renal pediatric

8/9/2019 renal pediatric

1/48

Renal MCQs


2/48

A 6-year-old boy presents with tea-colored urine. Hewas diagnosed with an upper respiratory tract infection2 days ago. His parents report that a siilar episodeoccurred ! onths ago. "here is no history of traua.#indings include$ blood pressure% &'()*' Hg+teperature% ,C /&''.!#0+ and absence of rash or

1oint abnoralities. eru copleent le3el is noral.

"he M4" li5ely eplanation of these findings is

A. Alport hereditary nephritis

7. idiopathic hypercalciuria

C. iunoglobulin A nephropathy /7erger disease08. postinfectious acute gloerulonephritis

&. 9. thin gloerular baseent ebrane nephropathy


3/48

A 2-wee5-old ale infant is being seen for a routine healthsuper3ision 3isit. :hysical eaination re3eals adistended abdoen% and the bladder can be palpatedabo3e the syphysis pubis. "he other has noticed thaturine ;dribbles< fro his urethra.

4f the following% the M4" li5ely diagnosis is

A. posterior urethral 3al3es

7. prune belly syndroe

C.urethral di3erticula8.urethral eatal stenosis

9. urethral stricture


4/48

Question . 6. A (-yr-old girl presents with cola-colored urine% oliguria%and

body edea 2 w5 after being treated for group A -heolyticstreptococcal

pharyngitis. Her copleent C, is noted to be 3ery low at &( g)d=.

>henshould this patient?s copleent C, le3el be repeated in order to

confir

your suspected diagnosis@

A0n & wee5

70n 2 w5

C0n , w5

80n ! w5

90n w5


5/48

Question . ,. "he presence of renalparenchyal scarring due to

3esicoureteral reflu is best deterined by$

A0 8MA scan

70 Renal ultrasonography

C0 BCD

80 C" scan

90 ntra3enous pyelography


6/48

Q0 All true about Ditlan syndroe ecept $

A0 Metabolic al5alosis.70 Hypo5aleia.

C0 Hypertension.

80 Hypocalcuria.

90 Hypoagneseia


7/48

Question . !(. An asyptoatic &6-yr-old African-Aericangirl with

hypertension is found to ha3e ,E proteinuria by dipstic5testing on id-day

and first orning 3oided urine saples. "he icroscopicanalysis shows '-2 red blood cells per high-power field."he ost li5ely diagnosis is$

A0:ostinfectious gloerulonephritis

708iabetic nephropathyC0 Minial-change disease

80 #ocal segental gloerulosclerosis

90 =upus nephritis


8/48

Question . !F. A ,-yr-old girl presents to the eergencydepartent with

anasarca. "he urinalysis shows !E proteinuria and isnegati3e for blood.

eru albuin is &.2 g)d= and seru creatinine is '.!g)d=. "he ost

li5ely diagnosis is$

A0 :ostinfectious gloerulonephritis

70 Minial-change disease

C0 gA nephropathy

80 =upus nephritis



9/48

Question . (!. A &'-yr-old girl presents with edea and grossheaturia. Her

e3aluation re3eals seru creatinine &.! g)d=% seru albuin 2.,g)d=% 2!-

hr urine protein ecretion (.( g% and C, &2 g)d=. "he ost li5ely

cause of hernephrotic syndroe is$

A0 Mebranoproliferati3e gloerulonephritis

70 Minial-change disease

C0 gA nephropathy80 Mebranous nephropathy



10/48

Question . &6. An -yr-old girl presents with dysuria% abdoinal pain%and

interittent pin5 urine. A urinalysis re3eals specific gra3ity of &.'2'% pHof 6.'%

2E heaturia% no protein% and (' red blood cells per high-power field. A

2!-hrurine specien re3eals 6 g)5g body weight of calciu. >hich of the

following is an acceptable treatent for this patient?s proble@

A0ncreased inta5e of sodiu-containing fluids

708ietary calciu restrictionC0ingle daily dose of hydrochlorothiaGide

80Bitain 8 suppleentation

90Bitain C suppleentation


11/48

Question . 2,. All of the following stateents regardingpoststreptococcal

gloerulonephritis /:D0 are true ecept$

A0 :D is coon in children 2 to ( yr of age

70 "he acute phase of :D usually resol3es in 6- w5C 0 Microscopic heaturia ay persist for &-2 yr following the

initial presentation of :D

80 "he seru C, le3el is usually reduced in the acute phase

of :D

90 "he best single antibody titer to docuent cutaneousstreptococcal infection is the deoyribonuclease /8ase0

7 antigen


12/48

Iou are e3aluating an -year-old girl in your office who hasfe3er and ild abdoinal pain. :hysical eainationre3eals a teperature of !'.'C /&'!.'#0 and a soft andnontender abdoen without flan5 or suprapubictenderness. rinalysis and icroscopy are negati3eecept for a positi3e dipstic5 test of &'' g)d= of protein/E20.

4f the following% the M4" li5ely cause of the proteinuria is

A. collagen 3ascular disease

7. high fe3erC.nephrotic syndroe

8.postinfectious acute gloerulonephritis

9. urinary tract infection


13/48

Question . ((. A newborn infant de3elops anasarca andpoor urine output

during the first wee5 of life. eru creatinine is '., g)d=and seru albuin

is &.' g)d=. >hich of the following clinical findings is leastli5ely@

A0 9nlarged placenta

70 :reaturity

C0 Rapid response to steroid therapy

80 9le3ated aternal seru -fetoprotein

90 Massi3e proteinuria


14/48

Question . 6!. A &!-yr-old girl de3elops acute renal failurerelated to Henoch-

ch nlein purpura gloerulonephritis. =aboratory findingsay include all of

the following ecept$

A0 Hypercalceia

70 Hyper5aleia

C0 Hyponatreia

80 Hyperphosphateia

90 Hypoalbuineia


15/48

Question . 2. Ris5 factors for urinary tractinfections include all of the

following ecept$

A0ncircucised penis

70 eual acti3ity

C0 Reflu nephropathy

80 8ouble-ureter systes

90 Chronic use of antibiotics


16/48

A &(-year-old boy presents with red urine following footballpractice. #indings on physical eaination are noral.rinalysis re3eals pH% 6.'+ specific gra3ity% &.'2'+ blood%E!+ protein% trace+ and ' to 2 red blood cells per high

power field.Aong the following% the M4" li5ely eplanation for the

red color of the urine is

A. heaturia

7. ingestion of food coloringC.yoglobinuria

8.presence of urates

9. traua


17/48

n addition to 3ascular throbosis% the M4"li5ely coplications obser3ed in childrenwho ha3e inial-change nephrotic

syndroe are$A. acute renal failure

7. chronic renal failure

C. hypercholesteroleia8. hypernatreia

9. hyponatreia


18/48

Question . &,. A ,-yr-old girl presents to your office with acute onset of

lethargy and pallor. "he child?s other reports that the child had bloody

diarrhea for ( days that cleared one day prior to presenting to youroffice. he

also notes acute onset of cola-colored urine. 4n eaination% the

patient ispale and lethargic. 7lood pressure is &2')' Hg. "he ost

appropriate

net step in diagnosis would be$

A0rinalysis

70J-ray eaination of the abdoen

C0rine culture

80Coplete blood cell count

90:rothrobin tie


19/48

A 2-onth-old infant is e3aluated for 3oiting and diarrhea.#indings include$ edea+ abdoinal distension+ widefontanelles and cranial sutures+ blood pressure% &'')6' Hg+ urinalysis% E! protein+ and seru albuin% &.2g)d=. "he other says that she had preeclapsia andthat the placenta was large. Iou suspect congenitalnephrotic syndroe.

"he M4" iportant anageent strategy for a goodoutcoe is

A. adinistration of 2(K albuin and furoseide

7. adinistration of high-dose corticosteroids

C. intensi3e edical follow-up% including referral for dialysisand renal transplantation

8. restriction of dietary protein

9. restriction of fluid and salt inta5e


20/48

Iou are eaining a &-day-old girl who was deli3ered3aginally at ter. :renatal fetal ultrasonography had

re3ealed the presence of left hydronephrosis. 4nphysical eaination% blood pressure is *()(' Hg%and the abdoen is soft% with palpable fullness in theright flan5.


A. posterior urethral 3al3es

7. ureterocele

C.ureteropel3ic 1unction obstruction8.uretero3esical obstruction

9. 3esicoureteral reflu


21/48

Question . !,. rine dipstic5 testing of a specien obtainedfro a febrile !-

yr-old child with acute 3iral gastroenteritis shows specificgra3ity &.','% pH

(.'% 2E proteinuria% and no blood cells. "he ost li5elycause of the patient?s

proteinuria is$

A0 "ransient proteinuria

70 ephrotic syndroe

C0 4rthostatic proteinuria80 Acute gloerulonephritis

90 Chronic gloerulonephritis


22/48

Question . 2. A ,-yr-old boy presents to your office with sudden onset of cola

colored urine% progressi3e facial swelling o3er the past , days% and decrease

urine 3olue o3er the past day. His eaination is notable for blood pressur&,')' Hg% periorbital edea% bibasilar rales% and an5le swelling. His

urinalysis is rear5able for ,E heaturia% &E proteinuria% &'' red blood cells

per high-power field% and red blood cell casts. His seru electrolytes are

noral and the seru albuin is ,.2 g)liter. "his clinical presentation is os

consistent with$

A0Acute renal failure

70Acute pyelonephritis

C0ephrotic syndroe

80Acute gloerulonephritis

90Chronic renal failure


23/48

Question . (. A &(-yr-old boy with a &2-yr history of icroscopicheaturia is

noted to ha3e bilateral high-freLuency sensorineural hearing loss%blood

pressure of &!')F' Hg% seru creatinine of &.( g)d=% and urinary

proteinof 2%''' g)2! hr. "his patient?s other also has icroscopic

heaturia. "he

ost li5ely ode of inheritance for this child?s gloerular disease is$

A0Autosoal doinant with incoplete penetrance

70J-lin5ed doinant

C0Autosoal recessi3e

80J-lin5ed recessi3e

90Autosoal doinant


24/48

Iou disco3er a right-sided% palpable abdoinal ass in anewborn ale who has had an uncoplicated perinatalcourse. =aboratory e3aluation re3eals$ creatinine% '.*g)d=+ noral findings on urinalysis+ and platelet count%

,('%''').4f the following% the M4" li5ely cause of this ass is

A. autosoal recessi3e polycystic 5idney disease

7. idgut 3ol3ulus

C. renal 3ein throbosis8.ureteropel3ic 1unction obstruction

9. >ils tuor


25/48

A (-year-old girl 3isited her doctor 2 wee5s ago to treat a sore throat.He prescribed an antibiotic that she too5% but the parents cannotrecall its nae. he presents at the eergency departent todaywith gross heaturia and periorbital edea. he has a blood

pressure of &(')F( Hg. "he attending physician suspects shehas acute postinfectious gloerulonephritis /:AD0. rinalysisre3eals too nuerous-to-count red blood cells and 2E protein. "oconfir the diagnosis% you easure seru copleent le3els+ theC, is (* g)d= /(.* g)=0 /low0 and the C! is 2! g)d= /2.! g)=0/noral0. >ithin , days% the gross heaturia and hypertensionresol3e spontaneously. i wee5s later you see her in your office.

4f the following% the laboratory results that would be consistent withresol3ing :AD are$

C, Heaturia :rotein

A. =ow Microscopic egati3e

7. =ow Microscopic :ositi3e

C. oral Microscopic egati3e8. oral Microscopic :ositi3e

9. =ow one egati3e


26/48

Iou are eaining a newborn in the nursery and

palpate a large ass in the abdoen.

4f the following% the M4" li5ely diagnosis is$

A.autosoal doinant polycystic 5idney disease

7.horseshoe 5idney

C. ulticystic 5idney dysplasia8. renal 3ein throbosis

9.>ils tuor


27/48

A (-year-old boy who has nephrotic syndroe hasde3eloped anasarca. #indings include$ blood pressure%F')6' Hg+ blood urea nitrogen% !' g)d=+ creatinine%

'.6 g)d=+ albuin% &.( g)d=+ noral C, le3el+ and !Eproteinuria. After recei3ing furoseide% he lost 2 = of fluidbut de3eloped abdoinal pain% heaturia% andhypertension. rinalysis shows N&'' red blood cells perhigh-power field.


A. acute gloerulonephritis

7. acute tubular necrosis

C.heorrhagic cystitis

8. interstitial nephritis

9. renal 3ein throbosis


28/48

Question . 2. A !-o-old boy is noted to ha3e poor growthat a routine well

child 3isit. Results of laboratory studies include serusodiu &!' ol)=%

potassiu ,.( ol)=% chloride &&6 ol)=% andbicarbonate &, ol)=. All of

the following should be considered in the differentialdiagnosis ecept$

A0 8istal renal tubular acidosis

70 Chronic diarrhea

C0 :roial renal tubular acidosis

80 =actic acidosis

90 Renal #anconi syndroe


29/48

A (-year-old boy presents with flan5 pain and short stature.#indings include$ creatinine% '.( g)d=+ sodiu% &,F9L)=+ potassiu% ,. 9L)=+ chloride% &&, 9L)=+bicarbonate% &( 9L)=+ calciu% F.' g)d=+ phosphorus%!.' g)d=+ urinalysis% ( to 2' red blood cells per high-power field+ plain radiography% bilateral renalcalcifications.

"he M4" li5ely cause of these renal calcifications is

A. cystinuria

7. distal renal tubular acidosis /type &0C.priary hyperparathyroidis

8.proial renal tubular acidosis /type 20

9. 3itain 8 intoication


30/48

Iou are e3aluating a 2-onth-old infant for icroscopicheaturia. He has a history of respiratory distresssyndroe and bronchopulonary dysplasia andcurrently is recei3ing caffeine and furoseide. rinalysisre3eals$ specific gra3ity% &.'&'+ pH% 6.(+ &( to 2' red

blood cells+ no protein+ and ' to 2 white blood cells.9lectrolyte le3els are noral.

4f the following% the M4" li5ely cause of the heaturia is$

A. benign failial heaturia

7. hypercalciuriaC.ulticystic 5idney dysplasia

8.tuor

9. urinary tract infection


31/48

he other and aternal grandfather of a 6-onth-old boyboth ha3e Alport syndroe.

4f the following% the M4" appropriate stateent toinclude in counseling this boy?s other about Alport

syndroe is that$A. affected boys freLuently suffer fro acroparesthesias

7. the boy has an increased ris5 for de3eloping >ils tuor

C. the disorder is ore se3ere in ales than in feales

8. there is a 2(K chance that her son has Alport syndroe9. there is no need to onitor her son for coplications of

the disorder until he is


32/48

rinalysis obtained during a health super3ision 3isit of a &'-year-old boy re3eals 2E protein. "he reainder of theurinalysis is noral. Results of faily and personaledical histories as well as physical eaination of theboy are negati3e.

4f the following% the 79" net step is to$

A. arrange consultation with a nephrologist

7. eaine the urine of faily ebers

C.obtain a 2!-hour urine saple for protein Luantification8.obtain renal ultrasonography

9. perfor a urinalysis on the first orning 3oid


33/48

4ne onth ago% a &'-year-old boy presented to you with edea of theface% hands% and feet. rinalysis re3ealed 2' to 2( red blood cellsand !E protein. Iou diagnosed nephrotic syndroe and placed hion a recoended regien of oral steroids. His face now ehibitscushingoid features% but his edea has not subsided. rinalysistoday re3eals !E protein and oderate blood.

4f the following% the M4" li5ely diagnosis at this tie is$

A. focal segental gloerulosclerosis

7. Henoch-chOnlein purpura

C. iunoglobulin A nephropathy

8. inial-change nephrotic syndroe9. postinfectious acute gloerulonephritis


34/48

A newborn ale has ecess abdoinal s5in%deficiency of the abdoinal usculature% andcryptorchidis.

4f the following% the M4" li5ely etiology of thesefindings is$

A.chronic aniotic fluid lea5age during pregnancy

7.early urethral obstruction

C.etrophy of the bladder8.polycystic 5idneys

9.renal agenesis


35/48

A prenatal ultrasonographic eaination of a alefetus at ,2 wee5s? gestation re3eals bilateralrenal aplasia.

>hen the infant is deli3ered se3eral wee5s later%

the condition M4" li5ely to be e3ident is$

A.bladder wall hypertrophy

7.cryptorchidis

C. incoplete de3elopent of the sacru

8. prune belly /wrin5led abdoinal s5in0

9.pulonary hypoplasia


36/48

A &,-onth-old child has growth retardation% polyuria andpolydipsia. Results of laboratory e3aluation include$seru creatinine% &*.* col)= /'.2 g)d=0+ blood ureanitrogen% ,.(* ol)= of urea /&' g)d=0+ sodiu% &,(

ol)= /&,( 9L)=0+ potassiu% , ol)= /, 9L)=0+chloride &&2 ol)= /&&2 9L)=0+ bicarbonate% &, ol)=/&, 9L)=0+ calciu% 2.&* ol)= /.* g)d=0+phosphorus% 2.' g)d=+ uric acid% 2.' g)d=+ seruglucose% (.' ol)= /F' g)d=0+ generaliGed ainoaciduria+ phosphaturia+ 5aliuresis+ and glycosuria.

4f the following% the M4" appropriate test to define theetiology of this child?s illness is

A. antidiuretic horone le3els

7. leu5ocyte cystine le3elsC.plasa renin acti3ity

8.seru agnesiu

9. slitlap eaination


37/48

A 2-year-old girl is aditted to the hospital for treatent ofdehydration and diarrhea. nitial laboratory e3aluationshowed$ seru creatinine% *'.* col)= /'. g)d=0+blood urea nitrogen% &!., ol)= of urea /!' g)d=0+

sodiu% &,( ol)= /&,( 9L)=0+ potassiu% ! ol)=/! 9L)=0+ chloride% &'' ol)= /&'' 9L)=0+bicarbonate% &( ol)= /&( 9L)=0+ urine pH% (.'+ urinesodiu% &' ol)= /&' 9L)=0+ urine potassiu% &'ol)= /&' 9L)=0+ and urine chloride% !' ol)= /!'9L)=0. 8espite hydration% a noral anion gap etabolicacidosis persists.


A. acute renal failure

7. chloride-losing nephropathyC.etrarenal losses of bicarbonate

8. renal tubular acidosis% type B

9. renal tubular acidosis% type


38/48

A ,-year-old girl presents with fe3er% left flan5 pain% anddysuria. 4n physical eaination% blood pressure is &'')(

Hg% teperature is ,FC /&'2.2#0% and there is leftcosto3ertebral angle tenderness. A catheriGed urine culturegrows ore than &''%''' C#), of 9scherichia coli.Results of renal ultrasonography are noral% and 3oidingcystourethrography shows bilateral grade , 3esicoureteralreflu /BR0. Iou prescribe antibiotics for &' days.

4f the following% the net 79" step is

A. no prophylais

7. periodic urine cultures for 6 onths

C.prophylais with antibiotics for 6 onths8.prophylais with antibiotics until the BR resol3es

9. referral to a urologist for surgical correction


39/48

Question . !. A &'-yr-old boy is noted to ha3e heaturia and proteinuria on a

routine physical eaination. He is without coplaints% and eaination

findings are noral. Results of blood cheistry studies are also noral% but

analysis of the 2!-hr urine specien re3eals 2 g of protein and a noral

creatinine clearance. A renal biopsy is perfored% which re3eals esangial

proliferati3e gloerulonephritis with 3ery bright iunoglobulin A depositsin the esangiu on iunofluorescence. >hich of the following stateents

is true regarding this child?s for of gloerulonephritis@

A0"his disease is ore coon in feales

70"he priary treatent is blood pressure control

C0:rogressi3e 5idney disease occurs in a a1ority ofchildren

80"he copleent C, 3alue is usually low

90Children with this disease rarely present with gross

heaturia


40/48

"he following are recognised presentationsof AR polycystic 5idney disease ecept $

A 7erry aneurys

7 ephrogenic diabetes insipidus

C 7ilateral flan5 asses at birth

8 :resentation with Hypertension

9 :otter?s yndroe


41/48

Question . 6(. A &2-yr-old boy presents with a long-standing history of

polyuria and polydipsia% progressi3e fatigue% decreased appetite%

orningnausea and eesis% weight loss% and ipaired growth 3elocity. n

addition% he

has had no response to a 6-o course of iron therapy for treatent ofaneia.

nitial laboratory e3aluation re3eals 7 of &2( g)d= and seru

creatinine of.* g)d=. 4ther epected laboratory features include all of the

following

ecept$

A09le3ated parathyroid horone le3el

70ncreased anion gap etabolic acidosis

C08ecreased le3els of growth horone

80all% echogenic 5idneys on ultrasonography

90Hypocalceia


42/48

Question . 6. Multicystic dysplastic 5idneys arecharacteriGed by all of the

following ecept$

A0 sually unilateral

70 ncidence of &$2%'''

C0 Autosoal doinant inheritance

80 Most coon neonatal abdoinal ass

90 o function


43/48

"hese features are associated with renal

osteodystrophy ecept $

A increased gut absorption of calciu

7 distal yopathy

C hypophosphataeia8 raised seru al5aline phosphatase


44/48

>hich of the following is characteristic of 7artter?s

yndroe@

&. A3ailable ar5s are shown in brac5ets

2. econdary hyperaldosteronis

,. Hyper5alaeia

!. Metabolic acidosis(. Reduced renal concentrating ability 8iarrhoea


45/48

Question . &2. All of the following gloerulardiseases often anifest with

rapidly progressi3e gloerulonephritis ecept$

A0>egener?s granuloatosis

70ysteic lupus erytheatosus

C0Mebranoproliferati3e gloerulonephritis

80Doodpasture syndroe

90#ocal segental gloerulosclerosis


46/48

A *-day-old infant is hospitaliGed because of lethargy. #indings include$blood pressure% ')!' Hg+ pulse% &!' beats)in+ respiratoryrate% 6' breaths)in+ creatinine% '.6 g)d=+ sodiu%&!' 9L)=+potassiu% (.' 9L)=+ chloride% &'' 9L)=+ bicarbonate% &' 9L)=+blood glucose% F' g)d=+ white blood cell count% &2%''')+noral cerebrospinal fluid+ and urine pH of (.(.


A. eningitis

7. organic acideia

C. renal tubular acidosis% type &

8. renal tubular acidosis% type 29. urea cycle defect


47/48

Question . &!. A *-o-old white ale infant presents withfailure to thri3e and

a 7 of *( g)d=. He has a history of a poor urinarystrea. "he ost li5ely

diagnosis is$

A0 Renal artery stenosis

70 Renal hypoplasia

C0 rogenic bladder80 :osterior urethral 3al3es

90 ephrolithiasis


48/48

Question . &'. Cystitis is associated with all

of the following ecept$

A0rgency

70Adeno3irus

C0#e3er

80Absence of renal scarring90eual acti3ity in feales

renal pediatric

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