4. In a patient with cirrhosis, which of the following is the most
common cause of portal hypertension?
A) Increased hepatic venous pressure gradient B) Increased portal blood
flow C) Portal vein thrombosis D) Hepatic artery vasodilation
Answer: A) Increased hepatic venous pressure gradient
Rationale: In cirrhosis, fibrosis and scarring of the liver tissue increase
resistance to blood flow through the liver, leading to an increase in the
hepatic venous pressure gradient. This elevated pressure in the portal
vein leads to portal hypertension, which can cause complications like
ascites and variceal bleeding.
5. Which of the following is a characteristic feature of nephrotic
syndrome?
A) Hematuria B) Proteinuria > 3.5 g/day C) Hypertension D)
Hyperkalemia
Answer: B) Proteinuria > 3.5 g/day
, Rationale: Nephrotic syndrome is characterized by a loss of large
amounts of protein in the urine (proteinuria > 3.5 g/day), which leads to
hypoalbuminemia and edema. Hematuria, hypertension, and
hyperkalemia are not typically characteristic features of nephrotic
syndrome, though they may occur in other kidney disorders.
6. In the pathophysiology of atherosclerosis, which of the following
contributes to plaque formation?
A) Endothelial cell injury B) Decreased LDL cholesterol C) Increased HDL
cholesterol D) Decreased smooth muscle cell proliferation
Answer: A) Endothelial cell injury
Rationale: Atherosclerosis begins with endothelial cell injury, which
allows low-density lipoprotein (LDL) cholesterol to infiltrate the arterial
wall. This process triggers an inflammatory response that leads to the
formation of plaques, consisting of lipids, smooth muscle cells, and
extracellular matrix.
7. Which of the following is the most common cause of non-alcoholic
fatty liver disease (NAFLD)?
A) Viral hepatitis B) Obesity C) Hemochromatosis D) Wilson’s disease
Answer: B) Obesity
Rationale: NAFLD is most commonly associated with obesity, as
excessive fat accumulation in the liver is strongly linked to metabolic
risk factors such as insulin resistance, hyperlipidemia, and hypertension.
Although other conditions like viral hepatitis and hemochromatosis can
lead to liver disease, obesity is the leading cause of NAFLD.
in a patient with diabetic ketoacidosis (DKA)?
A) Increased production of hydrogen ions (H+) B) Decreased renal
excretion of hydrogen ions (H+) C) Increased bicarbonate (HCO₃-) levels
D) Increased respiratory rate leading to excessive CO₂ loss
Answer: A) Increased production of hydrogen ions (H+)
Rationale: In DKA, the breakdown of fatty acids leads to the production
of ketone bodies, such as acetoacetate and β-hydroxybutyrate. These
ketone bodies release hydrogen ions, leading to metabolic acidosis. The
kidneys attempt to compensate by excreting more H+, but the acidosis
persists due to excessive ketone production.
2. In chronic obstructive pulmonary disease (COPD), which of the
following is the primary mechanism responsible for airflow limitation?
A) Inflammation of the small airways B) Bronchoconstriction C) Loss of
elastic recoil D) Impaired mucociliary clearance
Answer: C) Loss of elastic recoil
Rationale: COPD is characterized by a loss of elastic recoil due to
destruction of the alveolar walls and the alveolar-capillary membrane
(emphysema). This loss of elasticity leads to airway collapse during
expiration, limiting airflow. Chronic inflammation and
bronchoconstriction are also present but are secondary to the primary
problem of decreased elastic recoil.
3. A patient presents with tachycardia, tremors, and heat intolerance.
Lab results show decreased TSH and increased free T4. What is the
most likely diagnosis?
,A) Hypothyroidism B) Hyperthyroidism C) Adrenal insufficiency D)
Pheochromocytoma
Answer: B) Hyperthyroidism
Rationale: The clinical signs (tachycardia, tremors, heat intolerance) and
lab results (decreased TSH and increased T4) suggest hyperthyroidism.
The low TSH indicates that the thyroid gland is overactive and producing
excess thyroid hormone. This leads to increased metabolism and
symptoms such as tremors, heat intolerance, and tachycardia.
4. In a patient with cirrhosis, which of the following is the most
common cause of portal hypertension?
A) Increased hepatic venous pressure gradient B) Increased portal blood
flow C) Portal vein thrombosis D) Hepatic artery vasodilation
Answer: A) Increased hepatic venous pressure gradient
Rationale: In cirrhosis, fibrosis and scarring of the liver tissue increase
resistance to blood flow through the liver, leading to an increase in the
hepatic venous pressure gradient. This elevated pressure in the portal
vein leads to portal hypertension, which can cause complications like
ascites and variceal bleeding.
5. Which of the following is a characteristic feature of nephrotic
syndrome?
A) Hematuria B) Proteinuria > 3.5 g/day C) Hypertension D)
Hyperkalemia
Answer: B) Proteinuria > 3.5 g/day
, Rationale: Nephrotic syndrome is characterized by a loss of large
amounts of protein in the urine (proteinuria > 3.5 g/day), which leads to
hypoalbuminemia and edema. Hematuria, hypertension, and
hyperkalemia are not typically characteristic features of nephrotic
syndrome, though they may occur in other kidney disorders.
6. In the pathophysiology of atherosclerosis, which of the following
contributes to plaque formation?
A) Endothelial cell injury B) Decreased LDL cholesterol C) Increased HDL
cholesterol D) Decreased smooth muscle cell proliferation
Answer: A) Endothelial cell injury
Rationale: Atherosclerosis begins with endothelial cell injury, which
allows low-density lipoprotein (LDL) cholesterol to infiltrate the arterial
wall. This process triggers an inflammatory response that leads to the
formation of plaques, consisting of lipids, smooth muscle cells, and
extracellular matrix.
7. Which of the following is the most common cause of non-alcoholic
fatty liver disease (NAFLD)?
A) Viral hepatitis B) Obesity C) Hemochromatosis D) Wilson’s disease
Answer: B) Obesity
Rationale: NAFLD is most commonly associated with obesity, as
excessive fat accumulation in the liver is strongly linked to metabolic
risk factors such as insulin resistance, hyperlipidemia, and hypertension.
Although other conditions like viral hepatitis and hemochromatosis can
lead to liver disease, obesity is the leading cause of NAFLD.
