, Question 1
A patient with a history of cirrhosis and ascites presents with new-onset
confusion and asterixis. Serum ammonia is elevated. Which of the following is
the most appropriate initial pharmacologic management?
A. Lactulose titrated to 2-3 soft stools daily
B. Rifaximin monotherapy
C. Oral neomycin
D. IV lorazepam for agitation
Correct Answer: A - Lactulose titrated to 2-3 soft stools daily
RATIONALE
Lactulose is first-line for hepatic encephalopathy, aiming for 2-3 soft
stools/day to reduce ammonia absorption. Rifaximin is adjunctive,
neomycin is not first-line due to toxicity, and benzodiazepines worsen
encephalopathy.
Question 2
Which of the following best describes the mechanism by which SGLT2
inhibitors confer cardiovascular benefit in patients with type 2 diabetes and
heart failure?
A. Increased myocardial glucose uptake
B. Natriuresis and reduced preload/afterload
C. Direct beta-adrenergic blockade
D. Inhibition of angiotensin II receptors
Correct Answer: B - Natriuresis and reduced preload/afterload
RATIONALE
SGLT2 inhibitors promote glucosuria and natriuresis, reducing preload
and afterload, which improves heart failure outcomes. They do not
increase myocardial glucose uptake, block beta receptors, or inhibit
angiotensin receptors.
Page 2
, Question 3
A patient presents with unilateral facial droop, arm drift, and slurred speech
that began 45 minutes ago. Non-contrast CT of the head is negative for
hemorrhage. Which of the following is the most appropriate next step?
A. Administer IV alteplase if no contraindications
B. Start aspirin 325 mg immediately
C. Obtain MRI before any treatment
D. Give IV heparin bolus
Correct Answer: A - Administer IV alteplase if no
contraindications
RATIONALE
IV alteplase is indicated within 4.5 hours of ischemic stroke onset
after excluding hemorrhage. Aspirin is given after 24 hours, MRI
should not delay treatment, and heparin is not indicated acutely.
Question 4
Which of the following findings on urinalysis is most specific for acute
interstitial nephritis?
A. White blood cell casts
B. Eosinophiluria
C. Hyaline casts
D. Broad waxy casts
Correct Answer: B - Eosinophiluria
RATIONALE
Eosinophiluria is classically associated with acute interstitial nephritis,
often drug-induced. WBC casts suggest pyelonephritis, hyaline casts
are nonspecific, and broad waxy casts indicate chronic kidney disease.
Page 3
A patient with a history of cirrhosis and ascites presents with new-onset
confusion and asterixis. Serum ammonia is elevated. Which of the following is
the most appropriate initial pharmacologic management?
A. Lactulose titrated to 2-3 soft stools daily
B. Rifaximin monotherapy
C. Oral neomycin
D. IV lorazepam for agitation
Correct Answer: A - Lactulose titrated to 2-3 soft stools daily
RATIONALE
Lactulose is first-line for hepatic encephalopathy, aiming for 2-3 soft
stools/day to reduce ammonia absorption. Rifaximin is adjunctive,
neomycin is not first-line due to toxicity, and benzodiazepines worsen
encephalopathy.
Question 2
Which of the following best describes the mechanism by which SGLT2
inhibitors confer cardiovascular benefit in patients with type 2 diabetes and
heart failure?
A. Increased myocardial glucose uptake
B. Natriuresis and reduced preload/afterload
C. Direct beta-adrenergic blockade
D. Inhibition of angiotensin II receptors
Correct Answer: B - Natriuresis and reduced preload/afterload
RATIONALE
SGLT2 inhibitors promote glucosuria and natriuresis, reducing preload
and afterload, which improves heart failure outcomes. They do not
increase myocardial glucose uptake, block beta receptors, or inhibit
angiotensin receptors.
Page 2
, Question 3
A patient presents with unilateral facial droop, arm drift, and slurred speech
that began 45 minutes ago. Non-contrast CT of the head is negative for
hemorrhage. Which of the following is the most appropriate next step?
A. Administer IV alteplase if no contraindications
B. Start aspirin 325 mg immediately
C. Obtain MRI before any treatment
D. Give IV heparin bolus
Correct Answer: A - Administer IV alteplase if no
contraindications
RATIONALE
IV alteplase is indicated within 4.5 hours of ischemic stroke onset
after excluding hemorrhage. Aspirin is given after 24 hours, MRI
should not delay treatment, and heparin is not indicated acutely.
Question 4
Which of the following findings on urinalysis is most specific for acute
interstitial nephritis?
A. White blood cell casts
B. Eosinophiluria
C. Hyaline casts
D. Broad waxy casts
Correct Answer: B - Eosinophiluria
RATIONALE
Eosinophiluria is classically associated with acute interstitial nephritis,
often drug-induced. WBC casts suggest pyelonephritis, hyaline casts
are nonspecific, and broad waxy casts indicate chronic kidney disease.
Page 3
