Premium
PDF
PDF
Download Download
EXAMS
Correct | Questions & Answers (Verified Answers) With Rationales (2026 /
2027 Update)
This Document Contains:
140 Questions with Correct, Detailed and Verified Answers
2026/2027 Actual Exam Testbank
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
Page 1
,Question 1
A 45-year-old patient presents with progressive dyspnea on exertion, nonproductive cough, and
bilateral basilar crackles. Chest X-ray shows interstitial fibrosis with honeycombing. Spirometry
reveals FVC 60% predicted, FEV1/FVC 0.85. Which of the following is the most likely underlying
pathophysiology?
A) Granulomatous inflammation with noncaseating granulomas
B) Recurrent aspiration of gastric contents leading to bronchiolar inflammation
C) Repetitive alveolar injury with aberrant fibroblast proliferation and collagen deposition
D) Autoantibody-mediated destruction of alveolar-capillary basement membrane
Answer: C) Repetitive alveolar injury with aberrant fibroblast proliferation and collagen deposition
Explanation: Idiopathic pulmonary fibrosis (IPF) is characterized by usual interstitial pneumonia
(UIP) pattern with fibroblastic foci and honeycombing. Option C describes the
pathophysiology of IPF. Option A is seen in sarcoidosis, B in aspiration pneumonitis, D
in Goodpasture syndrome.
Question 2
A 60-year-old patient with type 2 diabetes and hypertension has an estimated glomerular filtration
rate (eGFR) of 28 mL/min/1.73 m² and urine albumin-to-creatinine ratio (UACR) of 450 mg/g.
Current medications include metformin, lisinopril, and atorvastatin. Which of the following
medication adjustments is most appropriate?
A) Discontinue metformin and continue lisinopril at current dose
B) Continue metformin and increase lisinopril dose
C) Discontinue metformin and switch lisinopril to an angiotensin receptor blocker
D) Discontinue both metformin and lisinopril, initiate insulin and amlodipine
Answer: A) Discontinue metformin and continue lisinopril at current dose
Explanation: Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis.
ACE inhibitors/ARBs are renoprotective and should be continued even in advanced
CKD. Option A is correct: stop metformin, continue lisinopril. Option B is unsafe
(metformin). Option C: switching ARB not necessary. Option D: no need to stop ACEi.
Page 2
,Question 3
A 35-year-old patient with a history of recurrent calcium oxalate kidney stones has a 24-hour urine
collection showing low urine volume (800 mL), hypercalciuria (350 mg/day), hyperoxaluria (60
mg/day), and low urinary citrate (150 mg/day). Which of the following is the most appropriate
initial dietary recommendation?
A) Increase dietary calcium intake and reduce sodium intake
B) Restrict dietary calcium to less than 800 mg/day
C) Increase intake of vitamin C supplements to 2000 mg/day
D) Reduce fluid intake to less than 1.5 L/day to concentrate urine
Answer: A) Increase dietary calcium intake and reduce sodium intake
Explanation: In calcium oxalate stones, dietary calcium restriction paradoxically increases oxalate
absorption and stone risk. Increasing calcium (with meals) binds oxalate in the gut,
reducing urinary oxalate. Low urine volume and low citrate are risk factors; sodium
reduction decreases calcium excretion. Option A is correct. Option B worsens
hyperoxaluria. Option C increases oxalate. Option D is harmful.
Question 4
A 50-year-old patient with hepatitis C cirrhosis (Child-Pugh class B) presents with acute onset of
confusion, asterixis, and elevated serum ammonia (120 ¼mol/L). Which of the following treatments
is most likely to reduce ammonia production in the colon?
A) Intravenous flumazenil
B) Oral lactulose
C) Intravenous L-ornithine L-aspartate
D) Oral neomycin
Answer: B) Oral lactulose
Explanation: Lactulose is a nonabsorbable disaccharide that acidifies the colon, trapping NH4+ and
reducing absorption. It also acts as an osmotic laxative to expel ammonia. Option B is
first-line. Option A (flumazenil) reverses benzodiazepine-induced encephalopathy, not
hepatic. Option C (LOLA) reduces ammonia but is not primarily colonic. Option D
(neomycin) reduces bacteria but is less preferred due to ototoxicity.
Page 3
, Question 5
A 30-year-old patient with no prior medical history presents with acute onset of severe, colicky
right flank pain radiating to the groin, gross hematuria, and nausea. Noncontrast CT reveals a 5
mm stone in the proximal right ureter with mild hydronephrosis. Which of the following is the
most appropriate next step in management?
A) Immediate referral for extracorporeal shock wave lithotripsy (ESWL)
B) Observation with adequate hydration and analgesia, and medical expulsive therapy
C) Ureteral stent placement followed by ureteroscopy in 2 weeks
D) Percutaneous nephrolithotomy
Answer: B) Observation with adequate hydration and analgesia, and medical expulsive therapy
Explanation: Stones "d5 mm in the proximal ureter have a high likelihood of spontaneous passage (up
to 80% within 4 weeks). Conservative management with hydration, NSAIDs, and
tamsulosin (medical expulsive therapy) is appropriate. Option A (ESWL) is reserved for
stones >5 mm or those not passing. Option C (stenting) is for obstruction with infection
or renal impairment. Option D (PCNL) is for large renal stones.
Question 6
A 70-year-old patient with hypertension and diabetes presents with acute onset of severe epigastric
pain radiating to the back, nausea, and vomiting. Serum lipase is 1200 U/L (normal <60). CT
abdomen shows peripancreatic fat stranding and a 3 cm pseudocyst. Which of the following is the
most likely etiology?
A) Hypertriglyceridemia (triglycerides >1000 mg/dL)
B) Gallstone disease
C) Alcohol use disorder
D) Autoimmune pancreatitis
Answer: B) Gallstone disease
Explanation: Gallstones are the most common cause of acute pancreatitis in patients over 50,
especially with hypertension and diabetes (risk factors for gallstones). The patient's
demographics and lack of alcohol history make gallstone etiology most likely. Option A
(hypertriglyceridemia) is possible but less common. Option C (alcohol) is more
common in younger males. Option D (autoimmune) is rare.
Page 4
Download Download
EXAMS
Correct | Questions & Answers (Verified Answers) With Rationales (2026 /
2027 Update)
This Document Contains:
140 Questions with Correct, Detailed and Verified Answers
2026/2027 Actual Exam Testbank
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
Page 1
,Question 1
A 45-year-old patient presents with progressive dyspnea on exertion, nonproductive cough, and
bilateral basilar crackles. Chest X-ray shows interstitial fibrosis with honeycombing. Spirometry
reveals FVC 60% predicted, FEV1/FVC 0.85. Which of the following is the most likely underlying
pathophysiology?
A) Granulomatous inflammation with noncaseating granulomas
B) Recurrent aspiration of gastric contents leading to bronchiolar inflammation
C) Repetitive alveolar injury with aberrant fibroblast proliferation and collagen deposition
D) Autoantibody-mediated destruction of alveolar-capillary basement membrane
Answer: C) Repetitive alveolar injury with aberrant fibroblast proliferation and collagen deposition
Explanation: Idiopathic pulmonary fibrosis (IPF) is characterized by usual interstitial pneumonia
(UIP) pattern with fibroblastic foci and honeycombing. Option C describes the
pathophysiology of IPF. Option A is seen in sarcoidosis, B in aspiration pneumonitis, D
in Goodpasture syndrome.
Question 2
A 60-year-old patient with type 2 diabetes and hypertension has an estimated glomerular filtration
rate (eGFR) of 28 mL/min/1.73 m² and urine albumin-to-creatinine ratio (UACR) of 450 mg/g.
Current medications include metformin, lisinopril, and atorvastatin. Which of the following
medication adjustments is most appropriate?
A) Discontinue metformin and continue lisinopril at current dose
B) Continue metformin and increase lisinopril dose
C) Discontinue metformin and switch lisinopril to an angiotensin receptor blocker
D) Discontinue both metformin and lisinopril, initiate insulin and amlodipine
Answer: A) Discontinue metformin and continue lisinopril at current dose
Explanation: Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis.
ACE inhibitors/ARBs are renoprotective and should be continued even in advanced
CKD. Option A is correct: stop metformin, continue lisinopril. Option B is unsafe
(metformin). Option C: switching ARB not necessary. Option D: no need to stop ACEi.
Page 2
,Question 3
A 35-year-old patient with a history of recurrent calcium oxalate kidney stones has a 24-hour urine
collection showing low urine volume (800 mL), hypercalciuria (350 mg/day), hyperoxaluria (60
mg/day), and low urinary citrate (150 mg/day). Which of the following is the most appropriate
initial dietary recommendation?
A) Increase dietary calcium intake and reduce sodium intake
B) Restrict dietary calcium to less than 800 mg/day
C) Increase intake of vitamin C supplements to 2000 mg/day
D) Reduce fluid intake to less than 1.5 L/day to concentrate urine
Answer: A) Increase dietary calcium intake and reduce sodium intake
Explanation: In calcium oxalate stones, dietary calcium restriction paradoxically increases oxalate
absorption and stone risk. Increasing calcium (with meals) binds oxalate in the gut,
reducing urinary oxalate. Low urine volume and low citrate are risk factors; sodium
reduction decreases calcium excretion. Option A is correct. Option B worsens
hyperoxaluria. Option C increases oxalate. Option D is harmful.
Question 4
A 50-year-old patient with hepatitis C cirrhosis (Child-Pugh class B) presents with acute onset of
confusion, asterixis, and elevated serum ammonia (120 ¼mol/L). Which of the following treatments
is most likely to reduce ammonia production in the colon?
A) Intravenous flumazenil
B) Oral lactulose
C) Intravenous L-ornithine L-aspartate
D) Oral neomycin
Answer: B) Oral lactulose
Explanation: Lactulose is a nonabsorbable disaccharide that acidifies the colon, trapping NH4+ and
reducing absorption. It also acts as an osmotic laxative to expel ammonia. Option B is
first-line. Option A (flumazenil) reverses benzodiazepine-induced encephalopathy, not
hepatic. Option C (LOLA) reduces ammonia but is not primarily colonic. Option D
(neomycin) reduces bacteria but is less preferred due to ototoxicity.
Page 3
, Question 5
A 30-year-old patient with no prior medical history presents with acute onset of severe, colicky
right flank pain radiating to the groin, gross hematuria, and nausea. Noncontrast CT reveals a 5
mm stone in the proximal right ureter with mild hydronephrosis. Which of the following is the
most appropriate next step in management?
A) Immediate referral for extracorporeal shock wave lithotripsy (ESWL)
B) Observation with adequate hydration and analgesia, and medical expulsive therapy
C) Ureteral stent placement followed by ureteroscopy in 2 weeks
D) Percutaneous nephrolithotomy
Answer: B) Observation with adequate hydration and analgesia, and medical expulsive therapy
Explanation: Stones "d5 mm in the proximal ureter have a high likelihood of spontaneous passage (up
to 80% within 4 weeks). Conservative management with hydration, NSAIDs, and
tamsulosin (medical expulsive therapy) is appropriate. Option A (ESWL) is reserved for
stones >5 mm or those not passing. Option C (stenting) is for obstruction with infection
or renal impairment. Option D (PCNL) is for large renal stones.
Question 6
A 70-year-old patient with hypertension and diabetes presents with acute onset of severe epigastric
pain radiating to the back, nausea, and vomiting. Serum lipase is 1200 U/L (normal <60). CT
abdomen shows peripancreatic fat stranding and a 3 cm pseudocyst. Which of the following is the
most likely etiology?
A) Hypertriglyceridemia (triglycerides >1000 mg/dL)
B) Gallstone disease
C) Alcohol use disorder
D) Autoimmune pancreatitis
Answer: B) Gallstone disease
Explanation: Gallstones are the most common cause of acute pancreatitis in patients over 50,
especially with hypertension and diabetes (risk factors for gallstones). The patient's
demographics and lack of alcohol history make gallstone etiology most likely. Option A
(hypertriglyceridemia) is possible but less common. Option C (alcohol) is more
common in younger males. Option D (autoimmune) is rare.
Page 4
