HCR 240 2026 PRACTICE EXAM LATEST 2026
UPDATE 100+ QUESTIONS AND DETAILED VERIFIED
ANSWERS FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A patient presents with sudden onset of severe right lower quadrant abdominal
pain, nausea, and fever. Which assessment finding most strongly suggests
appendicitis?
A) Pain relieved by eating
B) Pain that worsens with coughing
C) Left upper quadrant tenderness
D) Bilateral flank pain
Correct Answer: B
Explanation: Pain that worsens with coughing increases intra-abdominal pressure,
irritating the inflamed appendix. This is consistent with peritoneal signs in
appendicitis, whereas the other options are not typical for this condition.
Question 2
Which medication is considered first-line for acute anaphylaxis management?
A) Diphenhydramine
B) Albuterol
C) Epinephrine
D) Methylprednisolone
Correct Answer: C
Explanation: Epinephrine rapidly reverses bronchoconstriction, hypotension, and
edema in anaphylaxis via alpha and beta-adrenergic effects. Other agents are
adjunctive but not first-line for immediate life-threatening symptoms.
,Question 3
A 58-year-old male with a history of hypertension reports sudden, tearing chest
pain radiating to his back. His blood pressure is 160/90 in the right arm and
100/60 in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Explanation: Aortic dissection presents with tearing chest pain and differential
blood pressures in the arms due to propagation of the dissection flap. This is a
surgical emergency, unlike the other options which do not typically cause pulse
deficits.
Question 4
Which lab value is most specific for acute pancreatitis?
A) Elevated amylase
B) Elevated lipase
C) Elevated ALT
D) Elevated bilirubin
Correct Answer: B
Explanation: Lipase is more specific than amylase for pancreatic inflammation,
with higher sensitivity and longer half-life. Amylase can be elevated in salivary or
bowel disorders, while ALT and bilirubin point to hepatobiliary causes.
Question 5
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. What is the appropriate initial intervention?
A) Intubate immediately
B) Apply non-rebreather mask at 15 L/min
,C) Start supplemental oxygen to target SpO2 88-92%
D) Administer IV epinephrine
Correct Answer: C
*Explanation: In COPD, excessive oxygen can suppress hypoxic drive, leading to
hypercapnia. Target SpO2 88-92% balances oxygenation without CO2 retention,
unlike high-flow oxygen or unnecessary intubation.*
Question 6
Which finding on a 12-lead ECG is most consistent with acute ST-elevation
myocardial infarction (STEMI)?
A) ST depression in leads V1-V4
B) New left bundle branch block
C) Peaked T waves in lead II
D) ST elevation in leads II, III, and aVF
Correct Answer: D
Explanation: ST elevation in contiguous leads (II, III, aVF) indicates inferior wall
STEMI. New LBBB can represent ischemia but is not diagnostic for STEMI alone; ST
depression suggests NSTEMI or reciprocal changes.
Question 7
What is the primary mechanism of action of loop diuretics like furosemide?
A) Inhibition of sodium-chloride symporter in the distal tubule
B) Inhibition of sodium-potassium-chloride cotransporter in the thick ascending
limb
C) Antagonism of aldosterone receptors
D) Blockade of carbonic anhydrase
Correct Answer: B
Explanation: Loop diuretics act on the NKCC2 transporter in the thick ascending
limb of Henle, producing potent diuresis. The other options describe thiazides,
spironolactone, and acetazolamide respectively.
, Question 8
A 34-year-old woman presents with fatigue, joint pain, and a malar rash.
Laboratory tests show ANA positive, anti-dsDNA positive, and low C3. Which
diagnosis is most likely?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus (SLE)
C) Scleroderma
D) Sjögren’s syndrome
Correct Answer: B
Explanation: Malar rash, ANA positivity, anti-dsDNA, and low complement are
hallmark features of SLE. Rheumatoid arthritis typically shows anti-CCP, while
scleroderma has skin thickening and Sjögren’s presents with sicca symptoms.
Question 9
A patient with diabetes mellitus type 2 has a serum creatinine of 2.5 mg/dL and
an eGFR of 28 mL/min. Which oral medication should be avoided?
A) Metformin
B) Glipizide
C) Pioglitazone
D) Sitagliptin
Correct Answer: A
*Explanation: Metformin is contraindicated when eGFR <30 mL/min due to risk of
lactic acidosis. Glipizide is safe with dose adjustment; pioglitazone and sitagliptin
may be used with caution but metformin is specifically avoided.*
Question 10
Which electrolyte imbalance is most commonly associated with digoxin toxicity?
A) Hyponatremia
B) Hyperkalemia
UPDATE 100+ QUESTIONS AND DETAILED VERIFIED
ANSWERS FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A patient presents with sudden onset of severe right lower quadrant abdominal
pain, nausea, and fever. Which assessment finding most strongly suggests
appendicitis?
A) Pain relieved by eating
B) Pain that worsens with coughing
C) Left upper quadrant tenderness
D) Bilateral flank pain
Correct Answer: B
Explanation: Pain that worsens with coughing increases intra-abdominal pressure,
irritating the inflamed appendix. This is consistent with peritoneal signs in
appendicitis, whereas the other options are not typical for this condition.
Question 2
Which medication is considered first-line for acute anaphylaxis management?
A) Diphenhydramine
B) Albuterol
C) Epinephrine
D) Methylprednisolone
Correct Answer: C
Explanation: Epinephrine rapidly reverses bronchoconstriction, hypotension, and
edema in anaphylaxis via alpha and beta-adrenergic effects. Other agents are
adjunctive but not first-line for immediate life-threatening symptoms.
,Question 3
A 58-year-old male with a history of hypertension reports sudden, tearing chest
pain radiating to his back. His blood pressure is 160/90 in the right arm and
100/60 in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Explanation: Aortic dissection presents with tearing chest pain and differential
blood pressures in the arms due to propagation of the dissection flap. This is a
surgical emergency, unlike the other options which do not typically cause pulse
deficits.
Question 4
Which lab value is most specific for acute pancreatitis?
A) Elevated amylase
B) Elevated lipase
C) Elevated ALT
D) Elevated bilirubin
Correct Answer: B
Explanation: Lipase is more specific than amylase for pancreatic inflammation,
with higher sensitivity and longer half-life. Amylase can be elevated in salivary or
bowel disorders, while ALT and bilirubin point to hepatobiliary causes.
Question 5
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 88% on room air. What is the appropriate initial intervention?
A) Intubate immediately
B) Apply non-rebreather mask at 15 L/min
,C) Start supplemental oxygen to target SpO2 88-92%
D) Administer IV epinephrine
Correct Answer: C
*Explanation: In COPD, excessive oxygen can suppress hypoxic drive, leading to
hypercapnia. Target SpO2 88-92% balances oxygenation without CO2 retention,
unlike high-flow oxygen or unnecessary intubation.*
Question 6
Which finding on a 12-lead ECG is most consistent with acute ST-elevation
myocardial infarction (STEMI)?
A) ST depression in leads V1-V4
B) New left bundle branch block
C) Peaked T waves in lead II
D) ST elevation in leads II, III, and aVF
Correct Answer: D
Explanation: ST elevation in contiguous leads (II, III, aVF) indicates inferior wall
STEMI. New LBBB can represent ischemia but is not diagnostic for STEMI alone; ST
depression suggests NSTEMI or reciprocal changes.
Question 7
What is the primary mechanism of action of loop diuretics like furosemide?
A) Inhibition of sodium-chloride symporter in the distal tubule
B) Inhibition of sodium-potassium-chloride cotransporter in the thick ascending
limb
C) Antagonism of aldosterone receptors
D) Blockade of carbonic anhydrase
Correct Answer: B
Explanation: Loop diuretics act on the NKCC2 transporter in the thick ascending
limb of Henle, producing potent diuresis. The other options describe thiazides,
spironolactone, and acetazolamide respectively.
, Question 8
A 34-year-old woman presents with fatigue, joint pain, and a malar rash.
Laboratory tests show ANA positive, anti-dsDNA positive, and low C3. Which
diagnosis is most likely?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus (SLE)
C) Scleroderma
D) Sjögren’s syndrome
Correct Answer: B
Explanation: Malar rash, ANA positivity, anti-dsDNA, and low complement are
hallmark features of SLE. Rheumatoid arthritis typically shows anti-CCP, while
scleroderma has skin thickening and Sjögren’s presents with sicca symptoms.
Question 9
A patient with diabetes mellitus type 2 has a serum creatinine of 2.5 mg/dL and
an eGFR of 28 mL/min. Which oral medication should be avoided?
A) Metformin
B) Glipizide
C) Pioglitazone
D) Sitagliptin
Correct Answer: A
*Explanation: Metformin is contraindicated when eGFR <30 mL/min due to risk of
lactic acidosis. Glipizide is safe with dose adjustment; pioglitazone and sitagliptin
may be used with caution but metformin is specifically avoided.*
Question 10
Which electrolyte imbalance is most commonly associated with digoxin toxicity?
A) Hyponatremia
B) Hyperkalemia
