A 67-year-old man presents with sudden onset flank pain and hematuria. Ultrasound reveals enlargement of both kidneys. He is a known case of membranous nephropathy. What is the likely pathophysiology for his current presentation?

A 10-year-old boy is brought for a follow-up visit. He was diagnosed with nephrotic syndrome 3 months ago and had been started on a course of oral prednisolone. During the current visit, no improvement is noted with regards to facial puffiness and urine analysis reveals grade 3 proteinuria. Mutations in all of the following are associated with this condition except:

An 18-year-old otherwise healthy boy presents with complaints of hematuria. His father has also had similar complaints since childhood. Light microscopy of the renal biopsy specimen showed no abnormalities. Diffuse thinning of the glomerular basement membrane was seen on electron microscopy. What is the most likely diagnosis?

A 7-year-old girl is brought with complaints of generalized swelling of the body and frothy urine. Urinary examination revealed grade 3 proteinuria and the presence of hyaline and fatty casts. There were no red blood cells in the urine. Which of the following statements about her condition is true?

Urinary albumin excretion of how much is considered as microalbuminuria?

In a patient with nephrotic syndrome, all of the following are decreased except:

19-year-old male presents with swelling of the legs and periorbital puffiness. He also complains of frothy urine. His 24-hour urinary protein is 3.8 g/day. All of the following could be the etiology of his kidney disease except:

A 45-year-old man presents with swelling of the legs and hands, along with breathlessness on exertion. On examination, his jugular venous pressure is elevated, there is pedal edema, and an S3 gallop is audible. Urine routine shows 1+ proteinuria, and 24-hour urinary protein is 1.5 g/day. What is the most likely explanation for his proteinuria?

Gold standard investigation for diagnosis of adynamic bone disease is:

Which of the following is a recently approved NHE3 inhibitor used in the management of hyperphosphatemia in CKD with high bone turnover disease?

Which of the following is least likely to be seen in a patient with untreated chronic kidney disease (CKD)?

A 55-year-old lady with chronic kidney disease – stage 3 comes for routine evaluation. What is the finding in urine routine that is most appropriate for this diagnosis?

A 55-year-old woman with chronic kidney disease – stage 5 presents with palpitations. ECG reveals atrial fibrillation and she is started on warfarin. A week later, she develops a painful nodule over the abdomen followed by skin blackening and ulceration. Which of the following statements is NOT true about the underlying condition?

A 25-year-old lady presents to the OPD with swelling of the legs and frothy urine for 6 months. She also complains of joint pain and rashes. Urine routine examination shows 4+ protein. 24-hour urinary protein is 7.5 g/day. Renal biopsy reveals uniform thickening of the basement membrane, and electron microscopy demonstrates subepithelial deposits. According to the ISN/RPS lupus nephritis classification, which class does this biopsy represent?

A 40-year-old patient presents with swelling of legs, periorbital puffiness, frothy urine, and 24-hour urinary protein of 5.5 g/day. Renal biopsy is suggestive of membranous nephropathy. Which of the following antibodies is responsible for primary membranous nephropathy?

A 45-year-old gentleman presented as nephrotic syndrome, undergoes biopsy and is diagnosed as membranous nephropathy. His blood pressure is 160/90 mmHg. What is the drug of choice in this condition?

22-year-old lady has been recently diagnosed as Systemic Lupus Erythematosus. Which of the following investigations correlates best with kidney disease activity?

A 10-year-old child has bloody diarrhea. One week later, he developed swelling of legs and reduced urine output. On evaluation, his renal function tests were deranged with elevated creatinine and peripheral smear showed microangiopathic hemolytic anemia. What is the expected complement level in this patient?

A 20-year-old primigravida undergoes normal vaginal delivery at full term. On day 2 after delivery, she develops reduced urine output and swelling of her legs. Her serum creatinine was elevated, serum C3 was reduced, and serum C4 was normal. She had anemia and elevated LDH. Peripheral smear revealed hemolytic anemia. What is the most common cause of this condition?

A 20-year-old gentleman has sudden onset swelling of his legs and reduced urine output. On evaluation, the patient has microangiopathic hemolytic anemia, elevated creatinine, and low complement C3 level. Which of the following treatments is appropriate for the patient?

5-year-old child with swelling of legs and reduced urine output was brought to OPD. Investigation was suggestive of microangiopathic hemolytic anemia and low complement C3. Eculizumab was used in the treatment of this condition. What does this drug inhibit to bring about remission of the disease?

A 46-year-old lady, known case of Type 2 Diabetes Mellitus with bilateral diabetic retinopathy. The patient has proteinuria in urine examination and serum creatinine of 1.5 mg/dL. All of the following lesions are expected in the renal biopsy of this patient except:

A 15-year-old boy presents with swelling of his legs and reduced urine output for two months. He also complains of dizziness since childhood and reduced vision. On evaluation, he has anterior lenticonus and bilateral sensorineural hearing loss. His serum creatinine is 9 mg/dL. What is the inheritance of this disease?

A 20-year-old gentleman with chronic kidney disease stage two and a family history of kidney disease, along with sensorineural hearing loss and blindness, presents to OPD for further management. His BP is 160/110 mmHg. Renal biopsy reveals thinning and splitting of the basement membrane. What is the most appropriate management for him?

A 30-year-old lady comes with complaints of episodes of flank pain since 15 years. Her BP is normal and on evaluation, the ultrasound abdomen is normal, and renal function tests are normal. What is the most probable diagnosis in this patient?

A 50-year-old gentleman comes with complaints of abdominal swelling and flank pain. On evaluation with ultrasound, he has bilateral large kidneys with multiple cysts. He also gives a family history of kidney disease in his father and brother. All of the following statements are true about this condition except:

A 45-year-old lady comes with complaints of early satiety, abdominal distension, and abdominal pain. On evaluation, she has hypertension. Investigation shows creatinine of 1.5 mg/dL. Ultrasound reveals bilaterally enlarged kidneys with multiple cysts. All of the following are treatment options in this condition except:

A 60-year-old gentleman presents with complaints of swelling of legs and abdominal distension for three years. There is a history of cystic kidney disease in his family, and his father and cousin brother had undergone dialysis. All of the following are extra-renal manifestations of this disease except:

A 15-year-old child presents with seizures. On examination, the child has ungual fibroma, ash-leaf spots, and shagreen patches. What is the most common renal manifestation of this disease?

50-year-old patient, with a known case of Type 2 Diabetes Mellitus and chronic kidney disease with diabetic nephropathy, comes to the OPD for surgical fitness for the amputation of a diabetic foot. His arterial blood gas (ABG) analysis is as follows: pH 7.22, HCO₃⁻ 18 mEq/L, sodium 135 mEq/L, chloride 108 mEq/L, and potassium 6 mEq/L. What is the diagnosis?

A 56-year-old gentleman in the ICU received multiple blood transfusions, and citrate overload led to metabolic alkalosis. Hence, he was started on acetazolamide to reverse the metabolic abnormality. Two days later, his arterial blood gas (ABG) analysis shows pH 7.23, bicarbonate 18 mEq/L, sodium 136 mEq/L, chloride 110 mEq/L, and potassium 2.4 mEq/L. What are the coexistent abnormalities seen in this condition?

A 65-year-old gentleman with a known case of coronary artery disease underwent coronary angiography. His baseline creatinine was 0.8 mg/dl. Two weeks later, he developed an increase in serum creatinine to 2.3 mg/dl and livedo reticularis. His urine routine showed eosinophils without any active sediments. What is the diagnosis?

A 50-year-old lady with a history of recurrent urinary tract infection develops loin pain and fever with pus in the urine. She is started on intravenous amikacin based on urine culture sensitivity reports. Which of the following statements is true about the drug being used by her?

A 25-year-old gentleman with a history of consumption of antifreeze comes with a history of reduced urine output, haematuria. On evaluation, he has a high osmolar gap. Which of these crystals can be found in the urine examination of this patient?

A 52-year-old gentleman presents to OPD with following investigations. His serum urea is 100 mg/dl and serum creatinine is 1.2 mg/dl. This disproportionate increase of urea when compared to creatinine can be seen in all the below-mentioned conditions except:

A 35-year-old gentleman has had 20 episodes of running diarrhea per day for past two days. Upon examination, he had a pulse of 110 beats/min and a blood pressure of 100/70 mm Hg. He has reduced urine output, and it is highly colored. His urine routine is regular. What could be his Fractional excretion of sodium (FeNa)?

A 75-year-old patient undergoes Coronary artery bypass grafting (CABG) and in post-operative period was noticed to have reduced urine output for 2 hrs. What is the best biomarker to diagnose AKI in this patient?

25-year-old patient with road traffic accident was brought to ER. He was found to have multiple fractures and injury to muscles. On Foley’s catheterization, his urine was reddish brown in color, urea was 200 mmol/L, creatinine was 7.8 mg/dl, and potassium was 6.7 mEq/L. What is the cause of acute kidney injury in this patient?

Fanconi Syndrome affects

Which of the following is the cardiac sound that is better appreciated with a bell than the diaphragm of the stethoscope?

Which of the following murmur does not increase on passive leg raising?

A 5-year-old child was examined by a pediatrician. He heard a grade 3/6 ejection systolic murmur along the left sternal border. S2 is widely split and does not vary with respiration. Lungs are clear and abdomen is soft and non-tender. Most likely diagnosis in this case?

A patient is diagnosed with aortic stenosis. A 2nd medico is trying to listen to the murmur. Which of the following maneuvers may make it difficult for him to appreciate the murmur?

A 25-year-old athlete being evaluated for the possibility of hypertrophic obstructive cardiomyopathy since initial examination revealed a systolic murmur in the aortic area. Which of the following can help to consider HOCM over aortic stenosis clinically?

Which of the following is not a diastolic murmur?

Best location to auscultate for a murmur originating from aortic valve is:

Which of the following systolic murmur does not increase on squatting?

A 65-year-old is diagnosed with aortic stenosis. An ESM murmur was heard in aortic area. Which of the following is unlikely to be seen in this patient?

Which of the following sound does not increase on inspiration?

A 62-year-old male with a history of hypertension presents for a routine checkup. The physician wants to assess the character of the patient’s arterial pulse to evaluate for potential valvular disease. Which of the following sites is most appropriate for this assessment?

Which of the following statements about arterial pulse is false?

A 70-year-old man presents with progressive exertional dyspnea and episodes of chest discomfort. On carotid palpation, pulsus parvus et tardus is seen. Which valvular abnormality most likely explains these findings?

Pulsus bisferiens is characterised by:

In which of the following conditions increased pulse deficit is seen?

Which of the following conditions is not associated with wide pulse pressure?

A wave in JVP corresponds to which phase of the ventricular cardiac cycle?

Lancisi sign on JVP and pulsatile liver are features of:

In which of the following conditions y-descent is inconspicuous?

12-year-old is suspected of having rheumatic fever. She had a throat infection 3 weeks ago and has high anti-SLO titres. Which of the following is most likely to be the presenting symptom?

Drug of choice (DOC) for secondary prevention of rheumatic heart disease (RHD) in a patient with established diagnosis of rheumatic fever is:

20 year old was diagnosed with RHD with severe MS and mild MR.Cardiologist has suggested balloon mitral valvotomy.Which of the following is the underlying mechanism of Valvular stenosis in RHD that allows ballon valvotomy

15 year old girl with a past episode of rheumatic fever and mild carditis is planned for secondary prophylaxis.She has a documented severe allergic reaction to penicillin .Which of the following is the most appropriate alternative

55-year-old male presents with severe hypertension (BP 210/120 mmHg), altered mental status, headache, and dyspnea. CT brain shows cerebral edema. Which of the following findings is not considered a marker of hypertension-mediated acute organ damage?

38-year-old patient presented with episodes of syncope. On auscultation, he has a systolic murmur best heard in the right 2nd intercostal space. Murmur intensity increased on standing and decreased on squatting. What is the most likely diagnosis?

60-year-old man with a history of chest pain and diabetes is admitted with hypotension and elevated jugular venous pressure. ECG reveals ST elevation in leads II, III, and aVF. Echocardiography shows right ventricular dilation and impaired function. Additionally, his brother was diagnosed with restrictive cardiomyopathy. Which of the following conditions are both associated with the risk of right heart failure?

35-year-old was diagnosed with hypertrophic cardiomyopathy. His echocardiography is likely to show all the following features except:

A 60-year-old woman presents with increasing shortness of breath, fatigue, and noticeable swelling in her legs and abdomen. Physical examination reveals elevated jugular venous pressure, hepatomegaly, and ascites. Initial echocardiogram suggests possible constrictive pericarditis. Which of the following findings would be LEAST supportive of this diagnosis?

45-year-old woman presents with shortness of breath on exertion and fatigue. Cardiac evaluation, including echocardiography and cardiac catheterization, is performed. During the catheterization procedure, a characteristic “square root sign” pattern is observed in her ventricular pressure tracings. This finding is highly suggestive of which of the following conditions?

A 60-year-old male with a history of hypertension presents for follow-up. He reports experiencing chest discomfort during his evening walks, which is relieved by rest and sublingual nitroglycerin. Which of the following medications would be least useful in reducing his anginal symptoms?

A 62-year-old diabetic male with chronic stable angina is being managed for long-term cardiovascular risk reduction. Which of the following drugs are recommended to prevent major adverse cardiac events (MACE) in such patients?

65-year-old man with stable angina experiences chest pain during his morning walk. Which of the following is the first-line drug of choice for immediate relief of symptoms?

What is the most common cause for aortic stenosis?

10-year-old patient has come with her parents for a follow-up after she had pharyngitis a fortnight ago. Her parents complain that she is still warm to touch, unable to eat, and complains of generalised body ache and joint pain. She reports breathlessness on exertion. On examination, she is febrile, visibly fatigued, and is tachycardic. Joints are red, swollen, and tender. What type of murmur would you find in this patient?

60-year-old patient has presented to the casualty with acute-onset chest pain and shortness of breath. He has a history of familial hypercholesterolemia and has had hypertension since 7 years for which he has been taking medications. On examination, he has a thrusting apex beat and a systolic murmur which sounds like saw cutting wood. On ECG, there is ST depression and T-wave inversion in leads II, III, aVF, V5 and V6 along with deep S in V1 and tall R in V5, V6. What is the diagnosis?

A 10-year-old asymptomatic child is found to have a crescendo–decrescendo systolic murmur at the left upper sternal border on routine physical examination. Echocardiography reveals a thickened, immobile pulmonary valve with a peak pressure gradient of 60 mmHg across the valve. Which of the following is the most appropriate next step in management

neonate with critical pulmonary stenosis presents with cyanosis and respiratory distress shortly after birth. Which of the following medications is most likely to be beneficial in this situation?

A 4-month-old infant presents with progressive cyanosis, tachypnea, and poor feeding. On examination, there is a systolic ejection murmur at the left upper sternal border and a single S2 heart sound. Chest X-ray shows a boot-shaped heart. Which of the following is the most likely diagnosis?

45-year-old woman presents with progressive dyspnea on exertion, fatigue, and chest pain. On examination, there is a loud, harsh systolic ejection murmur best heard at the left second intercostal space, increasing with inspiration. Echocardiography shows a thickened and calcified pulmonary valve with a mean pressure gradient of 60 mmHg across the valve. What is the most likely diagnosis?

5-year-old child with dysmorphic features including a broad forehead, short stature, and intellectual disability presents with exercise intolerance and a systolic murmur heard best at the left upper sternal border. Echocardiography reveals multiple areas of narrowing in the peripheral branches of the pulmonary arteries. Peripheral pulmonary stenosis, as seen in this child, is most commonly associated with:

What is the paper speed of a standard ECG?

patient is suspected of posterior wall MI. What additional lead placement may be required for the detection of posterior wall MI?

Which of the following diseases cannot be diagnosed solely based on ECG?

35-year-old collapsed suddenly while talking to his boss at the office. His wearable smartwatch alerted about arrhythmia and interpreted it as VTib. He was not responding to verbal commands. What is the next best step in management?

patient was diagnosed with pulseless VT and was started on CPR. What is the next best step in management?

False about torsades de pointes is:

The drug of choice for AV blocks is

62-year-old man presents with palpitations and ECG shows a narrow-complex regular tachycardia at 180/min. Vagal maneuvers fail. He is hemodynamically stable. Which is the drug of choice?

A patient with torsades de pointes is brought to the emergency department. Which of the following drugs should be administered immediately?

Example of K+ Channel opener