A study of patients more than 25 years of age with body mass index above 30, dyslipidemia, hypertension, and fasting glucose averaging 115 mg/dL is performed. They have adipose tissue abnormalities including increased nonesterified fatty acid release, altered adipokines with decreased adiponectin, greater proinflammatory cytokine release, and diminished peroxisome proliferator-activated receptor gamma (PPARγ) function. Which of the following is the best initial therapeutic intervention for these patients?

Correct Answer: B

Rationale: The findings are those of insulin resistance from obesity with metabolic syndrome. Insulin resistance drives beta cell dysfunction, but other factors such as the TCF7L2 gene play a role in eventual development of overt type 2 diabetes mellitus. Excess free fatty acids may stimulate cytokine release from beta cells to promote inflammation and islet cell dysfunction. Lifestyle modification with dietary modification for weight reduction coupled with increased exercise will aid in reversing the insulin resistance so that no drug therapy is needed to control hyperglycemia.

Correct Answer: D

Rationale: Adrenal hormones (cortisol, epinephrine) raise glucose, mimic SNS, reduce inflammation; thirst is regulated by hypothalamus/ADH, not adrenal.

Correct Answer: D

Rationale: Mitral (bicuspid) valve has 2 cusps, allows flow from left atrium to ventricle.

Correct Answer: A

Rationale: Larger diameter reduces resistance (F = P/R), increasing flow; others impede it.

Correct Answer: D

Rationale: NFP = CHP - BCOP = 20 - 25 = -5 mm Hg; negative NFP means reabsorption.