Cardiovascular, Pulmonary &
Renal Integrated Exam 2026
Edition Questions with
Answers and Rationales
1.
A 67-year-old man with a history of hypertension presents with
progressive dyspnea, orthopnea, and bilateral ankle edema.
Echocardiography reveals a left ventricular ejection fraction of
30%. Which mechanism most directly explains the development
of pulmonary edema in this patient?
A. Decreased pulmonary vascular resistance
B. Increased pulmonary capillary hydrostatic pressure
C. Reduced plasma oncotic pressure
D. Increased lymphatic drainage
Answer: B. Increased pulmonary capillary hydrostatic pressure
Left ventricular systolic dysfunction increases left atrial and
pulmonary venous pressures, which raises pulmonary capillary
,hydrostatic pressure and promotes transudation of fluid into the
pulmonary interstitium and alveoli.
2.
A 24-year-old woman develops severe vomiting and diarrhea
for several days. Laboratory studies show a serum creatinine of
2.4 mg/dL, BUN of 68 mg/dL, and fractional excretion of sodium
of 0.4%. Which renal response is most likely?
A. Increased sodium excretion
B. Decreased renin release
C. Increased proximal tubular sodium reabsorption
D. Suppressed aldosterone secretion
Answer: C. Increased proximal tubular sodium reabsorption
Volume depletion activates the renin-angiotensin-aldosterone
system and sympathetic nervous system, increasing proximal
sodium and water reabsorption. A low fractional sodium
excretion supports prerenal kidney injury.
3.
A 58-year-old man with chronic obstructive pulmonary disease
develops worsening dyspnea and peripheral edema.
Echocardiography shows right ventricular enlargement with
,preserved left ventricular systolic function. Which process most
likely caused his right-sided heart failure?
A. Chronic pulmonary hypertension
B. Mitral valve stenosis
C. Left ventricular infarction
D. Aortic regurgitation
Answer: A. Chronic pulmonary hypertension
Chronic hypoxic pulmonary vasoconstriction and vascular
remodeling increase pulmonary vascular resistance, producing
pulmonary hypertension and eventually right ventricular
hypertrophy and failure.
4.
A patient with acute pulmonary embolism develops sudden
dyspnea, tachycardia, and hypoxemia. Which ventilation-
perfusion abnormality is most characteristic?
A. Low V/Q due to airway obstruction
B. High V/Q due to ventilated but underperfused alveoli
C. Complete absence of ventilation
D. Uniformly decreased ventilation and perfusion
Answer: B. High V/Q due to ventilated but underperfused
alveoli
, Pulmonary embolism obstructs pulmonary blood flow while
ventilation continues, creating regions of high V/Q and
physiologic dead space.
5.
A 72-year-old woman with severe aortic stenosis develops
exertional syncope and angina. Which ventricular adaptation
initially occurs in response to the increased afterload?
A. Eccentric hypertrophy
B. Concentric hypertrophy
C. Ventricular dilation without hypertrophy
D. Right ventricular hypertrophy
Answer: B. Concentric hypertrophy
Chronic pressure overload from aortic stenosis produces
sarcomere addition in parallel, resulting in concentric left
ventricular hypertrophy.
6.
A patient with advanced chronic kidney disease has a
hemoglobin concentration of 8.2 g/dL. Which mechanism best
explains this finding?
Renal Integrated Exam 2026
Edition Questions with
Answers and Rationales
1.
A 67-year-old man with a history of hypertension presents with
progressive dyspnea, orthopnea, and bilateral ankle edema.
Echocardiography reveals a left ventricular ejection fraction of
30%. Which mechanism most directly explains the development
of pulmonary edema in this patient?
A. Decreased pulmonary vascular resistance
B. Increased pulmonary capillary hydrostatic pressure
C. Reduced plasma oncotic pressure
D. Increased lymphatic drainage
Answer: B. Increased pulmonary capillary hydrostatic pressure
Left ventricular systolic dysfunction increases left atrial and
pulmonary venous pressures, which raises pulmonary capillary
,hydrostatic pressure and promotes transudation of fluid into the
pulmonary interstitium and alveoli.
2.
A 24-year-old woman develops severe vomiting and diarrhea
for several days. Laboratory studies show a serum creatinine of
2.4 mg/dL, BUN of 68 mg/dL, and fractional excretion of sodium
of 0.4%. Which renal response is most likely?
A. Increased sodium excretion
B. Decreased renin release
C. Increased proximal tubular sodium reabsorption
D. Suppressed aldosterone secretion
Answer: C. Increased proximal tubular sodium reabsorption
Volume depletion activates the renin-angiotensin-aldosterone
system and sympathetic nervous system, increasing proximal
sodium and water reabsorption. A low fractional sodium
excretion supports prerenal kidney injury.
3.
A 58-year-old man with chronic obstructive pulmonary disease
develops worsening dyspnea and peripheral edema.
Echocardiography shows right ventricular enlargement with
,preserved left ventricular systolic function. Which process most
likely caused his right-sided heart failure?
A. Chronic pulmonary hypertension
B. Mitral valve stenosis
C. Left ventricular infarction
D. Aortic regurgitation
Answer: A. Chronic pulmonary hypertension
Chronic hypoxic pulmonary vasoconstriction and vascular
remodeling increase pulmonary vascular resistance, producing
pulmonary hypertension and eventually right ventricular
hypertrophy and failure.
4.
A patient with acute pulmonary embolism develops sudden
dyspnea, tachycardia, and hypoxemia. Which ventilation-
perfusion abnormality is most characteristic?
A. Low V/Q due to airway obstruction
B. High V/Q due to ventilated but underperfused alveoli
C. Complete absence of ventilation
D. Uniformly decreased ventilation and perfusion
Answer: B. High V/Q due to ventilated but underperfused
alveoli
, Pulmonary embolism obstructs pulmonary blood flow while
ventilation continues, creating regions of high V/Q and
physiologic dead space.
5.
A 72-year-old woman with severe aortic stenosis develops
exertional syncope and angina. Which ventricular adaptation
initially occurs in response to the increased afterload?
A. Eccentric hypertrophy
B. Concentric hypertrophy
C. Ventricular dilation without hypertrophy
D. Right ventricular hypertrophy
Answer: B. Concentric hypertrophy
Chronic pressure overload from aortic stenosis produces
sarcomere addition in parallel, resulting in concentric left
ventricular hypertrophy.
6.
A patient with advanced chronic kidney disease has a
hemoglobin concentration of 8.2 g/dL. Which mechanism best
explains this finding?
