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Introduction and Importance: Multiple-choice questions (MCQs) offer a suitable means to assess the cognitive domain of learners with a high degree of objectivity. The study's objective is to formulate an equation for determining the ideal timing for MCQ examinations, thereby inspiring the development of a model to estimate the duration of these examinations., Methods: The authors generated a specific computer program that integrated with the operating system of the examination. Technical-specific features included the ability to calculate the speed of students taking examinations with images or videos in the questions or options. This bespoke computer program was designed specifically for assessing individual students' MCQ test-taking pace and generating a proctor report in a computer-readable format. Subsequently, data derived from this program underwent regression analysis to determine the speed at which students completed MCQ examinations., Outcomes: The data were collected from a total of 1035 examinees, all of whom were non-native English speakers. The average reading rate was 62.38±20.4 words/min. It was found that the rate decreased significantly in difficult (50.65±6.9 words/min) items compared to easy (82.29±21.3 words/min) and intermediate (60.56±19.1 words/min) items ( p <0.001), respectively. The linear regression analysis predicted option selection (words/min) as; 33.92+1.93(%tables/figures)+0.14(%recall)-0.37(%application), r 2 =0.45, p <0.001., Conclusion: It is not advisable to base the decision solely on reading time or time allocation. Examination administrators are advised to proactively plan ahead, with particular emphasis on establishing a well-defined taxonomy, as it constitutes a fundamental cornerstone in the utilization of the estimation equation., Competing Interests: None of the authors have a conflict of interest to disclose.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Hypokalemia, serum potassium (K) < 3.5 mEq/L, is a serious and common clinical problem. The traditional diagnosis of renal potassium losses is 24-hr urine potassium (24U(K)) > or = 20 mEq/day during hypokalemia. Immediate replacement of potassium is often required to prevent complication but may normalize serum K during 24-hr urine collection and render the test inconclusive., Material and Method: The authors examined the ability of urinary indices including 24U(K), transtubular potassium gradient (TTKG), fractional excretion of potassium (FE(K)), urine potassium-creatinine ratio (U(K/Cr)) and spot U(K) and introduced urine potassium per hour during the first 8 hours (U(K)/hr) as a novel index for evaluation of hypokalemia during treatment. Any serum K level > or = 4 mEq/L during urine collection was defined as normalized serum K. In the present study, the final classification of renal K losses in non-normalized 24-hr serum K group was made when 24U(K) > or = 20 mEq/day. In normalized group, the final classification of renal or non-renal K losses was based on the majority of the results of four urine indices including TTKG, FE(K) U(K/Cr) and spot U(K)., Results: Of 61 patients (renal:non-renal = 50:11), 51% and 18% met the criteria of normalized 24-hr and 8-hr serum K. Over all, the U(K)/hr > or = 0.9 mEq/hr can indicate renal K losses with a sensitivity of 96% and specificity of 72.7% compared with the 24U(K) > or = 20 mEq/day of 100% and 54.5%, respectively. In a subgroup of normalized 24-hr serum K, the sensitivity and specificity of U(K)/hr = 95.5% and 77.8% whereas 24U(K) = 100% and 44.4%, respectively, Conclusion: U(K)/hr is a new practical, simple, and reliable marker that can be applied to evaluate hypokalemic patients during treatment with comparable sensitivity and specificity with 24U(K).

IgA nephropathy (IgAN) is a form of glomerular diseases which is usually aggravated by infection in respiratory or gastrointestinal systems. The clinical manifestations in IgAN can be asymptomatic microscopic hematuria, gross hematuria, nephritic syndrome, nephrotic syndrome or acute renal injury from crescentic glomerulonephritis. Acute interstitial nephritis (AIN) has been previously described as an unusual cause of acute renal injury in IgAN. Hemoptysis from diffuse pulmonary hemorrhage is a rare manifestation in IgAN. We reported a patient who presented with fever hemoptysis from diffuse pulmonary hemorrhage, and acute renal injury. Renal biopsy revealed IgAN concomitant with AIN which was the cause of renal dysfunction. We conclude that pulmonary hemorrhage and acute interstitial nephritis can be found in IgAN. The etiology of pulmonary hemorrhage and acute interstitial nephritis might be from infection. Renal biopsy is a mandatory investigation to make the correct diagnosis.