AIPGMEE 2016 Pathology MCQ

A 77-year-old woman has chronic renal failure. Her serum
urea nitrogen is 40 mg/dL. She is given a diuretic medication
and loses 2 kg (4.4 lb). She reduces the protein in her diet and
her serum urea nitrogen decreases to 30 mg/dL. Which of the
following terms best describes cellular responses to disease and
treatment in this woman?
A Adaptation
B Apoptosis
C Necroptosis
D Irreversible injury
E Metabolic derangement
Answer- A
Normal cells handle physiologic demands and maintain
metabolic functions within narrow ranges, termed homeostasis.
Under disease conditions with stress on cells, there is
adaptation to a new steady state. In this case, the loss of renal
function leads to a higher urea nitrogen level as well as retention
of fluid. The diuretic induces loss of the excess fluid to
yield a new steady state. The protein restriction reduces urea
nitrogen excretion, which also leads to a new steady state.
Both are adaptations. Apoptosis refers to single cell necrosis
in response to injury. An irreversible injury leads to cell
death, but the changes described here are not evidence for
cellular necrosis. The metabolism of cells is maintained for
adaptation, with response to the diuretic and to protein restriction.