D236 Pathophysiology - Set 5 - Part 1

Correct Answer: Goblet cells

Goblet cell hyperplasia in chronic bronchitis increases mucus production, contributing to airway obstruction and productive cough symptoms.
Option a is incorrect because ciliated cells help clear mucus but don't produce it; they're often damaged in bronchitis.
Option c is incorrect because basal cells are progenitor cells that differentiate but don't directly produce mucus secretions.
Option d is incorrect because club cells secrete surfactant proteins in bronchioles, not the mucus overproduction described.

Correct Answer: Antigenic drift

Antigenic drift involves gradual mutations in viral surface proteins, allowing escape from existing antibodies requiring annual vaccine updates.
Option b is incorrect because while some viruses suppress immunity, antigenic drift specifically involves surface protein changes described.
Option c is incorrect because cell invasion helps viral replication but doesn't explain the immune evasion through protein changes.
Option d is incorrect because dormancy involves latent infections, not the continuous surface protein mutations described here.

Correct Answer: Compartmental pressure rise

Increased pressure within fascial compartments compresses vessels, causing ischemia requiring fasciotomy to prevent permanent damage immediately.
Option a is incorrect because arterial pressure typically remains normal; the compartment pressure exceeds perfusion pressure causing ischemia.
Option b is incorrect because venous pressure increases from compression; the primary problem is elevated compartment pressure.
Option d is incorrect because lymphatic pressure changes are secondary; the compartmental pressure elevation causes tissue damage.

Correct Answer: Potassium excess

Hyperkalemia from reduced renal excretion causes cardiac conduction abnormalities potentially leading to ventricular fibrillation and death.
Option a is incorrect because sodium excess causes volume overload but not the acute arrhythmias from potassium elevation.
Option c is incorrect because chloride follows sodium and doesn't independently cause the fatal arrhythmias described here.
Option d is incorrect because bicarbonate is typically low in kidney failure; potassium elevation causes cardiac emergencies.

Correct Answer: Columnar metaplasia

Chronic acid exposure causes intestinal columnar metaplasia replacing squamous epithelium, increasing adenocarcinoma risk significantly over time.
Option a is incorrect because the change involves epithelial type replacement, not hyperplasia of existing squamous cells.
Option c is incorrect because while scarring can occur, the characteristic change is metaplasia to columnar epithelium.
Option d is incorrect because the tissue undergoes metaplastic transformation rather than atrophy or tissue loss.

Correct Answer: Ganglion cell absence

Absent ganglion cells in colon segments prevent peristalsis, causing functional obstruction and toxic megacolon risk potentially.
Option a is incorrect because sensory nerves are present; the absence of ganglion cells prevents coordinated bowel movement.
Option c is incorrect because the problem is absent innervation, not excessive motor activity in affected segments.
Option d is incorrect because parasympathetic ganglion cells are specifically absent, not excessive in Hirschsprung disease.

Correct Answer: Partial thromboplastin time

PTT measures intrinsic pathway factors affected by heparin, allowing dose adjustment for therapeutic anticoagulation without excessive bleeding.
Option a is incorrect because prothrombin time monitors warfarin affecting extrinsic pathway, not heparin therapy described.
Option c is incorrect because bleeding time tests platelet function, not the coagulation cascade affected by heparin.
Option d is incorrect because thrombin time tests fibrinogen conversion, not the intrinsic pathway monitoring for heparin.

Correct Answer: Oncotic pressure loss

Massive proteinuria reduces plasma oncotic pressure, allowing fluid shift into interstitial spaces causing generalized edema formation.
Option a is incorrect because while sodium retention contributes, the primary cause is oncotic pressure loss from proteinuria.
Option c is incorrect because hydrostatic pressure doesn't primarily increase; oncotic pressure decrease drives edema formation described.
Option d is incorrect because lymphatics remain functional; the problem is oncotic pressure gradient loss from proteinuria.

Correct Answer: Inspiration difficulty

Restrictive diseases reduce lung compliance making expansion difficult during inspiration, while obstructive diseases impair expiration primarily.
Option a is incorrect because expiration difficulty characterizes obstructive diseases like COPD, not restrictive lung conditions.
Option c is incorrect because both can affect breathing rate; the mechanical difference is inspiration versus expiration difficulty.
Option d is incorrect because rhythm changes can occur in both; the distinction is mechanical breathing phase affected.

Correct Answer: Ketogenesis

Ketogenesis in liver converts fatty acids to ketones providing alternative brain fuel when glucose is scarce.
Option a is incorrect because glycolysis breaks down glucose which is depleted during starvation requiring alternative fuels.
Option b is incorrect because gluconeogenesis makes glucose from non-carbohydrate sources but ketones provide additional brain fuel.
Option d is incorrect because glycogenesis stores glucose as glycogen, opposite of the catabolic processes during starvation.

Correct Answer: Growth hormone excess

Excess growth hormone in adults causes acromegaly with soft tissue and bone enlargement since growth plates are closed.
Option a is incorrect because thyroid hormone affects metabolism and can influence growth but doesn't cause acromegaly features.
Option c is incorrect because insulin regulates glucose metabolism, not the bone and soft tissue growth described.
Option d is incorrect because cortisol excess causes Cushing syndrome with different features than acromegaly growth patterns.

Correct Answer: Alloimmune response

Alloimmune responses occur when recipient immune system recognizes donor tissue as foreign, attacking transplanted organs accordingly.
Option a is incorrect because autoimmunity involves self-tissue attack, not the donor tissue rejection described here.
Option c is incorrect because while rejection involves immune response, alloimmunity specifically describes transplant rejection mechanisms.
Option d is incorrect because immunodeficiency would reduce rejection risk; alloimmune response causes transplant rejection described.

Correct Answer: Misfolded protein

Misfolded alpha-1 antitrypsin accumulates in hepatocytes causing cirrhosis, while lung lacks protease inhibition causing emphysema.
Option a is incorrect because the protein is abnormally folded, not normal configuration, causing retention in liver cells.
Option c is incorrect because alpha-1 antitrypsin is endogenous, not foreign; misfolding prevents normal secretion from hepatocytes.
Option d is incorrect because the protein is misfolded rather than shortened; this misfolding causes hepatocyte accumulation.

Correct Answer: Rupture

Vessel rupture from hypertension or aneurysm causes hemorrhagic stroke with blood entering brain tissue causing damage.
Option a is incorrect because thrombosis causes ischemic stroke by blocking flow, not the bleeding described here.
Option b is incorrect because embolism blocks vessels causing ischemia, not hemorrhage into brain tissue described.
Option d is incorrect because vasospasm reduces flow but doesn't cause the vessel rupture and bleeding described.

Correct Answer: Gap junctions

Gap junctions form channels allowing ions and small molecules to pass directly between cells enabling synchronized activity.
Option a is incorrect because tight junctions seal spaces between cells preventing leakage, not allowing communication described.
Option c is incorrect because adherens junctions provide adhesion and structural support, not direct cytoplasmic communication channels.
Option d is incorrect because desmosomes provide mechanical strength through adhesion, not channels for molecular communication.

Correct Answer: Myoglobin

Myoglobin from damaged muscle precipitates in kidney tubules causing acute kidney injury requiring aggressive hydration treatment.
Option a is incorrect because while calcium shifts occur, myoglobin specifically causes the kidney damage in rhabdomyolysis.
Option c is incorrect because creatinine elevates from kidney damage but myoglobin causes the initial tubular injury.
Option d is incorrect because lactate may increase but myoglobin precipitation causes the characteristic kidney damage.

Correct Answer: Fibrillin defect

Fibrillin-1 mutations in Marfan syndrome weaken elastic fibers causing aortic dilation and potential dissection or rupture.
Option a is incorrect because while collagen is important, Marfan specifically involves fibrillin affecting elastic fiber integrity.
Option c is incorrect because elastin structure depends on fibrillin scaffolding; the primary defect involves fibrillin protein.
Option d is incorrect because laminin is basement membrane protein; Marfan involves fibrillin in elastic fiber assembly.

Correct Answer: Platelet versus fibrin

Primary hemostasis forms platelet plug while secondary hemostasis creates fibrin mesh strengthening the initial platelet clot.
Option a is incorrect because both occur at injury sites; the distinction is platelet plug versus fibrin formation.
Option c is incorrect because while timing differs, the key distinction is platelet aggregation versus coagulation cascade activation.
Option d is incorrect because calcium is needed for secondary hemostasis but the main difference is platelet versus fibrin.

Correct Answer: Autonomic neuropathy

Diabetic autonomic neuropathy damages vagus nerve and enteric neurons, impairing gastric motility causing gastroparesis symptoms progressively.
Option a is incorrect because while microangiopathy occurs, autonomic nerve damage specifically causes motility dysfunction described here.
Option c is incorrect because protein glycation contributes to complications but autonomic neuropathy directly impairs gut function.
Option d is incorrect because insulin resistance affects glucose control; autonomic neuropathy causes the motility problems described.

Correct Answer: Prolactin excess

Hyperprolactinemia from pituitary adenomas or medications stimulates milk production regardless of pregnancy or nursing status present.
Option a is incorrect because estrogen stimulates breast development but prolactin specifically triggers milk production described here.
Option c is incorrect because oxytocin causes milk ejection reflex, not the inappropriate milk production itself described.
Option d is incorrect because progesterone prepares breast tissue but prolactin specifically stimulates milk synthesis inappropriately.