wayground logo

Free Printable Worksheets

Font size

S
M
L
XL
Worksheets

Page 1

Total questions: 140

Worksheet time: 1hrs 10mins

Name
Class
Date
1.

In essential hypertension, the renal pressure–natriuresis curve shifts rightward. What is the immediate functional consequence of this shift?

a)

Higher arterial pressures are required to achieve the same sodium excretion

b)

Cardiac output reduction lessens compensatory natriuresis need

c)

Peripheral vascular resistance falls to prevent pressure-induced renal injury

d)

Kidneys excrete sodium adequately at lower arterial pressures

2.

A 68-year-old man with atherosclerosis has critical stenosis of the right renal artery. Despite a structurally normal left kidney, he develops severe resistant hypertension. What is the most appropriate physiological explanation?

a)

Stenosis completely blocks glomerular filtration in both kidneys increasing plasma volume

b)

Unilateral low renal flow triggers massive renin release sustaining systemic RAAS

c)

The affected kidney produces less renin because hypoperfusion reduces natriuresis

d)

The normal kidney reduces sodium excretion from systemic pressure rise

3.

A patient with an aldosterone-producing adenoma has hypertension, muscle weakness, and metabolic alkalosis. What key mechanism explains this presentation?

a)

RAAS activation with high renin stimulating aldosterone secretion

b)

Autonomous aldosterone elevating sodium reabsorption and potassium excretion

c)

Intravascular volume loss from renal sodium wasting raising peripheral resistance

d)

Renal prostaglandin increase boosting tubular flow and potassium loss

4.

A 68-year-old man presents with clinic blood pressure of 194/112 mmHg, asymptomatic, with no acute target-organ damage. According to AHA 2025 guidance, what is the initial management?

a)

Immediate intravenous nitroprusside administration

b)

Begin oral combination therapy and close follow-up within days

c)

Urgent ICU admission for arterial line monitoring

d)

High-dose loop diuretic for rapid volume reduction

5.

Which change best describes the pressure–natriuresis relationship in essential hypertension?

a)

Rightward shift requiring higher pressures for natriuresis

b)

No shift because natriuresis is pressure independent

c)

Leftward shift with increased sodium sensitivity

d)

Vertical upward shift indicating higher sodium excretion at any pressure

6.

Unilateral renal artery stenosis most often leads to which endocrine profile?

a)

Low renin, low aldosterone, metabolic acidosis

b)

High renin, high aldosterone, hypokalemia

c)

High renin, low aldosterone, hyponatremia

d)

Normal renin, high aldosterone, hyperkalemia

7.

Primary aldosteronism typically produces which electrolyte and acid–base pattern?

a)

Hyperkalemia with metabolic acidosis

b)

Normokalemia with respiratory alkalosis

c)

Hypernatremia with metabolic acidosis

d)

Hypokalemia with metabolic alkalosis

8.

In hypertensive emergencies, which finding mandates immediate IV antihypertensive therapy rather than outpatient management?

a)

Severely elevated blood pressure without symptoms

b)

Acute pulmonary edema with dyspnea and hypoxia

c)

Stable chronic kidney disease stage 3

d)

Age over 65 with isolated systolic hypertension

9.

Which agent is most appropriate for rapid BP control in hypertensive emergency complicated by aortic dissection?

a)

Hydralazine IM given in clinic

b)

Immediate-release nifedipine monotherapy

c)

Intravenous labetalol with prompt beta-blockade

d)

Oral ACE inhibitor titrated over days

10.

In primary aldosteronism, why does metabolic alkalosis occur?

a)

Renin lowers bicarbonate reabsorption in proximal tubule

b)

Sodium wasting raises bicarbonate generation systemically

c)

Aldosterone increases hydrogen secretion in collecting ducts

d)

Prostaglandins inhibit distal H+ secretion causing alkalosis

11.

Un paciente de 55 años presenta PA 150/92 mmHg en mediciones repetidas, sin comorbilidades. Según las guías AHA, ¿cuál es el manejo inicial recomendado?

a)

Reducir la PA a <140/90 mmHg en la primera hora

b)

Iniciar o intensificar antihipertensivo oral y reducir la PA gradualmente en 24–48 h

c)

Pedir TAC de cráneo y enviarlo a emergencias siempre

d)

Suspender todo antihipertensivo y observar 7 días

12.

Un paciente recibe tres fármacos a dosis óptimas: un IECA, un calcioantagonista y clortalidona. Su PA continúa en 156/94 mmHg. Según AHA 2025, ¿cuál es el siguiente paso terapéutico recomendado?

a)

Añadir espironolactona

b)

Iniciar hidralazina

c)

Añadir un betabloqueador

d)

Sustituir clortalidona por hidroclorotiazida

13.

Paciente de 72 años con hipertensión grado 2 y ERC estadio 3b. Está con losartán 100 mg/día y amlodipino 10 mg/día, PA aún en 152/88 mmHg. Según AHA 2025, ¿cuál es el siguiente paso terapéutico más adecuado?

a)

Iniciar espironolactona en dosis bajas

b)

Añadir diurético de asa por la función renal

c)

Cambiar losartán por un betabloqueador

d)

Añadir diurético tiazídico (clortalidona)

14.

Un paciente de 72 años con enfermedad renal crónica estadio 3a presenta hipertensión persistente pese a IECA y calcioantagonista, con hiperactividad del sistema renina–angiotensina–aldosterona. ¿Qué mecanismo contribuye de forma más directa al mantenimiento de la hipertensión?

a)

Disminución del retorno venoso por vasodilatación sistémica

b)

Aumento de la reabsorción tubular de sodio mediada por aldosterona

c)

Inhibición de la secreción de ADH por sobrecarga de volumen

d)

Reducción del volumen plasmático por vasoconstricción renal

15.

¿Cuál es el objetivo de reducir la PA gradualmente en 24–48 horas en hipertensión sin emergencia?

a)

Evitar taquifilaxia a los betabloqueadores

b)

Acelerar la diuresis forzada inmediata

c)

Facilitar la retirada rápida del IECA

d)

Prevenir hipoperfusión cerebral y renal

16.

En terapia antihipertensiva resistente con IECA, calcioantagonista y tiazida, ¿por qué la espironolactona es preferida como cuarto fármaco?

a)

Antagoniza aldosterona y reduce reabsorción de sodio

b)

Aumenta vasodilatación cerebral selectiva profunda

c)

Estimula liberación de renina pancreática primaria

d)

Bloquea receptores alfa-1 de forma irreversible

17.

En ERC estadio 3b, ¿por qué se prefiere un diurético de asa frente a una tiazida para control de PA?

a)

Incremento de síntesis de bradicinina

b)

Efecto directo sobre receptores AT1

c)

Menor riesgo de hipokalemia severa

d)

Mayor eficacia con TFG reducida

18.

Al cambiar clortalidona por hidroclorotiazida en hipertensión resistente, ¿qué efecto es más probable?

a)

Mejoría sustancial de PA sostenida

b)

Aumento marcado de función renal

c)

Corrección inmediata de hiponatremia

d)

Reducción similar o menor de PA

19.

En el contexto de RAAS hiperactivo, ¿qué cambio fisiológico esperas tras iniciar un antagonista de aldosterona?

a)

Disminución de reabsorción de sodio en túbulo colector

b)

Aumento del tono simpático periférico sostenido

c)

Incremento de vasoconstricción glomerular severa

d)

Potenciación de secreción de ADH central

20.

Para un paciente sin signos de daño a órgano diana y PA 150/92 mmHg, ¿qué conducta se debe evitar?

a)

Derivar a emergencias para TAC de cráneo

b)

Ajustar tratamiento y reducir PA en 24–48 horas

c)

Iniciar antihipertensivo oral con seguimiento cercano

d)

Educar sobre adherencia y monitoreo domiciliario

21.

For an adult with newly diagnosed hypertension and no compelling indications, what is the recommended initial management strategy?

a)

Start beta‑blocker monotherapy immediately

b)

Only lifestyle changes without medications

c)

Begin one or two antihypertensives plus lifestyle changes

d)

Wait six months and reassess without therapy

22.

Which antihypertensive drug class is NOT considered first‑line therapy in adults?

a)

Thiazide diuretics as foundational agents

b)

ACE inhibitors for renin‑angiotensin blockade

c)

Angiotensin receptor blockers for RAAS modulation

d)

Beta‑blockers as routine initial therapy

23.

What blood pressure target is recommended for most treated adults according to AHA guidance?

a)

Less than 120/70 mmHg universally

b)

Less than 130/80 mmHg routinely

c)

Less than 140/90 mmHg consistently

d)

Less than 150/90 mmHg overall

24.

Choose the statement that correctly distinguishes persistent from refractory hypertension.

a)

Persistent remains high on two drugs; refractory requires three including a diuretic

b)

Persistent due to poor adherence; refractory always has secondary cause

c)

Persistent elevated only in clinic; refractory elevated outside clinic

d)

Persistent misses goals despite three drugs; refractory despite five including thiazide and aldosterone antagonist

25.

A patient presents with elevated office blood pressures. What is the first step in diagnostic evaluation?

a)

Schedule a treadmill stress test

b)

Confirm elevation with repeated measures and ambulatory or home monitoring

c)

Start immediate pharmacologic treatment

d)

Order renal imaging studies promptly

26.

In older adults or those with eGFR around 40 mL/min, why is sacubitril/valsartan often initiated at a lower dose?

a)

Accelerated hepatic metabolism requires adjustment

b)

Greater risk of hypotension and renal deterioration

c)

Higher risk of hypoglycemia in this population

d)

Reduced clinical efficacy at standard doses

27.

When defining refractory hypertension, which combination is specifically included at adequate doses?

a)

Thiazide diuretic and aldosterone antagonist included

b)

Loop diuretic and beta‑blocker combination therapy

c)

Calcium channel blocker and ACE inhibitor only

d)

Direct renin inhibitor with alpha‑blocker

28.

Which step should be prioritized before labeling a patient as having persistent hypertension?

a)

Start five medications at low doses

b)

Confirm with multiple readings and out‑of‑office monitoring

c)

Assess adherence but skip ambulatory monitoring

d)

Exclude all secondary causes immediately

29.

For most adults under treatment, what is the preferred systolic/diastolic target threshold?

a)

Under 120/70 mmHg to maximize benefit

b)

Under 150/90 mmHg to reduce events

c)

Under 140/90 mmHg for simplicity

d)

Under 130/80 mmHg for optimal control

30.

Which statement best reflects current first‑line choices for adult hypertension therapy?

a)

Direct renin inhibitors are universally first‑line

b)

Beta‑blockers and alpha‑blockers are preferred initially

c)

All classes are equally recommended to start

d)

Thiazides, ACE inhibitors, and ARBs are first‑line; beta‑blockers are not

31.

Which of the following is an absolute contraindication to initiating sacubitril/valsartan?

a)

Mild hypotension (BP 95/60 mmHg)

b)

Mild hyperkalemia

c)

eGFR of 35 mL/min

d)

Pregnancy

32.

In which patient is SGLT2 inhibitor use contraindicated due to lack of efficacy and higher adverse event risk?

a)

eGFR 80 mL/min

b)

eGFR 32 mL/min

c)

eGFR 55 mL/min

d)

eGFR 18 mL/min

33.

A patient with type 2 diabetes, eGFR 40 mL/min, and prior HFrEF is started on an SGLT2 inhibitor despite HbA1c at goal. What is the primary reason?

a)

Increase eGFR substantially in the short term

b)

Improve glycemic control when HbA1c is already at target

c)

Prevent hypoglycemia during insulin therapy

d)

Reduce heart failure hospitalizations and slow renal disease

34.

Which statement best defines Diabetes Mellitus?

a)

A cluster of metabolic disorders whose common feature is hyperglycemia

b)

A condition with exclusively autoimmune and hereditary origins

c)

A group of metabolic disorders with a hypoglycemia phenotype

d)

An endocrine disorder only due to absolute insulin deficiency

35.

Type 1 Diabetes Mellitus is primarily characterized by:

a)

Glucose intolerance that typically manifests after age forty

b)

Destruction of pancreatic beta cells causing absolute or near-total insulin deficiency

c)

Peripheral insulin resistance and increased hepatic glucose output

36.

For a patient with HFrEF being considered for sacubitril/valsartan, which lab abnormality would most strongly caution against initiation?

a)

Severe hyperkalemia with ECG changes

b)

Mild hyponatremia without symptoms

c)

Borderline low blood pressure, asymptomatic

d)

Slightly elevated creatinine above baseline

37.

Which eGFR threshold most commonly signals reduced glycemic efficacy of SGLT2 inhibitors while cardio-renal benefits may persist?

a)

Near 30 mL/min/1.73 m²

b)

Below 20 mL/min/1.73 m²

c)

Around 45 mL/min/1.73 m²

d)

Above 60 mL/min/1.73 m²

38.

In T2DM with established HFrEF and CKD stage 3b, what outcome shows the most consistent benefit from SGLT2 inhibitors?

a)

Rapid HbA1c reduction over three months

b)

Increase in insulin secretion from beta cells

c)

Fewer heart failure hospitalizations and slower CKD progression

d)

Normalization of blood pressure within days

39.

Which pathophysiologic feature distinguishes Type 1 from Type 2 Diabetes Mellitus?

a)

Genetic monogenic defects of insulin receptor signaling

b)

Isolated hepatic insulin resistance with normal beta cells

c)

Primary insulin resistance with compensatory hyperinsulinemia

d)

Autoimmune beta-cell destruction leading to absolute insulin deficiency

40.

A 28-year-old with new-onset hyperglycemia, low C-peptide, and positive GAD antibodies most likely has:

a)

Maturity-onset diabetes of the young with receptor mutation

b)

Type 1 Diabetes Mellitus due to autoimmune beta-cell loss

c)

Stress hyperglycemia from acute illness only

d)

Type 2 Diabetes Mellitus with insulin resistance

41.

Type 2 diabetes is best characterized by which pathophysiologic pattern?

a)

Exclusive lipid metabolism defect

b)

Permanent hypersecretion of insulin

c)

Insulin resistance with lower secretion

d)

Absolute insulin deficiency early

42.

For most adults with type 2 diabetes, what HbA1c goal is generally recommended when hypoglycemia risk is low?

a)

Less than 5.5 percent

b)

Less than 6.0 percent universally

c)

Less than 7.0 percent if low risk

d)

Less than 8.5 percent always

43.

In patients with diabetes, which blood pressure target is commonly recommended by current guidelines?

a)

Below 150 over 90 mmHg

b)

Below 120 over 70 mmHg

c)

Below 140 over 90 mmHg

d)

Below 130 over 80 mmHg

44.

An adult with type 2 diabetes and high cardiovascular risk should aim for what LDL-cholesterol level?

a)

Under 130 mg/dL

b)

Under 100 mg/dL

c)

Under 70 mg/dL

d)

Under 55 mg/dL

45.

Which medication class for type 2 diabetes reduces risk of heart failure and slows kidney disease progression, beyond glycemic control?

a)

Metformin therapy

b)

DPP-4 inhibitors

c)

SGLT2 inhibitors

d)

Sulfonylureas

46.

Which feature distinguishes type 2 diabetes from type 1 in early disease?

a)

Ketosis-prone presentation

b)

Insulin resistance predominating

c)

Autoimmune beta-cell destruction

d)

Complete insulin absence early

47.

Selecting HbA1c targets requires balancing benefits and risks. Which option reflects individualized care when hypoglycemia risk is high?

a)

Fixed target below 5.5 percent

b)

Relaxed target due to risk

c)

Universal target below 7 percent

d)

Aggressive target below 6 percent

48.

For a 62-year-old with diabetes and albuminuria, which blood pressure goal aligns with guideline-based cardiovascular protection?

a)

Below 135 over 85 mmHg

b)

Below 130 over 80 mmHg

c)

Below 150 over 90 mmHg

d)

Below 140 over 90 mmHg

49.

A patient’s LDL is 82 mg/dL with high ASCVD risk. What is the next best step regarding lipid lowering?

a)

No change, already optimal

b)

Aim for less than 100 mg/dL

c)

Target under 130 mg/dL

d)

Intensify to under 70 mg/dL

50.

Among common glucose-lowering agents, which option offers cardiorenal benefits independent of HbA1c reduction?

a)

Metformin monotherapy

b)

Short-acting insulin

c)

DPP-4 inhibitor therapy

d)

SGLT2 inhibitor therapy

51.

Which class of antidiabetic drugs is referred to as "gliflozins" and acts by inhibiting renal glucose reabsorption?

a)

Inhibitors SGLT2 called gliflozins

b)

Thiazolidinediones activate PPAR-γ

c)

DPP-4 inhibitors prolong incretins

d)

Sulfonylureas increase insulin release

52.

A newly diagnosed type 2 diabetes patient with HbA1c of 9.2% needs initial therapy. What is the most recommended first step?

a)

Begin metformin as monotherapy

b)

Initiate dual therapy with metformin plus drug

c)

Start basal insulin immediately

d)

Start lifestyle modification alone

53.

In a patient with type 2 diabetes, obesity, and heart failure with reduced ejection fraction, adding an SGLT2 inhibitor provides which main physiological benefit?

a)

Improve skeletal muscle insulin sensitivity

b)

Reduce proximal glucose–sodium reabsorption lowering preload

c)

Increase pancreatic insulin secretion

d)

Raise sodium reabsorption to prevent hypovolemia

54.

What is the principal determinant of the glomerular filtration rate (GFR)?

a)

Glomerular hydrostatic pressure

b)

Plasma sodium concentration

c)

Tubular permeability

d)

Renal sympathetic activity

55.

Systemic arterial pressure rise does not significantly increase GFR primarily because which mechanism buffers glomerular perfusion?

a)

Enhanced proximal tubular sodium uptake

b)

Myogenic response of afferent arteriole

c)

Activation of sympathetic vasoconstriction

d)

Increased ADH secretion centrally

56.

For an adult with HbA1c 9.2%, why is basal insulin not typically initiated as the very first step?

a)

Risk of acute diabetic ketoacidosis

b)

Insulin always worsens heart failure

c)

Dual therapy achieves glycemic targets safely

d)

Metformin is contraindicated in obesity

57.

Which statement best explains SGLT2 inhibitors’ benefit in heart failure beyond glycemic control?

a)

They expand plasma volume reducing afterload

b)

They activate RAAS improving contractility

c)

They induce osmotic diuresis reducing preload

d)

They increase insulin secretion causing diuresis

58.

Choose the factor most directly increasing GFR when all else is constant.

a)

Higher efferent arteriolar tone

b)

Higher glomerular capillary hydrostatic pressure

c)

Greater Bowman’s space hydrostatic pressure

d)

Lower glomerular capillary hydrostatic pressure

59.

Which intervention most selectively lowers proximal tubular glucose transport in diabetes?

a)

Insulin analogs downregulate GLUT4 trafficking

b)

Metformin enhances hepatic AMPK

c)

SGLT2 inhibition blocks glucose–sodium cotransport

d)

Sulfonylureas open KATP channels in β-cells

60.

When renal sympathetic activity rises acutely, what is the expected immediate effect on GFR?

a)

Increase via proximal sodium reabsorption

b)

Increase due to efferent dilation

c)

Decrease via afferent vasoconstriction

d)

No change due to tubuloglomerular feedback

61.

Which statement best describes renal autoregulation of blood flow?

a)

It lowers filtration by constricting both arterioles

b)

It rapidly increases flow during sympathetic surges

c)

It keeps renal flow relatively constant across ranges

d)

It fully prevents pressure changes at all times

62.

Which factor most directly decreases the glomerular filtration rate (GFR)?

a)

Higher Bowman’s space hydrostatic pressure

b)

Lower plasma colloid osmotic pressure

c)

Constriction of the efferent arteriole

d)

Dilation of the afferent arteriole

63.

Angiotensin II primarily affects which renal microvascular segment to alter filtration?

a)

Efferent arteriole constriction predominates

b)

Afferent arteriole dilation predominates

c)

Peritubular capillary vasodilation predominates

d)

Glomerular capillary relaxation predominates

64.

Which change would most likely increase GFR in a healthy kidney?

a)

Higher plasma oncotic pressure

b)

Reduced afferent resistance only

c)

Lower Bowman’s space pressure

d)

Stronger efferent constriction only

65.

A patient with acute urinary obstruction develops reduced GFR. What mechanism explains this?

a)

Enhanced autoregulation eliminating pressure changes

b)

Increased Bowman’s space hydrostatic pressure

c)

Decreased renal blood flow from afferent dilation

d)

Lower plasma protein concentration raising oncotic pressure

66.

Which constitutional symptom profile is common at the onset of systemic lupus erythematosus (SLE)?

a)

Persistent hyperthermia without variation

b)

Severe hypertension at initial presentation

c)

Weight loss with intermittent fever

d)

Profuse night sweats due to tuberculosis

67.

For most patients with SLE without severe organ involvement, which maintenance therapy is recommended?

a)

Prednisone 40 mg daily chronically

b)

Azathioprine as first-line monotherapy

c)

Hydroxychloroquine for long-term control

d)

Cyclophosphamide for routine suppression

68.

Which immediate effect follows inhibition of the renin–angiotensin–aldosterone system in a euvolemic person?

a)

Efferent arteriolar dilation may lower GFR

b)

Afferent arteriolar dilation increases GFR

c)

Bowman’s pressure falls and GFR rises

d)

Autoregulation fully stabilizes renal blood flow

69.

During sympathetic activation, which reflex change is most likely in the renal arterioles to preserve filtration?

a)

Reflex afferent dilation predominates

b)

Reflex afferent constriction predominates

c)

Reflex efferent dilation predominates

d)

Reflex efferent constriction predominates

70.

A patient with suspected lupus presents with intermittent fever and weight loss. Which next step best balances diagnostic yield and safety?

a)

Begin cyclophosphamide immediately

b)

Schedule renal biopsy before labs

c)

Order ANA and anti-dsDNA testing

d)

Start high-dose prednisone empirically

71.

Which pulmonary complication occurs most frequently in patients with systemic lupus erythematosus (SLE)?

a)

Derrame pleural

b)

Sarcoidosis

c)

Embolia pulmonar masiva

d)

Fibrosis pulmonar idiopática

72.

A 28-year-old with SLE has anemia, elevated indirect bilirubin, and high LDH. Which test best confirms autoimmune hemolytic anemia?

a)

Perfil tiroideo

b)

Conteo de plaquetas

c)

Glucosa capilar

d)

Prueba de Coombs directa

73.

A 30-year-old woman with SLE shows low C3 and C4, moderate proteinuria, and granular casts. Which immunologic mechanism best explains the renal lesion?

a)

Activación del complemento por inmunocomplejos glomerulares

b)

Destrucción de podocitos por linfocitos CD8+

c)

Depósito de cristales de urato con inflamación renal

d)

Reabsorción tubular aumentada por anticuerpos antifosfolípidos

74.

What is the main advantage of finerenone over steroidal mineralocorticoid receptor antagonists in patients with type 2 diabetes and chronic kidney disease?

a)

Mayor selectividad y menor hiperpotasemia manteniendo efecto cardiorrenal

b)

Aumento de TFG por vasodilatación eferente

c)

Inhibición directa de la síntesis de aldosterona

d)

Estimulación de ENaC para excreción de potasio

75.

Which statement most accurately summarizes clinical benefits of SGLT-2 inhibitors beyond glycemic control?

a)

Reducción de eventos cardiorrenales y progresión de ERC

b)

Mejora exclusiva de la sensibilidad a la insulina

c)

Disminución de LDL como principal beneficio

d)

Aumento sostenido de la TFG sin efectos renales

76.

In SLE-related autoimmune hemolytic anemia, which laboratory pattern typically accompanies a positive direct Coombs test?

a)

Haptoglobina elevada con reticulocitos bajos

b)

Hemoglobina normal con plaquetas altas

c)

Bilirrubina indirecta alta con LDH elevada

d)

Bilirrubina indirecta baja con LDH normal

77.

For SLE nephritis with low complement levels, which pathologic finding is most consistent on urinalysis?

a)

Cilindros hialinos con glucosuria

b)

Cilindros granulosos con proteinuria moderada

c)

Cristales de urato sin proteinuria

d)

Hematuria aislada sin cilindros

78.

Which mechanism explains the lower hyperkalemia risk with finerenone compared to spironolactone?

a)

Bloqueo de síntesis de aldosterona sistémica

b)

Vasodilatación eferente del glomérulo

c)

Mayor selectividad por el receptor mineralocorticoide

d)

Inhibición de ENaC en túbulos colectores

79.

In patients with SGLT-2 inhibitor therapy, which kidney effect contributes to cardio-renal protection?

a)

Retención de sodio en túbulo proximal

b)

Estimulación de renina con vasoconstricción aferente

c)

Aumento sostenido de TFG por vasodilatación

d)

Reducción de hiperfiltración por natriuresis

80.

Which imaging or clinical sign is most consistent with the most common SLE pulmonary complication?

a)

Nódulos hilar con adenopatías sarcoideas

b)

Émbolos masivos en arterias pulmonares

c)

Opacidades difusas compatibles con fibrosis

d)

Derrame pleural visible en radiografía

81.

Which statement best describes the non-glycemic benefits of SGLT2 inhibitors in adults with diabetes?

a)

Lower weight and blood pressure, reduce heart failure hospitalizations

b)

Reduce HbA1c modestly without cardiovascular or renal benefits

c)

Increase natriuresis, raise hypoglycemia risk, third-line only

d)

Improve GFR dose-dependently only in poorly controlled diabetes

82.

In advanced chronic kidney disease (eGFR 15–29 mL/min/1.73 m²), starting an ACE inhibitor or ARB is most associated with which outcome?

a)

Lower risk of progressing to renal replacement therapy

b)

Higher likelihood of requiring dialysis due to hyperkalemia

c)

Marked reduction in all-cause mortality

d)

Stopping therapy leads to improved renal function

83.

What is the defining feature of hemodiafiltration compared with using diffusion or convection alone?

a)

Uses diffusion alone to clear uremic solutes

b)

Combines diffusion and convection for broad solute removal

c)

Does not require a semipermeable membrane

d)

Removes water only, not solutes

84.

In clinical practice, hemofiltration is most commonly chosen over hemodialysis in which scenario?

a)

Complete replacement of hepatic function

b)

Routine outpatient dialysis three times weekly

c)

Patients with normal renal function

d)

Acute kidney injury in intensive care settings

85.

Which primary transport mechanism removes solutes during standard hemodialysis?

a)

Ultrafiltration without solute movement

b)

Diffusion across the membrane

c)

Active transport via pumps

d)

Convection across the membrane

86.

A patient with heart failure and type 2 diabetes is started on an SGLT2 inhibitor. Which benefit is most consistently supported by trials regardless of HbA1c level?

a)

Dramatic improvements in measured GFR

b)

Reduced hospitalizations for heart failure events

c)

Large mortality reduction in all populations

d)

Elimination of hyperglycemia-related risks

87.

Why is hemofiltration frequently used in the ICU for patients with acute kidney injury?

a)

It allows continuous therapy with better hemodynamic stability

b)

It requires no membrane and is technically simpler

c)

It is superior for clearing only small molecules

d)

It fully replaces hepatic detoxification processes

88.

Which statement about natriuresis and hypoglycemia risk aligns with recommendations for SGLT2 inhibitors?

a)

They modestly lower HbA1c without renal or cardiac gains

b)

They markedly increase hypoglycemia and mortality; third-line only

c)

They increase natriuresis yet are avoided due to hypotension

d)

They improve survival in some trials independent of HbA1c

89.

Which modality relies predominantly on convection to remove solutes of varying sizes?

a)

Standard intermittent hemodialysis

b)

Hemodiafiltration with high-flux dialyzers

c)

Pure hemofiltration techniques

d)

Peritoneal dialysis via diffusion

90.

A clinician aims to improve clearance of middle molecules while maintaining diffusive removal of small solutes. Which modality best meets this goal?

a)

Hemofiltration alone

b)

Intermittent hemodialysis alone

c)

Hemodiafiltration combining mechanisms

d)

Slow continuous ultrafiltration without dialysate

91.

Which statement best defines when to initiate dialysis solely on renal function without symptoms?

a)

When GFR is less than or equal to 20 mL/min

b)

Only when symptoms appear regardless of GFR

c)

When GFR is less than or equal to 10 mL/min

d)

When GFR is less than or equal to 30 mL/min

92.

Which option correctly includes all classic clinical indications to start dialysis?

a)

Mild acidosis, hypocalcemia, insomnia, oliguria, pressure ulcers

b)

Anemia, edema, skin infections, oxaluria, obstructive uropathy

c)

Refractory acidosis, severe electrolyte disorders, intoxications, volume overload not responsive to diuretics, and uremia

d)

Acidosis, mild edema, urinary infections, mild oliguria, uremia

93.

Which is an absolute contraindication to using ACE inhibitors?

a)

Bilateral renal artery stenosis

b)

Dyslipidemia

c)

Diabetes mellitus

d)

Grade 1 arterial hypertension

94.

Carbonic anhydrase inhibitors like acetazolamide act primarily at which nephron segment?

a)

Proximal tubule

b)

Distal convoluted tubule

c)

Collecting duct

d)

Thick ascending limb of Henle

95.

A 29-year-old woman has bilateral lumbar pain, macroscopic hematuria, occasional headaches, and elevated blood pressure. Her mother required dialysis at 52 for hereditary renal disease. On exam, palpable renal masses, afebrile, no urinary symptoms. Which initial exam group is most appropriate for suspected autosomal dominant polycystic kidney disease?

a)

Renal ultrasound + serum creatinine + urinalysis

b)

Plain abdominal radiograph + urine culture + electrolytes

c)

Non-contrast abdominal CT + contrast abdominal CT

d)

Renal biopsy + magnetic resonance imaging

96.

In a patient with suspected polycystic kidney disease and hypertension, which mechanism explains why ACE inhibitors are often beneficial unless contraindicated?

a)

They stimulate proximal bicarbonate reabsorption

b)

They directly dissolve renal cyst walls

c)

They decrease efferent arteriolar resistance lowering intraglomerular pressure

d)

They increase efferent arteriolar constriction reducing GFR

97.

Which situation most strongly suggests urgent dialysis rather than continued medical management?

a)

Mild hyperkalemia responsive to diuretics

b)

Volume overload not improving with diuretics

c)

Stable anemia with normal electrolytes

d)

Asymptomatic GFR of 25 mL/min

98.

Which adverse effect risk makes ACE inhibitors unsafe in bilateral renal artery stenosis?

a)

Metabolic alkalosis from bicarbonate loss

b)

Acute drop in GFR from decreased efferent tone

c)

Hyperfiltration due to increased efferent tone

d)

Ototoxicity from tubular injury

99.

Acetazolamide decreases bicarbonate reabsorption. Which acid–base change is most typical early after starting acetazolamide?

a)

Metabolic alkalosis with high bicarbonate

b)

Metabolic acidosis with low bicarbonate

c)

Respiratory acidosis with high CO2

d)

Respiratory alkalosis with low CO2

100.

A patient with known autosomal dominant polycystic kidney disease presents with high fever, chills, and severe flank pain. Which complication is most likely?

a)

Minimal change disease nephrotic syndrome

b)

Nephrolithiasis with spontaneous resolution

c)

Renal cyst infection requiring antibiotics

d)

Simple renal cyst rupture with no therapy

101.

A patient with sudden right flank pain, hypotension, fever, and confusion is suspected of septic shock due to ruptured renal cyst. What is the most important initial management step?

a)

Start broad-spectrum IV antibiotics within first hour

b)

Request renal injury biomarkers prior to therapy

c)

Order contrast-enhanced abdominal CT before treatment

d)

Give NSAIDs and observe clinical evolution

102.

Which statement best describes the key feature of autosomal dominant polycystic kidney disease?

a)

Progressive formation of multiple renal cysts from ciliopathy

b)

No familial relation and not considered chronic kidney disease

c)

Lifelong small cysts with normal-sized kidneys

d)

Acquired disorder seen only in older adults

103.

A 55-year-old with polycystic kidneys develops gross hematuria after intense exercise, afebrile, bilateral renal masses on exam. What is the most likely cause of hematuria?

a)

Renal tumor associated with advanced cystic disease

b)

Acute pyelonephritis complicating cyst infection

c)

Rupture of a renal cyst with intrarenal bleeding

d)

Obstructive renal stone due to hyperuricosuria

104.

A patient with active SLE has proteinuria, edema, progressive dyspnea, and a pericardial friction rub. What is the most frequent cardiac complication of SLE explaining this finding?

a)

Acute pericarditis from autoimmune serositis

b)

Bacterial endocarditis due to immunosuppression

c)

Lupus myocarditis with fulminant heart failure

d)

Mitral stenosis from chronic valvular fibrosis

105.

In suspected septic shock from intra-abdominal source, which timing for antibiotics most reduces mortality?

a)

Within the first hour of recognition

b)

After initial NSAID analgesia

c)

After imaging confirms the source

d)

Only if cultures return positive

106.

Autosomal dominant polycystic kidney disease primarily results from defects in which cellular structure?

a)

Mitochondrial inner membrane complexes

b)

Primary cilia signaling mechanisms

c)

Nuclear pore transport channels

d)

Lysosomal acid hydrolase systems

107.

During evaluation of gross hematuria in polycystic kidneys after exertion, which immediate complication most closely aligns with the presentation?

a)

Glomerulonephritis with RBC casts predominance

b)

Papillary necrosis causing flank tenderness

c)

Cyst rupture leading to intrarenal bleeding

d)

Obstructive stone with colicky flank pain

108.

In SLE, which physical exam finding most strongly supports pericarditis as the cause of chest symptoms?

a)

Fixed split S2 without rub

b)

Pericardial friction rub on auscultation

c)

S3 gallop with displaced apex beat

d)

Harsh systolic murmur at upper sternal border

109.

Which imaging choice is least appropriate before initiating treatment in hemodynamically unstable suspected ruptured renal cyst with sepsis?

a)

Urgent contrast CT of abdomen and pelvis

b)

Point-of-care ultrasound for free fluid

c)

Plain abdominal radiograph assessment

d)

No immediate imaging, prioritize antibiotics

110.

Which hereditary pattern characterizes polycystic kidney disease discussed, often affecting multiple family members across generations?

a)

X-linked dominant transmission

b)

Autosomal dominant inheritance pattern

c)

Mitochondrial maternal inheritance

d)

Autosomal recessive inheritance pattern

111.

A 24-year-old woman presents with fatigue, intermittent low-grade fever, and non-erosive joint pain in hands and knees. Exam shows malar erythema. Labs: ANA 1:320 positive, anti-dsDNA positive, low C3-C4, no proteinuria or hematologic changes. According to EULAR/ACR 2023, what is the next best step to confirm systemic lupus erythematosus?

a)

Repeat ANA in 6 months due to insufficient criteria

b)

Mandatory renal biopsy to classify SLE per guidelines

c)

Confirm SLE as cumulative immunologic and clinical criteria exceed threshold

d)

Confirm SLE because ANA positivity establishes diagnosis

112.

For most adults with diabetes, what HbA1c target is recommended by ADA?

a)

Less than 8 percent

b)

Less than 7 percent

c)

Less than 6 percent

d)

Less than 5.7 percent

113.

According to ADA guidance, what is the first-line pharmacologic therapy for type 2 diabetes in most patients unless contraindicated?

a)

SGLT2 inhibitors as initial therapy

b)

Metformin as initial therapy

c)

GLP-1 receptor agonists as initial therapy

d)

Sulfonylureas as initial therapy

114.

Which annual screening test is recommended for diabetic kidney disease in patients with type 2 diabetes?

a)

Twenty-four hour urine creatinine clearance

b)

Serum potassium level measurement

c)

Urine albumin-to-creatinine ratio (ACR)

d)

Renal biopsy for early detection

115.

A 60-year-old man with type 2 diabetes and prior myocardial infarction one year ago is on metformin and glybenclamide. HbA1c is 7.4% with normal renal function. What change is prioritized per ADA?

a)

Initiate basal insulin therapy

b)

Add pioglitazone to regimen

c)

Replace sulfonylurea with an SGLT2 inhibitor

d)

Increase metformin dosage

116.

Low complement levels (C3 and C4) in a patient with suspected lupus most directly indicate which process?

a)

Reduced hepatic synthesis without immune activation

b)

Complement activation solely via lectin pathway

c)

Immune complex formation with complement consumption

d)

Isolated genetic deficiency of complement proteins

117.

In evaluating suspected lupus, why is a positive anti-dsDNA result clinically significant?

a)

It rules out renal involvement completely

b)

It replaces the need for ANA testing entirely

c)

It supports diagnosis and correlates with disease activity

d)

It indicates infection with double-stranded viruses

118.

For a patient with diabetes and established atherosclerotic cardiovascular disease, which drug class offers proven cardiovascular benefit beyond glycemic control?

a)

DPP-4 inhibitors without CV effects

b)

Thiazolidinediones increase heart failure risk

c)

SGLT2 inhibitors reduce major CV events

d)

Alpha-glucosidase inhibitors improve lipid profile

119.

When screening for diabetic nephropathy, what does the urine albumin-to-creatinine ratio primarily detect?

a)

Prerenal azotemia from dehydration

b)

Early glomerular microalbuminuria

c)

Advanced nephrotic-range proteinuria

d)

Tubular sodium handling abnormalities

120.

In an adult with HbA1c 7.4% on metformin and sulfonylurea, normal renal function, and prior MI, what rationale supports switching to an SGLT2 inhibitor?

a)

Superior hypoglycemia risk compared with sulfonylurea

b)

Provides cardiovascular and renal protection benefits

c)

Increases insulin secretion independent of glucose

d)

Primary effect is significant weight gain in all patients

121.

A 44-year-old patient with type 2 diabetes, hypertension, and microalbuminuria is on metformin and lisinopril. HbA1c is 7.0%, eGFR 58 mL/min, BP 138/86. Which intervention provides additional renal protection per ADA guidance?

a)

Initiate basal insulin therapy

b)

Switch to a different ACE inhibitor

c)

Start an SGLT2 inhibitor

d)

Increase metformin to maximum dose

122.

In a patient with end-stage renal disease and uremic symptoms who is about to begin renal replacement therapy, what advantage does hemodiafiltration offer compared with conventional hemodialysis?

a)

Greater removal of large solutes via diffusion plus convection

b)

Rapid volume reduction without hypotension risk

c)

Exclusive removal of small molecules by chemical gradient

d)

Reduced need for permanent vascular access

123.

A patient with congestive heart failure receives oral furosemide 40 mg every 12 hours to relieve edema. What is the primary site and mechanism of action of this drug?

a)

Inhibit Na+/Cl− cotransporter in distal convoluted tubule

b)

Block epithelial sodium channel in collecting duct

c)

Inhibit Na+/K+/2Cl− cotransporter in thick ascending limb

d)

Inhibit carbonic anhydrase in proximal tubule

124.

During prolonged furosemide therapy, a patient develops muscle weakness and arrhythmias. Which electrolyte disturbance most likely explains this?

a)

Hyponatremia

b)

Hypocalcemia

c)

Hyperkalemia

d)

Hypokalemia

125.

Which mechanism best explains why SGLT2 inhibitors confer renal protection in diabetic kidney disease?

a)

Decrease intraglomerular pressure via tubuloglomerular feedback

b)

Direct mesangial proliferation inhibition by receptor blockade

c)

Enhanced insulin secretion from pancreatic beta cells

d)

Upregulation of proximal tubular sodium reabsorption

126.

Hemodiafiltration improves clearance of middle molecules. Which clinical marker best reflects this improvement?

a)

Increased anion gap after dialysis completion

b)

Reduced bicarbonate buffering during treatment

c)

Higher serum creatinine immediately after session

d)

Lower beta-2 microglobulin levels post-treatment

127.

Loop diuretics like furosemide increase urinary excretion of several electrolytes. Which combination is most characteristic?

a)

Increased Na+ with decreased Ca2+ excretion

b)

Decreased Na+ with increased K+ excretion

c)

Decreased Na+, K+, Mg2+ excretion

d)

Increased Na+, K+, Ca2+ excretion

128.

Which adverse effect risk increases when furosemide is combined with other ototoxic agents such as aminoglycosides?

a)

Gastrointestinal bleeding

b)

Central visual scotomas

c)

Peripheral neuropathy

d)

Sensorineural hearing loss

129.

For a patient with heart failure and persistent edema despite furosemide, which strategy best augments diuresis while limiting potassium loss?

a)

Add spironolactone as an adjunct

b)

Add a thiazide diuretic sequentially

c)

Reduce loop diuretic dose gradually

d)

Switch to acetazolamide monotherapy

130.

Which finding suggests overdiuresis with loop diuretics requiring dose adjustment?

a)

Hypertension with low urine output and edema

b)

Bradycardia with normal electrolytes and creatinine

c)

Hyperglycemia with stable volume status

d)

Orthostatic hypotension with elevated BUN/creatinine ratio

131.

Which component of evidence-based practice focuses on integrating patient preferences into care decisions?

a)

Quality improvement metrics

b)

Population-level policy

c)

Patient values incorporation

d)

Clinical expertise application

132.

In clinical research, what is the primary purpose of a randomized controlled trial?

a)

Identify rare adverse events

b)

Generate exploratory hypotheses

c)

Establish causal relationships

d)

Describe population prevalence

133.

Which step comes first when appraising a journal article for clinical relevance?

a)

Assess external validity

b)

Check for publication bias

c)

Determine study question

d)

Evaluate statistical methods

134.

Which metric best represents the proportion of true positives among all positive test results?

a)

Negative predictive value

b)

Positive predictive value

c)

Sensitivity of the test

d)

Specificity of the test

135.

For a screening program, which characteristic is most important for a disease suitable for screening?

a)

Low incidence worldwide

b)

Long preclinical phase

c)

Complex diagnostic pathway

d)

High treatment toxicity

136.

A new antihypertensive shows a number needed to treat (NNT) of 25. What does this indicate?

a)

One event prevented per 25 treated

b)

Twenty-five events prevented overall

c)

High absolute risk reduction magnitude

d)

Minimal adverse event likelihood

137.

Which bias occurs when participants lost to follow-up differ systematically from those retained?

a)

Lead-time bias in screening

b)

Observer bias in trials

c)

Attrition bias in cohorts

d)

Recall bias in surveys

138.

When comparing diagnostic tests, which approach appropriately adjusts for disease prevalence differences?

a)

Use raw positive counts

b)

Use positive predictive value

c)

Use mean likelihood ratios

d)

Use sensitivity and specificity

139.

A patient prioritizes functional status over survival duration. Which outcome measure aligns with this preference?

a)

Biomarker level normalization

b)

Disease-free survival time

c)

Quality-adjusted life years

d)

Overall mortality reduction

140.

Which strategy most effectively reduces confounding in observational studies?

a)

Convenience sampling only

b)

Randomization of exposure

c)

Multivariable regression modeling

d)

Open-label study design

Similar Resources on Wayground

Chapter Objectives

138 questions

Chapter Objectives

quiz

Worksheet

•

University