Medical Content Library - EndlessMedical Academy

Welcome to the most comprehensive medical education content library, featuring 3630+ carefully curated questions across 171 medical categories, designed for medical students and healthcare professionals preparing for major examinations.

Last updated: March 16, 2026 at 06:27 AM UTC

3630+
Medical Questions
171
Medical Categories
24
Question Types
12
Case Types
4
Difficulty Levels

Table of Contents

All 24 Question Types

Diverse question formats to test every aspect of medical knowledge:

Best next diagnostic step
Diagnostic step questions test students ability to choose the most appropriate next investigation or test based on the clinical scenario. Students must consider cost-effectiveness, diagnostic yield, patient safety, and clinical guidelines.
Clinical features
Clinical features questions test recognition and understanding of disease manifestations. Students must identify key signs, symptoms, and clinical findings that characterize specific conditions or disease states.
Clinical trials
Clinical trials questions test understanding of research methodology, study design, and evidence-based medicine. Students must interpret research findings, understand study limitations, and apply evidence to clinical practice.
Common clinical pitfalls
Clinical pitfalls questions highlight common mistakes in clinical practice. Students must recognize potential errors in diagnosis, treatment, or patient management and understand strategies to avoid these pitfalls.
Common legal pitfalls
Legal pitfalls questions address medicolegal aspects of healthcare including informed consent, documentation, professional boundaries, and legal responsibilities. Students must understand how to practice defensively while maintaining good patient care.
Complications
Complications questions test knowledge of potential adverse outcomes associated with diseases or treatments. Students must identify, prevent, and manage complications while understanding risk factors and early warning signs.
Contraindications and precautions
Contraindication questions test knowledge of absolute and relative contraindications to medications, procedures, or interventions. Students must identify when treatments could be harmful and understand alternative approaches for high-risk patients.
Cost effectiveness
Cost effectiveness questions examine healthcare economics and resource allocation decisions. Students must consider cost-benefit ratios, healthcare system constraints, and value-based care principles in clinical decision-making.
Diagnostic failure scenario
Diagnostic failure questions present scenarios where standard diagnostic approaches have not yielded results. Students must demonstrate advanced clinical reasoning to identify alternative diagnostic strategies or consider rare conditions.
Differential diagnosis by any means
These questions test comprehensive differential diagnosis skills, integrating history, physical examination, laboratory results, and imaging to distinguish between multiple possible conditions. Students must synthesize all available information to reach the correct diagnosis.
Differential diagnosis by physical exam and history
These questions test the ability to differentiate between similar conditions based on subtle differences in physical examination findings and patient history. Students must recognize key distinguishing features that help narrow the differential diagnosis.
Differential diagnosis by testing
These questions focus on selecting the most appropriate diagnostic tests to differentiate between conditions with similar presentations. Students must understand which tests provide the most discriminatory information.
Emergency priorities
Emergency priorities questions test ability to rapidly assess and prioritize patient care in urgent situations. Students must demonstrate triage skills, immediate management decisions, and understanding of emergency protocols.
Epidemiology
Epidemiology questions test understanding of disease distribution, determinants, and population health patterns. Students must demonstrate knowledge of risk factors, prevalence, incidence, and public health implications.
Management
Management questions test comprehensive patient care skills including treatment planning, monitoring, follow-up care, and coordination between different healthcare providers and services.
Mechanism of action
Mechanism questions test understanding of underlying biological, pharmacological, or pathophysiological processes. Students must demonstrate knowledge of how interventions work at cellular, molecular, or systems levels.
Most likely diagnosis
Diagnostic questions focus on identifying the most likely diagnosis based on patient symptoms, signs, and test results. These questions test knowledge of disease presentations, differential diagnoses, and diagnostic criteria. The correct answer should be the single most likely diagnosis given the information provided.
Natural history
Natural history questions examine the typical course of diseases over time. Students must understand disease progression, factors affecting prognosis, and long-term outcomes with and without treatment.
Patient communication
Patient communication questions test interpersonal skills essential for medical practice. Students must demonstrate effective communication techniques, patient counseling skills, and ability to educate patients about their conditions.
Prevention strategies
Prevention questions focus on strategies to prevent disease occurrence, progression, or recurrence. Students must understand primary, secondary, and tertiary prevention approaches including screening programs and lifestyle modifications.
Recent changes
Recent changes questions focus on current developments in medical practice including new guidelines, treatments, or research findings. Students must stay current with evolving medical knowledge and practice standards.
Treatment approach
Treatment questions focus on selecting the most appropriate therapeutic intervention for a given condition. Students must consider patient factors, contraindications, drug interactions, and evidence-based guidelines to choose optimal treatment strategies.
Treatment failure scenario
Treatment failure questions test problem-solving skills when standard treatments are ineffective. Students must consider alternative therapies, drug resistance, compliance issues, or misdiagnosis.
Underlying pathology
Pathology questions focus on understanding disease processes at the tissue and cellular level. Students must identify pathological changes, understand disease progression, and connect pathophysiology to clinical manifestations.

All 12 Clinical Case Types

Real-world clinical scenarios across different healthcare settings:

Common clinical scenario
Common scenario cases represent frequently encountered clinical situations in everyday practice. These scenarios test competency in managing routine but important clinical presentations that form the foundation of medical practice.
Complicated condition
Complicated condition cases involve patients with multiple medical problems, complex comorbidities, or conditions that deviate from typical presentations. These scenarios test advanced clinical reasoning and management of complex patients.
Emergency
Emergency cases present acute, life-threatening, or rapidly deteriorating conditions that require immediate medical intervention. These scenarios test rapid assessment skills, priority setting, and urgent care protocols.
Emergency department case
Emergency department cases present acute medical conditions in the context of emergency care. These scenarios test triage skills, rapid assessment, emergency protocols, and acute care management typical of ED practice.
Multi-patient scenario
Multi-patient scenarios test ability to manage multiple patients simultaneously, prioritize care based on acuity, and efficiently allocate limited resources. These cases emphasize triage skills and system-level thinking.
Patient in critical condition
Critical condition cases present patients with life-threatening conditions requiring intensive care, continuous monitoring, and immediate interventions. These scenarios test critical care skills and emergency management.
Pregnant patient
Clinical scenarios involving Pregnant patient
Rare disease presentation
Rare presentation cases feature uncommon diseases or atypical presentations of known conditions. These scenarios test diagnostic skills when faced with unusual presentations and knowledge of rare but important conditions.
Resource-limited setting
Resource-limited cases present clinical scenarios where diagnostic tests, medications, or specialists may not be readily available. These scenarios test adaptability, clinical reasoning without extensive testing, and resource-conscious decision-making.
Routine visit
Routine visit cases represent typical outpatient encounters including preventive care, routine follow-ups, and standard consultations. These scenarios focus on systematic assessment, routine care protocols, and patient counseling.
Tricky question with subtle findings
Tricky findings cases feature subtle clinical signs or symptoms that can be easily overlooked. These scenarios test attention to detail, thorough clinical assessment, and recognition of subtle but important findings.
Typical presentation
Typical presentation cases feature classic signs and symptoms of common medical conditions. These scenarios test recognition of standard disease patterns and application of routine diagnostic and treatment protocols.

Difficulty Levels

Questions calibrated for different stages of medical education:

Easy
Easy questions test fundamental knowledge for early medical and nursing students. These questions focus on common conditions with typical presentations, basic diagnostic criteria, first-line treatments, and straightforward management plans. Easy questions require recall of basic medical facts and application of simple concepts. They typically include a more limited patient context with fewer variables.
Moderate
Moderate questions test knowledge for late-stage students and early career professionals. These questions involve less common conditions, atypical presentations of common conditions, more nuanced diagnostic criteria, second-line treatments, and management plans with multiple considerations. Moderate questions require integration of multiple concepts and application of clinical reasoning. They typically include more detailed patient context with additional variables to consider.
Hard
Hard questions test sophisticated knowledge expected of specialists, attendings, and subspecialists already in their careers. These questions cover rare conditions, complex atypical presentations, challenging diagnostic dilemmas, advanced treatments, and management plans requiring careful weighing of multiple factors. Hard questions require nuanced clinical judgment, complex decision-making, and deep integration of different medical domains. They typically include extensive patient context with many variables, subtle findings, and complex past medical history.
Expert
Expert questions test the highest level of medical knowledge and clinical expertise. These questions involve cutting-edge medical knowledge, complex diagnostic challenges, or specialized clinical scenarios that require renowned expert-level understanding. People knowing answers to these questions are usually involved themselves in latest research studies, are world wide known experts and have in-depth detailed knowledge in the domain area.

All 171 Medical Categories

Comprehensive coverage across all medical fields with question counts:

Advanced Imaging in Kidney Lesions 4 questions
Exploration of advanced imaging techniques, such as multiphase CT and diffusion-weighted MRI, to differentiate between malignant and benign kidney lesions.
Anatomy > Endocrine Anatomy 6 questions
Anatomy > Endocrine Anatomy
Anatomy > Hepatobiliary Anatomy 9 questions
Anatomy > Hepatobiliary Anatomy
Anatomy > Lower Limb Anatomy 5 questions
Anatomy > Lower Limb Anatomy
Anatomy > Oral Anatomy 8 questions
Anatomy > Oral Anatomy
Anatomy > Peripheral Neuroanatomy 3 questions
Anatomy > Peripheral Neuroanatomy
Biochemistry > Clinical Biochemistry 17 questions
Biochemistry > Clinical Biochemistry
Biochemistry > Enzymology 1 questions
Biochemistry > Enzymology
Biochemistry > Hormonal Biochemistry 3 questions
Biochemistry > Hormonal Biochemistry
Biochemistry > Molecular Genetics 4 questions
Biochemistry > Molecular Genetics
Biochemistry > Neurochemical Analysis 12 questions
Biochemistry > Neurochemical Analysis
Biochemistry > Oncological Biochemistry 6 questions
Biochemistry > Oncological Biochemistry
Clinical Pathology > Therapeutic plasma exchange 5 questions
Clinical Pathology > Therapeutic plasma exchange
Clinical Pathology > Therapeutic plasma exchange > Indications for TPE > Use of TPE in Dementia 2 questions
Clinical Pathology > Therapeutic plasma exchange > Indications for TPE > Use of TPE in Dementia
Clinical Pathology > Therapeutic plasma exchange > Indications for TPE > Use of TPE in Dementia > Neuroinflammation and TPE 5 questions
Clinical Pathology > Therapeutic plasma exchange > Indications for TPE > Use of TPE in Dementia > Neuroinflammation and TPE
Clinical Pathology > Therapeutic plasma exchange > Neurological Applications of TPE 2 questions
Clinical Pathology > Therapeutic plasma exchange > Neurological Applications of TPE
Clinical Pathology > Therapeutic plasma exchange > Oncologic Interventions with TPE 4 questions
Clinical Pathology > Therapeutic plasma exchange > Oncologic Interventions with TPE
Clinical Pathology > Therapeutic plasma exchange > Renal Applications of TPE 3 questions
Clinical Pathology > Therapeutic plasma exchange > Renal Applications of TPE
Clinical Pathology > Therapeutic plasma exchange > TPE Innovations and Research 8 questions
Clinical Pathology > Therapeutic plasma exchange > TPE Innovations and Research
Critical Care Medicine > Cardiovascular Support Strategies 1 questions
Critical Care Medicine > Cardiovascular Support Strategies
Cystic Kidney Lesions in Glomerulonephritis 2 questions
Cystic Kidney Lesions in Glomerulonephritis
Endocrinology > Pituitary Gland Disorders 5 questions
Endocrinology > Pituitary Gland Disorders
Imaging in Cystic vs Malignant Lesions 1 questions
Imaging in Cystic vs Malignant Lesions
Immunology 4 questions
Immunology
Internal Medicine 18 questions
Internal Medicine
Nephrology > Dialysis Management 5 questions
Nephrology > Dialysis Management
Nephrology > Glomerulonephritis 1 questions
Nephrology > Glomerulonephritis
Nephrology > Glomerulonephritis > Amyloid-Related GN 4 questions
Nephrology > Glomerulonephritis > Amyloid-Related GN
Nephrology > Glomerulonephritis > Autoimmune Connective Tissue GN 7 questions
Nephrology > Glomerulonephritis > Autoimmune Connective Tissue GN
Nephrology > Glomerulonephritis > Autoimmune-Triggered Crescentic GN 2 questions
Nephrology > Glomerulonephritis > Autoimmune-Triggered Crescentic GN
Nephrology > Glomerulonephritis > Bacterial Infection GN 7 questions
Nephrology > Glomerulonephritis > Bacterial Infection GN
Nephrology > Glomerulonephritis > Chronic Membranoproliferative GN 1 questions
Nephrology > Glomerulonephritis > Chronic Membranoproliferative GN
Nephrology > Glomerulonephritis > Chronic Sclerosing Glomerulonephritis 5 questions
Nephrology > Glomerulonephritis > Chronic Sclerosing Glomerulonephritis
Nephrology > Glomerulonephritis > Complement-Mediated GN 1 questions
Nephrology > Glomerulonephritis > Complement-Mediated GN
Nephrology > Glomerulonephritis > Cryoglobulinemic Glomerulonephritis 14 questions
Nephrology > Glomerulonephritis > Cryoglobulinemic Glomerulonephritis
Nephrology > Glomerulonephritis > Drug Toxicity GN 1 questions
Nephrology > Glomerulonephritis > Drug Toxicity GN
Nephrology > Glomerulonephritis > Eosinophilic GN 2 questions
Nephrology > Glomerulonephritis > Eosinophilic GN
Nephrology > Glomerulonephritis > Fabry Disease Nephropathy 1 questions
Nephrology > Glomerulonephritis > Fabry Disease Nephropathy
Nephrology > Glomerulonephritis > Fibrocellular Glomerular Disease 2 questions
Nephrology > Glomerulonephritis > Fibrocellular Glomerular Disease
Nephrology > Glomerulonephritis > Glomerular Hypercellularity Disorders 2 questions
Nephrology > Glomerulonephritis > Glomerular Hypercellularity Disorders
Nephrology > Glomerulonephritis > HIV-Associated Nephropathy 5 questions
Nephrology > Glomerulonephritis > HIV-Associated Nephropathy
Nephrology > Glomerulonephritis > Hematological Disorder GN 16 questions
Nephrology > Glomerulonephritis > Hematological Disorder GN
Nephrology > Glomerulonephritis > Henoch-Schönlein Purpura Nephritis 11 questions
Nephrology > Glomerulonephritis > Henoch-Schönlein Purpura Nephritis
Nephrology > Glomerulonephritis > Hepatitis C-Related GN 2 questions
Nephrology > Glomerulonephritis > Hepatitis C-Related GN
Nephrology > Glomerulonephritis > Hypertensive GN 5 questions
Nephrology > Glomerulonephritis > Hypertensive GN
Nephrology > Glomerulonephritis > IgA Nephropathy 11 questions
Nephrology > Glomerulonephritis > IgA Nephropathy
Nephrology > Glomerulonephritis > IgM Nephropathy 3 questions
Nephrology > Glomerulonephritis > IgM Nephropathy
Nephrology > Glomerulonephritis > Infection-Triggered Glomerulonephritis 2 questions
Nephrology > Glomerulonephritis > Infection-Triggered Glomerulonephritis
Nephrology > Glomerulonephritis > Infective Endocarditis-Associated GN 4 questions
Nephrology > Glomerulonephritis > Infective Endocarditis-Associated GN
Nephrology > Glomerulonephritis > Ion Channel Disorder GN 2 questions
Nephrology > Glomerulonephritis > Ion Channel Disorder GN
Nephrology > Glomerulonephritis > Ischemia-Induced GN 4 questions
Nephrology > Glomerulonephritis > Ischemia-Induced GN
Nephrology > Glomerulonephritis > Light Chain Deposition Disease 2 questions
Nephrology > Glomerulonephritis > Light Chain Deposition Disease
Nephrology > Glomerulonephritis > Lupus Nephritis 29 questions
Nephrology > Glomerulonephritis > Lupus Nephritis
Nephrology > Glomerulonephritis > Metabolic Syndrome GN 2 questions
Nephrology > Glomerulonephritis > Metabolic Syndrome GN
Nephrology > Glomerulonephritis > Minimal Change Disease 1 questions
Nephrology > Glomerulonephritis > Minimal Change Disease
Nephrology > Glomerulonephritis > Myeloma-Associated GN 28 questions
Nephrology > Glomerulonephritis > Myeloma-Associated GN
Nephrology > Glomerulonephritis > Obesity-Associated GN 4 questions
Nephrology > Glomerulonephritis > Obesity-Associated GN
Nephrology > Glomerulonephritis > Occupational Exposure GN 2 questions
Nephrology > Glomerulonephritis > Occupational Exposure GN
Nephrology > Glomerulonephritis > Paraneoplastic GN 5 questions
Nephrology > Glomerulonephritis > Paraneoplastic GN
Nephrology > Glomerulonephritis > Parasitic Infection GN 63 questions
Nephrology > Glomerulonephritis > Parasitic Infection GN
Nephrology > Glomerulonephritis > Pauci-Immune Glomerulonephritis 1 questions
Nephrology > Glomerulonephritis > Pauci-Immune Glomerulonephritis
Nephrology > Glomerulonephritis > Post-Infectious Glomerulonephritis 16 questions
Nephrology > Glomerulonephritis > Post-Infectious Glomerulonephritis
Nephrology > Glomerulonephritis > Pregnancy-Related GN 2 questions
Nephrology > Glomerulonephritis > Pregnancy-Related GN
Nephrology > Glomerulonephritis > Radiation-Induced GN 2 questions
Nephrology > Glomerulonephritis > Radiation-Induced GN
Nephrology > Glomerulonephritis > Rapidly Progressive Glomerulonephritis 9 questions
Nephrology > Glomerulonephritis > Rapidly Progressive Glomerulonephritis
Nephrology > Glomerulonephritis > Renal Parenchymal Infiltration GN 3 questions
Nephrology > Glomerulonephritis > Renal Parenchymal Infiltration GN
Nephrology > Glomerulonephritis > Secondary Glomerulonephritis 5 questions
Nephrology > Glomerulonephritis > Secondary Glomerulonephritis
Nephrology > Glomerulonephritis > Sports Supplement-Induced GN 3 questions
Nephrology > Glomerulonephritis > Sports Supplement-Induced GN
Nephrology > Glomerulonephritis > Systemic Vasculitis GN 11 questions
Nephrology > Glomerulonephritis > Systemic Vasculitis GN
Nephrology > Glomerulonephritis > Transplant-Related GN 1 questions
Nephrology > Glomerulonephritis > Transplant-Related GN
Nephrology > Glomerulonephritis > Vascular Injury GN 1 questions
Nephrology > Glomerulonephritis > Vascular Injury GN
Nephrology > Hydronephrosis and Obstruction 1 questions
Nephrology > Hydronephrosis and Obstruction
Nephrology > Hydronephrosis and Obstruction > Hydronephrosis in Tumor-Induced Obstruction 3 questions
Nephrology > Hydronephrosis and Obstruction > Hydronephrosis in Tumor-Induced Obstruction
Nephrology > Hypertension 7 questions
Nephrology > Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes 4 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Acromegaly-Associated Hypertension 6 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Acromegaly-Associated Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Adrenal Hyperplasia Hypertension 5 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Adrenal Hyperplasia Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Cushing's Syndrome Hypertension 66 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Cushing's Syndrome Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Hyperparathyroidism Hypertension 8 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Hyperparathyroidism Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes > PCOS and Hypertension 6 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > PCOS and Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Primary Hyperaldosteronism 11 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Primary Hyperaldosteronism
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Reninoma Hypertension 2 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Reninoma Hypertension
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Thyroid-Related Hypertension 4 questions
Nephrology > Hypertension > Endocrine Hypertension Syndromes > Thyroid-Related Hypertension
Nephrology > Hypertension > Hypertension Clinical Trials 4 questions
Nephrology > Hypertension > Hypertension Clinical Trials
Nephrology > Hypertension > Hypertension Complications 10 questions
Nephrology > Hypertension > Hypertension Complications
Nephrology > Hypertension > Hypertension Epidemiology Trends 3 questions
Nephrology > Hypertension > Hypertension Epidemiology Trends
Nephrology > Hypertension > Hypertension Genetic Research 16 questions
Nephrology > Hypertension > Hypertension Genetic Research
Nephrology > Hypertension > Hypertension Pathophysiology Insights 4 questions
Nephrology > Hypertension > Hypertension Pathophysiology Insights
Nephrology > Hypertension > Hypertension Screening Technologies 2 questions
Nephrology > Hypertension > Hypertension Screening Technologies
Nephrology > Hypertension > Hypertension in CKD 3 questions
Nephrology > Hypertension > Hypertension in CKD
Nephrology > Hypertension > Hypertension in Elderly Populations 12 questions
Nephrology > Hypertension > Hypertension in Elderly Populations
Nephrology > Hypertension > Lifestyle Modification Strategies 4 questions
Nephrology > Hypertension > Lifestyle Modification Strategies
Nephrology > Hypertension > Malignant Hypertension Crisis 2 questions
Nephrology > Hypertension > Malignant Hypertension Crisis
Nephrology > Hypertension > Neurogenic Hypertension Mechanisms 9 questions
Nephrology > Hypertension > Neurogenic Hypertension Mechanisms
Nephrology > Hypertension > Pediatric Hypertension Management 4 questions
Nephrology > Hypertension > Pediatric Hypertension Management
Nephrology > Hypertension > Pharmacological Treatment Advances 5 questions
Nephrology > Hypertension > Pharmacological Treatment Advances
Nephrology > Hypertension > Renovascular Hypertension > Advanced Pharmacotherapy Analysis 9 questions
Nephrology > Hypertension > Renovascular Hypertension > Advanced Pharmacotherapy Analysis
Nephrology > Hypertension > Renovascular Hypertension > Antihypertensive Drug Adherence 2 questions
Nephrology > Hypertension > Renovascular Hypertension > Antihypertensive Drug Adherence
Nephrology > Hypertension > Renovascular Hypertension > Biochemical Markers Evaluation 7 questions
Nephrology > Hypertension > Renovascular Hypertension > Biochemical Markers Evaluation
Nephrology > Hypertension > Renovascular Hypertension > Diagnostic Imaging Techniques 1 questions
Nephrology > Hypertension > Renovascular Hypertension > Diagnostic Imaging Techniques
Nephrology > Hypertension > Renovascular Hypertension > Dietary and Nutritional Factors 4 questions
Nephrology > Hypertension > Renovascular Hypertension > Dietary and Nutritional Factors
Nephrology > Hypertension > Renovascular Hypertension > Elderly Patient Considerations 3 questions
Nephrology > Hypertension > Renovascular Hypertension > Elderly Patient Considerations
Nephrology > Hypertension > Renovascular Hypertension > Endovascular Treatment Options 2 questions
Nephrology > Hypertension > Renovascular Hypertension > Endovascular Treatment Options
Nephrology > Hypertension > Renovascular Hypertension > Exercise and Physical Activity 3 questions
Nephrology > Hypertension > Renovascular Hypertension > Exercise and Physical Activity
Nephrology > Hypertension > Renovascular Hypertension > Fibromuscular Dysplasia Insights 12 questions
Nephrology > Hypertension > Renovascular Hypertension > Fibromuscular Dysplasia Insights
Nephrology > Hypertension > Renovascular Hypertension > Genetic Predisposition Studies 12 questions
Nephrology > Hypertension > Renovascular Hypertension > Genetic Predisposition Studies
Nephrology > Hypertension > Renovascular Hypertension > Hormonal Modulation Influence 1 questions
Nephrology > Hypertension > Renovascular Hypertension > Hormonal Modulation Influence
Nephrology > Hypertension > Renovascular Hypertension > Interventional Radiology Advances 2 questions
Nephrology > Hypertension > Renovascular Hypertension > Interventional Radiology Advances
Nephrology > Hypertension > Renovascular Hypertension > Lifestyle Intervention Outcomes 10 questions
Nephrology > Hypertension > Renovascular Hypertension > Lifestyle Intervention Outcomes
Nephrology > Hypertension > Renovascular Hypertension > Longitudinal Patient Studies 8 questions
Nephrology > Hypertension > Renovascular Hypertension > Longitudinal Patient Studies
Nephrology > Hypertension > Renovascular Hypertension > Medical Management Strategies 6 questions
Nephrology > Hypertension > Renovascular Hypertension > Medical Management Strategies
Nephrology > Hypertension > Renovascular Hypertension > Microvascular Complications 5 questions
Nephrology > Hypertension > Renovascular Hypertension > Microvascular Complications
Nephrology > Hypertension > Renovascular Hypertension > Pediatric Renovascular Hypertension 4 questions
Nephrology > Hypertension > Renovascular Hypertension > Pediatric Renovascular Hypertension
Nephrology > Hypertension > Renovascular Hypertension > Peripheral Vascular Implications 4 questions
Nephrology > Hypertension > Renovascular Hypertension > Peripheral Vascular Implications
Nephrology > Hypertension > Renovascular Hypertension > Pharmacokinetic Considerations 4 questions
Nephrology > Hypertension > Renovascular Hypertension > Pharmacokinetic Considerations
Nephrology > Hypertension > Renovascular Hypertension > Pregnancy-Related Considerations 4 questions
Nephrology > Hypertension > Renovascular Hypertension > Pregnancy-Related Considerations
Nephrology > Hypertension > Renovascular Hypertension > Research and Innovations 11 questions
Nephrology > Hypertension > Renovascular Hypertension > Research and Innovations
Nephrology > Hypertension > Renovascular Hypertension > Resistant Hypertension Challenges 8 questions
Nephrology > Hypertension > Renovascular Hypertension > Resistant Hypertension Challenges
Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 175 questions
Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment
Nephrology > Hypertension > Renovascular Hypertension > Stress and Psychosocial Factors 2 questions
Nephrology > Hypertension > Renovascular Hypertension > Stress and Psychosocial Factors
Nephrology > Hypertension > Renovascular Hypertension > Surgical Interventions 7 questions
Nephrology > Hypertension > Renovascular Hypertension > Surgical Interventions
Nephrology > Hypertension > Renovascular Hypertension > Technological Diagnostic Advances 2 questions
Nephrology > Hypertension > Renovascular Hypertension > Technological Diagnostic Advances
Nephrology > Hypertension > Resistant Hypertension Treatment 6 questions
Nephrology > Hypertension > Resistant Hypertension Treatment
Nephrology > Hypertension > Salt Sensitivity Studies 5 questions
Nephrology > Hypertension > Salt Sensitivity Studies
Nephrology > Lifestyle and Renal Health 11 questions
Nephrology > Lifestyle and Renal Health
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Diagnostic Imaging in MGRS 15 questions
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Diagnostic Imaging in MGRS
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 80 questions
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Genetics and MGRS 2 questions
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Genetics and MGRS
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > MGRS-Associated Renal Diseases 8 questions
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > MGRS-Associated Renal Diseases
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Pathophysiology MGRS 10 questions
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Pathophysiology MGRS
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Risk Stratification MGRS 2 questions
Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Risk Stratification MGRS
Nephrology > Nephrology Imaging > Advanced Imaging Techniques for Renal Lesions > 3D Imaging in Kidney Lesion Assessment 5 questions
Nephrology > Nephrology Imaging > Advanced Imaging Techniques for Renal Lesions > 3D Imaging in Kidney Lesion Assessment
Nephrology > Nephrology Imaging > CT Imaging in Kidney Lesions 5 questions
Nephrology > Nephrology Imaging > CT Imaging in Kidney Lesions
Nephrology > Nephrology Imaging > CT Imaging in Kidney Lesions > CT in Differentiating Malignant from Benign Kidney Lesions 6 questions
Nephrology > Nephrology Imaging > CT Imaging in Kidney Lesions > CT in Differentiating Malignant from Benign Kidney Lesions
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Advancements in Renal Tumor Contrast Imaging 10 questions
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Advancements in Renal Tumor Contrast Imaging
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation 8 questions
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation > Contrast-Enhanced Ultrasound Techniques 26 questions
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation > Contrast-Enhanced Ultrasound Techniques
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Ultrasound Criteria for Kidney Lesion Differentiation 1 questions
Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Ultrasound Criteria for Kidney Lesion Differentiation
Nephrology > Nephrology Imaging > Iodinated contrast 2 questions
Nephrology > Nephrology Imaging > Iodinated contrast
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Acute Kidney Injury Monitoring 6 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Acute Kidney Injury Monitoring
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Congenital Anomaly Detection 8 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Congenital Anomaly Detection
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Infective Lesion Identification 8 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Infective Lesion Identification
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Lymphoma Lesions Evaluation 4 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Lymphoma Lesions Evaluation
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Renal Stone Identification 22 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Renal Stone Identification
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Solid Mass Detection 5 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Solid Mass Detection
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Traumatic Injury Assessment 3 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Traumatic Injury Assessment
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Tumor Infiltration Analysis 5 questions
Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Tumor Infiltration Analysis
Nephrology > Nephrology Imaging > MRI Advances in Renal Lesion Evaluation > Functional MRI Techniques for Renal Lesion Evaluation 3 questions
Nephrology > Nephrology Imaging > MRI Advances in Renal Lesion Evaluation > Functional MRI Techniques for Renal Lesion Evaluation
Nephrology > Nephrology Surgery 3 questions
Nephrology > Nephrology Surgery
Nephrology > Proteinuria Studies 9 questions
Nephrology > Proteinuria Studies
Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Endocrine Hypertension Syndromes > Pheochromocytoma Hypertension 9 questions
Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Endocrine Hypertension Syndromes > Pheochromocytoma Hypertension
Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Renovascular Hypertension and Kidney Artery Disorders > Pathophysiological Mechanisms Exploration 15 questions
Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Renovascular Hypertension and Kidney Artery Disorders > Pathophysiological Mechanisms Exploration
Pharmacology 14 questions
Pharmacology
Pharmacology > Dermatological Pharmacology 2 questions
Pharmacology > Dermatological Pharmacology
Pharmacology > Neuropharmacology 1 questions
Pharmacology > Neuropharmacology
Pharmacology > Psychopharmacology 10 questions
Pharmacology > Psychopharmacology
Physiology > Cutaneous Physiology 4 questions
Physiology > Cutaneous Physiology
Physiology > Endocrine Physiology 5 questions
Physiology > Endocrine Physiology
Physiology > Endometrial Physiology 6 questions
Physiology > Endometrial Physiology
Physiology > Fetal Physiology 5 questions
Physiology > Fetal Physiology
Physiology > Lymphatic Physiology 3 questions
Physiology > Lymphatic Physiology
Physiology > Muscle Physiology 8 questions
Physiology > Muscle Physiology
Physiology > Reproductive Physiology 2 questions
Physiology > Reproductive Physiology
Physiology > Vascular Physiology 1 questions
Physiology > Vascular Physiology
Psychiatry > Adult Psychiatry > Mood Disorders 2 questions
Psychiatry > Adult Psychiatry > Mood Disorders
Psychiatry > Adult Psychiatry > Mood Disorders > Persistent Depressive Disorder 4 questions
Psychiatry > Adult Psychiatry > Mood Disorders > Persistent Depressive Disorder
Psychiatry > Adult Psychiatry > Mood Disorders > Postpartum Depression 9 questions
Psychiatry > Adult Psychiatry > Mood Disorders > Postpartum Depression
Psychiatry > Geriatric Psychiatry 61 questions
Psychiatry > Geriatric Psychiatry
Toxicology > Analytical Toxicology 9 questions
Toxicology > Analytical Toxicology
Toxicology > Clinical Toxicology 9 questions
Toxicology > Clinical Toxicology
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Toxicology > Forensic Toxicology

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Sample Medical Questions

Explore 400 example questions from our comprehensive database of 3630+ medical questions:

A 48-year-old man with biopsy-proven Takayasu arteritis (aortic involvement treated with prior glucocorticoids and tocilizumab, now off therapy for 8 months) an...
A. Anterior tarsal tunn...
B. Common fibular (pero...
C. L5 radiculopathy fro...
D. Posterior tarsal tun...
Type: diagnosis Difficulty: expert Category: Unknown 📷 Includes Image
A 50-year-old man with a history of hypertension, hyperlipidemia, and polymyalgia rheumatica treated with low-dose prednisone is brought to the emergency depart...
A. 70 percent or greate...
B. 50 to 69 percent sym...
C. 30 to 49 percent sym...
D. Less than 30 percent...
Type: clinical_trials Difficulty: easy Category: Unknown 📷 Includes Image
A 50-year-old woman comes to urgent care for abrupt left-sided flank pain that began 2 hours ago while she was preparing dinner. The pain is colicky, makes her ...
A. Distal ureter adjace...
B. Ureteropelvic juncti...
C. Mid-ureter at the pe...
D. Minor calyx within a...
Type: differential_physical_history Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old man presents to the medical ICU with abrupt hemoptysis, dark cola-colored urine, pleuritic chest discomfort, and rapidly progressive fatigue over ...
A. Deferring therapeuti...
B. Starting therapeutic...
C. Initiating daily pla...
D. Heparinizing for pre...
Type: clinical_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
A tertiary pediatric nephrology case conference reviews four biopsy-proven cases of primary IgA nephropathy in 5-year-old boys referred from different regional ...
A. Patient C, given sus...
B. Patient B, because m...
C. Patient D, because i...
D. Patient A, because r...
Type: differential_comprehensive Difficulty: expert Category: Unknown 📷 Includes Image
A 37-year-old woman comes to clinic because of a year of daily cough that is worse at work and improves on weekends. She works in food service in a downtown res...
A. Explain that office ...
B. Reassure that a norm...
C. Order an immediate b...
D. Send for CT of the c...
Type: patient_communication Difficulty: easy Category: Unknown 📷 Includes Image
A 50-year-old woman presents with 3 days of fever to 38.0 °C, diffuse skin pain, and rapidly worsening blisters after starting trimethoprim–sulfamethoxazole for...
A. Toxic epidermal necr...
B. Staphylococcal scald...
C. Pemphigus vulgaris w...
D. Acute generalized ex...
Type: diagnosis Difficulty: expert Category: Unknown 📷 Includes Image
A 37-year-old transgender man (assigned female at birth; prior ectopic pregnancy) is brought to the ED by EMS for abrupt, tearing retrosternal pain radiating to...
A. Abrupt, maximal ches...
B. Sharp, pleuritic pai...
C. Sudden unilateral pl...
D. Crushing substernal ...
Type: differential_physical_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 57-year-old woman presents to a cornea/refractive clinic for a routine consultation because progressive myopia and astigmatism impair classroom whiteboard wor...
A. Laser-assisted in si...
B. Epithelium-off corne...
C. Prospectively protoc...
D. Posterior chamber ph...
Type: contraindications Difficulty: expert Category: Unknown 📷 Includes Image
A 37-year-old woman presents to a storm-isolated rural urgent care on a night shift with pleuritic chest pain and dyspnea that began 4 hours ago while working a...
A. Defer iodinated-cont...
B. Proceed with iodinat...
C. Proceed with iodinat...
D. Switch to gadolinium...
Type: contraindications Difficulty: expert Category: Unknown 📷 Includes Image
A 57-year-old African-American woman is evaluated in the nephrology clinic after a routine screening urinalysis obtained by her primary-care clinician showed ne...
A. Ultrasound-guided pe...
B. Transjugular native ...
C. Ultrasound-guided pe...
D. CT-guided percutaneo...
Type: diagnostic_step Difficulty: expert Category: Unknown 📷 Includes Image
A 103-year-old man is brought to the emergency department from a skilled nursing facility for sudden confusion before breakfast. Staff report he received his us...
A. Give 25 g IV dextros...
B. Give 1 mg intramuscu...
C. Start insulin glargi...
D. Observe without trea...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 42-year-old gravida 2 para 1 at 28 weeks’ gestation presents to a combined maternal–fetal medicine and nephrology clinic for severe, persistent hypertension d...
A. Gradual ipsilateral ...
B. Stabilization of kid...
C. Rapid normalization ...
D. High likelihood of m...
Type: natural_history Difficulty: expert Category: Unknown 📷 Includes Image
A 5-year-old boy is admitted to a general pediatric ward in a U.S. community hospital for progressive edema and dark, foamy urine noted by his parents over 3 we...
A. Uncorrected coagulop...
B. Solitary native kidn...
C. Controlled blood pre...
D. NSAID exposure 48 ho...
Type: contraindications Difficulty: hard Category: Unknown 📷 Includes Image
Morning huddle on apheresis rounds: Three patients are scheduled today for albumin-based therapeutic plasma exchange as an adjunct in severe autoimmune blisteri...
A. Begin preventive cal...
B. Give diphenhydramine...
C. Avoid anticoagulatio...
D. Start prednisone 0.5...
Type: prevention Difficulty: easy Category: Unknown 📷 Includes Image
A 79-year-old woman is brought to the emergency department for sudden shortness of breath that began 2 hours ago. She has had poorly controlled blood pressure f...
A. Significant bilatera...
B. Unilateral renal art...
C. Primary hyperaldoste...
D. Pheochromocytoma cau...
Type: diagnostic_failure Difficulty: easy Category: Unknown
A 50-year-old man with stage 3 chronic kidney disease presents with several weeks of postprandial epigastric discomfort and intermittent black stools. Medicatio...
A. NSAID-induced gastri...
B. H. pylori pangastrit...
C. Functional dyspepsia...
D. Zollinger–Ellison sy...
Type: diagnosis Difficulty: moderate Category: Unknown 📷 Includes Image
A 45‑year‑old man with a history of antithrombin III deficiency presents with sudden palpitations and anxiety that began 30 minutes ago while at work. He exerci...
A. Repeat adenosine at ...
B. Begin amiodarone 150...
C. Administer metoprolo...
D. Proceed to immediate...
Type: treatment_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 26-year-old woman with metabolic syndrome and ulcerative colitis in remission presents with 15 months of steadily rising albuminuria. She smokes about 1 pack ...
A. Conspicuous glomerul...
B. Perihilar FSGS with ...
C. FSGS, not otherwise ...
D. Glomerulomegaly with...
Type: features Difficulty: expert Category: Unknown 📷 Includes Image
A 33-year-old Army veteran presents to an outpatient nephrology clinic after employer screening revealed persistent microscopic hematuria and variable proteinur...
A. Initiating disease‑s...
B. Relying on circulati...
C. Deferring any biopsy...
D. Assuming post‑exerci...
Type: clinical_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 37‑year‑old man comes to the emergency department with 24 hours of large‑volume, watery diarrhea occurring hourly, including at night, with lightheadedness an...
A. Non–anion gap metabo...
B. Metabolic alkalosis ...
C. High anion gap metab...
D. Profound hyperkalemi...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 51-year-old woman is brought to the ED after coughing up large volumes of bright‑red blood at home. She is pale but alert, with blood‑streaked sputum on arriv...
A. Secure the airway wi...
B. Obtain contrast-enha...
C. Insert a thoracostom...
D. Catheterize the pulm...
Type: treatment Difficulty: expert Category: Unknown 📷 Includes Image
A 36-year-old man with vitiligo, remote paroxysmal nocturnal hemoglobinuria requiring transfusions years ago (currently quiescent), iron deficiency anemia, prio...
A. Administer intraveno...
B. Restart targeted‑rel...
C. Stop losartan now an...
D. Begin emergent thera...
Type: treatment_failure Difficulty: expert Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 60‑year‑old man is admitted with 3 days of bruising, dark urine, and brief trouble finding words. He has hypothyroidism on levothyroxine 100 µg daily, remote ...
A. Faster normalization...
B. Faster platelet reco...
C. A large reduction in...
D. Prevention of congen...
Type: clinical_trials Difficulty: moderate Category: Unknown 📷 Includes Image
A 39‑year‑old man is undergoing a planned laparoscopic cholecystectomy for recurrent biliary pain with gallstones seen on ultrasound. He has a history of a pitu...
A. Transecting or clipp...
B. Using the infundibul...
C. Performing a fundus‑...
D. Obtaining an intraop...
Type: contraindications Difficulty: easy Category: Unknown 📷 Includes Image
A 26-year-old man is brought to the emergency department by a coworker for two days of nausea, generalized pruritus, and reduced urine output with dark specks. ...
A. Start oral prednison...
B. Initiate oral predni...
C. Administer intraveno...
D. Continue strict culp...
Type: clinical_pitfalls Difficulty: expert Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 50-year-old woman presents with worsening shortness of breath and wheeze over 2 days. She is unemployed and has a complex tobacco history: quit 1 year ago aft...
A. Perform endotracheal...
B. Continue NIV unchang...
C. Administer only addi...
D. Switch to high‑flow ...
Type: treatment_failure Difficulty: moderate Category: Unknown 📷 Includes Image
A 35-year-old woman presents to a rural urgent care with severe dyspnea and pleuritic chest tightness that worsened over 12 hours while working a double shift i...
A. Begin oral prednison...
B. Start oral prednison...
C. Initiate oral predni...
D. Start oral prednison...
Type: treatment Difficulty: expert Category: Unknown 📷 Includes Image
During a busy afternoon in the paediatric hypertension clinic you evaluate two patients. Patient A is a 14-year-old girl with isolated systolic hypertension an...
A. “Several tests can m...
B. “Catheter angiograph...
C. “CT angiography is b...
D. “An MR angiogram is ...
Type: patient_communication Difficulty: hard Category: Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation > Contrast-Enhanced Ultrasound Techniques 📷 Includes Image
A 41-year-old man presents with persistent right foot weakness and tripping 6 weeks after an inversion ankle sprain sustained while jogging. He has a history of...
A. Suspect common peron...
B. Increase lumbar phys...
C. Start high‑dose oral...
D. Arrange urgent lumba...
Type: treatment_failure Difficulty: easy Category: Unknown 📷 Includes Image
An 81-year-old man is brought to the emergency department 20 minutes after abrupt pleuritic chest pain, presyncope, and new shortness of breath that began while...
A. Administer systemic ...
B. Begin unffractionate...
C. Give intravenous opi...
D. Start high-dose vaso...
Type: emergency_priorities Difficulty: moderate Category: Unknown 📷 Includes Image
A 22-year-old man with rheumatoid arthritis presents with sudden right-sided pleuritic chest pain and dyspnea while lifting boxes. He is tall and slender. Vital...
A. Avoid noninvasive po...
B. Initiate continuous ...
C. Provide high‑flow ox...
D. Administer an inhale...
Type: contraindications Difficulty: easy Category: Unknown 📷 Includes Image
A 23-year-old woman is brought to the emergency department after 24 hours of relentless vomiting, dizziness when standing, and diffuse abdominal cramping. She r...
A. Give hydrocortisone ...
B. Administer dexametha...
C. Begin oral hydrocort...
D. Hold all glucocortic...
Type: recent_changes Difficulty: moderate Category: Unknown 📷 Includes Image
A 34‑year‑old woman presents for chronic anterior knee pain that worsens after prolonged sitting and when walking down stairs. She denies fever, locking, or nig...
A. Ordering a knee MRI ...
B. Recommending a struc...
C. Using a short trial ...
D. Discussing weight lo...
Type: clinical_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 33-year-old man with a prior biopsy diagnosis of primary focal segmental glomerulosclerosis presents to the emergency department with swelling that has worsen...
A. Enoxaparin 40 mg sub...
B. Enoxaparin 30 mg sub...
C. Unfractionated hepar...
D. Withhold any anticoa...
Type: prevention Difficulty: hard Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 44-year-old woman with chronic otitis media presents to the emergency department with 2 days of polyuria, polydipsia, diffuse abdominal pain, and progressive ...
A. Begin resuscitation ...
B. Administer two liter...
C. Start a fixed-rate i...
D. Admit to the intensi...
Type: recent_changes Difficulty: moderate Category: Unknown 📷 Includes Image
A 55-year-old retired man presents to urgent care with 2 days of dark red urine that started the day after a sore throat and fever. He reports palpitations yest...
A. Circulating galactos...
B. Classical complement...
C. Linear anti–glomerul...
D. Pauci-immune ANCA-as...
Type: differential_comprehensive Difficulty: moderate Category: Unknown 📷 Includes Image
A 97-year-old man presents to the ED with sudden right‑sided pleuritic chest pain and breathlessness after a coughing fit. He has nephrolithiasis and a history ...
A. We place the tube on...
B. We put the tube at t...
C. We insert it below t...
D. We use a large troca...
Type: patient_communication Difficulty: easy Category: Unknown 📷 Includes Image
A 65-year-old man who works in food service presents with numbness and tingling of the right hand for 2 months. He notices difficulty opening jars and fine moto...
A. Ulnar nerve compress...
B. Ulnar neuropathy at ...
C. C8–T1 radiculopathy ...
D. Median nerve entrapm...
Type: differential_comprehensive Difficulty: easy Category: Unknown 📷 Includes Image
An 88-year-old man with biopsy-proven primary IgA nephropathy returns after 12 months of optimized supportive therapy. Past medical history includes seropositiv...
A. Add iptacopan (Fabha...
B. Switch ACE inhibitor...
C. Repeat targeted-rele...
D. Initiate oral cyclop...
Type: treatment_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 32-year-old woman is brought to the emergency department after a high-speed motor vehicle collision with dashboard impact to the right knee and a brief loss o...
A. Common fibular (pero...
B. Tibial nerve, typica...
C. Femoral nerve, more ...
D. Sural nerve, a cutan...
Type: epidemiology Difficulty: moderate Category: Unknown 📷 Includes Image
A 29-year-old warehouse worker presents to a community clinic on a winter evening with crushing forearm pain two hours after his nondominant left arm was trappe...
A. Perform emergent dec...
B. Measure compartment ...
C. Elevate the limb abo...
D. Obtain MRI of the fo...
Type: emergency_priorities Difficulty: easy Category: Unknown 📷 Includes Image
A 26-year-old woman (5 ft 5 in, 60 kg) with perinatally acquired HIV on bictegravir/emtricitabine/tenofovir alafenamide and portopulmonary hypertension on silde...
A. Discontinue piperaci...
B. Discontinue piperaci...
C. Discontinue piperaci...
D. Switch empiric wound...
Type: emergency_priorities Difficulty: hard Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 78-year-old transgender man (assigned female at birth, cervix intact) with long-standing cirrhosis presents for discussion of cancer risk and surveillance pri...
A. Beginning in the dir...
B. HCV‑related HCC has ...
C. Since 2015, HBV‑rela...
D. Apparent MASLD/NAFLD...
Type: epidemiology Difficulty: expert Category: Unknown 📷 Includes Image
A 52-year-old man is brought to the emergency department 1 hour after abruptly awakening from sleep with severe dyspnea. Three similar episodes over the precedi...
A. Percutaneous translu...
B. Addition of spironol...
C. Open surgical aortor...
D. Elective nephrectomy...
Type: treatment Difficulty: hard Category: Nephrology > Glomerulonephritis > IgA Nephropathy 📷 Includes Image
A 24-year-old man of East Asian ancestry is transferred to a regional burn/ICU for rapidly progressive mucocutaneous disease that began 48 hours after a week of...
A. Institute permanent ...
B. Avoid only carbamaze...
C. Avoid carbamazepine ...
D. Use a stratified re‑...
Type: prevention Difficulty: hard Category: Unknown 📷 Includes Image
A 49-year-old woman arrives at the emergency department complaining of 36 hours of marked fatigue, dizziness, and scant urine output. Four days ago her new prim...
A. Adding an angiotensi...
B. Continuing the newly...
C. Failing to discontin...
D. Performing captopril...
Type: clinical_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
Four patients are seen in a tertiary endocrine clinic on the same day. All have recent ultrasound of the thyroid and cytology or histology, along with other inv...
A. The patient whose th...
B. The patient whose fi...
C. The patient whose lo...
D. The patient with a h...
Type: pathology Difficulty: hard Category: Unknown 📷 Includes Image
A 49‑year‑old man presents with a longitudinally expanding brown‑black streak under the right great toenail for 9 months. He first noticed it after a trail‑runn...
A. Subungual melanoma (...
B. Chronic subungual he...
C. Long‑standing acral ...
D. Onychomycosis causin...
Type: differential_comprehensive Difficulty: hard Category: Unknown 📷 Includes Image
A 34-year-old woman reports 3 months of exertional chest tightness and two near-syncope episodes while carrying drywall at her construction job. She denies alco...
A. Prospective ECG‑gate...
B. Free‑breathing whole...
C. Non‑ECG‑gated high‑p...
D. Prospective ECG‑gate...
Type: diagnostic_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 27-year-old graduate student with relapsing polychondritis and keratoconus presents with 3 days of diplopia, dysphagia, nasal speech, dyspnea when supine, and...
A. Initiate therapeutic...
B. Initiate therapeutic...
C. Administer eculizuma...
D. Repeat a complete 5‑...
Type: treatment_failure Difficulty: hard Category: Unknown 📷 Includes Image
A 50-year-old retired man presents with 4 months of deep aching pain in the groin and medial thigh radiating toward the knee, worse when walking downstairs and ...
A. Obturator nerve entr...
B. Femoral neuropathy i...
C. Lateral femoral cuta...
D. Sciatic nerve compre...
Type: differential_comprehensive Difficulty: easy Category: Unknown 📷 Includes Image
During a mid‑January blizzard, the state patrol closes both mountain passes and grounds rotary and fixed‑wing transport for 12–18 hours across a sparsely served...
A. Define the primary o...
B. Use patient‑level GE...
C. Select time‑to‑first...
D. Adopt a clinic‑level...
Type: clinical_trials Difficulty: expert Category: Unknown 📷 Includes Image
A 29-year-old woman presents to a primary care clinic with 6 weeks of progressive bilateral leg swelling, increasingly foamy urine, and morning periorbital puff...
A. Primary focal segmen...
B. Primary focal segmen...
C. Minimal change disea...
D. Membranous nephropat...
Type: diagnosis Difficulty: moderate Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 45-year-old woman employed in manufacturing reports 6 weeks of progressive headaches, subtle word‑finding pauses noticed by coworkers, and two brief episodes ...
A. Demonstration of who...
B. Demonstration of ATR...
C. Detection of focal o...
D. MGMT promoter methyl...
Type: recent_changes Difficulty: hard Category: Unknown 📷 Includes Image
A 40-year-old woman is seen in a U.S. university nephrology clinic for progressive chronic kidney disease of uncertain cause. She reports 3 months of fatigue, n...
A. “Let’s decide this t...
B. “Given hematuria and...
C. “To avoid bleeding, ...
D. “We can forgo biopsy...
Type: patient_communication Difficulty: expert Category: Unknown 📷 Includes Image
A 53-year-old man presents to the clinic with 6 weeks of a rough, weak voice and coughing when drinking thin liquids. He denies fever or chest pain. He feels wi...
A. Flexible fiberoptic ...
B. Contrast-enhanced CT...
C. Videofluoroscopic ba...
D. Serum acetylcholine ...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
An 89-year-old woman comes to clinic with her daughter for difficulty following conversations in restaurants and when the television is on. She says voices soun...
A. Loss of outer hair c...
B. Bony fixation of the...
C. Middle ear effusion ...
D. Acute loop diuretic ...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 23-year-old man is brought to the emergency department by his partner after abrupt-onset explosive holocephalic headache while gaming, followed by projectile ...
A. Defer lumbar punctur...
B. Start broad-spectrum...
C. Place an emergent lu...
D. Request intervention...
Type: legal_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 56-year-old woman receiving thrice-weekly low-flux hemodialysis for 4 years because of diabetic and hypertensive kidney disease presents to a rural dialysis o...
A. Combined oral contra...
B. Depot medroxyprogest...
C. Referral for inserti...
D. Oral medroxyprogeste...
Type: contraindications Difficulty: hard Category: Pharmacology > Psychopharmacology 📷 Includes Image
You are consulting for a city health department working with regional nephrology practices to prioritize risk-stratified surveillance for focal segmental glomer...
A. A > D > C > B.
B. D > A > C > B.
C. A > C > D > B.
D. C > A > D > B.
Type: epidemiology Difficulty: expert Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 59-year-old man is referred to an academic obesity clinic for evaluation of lifelong, severe obesity that began before kindergarten. He describes persistent, ...
A. Approximately 60%, b...
B. Approximately 55%, b...
C. Approximately 74%, b...
D. Approximately 58%, b...
Type: epidemiology Difficulty: hard Category: Unknown
A 49-year-old gravida 2 para 1 at 22 weeks’ gestation is co-managed for biopsy-proven IgA nephropathy. Comorbidities include polymyalgia rheumatica now off gluc...
A. Neutralization of AP...
B. Ligand trapping of b...
C. Oral inhibition of c...
D. Enteric targeted‑rel...
Type: mechanism Difficulty: hard Category: Unknown 📷 Includes Image
A 35-year-old woman who works as an inpatient nurse comes to the ED for sudden coughing of bright red blood that began 20 minutes ago while she was walking from...
A. Place the patient in...
B. Initiate immediate e...
C. Place the patient in...
D. Sit the patient bolt...
Type: emergency_priorities Difficulty: moderate Category: Unknown 📷 Includes Image
A 52-year-old woman is admitted to the intensive care unit with abrupt worsening of previously well-controlled hypertension. She has coronary artery disease sta...
A. Catheter-based renal...
B. Contrast-enhanced CT...
C. Repeat duplex Dopple...
D. Selective renal vein...
Type: diagnostic_step Difficulty: expert Category: Unknown 📷 Includes Image
A 27-year-old woman returns 10 days after starting outpatient therapy for suspected drug-associated tubulointerstitial nephritis. She had been taking high‑dose ...
A. Arrange an ultrasoun...
B. Increase prednisone ...
C. Start mycophenolate ...
D. Add lisinopril 10 mg...
Type: treatment_failure Difficulty: easy Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 28-year-old man is brought to the ED with fever, rigors, and hypotension after two days of dysuria and flank pain. He is retired from competitive sports and h...
A. Hours 0–6: high card...
B. Hours 0–6: low cardi...
C. Persistent high SVR ...
D. Rapid normalization ...
Type: natural_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 32-year-old G3P1 woman at 26 weeks’ gestation presents for prenatal follow‑up after a failed 1‑hour glucose screen (50‑g load 158 mg/dL) and an abnormal 3‑hou...
A. Placental human plac...
B. Primary placental gr...
C. Autoimmune β‑cell de...
D. Progesterone deficie...
Type: pathology Difficulty: moderate Category: Unknown 📷 Includes Image
A 25-year-old woman with advanced chronic kidney disease being evaluated for kidney transplantation presents to clinic for a routine check. She lives with her f...
A. Acute pyelonephritis...
B. Asymptomatic bacteri...
C. Drug-induced interst...
D. Thyroid storm explai...
Type: differential_comprehensive Difficulty: easy Category: Unknown 📷 Includes Image
A surgical quality-improvement team designs a multicenter trial to evaluate whether intermittent intraoperative neural monitoring (IONM) reduces recurrent laryn...
A. Randomize patients; ...
B. Adopt a historical c...
C. Randomize by surgeon...
D. Conduct an open-labe...
Type: clinical_trials Difficulty: moderate Category: Unknown 📷 Includes Image
A 27-year-old woman with biopsy‑proven focal segmental glomerulosclerosis diagnosed 6 weeks ago returns for follow‑up. She reports persistent leg swelling, morn...
A. Venous thromboemboli...
B. Renal vein thrombosi...
C. Ischemic arterial th...
D. Acute kidney injury ...
Type: complications Difficulty: moderate Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
During a 6-week interval, three patients with established systemic sclerosis are admitted to a tertiary nephrology service for abrupt oligo-anuric acute kidney ...
A. Anti–RNA polymerase ...
B. Anti–centromere anti...
C. Anti–topoisomerase I...
D. Anti–U1 ribonucleopr...
Type: epidemiology Difficulty: expert Category: Pharmacology 📷 Includes Image
A 38‑year‑old woman presents for evaluation of a gradually enlarging brown macule on the left malar cheek present for about 14 months. She notes slow, asymmetri...
A. Lentigo maligna mela...
B. Pigmented actinic ke...
C. Macular seborrheic k...
D. Solar lentigo with s...
Type: differential_physical_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 30-year-old man presents to the clinic with months of foreign-body sensation at the back of the tongue and intermittent dysphagia for solids. He has no dyspne...
A. Lingual thyroid ecto...
B. Thyroglossal duct cy...
C. Second branchial cle...
D. Ectopic thymus in th...
Type: differential_comprehensive Difficulty: easy Category: Unknown 📷 Includes Image
A 35-year-old woman with metabolic syndrome, seborrheic dermatitis, urticaria, Wolff–Parkinson–White syndrome (no ablation), and a known heterozygous ornithine ...
A. Plasma ammonia level...
B. Comprehensive autoim...
C. Serum lactate and py...
D. Serum copper, 24‑hou...
Type: differential_testing Difficulty: moderate Category: Unknown 📷 Includes Image
A 61-year-old man presents to the emergency department with sharp, left-sided chest pain that began 12 hours ago. The pain worsens with deep inspiration and whe...
A. Acute pericarditis c...
B. Acute ST-elevation m...
C. Pulmonary embolism p...
D. Aortic dissection wi...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 50-year-old woman with mixed connective tissue disease managed with prednisone 15 mg/day and hydroxychloroquine 200 mg twice daily, primary hypothyroidism on ...
A. Convert immediately ...
B. Continue alternate‑d...
C. Switch to selective ...
D. Stop extracorporeal ...
Type: treatment_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 55-year-old woman is hospitalized for profuse watery diarrhea occurring 10–12 times daily with cramping and lightheadedness. She completed oral vancomycin 125...
A. Add bezlotoxumab 10 ...
B. Repeat the same 10‑d...
C. Use fidaxomicin 200 ...
D. Proceed directly to ...
Type: treatment_failure Difficulty: hard Category: Unknown 📷 Includes Image
A 52-year-old man is in the PACU after elective laparoscopic inguinal hernia repair under general anesthesia with sevoflurane and a single uncomplicated intubat...
A. Admit to ICU with ar...
B. Admit to ICU for at ...
C. Admit to ICU for 36 ...
D. Admit to ICU for 48–...
Type: natural_history Difficulty: expert Category: Unknown 📷 Includes Image
An 82-year-old man is brought to a rural district hospital because of progressively difficult-to-control blood pressure during the past 8 months. He and his fam...
A. Obtain duplex Dopple...
B. Arrange immediate tr...
C. Start a low‑dose ACE...
D. Proceed directly to ...
Type: treatment Difficulty: hard Category: Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation > Contrast-Enhanced Ultrasound Techniques 📷 Includes Image
A 30-year-old transgender woman (assigned male at birth) presents with 2 days of progressive shortness of breath and new right calf pain after a 9-hour car trip...
A. Explain clearly that...
B. Say that all modern ...
C. Recommend placing an...
D. Delay any anticoagul...
Type: patient_communication Difficulty: moderate Category: Unknown 📷 Includes Image
A 56-year-old woman presents to a general neurology clinic with 36 hours of painless right foot drop that began after a 6-hour intercity bus ride during which s...
A. Preserved ankle inve...
B. Isolated great-toe e...
C. A pronounced Tinel-l...
D. Diminished medial ha...
Type: clinical_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 54-year-old woman with gastroesophageal reflux disease, secondary hyperparathyroidism, nasal polyps, prior hookworm infection, and remote coccidioidomycosis p...
A. Explain that irritat...
B. Explain that the vis...
C. Explain that the par...
D. Explain that pleurit...
Type: patient_communication Difficulty: hard Category: Unknown 📷 Includes Image
A 99‑year‑old woman living in assisted living is seen after a routine lab panel showed potassium 5.8 mmol/L (prior 4.7 mmol/L) with creatinine 1.1 mg/dL. She ha...
A. Explain that potassi...
B. Advise starting over...
C. State that diet has ...
D. Recommend immediate ...
Type: patient_communication Difficulty: easy Category: Unknown 📷 Includes Image
A 71-year-old woman on thrice‑weekly in‑center hemodialysis for diabetic kidney disease is transferred from her outpatient unit 35 minutes after treatment began...
A. Stop all ongoing tre...
B. Stop all ongoing tre...
C. At the beginning of ...
D. Manage this as a dia...
Type: diagnostic_failure Difficulty: moderate Category: Unknown 📷 Includes Image
A 34-year-old gravida 2 para 1 at 36 weeks by reliable dates collapses in the ED waiting area while accompanying a family member. She becomes unresponsive with ...
A. Perform high‑quality...
B. Use right uterine di...
C. Place a rigid wedge ...
D. Keep the patient sup...
Type: clinical_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 29-year-old woman with a history of rheumatic heart disease and ulcerative colitis is brought to the emergency department for high fever and weakness. She dri...
A. Perform bedside tran...
B. Repeat troponin test...
C. Order a gallium scan...
D. Schedule outpatient ...
Type: diagnostic_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 33‑year‑old primigravid woman at 22 weeks’ gestation is co‑managed by maternal–fetal medicine and nephrology for increasing proteinuria. Eighteen months befor...
A. Defer disease‑modify...
B. Initiate a dual endo...
C. Start an SGLT2 inhib...
D. Begin targeted‑relea...
Type: clinical_trials Difficulty: expert Category: Unknown 📷 Includes Image
A 34-year-old man presents to urgent care with palpitations and lightheadedness after drinking strong coffee. He has ulcerative colitis in clinical remission, a...
A. Carotid sinus massag...
B. Carotid sinus massag...
C. A modified Valsalva ...
D. Intravenous adenosin...
Type: contraindications Difficulty: moderate Category: Unknown 📷 Includes Image
A 97-year-old man comes to the emergency department with two days of more shortness of breath and cough. He lives at home and usually walks with a cane. His dau...
A. Provide a qualified ...
B. Use the daughter as ...
C. Assume that hearing ...
D. Delay all care until...
Type: legal_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 55-year-old woman is 36 hours after an uncomplicated laparoscopic cholecystectomy for biliary colic. She has idiopathic pulmonary fibrosis treated with pirfen...
A. A small accessory su...
B. A dehisced cystic du...
C. A partial common hep...
D. Ischemic necrosis of...
Type: treatment_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 27-year-old man who works in food service presents with nocturnal numbness and tingling in the thumb, index, and middle fingers of his dominant hand that bega...
A. Use the CTS‑6 clinic...
B. Obtain EMG/NCS in al...
C. Recommend routine po...
D. Prefer corticosteroi...
Type: recent_changes Difficulty: easy Category: Unknown 📷 Includes Image
A 25-year-old man who works in a metal fabrication plant is brought to the urgent care after twisting his right leg while stepping off a low platform at work an...
A. Common peroneal neur...
B. Sciatic nerve transe...
C. Tibial nerve palsy a...
D. Saphenous nerve entr...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 59-year-old woman with known coronary artery disease, a rare asthma‑predominant vasculitis (also called eosinophilic granulomatosis with polyangiitis), chroni...
A. Outpatient coronary ...
B. Outpatient coronary ...
C. Immediate invasive c...
D. Transesophageal echo...
Type: cost_effectiveness Difficulty: moderate Category: Unknown 📷 Includes Image
A 49-year-old woman presents to the emergency department after slipping on a wet kitchen floor and landing on her outstretched right hand. She reports focal pai...
A. Apply a thumb spica ...
B. Obtain a CT scan of ...
C. Begin early wrist ra...
D. Place a short‑arm ul...
Type: management Difficulty: easy Category: Unknown 📷 Includes Image
A 32-year-old G2P1 at 24 weeks’ gestation is evaluated in a joint maternal–fetal medicine and nephrology clinic for 10 days of malaise, nausea, generalized prur...
A. Stop omeprazole imme...
B. Admit for immediate ...
C. Start empiric low‑do...
D. Admit for 24–72 hour...
Type: cost_effectiveness Difficulty: expert Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 32‑year‑old man comes to the ED with a severe headache, shortness of breath, and chest tightness for 30 minutes. He has primary hyperaldosteronism, Factor V L...
A. Start an IV nicardip...
B. Start an IV nicardip...
C. Give sublingual nife...
D. Give oral captopril ...
Type: management Difficulty: easy Category: Unknown 📷 Includes Image
A 55-year-old woman who works in healthcare presents to the emergency department with fever and a rapidly progressive, painful, targetoid eruption with early bl...
A. Stop the drug, docum...
B. Add an allergy entry...
C. Prescribe a prolonge...
D. Capture high-resolut...
Type: legal_pitfalls Difficulty: moderate Category: Unknown
A 74-year-old man with a history of pauci-immune crescentic glomerulonephritis diagnosed 18 months ago by native kidney biopsy presents to nephrology clinic for...
A. Initiate an SGLT2 in...
B. Add finerenone 10 mg...
C. Begin high-dose oral...
D. Start dual renin–ang...
Type: prevention Difficulty: moderate Category: Unknown 📷 Includes Image
A 50-year-old woman presents with persistent microscopic hematuria and proteinuria discovered on workplace screening 10 months ago. She has gastroesophageal ref...
A. Document shared deci...
B. Start targeted–relea...
C. Discontinue losartan...
D. State that SGLT2 inh...
Type: legal_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
A 43-year-old woman is transported from a factory floor for convulsions that never fully stopped after onset. Prehospital therapy was midazolam 10 mg IM without...
A. Initiate ketamine wi...
B. Start propofol with ...
C. Load pentobarbital 1...
D. Use midazolam alone ...
Type: treatment Difficulty: expert Category: Unknown 📷 Includes Image
A 33-year-old man with long-standing circadian rhythm sleep disorder and prior aortic dissection repaired surgically presents to a small Critical Access Hospita...
A. Start lisinopril 10 ...
B. Order targeted–relea...
C. Begin lisinopril 10 ...
D. Request compassionat...
Type: cost_effectiveness Difficulty: moderate Category: Unknown 📷 Includes Image
A 48-year-old man is referred for counseling after a biopsy-proven IgA-dominant mesangial glomerulonephritis with segmental endocapillary hypercellularity and n...
A. Because your HBV DNA...
B. Since your liver enz...
C. Antivirals will not ...
D. We should delay any ...
Type: patient_communication Difficulty: hard Category: Unknown 📷 Includes Image
A 30-year-old woman is brought to the emergency department after collapsing at home. Prehospital blood pressure was 58/32 mm Hg; after 2 L isotonic crystalloid ...
A. An intensely pruriti...
B. New bilateral pittin...
C. Absence of rash or f...
D. Painful facial edema...
Type: differential_physical_history Difficulty: expert Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
Four adults present to a sports medicine clinic after ankle injuries; none has fracture on radiographs, and all have intact proximal neurovascular exams. Each w...
A. Anterior talofibular...
B. Calcaneofibular liga...
C. Posterior talofibula...
D. Deltoid ligament is ...
Type: epidemiology Difficulty: hard Category: Unknown 📷 Includes Image
An 86-year-old woman with obesity hypoventilation syndrome and chronic pain is admitted after acute substernal tightness preceded by intense grief at a family f...
A. Acute emotional stre...
B. Viral prodrome with ...
C. Fixed perfusion defe...
D. Positional chest pai...
Type: features Difficulty: hard Category: Unknown 📷 Includes Image
A 28-year-old woman with a history of atrial fibrillation and chronic fatigue syndrome presents for a routine heart failure visit. She smokes 10 cigarettes dail...
A. Increase distal tubu...
B. Directly inhibit ren...
C. Cause selective effe...
D. Stimulate atrial nat...
Type: mechanism Difficulty: moderate Category: Unknown 📷 Includes Image
A 16-year-old girl presents to the emergency department with 2 days of throbbing bifrontal headaches and intermittent blurred vision. Eight months ago she under...
A. Enroll in a multidis...
B. Adopt a DASH‑style e...
C. Join a clinic exerci...
D. Eliminate all caffei...
Type: management Difficulty: hard Category: Unknown 📷 Includes Image
A 50-year-old man with asbestosis, vasculitis in remission, and esophageal varices presents with severe dyspnea and somnolence. He works in healthcare, smokes 2...
A. Start noninvasive ve...
B. Intubate immediately...
C. Begin high‑flow nasa...
D. Order urgent CT pulm...
Type: cost_effectiveness Difficulty: easy Category: Unknown 📷 Includes Image
A 73-year-old farmer is seen at a remote clinic two hours from the nearest hospital. Roads and phone service are intermittent after heavy flooding, and there is...
A. A delayed T‑cell imm...
B. A delayed antibody r...
C. An immediate IgE‑med...
D. Direct metal toxicit...
Type: mechanism Difficulty: easy Category: Unknown 📷 Includes Image
A 39-year-old woman presents with 4 months of dry cough, exertional dyspnea, and vague chest tightness. Vital signs: pulse 53/min, temperature 36.6°C, respirato...
A. Bilateral hilar lymp...
B. Apical cavitary dise...
C. Monoclonal B-cell po...
D. Centrilobular ground...
Type: features Difficulty: easy Category: Unknown 📷 Includes Image
A 37-year-old right-handed man comes to the emergency department after two seizures in one day. Each spell began with shaking in his right hand and then his who...
A. Astrocytoma with a k...
B. Astrocytoma with a k...
C. Oligodendroglioma wi...
D. Glioblastoma without...
Type: recent_changes Difficulty: easy Category: Unknown 📷 Includes Image
A 28-year-old man with a history of Brugada syndrome (type 1 ECG pattern documented during fever), prior thyrotoxicosis now euthyroid, and antiphospholipid anti...
A. Give a rapid 6 mg IV...
B. Proceed directly to ...
C. Start an amiodarone ...
D. Send the patient for...
Type: differential_testing Difficulty: hard Category: Unknown 📷 Includes Image
A 29-year-old woman was sent after her primary care clinician palpated a left thyroid nodule. She has opioid use disorder in sustained treatment on buprenorphin...
A. Order I‑123 thyroid ...
B. Proceed to ultrasoun...
C. Schedule repeat ACR ...
D. Obtain contrast‑enha...
Type: cost_effectiveness Difficulty: expert Category: Unknown 📷 Includes Image
A 27-year-old man presents with 3 weeks of progressive tripping and inability to lift the front of his right foot while walking. He works at a computer and rout...
A. Compression mononeur...
B. L5 radiculopathy fro...
C. Tibial neuropathy in...
D. Proximal sciatic neu...
Type: diagnosis Difficulty: hard Category: Unknown 📷 Includes Image
A 93-year-old woman is moved from the ED to a monitored step‑down bed after a ground‑level fall at her assisted‑living facility one hour after eating a sandwich...
A. Raise the head of th...
B. Start a turning and ...
C. Apply sequential com...
D. Insert an indwelling...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old woman presents with abrupt palpitations, lightheadedness, and dyspnea that started 30 minutes ago while walking upstairs. She has pulmonary hypert...
A. Degeneration to vent...
B. Marked acceleration ...
C. Transient hypotensio...
D. Torsades de pointes ...
Type: complications Difficulty: moderate Category: Unknown 📷 Includes Image
A 51-year-old woman with hydronephrosis and long-standing schizophrenia presents with 6 weeks of progressive midline low back pain, worse at night, and low-grad...
A. Administering a line...
B. Using a macrocyclic ...
C. Performing contrast‑...
D. Deferring contrast e...
Type: contraindications Difficulty: expert Category: Unknown 📷 Includes Image
A 33-year-old at 12 weeks’ gestation with SLE and prior lupus nephritis presents for prenatal nephrology consultation. Vitals: pulse 104/min, temperature 35.6°C...
A. Stopping hydroxychlo...
B. Switching from labet...
C. Starting low-dose as...
D. Continuing azathiopr...
Type: clinical_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
A 23-year-old woman presents to primary care for a routine visit and review of persistent palpitations, heat intolerance, and activity-induced lightheadedness. ...
A. A standardized 10‑mi...
B. Carotid sinus massag...
C. Immediate electrophy...
D. Twenty‑four‑hour Hol...
Type: diagnostic_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 45-year-old man with a 10-year history of treatment-resistant hypertension is seen in an interventional radiology pre-procedure clinic to determine candidacy ...
A. Uncorrected coagulop...
B. Severely atrophic bi...
C. Prior contrast-assoc...
D. Resting sinus bradyc...
Type: contraindications Difficulty: hard Category: Unknown 📷 Includes Image
A 41-year-old woman reports 10 days of blurred central vision in her right eye. Straight lines look wavy and there is a small gray spot that makes reading diffi...
A. Observation and trig...
B. Immediate intravitre...
C. Urgent focal macular...
D. Start a systemic cor...
Type: natural_history Difficulty: moderate Category: Unknown 📷 Includes Image
An 83-year-old woman in a rural town presents to urgent care because her right foot has been “slapping the floor” for 3 days and she has begun tripping on rugs....
A. Remove the tight wra...
B. Start high‑dose intr...
C. Arrange urgent MRI o...
D. Schedule immediate s...
Type: treatment Difficulty: easy Category: Unknown 📷 Includes Image
A 22-year-old woman reports 3 weeks of photophobia, eye pain, and blurred vision, followed by 10 days of fatigue, polyuria, and dull bilateral flank discomfort ...
A. Tubulointerstitial n...
B. Drug‑induced acute i...
C. IgG4‑related tubuloi...
D. Sarcoidosis with gra...
Type: differential_comprehensive Difficulty: expert Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 58-year-old woman is brought to the emergency department after tripping over a curb and landing on her outstretched right hand. She has immediate radial-sided...
A. Place a short‑arm th...
B. Discharge with oral ...
C. Order immediate nerv...
D. Apply a removable el...
Type: clinical_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
A 64-year-old woman presents for a routine visit because of 3 months of heel pain. The pain is worst with the first steps out of bed and after long car rides; i...
A. Plantar fasciitis ch...
B. Tarsal tunnel syndro...
C. Insertional Achilles...
D. Morton neuroma with ...
Type: differential_physical_history Difficulty: easy Category: Unknown 📷 Includes Image
A 29-year-old man presents to a U.S. emergency department with pleuritic chest pain, dyspnea, and scant blood‑streaked sputum 4 days after returning from a trop...
A. With modern low‑ or ...
B. Because eGFR 60–89 m...
C. Cystatin C markedly ...
D. Iso‑osmolality iodix...
Type: epidemiology Difficulty: expert Category: Unknown 📷 Includes Image
A 44-year-old woman presents to clinic with 3 weeks of aching pain along the thumb side of her right wrist that worsens when lifting her 10‑month‑old child and ...
A. Finkelstein maneuver...
B. Eichhoff maneuver pe...
C. Phalen test with 60‑...
D. Anatomic snuffbox pa...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 17-year-old male with severe combined immunodeficiency (childhood diagnosis), cataract extraction, secondary hyperparathyroidism from prior vitamin D deficien...
A. Initiate emergent th...
B. Start rituximab indu...
C. Begin oral cyclophos...
D. Administer methylpre...
Type: emergency_priorities Difficulty: expert Category: Unknown 📷 Includes Image
A 34-year-old woman (G2P1) at 24 weeks’ gestation is referred to an outpatient maternal–fetal medicine clinic for evaluation of rapid weight gain. Prepregnancy ...
A. Wide violaceous stri...
B. Centripetal fat gain...
C. Progressive dependen...
D. Intermittent nausea ...
Type: features Difficulty: moderate Category: Unknown
A 59-year-old man who lives in an assisted-living facility presents with 5 days of fever, itchy red rash, dark “cola-colored” urine, and worsening fatigue. Thre...
A. Explain that the pat...
B. Advise strict lifelo...
C. Reassure that the ki...
D. Obtain HLA‑B*13:01 g...
Type: patient_communication Difficulty: hard Category: Unknown 📷 Includes Image
A 9-year-old girl is evaluated after the school nurse recorded several elevated blood‑pressure readings. Over 3 months she has had occasional throbbing bifronta...
A. Persistent hypertens...
B. Blood pressure norma...
C. Mildly elevated bloo...
D. Hypertension typical...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 37-year-old woman with antiphospholipid antibody syndrome presents with 90 minutes of crushing substernal chest pain radiating to the left arm and jaw. She wo...
A. Papillary muscle rup...
B. Post-infarction vent...
C. Left ventricular fre...
D. Early left ventricul...
Type: complications Difficulty: hard Category: Unknown 📷 Includes Image
A 12-year-old boy is evaluated for 10 weeks of dark, cola-colored urine and new morning facial puffiness. He has no recent sore throat, skin infection, or fever...
A. Dominant C3 depositi...
B. Granular deposition ...
C. Linear deposition of...
D. Absence of immune de...
Type: pathology Difficulty: easy Category: Nephrology > Glomerulonephritis > Systemic Vasculitis GN 📷 Includes Image
A 39-year-old woman who rotates day and night shifts in a regional hospital cafeteria arrives to the emergency department 18 hours after noticing cola-colored u...
A. Make the percentage ...
B. Define complete prot...
C. Use total eGFR slope...
D. Adopt a hard clinica...
Type: clinical_trials Difficulty: hard Category: Unknown 📷 Includes Image
A 30-year-old man with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, autosomal dominant polycystic kidney disease, and biopsy-proven focal segmental gl...
A. Collect serum and st...
B. Order anti–P/Q–type ...
C. Give an edrophonium ...
D. Treat presumptively ...
Type: diagnostic_failure Difficulty: hard Category: Unknown 📷 Includes Image
A 60-year-old woman comes to the emergency department with sudden shortness of breath and chest pressure that began 45 minutes ago. She lives alone, works in a ...
A. Perform urgent echoc...
B. Repeat a blind subxi...
C. Give 500–1000 mL of ...
D. Defer drainage overn...
Type: treatment_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 49-year-old man comes for a routine annual visit and asks about his risk of IgA nephropathy because his sister in Japan was recently diagnosed. He is completi...
A. IgA nephropathy is m...
B. The highest prevalen...
C. Rates are similar wo...
D. Prevalence is highes...
Type: epidemiology Difficulty: moderate Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 24-year-old pregnant woman (G2P1 at 27 weeks) with systemic lupus erythematosus and prior class II lupus nephritis presents with 3 days of new swelling of the...
A. Obtain a serum sFlt–...
B. Check anti–dsDNA and...
C. Repeat a 24-hour uri...
D. Order contrast-enhan...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 46-year-old woman with autoimmune hepatitis, stress urinary incontinence, medullary sponge kidney, gastroesophageal reflux disease, basal cell carcinoma statu...
A. Allergic reactions a...
B. Allergic reactions o...
C. Albumin replacement ...
D. There is no meaningf...
Type: epidemiology Difficulty: hard Category: Unknown 📷 Includes Image
A 73-year-old man with a history of membranous nephropathy diagnosed by renal biopsy 6 years ago, chronic otitis media with hearing loss, scoliosis, remote hook...
A. Document shared deci...
B. Initiate iptacopan 2...
C. Begin high‑dose pred...
D. Order urgent ground ...
Type: legal_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
A 28-year-old at 9 weeks’ gestation presents with palpitations, tremor, heat intolerance, and a 4-kg unintentional weight loss. She has chronic sinus congestion...
A. Start propylthiourac...
B. Start methimazole 10...
C. Start levothyroxine ...
D. Arrange radioiodine ...
Type: treatment Difficulty: easy Category: Unknown 📷 Includes Image
A 32-year-old woman with type 2 diabetes diagnosed 3 years ago presents for routine follow-up. She reports mild exertional shortness of breath since a recent co...
A. Moderately increased...
B. Albuminuria usually ...
C. Most patients with a...
D. Long-term kidney out...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 105-year-old man is brought to the emergency department from home for sudden trouble breathing that began while he was sitting at the dinner table. He lives w...
A. Immediate bedside th...
B. Immediate repeat por...
C. CT pulmonary angiogr...
D. Tilt‑table testing w...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
An 18-year-old woman presents to the emergency department with pleuritic chest pain, lightheadedness, and progressive fatigue over 4 days. She has acne vulgaris...
A. Immediate bedside tr...
B. ECG‑gated noncontras...
C. Formal transesophage...
D. Urgent diagnostic pe...
Type: diagnostic_step Difficulty: hard Category: Unknown 📷 Includes Image
A 28-year-old pregnant woman (G1P0, 28 weeks) with systemic lupus erythematosus presents for urgent assessment of new edema and rising home blood pressures. She...
A. Obtain a serum sFlt‑...
B. Order trial screenin...
C. Rely on urine dipsti...
D. Use noninvasive feta...
Type: differential_testing Difficulty: expert Category: Unknown 📷 Includes Image
You are asked to counsel a 35-year-old man with biopsy-proven primary IgA nephropathy about prognosis over the next several years. He reports intermittent gross...
A. Progressive CKD is l...
B. Spontaneous remissio...
C. Rapid crescentic pro...
D. Prognosis is governe...
Type: natural_history Difficulty: hard Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 28-year-old man with 18 months of progressive forgetfulness, misplacing tools, missed bill payments, two episodes of getting lost in familiar neighborhoods, a...
A. Moderate‑stage Alzhe...
B. Mild Alzheimer’s dis...
C. Moderate Alzheimer‑p...
D. Moderate dementia wi...
Type: features Difficulty: hard Category: Unknown 📷 Includes Image
A 15-year-old boy presents to the emergency department with sudden-onset cola-colored urine after one day of sore throat and rhinorrhea. He feels lightheaded an...
A. Repeat same-encounte...
B. Order immediate cont...
C. Collect a 24-hour ur...
D. Admit for inpatient ...
Type: cost_effectiveness Difficulty: hard Category: Unknown 📷 Includes Image
A 12-year-old girl is brought by her mother for a routine visit to establish care and discuss school vaccines. She has obstructive sleep apnea treated with nigh...
A. Administer the 9‑val...
B. Defer HPV vaccinatio...
C. Give a 3‑dose HPV se...
D. Provide intranasal l...
Type: prevention Difficulty: easy Category: Unknown 📷 Includes Image
A 31-year-old female veteran is evaluated in a cardiopulmonary clinic for months of exertional dyspnea, near-fainting when climbing stairs, and headaches after ...
A. Persistent platypnea...
B. Intermittent improve...
C. Progressive RV remod...
D. Upright oxygen norma...
Type: natural_history Difficulty: hard Category: Unknown 📷 Includes Image
A 29-year-old man presents with 2 days of cough productive of blood‑tinged sputum, pleuritic chest pain, malaise, and dark cola‑colored urine. He is unemployed,...
A. Begin daily therapeu...
B. Start eculizumab 900...
C. Schedule plasma exch...
D. Hold plasma exchange...
Type: management Difficulty: moderate Category: Unknown 📷 Includes Image
A 20-year-old pregnant woman at 22 weeks’ gestation presents for counseling about normal cardiovascular changes in pregnancy. She works in construction, lives w...
A. Rise in cardiac outp...
B. Decreased cardiac ou...
C. Marked hypovolemia w...
D. Fixed split second h...
Type: features Difficulty: easy Category: Unknown 📷 Includes Image
A 24-year-old man, 14 months after a living‑donor kidney transplant for congenital obstructive uropathy, presents with 8 weeks of rising creatinine, low‑grade f...
A. Crisp nuclear immuno...
B. Patchy SV40 large T ...
C. RNAscope BK viral RN...
D. Positive immunostain...
Type: pathology Difficulty: expert Category: Unknown 📷 Includes Image
A 27-year-old man presents to an urban emergency department with 2 hours of nonexertional chest pressure that began at rest and has eased to a dull ache. He den...
A. Low risk is defined ...
B. Low risk is under 5%...
C. Outpatient follow‑up...
D. Low risk is under 2%...
Type: epidemiology Difficulty: moderate Category: Unknown 📷 Includes Image
A 45-year-old man presents for a routine visit to review recent laboratory results ordered for fatigue and neck tightness. He works in education and lives in an...
A. Ask about biotin use...
B. Begin methimazole 10...
C. Order a radioactive ...
D. Check reverse T3 to ...
Type: clinical_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 42-year-old woman presents to the emergency department after a fall onto her right chest while walking down stairs. She reports sharp right-sided chest pain t...
A. Insert a small-bore ...
B. Insert a chest tube ...
C. Place a large-bore t...
D. Insert the tube post...
Type: prevention Difficulty: easy Category: Unknown 📷 Includes Image
A 38-year-old woman comes to the nephrology clinic for new swelling of both legs and puffiness around the eyes that have worsened over 3 weeks. She reports foam...
A. Oral prednisone 1 mg...
B. Oral tacrolimus 0.05...
C. Oral losartan 100 mg...
D. Intravenous cyclopho...
Type: treatment Difficulty: easy Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 49‑year‑old gravida 2, para 1 at 24 weeks’ gestation is admitted for her third episode of biliary colic in 6 weeks, now with 2 days of pale stools and pruritu...
A. Obtain the critical ...
B. Use an infundibular ...
C. Defer surgery until ...
D. Perform routine preo...
Type: prevention Difficulty: hard Category: Unknown 📷 Includes Image
A 29-year-old man collapses near the finish line of a 100-km summer ultramarathon. The ambient temperature is 38 °C (100 °F). He is transported to the emergency...
A. Rapid whole-body ice...
B. Evaporative cooling ...
C. Intravenous acetamin...
D. Immediate empiric va...
Type: treatment Difficulty: easy Category: Unknown 📷 Includes Image
A 45-year-old G2P1 at 28 weeks’ gestation presents with 5 days of fluctuating horizontal diplopia late in the day, nasal speech, fatigable chewing with jaw clau...
A. Acetylcholine recept...
B. Muscle-specific kina...
C. Acetylcholine recept...
D. Lambert–Eaton myasth...
Type: differential_comprehensive Difficulty: hard Category: Unknown 📷 Includes Image
A 44-year-old woman is evaluated in a nephrology clinic for persistently elevated blood pressure despite therapy with amlodipine 10 mg once daily, chlorthalidon...
A. A common single-nucl...
B. Autosomal dominant m...
C. Autosomal dominant l...
D. Autosomal dominant m...
Type: epidemiology Difficulty: moderate Category: Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Endocrine Hypertension Syndromes > Pheochromocytoma Hypertension 📷 Includes Image
A 33-year-old woman with retinitis pigmentosa is found at home after a space‑heater fire with soot on her face and singed nasal hairs. EMS notes headache, confu...
A. Carbon monoxide pois...
B. High–altitude hypoxe...
C. Methemoglobinemia ca...
D. Acute cyanide toxici...
Type: mechanism Difficulty: expert Category: Unknown 📷 Includes Image
A 32-year-old woman presents to the emergency department with rapid‑onset itching, flushing, urticaria over the trunk and limbs, mild lip swelling, and chest ti...
A. After initial resolu...
B. Once symptoms resolv...
C. Delayed serum sickne...
D. Anaphylaxis is monop...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old woman at 14 weeks’ gestation (G2P1) plans to accompany her partner on a work assignment to a high-altitude town located at 3,400 m (11,150 ft) for...
A. Advise slow ascent o...
B. Begin acetazolamide ...
C. Start tadalafil 10 m...
D. Recommend rapid asce...
Type: prevention Difficulty: expert Category: Unknown 📷 Includes Image
A 31-year-old man is admitted with high fever, dyspnea, and productive cough with rust-colored sputum for 36 hours. He is celibate, quit smoking 10 years ago af...
A. Start intravenous hy...
B. Start intravenous me...
C. Avoid adjunctive cor...
D. Give dexamethasone 6...
Type: treatment Difficulty: moderate Category: Unknown 📷 Includes Image
In an internal-medicine run clinic, four patients with acute monoarthritis present during the same hour. Each has a distinct comorbidity pattern, and synovial f...
A. For the patient with...
B. For the patient with...
C. For the patient with...
D. For the patient two ...
Type: treatment Difficulty: hard Category: Unknown 📷 Includes Image
A 99-year-old woman comes for a routine visit to review adult vaccines before winter. She lives with her spouse in a one‑story home, is in a monogamous relation...
A. Give a single 0.5 mL...
B. Give a single dose o...
C. Administer a zoster ...
D. Start a three‑dose h...
Type: recent_changes Difficulty: moderate Category: Unknown 📷 Includes Image
A 25-year-old man with a history of pulmonary hypertension and remote nephrectomy for renal cell carcinoma presents at a mountain urgent-care clinic with sudden...
A. At the ureterovesica...
B. At the ureteropelvic...
C. Where the ureter cro...
D. Within a calyceal in...
Type: clinical_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 33-year-old garment factory worker presents to a rural clinic in the mountains during a multi-day road closure. She reports 8 months of hand paresthesia that ...
A. Use CTS-6 to confirm...
B. Defer therapy until ...
C. Begin serial landmar...
D. Treat presumed cervi...
Type: clinical_trials Difficulty: hard Category: Unknown 📷 Includes Image
A 21-year-old woman with genetically confirmed X‑linked ornithine transcarbamylase deficiency (maternal carrier testing in childhood and characteristic plasma a...
A. Initiate pulse syste...
B. Start targeted‑relea...
C. Begin APRIL blockade...
D. Start mycophenolate ...
Type: contraindications Difficulty: hard Category: Unknown 📷 Includes Image
A 73-year-old woman with protein S deficiency (not anticoagulated), chronic aortic regurgitation (mild), kyphosis, and a remote empyema presents with abrupt pal...
A. Selective right coro...
B. Selective left circu...
C. Coronary CT angiogra...
D. Immediate invasive e...
Type: diagnostic_step Difficulty: hard Category: Unknown 📷 Includes Image
A 32-year-old woman at 36 weeks of pregnancy presents to the labor triage area with painful contractions and a sudden choking episode after drinking a protein s...
A. Right mainstem intub...
B. Left mainstem intuba...
C. Esophageal intubatio...
D. Bilateral tension pn...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 46-year-old woman with type 2 diabetes and a recent diagnosis of dermatitis herpetiformis presents to the emergency department with dark red-brown urine, ankl...
A. Immediate urine phas...
B. CT angiography of th...
C. Serologic panel for ...
D. Cystoscopy in the em...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 37-year-old woman with stage 5 chronic kidney disease from lupus nephritis missed two hemodialysis sessions because of transportation problems. She presents f...
A. Potassium will move ...
B. Potassium will be re...
C. The treatment will c...
D. Most potassium will ...
Type: mechanism Difficulty: easy Category: Pharmacology > Psychopharmacology 📷 Includes Image
A term female neonate is born at 39 weeks 1 day by spontaneous vaginal delivery to a 28-year-old G2P2 mother with insulin‑treated hyperglycemia in late pregnanc...
A. Administer 40% oral ...
B. Administer 40% oral ...
C. Give 40% oral dextro...
D. Begin a prophylactic...
Type: prevention Difficulty: hard Category: Unknown 📷 Includes Image
A 30-year-old man presents to the emergency department with acute left-sided flank pain that began while lifting a heavy box at work. He has a history of tricho...
A. Proceed to low-dose ...
B. Repeat renal ultraso...
C. Obtain intravenous u...
D. Order a plain abdomi...
Type: diagnostic_failure Difficulty: easy Category: Unknown
A 24‑year‑old woman with a history of dilated cardiomyopathy and mitral stenosis arrives with brief, sharp chest pain that began at rest and resolved during tri...
A. Use high-sensitivity...
B. Order routine CK-MB ...
C. Admit all low-risk c...
D. Send patients for im...
Type: cost_effectiveness Difficulty: easy Category: Unknown 📷 Includes Image
A 35-year-old graduate student reports intermittent gross hematuria and a rise in albuminuria over several months. She has a history of medullary sponge kidney ...
A. Primary IgA nephropa...
B. IgA‑dominant infecti...
C. IgA vasculitis nephr...
D. C3 glomerulopathy wi...
Type: diagnosis Difficulty: expert Category: Unknown 📷 Includes Image
An 83-year-old man (age corrected from a clerical entry of 123) presents to the ED after sudden lightheadedness and a brief fall without head injury. He has a h...
A. Sustained monomorphi...
B. Supraventricular tac...
C. Atrial flutter with ...
D. Preexcited atrial fi...
Type: differential_comprehensive Difficulty: easy Category: Unknown 📷 Includes Image
You are asked to triage four simultaneous referrals to a tertiary autoimmune blistering disease clinic to decide which single case is most consistent with a dia...
A. Patient 1 most likel...
B. Patient 2 most likel...
C. Patient 3 most likel...
D. Patient 4 most likel...
Type: differential_comprehensive Difficulty: hard Category: Unknown 📷 Includes Image
A 33-year-old gravida 2 para 1 at 30 weeks’ gestation presents with 12 hours of right upper quadrant abdominal pain, headache, and new visual blurring prior to ...
A. HELLP syndrome (pree...
B. Acute fatty liver of...
C. Uncomplicated biliar...
D. Acute viral hepatiti...
Type: differential_physical_history Difficulty: hard Category: Unknown 📷 Includes Image
A 35‑year‑old woman presents to the ED after a low‑speed rear‑end motor vehicle collision with brief lightheadedness. Vitals are pulse 61/min, temperature 36.4°...
A. Alport syndrome due ...
B. Thin basement membra...
C. Recurrent exercise‑i...
D. Lower urinary tract ...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 71-year-old man with chronic osteomyelitis of the right tibia (intermittent drainage), paroxysmal nocturnal hemoglobinuria, common variable immunodeficiency w...
A. Obtain two sets of b...
B. Proceed first to ult...
C. Initiate low‑dose co...
D. Defer systemic antib...
Type: emergency_priorities Difficulty: expert Category: Unknown 📷 Includes Image
A 39-year-old woman who works in healthcare comes to urgent care for new bubbly urine, mild eyelid puffiness in the morning, and shoes that feel tight by evenin...
A. Collect a clean‑catc...
B. Send her home to do ...
C. Draw blood today onl...
D. Arrange an urgent na...
Type: diagnostic_step Difficulty: easy Category: Unknown 📷 Includes Image
A 29-year-old G2P1 at 32 weeks by certain dates presents to labor and delivery triage with 30 minutes of palpitations, breathlessness on exertion, and lighthead...
A. Administer adenosine...
B. Administer diltiazem...
C. Administer amiodaron...
D. Proceed directly to ...
Type: management Difficulty: hard Category: Unknown 📷 Includes Image
A 4-year-old girl is seen for persistently high arm blood pressures noted on two visits. Her parents report occasional headaches and that her feet feel cold aft...
A. Coarctation of the a...
B. Renal artery stenosi...
C. Primary hyperaldoste...
D. Pheochromocytoma wit...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 20-year-old college student presents to an urgent care clinic with 4 days of malaise, low-grade fevers at home, new darker urine, and a faint itchy rash on th...
A. Drug‑induced acute i...
B. Acute tubular necros...
C. Post‑streptococcal g...
D. Acute bacterial pyel...
Type: diagnosis Difficulty: easy Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 66-year-old man (78 kg) is evaluated for 6 weeks of intensely itchy, tense blisters on the abdomen and flexor forearms. He has no mouth pain, no dysphagia, an...
A. Bullous pemphigoid, ...
B. Mucous membrane pemp...
C. Pemphigus vulgaris, ...
D. Stevens–Johnson synd...
Type: diagnosis Difficulty: moderate Category: Unknown 📷 Includes Image
A 20-year-old primigravida at 14 weeks’ gestation with a history of adolescent scoliosis and compensated congestive heart failure presents to a tertiary obstetr...
A. Continue non‑teratog...
B. Start sparsentan 200...
C. Begin targeted‑relea...
D. Add dapagliflozin 10...
Type: clinical_trials Difficulty: expert Category: Unknown 📷 Includes Image
A 27-year-old man presents to the emergency department with sudden large‑volume bright red hemoptysis and lightheadedness. He has a history of bronchiectasis af...
A. Place in lateral dec...
B. Insert a nasogastric...
C. Use noninvasive vent...
D. Nebulize tranexamic ...
Type: treatment Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old woman is evaluated in a hypertension clinic for persistent elevation of blood pressure first noted 6 months ago during a pre-employment examinatio...
A. Computed tomographic...
B. Contrast-enhanced ma...
C. Catheter-based digit...
D. Repeat high-quality ...
Type: diagnostic_step Difficulty: expert Category: Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Endocrine Hypertension Syndromes > Pheochromocytoma Hypertension 📷 Includes Image
A 24-year-old man presents for a routine visit to establish care. He reports intermittent wheeze with colds in childhood and persistent exertional breathlessnes...
A. Obstructive spiromet...
B. Obstructive spiromet...
C. Restrictive pattern ...
D. Normal spirometry wi...
Type: features Difficulty: easy Category: Unknown 📷 Includes Image
A 75-year-old woman is referred for “treatment failure” of presumed primary IgA nephropathy after 10 months of maximized supportive therapy. Over that period sh...
A. Reclassify this as s...
B. Treat as primary IgA...
C. Start pulse methylpr...
D. Add urgent plasmaphe...
Type: treatment_failure Difficulty: hard Category: Unknown 📷 Includes Image
A 35-year-old woman with a history of pelvic inflammatory disease presents for evaluation of exertional chest sensations described as a “whoosh” during running....
A. Move from standing t...
B. Abruptly stand from ...
C. Perform the Valsalva...
D. Administer inhaled a...
Type: differential_physical_history Difficulty: easy Category: Unknown 📷 Includes Image
A 27-year-old woman presents with abrupt severe, diffuse, mid‑abdominal pain that began 2 hours ago. She describes constant pain out of proportion to the mild d...
A. CT angiography of th...
B. Mesenteric duplex ul...
C. Noncontrast CT of th...
D. Urgent colonoscopy w...
Type: diagnostic_step Difficulty: moderate Category: Unknown 📷 Includes Image
A 32-year-old man presents to nephrology clinic with 2 weeks of malaise, a pruritic morbilliform rash, tea-colored urine, and ankle swelling that began six week...
A. Obtain a native kidn...
B. Pursue a cryoglobuli...
C. Rely on serial ANCA ...
D. Proceed with protoco...
Type: differential_testing Difficulty: expert Category: Unknown 📷 Includes Image
A 42-year-old construction worker with type 2 diabetes, known Brugada syndrome (type 1 ECG pattern on prior testing, no ICD), and a remote inguinal hernia repai...
A. Begin IV nicardipine...
B. Give sublingual imme...
C. Start high‑dose IV n...
D. Administer full‑dose...
Type: emergency_priorities Difficulty: moderate Category: Unknown 📷 Includes Image
A 21-year-old college student presents with two recent episodes of dark, tea‑colored urine that began within 24–36 hours of sore throat and nasal congestion. He...
A. Circulating galactos...
B. Nephritogenic strept...
C. Linear anti‑glomerul...
D. Immune complexes fro...
Type: mechanism Difficulty: moderate Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 48-year-old retired woman presents to a small rural clinic during a severe ice storm with sudden, painless loss of vision in her right eye that began about 3 ...
A. Begin ocular first‑a...
B. Defer all ocular mea...
C. Administer full‑dose...
D. Treat as an ocular a...
Type: emergency_priorities Difficulty: easy Category: Unknown 📷 Includes Image
A 44-year-old woman is brought to a crowded urban emergency department with 4 days of progressive dyspnea and left-sided chest tightness. She reports chronic no...
A. Re‑expansion pulmona...
B. Re‑expansion pulmona...
C. Purely hydrostatic o...
D. Ventilation‑induced ...
Type: complications Difficulty: expert Category: Unknown 📷 Includes Image
A 16-year-old boy is brought to the emergency department for 3 weeks of abrupt behavioral change (insomnia, irritability, inappropriate laughter), short-term me...
A. Initiate hospital‑ba...
B. Defer plasma exchang...
C. Use immunoadsorption...
D. Adopt an outpatient ...
Type: recent_changes Difficulty: hard Category: Unknown 📷 Includes Image
A 56-year-old retired man is brought to a small critical-access hospital during a winter ice storm that has grounded air and ground transfers for an estimated 1...
A. Primary aldosteronis...
B. Renal artery stenosi...
C. Liddle syndrome due ...
D. Cushing disease with...
Type: differential_comprehensive Difficulty: moderate Category: Unknown 📷 Includes Image
Four 60‑year‑old men present over one month with newly noticed anterior neck lumps found while shaving. All have normal CBC, comprehensive metabolic panel, and ...
A. Patient A with a mid...
B. Patient B with a lat...
C. Patient C with a pul...
D. Patient D with a fir...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 69-year-old woman with COPD, obstructive sleep apnea, prior exposure to head-and-neck radiation, and growth hormone deficiency is referred for management of m...
A. Biopsy the 1.7-cm TR...
B. Biopsy only the 2.7-...
C. Biopsy all three now...
D. Observe all nodules ...
Type: treatment Difficulty: easy Category: Unknown 📷 Includes Image
A 36-year-old man is brought to a step-down unit from the ED for persistent hypotension and dizziness after two days of watery diarrhea and poor oral intake. He...
A. Perform a passive le...
B. Place the patient in...
C. Sit the patient upri...
D. Turn the patient to ...
Type: clinical_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
A 40-year-old man is brought to the emergency department by his partner for two days of feverishness, tremor, insomnia, and worsening anxiety. He has no known d...
A. Antithyroid‑drug–ind...
B. Cholestatic liver in...
C. ANCA‑associated smal...
D. Thionamide‑induced h...
Type: complications Difficulty: moderate Category: Unknown 📷 Includes Image
A 33-year-old woman is evaluated for persistently elevated blood pressure despite 3 months of lifestyle modification that includes a low-sodium diet, a 5-kg wei...
A. Duplex Doppler ultra...
B. Computed tomographic...
C. Serum thyroid-stimul...
D. Transthoracic echoca...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 10-year-old boy is brought to a metropolitan emergency department for 5 days of progressive generalized edema and a 3-kg weight increase. He notes morning fac...
A. Focal and segmental ...
B. Glomerulomegaly with...
C. Normal-appearing glo...
D. Diffuse glomerular b...
Type: pathology Difficulty: hard Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 4-year-old boy (weight 16 kg) is brought to the emergency department with 24 hours of profuse watery diarrhea and repeated emesis. He has had only one small v...
A. Initiating hypotonic...
B. Resuscitating with i...
C. Using a balanced iso...
D. Administering a sing...
Type: clinical_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
A 22‑year‑old woman is 16 weeks pregnant. She underwent a living‑donor kidney transplant 3 years ago and has had no rejection in the past 2 years. She works par...
A. Continue tacrolimus ...
B. Continue tacrolimus ...
C. Increase tacrolimus ...
D. Switch tacrolimus to...
Type: cost_effectiveness Difficulty: hard Category: Unknown 📷 Includes Image
An 8-year-old boy is recovering on a pediatric surgical floor after resection of a 1.6‑cm peripheral left lower lobe nodule located within a single bronchopulmo...
A. Prolonged postoperat...
B. Hospital‑acquired pn...
C. Middle lobe torsion ...
D. Small apical pneumot...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 33-year-old man with hereditary angioedema due to C1 inhibitor deficiency (type I) presents to the ED with rapidly progressive hoarseness, throat tightness, a...
A. Intravenous plasma‑d...
B. Intravenous plasma‑d...
C. Subcutaneous icatiba...
D. Intravenous recombin...
Type: treatment_failure Difficulty: expert Category: Unknown 📷 Includes Image
A term male newborn (39 weeks) is brought to a warmer immediately after an uncomplicated vaginal delivery. Birth weight is 3.2 kg. He has nasal flaring and subc...
A. Provide bag-mask ven...
B. Insert a laryngeal m...
C. Intubate the trachea...
D. Begin gentle pressur...
Type: contraindications Difficulty: easy Category: Unknown 📷 Includes Image
A 20-year-old woman with cystic fibrosis diagnosed in infancy presents to a U.S. emergency department with 36 hours of increased cough productive of thick, gree...
A. Loss-of-function of ...
B. Primary ciliary dyne...
C. Gain-of-function mut...
D. Alpha-1 antitrypsin ...
Type: mechanism Difficulty: moderate Category: Unknown 📷 Includes Image
A 46-year-old man with cerebral palsy, depression, rheumatic mitral stenosis, gout, binge‑eating disorder, coal workers pneumoconiosis, and plantar fasciitis pr...
A. Jarisch–Herxheimer r...
B. Immediate IgE‑mediat...
C. Serum sickness–like ...
D. Hoigné syndrome (pro...
Type: complications Difficulty: expert Category: Unknown 📷 Includes Image
A 52-year-old woman with myelodysplastic syndrome diagnosed 8 months ago presents with 3 months of progressive exertional dyspnea, now at rest, dry cough with o...
A. Pulmonary alveolar p...
B. Pulmonary alveolar p...
C. Pulmonary alveolar p...
D. Lymphangioleiomyomat...
Type: epidemiology Difficulty: hard Category: Unknown 📷 Includes Image
A 37-year-old man is referred to nephrology for edema and heavy proteinuria. Over 6 weeks he noted periorbital swelling in the mornings and progressive ankle sw...
A. Tip variant focal se...
B. Cellular variant foc...
C. Perihilar variant fo...
D. Membranous nephropat...
Type: pathology Difficulty: hard Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 37-year-old man comes for evaluation of a persistent dry cough that began several weeks ago. He has a history of minimal change disease with past edema, gout ...
A. Dry, persistent coug...
B. Dry cough that clear...
C. Productive cough wit...
D. Wheezing bronchitis ...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 51-year-old woman with a sedentary manufacturing job and a vegan diet is referred for evaluation of difficult-to-control blood pressure and episodic palpitati...
A. Renovascular hyperte...
B. Atherosclerotic righ...
C. Fibromuscular dyspla...
D. White‑coat hypertens...
Type: diagnosis Difficulty: hard Category: Nephrology > Glomerulonephritis > Hematological Disorder GN 📷 Includes Image
A 31-year-old man with tricuspid regurgitation and genetically confirmed antithrombin (SERPINC1) deficiency is admitted after a non–ST-elevation myocardial infa...
A. Add ezetimibe 10 mg ...
B. Defer any nonstatin ...
C. Start inclisiran 284...
D. Initiate a PCSK9 mon...
Type: prevention Difficulty: expert Category: Unknown 📷 Includes Image
A 16-year-old boy with kidney failure is in his first week of outpatient hemodialysis through a right internal jugular tunneled catheter. He lives with his moth...
A. Stop the blood pump ...
B. Stop the blood pump;...
C. Sit him upright; giv...
D. Stop the blood pump;...
Type: diagnostic_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 35-year-old man is brought to the emergency department by his partner after an abrupt coughing and choking episode during the night. He fell asleep supine on ...
A. Superior (posterior)...
B. Posterior segment of...
C. Lingular inferior se...
D. Apicoposterior segme...
Type: mechanism Difficulty: moderate Category: Unknown 📷 Includes Image
A 23-year-old man presents for routine hepatology follow‑up. He works in manufacturing with intermittent solvent exposure. He has type 1 diabetes on an insulin ...
A. Primary sclerosing c...
B. Primary biliary chol...
C. IgG4‑related scleros...
D. Postsurgical common ...
Type: differential_comprehensive Difficulty: hard Category: Unknown 📷 Includes Image
A 58-year-old man with chronic kidney disease and biopsy-proven IgA nephropathy returns after a recent hospitalization for shortness of breath. Medical history ...
A. Keep the kidney‑prot...
B. Start targeted‑relea...
C. Add a full‑dose angi...
D. Because of PNH and s...
Type: patient_communication Difficulty: moderate Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 13-year-old boy is brought to the emergency department with 2 days of painful midline neck swelling, fever at home to 41.4°C, odynophagia, and a muffled “hot-...
A. Begin intravenous am...
B. Perform immediate be...
C. Start oral amoxicill...
D. Proceed to emergent ...
Type: clinical_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 29-year-old man with biopsy‑proven primary focal segmental glomerulosclerosis (Columbia NOS variant on light microscopy; immunofluorescence with IgM/C3 trappi...
A. Initiate oral tacrol...
B. Start oral cyclospor...
C. Administer rituximab...
D. Begin mycophenolate ...
Type: management Difficulty: moderate Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 57-year-old man presents to clinic after his primary care physician noted persistent mild hypercalcemia on two separate basic metabolic panels obtained over t...
A. Loss-of-function of ...
B. Overexpression of pa...
C. Ectopic production o...
D. Gain-of-function mut...
Type: pathology Difficulty: moderate Category: Unknown 📷 Includes Image
A 56-year-old man is brought to the ED by EMS for confusion and severe weakness. He is known to nephrology for biopsy‑proven AL (light‑chain) amyloidosis with r...
A. Initiate emergent he...
B. Continue temporizing...
C. Delay treatment unti...
D. Disclose full detail...
Type: legal_pitfalls Difficulty: easy Category: Nephrology > Glomerulonephritis > Myeloma-Associated GN 📷 Includes Image
A 38-year-old woman with asthma and congenital sensorineural hearing loss is hospitalized for a necrotizing soft-tissue infection of the left forearm. Eight day...
A. Nonoliguric acute tu...
B. Acute interstitial n...
C. Acute tubular injury...
D. Hemodynamically medi...
Type: diagnosis Difficulty: hard Category: Psychiatry > Geriatric Psychiatry 📷 Includes Image
A 78‑year‑old man comes to the emergency department with fever, burning urination, perineal pain, and difficulty starting his urine stream for 3 days. He began ...
A. Start oral ciproflox...
B. Start oral trimethop...
C. Continue nitrofurant...
D. Give a single dose o...
Type: treatment_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 52-year-old man is evaluated at a tertiary cognitive disorders service for a 7-week history of rapidly progressive cognitive decline. His spouse reports abrup...
A. Start therapeutic pl...
B. Begin high-dose intr...
C. Administer rituximab...
D. Initiate therapeutic...
Type: cost_effectiveness Difficulty: expert Category: Unknown 📷 Includes Image
A 46-year-old woman at 20 weeks’ gestation presents for shared nephrology–obstetrics care. She has chronic kidney disease with prior biopsy‑proven membranous ne...
A. Do not start SGLT2 i...
B. Start nifedipine ext...
C. Initiate targeted‑re...
D. Enroll immediately i...
Type: clinical_trials Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old woman comes to clinic for a routine visit. For three months she has had loose stools 3–4 times daily with urgency, bright red blood on toilet pape...
A. Relapsing–remitting ...
B. Discontinuous, full-...
C. A brief self-limited...
D. A functional bowel d...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 59-year-old G3P1 woman at 24 weeks of gestation after donor-egg IVF is transported to a tertiary emergency department for abrupt severe epigastric pain radiat...
A. Initiate emergent th...
B. Proceed with double‑...
C. Escalate medical the...
D. Start a continuous u...
Type: emergency_priorities Difficulty: expert Category: Unknown 📷 Includes Image
A 41-year-old woman with no known structural heart disease presents to urgent care with 35 minutes of abrupt-onset pounding palpitations, throat fullness, and l...
A. A prior sinus‑rhythm...
B. During the tachycard...
C. Pseudo r′ in V1 and ...
D. Emergence of rate‑re...
Type: features Difficulty: expert Category: Unknown 📷 Includes Image
A 25-year-old man is brought to a United States Level I trauma center after a high-speed dashboard impact in a head-on motor vehicle collision. He arrives obtun...
A. Transection or throm...
B. Isolated anterior ti...
C. Distal superficial f...
D. Combined popliteal v...
Type: diagnosis Difficulty: hard Category: Unknown 📷 Includes Image
A 58-year-old woman with autosomal dominant polycystic kidney disease presents with a pounding occipital headache and brief blurry vision that began this mornin...
A. A saccular aneurysm ...
B. Dissection of the ab...
C. Pseudoaneurysm of th...
D. Congenital coronary ...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 32-year-old woman in her second trimester (24 weeks) with a 6-year history of ulcerative colitis presents for routine prenatal care co-managed by gastroentero...
A. Activity in pregnanc...
B. Pregnancy universall...
C. Flare risk is highes...
D. Disease activity is ...
Type: natural_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 35-year-old woman is seen in the nephrology clinic for persistently elevated blood pressure. Six months ago her seated office readings averaged 165/100 mm Hg...
A. Multifocal string-of...
B. Continuous high-pitc...
C. Sister’s history of ...
D. Bilateral renal-arte...
Type: features Difficulty: hard Category: Nephrology: Kidney Disease Diagnosis and Management > Hypertension and Renal Health > Endocrine Hypertension Syndromes > Pheochromocytoma Hypertension 📷 Includes Image
A 51-year-old man with biopsy-confirmed primary focal segmental glomerulosclerosis and stage 3b CKD presents for evaluation of persistent clinic hypertension de...
A. Arrange 24‑hour ambu...
B. Hold losartan for 2 ...
C. Proceed directly to ...
D. Add clonidine 0.1 mg...
Type: diagnostic_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 55-year-old woman is in the post-anesthesia care unit 2 hours after a total thyroidectomy with left central neck dissection for cytology-proven papillary thyr...
A. Bilateral recurrent ...
B. Symmetric injury to ...
C. Bilateral internal b...
D. Bilateral division o...
Type: complications Difficulty: expert Category: Unknown 📷 Includes Image
A 32-year-old man is brought to the emergency department after being struck by a car while crossing the street. He was thrown onto his right side and briefly un...
A. Portable anteroposte...
B. Noncontrast CT of th...
C. MRI of the pelvis wi...
D. Focused ultrasound o...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 53-year-old woman presents 36 hours after a left hemithyroidectomy for a dominant 2.8‑cm thyroid nodule. She reports new difficulty projecting her voice, inab...
A. External branch of t...
B. Recurrent laryngeal ...
C. Internal branch of t...
D. Glossopharyngeal ner...
Type: complications Difficulty: hard Category: Unknown 📷 Includes Image
A 33-year-old woman at 28 weeks of pregnancy presents with new left calf pain and swelling that began yesterday after a 6‑hour car ride. She notes mild shortnes...
A. Order duplex compres...
B. Order a D‑dimer bloo...
C. Proceed directly to ...
D. Perform contrast ven...
Type: diagnostic_step Difficulty: easy Category: Unknown 📷 Includes Image
A 22-year-old woman presents with five days of jaundice, dark urine, diffuse abdominal discomfort, nausea, and progressive fatigue. She lives with her spouse, s...
A. In fulminant Wilson ...
B. Most adults with Wil...
C. High‑dose penicillam...
D. Albumin dialysis is ...
Type: natural_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 56-year-old man presents to the emergency department after a brief episode of lightheadedness while standing at work. He denies chest pain, syncope, or dyspne...
A. Lead-time bias infla...
B. Length-time bias und...
C. Confounding by age b...
D. Ascertainment bias t...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 21-year-old woman with schizoaffective disorder and restrictive cardiomyopathy is evaluated for chronic dyspepsia and iron‑deficiency anemia found on screenin...
A. Persistent H. pylori...
B. Once intestinal meta...
C. Successful eradicati...
D. Risk reduction after...
Type: natural_history Difficulty: expert Category: Unknown 📷 Includes Image
A 35-year-old woman presents to clinic with 6 months of progressive heat intolerance, new-onset palpitations noted on her smartwatch, unintentional 6-kg weight ...
A. TSH receptor antibod...
B. Painless (silent) th...
C. Toxic multinodular g...
D. Exogenous thyroid ho...
Type: differential_comprehensive Difficulty: moderate Category: Unknown 📷 Includes Image
A 20-year-old woman at approximately 6 weeks of pregnancy by dates presents for her first prenatal visit. She reports mild fatigue and nausea without vomiting. ...
A. Increase levothyroxi...
B. Continue the same da...
C. Switch now from levo...
D. Stop levothyroxine d...
Type: management Difficulty: easy Category: Unknown 📷 Includes Image
A 39-year-old man with a 15-year history of high blood pressure and gout comes to the emergency department 8 hours after sudden, severe back-of-head pain, blurr...
A. Start IV nicardipine...
B. Start IV sodium nitr...
C. Give immediate‑relea...
D. Give a single 20 mg ...
Type: management Difficulty: easy Category: Unknown 📷 Includes Image
A 25-year-old man collapses during a midafternoon ruck in full gear at a humid military training site after a 5-day heat wave. EMS finds him confused, agitated,...
A. Exertional heat stro...
B. Exertional heat stro...
C. Adrenal crisis with ...
D. Serotonin toxicity f...
Type: differential_physical_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 54-year-old man with a history of recurrent sinus infections in early adulthood (serum IgA repeatedly low‑normal but not absent), type 2 diabetes (A1c 7.4%), ...
A. Add targeted‑release...
B. Begin sibeprenlimab ...
C. Start atacicept 150 ...
D. Escalate to high‑dos...
Type: treatment Difficulty: hard Category: Unknown 📷 Includes Image
A 21-year-old woman presents to a U.S. academic emergency department after 48 hours of malaise, pruritic truncal rash, new bilateral ankle swelling, and reduced...
A. Partial recovery fol...
B. Near-complete renal ...
C. Progressive decline ...
D. Relapsing–remitting ...
Type: natural_history Difficulty: hard Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 56-year-old woman presents to urgent care for 2 weeks of fatigue, decreased urine output, and a new itchy red bumpy rash across the trunk and upper arms. She ...
A. Drug‑induced acute i...
B. Ischemic acute tubul...
C. Poststreptococcal gl...
D. Acute bacterial pyel...
Type: diagnosis Difficulty: easy Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 25‑year‑old woman with end‑stage kidney disease secondary to congenital anomalies is being expedited for kidney‑transplant listing after a prolonged evaluatio...
A. Documented active sy...
B. History of treated G...
C. Remote myelodysplast...
D. Allergy to amoxicill...
Type: features Difficulty: easy Category: Unknown 📷 Includes Image
A 34-year-old man with hypertrophic cardiomyopathy (max septal thickness 20 mm, no resting LVOT gradient, AICD not yet placed), prior blastomycosis (treated), b...
A. Begin an early discl...
B. Provide a prompt fac...
C. Direct a detailed up...
D. Give a brief clinica...
Type: management Difficulty: expert Category: Unknown 📷 Includes Image
A 32-year-old man with a JAK2 V617F–positive myeloproliferative neoplasm (previously treated with ruxolitinib, now off therapy) arrives to a tertiary ED with ab...
A. Start immediate high...
B. Perform emergent leu...
C. Begin low‑dose hydro...
D. Proceed directly to ...
Type: emergency_priorities Difficulty: expert Category: Unknown 📷 Includes Image
During a winter power outage, a 95-year-old woman is brought to the ED after family ran a gasoline generator in an attached garage for 6 hours. She is somnolent...
A. Treat suspected CO e...
B. Follow pulse oximetr...
C. Order a standard art...
D. Give bronchodilators...
Type: clinical_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A hospital nephrology translational unit runs an IRB‑approved, prospective registry for suspected or biopsy‑proven IgA‑dominant glomerular disease to study inve...
A. Adopt an IRB‑approve...
B. Use the HIPAA right‑...
C. Batch‑upload raw non...
D. Implement an IRB‑app...
Type: legal_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 23-year-old man with biopsy‑proven primary IgA nephropathy 10 months ago (Oxford M1 E0 S1 T1 C0) presents for persistent proteinuria despite optimized support...
A. Discontinue losartan...
B. Start sparsentan 400...
C. Add targeted‑release...
D. Begin high‑dose syst...
Type: treatment_failure Difficulty: hard Category: Unknown 📷 Includes Image
Dialysis technician case conference (United States). A 40‑year‑old woman with end‑stage kidney disease on automated peritoneal dialysis presents to the peritone...
A. Suspend peritoneal d...
B. Suspend peritoneal d...
C. Suspend peritoneal d...
D. Suspend peritoneal d...
Type: complications Difficulty: hard Category: Unknown 📷 Includes Image
A 27-year-old woman presents to the emergency department with 3 weeks of progressively worsening fatigue, pleuritic chest pain, intermittent nosebleeds, dark ur...
A. Granulomatosis with ...
B. Microscopic polyangi...
C. Levamisole-adulterat...
D. Drug-induced ANCA va...
Type: diagnostic_failure Difficulty: hard Category: Pharmacology 📷 Includes Image
An 84‑year‑old man (current smoker 40 pack‑years; tetracycline caused rash) with SLE and biopsy‑proven class IV‑G lupus nephritis was admitted with fever (38.9 ...
A. Add obinutuzumab 100...
B. Administer rituximab...
C. Switch immediately t...
D. Escalate to voclospo...
Type: treatment_failure Difficulty: moderate Category: Unknown 📷 Includes Image
A 65‑year‑old man with a history of abdominal aortic aneurysm repair, prior ventricular fibrillation resuscitated 4 years ago, asthma, and hypersensitivity pneu...
A. Give IV atropine 1 m...
B. Start a long-acting ...
C. Order only inpatient...
D. Give an immediate la...
Type: clinical_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 64‑year‑old woman with mild rheumatic mitral stenosis and remote spontaneous pneumothorax presents with a year of intermittent microscopic hematuria and now r...
A. Proceed with native ...
B. Repeat serum Gd‑IgA1...
C. Order a urine Gd‑IgA...
D. Defer further evalua...
Type: diagnostic_failure Difficulty: hard Category: Unknown 📷 Includes Image
A 4-year-old girl is evaluated at a tertiary pediatric immunology clinic for 9 months of persistent, non-tender generalized lymphadenopathy, intermittent spleno...
A. Repeat high‑quality ...
B. Proceed directly to ...
C. Send a biomarker tri...
D. Order trio whole‑gen...
Type: cost_effectiveness Difficulty: expert Category: Unknown 📷 Includes Image
Near closing time at a busy urgent‑care hub with shared resources, only one portable ultrasound machine and one 12‑lead ECG cart are immediately available. You ...
A. Immediate bedside tr...
B. CT pulmonary angiogr...
C. Full pulmonary funct...
D. Cardiac MRI for Pati...
Type: diagnostic_step Difficulty: easy Category: Unknown 📷 Includes Image
A 59‑year‑old man arrives to the emergency department minutes after abrupt, crushing substernal pain with diaphoresis and dyspnea. He smoked 3 packs/day for dec...
A. A large multicenter ...
B. Instrumental‑variabl...
C. Although 30‑day mort...
D. The randomized trial...
Type: clinical_trials Difficulty: expert Category: Unknown 📷 Includes Image
You are staffing a multidisciplinary memory clinic where two individuals are scheduled back-to-back and both ask about therapeutic plasma exchange (TPE) for dem...
A. Explain that, per 20...
B. State that ASFA 2023...
C. Recommend against TP...
D. Offer TPE broadly ac...
Type: patient_communication Difficulty: moderate Category: Unknown
A 41-year-old woman is rushed to a United States emergency department after slipping at work and sustaining a painful anterior shoulder dislocation while carryi...
A. Ultrasound‑guided su...
B. Ultrasound‑guided su...
C. Combined posterior s...
D. Ultrasound‑guided su...
Type: treatment_failure Difficulty: hard Category: Unknown 📷 Includes Image
An 18-year-old man presents with months of paroxysmal pounding headaches, profuse diaphoresis, palpitations with tremulousness, and episodic pallor followed by ...
A. Immediate propranolo...
B. Add a beta-adrenergi...
C. Initiate doxazosin 1...
D. Use a titratable int...
Type: contraindications Difficulty: moderate Category: Unknown 📷 Includes Image
A 53-year-old woman who works as a surgical technologist presents to the nephrology clinic for evaluation of increasingly difficult-to-control hypertension and ...
A. Personally conduct a...
B. Proceed on the basis...
C. Invoke implied conse...
D. Have the nurse witne...
Type: legal_pitfalls Difficulty: hard Category: Nephrology > Hypertension > Renovascular Hypertension > Fibromuscular Dysplasia Insights 📷 Includes Image
A 30-year-old road worker collapses at an outdoor job site during a heat wave while wearing heavy protective clothing. Coworkers report confusion and stumbling ...
A. Administer acetamino...
B. Start whole‑body ice...
C. Apply mist and fans ...
D. Remove insulating cl...
Type: contraindications Difficulty: easy Category: Unknown 📷 Includes Image
A 12-year-old girl with genetically confirmed multiple endocrine neoplasia type 2B is referred to pediatric nephrology for intermittent cola-colored urine and n...
A. Adopt a tiered, outp...
B. Adopt a tiered, outp...
C. Proceed to early kid...
D. Use an outpatient-fi...
Type: cost_effectiveness Difficulty: expert Category: Unknown 📷 Includes Image
A 50-year-old man, a former smoker who works intermittently in education and is currently unemployed, reports a sudden pop in the right posterior ankle while st...
A. Perform immediate be...
B. Obtain immediate MRI...
C. Apply plantarflexion...
D. Rely on classic clin...
Type: cost_effectiveness Difficulty: hard Category: Unknown 📷 Includes Image
A 56-year-old man presents with 18 hours of acutely painful right knee swelling, erythema, and warmth without trauma. He works in healthcare. Triage recorded a ...
A. Perform urgent bedsi...
B. Start empiric intrav...
C. Perform ultrasound-g...
D. Begin oral prednison...
Type: clinical_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
A 47‑year‑old woman with 15 years of type 2 diabetes complicated by proliferative diabetic retinopathy (laser treated) and multiple endocrine neoplasia type 2A ...
A. Defer a native kidne...
B. Schedule an outpatie...
C. Proceed with an inpa...
D. Arrange an inpatient...
Type: complications Difficulty: moderate Category: Unknown 📷 Includes Image
A 45-year-old man is brought to the emergency department with acute shortness of breath and coughing up bright red blood that began overnight. Over the past wee...
A. Autoantibodies targe...
B. Autoantibodies targe...
C. Autoantibodies targe...
D. Autoantibodies targe...
Type: mechanism Difficulty: moderate Category: Unknown 📷 Includes Image
A 4-year-old boy becomes suddenly more cyanotic and lethargic while crying during a blood draw. The nurse notes that he briefly squats on the gurney and then li...
A. Tetralogy of Fallot ...
B. Transposition of the...
C. Severe bronchiolitis...
D. Primary pulmonary ar...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 60-year-old woman with no known connective tissue disease is transferred for escalation of care after 3 months of progressive exertional dyspnea, now limiting...
A. Pursue germline test...
B. Proceed with video‑a...
C. Undertake diagnostic...
D. Start high‑dose dual...
Type: diagnostic_failure Difficulty: expert Category: Unknown 📷 Includes Image
An 85-year-old man presents for urgent inpatient evaluation of painless gross hematuria that began the morning after an upper‑respiratory syndrome. He has two p...
A. Percutaneous biopsy ...
B. Proceed now with sta...
C. Avoid biopsy entirel...
D. Administer desmopres...
Type: contraindications Difficulty: hard Category: Unknown 📷 Includes Image
A 36-year-old woman on active military reserve duty presents with burning pain and paresthesia radiating down the posterior thigh and lateral calf after receivi...
A. Avoid dorsogluteal i...
B. Continue dorsoglutea...
C. Switch to subcutaneo...
D. Prefer ventrogluteal...
Type: treatment Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old man with cerebral palsy and a history of genital herpes presents to urgent care with unilateral left calf swelling and aching after a 12‑hour car ...
A. Deep veins of the lo...
B. Upper extremity deep...
C. Dural venous sinuses...
D. Portal and mesenteri...
Type: epidemiology Difficulty: easy Category: Unknown 📷 Includes Image
A 33‑year‑old woman presents to the emergency department with eight hours of severe epigastric pain radiating straight through to the back, worse when lying sup...
A. Acute gallstone panc...
B. Acute viral hepatiti...
C. Splenic infarction f...
D. Mechanical small‑bow...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 48-year-old man with biopsy‑proven IgA nephropathy (Oxford M1 E0 S1 T1 C0) and persistent proteinuria presents for management of treatment failure. Past medic...
A. Start sibeprenlimab ...
B. Replace losartan wit...
C. Begin oral iptacopan...
D. Repeat a second cons...
Type: treatment_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 23-year-old woman is brought to the emergency department for 36 hours of intractable nonbloody, nonbilious emesis with early satiety, weakness, and lightheade...
A. Begin isotonic 0.9% ...
B. Infuse lactated Ring...
C. Start 0.45% saline a...
D. Administer acetazola...
Type: clinical_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
A 114-year-old man presents to a community dermatology clinic for a routine visit to review a 9‑month history of skin fragility on the dorsal hands and forearms...
A. Epidermolysis bullos...
B. Bullous pemphigoid w...
C. Porphyria cutanea ta...
D. Dermatitis herpetifo...
Type: differential_comprehensive Difficulty: hard Category: Unknown 📷 Includes Image
A 50-year-old woman with autosomal dominant polycystic kidney disease, distal symmetric peripheral neuropathy, and heart failure with preserved ejection fractio...
A. CT enterography with...
B. MRCP to seek occult ...
C. HIDA scintigraphy to...
D. Upper endoscopy with...
Type: diagnostic_step Difficulty: moderate Category: Unknown 📷 Includes Image
A 40-year-old woman presents to a high-acuity ED for sudden cola-colored urine that began 18 hours after the onset of a sore throat, rhinorrhea, and low-grade m...
A. Proceed with ultraso...
B. Select a transjugula...
C. Defer any biopsy for...
D. Initiate high‑dose i...
Type: differential_physical_history Difficulty: expert Category: Unknown 📷 Includes Image
An 81-year-old man is referred to a multidisciplinary obesity genetics conference after decades of severe obesity and progressive multisystem disease, with the ...
A. Implement a kidney-r...
B. Implement a cardiomy...
C. Implement a vision-l...
D. Implement an obstruc...
Type: prevention Difficulty: expert Category: Unknown 📷 Includes Image
A 27-year-old woman presents to a primary care clinic the day after inverting her right ankle when stepping off a curb while carrying groceries. She finished a ...
A. Apply the Ottawa Ank...
B. Treat as a grade I s...
C. Order urgent MRI of ...
D. Schedule CT angiogra...
Type: emergency_priorities Difficulty: easy Category: Unknown 📷 Includes Image
A 56-year-old woman presents to a rural urgent care in the mountains during an ice storm. Highway closures and rotor‑wing icing delay transfer an estimated 8–12...
A. Recurrent pounding h...
B. Sustained heat intol...
C. Episodic intense fea...
D. Flushing with watery...
Type: features Difficulty: expert Category: Unknown 📷 Includes Image
A 47-year-old G1P0 at 18 weeks’ gestation after IVF is co-managed by nephrology and maternal–fetal medicine for rising proteinuria and intermittent microscopic ...
A. If and only if biops...
B. Schedule a prone per...
C. Avoid kidney biopsy ...
D. Prefer transjugular ...
Type: prevention Difficulty: hard Category: Unknown 📷 Includes Image
A 29-year-old man presents to the ED with escalating deep pain and swelling of the right calf 8 hours after prolonged downhill running in tight compression slee...
A. Avoid dense regional...
B. Place a continuous p...
C. Elevate the limb wel...
D. Begin IV ketorolac a...
Type: clinical_pitfalls Difficulty: hard Category: Unknown 📷 Includes Image
A 26-year-old woman presents to the emergency department with lightheadedness and fatigue. She has Addison's disease on chronic hydrocortisone, chronic spontane...
A. Competitive antagoni...
B. Direct beta-1 adrene...
C. Phosphodiesterase-3 ...
D. Opening cardiac ATP‑...
Type: mechanism Difficulty: easy Category: Unknown 📷 Includes Image
A 50-year-old woman with autoimmune hepatitis (off steroids), prior empyema (resolved), and protein S deficiency presents to the emergency department with fever...
A. Spectrum bias from e...
B. Verification bias fr...
C. Lead-time bias from ...
D. Hawthorne effect fro...
Type: diagnosis Difficulty: moderate Category: Unknown 📷 Includes Image
A 53-year-old man with sarcoidosis (mediastinal lymph node fine-needle aspiration demonstrating noncaseating granulomas) and Sjögren’s syndrome presents to the ...
A. Cellular crescents i...
B. Endocapillary hyperc...
C. Mesangial hypercellu...
D. Segmental glomerulos...
Type: pathology Difficulty: hard Category: Unknown 📷 Includes Image
An African American woman, 51 years old, with cirrhosis from prior hepatitis C successfully treated, reports 3 days of progressive exertional dyspnea, new ortho...
A. Atrial fibrillation ...
B. Typical atrial flutt...
C. Paroxysmal supravent...
D. Multifocal atrial ta...
Type: differential_comprehensive Difficulty: moderate Category: Unknown 📷 Includes Image
A 30-year-old man is brought to the emergency department after developing sudden blurred vision, a severe frontal headache, and a brief generalized tonic–clonic...
A. A lateral-to-umbilic...
B. An early-peaking, pu...
C. A short, midline sys...
D. A posterior costover...
Type: differential_physical_history Difficulty: expert Category: Unknown 📷 Includes Image
An 82-year-old woman with polymyalgia rheumatica on prednisone 5 mg daily, gout, chronic hepatitis B–related cirrhosis (Child–Pugh class B), a remote history of...
A. Proceed urgently wit...
B. Perform PCI by a fem...
C. Defer angiography fo...
D. Use radial access bu...
Type: recent_changes Difficulty: hard Category: Unknown 📷 Includes Image
A 2-year-old boy is seen for frequent runny nose, cough, and ear infections since starting daycare, and for 3 months of intermittent loose stools without blood....
A. Selective IgA defici...
B. Common variable immu...
C. X‑linked agammaglobu...
D. Chronic granulomatou...
Type: differential_comprehensive Difficulty: moderate Category: Unknown 📷 Includes Image
A 53-year-old woman is evaluated in an academic nephrology clinic for a subacute increase in serum creatinine detected on routine outpatient labs. Over 3 weeks ...
A. Obtain a native‑kidn...
B. Send Hansel‑stain ur...
C. Initiate empiric hig...
D. Repeat noncontrast C...
Type: diagnostic_step Difficulty: hard Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 69-year-old woman who works as an inpatient nurse presents to primary care for a routine after-work medication reconciliation and refill review. She is a form...
A. Activate EMS for eme...
B. Initiate EMS transfe...
C. Arrange direct ICU a...
D. Start a nicardipine ...
Type: management Difficulty: expert Category: Unknown 📷 Includes Image
A 32-year-old man with pulmonary hypertension and a recent dental procedure presents with shortness of breath and dizziness. Vital signs: temperature 37.7°C, pu...
A. Methemoglobinemia wi...
B. Carboxyhemoglobinemi...
C. Pulmonary embolism p...
D. Opioid‑induced hypov...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 27-year-old man with known ornithine transcarbamylase deficiency is brought to the emergency department by friends for progressive confusion and vomiting afte...
A. Start IV dextrose wi...
B. Begin lactulose and ...
C. Give high‑protein en...
D. Start broad‑spectrum...
Type: management Difficulty: easy Category: Unknown 📷 Includes Image
A 59-year-old man arrives in the emergency department with progressive dyspnea and right‑sided chest discomfort that worsened over a week. He has a remote histo...
A. Occupational asbesto...
B. Cigarette smoking ap...
C. Mesothelioma typical...
D. Because asbestos min...
Type: epidemiology Difficulty: moderate Category: Unknown 📷 Includes Image
A 48-year-old African American woman with a 15-year history of systemic lupus erythematosus (SLE), long-standing hyperlipidemia, and well-controlled hypertensio...
A. Immune complex–media...
B. Immune complex–media...
C. Immune complex disea...
D. Pauci‑immune necroti...
Type: mechanism Difficulty: hard Category: Nephrology > Hypertension > Endocrine Hypertension Syndromes > Cushing's Syndrome Hypertension 📷 Includes Image
Emergency department. A 47-year-old woman arrives with sudden right-sided pleuritic chest pain and increasing shortness of breath that started while lifting a h...
A. A one‑way pleural ai...
B. Diffuse alveolar dam...
C. Lobar consolidation ...
D. Mucus plugging of se...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 59-year-old man in Minnesota in January reports 3 weeks of profound fatigue, dyspnea with mild uphill walking, episodic dark “cola‑colored” urine after being ...
A. Lower the dialysate ...
B. Maintain an intentio...
C. Prescribe isothermic...
D. If intradialytic hyp...
Type: contraindications Difficulty: hard Category: Unknown 📷 Includes Image
You are participating in a quality-improvement audit at an academic hypertension clinic. Four women with long-standing primary hypertension and angiographically...
A. Patient 1: high diet...
B. Patient 2: regular c...
C. Patient 3: chronical...
D. Patient 4: daily caf...
Type: epidemiology Difficulty: moderate Category: Unknown 📷 Includes Image
A 94-year-old man is admitted to a small critical-access hospital after a displaced intertrochanteric hip fracture from a ground-level fall. According to EMS, n...
A. Begin active rewarmi...
B. Use passive cotton b...
C. Administer additiona...
D. Delay surgery until ...
Type: complications Difficulty: moderate Category: Unknown 📷 Includes Image
An 8-year-old boy with a recent diagnosis of pauci-immune crescentic glomerulonephritis (renal biopsy at a children’s hospital two weeks ago with pauci-immune n...
A. Agree on a written h...
B. Agree on a home plan...
C. Start lisinopril 0.0...
D. Focus on fluids at h...
Type: patient_communication Difficulty: moderate Category: Unknown 📷 Includes Image
A 59-year-old woman is in the ICU after an out-of-hospital cardiac arrest with ROSC following defibrillation for polymorphic ventricular tachycardia in the sett...
A. Repeat the entire BD...
B. Accept the earlier t...
C. Order an immediate a...
D. Defer all testing fo...
Type: legal_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 24-year-old man with newly diagnosed nonischemic heart failure with reduced ejection fraction (LVEF 28% on recent echocardiogram) presents for a routine clini...
A. NT‑proBNP often fall...
B. Meaningful LVEF impr...
C. Guideline therapy ra...
D. Reverse remodeling o...
Type: natural_history Difficulty: moderate Category: Clinical Pathology > Therapeutic plasma exchange > TPE Innovations and Research 📷 Includes Image
Four recruits present to the base clinic after a week of load‑bearing marches. Vitals at triage are stable in all four. Medications used by the group are occasi...
A. Patient C: Sudden ho...
B. Patient A: Inversion...
C. Patient B: Painful r...
D. Patient D: Lateral e...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 55-year-old man with seropositive rheumatoid arthritis on methotrexate 15 mg weekly with folic acid, calcium pyrophosphate deposition disease, silicosis with ...
A. Arrange a transjugul...
B. Proceed with percuta...
C. Delay any biopsy for...
D. Schedule a same‑day ...
Type: contraindications Difficulty: expert Category: Unknown 📷 Includes Image
A 40-year-old woman in her second trimester (22 weeks by dates) presents with acute pleuritic chest pain and shortness of breath that began 3 hours ago while wa...
A. Start therapeutic lo...
B. Delay all treatment ...
C. Give warfarin by mou...
D. Use D‑dimer alone to...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 38-year-old man is brought to the emergency department after a fall on an outstretched hand during a basketball game. His shoulder appears flattened and he ca...
A. Neuropraxic axillary...
B. Immediate complete a...
C. Brachial plexus root...
D. Cervical spinal cord...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 54-year-old man with a 40‑pack‑year smoking history and laryngopharyngeal reflux presents with crushing chest pain of 90 minutes’ duration. Initial ECG shows ...
A. Ischemia‑reperfusion...
B. Persistent epicardia...
C. Diffuse epicardial a...
D. Diffuse myocyte apop...
Type: mechanism Difficulty: hard Category: Unknown 📷 Includes Image
A 28-year-old G2P1 at 22 weeks’ gestation presents with 12 hours of fever, severe headache, photophobia, and neck stiffness. She reports fetal movement and no l...
A. Explain risks, benef...
B. Provide a balanced e...
C. Seek a court order t...
D. Ask her husband to t...
Type: differential_comprehensive Difficulty: easy Category: Unknown 📷 Includes Image
A 46-year-old woman in assisted living presents to finalize therapy for biopsy‑proven IgA nephropathy diagnosed six weeks ago after evaluation for recurrent mic...
A. Obtain and document ...
B. Start targeted‑relea...
C. Initiate sparsentan ...
D. Rely on the assisted...
Type: legal_pitfalls Difficulty: expert Category: Unknown 📷 Includes Image
A 54-year-old woman with a history of osteonecrosis of the hip, prior acute tubular necrosis during septic shock 6 years ago, and treated trichomoniasis present...
A. Induction with ritux...
B. Cyclophosphamide 2 m...
C. Mycophenolate mofeti...
D. Pulse methylpredniso...
Type: treatment Difficulty: hard Category: Unknown 📷 Includes Image
A 4-year-old boy is brought to the emergency department after sudden onset of right‑sided chest pain and progressive shortness of breath while playing. He has n...
A. Rising intrapleural ...
B. Air accumulates in t...
C. Vagal reflex firing ...
D. Acute pulmonary capi...
Type: mechanism Difficulty: easy Category: Unknown 📷 Includes Image
A 27-year-old woman presents for evaluation of recurrent dark, cola-colored urine that typically appears 24–72 hours after uncomplicated upper-respiratory infec...
A. Oral targeted‑releas...
B. Budesonide MMX 9 mg ...
C. Sparsentan initiated...
D. Iptacopan 200 mg ora...
Type: mechanism Difficulty: moderate Category: Unknown 📷 Includes Image
A 62-year-old woman presents with 3 weeks of dark “cola-colored” urine, decreasing urine output, fatigue, and ankle swelling. Four months ago her serum creatini...
A. Obtain baseline hepa...
B. Perform bronchoscopy...
C. Order repeat ANCA ti...
D. Collect a 24-hour ur...
Type: diagnostic_step Difficulty: hard Category: Unknown 📷 Includes Image
An 87-year-old man presents to urgent care the morning after tripping on a curb and striking the outside of his right knee. Since the fall he drags the right fo...
A. Compression or injur...
B. Isolated deep fibula...
C. Tibial nerve injury ...
D. Superficial fibular ...
Type: mechanism Difficulty: easy Category: Unknown 📷 Includes Image
A 47-year-old woman is referred for blood and protein in the urine found on screening. She has no fever, throat pain, or recent travel. She had a small skin abs...
A. Ultrasound‑guided pe...
B. Serum galactose‑defi...
C. Throat culture with ...
D. Repeat endoscopic ul...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 41-year-old woman with idiopathic pulmonary fibrosis presents with 2 weeks of fatigue, darker urine on awakening, and mild periorbital puffiness. Medications ...
A. T cell–mediated dela...
B. Type II antibody‑med...
C. Immune complex–media...
D. Direct, dose‑depende...
Type: mechanism Difficulty: hard Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 34-year-old man presents with 4 days of fever to 40.6°C, chills, malaise, and worsening left knee pain. He denies chest pain but has pleuritic discomfort and ...
A. Transesophageal echo...
B. Repeat transthoracic...
C. 18F‑FDG PET/CT first...
D. Defer all imaging un...
Type: diagnostic_step Difficulty: hard Category: Unknown 📷 Includes Image
An 84-year-old woman in a high‑plains farming community presents to a critical‑access clinic during an ice storm with progressive gait instability, lateral‑hip ...
A. Contralateral pelvic...
B. Difficulty rising fr...
C. Wide‑based gait with...
D. Acute foot drop with...
Type: features Difficulty: expert Category: Unknown 📷 Includes Image
A 29-year-old man presents with a painless midline neck mass that elevates with tongue protrusion and swallowing. He denies fever, weight loss, dysphagia, odyno...
A. Recurrence after inc...
B. Observation is prefe...
C. Simple cyst excision...
D. Needle sclerotherapy...
Type: natural_history Difficulty: moderate Category: Unknown 📷 Includes Image
A 10-year-old girl is brought to the emergency department after a self-limited 1-minute generalized tonic–clonic seizure that was preceded by a severe bifrontal...
A. Magnetic resonance a...
B. Noncontrast MR angio...
C. Low-dose pediatric C...
D. Observation with esc...
Type: treatment_failure Difficulty: moderate Category: Nephrology > Nephrology Imaging > Imaging in Kidney Tumor Identification > Differentiation Between Malignant and Benign Kidney Tumors > Advanced Ultrasound Techniques for Kidney Lesion Differentiation > Contrast-Enhanced Ultrasound Techniques 📷 Includes Image
Four patients arrive during the same overnight shift. The emergency department has one resuscitation bay available for immediate antidotal therapy while others ...
A. Treat Patient A with...
B. Treat Patient B with...
C. Treat Patient C with...
D. Treat Patient D with...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
During a single 12-hour admitting shift you must interpret randomized data on therapeutic plasma exchange (TPE) to allocate ICU time and apheresis resources. P...
A. For severe ANCA-asso...
B. In ANCA-associated d...
C. For lung transplant ...
D. In eosinophilic gran...
Type: clinical_trials Difficulty: hard Category: Unknown 📷 Includes Image
A 48-year-old man presents to the emergency department with fever, shaking chills, and diffuse myalgias beginning this afternoon during his shift in a manufactu...
A. Use balanced crystal...
B. Prefer 0.9% saline f...
C. Begin colloid (album...
D. Delay fluid administ...
Type: clinical_trials Difficulty: moderate Category: Unknown 📷 Includes Image
A 30-year-old woman in her second trimester (24 weeks) presents with paroxysmal headaches, palpitations, diaphoresis, and labile blood pressures recorded at hom...
A. Begin alpha-adrenerg...
B. Initiate beta-blocka...
C. Administer iodine-12...
D. Proceed directly to ...
Type: patient_communication Difficulty: hard Category: Unknown 📷 Includes Image
A 32-year-old woman with a 5-year history of systemic lupus erythematosus (intermittent photosensitive rash and symmetric inflammatory arthritis, presently quie...
A. Pulse intravenous me...
B. Pulse intravenous me...
C. Pulse intravenous me...
D. Pulse intravenous me...
Type: management Difficulty: hard Category: Nephrology > Hypertension > Endocrine Hypertension Syndromes > Cushing's Syndrome Hypertension 📷 Includes Image
A 45-year-old woman with a vegan diet, prior cigarette use (0.5 pack/day for 10 years, quit 15 years ago), and no known allergies is evaluated in nephrology cli...
A. Compared with PR3-AN...
B. After adjusting for ...
C. In MPO-ANCA remissio...
D. Glucocorticoid-spari...
Type: natural_history Difficulty: expert Category: Unknown 📷 Includes Image
A 60-year-old woman with coronary artery disease, protein S deficiency, atopic dermatitis, retinitis pigmentosa, and nephrolithiasis presents for evaluation of ...
A. Aberrant mucosal pro...
B. APRIL‑driven expansi...
C. Soluble CD89–IgA1 co...
D. Neutral‑glycan IgA1 ...
Type: mechanism Difficulty: expert Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 54‑year‑old man is evaluated in an outpatient nephrology clinic after preoperative labs suggested chronic kidney disease. He reports 3 months of progressive a...
A. Arrange within 7 day...
B. Defer biopsy and ins...
C. Avoid biopsy because...
D. Proceed immediately ...
Type: clinical_trials Difficulty: moderate Category: Unknown 📷 Includes Image
A 39-year-old pregnant woman at 28 weeks presents with sudden pleuritic chest pain and shortness of breath that began 1 hour ago while folding laundry. She has ...
A. Order a ventilation–...
B. Order CT pulmonary a...
C. Use D‑dimer testing ...
D. Perform bilateral le...
Type: diagnostic_step Difficulty: moderate Category: Unknown 📷 Includes Image
A 57-year-old man is admitted for hypotension, acute kidney injury, and gross hematuria with a nephritic urine sediment. He has no known allergies. Vital signs:...
A. Record and verify a ...
B. Document that the pa...
C. Check only hepatitis...
D. Obtain a signed gene...
Type: legal_pitfalls Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old woman (body mass index 42 kg/m2) is brought to the emergency department after abruptly awakening with severe shortness of breath and chest pressur...
A. Selective renal digi...
B. Respiratory-gated co...
C. Catheter-based renal...
D. Selective renal angi...
Type: diagnostic_failure Difficulty: expert Category: Unknown 📷 Includes Image
A 44-year-old man presents with 6 days of dark, tea-colored urine, fatigue, and low-grade fevers. Three weeks earlier he returned from Thailand, where he visite...
A. Continuing hydralazi...
B. Stopping hydralazine...
C. Attributing the acut...
D. Omitting inpatient S...
Type: clinical_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
A 59-year-old man is brought from a manufacturing plant after abrupt fever, shaking chills, confusion, left flank pain, and dysuria. He exercises regularly and ...
A. Peripheral vasodilat...
B. Endothelin‑driven sy...
C. Primary myocardial p...
D. Acute pericardial ta...
Type: pathology Difficulty: moderate Category: Unknown 📷 Includes Image
A 24-year-old woman is brought to the emergency department for sudden palpitations, lightheadedness, and mild chest pressure that began 30 minutes ago while wal...
A. Paroxysmal supravent...
B. Sinus tachycardia fr...
C. Atrial fibrillation ...
D. Monomorphic ventricu...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 23-year-old woman who is 9 weeks pregnant comes to clinic with tremor, heat intolerance, palpitations, and weight loss. She has a history of Factor V Leiden t...
A. Start propylthiourac...
B. Start methimazole th...
C. Use radioactive iodi...
D. Treat with propranol...
Type: differential_physical_history Difficulty: easy Category: Unknown 📷 Includes Image
A 73-year-old man with end-stage kidney disease receives thrice-weekly in-center hemodialysis. Since his last treatment 2 days ago, he has gained 3.0 kg and rep...
A. During this 4-hour i...
B. During this 4-hour i...
C. During this 4-hour i...
D. During this 4-hour i...
Type: mechanism Difficulty: easy Category: Unknown 📷 Includes Image
Emergency department, a July evening. A 31-year-old man collapses at work with a sudden, severe retro-orbital headache followed by emesis and difficulty navigat...
A. Noncontrast head CT ...
B. Pituitary‑protocol M...
C. Contrast‑enhanced mu...
D. CT angiography of th...
Type: cost_effectiveness Difficulty: expert Category: Unknown 📷 Includes Image
A 47-year-old man presents to an outpatient reproductive endocrinology clinic for evaluation of 14 months of decreased libido, fewer morning erections, erectile...
A. Obtain two repeat ea...
B. Proceed directly to ...
C. Measure a single ear...
D. Start empiric select...
Type: diagnostic_step Difficulty: expert Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Diagnostic Imaging in MGRS 📷 Includes Image
A 25‑year‑old woman with SLE is admitted to the ICU with 24 hours of dyspnea and oliguria. On arrival: blood pressure 44/27 mm Hg requiring vasopressors, respir...
A. Initiate mycophenola...
B. Start cyclophosphami...
C. Begin voclosporin 23...
D. Administer obinutuzu...
Type: recent_changes Difficulty: expert Category: Unknown 📷 Includes Image
A 12-year-old girl with no chronic illnesses presents with sudden palpitations and mild shortness of breath that began during a school basketball game. She deni...
A. Give adenosine 0.1 m...
B. Proceed directly to ...
C. Administer amiodaron...
D. Start metoprolol tar...
Type: recent_changes Difficulty: easy Category: Unknown 📷 Includes Image
A 57-year-old man with known Brugada syndrome, bulimia nervosa, varicocele, congestive heart failure, social anxiety disorder, multiple endocrine neoplasia type...
A. Administer a sodium‑...
B. Schedule an exercise...
C. Order a laryngoscopy...
D. Arrange fluorescein ...
Type: differential_testing Difficulty: easy Category: Unknown 📷 Includes Image
A 4-year-old boy is brought for a well‑child visit. Parents report normal growth and activity. He has spastic diplegic cerebral palsy with good mobility using a...
A. Innocent Still’s mur...
B. Small ventricular se...
C. Atrial septal defect...
D. Hypertrophic cardiom...
Type: differential_physical_history Difficulty: easy Category: Unknown 📷 Includes Image
A 36-year-old woman is referred for evaluation of swelling around the eyes in the morning and increasing ankle swelling over the past month. She notes foamy uri...
A. Primary (immune‑medi...
B. Minimal change disea...
C. PLA2R‑associated mem...
D. IgA nephropathy with...
Type: diagnosis Difficulty: moderate Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 32-year-old man is brought to the emergency department after suddenly collapsing while watching television. He has a history of heart failure with preserved e...
A. Without early restor...
B. In many young adults...
C. Blocking the anterio...
D. A tear in a single v...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 31-year-old woman presents to the emergency department with 5 days of malaise, pruritic erythematous macules over the trunk, decreased urine output, and dull ...
A. Stop omeprazole and ...
B. Stop both omeprazole...
C. Stop both omeprazole...
D. Treat for presumed o...
Type: emergency_priorities Difficulty: hard Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 51-year-old woman with focal segmental glomerulosclerosis (baseline creatinine 1.2 mg/dL) and history of severe combined immunodeficiency status post hematopo...
A. Perform emergent fou...
B. Elevate the limb abo...
C. Start full‑dose anti...
D. Administer high‑dose...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 30-year-old former industrial hygienist with biopsy-confirmed IgA nephropathy (MEST‑C M1 E0 S1 T0 C0) seeks evaluation for fluctuating albuminuria despite adh...
A. Obtain two consecuti...
B. Use Bayesian‑adjuste...
C. Adopt an AI model th...
D. Perform ambulatory b...
Type: diagnostic_step Difficulty: expert Category: Unknown 📷 Includes Image
A 7-year-old girl has 6 months of intensely itchy eczematous plaques on both earlobes around pierced studs, a plaque beneath the periumbilical jeans snap, and a...
A. Perform standardized...
B. Order skin‑prick tes...
C. Stop all topical cor...
D. Schedule a punch or ...
Type: clinical_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
An 8-year-old girl presents with 2 days of right‑sided chest pain that worsens with deep breaths and a dry cough. She has type 1 diabetes treated with basal‑bol...
A. Bronchial breath sou...
B. Hyperresonance to pe...
C. Stony dullness to pe...
D. Diffuse expiratory w...
Type: differential_physical_history Difficulty: easy Category: Unknown 📷 Includes Image
A 23-year-old man with type 1 diabetes mellitus and congenital aortic stenosis collapses at home with palpitations and lightheadedness during a viral illness wi...
A. Facial flushing is t...
B. Chest discomfort mos...
C. Dyspnea is the most ...
D. Headache is the most...
Type: epidemiology Difficulty: easy Category: Unknown 📷 Includes Image
Four patients arrive to the emergency department within one hour of each other for hematemesis or melena. All are hemodynamically monitored and receive large-bo...
A. The patient with dai...
B. The patient with pos...
C. The patient with rep...
D. The patient with cir...
Type: mechanism Difficulty: moderate Category: Unknown 📷 Includes Image
An 8-year-old girl presents for a routine outpatient visit to complete school health forms and to reconcile her chart. Past records from a children’s hospital d...
A. Chart the low finger...
B. Diagnose chronic hyp...
C. Delete the abnormal ...
D. Order arterial blood...
Type: legal_pitfalls Difficulty: moderate Category: Unknown 📷 Includes Image
A 34-year-old construction worker presents to the emergency department after twisting his right knee while stepping off a scaffold. He heard a pop, felt immedia...
A. Complete common fibu...
B. Isolated superficial...
C. Absent tibialis ante...
D. Complete palsy but p...
Type: natural_history Difficulty: hard Category: Unknown 📷 Includes Image
An 86-year-old woman presents for evaluation of 8 months of fatigue and urine that turns tea‑colored for 1–2 days after head colds. She has had microscopic hema...
A. Primary IgA nephropa...
B. Infection‑related Ig...
C. Thin basement membra...
D. Immune complex–media...
Type: diagnosis Difficulty: moderate Category: Nephrology > Monoclonal gammopathy of renal significance (MGRS) > Epidemiology of MGRS 📷 Includes Image
A 22-year-old man presents with 48 hours of rapidly progressive limb weakness and dysphagia following watery diarrhea one week ago. He received an inactivated i...
A. Begin therapeutic pl...
B. Perform four exchang...
C. Administer IV immuno...
D. Use two exchanges of...
Type: management Difficulty: moderate Category: Unknown 📷 Includes Image
A 38-year-old G2P1 at 24 weeks’ gestation is seen in a combined maternal–fetal medicine and nephrology clinic for 10 days of malaise, reduced appetite, and decr...
A. Stop amoxicillin–cla...
B. Start oral prednisol...
C. Begin mycophenolate ...
D. Defer all immunomodu...
Type: treatment Difficulty: moderate Category: Nephrology > Glomerulonephritis > Parasitic Infection GN 📷 Includes Image
A 38-year-old man of West African ancestry presents to a community nephrology clinic with 6 weeks of progressive periorbital puffiness, foamy urine, and bilater...
A. Interferon‑driven up...
B. Autosomal‑dominant I...
C. TRPC6 channel gain‑o...
D. PLA2R‑mediated subep...
Type: mechanism Difficulty: hard Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 48-year-old woman with heart failure with preserved ejection fraction (HFpEF) reports escalating bilateral knee and lower-back pain after lifting boxes at hom...
A. Schedule acetaminoph...
B. Start ibuprofen 600 ...
C. Stop buprenorphine–n...
D. Begin intravenous ke...
Type: treatment Difficulty: hard Category: Unknown 📷 Includes Image
A 43-year-old man is brought by his partner for 7 weeks of very fast memory loss, clumsiness, and sudden arm jerks set off by sounds. He now knows his name but ...
A. This is a fast and f...
B. Because some immune ...
C. Giving intravenous i...
D. Urgent plasma exchan...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 38-year-old woman comes to a rural outpatient clinic for follow-up of persistently elevated home blood-pressure readings (160–175/100–110 mm Hg) despite adher...
A. I hear your concern ...
B. Your insurance only ...
C. Every young woman wi...
D. Let’s just wait unti...
Type: patient_communication Difficulty: hard Category: Biochemistry > Clinical Biochemistry 📷 Includes Image
A 68-year-old woman comes to a hospital clinic for a routine visit to review medicines. As a child she had a serious immune problem and received a bone marrow t...
A. Pneumocystis lung in...
B. Community lung infec...
C. Severe C. difficile ...
D. Shingles meningitis ...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 30‑year‑old woman underwent total thyroidectomy earlier today for a large multinodular goiter. Forty‑five minutes after arrival to the post‑anesthesia care un...
A. Rapidly expanding po...
B. Acute bilateral recu...
C. Pulmonary embolism p...
D. Acute hypocalcemia f...
Type: complications Difficulty: easy Category: Unknown 📷 Includes Image
A 35-year-old woman comes to the emergency department because of severe, throbbing headaches and brief episodes of blurred vision that have been getting worse o...
A. Scarring in the midd...
B. Fatty plaque in the ...
C. Widespread vessel wa...
D. Cheese-like granulom...
Type: pathology Difficulty: easy Category: Unknown 📷 Includes Image
A 32-year-old man with a high-sodium diet is referred for evaluation of long-standing, treatment-refractory hypertension. Over 4 years he has had progressive mo...
A. Unilateral aldostero...
B. Bilateral idiopathic...
C. Liddle syndrome due ...
D. Apparent mineralocor...
Type: differential_physical_history Difficulty: expert Category: Unknown 📷 Includes Image
A 45-year-old woman with multiple sclerosis, prior spontaneous pneumothorax, moderate aortic stenosis, and maple syrup urine disease returns from travel in Asia...
A. STAT serum TSH with ...
B. Order a TSH‑with‑ref...
C. Send free T4 and fre...
D. Obtain reverse T3 wi...
Type: differential_testing Difficulty: expert Category: Unknown 📷 Includes Image
A 60-year-old man with known homocystinuria and stage 3 chronic kidney disease presents to the ED with sudden generalized weakness. Vital signs: pulse 112/min, ...
A. Give intravenous cal...
B. Start insulin regula...
C. Arrange urgent hemod...
D. Administer oral sodi...
Type: emergency_priorities Difficulty: easy Category: Unknown 📷 Includes Image
A 45-year-old man presents to a nurse-run critical access clinic in a mountain town during a snow and ice storm that has grounded air transport and closed the m...
A. Use a clear stop mes...
B. Tell him to stop dap...
C. Advise reducing the ...
D. Reassure him that th...
Type: patient_communication Difficulty: moderate Category: Unknown 📷 Includes Image
A 17-year-old boy with painful oral and scalp erosions is diagnosed with moderate-to-severe pemphigus vulgaris after lesional histology shows suprabasal acantho...
A. In a randomized tria...
B. The trial reported c...
C. Rituximab was inferi...
D. Mycophenolate mofeti...
Type: clinical_trials Difficulty: easy Category: Unknown
A 32-year-old man with chronic obstructive pulmonary disease diagnosed by prior spirometry, obstructive sleep apnea on CPAP, and chronic sinusitis presents to t...
A. Titrate supplemental...
B. Apply a non‑rebreath...
C. Withhold any supplem...
D. Start noninvasive ve...
Type: management Difficulty: easy Category: Unknown 📷 Includes Image
A 46‑year‑old man who works as a long‑distance truck driver is seen in a small community hospital where cystatin C testing is not available and transfer is dela...
A. Estimate GFR with th...
B. Prefer MDRD with rac...
C. Dose drugs by Cockcr...
D. Screen using urine d...
Type: recent_changes Difficulty: moderate Category: Unknown 📷 Includes Image
A 42-year-old woman is admitted to a U.S. medical ICU with escalating dyspnea, abdominal distension, and rapid weight gain after 6 weeks of worsening edema and ...
A. After sustained pres...
B. Once pressor-free an...
C. After hemodynamic st...
D. Following vasopresso...
Type: management Difficulty: expert Category: Nephrology > Hypertension > Renovascular Hypertension > Screening and Risk Assessment 📷 Includes Image
A 28-year-old woman is evaluated for persistent hypertension. Ten months ago, hydrochlorothiazide was titrated to 50 mg once daily. Eight weeks later, amlodipi...
A. Perform percutaneous...
B. Add spironolactone 2...
C. Perform percutaneous...
D. Schedule surgical ao...
Type: treatment Difficulty: easy Category: Nephrology > Nephrology Imaging > Kidney lesions on ultrasound > Solid Mass Detection 📷 Includes Image
A 49-year-old woman presents with acute dyspnea and perioral cyanosis that began at rest after a week of bed rest for a viral syndrome. She is anxious but orien...
A. Stop high‑dose bioti...
B. Begin methimazole wi...
C. Order a radioactive ...
D. Ignore the supplemen...
Type: recent_changes Difficulty: moderate Category: Unknown 📷 Includes Image
A 30-year-old woman with SLE and a history of class III lupus nephritis in sustained remission for 18 months presents for routine prenatal care at 10 weeks’ ges...
A. Live birth is likely...
B. Maternal renal failu...
C. Live birth is likely...
D. Quiescence eliminate...
Type: natural_history Difficulty: easy Category: Unknown 📷 Includes Image
A 22-year-old woman with autoimmune hepatitis on azathioprine 50 mg daily, remote hepatitis B infection (childhood treatment; HBsAg negative, anti‑HBs positive)...
A. Report the exposure ...
B. Report a cumulative ...
C. Report a prevalence ...
D. Report a hazard rati...
Type: epidemiology Difficulty: moderate Category: Unknown 📷 Includes Image
A 52-year-old man with multiple endocrine neoplasia type 2B status post total thyroidectomy (on levothyroxine) presents with sudden right-sided pleuritic chest ...
A. Right tension pneumo...
B. Large right simple p...
C. Massive right hemoth...
D. Cardiac tamponade du...
Type: diagnosis Difficulty: easy Category: Unknown 📷 Includes Image
A 56-year-old man who preps food on long standing shifts and often rests with his right leg crossed over the left on a low stool develops abrupt right foot slap...
A. Common fibular (pero...
B. Isolated deep fibula...
C. Anterior tarsal tunn...
D. Peroneal-division sc...
Type: differential_comprehensive Difficulty: expert Category: Unknown 📷 Includes Image
You are asked to see a 29-year-old woman, 32 weeks pregnant with her first child, who presents to the obstetric triage unit with 3 days of progressive shortness...
A. Transthoracic echoca...
B. Serum NT‑proBNP leve...
C. CT pulmonary angiogr...
D. Treadmill exercise s...
Type: differential_testing Difficulty: easy Category: Clinical Pathology > Therapeutic plasma exchange > TPE Innovations and Research 📷 Includes Image
A 54-year-old woman presents to a rural critical-access hospital with leg swelling and nocturia. The facility has intermittent internet, limited subspecialty co...
A. Avoid initiating voc...
B. Avoid belimumab IV s...
C. Avoid any calcineuri...
D. Withhold all immunos...
Type: contraindications Difficulty: expert Category: Unknown 📷 Includes Image
A 28‑year‑old pregnant woman at 14 weeks’ gestation (G1P0) with SLE and prior ISN/RPS class IV‑S lupus nephritis achieved complete renal response 18 months ago ...
A. Continue hydroxychlo...
B. Start belimumab IV 1...
C. Add voclosporin 23.7...
D. Stop all immunosuppr...
Type: natural_history Difficulty: expert Category: Unknown 📷 Includes Image
Four adults present to a hospital‑affiliated primary care clinic for same‑day health maintenance. The nurse must choose one vaccine action to complete today tha...
A. Administer a single ...
B. Give PCV15 today to ...
C. Administer PCV20 tod...
D. Prioritize starting ...
Type: complications Difficulty: hard Category: Unknown 📷 Includes Image
A 19-year-old male presents for a routine outpatient fertility evaluation after 18 months of infertility with his 19-year-old partner. He reports a long-standin...
A. Offer microsurgical ...
B. Offer laparoscopic a...
C. Proceed with transve...
D. Perform microsurgica...
Type: management Difficulty: expert Category: Unknown
A 32-year-old woman with congestive heart failure from prior myocarditis, bronchiolitis obliterans with chronic cough, and nasal polyps presents to urgent care ...
A. Calculate post-test ...
B. Order imaging immedi...
C. Rely on sensitivity ...
D. Repeat the same test...
Type: diagnostic_step Difficulty: easy Category: Unknown 📷 Includes Image
A 20-year-old woman comes to clinic for a routine physical before starting a new semester. She has no medical complaints. Vitals: pulse 97 bpm, temperature 36.0...
A. About 90% of people ...
B. Roughly 30% of label...
C. Only about 5% of lab...
D. Nearly all—around 99...
Type: epidemiology Difficulty: easy Category: Unknown 📷 Includes Image
A 37-year-old woman comes to a community clinic serving a remote mountain area because of new itchy blisters on her abdomen and thighs for three weeks. She work...
A. Perilesional 3–5 mm ...
B. Edge-of-blister biop...
C. Bedside Tzanck smear...
D. Serum tryptase level...
Type: diagnostic_failure Difficulty: easy Category: Unknown 📷 Includes Image
A 36-year-old woman at 28 weeks’ gestation (G2P1) is transferred to a tertiary obstetric service with 48 hours of dark, tea‑colored urine following a febrile ph...
A. IgA nephropathy flar...
B. Superimposed atypica...
C. Acute bacterial urin...
D. New‑onset class III/...
Type: differential_comprehensive Difficulty: expert Category: Unknown 📷 Includes Image
A 78-year-old woman with known congenital thrombotic thrombocytopenic purpura (documented ADAMTS13 mutations with chronically undetectable activity) presents to...
A. Administer recombina...
B. Initiate daily 1.0–1...
C. Premedicate and use ...
D. Start caplacizumab 1...
Type: recent_changes Difficulty: expert Category: Unknown 📷 Includes Image