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When evaluating a patient with acute chest pain, what are the three life-threatening diagnoses that must always be considered?
Which of the following is an obstructive cause of reduced coronary blood flow?
A 48-year-old man presents with chest pain. He has a brother who had a myocardial infarction at age 52. Which statement about this family history is correct regarding CAD risk?
Which of the following is the single most important modifiable risk factor for coronary artery disease?
Which two conditions are considered CAD equivalents, meaning they carry the same cardiovascular risk as established CAD?
A 55-year-old man presents with new-onset erectile dysfunction. Which of the following statements is most accurate?
Cocaine use as a cardiovascular risk factor is unique because it:
Which of the following best describes classic angina pectoris?
A patient describes chest pain that occurs predictably on walking two blocks but resolves completely with 3 minutes of rest. His resting ECG is normal. What type of angina does this represent?
A patient reports chest pain that wakes him at 3 AM, is not associated with exertion, and sometimes improves if he gets up and walks around. ECG during an episode shows ST elevation. Which diagnosis is most likely?
At what percentage of luminal occlusion does Coronary Artery Disease (CAD) typically become symptomatic?
A patient with Prinzmetal's angina is started on propranolol. Which of the following is expected?
Angina with Normal Coronary Angiography (ANOCA) is most common in which group, and what is the most common cause?
What does the resting ECG typically show in a patient with stable angina between episodes?
Which of the following best defines Ischaemic Heart Disease (IHD)?
What constitutes a positive exercise ECG (treadmill test)?
Which pharmacologic stress agent is contraindicated in patients with reactive airway disease?
A negative exercise stress test in a patient with chest pain means:
Which ECG lead group corresponds to the territory of the Left Anterior Descending (LAD) artery?
ST elevation in leads II, III, and aVF most likely indicates occlusion of which coronary artery?
Sublingual glyceryl trinitrate (GTN) relieves angina primarily by which mechanism?
Which anti-anginal drug works by inhibiting the SA node funny current (If) to reduce heart rate?
Trimetazidine exerts its anti-anginal effect through which mechanism?
Which of the following is the LDL-C target for a patient classified as very high cardiovascular risk?
What is the mechanism of restenosis after coronary stent implantation, and how is it prevented?
Stent thrombosis is most closely associated with which of the following?
The COURAGE Trial demonstrated which of the following?
Which graft is preferred in CABG surgery, and why?
Which of the following correctly distinguishes Unstable Angina (UA) from NSTEMI?
What is the common underlying pathophysiological mechanism of all acute coronary syndromes?
What does Wellens' Syndrome represent on ECG, and why is it clinically important?
A patient with acute chest pain has a normal ECG in the emergency department. Which of the following statements is correct?
New Left Bundle Branch Block (LBBB) in a patient with acute chest pain should be treated as:
Why is CK-MB preferred over troponin for detecting re-infarction in a patient who had an MI 5 days ago?
What does the mnemonic MONABCH represent in immediate ACS management?
Which of the following drugs should NOT be included in the acute management of ACS?
Why is thrombolysis NOT beneficial in UA/NSTEMI?
What are the three diagnostic criteria for STEMI?
What is the correct sequence of ECG changes following a STEMI over time?
How is Posterior STEMI identified on a standard 12-lead ECG?
What is the preferred reperfusion strategy for STEMI, and what is the door-to-reperfusion time target?
When is fibrinolysis indicated for STEMI instead of primary PCI?
Which fibrinolytic agent must NOT be combined with heparin, and why?
Why must beta-blockers be used cautiously in inferior MI?
What is the pathophysiology of RV infarction, and how commonly does it complicate inferior MI?
A patient with inferior STEMI develops hypotension, clear lung fields, and elevated JVP. What is the most likely diagnosis and correct immediate management?
How is RV infarction confirmed on ECG?
Which of the following correctly summarizes the difference in reperfusion approach between STEMI and UA/NSTEMI?
Which post-MI complication presents with a new loud holosystolic murmur and a palpable thrill, hypotension, and elevated JVP?
Papillary muscle rupture after MI presents with which of the following?
What is the timing and mechanism of Dressler's Syndrome after MI?
True ventricular aneurysm after MI has which characteristic ECG finding?
What is the best diagnostic test for mechanical complications of MI (free wall rupture, VSD, papillary muscle rupture)?
Which of the following is the correct treatment for Ventricular Fibrillation (VF) post-MI?
AV block complicating inferior MI should be treated first with which of the following?
What are the post-ACS discharge medications represented by the mnemonic ASBS?
What does the Frank-Starling Law describe, and what happens when preload becomes excessive in HF?
Which of the following best defines heart failure?
What is the approximate 5-year mortality of heart failure?
Which of the following statements about the epidemiology of heart failure is TRUE?
A 65-year-old man with known ischemic heart disease develops worsening dyspnea. Which mechanism most likely explains his heart failure?
Which of the following causes restrictive cardiomyopathy?
A patient with HOCM is examined. Which of the following statements about diastolic function in HOCM is CORRECT?
According to Laplace's Law, what is the consequence of increased afterload in heart failure?
Which neurohormonal system activated in HF leads to sodium and water retention, increasing both preload AND afterload, ultimately creating a vicious cycle of myocyte damage?
What are the NT-proBNP thresholds for diagnosing heart failure?
A patient with LVEF of 20% presents with no signs of fluid overload (no edema, no rales, normal JVP). Which statement is correct?
Hyponatremia in severe heart failure is caused by which mechanism, and what does it signify prognostically?
What is the normal range for ejection fraction? What EF defines HFrEF?
A patient with a normal ejection fraction presents with dyspnea on exertion, orthopnea, and elevated BNP. She has a history of hypertension, obesity, and type 2 DM. Which diagnosis best fits?
Which type of heart failure is associated with elevated JVP, bilateral leg edema, ascites, and tender hepatomegaly — but WITHOUT bilateral lung crackles?
A patient with NYHA Class III heart failure has symptoms with which level of activity?
Which of the following is the most common precipitant of acute decompensation in a patient with chronic stable heart failure?
How do NSAIDs precipitate acute decompensation of heart failure?
A patient with decompensated HF presents with bilateral leg edema, ascites, high JVP, and bilateral rales. His BP is 160/95 mmHg. Which of the following findings is NOT consistent with heart failure?
The S3 gallop in heart failure:
What does the S4 gallop indicate and in which condition does it commonly occur?
What is the "ABCDE" mnemonic for chest X-ray findings in heart failure?
A patient with CHF has bilateral pleural effusions on CXR. What type of fluid are these effusions and what is the primary mechanism?
Does cardiac tamponade cause acute cardiogenic pulmonary edema?
Pulmonary hypertension in a patient with mitral regurgitation is classified as which WHO group, and what is the mechanism?
What is functional mitral regurgitation in HFrEF, and how is it managed?
What is the gold standard investigation to classify HFrEF from HFpEF?
What does an elevated PCWP on right heart catheterization indicate?
Which of the following diuretics reduces mortality in HFrEF?
A patient with acute decompensated HF presents with pulmonary edema, low BP, and rising creatinine. What is the first-line treatment?
What is the mechanism by which loop diuretics help in acute HF, and what is their main adverse effect?
What clinical trial demonstrated the mortality benefit of enalapril (ACE inhibitor) in HFrEF?
What is sacubitril/valsartan (Entresto), and what trial proved its benefit over enalapril?
Which beta-blockers are approved for use in HFrEF, and what mortality benefit do they provide?
A patient with HFrEF (EF 28%) on maximally tolerated metoprolol has a heart rate of 82 bpm and remains in sinus rhythm. Which drug should be added to further reduce heart rate?
Which of the following statements about digoxin in HF is CORRECT?
What is the mechanism of SGLT-2 inhibitors in heart failure, and is their benefit dependent on diabetic status?
A patient with HFrEF and type 2 diabetes mellitus is receiving standard HF therapy (ACEi + BB + MRA). Which medication should be added because it improves outcomes in BOTH conditions?
In a diabetic patient with heart failure, which drug class causes fluid retention and worsens HF?
What are the four GDMT pillars for HFrEF that all reduce mortality?
A 68-year-old man with HFrEF (EF 30%) has been on optimal GDMT for 4 months. His QRS is 145 ms with LBBB morphology. Which device therapy is indicated?
What are the indications for CRT (cardiac resynchronization therapy)?
Inotropes (dobutamine, milrinone) in advanced HF are associated with:
Which of the following is CONTRAINDICATED in HFrEF?
A 55-year-old woman with HFrEF and type 2 DM is on metformin. Her GFR is 28 mL/min and creatinine is rising. What is the most appropriate next pharmacological step?
What is the role of noninvasive ventilation (NIV/BiPAP) in acute heart failure?
Which of the following best describes the mechanism of cardiorenal syndrome type 1?
How is venous stasis edema differentiated from HF-related leg edema?
Which of the following is a cause of HIGH-output heart failure?
A patient with HFrEF has a 12-lead ECG showing LBBB (QRS 155 ms). Before considering CRT, what is the minimum duration of optimal GDMT required?
All of the following can precipitate acute decompensation of chronic HF EXCEPT:
A 72-year-old man with CHF is found to have a serum Na⁺ of 128 mEq/L. He takes furosemide and enalapril. Which statement about his hyponatremia is most accurate?
Which of the following most accurately describes the ACC/AHA heart failure staging system?
Which of the following statements about the RALES trial is correct?
All of the following are true regarding heart failure management EXCEPT:
Which of the following best explains why the acute treatment of decompensated HF differs from the chronic treatment?
In HCM, systolic anterior motion (SAM) of the anterior mitral valve leaflet causes which TWO simultaneous complications?
Which of the following correctly matches each cardiomyopathy type to its left ventricular ejection fraction (LVEF)?
A 45-year-old man is found to have dilated cardiomyopathy on echocardiography. Which of the following statements about his management is FALSE?
A 32-year-old woman develops progressive dyspnea and leg swelling 3 months after delivering her first baby. Echocardiography shows a dilated LV with an EF of 30%. Which of the following regarding her condition is correct?
A 55-year-old woman is admitted with a severe emotional shock. ECG and troponin mimic an anterior MI, but urgent coronary angiography reveals no obstructive coronary disease. Echocardiography shows apical ballooning with hyperdynamic basal contraction. What is the expected clinical course?
A 28-year-old develops acute heart failure with reduced EF following an upper respiratory infection. The gold standard histological diagnosis and the gold standard non-invasive investigation are, respectively:
Which DCM echocardiographic finding best distinguishes non-ischemic DCM from ischemic (post-MI) DCM?
Which of the following is NOT one of the 4 pillars of guideline-directed medical therapy (GDMT) for DCM with reduced EF?
Hypertrophic cardiomyopathy (HCM) is characterized by all of the following EXCEPT:
A 22-year-old competitive athlete collapses during a football match. He is resuscitated successfully. ECG shows deep Q waves in inferolateral leads and LVH pattern. Echocardiography shows IVS thickness of 19 mm with SAM and LVOT gradient of 60 mmHg. What is the MOST important intervention?
Which of the following risk factors carries the HIGHEST threshold for predicting sudden cardiac death in HCM and is directly stated as a cutoff value?
A patient with known HCM develops worsening dyspnea. On examination, the systolic ejection murmur is louder than during the last visit. Which maneuver was the patient most likely doing before coming to the clinic?
A patient with HOCM asks if Valsalva maneuver would make their heart murmur louder or softer, and how this compares to a patient with aortic stenosis (AS) doing the same maneuver.
Which of the following drugs should be AVOIDED in a patient with hypertrophic obstructive cardiomyopathy (HOCM)?
In alcohol septal ablation for HOCM, which coronary vessel is specifically targeted?
A 35-year-old patient with HCM is found to have an LVOT gradient of 70 mmHg despite maximum doses of beta-blockers and verapamil. What is the most appropriate next step?
An infant of a diabetic mother develops a heart murmur and echo shows thickened interventricular septum. What is the expected clinical course?
A patient with restrictive cardiomyopathy (RCM) is found to have normal-sized ventricles on echocardiography. Which additional finding would most strongly support the diagnosis?
All of the following are recognized causes of restrictive cardiomyopathy EXCEPT:
A patient with cardiac amyloidosis is found to have low-voltage QRS complexes on ECG despite thick-walled ventricles on echocardiography. What explains this apparently paradoxical finding?
A patient with advanced restrictive cardiomyopathy is noted to have a paradoxical rise in JVP during inspiration. What is this sign called, and in which condition is it characteristically ABSENT?
A 25-year-old male athlete presents with palpitations and an episode of syncope during training. His ECG shows T-wave inversions in V1–V3 and a small deflection after the QRS complex in V1–V2. Cardiac MRI shows fibrofatty replacement of the right ventricular wall. What is the most specific ECG finding described, and what is the diagnosis?
Which of the following is the gold standard diagnostic investigation for ARVD?
A patient with confirmed ARVD asks if they can continue recreational jogging. What is the correct advice?
Which of the following correctly pairs each cardiomyopathy with its most specific ECG finding?
Which of the following cardiomyopathies has a surgical cure?
A 50-year-old patient presents with progressive edema, massive ascites, markedly elevated JVP, hepatomegaly, and dyspnea. Echocardiography shows normal LV size, normal LVEF, and bilaterally dilated atria. Which cardiomyopathy best fits this presentation?
Which of the following statements about dilated cardiomyopathy (DCM) is TRUE?
A student is studying cardiomyopathies and becomes confused between DCM and HCM. Which single feature most definitively distinguishes HCM from DCM?
Which two cardiomyopathies carry the highest risk of sudden cardiac death, and in which age groups?
Which of the following features is CORRECTLY matched to its cardiomyopathy?
What is the most sensitive echocardiographic sign of cardiac tamponade?
At what minimum pericardial effusion volume does the chest X-ray typically begin to show an enlarged cardiac silhouette?
Comparing cardiac tamponade and constrictive pericarditis: which of the following correctly states a key distinction between the two?
A patient presents with progressive exertional dyspnea, markedly raised JVP, peripheral edema, and hepatomegaly. Echo shows a large pericardial effusion with RV diastolic collapse. BP is 85/60 mmHg and HR is 120 bpm. Which triad is confirmed?
A 40-year-old male is found to have thickening of the pericardium > 4 mm on CT, biventricular equalization of diastolic pressures on catheterization, and a prominent early diastolic sound on auscultation. His LVEF is 65%. Which is the most appropriate next step?
What is the immediate definitive treatment for cardiac tamponade?
What is the most common cause of constrictive pericarditis worldwide?
Kussmaul's sign is defined as a paradoxical rise in JVP during inspiration. In which of the following conditions is it classically PRESENT?
On cardiac catheterization, what is the "square root sign" and in which condition is it seen?
A patient with constrictive pericarditis has a prominent, sharp y descent on JVP waveform analysis. What is this sign called and what is its mechanism?
Which of the following is the most common cause of acute pericarditis in developed countries?
Which of the following is NOT a recognized cause of acute pericarditis?
A 25-year-old male presents with sharp chest pain that is worsened by lying flat and relieved by sitting up and leaning forward. Which structure does this positional relief reflect?
Which combination of findings would MOST strongly suggest constrictive pericarditis over restrictive cardiomyopathy?
What is the pericardial knock and in which condition is it heard?
The pericardial friction rub is best heard when the patient is in which position, and using which part of the stethoscope?
Which of the following is NOT a typical clinical feature of uncomplicated acute pericarditis?
On ECG, what is the most specific sign of acute pericarditis?
Which ECG feature best distinguishes acute pericarditis from STEMI?
What is the first-line treatment for acute pericarditis?
According to the COPE trial, what recurrence rate reduction did colchicine achieve when added to aspirin in acute pericarditis?
Why are corticosteroids NOT first-line in viral/idiopathic acute pericarditis?
Which of the following is the correct treatment for uremic pericarditis?
Dressler's syndrome is an immune-mediated post-MI pericarditis. What is its typical time window?
Which factor is more critical than total fluid volume in determining whether pericardial effusion causes tamponade?
What is the definitive curative treatment for constrictive pericarditis?
On ECG, what does "electrical alternans" indicate and in which pericardial condition is it most characteristic?
Which of the following correctly lists Beck's Triad for cardiac tamponade?
Which physical sign is defined as an exaggerated inspiratory fall in systolic blood pressure greater than 10 mmHg, and is a hallmark of cardiac tamponade?
Kussmaul's sign is ABSENT in cardiac tamponade. Which statement correctly explains why?
Which JVP waveform finding is characteristic of cardiac tamponade and directly distinguishes it from constrictive pericarditis?
A 48-year-old man has a harsh ejection systolic murmur at the right upper sternal border that radiates to the carotids. A medical student asks what the character of the apex beat should be. What is the correct answer?
A 38-year-old woman from Yemen presents with exertional dyspnea, palpitations, and new-onset atrial fibrillation. Auscultation reveals a loud S1 and a mid-diastolic rumble at the apex. What is the MOST common underlying cause of this presentation?
In a patient with mitral stenosis, what does a shorter S2–OS interval indicate?
A patient with mitral stenosis and atrial fibrillation suffers a transient ischemic attack (TIA). What is the underlying mechanism?
A patient with mitral stenosis develops pulmonary hypertension. On right heart catheterization, PCWP is 22 mmHg. Which WHO group of pulmonary hypertension does this represent, and what is the correct treatment approach?
A patient with rheumatic mitral stenosis is being evaluated for percutaneous balloon mitral commissurotomy (PTMC). Which of the following findings on echocardiography would be a CONTRAINDICATION to PTMC?
A 55-year-old man has a pansystolic murmur at the apex that radiates to the left axilla. S1 is soft. The apex beat is displaced laterally. Which of the following is the most likely diagnosis?
Which of the following best explains why acute severe mitral regurgitation (e.g., from papillary muscle rupture) may present with a SOFT or ABSENT murmur, despite massive regurgitation?
A 32-year-old woman is found to have a mid-systolic click followed by a late systolic murmur on auscultation. When she stands up, the click moves earlier and the murmur becomes louder. What is the diagnosis?
A murmur is heard along the left lower sternal border. It is holosystolic and INCREASES in intensity with inspiration. What is the most likely diagnosis?
A 28-year-old IV drug user presents with fever, rigors, and a new holosystolic murmur at the left lower sternal border. Chest X-ray shows multiple peripheral pulmonary nodules. What is the most likely valve affected?
A 22-year-old patient presents with palpitations and is found to have a diastolic murmur at the left lower sternal border along with giant A waves in the jugular venous pulse (JVP). What is the most likely diagnosis?
A 10-year-old boy is found to have a systolic crescendo-decrescendo murmur at the left upper sternal border. Echocardiography confirms pulmonic stenosis with fused commissures and thickened leaflets. What is the most likely etiology?
A 35-year-old man who underwent surgical repair of Tetralogy of Fallot in childhood now presents with progressive dyspnea and RV dilation. A diastolic decrescendo murmur is heard at the left upper sternal border. What is the MOST likely diagnosis?
Which of the following statements regarding aortic regurgitation is FALSE?
Which of the following patients should receive antibiotic prophylaxis before undergoing a dental extraction?
A young woman has a history of mitral stenosis and is about to undergo a dental procedure. Her dentist asks about the antibiotic to be prescribed for endocarditis prophylaxis. However, she reports a severe allergy to penicillin with anaphylaxis. Which antibiotic is the most appropriate alternative?
A 50-year-old man has a blood pressure of 160/40 mmHg, a blowing early diastolic decrescendo murmur at the lower left sternal border, head bobbing with each heartbeat, and visible nail-bed pulsations. Which of the following correctly names the eponymous signs for head bobbing and nail-bed pulsations respectively?
A patient with mitral regurgitation is found on echo to have a structurally normal mitral valve with normal leaflets. The MR is caused by lateral displacement of the papillary muscles from a severely dilated LV due to dilated cardiomyopathy. What type of MR is this called?
A 50-year-old woman with known mitral regurgitation and pulmonary edema is diagnosed with pulmonary hypertension by echocardiography. What is the underlying mechanism?
A 60-year-old woman with a new mechanical aortic valve and prior history of atrial fibrillation is started on warfarin. What is the most appropriate INR target for her?
Which of the following best describes the apex beat character in mitral stenosis?
Which of the following is NOT true about aortic stenosis?
A 35-year-old woman with known mitral valve prolapse (MVP) is auscultated in two positions. Sitting upright, she has a mid-systolic click followed by a late systolic murmur. When she squats, the click moves later and the murmur shortens significantly. What explains this change with squatting?
A patient with aortic regurgitation is due for cardiac surgery for an aortic dissection. The anesthesiologist considers using an intra-aortic balloon pump (IABP) for hemodynamic support. Is IABP appropriate in this context, given the AR?
An echocardiographer describes a mitral valve with a Wilkins score of 10, calcified leaflets, and a mitral valve area of 1.0 cm². There is no LA thrombus and no significant MR. What is the best treatment for this patient's mitral stenosis?
A 65-year-old man with rheumatic heart disease develops both mitral stenosis and mitral regurgitation. On examination, his apex beat is displaced laterally and is hyperdynamic. What does the displaced, hyperdynamic apex beat indicate in this mixed valve disease?
Which of the following valve lesions produces a diastolic murmur at the LEFT UPPER sternal border?
A patient is diagnosed with carcinoid syndrome. Which of the following CORRECTLY describes the cardiac manifestations?
A 55-year-old man is found to have an early diastolic decrescendo murmur at the lower left sternal border. He has a blood pressure of 155/45 mmHg. His LV is markedly dilated on echo. Which of the following additional findings would be MOST consistent with the diagnosis?
Which of the following best explains why mitral stenosis most commonly leads to ATRIAL FIBRILLATION rather than ventricular arrhythmias?
In assessing aortic stenosis severity using echocardiography, which set of values confirms SEVERE disease?
A 40-year-old man with chronic severe aortic regurgitation is asymptomatic. His LVEF is 52% and his LV end-systolic diameter is 52 mm on recent echo. Should surgical valve replacement be recommended?
Which of the following CORRECTLY pairs each valve lesion with its murmur character and optimal auscultation position?
A cardiac valve becomes calcified and stiffened, preventing it from opening fully during systole. Which of the following best describes the hemodynamic consequence and the resulting pattern of cardiac remodeling?
A patient with known aortic regurgitation presents with acute-onset severe dyspnea and cardiogenic shock 3 days after being diagnosed with infective endocarditis. Compared to a patient with chronic compensated AR, why is this patient's presentation so dramatically different?
A 42-year-old man presents with exertional dyspnea. On examination, you hear a harsh systolic murmur radiating to the carotids. Which investigation should be ordered first?
A 68-year-old woman underwent mechanical mitral valve replacement 3 years ago for rheumatic mitral stenosis. She has no additional risk factors. Which INR range is most appropriate for her long-term anticoagulation?
A patient with a mechanical heart valve asks whether she can switch to rivaroxaban (a NOAC) instead of warfarin for convenience. Which of the following is the most appropriate response?
A 55-year-old woman from Jordan presents with dyspnea, palpitations, and a mid-diastolic rumbling murmur at the apex. Her ECG shows atrial fibrillation. She reports having had multiple sore throats as a child in Egypt. Which valve is MOST likely to be affected?
A 45-year-old man from Sub-Saharan Africa is found to have classic rheumatic mitral stenosis. Echocardiography shows a mid-diastolic rumble with a hockey-stick deformity of the anterior mitral leaflet. What does the hockey-stick deformity represent?
A 62-year-old man is found to have tricuspid valve stenosis and pulmonic valve regurgitation on echocardiography. He also has elevated urinary 5-HIAA levels. Which substance is directly responsible for the cardiac valve changes in this patient?
A patient with carcinoid syndrome is found to have both tricuspid and mitral valve disease on echocardiography. Which of the following is the MOST likely explanation for the left-sided valve involvement?
A 72-year-old man presents with an ejection systolic murmur at the right upper sternal border. Which of the following is the MOST common cause of this presentation in this age group?
A patient with severe aortic stenosis has an LV systolic pressure of 180 mmHg and an aortic systolic pressure of 120 mmHg. What is the transvalvular gradient, and does this meet the echo criteria for severe AS?
A 70-year-old woman with known aortic stenosis was previously asymptomatic. She now presents with exertional dyspnea, orthopnea, and an S3 gallop. According to the classic symptomatic triad of AS, what is the approximate survival without valve replacement, and what does this symptom indicate?
On examination of a patient with aortic stenosis, you find a heaving, sustained, non-displaced apex beat. A medical student asks: "Isn't the apex beat supposed to be tapping in aortic stenosis?" What is the correct response?
Which of the following statements about the aortic stenosis murmur is TRUE?
A patient with severe aortic stenosis develops symptomatic hypotension in the emergency department. A colleague suggests giving IV nitroglycerine for afterload reduction. What is the risk of this approach?
What advantage does TAVR (Transcatheter Aortic Valve Replacement) offer compared to surgical aortic valve replacement (SAVR)?
A 58-year-old man has aortic regurgitation. Echocardiography shows a markedly dilated LV with increased cavity size and relatively preserved wall thickness. Which of the following correctly explains this finding?
A patient with severe chronic aortic regurgitation has a blood pressure of 160/40 mmHg. Which of the following eponymous signs would you expect on physical examination?
A mid-diastolic rumbling murmur is heard at the apex of a patient with known severe aortic regurgitation. There is no opening snap. What is the most likely explanation?
Which of the following would increase Bowman's capsule hydrostatic pressure (Pb) and thereby decrease GFR?
Which three variables are used in the CKD-EPI equation to estimate GFR?
Sustained efferent arteriolar constriction initially raises GFR, but with continued constriction GFR eventually falls. What explains this?
Aldosterone is released from the adrenal cortex in response to which two triggers?
Regarding renin levels in different populations, which statement is TRUE?
Which of the following is NOT a recognized direct physiological stimulus for renin release?
Which segment of the loop of Henle is impermeable to water but actively reabsorbs Na+, K+, and Cl- via the NKCC2 cotransporter?
Why does creatinine clearance tend to overestimate true GFR?
Regarding the loop of Henle, which statement is FALSE?
Which three mechanisms trigger renin release from juxtaglomerular cells?
Where does the final activation step of vitamin D (1-alpha hydroxylation) occur?
Which layer of the glomerular filtration barrier is primarily responsible for the "charge barrier" that repels negatively charged plasma proteins like albumin?
Which diuretic class acts on the early distal convoluted tubule by blocking the Na+/Cl- cotransporter?
What is the mechanism of action of parathyroid hormone (PTH) at the early distal convoluted tubule?
If normal renal plasma flow (RPF) is 625 mL/min and glomerular filtration rate (GFR) is 125 mL/min, what is the filtration fraction?
Which cell type in the late distal tubule/collecting duct is the target of potassium-sparing diuretics such as spironolactone and amiloride?
Type A intercalated cells contribute to acid-base regulation by which mechanism?
At what vertebral level does the right kidney's upper border typically lie, and why is the right kidney positioned lower than the left?
What is the correct order of structures at the renal hilum from anterior to posterior?
Loss of which structure is associated with nephroptosis (downward displacement of the kidney)?
Natriuretic peptides (ANP/BNP) achieve their natriuretic effect through which primary mechanism?
ADH increases water reabsorption in the collecting duct by which mechanism?
Which part of the male urethra is the widest and most dilatable?
The apex of each renal pyramid (the renal papilla) is surrounded by which structure?
What is the correct order of the renal arterial branching sequence?
Why is the left kidney preferred for live-donor nephrectomy?
Which of the following is NOT one of the classical criteria for an ideal GFR tracer?
Which of the following is a common site of ureteric constriction where kidney stones are most likely to lodge?
What is the function of the oblique intramural course of the ureter through the bladder wall?
What is the primary stimulus for erythropoietin (EPO) production, and where is it produced?
What percentage of filtered Na+, Cl-, HCO3-, and K+ is reabsorbed in the proximal tubule?
What are the two capillary beds associated with each nephron?
A patient has isolated tryptophan malabsorption in the proximal tubule, presenting with a pellagra-like skin rash and aminoaciduria. What is this condition?
If normal renal plasma flow (RPF) is 625 mL/min and glomerular filtration rate (GFR) is 125 mL/min, what is the filtration fraction?
Which three variables are used in the CKD-EPI equation to estimate GFR?
What percentage of filtered Na+, Cl-, HCO3-, and K+ is reabsorbed in the proximal tubule?
Natriuretic peptides (ANP/BNP) achieve their natriuretic effect through which primary mechanism?
Which layer of the glomerular filtration barrier is primarily responsible for the "charge barrier" that repels negatively charged plasma proteins like albumin?
Sustained efferent arteriolar constriction initially raises GFR, but with continued constriction GFR eventually falls. What explains this?
Which of the following would increase Bowman's capsule hydrostatic pressure (Pb) and thereby decrease GFR?
Which of the following is NOT one of the classical criteria for an ideal GFR tracer?
Why does creatinine clearance tend to overestimate true GFR?
Which part of the male urethra is the widest and most dilatable?
What are the two capillary beds associated with each nephron?
At what vertebral level does the right kidney's upper border typically lie, and why is the right kidney positioned lower than the left?
What is the correct order of structures at the renal hilum from anterior to posterior?
Loss of which structure is associated with nephroptosis (downward displacement of the kidney)?
The apex of each renal pyramid (the renal papilla) is surrounded by which structure?
What is the correct order of the renal arterial branching sequence?
Why is the left kidney preferred for live-donor nephrectomy?
Which of the following is a common site of ureteric constriction where kidney stones are most likely to lodge?
What is the function of the oblique intramural course of the ureter through the bladder wall?
A patient has isolated tryptophan malabsorption in the proximal tubule, presenting with a pellagra-like skin rash and aminoaciduria. What is this condition?
Which segment of the loop of Henle is impermeable to water but actively reabsorbs Na+, K+, and Cl- via the NKCC2 cotransporter?
Regarding the loop of Henle, which statement is FALSE?
Which diuretic class acts on the early distal convoluted tubule by blocking the Na+/Cl- cotransporter?
What is the mechanism of action of parathyroid hormone (PTH) at the early distal convoluted tubule?
Which cell type in the late distal tubule/collecting duct is the target of potassium-sparing diuretics such as spironolactone and amiloride?
Type A intercalated cells contribute to acid-base regulation by which mechanism?
ADH increases water reabsorption in the collecting duct by which mechanism?
Which three mechanisms trigger renin release from juxtaglomerular cells?
Which of the following is NOT a recognized direct physiological stimulus for renin release?
Regarding renin levels in different populations, which statement is TRUE?
Aldosterone is released from the adrenal cortex in response to which two triggers?
Where does the final activation step of vitamin D (1-alpha hydroxylation) occur?
What is the primary stimulus for erythropoietin (EPO) production, and where is it produced?
Why does the serum BUN:creatinine ratio rise above 20:1 in pre-renal AKI specifically?
Which of the following variables is used in the CKD-EPI equation for estimating GFR?
A patient with heart failure and cirrhosis develops rising creatinine with low urinary sodium and a bland urinalysis. IV fluid administration fails to improve renal function. What is the most likely diagnosis?
Why do NSAIDs precipitate pre-renal AKI in a volume-depleted patient?
By what mechanism do ACE inhibitors and ARBs precipitate pre-renal AKI, particularly in a patient with bilateral renal artery stenosis?
A patient's creatinine rises after a hypotensive episode and shows muddy brown granular casts on urine microscopy. What is the diagnosis?
Which laboratory pattern differentiates acute tubular necrosis from pre-renal AKI?
Why are the S3 segment of the proximal tubule and the thick ascending limb particularly vulnerable to ischemic injury in ATN?
What is the typical clinical course of ischemic acute tubular necrosis?
Why can diuretics make the fractional excretion of sodium (FeNa) unreliable when evaluating AKI?
Which of the following best defines Acute Kidney Injury (AKI)?
A patient develops a rash and fever two days after starting a new antibiotic, with sterile pyuria and urine eosinophils on urinalysis. What is the most likely diagnosis?
A patient develops brown, tea-colored urine after a crush injury, with a serum CK of 45,000 U/L. Urine dipstick is positive for blood, but microscopy shows almost no red blood cells. What is the diagnosis?
What is the mainstay of treatment for rhabdomyolysis-induced AKI?
A patient develops a rise in creatinine 2 days after undergoing coronary angiography with iodinated contrast. What is the most likely diagnosis, and what is its typical time course?
A patient undergoing chemotherapy for Burkitt lymphoma develops nausea, muscle cramps, and peaked T waves on ECG within 48 hours of treatment. Labs show hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. What is the diagnosis?
What is the primary strategy for preventing tumor lysis syndrome in a high-risk chemotherapy patient?
Which of the following is required for post-renal AKI to cause a significant rise in serum creatinine?
What is the test of choice for evaluating suspected post-renal AKI?
Which mnemonic is used to remember the indications for urgent dialysis in AKI, and what does it stand for?
Which drug should be held in a patient with newly diagnosed AKI due to the risk of a serious metabolic complication?
A patient's serum creatinine rises from a normal baseline to 2.2 mg/dL, and it returns toward normal after IV fluid administration. What does this reversibility with fluids indicate?
What is the significance of a "non-oliguric" pattern of AKI, and with which drug class is it classically associated?
A patient with cirrhosis and ascites develops progressively rising creatinine, low urinary sodium, and bland urine sediment, but the renal function does not improve with albumin and fluid challenge. What condition should be suspected?
Which finding on urine microscopy would suggest acute interstitial nephritis rather than acute tubular necrosis?
Which of the following ideally characterizes a "perfect" GFR tracer such as inulin?
Which KDIGO criterion is NOT sufficient on its own to diagnose AKI?
What is the most common overall cause of AKI in hospitalized patients?
Which set of urinary findings is most consistent with pre-renal AKI?
In a young adult with mitral stenosis, atrial fibrillation, and a history of childhood "growing pains" and sore throats, what should be strongly suspected?
Which of the following is NOT a recognized major complication of chronic rheumatic heart disease?
How should atrial fibrillation with mitral stenosis be managed in chronic RHD?
When is percutaneous balloon mitral valvotomy (PBMV) an appropriate treatment option?
Which statement best describes the relationship between acute rheumatic fever (ARF) and rheumatic heart disease (RHD)?
What is the typical latency between streptococcal pharyngitis and the onset of acute rheumatic fever?
What is the underlying immune mechanism of acute rheumatic fever?
Which finding is pathognomonic for rheumatic carditis and is found only in the heart?
What is required to diagnose acute rheumatic fever using the Jones criteria?
A 14-year-old boy presents with fever, migratory polyarthritis, and a new systolic murmur. What provides the diagnostic framework for confirming ARF in this patient?
Which of the following is NOT one of the major Jones criteria?
In current diagnostic schemes, how is subclinical carditis (valvular regurgitation seen only on echocardiography, without an audible murmur) classified?
Which is the most common major manifestation of acute rheumatic fever, and in approximately what percentage of patients does it occur?
What is a characteristic feature of the arthritis seen in ARF?
How does the incidence of carditis in ARF change with patient age?
What is the Carey Coombs murmur, and what causes it?
Approximately how long after the initial ARF episode does Sydenham chorea typically appear, and what proportion of affected patients go on to develop chronic RHD?
Which skin finding appears more than 3 weeks after other ARF manifestations, and therefore helps confirm rather than establish the diagnosis?
What percentage of throat cultures are positive in suspected ARF, and why?
A patient with clinical features suggestive of ARF has a normal ASO titre. What is the most appropriate interpretation?
What does echocardiography typically show in acute rheumatic carditis?
What is the recommended regimen to eradicate residual streptococcal infection at the time of ARF diagnosis?
What is the first-line treatment for the arthritis and fever of ARF, and what is notable about the response?
When are glucocorticoids indicated in ARF, and what is the typical dosing?
Acute rheumatic carditis with decompensated heart failure (tachypnoea, pulmonary oedema, hepatomegaly, gallop rhythm) should be managed as:
What is the preferred regimen for secondary prophylaxis after ARF?
What is the recommended duration of secondary prophylaxis for a patient with ARF, carditis, and residual valvular disease?
Does long-term secondary antibiotic prophylaxis after ARF protect against infective endocarditis?
What is the main pathological process underlying chronic rheumatic heart disease?
Which valve morphology is classically described as having a "fish-mouth" orifice with fused commissures?
In chronic rheumatic heart disease, which valve is affected in more than 90% of cases?
A young woman presents with progressive exertional dyspnoea, orthopnoea, a loud S1, an opening snap, and a mid-diastolic rumble best heard at the apex. What is the most likely diagnosis?
What is the primary mechanism responsible for anemia in CKD?
Which of the following best defines chronic kidney disease (CKD) according to KDIGO 2012?
A 58-year-old diabetic patient has an eGFR of 72 mL/min/1.73 m² and a urine ACR of 180 mg/g on two separate occasions three months apart. How is this patient classified according to KDIGO 2012?
What is the recommended first-line screening test for early diabetic nephropathy?
Which of the following represents the correct pattern of electrolyte and hormonal disturbances in CKD-MBD?
A patient with stage 4 CKD has persistently elevated PTH and low serum calcium despite dietary phosphate restriction and active vitamin D supplementation. He is started on cinacalcet. What is the mechanism of action of cinacalcet?
A CKD patient on hemodialysis develops severe, painful skin nodules with a reticulate purple discoloration and progressive black eschar on his abdomen. His serum phosphate has been chronically elevated. What is the most likely diagnosis?
A 65-year-old man with CKD stage 3b and hypertension has been taking ibuprofen daily for knee pain. What is the most appropriate action?
Which antibiotic class is most likely to cause non-oliguric acute kidney injury by concentrating in the renal cortex via megalin-mediated endocytosis?
An MRI scan is planned for a patient with CKD stage 4 (eGFR 20 mL/min). The radiologist requests gadolinium contrast for better tissue characterization. What is the most important concern?
What is the correct AEIOU mnemonic for emergent dialysis indications, and which represents the most common real-world indication?
A 50-year-old woman with CKD (eGFR 9 mL/min) presents with nausea, vomiting, and arthralgia. Her electrolytes show mild hyperkalemia (K⁺ 5.8 mEq/L) and mild metabolic acidosis (HCO₃ 18 mEq/L). What is the primary indication for initiating dialysis in this patient?
Why is peritoneal dialysis (PD) preferred over hemodialysis (HD) in patients with frequent intradialytic hypotension?
In hemodialysis, blood and dialysate flow in opposite directions (countercurrent). What is the purpose of this arrangement?
An arteriovenous fistula (AVF) is created in the wrist of a patient approaching dialysis. Six weeks later, the vein is noted to be dilated with a thickened wall. What physiological process explains this change?
A woman with heart failure and CKD (eGFR 45 mL/min) has a urine ACR of 250 mg/g. She is already on an ACE inhibitor and her BP is well controlled. What is the most appropriate next step to further slow CKD progression?
What is the primary renoprotective mechanism of ACE inhibitors in diabetic nephropathy, independent of their antihypertensive effect?
Which of the following statements about the nephron number and kidney anatomy is correct?
Which of the following correctly describes the role of the kidney in vitamin D metabolism?
A patient with CKD and secondary hyperparathyroidism undergoes a kidney transplant. Three years later, despite a functioning transplant with eGFR 65, his serum calcium is 11.2 mg/dL and PTH remains markedly elevated. What is the most likely explanation?
Which of the following best describes the ECG in atrial flutter?
Which antiarrhythmic drug is preferred for rhythm control in AF occurring in a patient with heart failure and reduced ejection fraction?
Which type of ventricular tachycardia carries a better prognosis?
A patient in the emergency department is found in a wide complex tachycardia at 180 bpm, but is conscious with a blood pressure of 90/60 mmHg. What is the most appropriate immediate treatment?
A patient with pulseless ventricular tachycardia is found during cardiac arrest. What is the correct initial treatment?
Which of the following rhythms in cardiac arrest is NON-shockable?
Why was atropine removed from ACLS guidelines for asystole in 2010?
Which of the following correctly describes Torsades de Pointes on an ECG?
What is the first-line treatment for Torsades de Pointes?
Which electrolyte abnormality is the MOST POTENT cause of QT prolongation?
A patient on erythromycin develops a prolonged QT interval followed by a polymorphic tachycardia. What does hypercalcemia do to the QT interval?
The QTc in a patient is calculated as 520 ms. What is the clinical significance?
What is the FIRST ECG change seen in progressive hyperkalemia?
A patient with chronic renal failure has a K⁺ of 7.5 mEq/L. ECG shows absent P waves and wide QRS complexes. What is the correct order of emergency treatment?
U waves on an ECG are characteristic of which electrolyte abnormality?
Which Class of antiarrhythmic drugs does NOT typically cause bradycardia?
A patient with AF and no structural heart disease requires pharmacological rhythm control. Which drug is most appropriate?
Which antiarrhythmic drug is used for acute PSVT termination and is contraindicated in asthma?
A patient's ECG shows a PR interval spanning 6 small squares. What does this indicate?
On a standard ECG recorded at 25 mm/sec, what is the duration represented by one large square?
A QRS complex spanning 4 small squares on an ECG is most consistent with:
On a regular rhythm ECG, there are 3 large squares between consecutive R waves. What is the heart rate?
Which statement about cardiac conduction velocity is CORRECT?
Which of the following correctly defines tachyarrhythmia?
Which mechanism is responsible for Torsades de Pointes?
A patient presents with palpitations. ECG shows a narrow QRS tachycardia at 180 bpm with no visible P waves before any QRS. The rhythm terminates with carotid sinus massage. What is the most likely diagnosis?
A 25-year-old woman presents with sudden-onset palpitations. ECG shows narrow QRS tachycardia at 200 bpm. Retrograde P' waves are seen immediately after the QRS complexes as pseudo-S' deflections in lead II. What is the mechanism?
Which ECG finding in sinus rhythm is pathognomonic of WPW syndrome?
A patient with known WPW syndrome develops atrial fibrillation. Which of the following drugs is MOST dangerous to give?
A hemodynamically stable patient with SVT does not respond to Valsalva maneuver or carotid sinus massage. What is the most appropriate next step?
Adenosine is contraindicated in which of the following conditions?
A patient is found to have an atrial rate of 300/min with regular sawtooth waves and a ventricular rate of 150/min. What AV conduction ratio is present?
Which of the following is the HALLMARK ECG feature of atrial fibrillation?
A patient with AF is examined. Which finding would be INCONSISTENT with the diagnosis?
What is the most common overall cause of atrial fibrillation?
AF lasting more than 48 hours requires anticoagulation before cardioversion. What is the rationale?
A patient with non-valvular AF has a CHA₂DS₂-VASc score of 3. What is the appropriate anticoagulation strategy?
A patient in AF develops hypotension and acute pulmonary edema. What is the immediate treatment?
On renal biopsy of a patient with nephrotic syndrome, light microscopy shows diffuse capillary wall thickening without glomerular hypercellularity. Silver stain reveals "spike" projections from the GBM. Electron microscopy shows dome-shaped electron-dense deposits on the epithelial side of the GBM with GBM material projecting between them. What is the prognosis of this condition without treatment?
A 38-year-old HIV-positive male presents with 6 g/day of proteinuria and renal impairment. Renal biopsy shows focal segmental sclerosis with a "collapsing" pattern. Which statement about this condition is correct?
Renal biopsy from a patient with nephritic syndrome shows double contour ("tram track") appearance of the GBM on light microscopy, with mesangial cell interposition. Immunofluorescence is positive for IgG and C3 in a granular pattern. Complement is low. Which of the following additional findings best supports MPGN Type I over Type II?
A 55-year-old woman presents with proteinuria of 8 g/day, hypoalbuminemia, and bilateral leg edema. Her renal biopsy shows amorphous PAS-positive deposits within the mesangium, forming nodular structures in the center of glomerular lobules. She has had type 2 diabetes mellitus for 18 years. Which is the MOST SPECIFIC biopsy finding for her diagnosis?
A 60-year-old woman with a 20-year history of rheumatoid arthritis presents with bilateral lower limb edema, frothy urine, and proteinuria of 7 g/day. Renal biopsy shows amorphous eosinophilic deposits in the mesangium. Congo red staining under polarized light reveals apple-green birefringence. What is the mechanism of renal injury?
A 70-year-old man presents with back pain, fatigue, and renal impairment. Urine dipstick shows negative protein, but a 24-hour urine collection reveals 4 g of total protein. Serum calcium is elevated and a bone marrow biopsy shows 35% plasma cells. Which finding on renal biopsy would be most expected?
A 25-year-old man presents with recurrent hematuria, sensorineural hearing loss, and poor visual acuity. His father had similar symptoms and died of renal failure in his 30s. Electron microscopy of his renal biopsy shows irregular alternating thinning and thickening of the GBM with a "basket-weave" appearance. Light microscopy also shows foamy tubular cells. What is the most likely genetic defect?
A 7-year-old boy presents with tea-colored urine, periorbital puffiness, and hypertension 2 weeks after a sore throat. Urinalysis shows hematuria, RBC casts, and mild proteinuria. Which complement pattern is expected?
A 35-year-old woman with SLE presents with nephrotic-range proteinuria (5 g/day) but no hematuria and normal complement levels. Renal biopsy shows basement membrane thickening without hypercellularity, and immunofluorescence shows granular IgG and C3 in a peripheral loop pattern. Which lupus nephritis class does this represent?
A 16-year-old male presents with gross hematuria that started the same day he developed a sore throat. He has had three similar episodes over the past 2 years, each triggered by an upper respiratory infection. Renal biopsy shows mesangial hypercellularity on light microscopy. Which immunofluorescence finding is expected?
A patient with known SLE develops worsening renal function, hematuria, and heavy proteinuria. Biopsy shows diffuse glomerular proliferation affecting > 50% of glomeruli with "wire looping" of capillaries on light microscopy. Immunofluorescence is positive for IgG, IgA, IgM, C3, and C1q. Which of the following best describes the expected serology?
A 28-year-old man presents with rapidly progressive renal failure and hemoptysis. Chest X-ray shows bilateral pulmonary infiltrates. Renal biopsy demonstrates crescentic GN with crescents all at the same stage of development. Immunofluorescence shows a smooth, continuous linear IgG deposition along the GBM. What is the most appropriate initial treatment?
A 52-year-old man with chronic sinusitis, recurrent nosebleeds, and saddle-nose deformity develops rapidly progressive renal failure. ANCA testing is positive. Renal biopsy shows crescentic GN with no immune deposits on immunofluorescence. Which ANCA pattern and antibody are most likely?
A 12-year-old girl presents with palpable purpura on her buttocks and legs, colicky abdominal pain, and blood in her stool. She also has bilateral knee joint pain. Urinalysis shows hematuria and mild proteinuria. Which investigation finding would be expected on skin or kidney biopsy?
A 40-year-old man with no significant past medical history presents with massive proteinuria, hypoalbuminemia, and bilateral leg swelling. He is found to have deep vein thrombosis. Renal biopsy shows LM with completely normal glomeruli, negative immunofluorescence, and diffuse effacement of podocyte foot processes on EM. He denies any recent viral illness or NSAID use. What association must be actively excluded in this adult patient?
A 10-year-old girl presents with lower limb edema, periorbital puffiness, and frothy urine. Urinalysis: 4+ protein, no blood, no casts. Serum albumin 1.5 g/dL. Complement is normal. Renal biopsy is performed. Light microscopy is completely normal. Which is the correct next step in interpreting this biopsy?
A 14-year-old boy is found to have persistent microscopic hematuria on a school screening test. He has had two prior episodes of gross hematuria during febrile illnesses. His maternal grandfather became deaf in his 50s and died of renal failure. Electron microscopy of his renal biopsy would most likely show:
Which of the following correctly pairs an electron microscopy finding with its corresponding diagnosis?
A 6-year-old girl develops periorbital swelling and frothy urine 1 week after a viral upper respiratory infection. Urinalysis shows 4+ proteinuria and no hematuria. Serum albumin is 1.8 g/dL. Renal biopsy light microscopy appears completely normal. What is the next most appropriate diagnostic step and expected finding?
A 45-year-old white male non-diabetic presents with 5 g/day of proteinuria and lower limb edema. He has no hematuria. Serum anti-PLA2R antibodies are positive. Electron microscopy shows dome-shaped deposits on the epithelial (podocyte) side of the GBM with GBM material projecting between them. What is the expected light microscopy finding?
Which of the following does NOT cause tubular basement membrane (TBM) deposits?
A 65-year-old man undergoes emergent repair of a ruptured abdominal aortic aneurysm. Postoperatively he is oliguric with rising BUN and creatinine. Urinalysis shows muddy brown granular casts. Which of the following best explains his renal failure?
A patient with ATN is in the oliguric phase. Which electrolyte abnormality is most immediately life-threatening?
A patient recovering from ATN now produces 3 liters of urine per day. His potassium is 3.0 mEq/L. Which of the following best explains this finding?
A patient with ATN develops persistent hypokalemia despite adequate potassium replacement. Magnesium level is 0.6 mEq/L (low). What is the most likely explanation?
A patient with ATN has the following labs: BUN 60 mg/dL, creatinine 3.0 mg/dL, FENa 3.2%, and muddy brown casts on urinalysis. IV saline is given but creatinine continues to rise. Which finding MOST helps distinguish this from pre-renal AKI?
A patient receiving gentamicin for 10 days develops rising creatinine. Which of the following correctly describes the mechanism of aminoglycoside nephrotoxicity?
Which of the following statements about aminoglycosides is FALSE?
A patient receiving IV contrast for a CT pulmonary angiogram develops a creatinine rise from 1.0 to 1.5 mg/dL within 24 hours. He is non-oliguric. FENa is 0.7%. Which of the following best explains this presentation?
A patient with HIV on TMP-SMX for PCP prophylaxis has a creatinine that rose from 0.9 to 1.3 mg/dL over 5 days. He is making normal amounts of urine, has no casts on urinalysis, and his cystatin C is unchanged. What is the most likely explanation?
Which of the following is NOT a useful treatment in established ATN?
A 28-year-old woman develops fever, maculopapular rash, and rising creatinine 10 days after starting TMP-SMX for a urinary tract infection. Urinalysis shows WBC casts and sterile pyuria with no bacteria. Peripheral eosinophilia is noted. What is the diagnosis?
Which of the following correctly ranks the causes of acute interstitial nephritis by frequency?
A patient with AIN responds to stopping the offending drug, but two months later develops mild indolent renal impairment that progresses over years. What is the most likely diagnosis?
An elderly patient with chronic low back pain has been taking ibuprofen daily for three years. He now has a mild, slowly rising creatinine of 1.8 mg/dL. Urinalysis is non-specific. What is the most likely diagnosis and management?
Which of the following is NOT a recognized renal complication of NSAIDs?
A 45-year-old woman with poorly controlled diabetes and chronic NSAID use for arthritis presents with gross hematuria and right flank pain. Urinalysis shows red cells and white cells but no bacteria and no casts. CT scan shows irregular filling defects in the renal pelvis. What is the diagnosis?
Which of the following patients is at risk for renal papillary necrosis due to sickling in the renal medulla?
A 35-year-old man with recurrent gross hematuria and flank pain undergoes urinalysis showing red and white blood cells, necrotic tissue fragments, no bacteria, and no casts. What is the best initial test and the definitive diagnostic test for his condition?
Regarding eplerenone, which of the following statements is FALSE?
A patient is started on eplerenone for heart failure with reduced ejection fraction. His eGFR is 25 mL/min and he is also on an ACE inhibitor. Which complication requires immediate monitoring?
A patient recovering from ATN develops polyuria producing 4 liters per day with a potassium of 2.8 mEq/L. Despite giving 80 mEq of IV potassium over 8 hours, potassium remains at 2.9 mEq/L. What should be checked and corrected first?
Which of the following casts and their corresponding conditions are correctly matched?
A patient presents with acute renal failure, proteinuria, and RBC casts. Renal biopsy is performed and shows crescentic glomerulonephritis. Immunofluorescence shows no staining for IgG, IgA, IgM, or complement. Which of the following serological tests should be ordered next?
Which of the following is the most common cause of RPGN overall?
A 24-year-old male presents with hemoptysis and hematuria. Urinalysis shows RBC casts and proteinuria. Renal biopsy reveals crescents on light microscopy and a linear immunofluorescence pattern. Which of the following best describes the target antigen in this condition?
A 19-year-old male presents with hematuria, hemoptysis, and rapidly rising creatinine. Serum anti-GBM antibodies are positive. Renal biopsy shows crescents and linear IgG deposits along the GBM. Which treatment should be added to IV steroids and cyclophosphamide specifically for this condition?
A 55-year-old male presents with sinusitis, nasal crusting, and hemoptysis. He develops hematuria and rapidly declining renal function. Renal biopsy reveals crescents with negative immunofluorescence. Serology is most likely to show which of the following?
Which of the following correctly matches the RPGN type to its immunofluorescence pattern and underlying mechanism?
A patient with known SLE develops rapidly progressive renal failure. Urinalysis shows RBC casts. Renal biopsy reveals crescents on light microscopy and a granular immunofluorescence pattern with deposits of IgG, IgA, IgM, and C3. What class of lupus nephritis does this represent, and what type of RPGN is it?
A 45-year-old woman with a 10-year history of asthma and recurrent sinusitis presents with wrist drop (mononeuritis multiplex), eosinophilia (WBC 15,000, eosinophils 45%), and hematuria. Renal biopsy shows crescents and pauci-immune IF. Serology shows p-ANCA positivity. What is the diagnosis?
All of the following are true about RPGN EXCEPT:
A renal biopsy in a patient with rapidly progressive glomerulonephritis shows crescents on light microscopy and a granular "lumpy-bumpy" immunofluorescence pattern. Which hypersensitivity mechanism underlies this finding?
A patient has pH 7.45, pCO₂ 24 mmHg, HCO₃⁻ 18 mEq/L. What is the correct interpretation?
A patient with end-stage renal disease on dialysis develops metabolic acidosis. Which of the following is the expected acid-base pattern?
What is the correct treatment principle for aspirin (salicylate) overdose and why does it work?
A patient with suspected toxic alcohol ingestion has an elevated osmolar gap early on, but when the ABG is rechecked several hours later, the osmolar gap has normalized while the AG has markedly increased. What explains this pattern?
A patient has pH 7.48, pCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L. What is the PRIMARY disorder?
A patient with heart failure and cirrhosis develops metabolic alkalosis from aggressive loop diuretic use. What is the urine Cl⁻ expected to show and what treatment is appropriate?
A patient has pH 7.28, pCO₂ 55 mmHg, HCO₃⁻ 25 mEq/L. What is the primary acid-base disorder?
A COPD patient has pH 7.36, pCO₂ 60 mmHg, HCO₃⁻ 33 mEq/L. What is the correct interpretation?
Which of the following is the MOST COMMON chronic cause of respiratory acidosis?
A patient presents with confusion, headache, and progressively worsening somnolence. ABG shows pH 7.22, pCO₂ 72 mmHg, HCO₃⁻ 29 mEq/L. What is the most likely underlying mechanism?
A patient presents with tingling in both hands, carpopedal spasm, and a respiratory rate of 28/min following a panic attack. ABG: pH 7.52, pCO₂ 26 mmHg, HCO₃⁻ 21 mEq/L. What is the diagnosis?
A mountaineer ascends rapidly to 4,500 m. Which of the following best describes the expected immediate acid-base change?
Acetazolamide is used to speed high-altitude acclimatization. What acid-base disturbance does it intentionally create?
Which of the following is NOT a cause of respiratory alkalosis?
A patient has pH 7.30, pCO₂ 28 mmHg, HCO₃⁻ 13 mEq/L. Na 140, Cl 108. What is the complete diagnosis?
A patient has pH 7.32, pCO₂ 24 mmHg, HCO₃⁻ 12 mEq/L, Na 140, Cl 116. Calculate the anion gap and classify the metabolic acidosis.
Which of the following causes NAGMA (normal anion gap metabolic acidosis)?
Which of the following is LEAST likely to cause high anion gap metabolic acidosis (HAGMA)?
A patient is found confused with a bottle of aspirin. ABG shows pH 7.38, pCO₂ 18 mmHg, HCO₃⁻ 10 mEq/L, AG = 20. Apply Winter's Formula. What is the conclusion?
A patient with DKA also has been vomiting for 3 days before presentation. AG = 28, HCO₃⁻ = 18. What does the Delta-Delta suggest?
A patient ingests antifreeze. He presents with confusion and visual blurring. ABG shows HAGMA. Serum osmolality (measured) = 330 mOsm/kg. Calculated: 2(140) + 5/18 + 15/2.8 = 291. What is the osmolar gap and what does it suggest?
A patient ingests antifreeze and presents with flank pain and decreased urine output. Urinalysis shows calcium oxalate crystals. What is the most likely toxin and its mechanism?
A patient on long-term isoniazid therapy for tuberculosis presents to the emergency department in status epilepticus. ABG shows HAGMA. What is the mechanism linking INH to this acid-base picture?
A diabetic patient presents with vomiting, abdominal pain, and Kussmaul respirations. ABG: pH 7.18, pCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L, Na 138, Cl 100. What is the Delta-Delta ratio and what does it indicate?
A patient presents with acute iron ingestion. Which of the following best describes the mechanism of HAGMA in iron poisoning?
Which type of renal tubular acidosis (RTA) is associated with HYPERKALEMIA, and why?
Large-volume normal saline infusion causes hyperchloremic NAGMA. Which fluid does NOT cause this and why?
A patient has pH 7.52, HCO₃⁻ 36 mEq/L, pCO₂ 46 mmHg. Urine Cl⁻ is 8 mEq/L. What is the diagnosis and treatment?
A patient has hypertension, hypokalemia, metabolic alkalosis, and low aldosterone. Which of the following is the MOST LIKELY diagnosis?
A patient who regularly chews licorice presents with hypertension and hypokalemia. Serum aldosterone is low. What is the mechanism?
Compare Bartter syndrome and Gitelman syndrome. Which statement is CORRECT?
A patient presents with vomiting, volume depletion, and metabolic alkalosis. Despite giving IV normal saline, the alkalosis does not correct. What is the most likely additional finding and explanation?
Which of the following best explains why the kidneys fail to excrete excess HCO₃⁻ in the maintenance phase of metabolic alkalosis?
Why must IE always be treated with IV rather than oral antibiotics?
What is the sensitivity of transthoracic echocardiography (TTE) for detecting vegetations in IE?
A patient with suspected IE has a negative TEE. Clinical suspicion remains high. What should be done?
TEE is the OPTIMAL method for detecting which of the following complications of IE?
A new AV block on ECG in a patient with IE most likely indicates:
Which is more reliable for monitoring treatment response in IE — ESR or CRP?
A patient has: positive blood cultures for S. aureus from 2 separate cultures + fever + Osler's nodes + predisposing cardiac condition. Using the Modified Duke Criteria, this patient has:
Which of the following is a MAJOR Duke criterion?
Which of the following echocardiographic findings qualifies as a MAJOR Duke criterion?
Which of the following is NOT included in the MAJOR Duke criteria?
Which of the following findings is a MINOR Duke criterion — vascular phenomenon?
Which of the following findings is a MINOR Duke criterion — immunological phenomenon?
What is the empirical antibiotic regimen for subacute native valve IE in a haemodynamically stable patient?
What is the empirical antibiotic regimen for ACUTE IE or septic presentation?
When should empirical antibiotics be WITHHELD in IE?
What is the targeted antibiotic regimen for MSSA native valve IE?
What is the targeted antibiotic regimen for MRSA native valve IE?
What are the three mechanisms targeted by antibiotic prophylaxis in IE?
Which antibiotic regimen is used for prosthetic valve IE (PVE) caused by either MSSA or MRSA that is NOT used for native valve IE?
What is the total duration of IV antibiotic therapy for native valve IE (NVE) vs prosthetic valve IE (PVE)?
What is the most common and strongest indication for cardiac surgery in IE?
Which of the following is an indication for surgery REQUIRED for optimal outcome in IE?
What vegetation size threshold makes surgery STRONGLY CONSIDERED in IE?
How long must antibiotics be given before declaring treatment failure and considering surgery for uncontrolled infection in IE?
A patient with IE has a mechanical prosthetic valve and develops a CNS embolic event. What should be done with anticoagulation?
Should new antiplatelet therapy be initiated in IE to reduce embolic events?
After initial response to antibiotics, a patient with IE develops a return of fever. What percentage of IE patients experience this and what usually causes it?
In uncomplicated IE on appropriate antibiotics, how long may fever persist before fully resolving?
Which of the following is a neurological complication of IE?
Which of the following represents the three main predictors of poor prognosis in IE?
Which of the following patients requires IE prophylaxis?
For which dental procedure is IE prophylaxis recommended in high-risk patients?
Is a coronary artery stent a high-risk condition for IE requiring antibiotic prophylaxis?
Prophylaxis for IE is NOT routinely recommended for which of the following procedures, even in high-risk patients?
How do the AHA and NICE guidelines differ regarding IE prophylaxis for dental procedures?
Extracardiac manifestations of IE such as vasculitis, skin lesions, and glomerulonephritis arise from:
Which organism is currently the most common overall cause of IE globally?
Which of the following best defines infective endocarditis?
Which of the following organisms can cause IE in a previously NORMAL heart?
What is the incidence of IE in community-based studies?
In a large British study of IE, what percentage of patients had NO pre-existing cardiac abnormality?
Which of the following factors increases the case fatality rate in IE beyond the baseline ~20%?
Which of the following is a CARDIAC risk factor for IE?
Which of the following is a NON-CARDIAC risk factor for IE?
What is the correct sequence of events in the pathophysiology of IE vegetation formation?
Why are bacteria within IE vegetations difficult to eradicate?
Which cardiac lesion carries the HIGHEST risk of IE?
What is the diagnostic classification for a patient with 2 MAJOR Duke criteria?
What virulence factor allows S. aureus to adhere to damaged endothelium and prosthetic material?
In an IVDU patient with IE caused by S. aureus, which valve is preferentially affected and why?
Which organism causing IE is most strongly associated with colorectal cancer?
A patient with IE caused by Streptococcus gallolyticus. What investigation is mandatory?
Which of the following correctly describes Enterococcal IE?
Which of the following accurately describes the HACEK group?
Which clinical clue suggests Q fever (Coxiella burnetii) endocarditis?
What is the serological diagnostic threshold for Coxiella burnetii (Q fever) endocarditis?
Which organism causes IE in patients with in-dwelling IV catheters or prolonged broad-spectrum antibiotics, particularly in immunocompromised patients?
Coagulase-negative staphylococci (e.g., S. epidermidis) are the most common organisms in which form of IE?
Which of the following distinguishes subacute IE from acute IE?
Which clinical features are typically ABSENT in acute IE but present in subacute IE?
A patient develops unexplained fever 3 weeks after cardiac valve surgery with a new heart murmur. What is the most likely diagnosis and the most common causative organism in this setting?
IE most commonly affects which side of the heart, and in what percentage of cases?
A patient with IVDU presents with fever, cough, pleuritic chest pain, and haemoptysis. CXR shows multiple nodular opacities. Which is the most likely diagnosis and its mechanism?
What is the frequency of fever in IE?
What is the frequency of microscopic haematuria in IE?
What is the frequency of elevated CRP in IE?
Osler's nodes are:
Janeway lesions are:
Which of the following correctly distinguishes Osler's nodes from Janeway lesions?
What are Roth's spots?
Digital clubbing in IE is:
What is the pivotal investigation in IE and how many sets should be collected?
In a patient with suspected NVE who has not received antibiotics in the prior 2 weeks, what is the recommended blood culture protocol?
Why must blood cultures in IE be taken from different peripheral venipuncture sites at intervals ≥6 hours apart?
Blood cultures in IE remain negative after 48–72 hours. What should be done?
Which drug used for hypertension primarily raises triglycerides and lowers HDL?
According to ESC/EAS guidelines, what is the LDL target for a patient at very high cardiovascular risk?
Which physical sign is most specific for familial hypercholesterolemia (Type IIa)?
Corneal arcus is considered clinically significant when found at which age?
A patient presents with recurrent acute pancreatitis and a triglyceride level of 1500 mg/dL. The plasma has a milky appearance. Which familial dyslipidemia is most likely?
What is the inheritance pattern of Type I dyslipidemia (Hyperchylomicronemia)?
A 25-year-old man suffers a myocardial infarction. His LDL is 450 mg/dL. He has tendon xanthomas and a family history of early MI. What is the most likely diagnosis?
Which familial dyslipidemia is caused by mutations in the Apolipoprotein E (APO-E) gene?
Which familial dyslipidemia is strongly associated with Type 2 diabetes mellitus?
Which of the following is NOT one of the five diagnostic criteria for metabolic syndrome?
Metabolic syndrome confers approximately what increased risk of cardiovascular disease and type 2 diabetes?
A 55-year-old diabetic patient (age > 40) with no history of vascular disease has an LDL of 110 mg/dL. What statin therapy is indicated?
A 45-year-old non-diabetic man with LDL of 95 mg/dL has a calculated 10-year ASCVD risk of 9%. What is the most appropriate next step?
A patient has an LDL of 210 mg/dL with no other cardiovascular risk factors. What statin intensity is indicated?
Which of the following correctly lists the stepwise approach to LDL-lowering therapy in high-risk patients?
Which of the following is the correct mechanism of statin-induced upregulation of LDL receptors?
A patient on atorvastatin develops weakness and muscle soreness. CK levels are normal. What is the correct diagnosis?
A patient on simvastatin is started on clarithromycin for a respiratory infection. Two weeks later he develops severe muscle pain and dark urine. What is the mechanism of this complication?
Which two statins are NOT metabolized by the CYP450 (P450) system and are therefore safer when P450-inhibiting drugs must be co-administered?
Grapefruit juice increases the toxicity of certain statins through which mechanism?
What is the major and most characteristic adverse effect of niacin?
How can niacin-induced flushing be prevented?
Why should niacin be avoided in patients with diabetes?
What is the primary lipid effect of niacin?
What is the mechanism of action of fibrates?
Which fibrate is most strongly associated with rhabdomyolysis when combined with statin therapy, and which is preferred instead?
What are the adverse effects of fibrates?
Ezetimibe blocks which transporter to inhibit intestinal cholesterol absorption?
Which of the following statements about ezetimibe is TRUE?
Which clinical trial demonstrated cardiovascular benefit for ezetimibe added to statin therapy in ACS patients?
What is the mechanism by which bile acid resins lower LDL?
Which is a recognized adverse effect of bile acid resins?
Omega-3 fatty acids lower triglycerides primarily by which mechanism?
What is the normal physiologic role of PCSK9, and how do PCSK9 inhibitors counteract it?
By how much do PCSK9 inhibitors reduce LDL-C when added to maximally tolerated statin therapy?
What is the major adverse effect of PCSK9 inhibitors, and what is their main practical limitation in clinical use?
A patient with very high TG (TG = 950 mg/dL) needs treatment to prevent pancreatitis. Which drug class is most appropriate?
Which of the following drug combinations most significantly increases the risk of rhabdomyolysis?
Which lipid-lowering drug class is most appropriate for a patient with isolated low HDL-C?
A patient cannot tolerate statins due to myalgias. Which of the following is the best alternative to lower LDL?
All of the following are adverse effects of niacin EXCEPT:
A patient has type 2 diabetes and needs a lipid-lowering drug for hypertriglyceridemia. Which agent should be avoided?
Which of the following lipid-lowering drugs acts by inhibiting HMG-CoA reductase?
What is the optimal LDL-C level for most patients?
A patient with documented coronary artery disease has an LDL of 85 mg/dL. What is the appropriate LDL treatment target?
Which of the following is the most potent drug class for lowering LDL cholesterol?
Which of the following is NOT a recognized secondary cause of hyperlipidemia?
Most patients with hyperlipidemia have no physical signs. Physical findings typically indicate which condition?
A patient with pulmonary hypertension is comfortable at rest but develops dyspnoea when climbing several flights of stairs. She has no symptoms during light activities on flat ground. What is her WHO functional class?
What is the primary mechanism by which massive pulmonary embolism causes hypotension?
Which of the following is the gold standard investigation for confirming pulmonary hypertension?
A patient with COPD and cor pulmonale has a PaO₂ of 52 mmHg on room air. Which intervention has the strongest evidence for improving survival?
All of the following can cause acute pulmonary oedema EXCEPT:
Which of the following is the first-line treatment for Group 1 pulmonary arterial hypertension in intermediate-to-high risk patients?
What is the mechanism of action of PDE-5 inhibitors in pulmonary arterial hypertension?
A patient with pulmonary arterial hypertension is started on treatment. Which drug is approved for BOTH Group 1 PAH and Group 4 CTEPH?
Which of the following correctly describes the echocardiographic findings in cor pulmonale?
Why may signs of RV enlargement be absent or difficult to detect in a patient with COPD and cor pulmonale?
Which of the following regarding CTEPH (WHO Group 4 PH) is correct?
A patient with chronic cor pulmonale secondary to IPF develops severe right heart failure. Diuretics are initiated. Which of the following is the most important consideration when using diuretics in this setting?
Which haematological finding is expected in a patient with longstanding cor pulmonale secondary to COPD and chronic hypoxaemia?
A patient with cor pulmonale and right heart failure is started on treatment. Which statement about management is INCORRECT?
What is the correct definition of cor pulmonale?
Which of the following is the correct core pathophysiological sequence of cor pulmonale?
A 58-year-old man with severe COPD presents with progressive dyspnoea, raised JVP, pitting ankle oedema, and a loud P2. What is the most likely diagnosis?
Which WHO group of pulmonary hypertension is the most common cause of pulmonary hypertension overall in adults?
Which WHO group of pulmonary hypertension is most responsible for causing cor pulmonale?
A 34-year-old woman has a history of multiple pulmonary emboli and three spontaneous abortions. She now has dyspnoea on exertion, a raised JVP, and a loud pulmonic second sound. What is the most consistent physical finding in pulmonary hypertension?
Why do the symptoms of left atrial myxoma change with body position?
All of the following are true about cardiac myxoma EXCEPT:
A left atrial myxoma patient develops a sudden onset right hemiplegia. What is the most likely mechanism?
What is the first-line investigation for suspected cardiac myxoma?
What is the treatment of choice for cardiac myxoma?
Which statement about cardiac tumors is INCORRECT?
A patient is found to have multiple myxomas in unusual cardiac locations and has a family history of similar tumors. Skin examination reveals areas of pigmentation. What syndrome should be suspected?
What is the most common primary cardiac tumor in children, and with which genetic condition is it strongly associated?
Which imaging modality provides the best tissue characterisation of cardiac masses, including identification of fat, fibrosis, and vascularity?
A small mobile lesion with a "sea-anemone" appearance is found on the aortic valve during echocardiography performed for stroke workup in a 55-year-old man. What is the most likely diagnosis?
In which cardiac chamber does angiosarcoma most commonly arise, and what is its characteristic presentation?
A 45-year-old HIV-positive patient develops new-onset arrhythmias, progressive heart failure, and a pericardial effusion. Imaging reveals an infiltrative mass in the right heart. What is the most likely primary malignant cardiac diagnosis?
Which of the following correctly describes the spread of renal cell carcinoma to the heart?
A 62-year-old woman with advanced breast cancer develops progressive dyspnoea and a new large pericardial effusion. What is the most important diagnosis to consider?
Which of the following correctly describes the relative frequency of cardiac tumors?
What is the most common primary cardiac tumor in adults?
A 38-year-old woman presents with exertional dyspnoea that worsens when she lies on her left side, an episode of stroke three weeks ago, and low-grade fever with raised ESR. Echocardiography reveals a mobile mass in the left atrium attached to the interatrial septum. What is the most likely diagnosis?
What is the pathognomonic auscultatory finding of left atrial myxoma?
Where is the stalk of a left atrial myxoma most commonly attached?
Which of the following is the correct management approach for each type of cardiac tumor?
A 35-year-old patient develops polyuria, polydipsia, and serum Na⁺ of 152 mmol/L after a head injury. Urine osmolality is 80 mOsm/kg despite hypernatraemia. What is the most likely diagnosis?
What is the normal range of plasma sodium?
A low serum sodium level indicates which of the following?
What is the mandatory first step in evaluating any patient with unexplained hyponatraemia?
A patient has a serum Na⁺ of 128 mmol/L with a plasma osmolality of 290 mOsm/kg. Which of the following is the most likely diagnosis?
A patient with DKA has serum Na⁺ of 126 mmol/L and plasma osmolality of 320 mOsm/kg. What type of hyponatraemia is this?
In true hypo-osmolar hyponatraemia, a urine osmolality of less than 100 mOsm/kg indicates which of the following?
Which combination of findings is most consistent with SIADH?
Which of the following is the most classic paraneoplastic cause of SIADH?
Why does giving normal saline worsen hyponatraemia in SIADH?
A patient with heart failure has serum Na⁺ of 128 mmol/L, bilateral pitting oedema, raised JVP, urine Na⁺ of 18 mmol/L, and urine Osm of 420 mOsm/kg. What is the mechanism of hyponatraemia?
A patient presents with acute hyponatraemia (Na⁺ 108 mmol/L) developing over 12 hours after a marathon. She is confused and has a generalised seizure. What is the most appropriate immediate treatment?
What is the maximum safe rate for correcting chronic hyponatraemia, and why?
Which of the following patients is at highest risk of developing osmotic demyelination syndrome (ODS) if hyponatraemia is corrected too rapidly?
Which drug is used for chronic SIADH when fluid restriction alone is insufficient?
A patient with hypovolaemic hyponatraemia caused by vomiting has urine Na⁺ of 12 mmol/L. Which of the following best explains this finding?
Hypernatraemia is always associated with which of the following?
Which drug is the most common cause of nephrogenic diabetes insipidus?
What is the paradoxical treatment for nephrogenic diabetes insipidus, and why does it work?
Which of the following correctly matches the cause of hyponatraemia with its expected urine osmolality and urine sodium?
A patient with DKA has K+ of 5.8 mEq/L at presentation. Why must K+ be closely monitored during insulin treatment?
What is the normal serum potassium range?
What is the maximum safe IV KCl infusion rate via a peripheral line?
Which of the following correctly describes how the Na/K+ ATPase pump works?
Which hormone is primarily responsible for renal potassium excretion?
A patient is started on furosemide for heart failure and develops hypokalemia. What is the mechanism?
A patient develops hypokalemia after receiving large doses of albuterol for severe asthma. What is the mechanism?
Which of the following mechanisms explains how alkalosis causes hypokalemia?
A patient has hypokalemia that is not responding to potassium replacement. Which electrolyte must be checked and corrected first?
Which of the following is the characteristic EKG finding of hypokalemia?
A patient on digoxin develops hypokalemia. Why is this particularly dangerous?
A patient with hypokalemia has a urine K+ of 8 mmol/L. What does this indicate?
A patient with hypokalemia, urine K+ > 20 mmol/L, and metabolic acidosis most likely has which condition?
What is the correct treatment for a patient with K+ of 2.8 mEq/L and no EKG changes?
Which of the following is NOT a cause of hypokalemia?
Which of the following is the most common mechanism of hyperkalemia in clinical practice?
A diabetic patient with poor glucose control presents with K+ of 6.2 mEq/L. What is the primary mechanism?
How does acidosis cause hyperkalemia?
A patient on propranolol (non-selective beta-blocker) develops hyperkalemia. What is the mechanism?
A patient with leukemia receives chemotherapy and develops K+ of 6.8 mEq/L with elevated uric acid and phosphate. What is the diagnosis?
Which EKG finding is the EARLIEST sign of hyperkalemia?
Hyperkalemia ECG changes include all of the following EXCEPT:
A patient with hyperkalemia and EKG showing peaked T waves. What is the FIRST treatment to give?
A patient with hyperkalemia is given insulin. Why is dextrose 50 (D50) administered simultaneously?
Which of the following treatments for hyperkalemia actually eliminates potassium from the body?
What percentage of total body potassium is intracellular?
When is hemodialysis indicated for hyperkalemia?
What is pseudohyperkalemia, and what is its most common cause?
What is the classic electrolyte pattern of Addison's disease?
A patient presents with severe hypertension, hypokalemia, and metabolic alkalosis. Renin is low and aldosterone is low. What is the most likely diagnosis?
What is the correct treatment for Liddle syndrome?
Which of the following does NOT cause hypokalemia with hypertension?
Where does spironolactone act in the nephron?
Which statement about spironolactone is FALSE?
Which is a potassium-sparing diuretic?
What is the key pharmacological difference between spironolactone and eplerenone?
A patient with hyperkalemia has a sine wave pattern on EKG. What does this signify?
A patient is found to have K+ of 6.5 mEq/L. The lab flags the sample as hemolyzed. What is the next step?
Which drug causes hyperkalemia by directly inhibiting Na/K+ ATPase?
Which of the following causes hypophosphatemia through a PTH-mediated mechanism?
A 35-year-old woman presents with muscle cramps and tingling around the mouth. On examination, inflating a BP cuff above systolic for 3 minutes causes wrist and finger flexion. Her serum calcium is 7.2 mg/dL and albumin is 4.0 g/dL. Which of the following best explains this finding?
A 28-year-old woman with a history of thyroid cancer undergoes total thyroidectomy. Three days later she develops perioral tingling, muscle twitching, and a prolonged QT interval on ECG. Serum calcium is 6.8 mg/dL. What is the most likely underlying mechanism?
Which of the following electrolyte abnormalities causes a PROLONGED QT interval?
Which of the following electrolyte abnormalities causes a SHORTENED QT interval on ECG?
A 55-year-old woman is found to have Ca 11.2 mg/dL on routine labs. She is asymptomatic. PTH is elevated at 95 pg/mL (normal 15–65). Phosphate is 2.0 mg/dL. What is the most likely diagnosis?
A 62-year-old man is admitted with Ca 13.8 mg/dL, weight loss, and a 40-pack-year smoking history. His PTH is undetectable. Which mechanism is MOST likely responsible for his hypercalcemia?
A 67-year-old hospitalized patient has Ca 14.5 mg/dL, back pain, and creatinine 3.2 mg/dL. Blood smear shows rouleaux formation and ESR is 120 mm/hr. What is the most likely diagnosis?
A 45-year-old woman with confirmed primary hyperparathyroidism (Ca 11.0 mg/dL, PTH 88 pg/mL) is being evaluated for parathyroid surgery. Which investigation is the NEXT most appropriate step?
A patient with severe symptomatic hypercalcemia (Ca 15.2 mg/dL) is started on IV normal saline and calcitonin. After 36 hours, the calcium-lowering effect of calcitonin has diminished significantly despite continued use. What is the explanation?
Which of the following should NOT be used in the management of hypercalcemia?
A patient on furosemide develops hypokalemia that fails to correct despite aggressive potassium replacement. Serum magnesium is 1.1 mEq/L. What is the mechanism of the persistent hypokalemia?
A patient with severe hypomagnesemia (Mg 0.8 mEq/L) also has low serum calcium (Ca 7.1 mg/dL) and low PTH (18 pg/mL). Which of the following best explains the low PTH despite low calcium?
A patient with hypomagnesemia is treated with IV calcium gluconate for symptomatic hypocalcemia but shows no improvement. What is the most important next step?
Which of the following is the most common cause of hypomagnesemia in a hospitalized alcoholic patient?
A patient with Mg 3.8 mEq/L presents with loss of deep tendon reflexes and weakness. What is the best immediate treatment?
Which of the following correctly describes the effect of very high magnesium levels on calcium?
A 22-year-old athlete presents with severe muscle weakness, difficulty breathing, and respiratory fatigue. He was recently diagnosed with anorexia nervosa and has been in a refeeding program for 5 days. Which electrolyte abnormality is most responsible for his current symptoms?
A patient in the ICU is being treated for DKA with IV insulin and fluids. Before insulin was started, serum phosphate was 3.8 mg/dL. Six hours after starting insulin, the repeat phosphate is 1.4 mg/dL. What is the mechanism?
Which of the following is the most common cause of hyperphosphatemia?
A patient with CKD stage 5 develops painful skin nodules and necrosis. Serum calcium is 9.8 mg/dL and phosphate is 7.2 mg/dL. What is the most likely diagnosis?
Which of the following correctly describes the CKD cascade leading to secondary hyperparathyroidism?
Which of the following phosphate binders is preferred in a CKD patient who already has an elevated calcium-phosphate product?
A 50-year-old woman presents with constipation, fatigue, and polyuria. Serum calcium is 12.4 mg/dL. What is the mechanism of polyuria in this patient?
A patient presents with hypercalcemia and low PTH. Workup reveals elevated serum ACE and bilateral hilar lymphadenopathy on chest X-ray. What is the mechanism of hypercalcemia in this patient?
A patient on long-term thiazide diuretics is found to have mild hypercalcemia (Ca 10.8 mg/dL) and hypomagnesemia (Mg 1.2 mEq/L). He also has low serum potassium. What single correction would most effectively address the hypokalemia?
Which of the following correctly pairs a cause of central DI with its mechanism?
Which drug used in central DI works by inhibiting renal prostaglandins, thereby enhancing ADH action?
All of the following are dietary recommendations for patients with DI EXCEPT:
What is the definition of true polyuria?
A patient produces 5 L of urine per day. Labs show plasma Na⁺ of 150 mEq/L and urine osmolality of 80 mOsm/kg. Which mechanism best explains this picture?
Which of the following correctly describes the ADH physiology pathway?
What is the difference between the V1 and V2 receptors of ADH, and why does desmopressin not cause vasoconstriction?
Which of the following statements about diabetes insipidus (DI) is correct?
Initial labs in a patient with polyuria show: plasma Na⁺ 128 mEq/L, plasma osmolality 262 mOsm/kg, urine osmolality 95 mOsm/kg. What is the most likely diagnosis?
What is the ADH level in nephrogenic diabetes insipidus (NDI)?
Which of the following is the most common form of diabetes insipidus?
What dietary modification reduces urine volume in both central and nephrogenic DI, and why?
A patient undergoes surgery for a pituitary adenoma. On day 2 postoperatively, urine output rises to 8 L/day with plasma Na⁺ of 152 mEq/L. On day 7, urine output drops and serum Na⁺ falls to 128 mEq/L. On day 14, polyuria returns. Which pattern does this describe?
Which of the following is the most important drug cause of nephrogenic DI?
Why is amiloride specifically used in lithium-induced nephrogenic DI rather than other forms of NDI?
A patient with known hypercalcemia develops polyuria with low urine osmolality and normal ADH levels. Which is the correct mechanism?
Which hereditary form of nephrogenic DI is X-linked recessive and what is the defect?
What is the hallmark urine finding in diabetes insipidus?
When does hypernatremia develop in a patient with diabetes insipidus?
What is the first step in the diagnostic workup of a patient suspected to have polyuria?
What does the water deprivation test measure, and what result confirms diabetes insipidus?
After a water deprivation test, desmopressin is administered. Urine osmolality rises from 95 mOsm/kg to 820 mOsm/kg. What does this result indicate?
A 32-year-old woman with bipolar disorder on long-term lithium presents with 8 L/day of dilute urine. ADH level is elevated. Water deprivation test shows urine osmolality of 88 mOsm/kg; after desmopressin, it remains at 92 mOsm/kg. Serum calcium and potassium are normal. What is the best management?
Which of the following statements about primary polydipsia is FALSE?
After water deprivation, urine osmolality is 85 mOsm/kg. After desmopressin, urine osmolality remains at 90 mOsm/kg. What is the diagnosis?
Which of the following correctly lists the urine osmolality after water deprivation and after desmopressin for all four possible diagnoses?
What is the first-line treatment for central diabetes insipidus?
How do thiazide diuretics paradoxically reduce urine output in nephrogenic DI?
Why must hypernatremia from DI be corrected at a maximum rate of 12 mEq/L per day?
A 40-year-old man from Sudan presents with hematuria. He recalls frequent freshwater swimming as a child. Cystoscopy shows a thickened, inflamed bladder wall. What is the most likely diagnosis?
A 58-year-old man with newly diagnosed renal cell carcinoma is found to have an elevated hematocrit of 58%. What is the most likely mechanism?
Which of the following is the most common kidney tumor?
A 62-year-old male smoker presents with painless gross hematuria. Urinalysis shows red blood cells but no casts and no dysmorphic RBCs. What is the most appropriate next step?
A 55-year-old male develops a new left-sided varicocele that does not decompress when he lies supine. What diagnosis must be ruled out?
Which of the following is NOT a recognized risk factor for renal cell carcinoma?
Von Hippel-Lindau (VHL) disease is characterized by which of the following combinations?
A patient with metastatic RCC is started on systemic therapy. The drug works by blocking the PD-1 pathway to trigger T-cell activation against the tumor. Which drug is being described?
A patient with RCC is started on high-dose aldesleukin (IL-2). Shortly after infusion, he develops hypotension, fever, and chills. What is the most likely explanation?
Which of the following is the most common type of bladder cancer?
Which of the following is the most important risk factor for transitional cell carcinoma (TCC) of the bladder?
A chemotherapy nurse who has worked with cyclophosphamide for 15 years is found to have bladder cancer on routine cystoscopy. Which histological type is most likely?
Bladder cancer is found to be non-muscle-invasive on cystoscopy and biopsy. What is the most appropriate initial management?
A patient with muscle-invasive TCC of the bladder is not a surgical candidate. His oncologist decides to use intravesical BCG. What is the mechanism of action of BCG in bladder cancer?
Which of the following bladder cancers is caused by chronic bladder inflammation rather than chemical or genetic causes?
What is the sequence of events in Schistosoma haematobium infection leading to bladder cancer?
A newborn is noted to have urine dripping from the umbilicus. What is the most likely diagnosis?
A 45-year-old man presents with a painful midline suprapubic mass. Imaging shows a cystic lesion between the bladder dome and the umbilicus. What is the most likely diagnosis?
Which malignancy is specifically associated with a urachal remnant?
A 67-year-old man with RCC has a serum calcium of 3.1 mmol/L (elevated) and normal PTH. Bone scan shows no metastases. What is the most likely cause of his hypercalcemia?
All of the following are risk factors for transitional cell carcinoma of the bladder EXCEPT:
A patient with RCC is told his tumor is poorly responsive to standard chemotherapy. Which treatment approach is most appropriate for metastatic disease?
Which of the following correctly pairs the bladder cancer type with its most important risk factor?
Which of the following statements about RCC genetics is correct?
What is the most common extrarenal manifestation of ADPKD?
What is the incidence of ADPKD, and why is it clinically significant?
A patient with ADPKD is found to carry a PKD1 mutation. Which of the following best describes his expected clinical course compared to a patient with a PKD2 mutation?
A 30-year-old woman with ADPKD asks about the risk that her child will inherit the disease. What is the correct answer?
A neonate is born with massively enlarged echogenic kidneys bilaterally. There is oligohydramnios, pulmonary hypoplasia, and typical facial features. What is the most likely diagnosis?
Which of the following correctly describes when renal cysts become visible on ultrasound in ADPKD?
A 35-year-old man with ADPKD presents with headache and sudden loss of consciousness. He is found to have a subarachnoid hemorrhage. Which extrarenal manifestation of ADPKD explains this complication?
A 32-year-old woman is referred for investigation of hypertension and hematuria. Renal ultrasound shows multiple bilateral cysts. She reports that her father died suddenly at age 40 from a "brain bleed." What is the most likely diagnosis and the mechanism of her hypertension?
What is the first-line diagnostic test for ADPKD, and what are the criteria for a patient aged 15–39 years?
What is the mechanism of action of tolvaptan in ADPKD?
Which of the following patients with ADPKD is most appropriate for treatment with tolvaptan?
What is the key contraindication to tolvaptan use in ADPKD?
Which antibiotic class is preferred for treating cyst infections in ADPKD, and why?
A patient on hemodialysis for 10 years is found to have multiple cysts in both shrunken kidneys on routine imaging. He has no family history of kidney disease. Which diagnosis best explains this finding?
A renal cyst is described on CT as thin-walled, non-enhancing, homogeneous, and without septations. What is the correct classification and management?
Which imaging feature most strongly suggests that a renal cyst is potentially malignant?
In which ADPKD patients is screening for intracranial aneurysms with MRA of the head indicated?
What is the Bosniak classification system used for?
Which of the following correctly distinguishes ADPKD from ARPKD?
All of the following are recognized extrarenal manifestations of ADPKD EXCEPT:
A 27-year-old man is found to have multiple bilateral renal cysts on ultrasound. He has a positive family history of kidney disease but normal renal function. What is the most likely diagnosis?
Which of the following conditions causes cortical scarring predominantly at the upper and lower poles of the kidney?
Which of the following best describes the disposition decision for a patient with acute pyelonephritis?
What is the most common structural cause of recurrent pyelonephritis in children?
Which of the following is NOT a recognized risk factor for urinary tract infection?
A 70-year-old male ICU patient with urosepsis is started on empiric piperacillin-tazobactam. Blood cultures drawn on admission grow E. coli sensitive to ceftriaxone after 48 hours. What is the most appropriate next step?
A 68-year-old male smoker presents with two episodes of painless gross hematuria over the past month. He has no dysuria, fever, or flank pain. Urinalysis shows red blood cells but no WBCs, no nitrites, and no leukocyte esterase. What is the most likely diagnosis and the gold standard investigation?
Which of the following organisms causes a UTI with a nitrite-negative urinalysis?
Which of the following correctly describes the route of infection in most UTIs?
Which organism is responsible for 75–95% of all urinary tract infections?
A 32-year-old woman presents with chronic pelvic pain and urinary urgency lasting 8 weeks. She has had three negative urine cultures and two courses of antibiotics with no improvement. Urinalysis is unremarkable. What is the most likely diagnosis and its first-line treatment?
A 22-year-old sexually active woman presents with dysuria and urinary frequency. Urinalysis shows pyuria and positive leukocyte esterase, but the nitrite test is negative. Which organism is most likely responsible?
Which of the following urinary findings is pathognomonic for upper urinary tract (renal) involvement?
A 28-year-old woman presents with dysuria, frequency, and suprapubic pain for 2 days. Temperature is 36.8°C. Urinalysis shows pyuria and positive leukocyte esterase. What is the most appropriate next step?
Which of the following is the most appropriate first-line antibiotic for uncomplicated cystitis?
A 35-year-old pregnant woman is found to have asymptomatic bacteriuria on routine prenatal screening. What is the correct management?
Which of the following correctly identifies all features of complicated UTI?
A 45-year-old woman presents with fever (38.9°C), right flank pain, CVA tenderness, and dysuria for 3 days. Urinalysis shows pyuria, positive nitrites, and WBC casts. What is the most likely diagnosis?
A 60-year-old man with pyelonephritis is started on IV broad-spectrum antibiotics. After 48 hours of treatment, he remains febrile and continues to have flank pain. Which complication should be suspected?
Which of the following best describes the histological appearance of chronic pyelonephritis?
A CT scan of a 55-year-old woman with recurrent UTIs and flank pain shows a unilateral enlarged kidney with multiple rounded low-attenuation areas and a central calculus. What is the most likely diagnosis and its treatment?
Which of the following correctly pairs the stone type with its characteristic urine finding?
Which of the following kidney stones is NOT visible on plain abdominal X-ray (KUB)?
A patient with flank pain and hematuria has no stone visible on abdominal X-ray. CT scan confirms a stone. Which two stone types should be considered?
A patient has flank pain and hematuria. The stone is located at the lower ureter near the vesicoureteral junction. Where would you expect the pain to radiate?
The most common cause of calcium stones is:
A patient with Crohn's disease develops recurrent calcium oxalate stones. What is the mechanism?
Which of the following increases urinary calcium through reduced proximal tubular calcium reabsorption?
Which of the following is NOT recommended for prevention of recurrent calcium oxalate stones?
A 5 mm calcium stone is found in the ureter of a patient with mild flank pain. The most appropriate management is:
Nifedipine and tamsulosin are used in nephrolithiasis for which purpose?
Struvite stones are always caused by infection with which type of bacteria?
A 45-year-old woman presents with dysuria, urinary frequency, mild flank pain, and hematuria. CT scan shows a large branching stone filling the right renal pelvis and calyces. What is the most likely stone type and required treatment?
Which urine pH is associated with struvite stone formation?
Uric acid stones form when uric acid precipitates from urine. Which equilibrium explains why alkaline urine prevents this?
A 55-year-old man with a known history of gout presents with flank pain, hematuria, and no stone visible on abdominal X-ray. CT confirms a 7 mm stone. What is the most appropriate treatment?
Which of the following conditions causes uric acid stones through acidic urine rather than hyperuricemia?
A 10-year-old boy presents with his third episode of kidney stones in two years. His mother also had kidney stones as a child. Urinalysis shows hexagonal crystals. What is the diagnosis?
Cystinuria is caused by a defect in tubular reabsorption of which group of amino acids?
Which of the following is the correct treatment approach for cystine stones?
How is cystinuria diagnosed in the laboratory?
Which two stone types share the same treatment strategy?
All of the following are true about struvite stones EXCEPT:
A patient is prescribed thiazide diuretics for recurrent calcium stones. What is the mechanism of benefit?
Which of the following correctly lists the four kidney stone types in order from most to least common?
A pregnant woman at 28 weeks gestation presents with right flank pain and hematuria. Which is the most appropriate initial imaging test?
A 35-year-old man presents with severe colicky right flank pain radiating to the groin, hematuria, and nausea. Which is the best initial imaging test?
Compare the plasma HCO₃⁻ levels across the three RTA types. Which correctly ranks them from most severe to mildest?
Which of the following correctly matches each RTA type with its urine pH and plasma K⁺?
A patient on tenofovir for HIV develops glycosuria with a normal blood glucose, aminoaciduria, hypophosphatemia, and a mild metabolic acidosis with low urine pH. What is the most likely diagnosis?
Which of the following drug pairs both cause Type II RTA through carbonic anhydrase inhibition?
Which of the following correctly describes the defect in Type I (Distal) RTA?
A patient with a known autoimmune condition presents with bilateral kidney stones, HCO₃⁻ of 8 mEq/L, K⁺ of 2.8 mEq/L, and urine pH of 6.3. Which autoimmune condition most likely underlies this presentation?
What is the treatment for Type I (Distal) RTA, and what are the goals of treatment?
Which of the following statements about the urine anion gap in RTA is correct?
A patient has metabolic acidosis with plasma HCO₃⁻ of 7 mEq/L and urine pH of 6.4. What is the most likely diagnosis?
How is the diagnosis of Type I (Distal) RTA confirmed using the ammonium chloride challenge?
Why does Type I (Distal) RTA cause calcium phosphate kidney stones but Type II does not?
Which autoimmune disease is most classically associated with Type I (Distal) RTA?
How does amphotericin B cause Type I (Distal) RTA?
What is the defining feature of Type IV RTA that distinguishes it from all other RTA types?
Which of the following is shared by all types of renal tubular acidosis?
In Type IV RTA, the urine pH is low (< 5.4) despite inadequate acid excretion. Why?
A patient has metabolic acidosis. The urine anion gap (Na + K − Cl) is negative. Which of the following best explains this finding?
The "neGUTive in GI" mnemonic refers to which finding?
What is hyporeninemic hypoaldosteronism, and what is its most common cause?
Which of the following drug combinations is most likely to cause Type IV RTA?
Which of the following correctly describes the defect in Type II (Proximal) RTA?
A patient with Type II RTA reaches a new HCO₃⁻ steady state of 15 mEq/L. Why does the acidosis stabilize rather than worsen indefinitely?
Why does Type II (Proximal) RTA cause hypokalemia?
How does TMP/SMX (trimethoprim-sulfamethoxazole) cause Type IV RTA?
A 68-year-old man with type 2 diabetes and chronic kidney disease (GFR 45 mL/min) is found to have K⁺ of 5.9 mEq/L and HCO₃⁻ of 18 mEq/L on routine labs. His urine pH is 5.0. What is the most likely diagnosis?
Which dynamic test is the gold standard for simultaneously assessing both GH reserve and ACTH reserve?
Which of the following best describes the pathophysiologic difference between primary and secondary empty sella syndrome?
A 30-year-old man presents with euvolemic hyponatremia. Labs show: serum osmolality 262 mOsm/kg, urine osmolality 490 mOsm/kg, urine sodium 62 mEq/L. Thyroid and adrenal function are normal. Serum sodium is 128 mEq/L and the patient is asymptomatic. What is the first-line treatment?
A 45-year-old postpartum woman is found to have a sellar mass on MRI. Her morning cortisol is low and ACTH is also low. TSH and Free T4 are normal. Which diagnosis best fits this presentation?
A 52-year-old obese woman with chronic headaches has an MRI showing a CSF-filled sella with a thin rim of pituitary tissue. Her full pituitary hormone panel is entirely normal. What is the most appropriate management?
A patient with known panhypopituitarism is started on levothyroxine without glucocorticoid replacement. Two days later he develops severe hypotension, hypoglycemia, and altered consciousness. What is the mechanism of this complication?
A patient with hypopituitarism has both ACTH and TSH deficiency confirmed. In which order should hormone replacement be initiated, and why?
A 17-year-old male with Kallmann syndrome is given repetitive pulsatile GnRH, which results in normal LH and FSH secretion. What does this response confirm?
A patient has low Free T4 and a TSH that is 1.8 mIU/L (low-normal). What is the correct interpretation, and how should this be managed?
Which of the following best differentiates secondary adrenal insufficiency (ACTH deficiency) from primary adrenal insufficiency (Addison's disease)?
A patient with empty sella develops spontaneous clear unilateral nasal discharge. What is the most specific test to confirm the nature of this fluid?
A 34-year-old woman delivered a baby 6 months ago following massive postpartum hemorrhage. She now presents with failure to breastfeed, no return of menstruation, and progressive fatigue with cold intolerance. What is the most likely diagnosis?
A patient with severe SIADH (Na 112 mEq/L with seizures) is treated with 3% hypertonic saline. After 14 hours, sodium has risen from 112 to 128 mEq/L (a rise of 16 mEq/L). What immediate complication is this patient now at risk for?
A 28-year-old male presents with failure to progress through puberty, micropenis, and complete loss of smell since birth. LH, FSH, and testosterone are all low. What single feature distinguishes this condition from all other causes of hypogonadotropic hypogonadism?
A patient with Kallmann syndrome wishes to restore his fertility. Which of the following is the most appropriate treatment?