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Q1. Which mechanism is primarily responsible for the
development of insulin resistance in type 2 diabetes mellitus?
A. Autoimmune destruction of pancreatic beta cells
B. Downregulation of insulin receptors and post-receptor
signaling defects
C. Increased hepatic glycogen storage
D. Excess glucagon secretion from alpha cells
Answer: B
*Rationale: Insulin resistance results from decreased
responsiveness of peripheral tissues (muscle, fat, liver) due to
impaired insulin receptor function and post-receptor signaling
abnormalities. This is the primary pathophysiologic defect in type
2 diabetes, unlike type 1 which involves autoimmune beta-cell
destruction .*
,Q2. Portal hypertension most directly contributes to which
complication of liver cirrhosis?
A. Hepatic encephalopathy
B. Ascites
C. Hypoglycemia
D. Jaundice
Answer: B
Rationale: Increased portal venous pressure leads to fluid
transudation into the peritoneal cavity through increased
hydrostatic pressure in portal capillaries. This directly causes ascites,
while hepatic encephalopathy results from impaired ammonia
metabolism .
Q3. Which electrolyte abnormality is most commonly
associated with acute adrenal insufficiency?
A. Hypernatremia
B. Hypokalemia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: Aldosterone deficiency in acute adrenal insufficiency
leads to impaired potassium excretion by the kidneys, resulting in
hyperkalemia. This is a key distinguishing feature from secondary
adrenal insufficiency where aldosterone is preserved .
Q4. Which mechanism best explains the development of
pulmonary edema in left-sided heart failure?
A. Increased pulmonary arterial resistance
B. Reduced alveolar surfactant
,C. Elevated pulmonary capillary hydrostatic pressure
D. Decreased plasma oncotic pressure
Answer: C
Rationale: Left ventricular failure causes blood to back up into the
pulmonary circulation. This increases pulmonary capillary
hydrostatic pressure, forcing fluid out of capillaries and into the
interstitial space and alveoli .
Q5. Atherosclerosis begins with endothelial injury, followed
by:
A. Plaque calcification
B. Foam cell formation
C. Thrombus development
D. Smooth muscle apoptosis
Answer: B
Rationale: After endothelial injury, oxidized LDL cholesterol is
engulfed by macrophages, which then transform into foam cells.
These foam cells accumulate to form fatty streaks, the earliest
atherosclerotic lesions .
Q6. Which complication is most closely associated with long-
term uncontrolled hypertension?
A. Aortic stenosis
B. Left ventricular hypertrophy
C. Dilated cardiomyopathy
D. Pericardial effusion
Answer: B
Rationale: Chronic pressure overload from hypertension forces the
left ventricle to work harder, leading to concentric myocardial
, thickening (hypertrophy). This compensatory mechanism eventually
decompensates, increasing risk for heart failure .
Q7. In septic shock, hypotension primarily results from:
A. Decreased blood volume
B. Myocardial infarction
C. Systemic vasodilation
D. Increased systemic vascular resistance
Answer: C
Rationale: Inflammatory mediators (cytokines, nitric oxide) released
during sepsis cause widespread vasodilation and increased capillary
permeability. This reduces systemic vascular resistance, leading to
distributive shock .
Q8. Which condition is associated with increased risk of
ventricular dysrhythmias?
A. Hypokalemia
B. Hypernatremia
C. Hypocalcemia
D. Hypermagnesemia
Answer: A
Rationale: Low potassium levels alter cardiac conduction by
affecting repolarization of cardiac myocytes. This increases the risk
of potentially fatal ventricular arrhythmias including torsades de
pointes and ventricular fibrillation .
Q9. Hyperlipidemia contributes to atherosclerosis primarily
through:
A. Direct damage to the tunica adventitia
B. Oxidation of LDL particles in the vessel wall