diff --git a/.env.example b/.env.example
index dd68c79c..f95c57d0 100644
--- a/.env.example
+++ b/.env.example
@@ -258,6 +258,10 @@ DB_PASSWORD=pedscribe_secret_change_me
 # CLINICAL_ASSISTANT_MCP_REQUEST_TIMEOUT_MS=90000
 # CLINICAL_ASSISTANT_MCP_SESSION_TTL_MS=600000
 # CLINICAL_ASSISTANT_MCP_CONCURRENCY=3   # library searches in flight at once; they used to run one at a time
+# CLINICAL_ASSISTANT_MCP_QUEUE_MAX=        # callers allowed to wait for a slot (default 4 x concurrency); past it: "busy, try again"
+# CLINICAL_ASSISTANT_MCP_QUEUE_WAIT_MS=8000 # how long a caller waits in that line before being told the library is busy
+# CLINICAL_ASSISTANT_ASK_LIMIT_PER_MINUTE=30 # paid assistant questions per user per minute, counted in Redis (no Redis: no limit)
+# CLINICAL_ASSISTANT_RETRIEVAL_CACHE_TTL_S=60 # same library search within this window is answered from Redis; 0 disables
 # CLINICAL_ASSISTANT_MCP_WARMUP=            # open a session at boot
 # CLINICAL_ASSISTANT_MCP_WARMUP_DELAY_MS=
 
diff --git a/src/middleware/rateLimit.js b/src/middleware/rateLimit.js
new file mode 100644
index 00000000..12c4ff29
--- /dev/null
+++ b/src/middleware/rateLimit.js
@@ -0,0 +1,45 @@
+// A per-user ceiling on the expensive routes, counted in Redis so every
+// replica sees the same count. Fixed windows: the key carries the window's
+// start, INCR counts, EXPIRE lets it fall away on its own.
+//
+// Without Redis the limiter lets everything through. A missing cache must
+// never turn into a refused question; it only means one process's view.
+var { getRedis } = require('../utils/redis');
+
+function positiveInt(value, fallback) {
+  var n = Number(value);
+  return Number.isFinite(n) && n > 0 ? Math.floor(n) : fallback;
+}
+
+// rateLimit('clinical-chat', { limit: 30, windowSeconds: 60 })
+function rateLimit(scope, opts) {
+  opts = opts || {};
+  var limit = positiveInt(opts.limit, 30);
+  var windowSeconds = positiveInt(opts.windowSeconds, 60);
+  return async function(req, res, next) {
+    var who = req.user && req.user.id;
+    if (!who) return next();
+    var redis;
+    try { redis = await getRedis(); } catch (e) { redis = null; }
+    if (!redis) return next();
+    var windowStart = Math.floor(Date.now() / 1000 / windowSeconds) * windowSeconds;
+    var key = 'rl:' + scope + ':' + who + ':' + windowStart;
+    var count;
+    try {
+      count = await redis.incr(key);
+      if (count === 1) await redis.expire(key, windowSeconds + 1);
+    } catch (e) {
+      return next();
+    }
+    if (count <= limit) return next();
+    var retryAfter = windowStart + windowSeconds - Math.floor(Date.now() / 1000);
+    res.set('Retry-After', String(Math.max(1, retryAfter)));
+    return res.status(429).json({
+      error: 'You have sent a lot of questions in the last minute. Please wait a moment and try again.',
+      code: 'RATE_LIMITED',
+      retryAfter: Math.max(1, retryAfter)
+    });
+  };
+}
+
+module.exports = { rateLimit };
diff --git a/src/routes/clinicalAssistant.js b/src/routes/clinicalAssistant.js
index 1e2101a5..6da98f55 100644
--- a/src/routes/clinicalAssistant.js
+++ b/src/routes/clinicalAssistant.js
@@ -10,6 +10,7 @@ var axios = require('axios');
 var router = express.Router();
 var db = require('../db/database');
 var { authMiddleware } = require('../middleware/auth');
+var { rateLimit } = require('../middleware/rateLimit');
 var { callAI, callAIStream } = require('../utils/ai');
 var generatedImages = require('../utils/generatedImages');
 var imageTool = require('../utils/imageTool');
@@ -51,6 +52,17 @@ var { DEFAULT_BEHAVIOR } = require('../utils/clinicalPrompts');
 // router.use(authMiddleware) gates every /api path, including routes owned by
 // routers mounted after it in server.js.
 router.use('/clinical-assistant', authMiddleware);
+// The paid routes: a question costs a library search and a model call, so
+// one account gets a bounded number per minute. Counted in Redis, shared by
+// every replica; without Redis nothing is refused.
+function positiveIntEnv(name, fallback) {
+  var n = Number(process.env[name]);
+  return Number.isFinite(n) && n > 0 ? Math.floor(n) : fallback;
+}
+var askLimit = rateLimit('clinical-ask', {
+  limit: positiveIntEnv('CLINICAL_ASSISTANT_ASK_LIMIT_PER_MINUTE', 30), windowSeconds: 60
+});
+router.post(['/clinical-assistant/chat', '/clinical-assistant/chat/stream', '/clinical-assistant/image', '/clinical-assistant/image/jobs'], askLimit);
 
 var MAX_SAVED_CHATS_PER_USER = 100;
 var MAX_SAVED_CHAT_TITLE = 160;
@@ -559,6 +571,26 @@ router.get('/clinical-assistant/image/jobs/:id/download', async function(req, re
   } catch (e) { res.status(e.statusCode || 503).json({ error: e.statusCode ? e.message : 'Image service unavailable' }); }
 });
 
+// The same question asked twice in a minute (a retry, a refresh, two people on
+// the same case) is answered from Redis instead of the library. The index only
+// changes when the admin re-runs it, so a short window loses nothing; 0 turns
+// it off. Without Redis every search goes to the library, as before.
+var RETRIEVAL_CACHE_TTL_S = positiveIntEnv('CLINICAL_ASSISTANT_RETRIEVAL_CACHE_TTL_S', 60);
+function retrievalCacheKey(query, opts) {
+  var hash = require('crypto').createHash('sha256').update(String(query)).digest('hex');
+  return 'retrieval:' + hash + ':' + opts.limit + ':' + (opts.includeContext ? 1 : 0) + ':' + opts.contextChars;
+}
+async function cachedSemanticSearch(query, opts, timing) {
+  var cache = redisCache && typeof redisCache.getJson === 'function' ? redisCache : null;
+  if (!RETRIEVAL_CACHE_TTL_S || !cache) return semanticSearch(query, opts);
+  var key = retrievalCacheKey(query, opts);
+  var hit = await cache.getJson(key).catch(function() { return null; });
+  if (hit) { if (timing) timing.searchCached = true; return hit; }
+  var response = await semanticSearch(query, opts);
+  cache.setJson(key, response, RETRIEVAL_CACHE_TTL_S).catch(function() {});
+  return response;
+}
+
 async function prepareAssistantChat(body) {
   body = body || {};
   var checked = checkConversation(body.history, body.message, await getConversationLimit());
@@ -592,11 +624,11 @@ async function prepareAssistantChat(body) {
     return message;
   });
   timing.rewriteMs = Date.now() - phase; phase = Date.now();
-  var searchResponse = await semanticSearch(searchQuery, {
+  var searchResponse = await cachedSemanticSearch(searchQuery, {
     limit: searchLimit,
     includeContext: includeContext,
     contextChars: contextChars
-  });
+  }, timing);
   timing.searchMs = Date.now() - phase;
   // Retrieval is text-only. The multimodal path called nc_multimodal_search
   // against a second hardcoded collection with an embedding service that was
diff --git a/src/utils/clinicalMcpClient.js b/src/utils/clinicalMcpClient.js
index 565610af..087b7566 100644
--- a/src/utils/clinicalMcpClient.js
+++ b/src/utils/clinicalMcpClient.js
@@ -22,6 +22,12 @@ var _mcpCallQueue = Promise.resolve();
 // session, so a small bound is enough to stop the queueing without letting a
 // burst pile onto it.
 var MCP_CONCURRENCY = positiveInt(process.env.CLINICAL_ASSISTANT_MCP_CONCURRENCY, 3);
+// The queue behind those slots is bounded too. Past MCP_QUEUE_MAX waiters, or
+// after MCP_QUEUE_WAIT_MS in line, a caller is told the library is busy
+// instead of holding a request open indefinitely: a burst then degrades into
+// a few quick "try again" answers rather than a minute of silence for everyone.
+var MCP_QUEUE_MAX = positiveInt(process.env.CLINICAL_ASSISTANT_MCP_QUEUE_MAX, MCP_CONCURRENCY * 4);
+var MCP_QUEUE_WAIT_MS = positiveInt(process.env.CLINICAL_ASSISTANT_MCP_QUEUE_WAIT_MS, 8000);
 var _inFlight = 0;
 var _waiting = [];
 // The session is renewed before it expires, in the background, so no one
@@ -117,14 +123,36 @@ function warmMcpSession() {
   return getMcpSession();
 }
 
+function busyError() {
+  var e = new Error('The library is busy right now. Please try again in a moment.');
+  e.statusCode = 503;
+  e.code = 'RETRIEVAL_BUSY';
+  e.retryAfterSeconds = 5;
+  return e;
+}
+
 function acquireSlot() {
   if (_inFlight < MCP_CONCURRENCY) { _inFlight++; return Promise.resolve(); }
-  return new Promise(function(resolve) { _waiting.push(resolve); });
+  if (_waiting.length >= MCP_QUEUE_MAX) return Promise.reject(busyError());
+  return new Promise(function(resolve, reject) {
+    var waiter = { resolve: resolve, timer: null };
+    waiter.timer = setTimeout(function() {
+      var at = _waiting.indexOf(waiter);
+      if (at !== -1) _waiting.splice(at, 1);
+      reject(busyError());
+    }, MCP_QUEUE_WAIT_MS);
+    if (waiter.timer.unref) waiter.timer.unref();
+    _waiting.push(waiter);
+  });
 }
 
 function releaseSlot() {
   var next = _waiting.shift();
-  if (next) next(); else _inFlight--;
+  if (next) { clearTimeout(next.timer); next.resolve(); } else _inFlight--;
+}
+
+function queueDepth() {
+  return { inFlight: _inFlight, waiting: _waiting.length, concurrency: MCP_CONCURRENCY, queueMax: MCP_QUEUE_MAX };
 }
 
 async function callMcpTool(name, args) {
@@ -374,6 +402,7 @@ function parseMcpResponse(body) {
 
 module.exports = {
   semanticSearch: semanticSearch,
+  queueDepth: queueDepth,
   indexedTopicSuggestions: indexedTopicSuggestions,
   getMcpHealth: getMcpHealth,
   warmMcpSession: warmMcpSession,
diff --git a/test/assistant-attachment-roundtrip.test.js b/test/assistant-attachment-roundtrip.test.js
index 7f1bb9db..4766420b 100644
--- a/test/assistant-attachment-roundtrip.test.js
+++ b/test/assistant-attachment-roundtrip.test.js
@@ -55,6 +55,7 @@ function server(options = {}) {
   const mocks = {
     express, axios: { async post(url, payload) { if (String(url).includes('/translate')) return { data: { translatedText: 'Synthetic translation.' } }; calls.images.push(payload); return { data: { data: [{ b64_json: 'c3ludGhldGlj' }] } }; } }, crypto: require('node:crypto'), '../db/database': db,
     '../middleware/auth': { authMiddleware() {} },
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     './auth': { __sendEmail: async () => false }, '../utils/ai': options.ai || { callAI: ai, callAIStream: ai },
     '../utils/errors': { gatewayUrl: path => 'http://synthetic.invalid' + path }, '../utils/litellm': { getLiteLLMHeaders: () => ({}) }, '../utils/logger': { audit() {}, error() {}, warn() {} },
     '../utils/crypto': { encryptString: value => 'encrypted:' + value, decryptString: value => value.replace(/^encrypted:/, '') },
diff --git a/test/assistant-image-attachments.test.js b/test/assistant-image-attachments.test.js
index 896aefcf..db308366 100644
--- a/test/assistant-image-attachments.test.js
+++ b/test/assistant-image-attachments.test.js
@@ -53,6 +53,7 @@ function server(options = {}) {
   const mocks = {
     express, axios: { async post(url, payload) { if (String(url).includes('/translate')) return { data: { translatedText: 'Synthetic translation.' } }; calls.images.push(payload); return { data: { data: [{ b64_json: 'c3ludGhldGlj' }] } }; } }, crypto: require('node:crypto'), '../db/database': db,
     '../middleware/auth': { authMiddleware() {} },
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     './auth': { __sendEmail: async () => false }, '../utils/ai': options.ai || { callAI: ai, callAIStream: ai },
     '../utils/errors': { gatewayUrl: path => 'http://synthetic.invalid' + path }, '../utils/litellm': { getLiteLLMHeaders: () => ({}) }, '../utils/logger': { audit() {}, error() {}, warn() {} },
     '../utils/crypto': { encryptString: value => 'encrypted:' + value, decryptString: value => value.replace(/^encrypted:/, '') },
diff --git a/test/assistant-rate-limit-and-cache.test.js b/test/assistant-rate-limit-and-cache.test.js
new file mode 100644
index 00000000..05f0954b
--- /dev/null
+++ b/test/assistant-rate-limit-and-cache.test.js
@@ -0,0 +1,68 @@
+// A person gets a bounded number of paid questions a minute, counted in
+// Redis; and the same library search twice in a minute is answered from
+// Redis. Neither refuses anything when Redis is absent.
+const test = require('node:test');
+const assert = require('node:assert/strict');
+const fs = require('node:fs');
+const path = require('node:path');
+const Module = require('node:module');
+
+function fakeRedis() {
+  const store = new Map();
+  return {
+    store,
+    incr: async k => { const v = (store.get(k) || 0) + 1; store.set(k, v); return v; },
+    expire: async () => 1
+  };
+}
+
+function loadLimiter(redis) {
+  const target = require.resolve('../src/middleware/rateLimit');
+  delete require.cache[target];
+  const original = Module._load;
+  Module._load = function(request, parent) {
+    if (/utils\/redis$/.test(request)) return { getRedis: async () => redis };
+    return original.apply(this, arguments);
+  };
+  try { return require(target); } finally { Module._load = original; }
+}
+
+function run(mw, userId) {
+  return new Promise(resolve => {
+    const res = { headers: {}, set(k, v) { this.headers[k] = v; }, status(c) { this.code = c; return this; }, json(b) { this.body = b; resolve({ res, next: false }); } };
+    mw({ user: { id: userId } }, res, () => resolve({ res, next: true }));
+  });
+}
+
+test('the limit counts per user per window and answers 429 with a retry hint past it', async () => {
+  const { rateLimit } = loadLimiter(fakeRedis());
+  const mw = rateLimit('t', { limit: 2, windowSeconds: 60 });
+  assert.equal((await run(mw, 1)).next, true);
+  assert.equal((await run(mw, 1)).next, true);
+  const third = await run(mw, 1);
+  assert.equal(third.next, false);
+  assert.equal(third.res.code, 429);
+  assert.equal(third.res.body.code, 'RATE_LIMITED');
+  assert.ok(Number(third.res.headers['Retry-After']) >= 1);
+  assert.equal((await run(mw, 2)).next, true, 'another user has their own count');
+});
+
+test('without Redis nothing is refused', async () => {
+  const { rateLimit } = loadLimiter(null);
+  const mw = rateLimit('t', { limit: 1, windowSeconds: 60 });
+  assert.equal((await run(mw, 1)).next, true);
+  assert.equal((await run(mw, 1)).next, true);
+});
+
+test('the paid assistant routes sit behind the limiter, and the library search is cached briefly', () => {
+  const route = fs.readFileSync(path.join(__dirname, '..', 'src/routes/clinicalAssistant.js'), 'utf8');
+  assert.match(route, /router\.post\(\['\/clinical-assistant\/chat', '\/clinical-assistant\/chat\/stream', '\/clinical-assistant\/image', '\/clinical-assistant\/image\/jobs'\], askLimit\)/);
+  assert.match(route, /rateLimit\('clinical-ask', \{\s*limit: positiveIntEnv\('CLINICAL_ASSISTANT_ASK_LIMIT_PER_MINUTE', 30\), windowSeconds: 60/);
+  assert.match(route, /await cachedSemanticSearch\(searchQuery, \{/);
+  assert.match(route, /RETRIEVAL_CACHE_TTL_S = positiveIntEnv\('CLINICAL_ASSISTANT_RETRIEVAL_CACHE_TTL_S', 60\)/);
+  assert.match(route, /if \(!RETRIEVAL_CACHE_TTL_S \|\| !cache\) return semanticSearch\(query, opts\)/, '0 turns the cache off, and so does a missing cache');
+  assert.match(route, /cache\.setJson\(key, response, RETRIEVAL_CACHE_TTL_S\)\.catch/, 'a cache write failure never fails the answer');
+  const client = fs.readFileSync(path.join(__dirname, '..', 'src/utils/clinicalMcpClient.js'), 'utf8');
+  assert.match(client, /e\.message\s*=|new Error\('The library is busy right now/, 'the busy answer reads as a sentence');
+  assert.doesNotMatch(client.slice(client.indexOf('function busyError'), client.indexOf('function acquireSlot')), /MCP/, 'so assistantErrorMessage passes it through unchanged');
+});
diff --git a/test/assistant-translate.test.js b/test/assistant-translate.test.js
index b53ee2fa..41fd26a2 100644
--- a/test/assistant-translate.test.js
+++ b/test/assistant-translate.test.js
@@ -81,7 +81,7 @@ test('translate route is owner-bound, validated and cached; admin default provid
   const db = { async getSetting(key) { return null; }, async get() { return null; }, async run() { return { lastInsertRowid: 1 }; }, async query() { return { rows: [] }; } };
   const mocks = {
     express, axios: { async post(url, payload) { calls.push(String(url)); return { data: { translatedText: 'Traducción sintética.' } }; } }, crypto: require('node:crypto'),
-    '../db/database': db, '../middleware/auth': { authMiddleware() {} }, '../utils/ai': { callAI: async () => ({}), callAIStream: async () => ({}) },
+    '../db/database': db, '../middleware/auth': { authMiddleware() {} }, '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } }, '../utils/ai': { callAI: async () => ({}), callAIStream: async () => ({}) },
     '../utils/errors': { gatewayUrl: p => 'http://synthetic.invalid' + p }, '../utils/litellm': { getLiteLLMHeaders: () => ({}) }, '../utils/logger': { audit() {}, error() {}, warn() {} },
     '../utils/crypto': { encryptString: v => 'encrypted:' + v, decryptString: v => v.replace(/^encrypted:/, '') },
     '../utils/redis': { async getJson() { return null; }, async setJson() {} }, '../utils/clinicalPromptPool': { createClinicalPromptPool: () => ({}) },
diff --git a/test/clinical-conversation.test.js b/test/clinical-conversation.test.js
index b3773705..58b777ab 100644
--- a/test/clinical-conversation.test.js
+++ b/test/clinical-conversation.test.js
@@ -37,6 +37,7 @@ function server(options = {}) {
   const mocks = {
     express, axios: { async post(url, payload) { if (String(url).includes('/translate')) return { data: { translatedText: 'Synthetic translation.' } }; calls.images.push(payload); return { data: { data: [{ b64_json: 'c3ludGhldGlj' }] } }; } }, crypto: require('node:crypto'), '../db/database': db,
     '../middleware/auth': { authMiddleware() {} },
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     './auth': { __sendEmail: async () => false }, '../utils/ai': options.ai || { callAI: ai, callAIStream: ai },
     '../utils/errors': { gatewayUrl: path => 'http://synthetic.invalid' + path }, '../utils/litellm': { getLiteLLMHeaders: () => ({}) }, '../utils/logger': { audit() {}, error() {}, warn() {} },
     '../utils/crypto': { encryptString: value => 'encrypted:' + value, decryptString: value => value.replace(/^encrypted:/, '') },
diff --git a/test/generated-image-tools.test.js b/test/generated-image-tools.test.js
index 5404e9c2..abf22338 100644
--- a/test/generated-image-tools.test.js
+++ b/test/generated-image-tools.test.js
@@ -76,6 +76,7 @@ function route(file, ai, jobs) {
     express, axios:{}, crypto:require('crypto'), multer:require('multer'), path:require('path'),
     '../utils/ai':ai, '../db/database':{getSetting:async key=>key.includes('model')?'test':null,all:async()=>[]},
     '../middleware/auth':{authMiddleware(){},moderatorMiddleware(){}},
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     '../utils/crypto':{},'../utils/urlSafety':{},'../utils/policy':{requireFeature:()=>()=>{}},
     // Retrieval is opt-in and these cases do not ask for it; the stub proves
     // the route never reaches the corpus unless useCorpus was set.
diff --git a/test/mcp-client-concurrency.test.js b/test/mcp-client-concurrency.test.js
index 47dff1e3..e4e5dfd2 100644
--- a/test/mcp-client-concurrency.test.js
+++ b/test/mcp-client-concurrency.test.js
@@ -6,10 +6,17 @@ const fs = require('node:fs');
 const path = require('node:path');
 const src = fs.readFileSync(path.join(__dirname, '..', 'src/utils/clinicalMcpClient.js'), 'utf8');
 
+// The slot and queue logic on its own, with the bounds given explicitly.
+function slots(concurrency, queueMax, waitMs) {
+  const slice = src.slice(src.indexOf('function busyError'), src.indexOf('async function callMcpTool'));
+  return new Function('MCP_CONCURRENCY', 'MCP_QUEUE_MAX', 'MCP_QUEUE_WAIT_MS',
+    'var _inFlight = 0, _waiting = [];' + slice +
+    '; return { acquireSlot, releaseSlot, count: () => _inFlight, waiting: () => _waiting.length };')(concurrency, queueMax, waitMs);
+}
+
 test('a bounded number of calls run at once; the rest wait their turn', async () => {
   // The slot logic on its own, with the environment's default bound.
-  const slice = src.slice(src.indexOf('function acquireSlot'), src.indexOf('async function callMcpTool'));
-  const fn = new Function('MCP_CONCURRENCY', 'var _inFlight = 0, _waiting = [];' + slice + '; return { acquireSlot, releaseSlot, count: () => _inFlight, waiting: () => _waiting.length };')(3);
+  const fn = slots(3, 12, 8000);
   await fn.acquireSlot(); await fn.acquireSlot(); await fn.acquireSlot();
   assert.equal(fn.count(), 3);
   let fourthStarted = false;
@@ -25,6 +32,36 @@ test('a bounded number of calls run at once; the rest wait their turn', async ()
   assert.equal(fn.count(), 0);
 });
 
+test('past the queue bound a caller is told the library is busy, not held', async () => {
+  const fn = slots(1, 2, 8000);
+  await fn.acquireSlot();
+  const second = fn.acquireSlot(); const third = fn.acquireSlot();
+  assert.equal(fn.waiting(), 2);
+  await assert.rejects(fn.acquireSlot(), e => e.statusCode === 503 && e.code === 'RETRIEVAL_BUSY' && e.retryAfterSeconds === 5);
+  fn.releaseSlot(); await second; fn.releaseSlot(); await third; fn.releaseSlot();
+  assert.equal(fn.count(), 0);
+});
+
+test('a caller that waits too long is released from the line, and the line forgets it', async () => {
+  const fn = slots(1, 4, 20);
+  // The wait timer is unref'd (a live search keeps the process up in real
+  // use); hold the loop open here so it can fire.
+  const hold = setTimeout(() => {}, 200);
+  await fn.acquireSlot();
+  const late = fn.acquireSlot();
+  await assert.rejects(late, e => e.code === 'RETRIEVAL_BUSY');
+  assert.equal(fn.waiting(), 0, 'the timed-out waiter is gone');
+  fn.releaseSlot();
+  assert.equal(fn.count(), 0, 'releasing does not hand the slot to a caller that already gave up');
+  clearTimeout(hold);
+});
+
+test('the queue bounds and the busy answer are wired where the route can see them', () => {
+  assert.match(src, /MCP_QUEUE_MAX = positiveInt\(process\.env\.CLINICAL_ASSISTANT_MCP_QUEUE_MAX, MCP_CONCURRENCY \* 4\)/);
+  assert.match(src, /MCP_QUEUE_WAIT_MS = positiveInt\(process\.env\.CLINICAL_ASSISTANT_MCP_QUEUE_WAIT_MS, 8000\)/);
+  assert.match(src, /queueDepth: queueDepth/);
+});
+
 test('the serial promise chain is gone, the session is kept warm, and the split is logged', () => {
   assert.doesNotMatch(src, /_mcpCallQueue = queued\.catch/, 'no more one-at-a-time chain');
   assert.match(src, /var MCP_CONCURRENCY = positiveInt\(process\.env\.CLINICAL_ASSISTANT_MCP_CONCURRENCY, 3\)/);
diff --git a/test/my-resources-refine.test.js b/test/my-resources-refine.test.js
index 1b94a3b1..7d507f4a 100644
--- a/test/my-resources-refine.test.js
+++ b/test/my-resources-refine.test.js
@@ -57,6 +57,7 @@ function router(t, overrides = {}) {
       }
     },
     '../middleware/auth': { authMiddleware: (req, res, next) => next() },
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     '../utils/ai': {
       callAI: async (messages, options) => {
         aiCalls.push({ messages, options });
diff --git a/test/patient-takehome.test.js b/test/patient-takehome.test.js
index 3cf7c576..fab853dc 100644
--- a/test/patient-takehome.test.js
+++ b/test/patient-takehome.test.js
@@ -33,6 +33,7 @@ function server(t, overrides = {}) {
       query: async () => ({ rows: [] })
     },
     '../middleware/auth': { authMiddleware: (req, res, next) => next() },
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     '../utils/ai': { callAI: async (messages, options) => { aiCalls.push({ messages, options }); return { content: 'Take home [1] text.', model: 'synthetic-chat' }; }, callAIStream: async () => { throw new Error('unexpected'); }, activeProvider: 'synthetic', discoverModels: async () => [], vertexClient: null, litellmClient: null, applyImageAttachments: x => x },
     '../utils/generatedImages': { workflows: ['clinical_assistant'], snapshot: async () => ({}), enqueue: async () => ({}), tick: async () => {}, ready: async () => {} },
     '../utils/visionTool': require('../src/utils/visionTool'),
@@ -132,6 +133,7 @@ test('a text-only answer no longer conjures an image; the model must call the to
     axios: {},
     '../db/database': { get: async () => null, getSetting: async () => '', all: async () => [], run: async () => ({ changes: 1, lastInsertRowid: 1 }), query: async () => ({ rows: [] }) },
     '../middleware/auth': { authMiddleware: (req, res, next) => next() },
+    '../middleware/rateLimit': { rateLimit() { return function(req, res, next) { next(); }; } },
     '../utils/ai': { callAI: async () => ({ content: 'Create a poster showing oxygen delivery for neonates.' }), callAIStream: async () => ({ content: 'Create a poster showing oxygen delivery for neonates.' }) },
     '../utils/generatedImages': { service: () => ({ enqueue: async (owner, workflow, input, key, replay, context, model) => { jobs.push({ owner, workflow, input, model }); return { jobId: 'job-x', status: 'pending', imageUrl: null }; } }), imageContext: (r, h) => ({ request: r, history: h }), requestKey: b => 'k' + String(b).length },
     '../utils/imageTool': { tools: [], dispatch: async ai => ai },