LE 6 (Mas OLDER) Feeds Flashcards
- A 2-day-old newborn presents with hypocalcemic seizures, cyanosis at birth, a cardiac murmur, and mild respiratory distress. A cleft palate is also noted. What is the most likely diagnosis?
A. Wiskott-Aldrich syndrome
B. Shwachman-Diamond syndrome
C. Chronic granulomatous disease
D. DiGeorge syndrome
D. DiGeorge syndrome
Rationale: DiGeorge syndrome presents with hypocalcemia (due to parathyroid hypoplasia), congenital heart defects, immune deficiency (due to thymic hypoplasia), and facial abnormalities.
- In which stage of acute nephritic syndrome does hypertensive encephalopathy usually occur?
A. Early convalescent
B. Diuretic
C. Oliguric
D. Latent
C. Oliguric
Rationale: Hypertensive encephalopathy is most likely to occur during the oliguric phase of acute nephritic syndrome due to fluid overload and severe hypertension.
- Complement C3 is a ß protein demonstrated by its deposition within or near the glomerular basement membrane. It is decreased in which of the following conditions?
A. APSGN
B. IgA nephropathy
C. Nephrotic syndrome
D. Rapidly progressive glomerulonephritis
A. APSGN
Rationale: Acute post-streptococcal glomerulonephritis (APSGN) is associated with decreased serum C3 due to complement activation via the alternative pathway.
- The common manifestations of UTI in older children are:
A. Fever, vomiting, diarrhea
B. Abdominal/flank pain, dysuria, malodorous urine
C. Asymptomatic
D. Oliguria, hypertension, edema
B. Abdominal/flank pain, dysuria, malodorous urine
Rationale: UTI symptoms in older children typically include dysuria, abdominal or flank pain, and foul-smelling urine. Younger children may present with fever, vomiting, and diarrhea.
- What is the definitive diagnostic test for acute pyelonephritis in children?
A. Intravenous pyelogram
B. Ultrasound
C. Vesicourethral cystogram
D. Renal scan
B. Ultrasound
- To diagnose UTI in children, urine culture should at least show how many colony-forming units (CFU)?
A. 1,000,000
B. 100,000
C. 10,000
D. None of these
B. 100,000
Rationale: A bacterial count of ≥100,000 CFU/mL in a clean-catch specimen is diagnostic of UTI. In symptomatic patients, ≥1,000 CFU/mL may also be considered significant.
- A 16-year-old boy notices a painless mass on the left side of his scrotum. What is the most likely diagnosis?
A. Torsion of the testes
B. Epididymitis
C. Varicocele
D. Hydrocele
C. Varicocele
Rationale: A varicocele is a collection of dilated veins in the spermatic cord, most commonly occurring on the left side due to venous drainage anatomy.
- A newborn delivered to a G1P1 mother with oligohydramnios has an abdominal finding of a single umbilical artery. This is associated with:
A. Polycystic kidney
B. Hydronephrosis
C. Renal agenesis
D. Renal hypoplasia
C. Renal agenesis
Rationale: A single umbilical artery is associated with congenital renal abnormalities, particularly renal agenesis, which may lead to oligohydramnios.
- At what age is corrective surgery recommended for a child with unilateral undescended testes?
A. Between 12 – 18 months
B. After puberty
C. Newborn period
D. Before puberty
A. Between 12 – 18 months
Rationale: Orchidopexy is ideally performed between 6 to 18 months to reduce the risk of infertility and malignancy.
- A child with APSGN has persistent low C3, RBC casts, BUN > 40 mg/dL, and creatinine > 2 mg/dL on follow-up at 4 months. What is the most appropriate next step?
A. VCUG
B. Renal biopsy
C. Renal scanning
D. Plain KUB
B. Renal biopsy
Rationale: Persistent low C3 and worsening renal function beyond 2 months suggest an alternative diagnosis like membranoproliferative glomerulonephritis or lupus nephritis, warranting a biopsy.
- A 2-year-old male develops a URI followed by generalized edema. BP is normal. UA shows 2-5 RBCs, 4+ proteinuria, BUN > 19 mg/dL, creatinine 6 mg/dL, cholesterol 402 mg/dL, ASO titer 1:160, and C3 892 mg/dL. What is the most likely diagnosis?
A. PSGN
B. IgA nephropathy
C. Henoch-Schönlein purpura nephritis
D. Minimal change disease
D. Minimal change disease
Rationale: Minimal change disease (MCD) is the most common cause of nephrotic syndrome in young children, characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and normal complement levels.
- Which of the following statements about acute post-streptococcal glomerulonephritis (APSGN) in children is correct?
A. It is most common in children 15 years and above
B. It usually presents as acute renal failure
C. It follows the onset of streptococcal infection by 3-4 days
D. It can result from either streptococcal pharyngitis or streptococcal impetigo
D. It can result from either streptococcal pharyngitis or streptococcal impetigo
Rationale: APSGN occurs after Streptococcus pyogenes infections, including both pharyngitis and impetigo. The latency period is typically 1-2 weeks for pharyngitis and 3-6 weeks for impetigo.
- In the treatment of urinary tract infections (UTIs), the main goal is:
A. Prevent emergence of resistant strains
B. Prevent gram-negative sepsis
C. Prevent renal scarring
D. Preserve bladder function
C. Prevent renal scarring
Rationale: Renal scarring can lead to long-term complications such as hypertension and chronic kidney disease, making its prevention the primary goal in pediatric UTI management.
- Wilm’s tumor is the most frequent malignant tumor of the genitourinary tract. What is the most common presenting sign?
A. Hematuria
B. Abdominal pain
C. Loss of weight
D. Abdominal mass
D. Abdominal mass
Rationale: Wilm’s tumor often presents as a painless abdominal mass detected incidentally by caregivers, with hematuria and hypertension occurring in some cases.
- The most common form of primary idiopathic nephrotic syndrome is:
A. Focal segmental glomerulosclerosis
B. Membranoproliferative glomerulonephritis
C. Membranous glomerulopathy
D. Minimal change disease
D. Minimal change disease
Rationale: Minimal change disease is the leading cause of nephrotic syndrome in children, characterized by podocyte effacement on electron microscopy and steroid responsiveness.
- The initial signs one might expect in a 5-year-old boy presenting with dark brown urine and healing impetigo are:
A. Headache
B. Oliguria
C. Periorbital edema
D. Dyspnea
C. Periorbital edema
Rationale: APSGN commonly presents with periorbital edema, hematuria (cola-colored urine), hypertension, and oliguria due to immune complex deposition in the glomeruli.
- The most common cause of gross hematuria in the general pediatric setting is:
A. Acute pyelonephritis
B. Acute post-streptococcal glomerulonephritis
C. Benign familial hematuria
D. IgA nephropathy
D. IgA nephropathy
- Which of the following conditions is least commonly observed in APSGN?
A. Hematuria
B. Edema
C. Hypertension
D. Renal failure
D. Renal failure
Rationale: While APSGN can cause acute kidney injury, complete renal failure is uncommon. Most cases resolve spontaneously with supportive care.
- A 1-year-old child presents with recurrent UTIs and enlarged kidneys on ultrasound. What is the best next step for evaluation?
A. Renal tomography
B. Voiding cystourethrogram (VCUG)
C. Plain film KUB
D. MRI
B. Voiding cystourethrogram (VCUG)
Rationale: Recurrent UTIs with kidney enlargement raise suspicion for vesicoureteral reflux (VUR), best diagnosed with VCUG to assess for reflux of urine into the ureters and kidneys.
- A 3-year-old boy presents with an abdominal mass, hydronephrosis, and recurrent E. coli UTIs. What is the most likely cause?
A. Adrenal hemorrhage
B. Wilm’s tumor
C. Obstruction of the ureteropelvic junction
D. Obstruction of the vesicoureteral junction
C. Obstruction of the ureteropelvic junction
Rationale: UPJ obstruction is a common congenital cause of hydronephrosis, leading to recurrent UTIs and possible abdominal mass due to fluid accumulation.
- A 3-year-old boy had diarrhea a week ago and now presents with oliguria, edema, and petechial rash. Lab results: Hgb 5-9 g/dL, platelet count 50,000/mm³, protein +2, RBC 8-10/hpf. What is the most likely diagnosis?
A. Hemolytic uremic syndrome (HUS)
B. Post-streptococcal glomerulonephritis
C. Nephrotic syndrome
D. Systemic lupus erythematosus
A. Hemolytic uremic syndrome (HUS)
Rationale: HUS follows diarrheal illness (often E. coli O157:H7) and is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury.
- Children with chronic renal failure may present with:
A. Mental retardation
B. Growth retardation
C. Hypotension
D. Hypokalemia
B. Growth retardation
Rationale: Chronic renal failure leads to growth retardation due to metabolic acidosis, poor nutrition, and disturbances in calcium-phosphate metabolism affecting bone growth.
- Which of the following statements about the management of nephrotic syndrome is correct?
A. Renal biopsy prior to giving immunosuppressive drugs
B. Steroid-responsive in minimal change lesions
C. Steroid-resistant if failure to respond despite 1 week of prednisone
D. Complete remission is possible if urinary protein is > 40 mg/m²/hr
B. Steroid-responsive in minimal change lesions
Rationale: Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children and is highly responsive to corticosteroid therapy (prednisone). Over 90% of cases achieve remission with steroids.
- Hypocomplementemia and hematuria are seen in:
A. APSGN
B. Acute pyelonephritis
C. Nephrotic syndrome
D. Renal tuberculosis
A. APSGN
Rationale: APSGN is characterized by low serum complement (C3) levels due to immune complex deposition and hematuria due to glomerular inflammation.
- The most frequent cause of graft loss in pediatric renal transplant patients is:
A. Trauma to the graft
B. Technical difficulties
C. Rejection reactions
D. Infection
C. Rejection reactions
Rationale: Acute and chronic rejection remain the most common causes of graft failure, necessitating lifelong immunosuppressive therapy.
- A 4-year-old boy had an URTI 2 weeks earlier and now presents with generalized edema. BP: 90/50 mmHg, Urinalysis: RBC 2-5/hpf, Protein +4, BUN 19 mg/dL, Cr 1.0 mg/dL, Cholesterol 402 mg/dL, ASO titer 150, C3 900 g/dL. What is the most likely diagnosis?
A. Focal segmental glomerulosclerosis
B. Minimal change nephrotic syndrome
C. Post-streptococcal glomerulonephritis
D. Membranous glomerulonephritis
B. Minimal change nephrotic syndrome
Rationale: Minimal change disease is the most common nephrotic syndrome in children, presenting with edema, heavy proteinuria, normal C3 levels, and hypoalbuminemia.
- True statement about vesicoureteral reflux (VUR):
A. It is non-hereditary
B. It predisposes to episodes of pyelonephritis
C. It always needs surgical correction
D. Only boys are affected
B. It predisposes to episodes of pyelonephritis
Rationale: VUR allows urine to reflux into the ureters, increasing the risk of recurrent UTIs and pyelonephritis, which may lead to renal scarring.
- Among the following, the last finding to resolve in a child with APSGN is usually:
A. Elevated BUN
B. Hypertension
C. Edema
D. Microscopic hematuria
D. Microscopic hematuria
Rationale: While edema and hypertension resolve within weeks, microscopic hematuria can persist for several months to a year.
- Which of the following statements about undescended testes is true?
A. It is histologically normal at birth
B. It is usually located in the inguinal canal
C. Testicular descent occurs early in gestation
D. It descends spontaneously 6 months after birth
A. It is histologically normal at birth
Rationale: An undescended testis (cryptorchidism) is histologically normal at birth, but over time, it may undergo degenerative changes, leading to impaired spermatogenesis and an increased risk of infertility and malignancy.
- A hydrocele that completely reduces when compressed is most likely due to:
A. Epididymitis
B. Spermatocele
C. Testicular tumor
D. Inguinal hernia
D. Inguinal hernia
Rationale: A communicating hydrocele, associated with an inguinal hernia, reduces completely when compressed due to an open processus vaginalis.
- Hyperlipidemia in nephrotic syndrome is possibly secondary to:
A. Overproduction of lipoproteins
B. Lower levels of lipoprotein lipase
C. Both A and B are correct
D. Neither A nor B are correct
C. Both A and B are correct
Rationale: Hyperlipidemia in nephrotic syndrome results from increased hepatic lipoprotein production (due to low oncotic pressure) and decreased lipoprotein clearance.
- Clinically apparent edema usually is not seen until serum albumin levels drop below:
A. 5.0 gm/dL
B. 4.0 gm/dL
C. 3.0 gm/dL
D. 2.0 gm/dL
D. 2.0 gm/dL
Rationale: Generalized edema in nephrotic syndrome typically develops once serum albumin falls below 2.0 g/dL due to reduced oncotic pressure leading to fluid leakage into the interstitial space.
- Indications for renal biopsy in a patient with nephrotic syndrome include:
A. Continued proteinuria after a week of prednisone treatment
B. A patient with a history of systemic lupus erythematosus
C. Cholesterol level greater than 400 gm/dL
D. Relapse 1 year after initial therapy
B. A patient who has a history of systemic lupus erythematosus
Rationale: Renal biopsy is indicated in nephrotic syndrome when secondary causes, such as lupus nephritis, are suspected. Patients with systemic lupus erythematosus (SLE) are at risk for lupus nephritis, which requires biopsy to determine the type and severity of kidney involvement.
- The most common cause of mortality in primary idiopathic nephrotic syndrome is:
A. Bacterial infection
B. Congestive heart failure
C. Seizures
D. Acute renal failure
A. Bacterial infection
Rationale: Nephrotic syndrome is associated with increased susceptibility to infections, particularly bacterial sepsis, peritonitis, pneumonia, and cellulitis due to loss of immunoglobulins in the urine.
- In 25% of children under 10 years old, recurrent UTIs are usually associated with:
A. Renal stones
B. Chronic glomerulonephritis
C. Vesicoureteral reflux (VUR)
D. Renal tumors
C. Vesicoureteral reflux (VUR)
Rationale: VUR is found in 25-30% of children with recurrent UTIs. Primary VUR can resolve spontaneously, while secondary VUR requires intervention.
- The best treatment for generalized edema in nephrotic syndrome is:
A. Antibiotics
B. Diuretics
C. 5% albumin
D. Prednisone
D. Prednisone
Rationale: Corticosteroids (e.g., prednisone) are the first-line treatment for nephrotic syndrome, addressing the underlying glomerular pathology and reducing proteinuria, which in turn resolves edema.
- A 12-year-old presents with severe arthritis of the hips and sacroiliac joints. Labs reveal HLA-B27 positivity. What is the most likely diagnosis?
A. Juvenile idiopathic arthritis
B. Systemic lupus erythematosus
C. Henoch-Schönlein purpura
D. Reactive arthritis
A. Juvenile idiopathic arthritis
Rationale: Juvenile idiopathic arthritis (JIA), specifically the enthesitis-related subtype, is strongly associated with HLA-B27 and commonly affects the axial skeleton and sacroiliac joints.
- A child presents with ear discharge for almost 3 weeks but has no pain or fever. What is the appropriate management?
A. Refer immediately to a hospital
B. Start oral antibiotics for 5 days
C. Dry by ear wicking
D. Give paracetamol oral
C. Dry by ear wicking
✅ Correct
Rationale: Chronic ear infection (≥14 days of discharge) is managed with ear wicking and topical quinolone eardrops for 14 days, with a follow-up in 5 days
.
- A child with stridor during sleep was brought to you. The child has been coughing for 2 weeks and had fever for a week. Which of the following is NOT suitable management based on IMCI before referral?
A. Give Vitamin A
B. Prevent low blood sugar
C. Give the first dose of antibiotics
D. Request a chest X-ray
D. Request a chest X-ray
✅ Correct
Rationale: IMCI guidelines prioritize giving the first dose of antibiotics, preventing hypoglycemia, and providing Vitamin A before urgent referral. Ordering a chest X-ray is not an immediate step in the emergency management of stridor
- A child with fever was brought to the health center. Which of the following danger signs would indicate an immediate referral to a hospital?
A. The child is irritably crying
B. The child does not like to drink
C. The child just had convulsions
D. The child is very sleepy but easily aroused
C. The child just had convulsions
✅ Correct
Rationale: Any history of convulsions in a febrile child is a danger sign that requires urgent hospital referral, as it may indicate severe febrile disease such as meningitis or sepsis
.
- A 3-year-old girl comes in for consultation due to cough. How will you assess and classify the cough?
A. Look for signs of chest deformity
B. Note for stridor when the child is not crying
C. Ask what time of the day the child coughs
D. Count the breaths; 30 breaths/min means fast breathing
B. Note for stridor when the child is not crying
Rationale:
- The IMCI chart states that when assessing a child with cough or difficult breathing, you should:
- Count the breaths in one minute
- Look for chest indrawing
- Look and listen for stridor
- Look and listen for wheezing
- Stridor in a calm child (i.e., not crying) is a sign of severe pneumonia or very severe disease and requires urgent referral.
Why the other options are incorrect?
- A. Look for signs of chest deformity ❌ → Not an immediate classification criterion for pneumonia under IMCI.
- C. Ask what time of the day the child coughs ❌ → Not part of IMCI assessment for classifying pneumonia.
- D. Count the breaths; 30 breaths/min means fast breathing ❌ → Incorrect threshold. The correct IMCI fast breathing criteria are:
- ≥50 breaths/min for 2 months up to 12 months
- ≥40 breaths/min for 12 months up to 5 years
- You diagnose a child with pneumonia. What is the appropriate action?
A. Relieve the cough with a cough suppressant
B. Give appropriate antibiotics for 5 days
C. Ask the mother to follow up after 7 days
D. Refer to a hospital
B. Give appropriate antibiotics for 5 days
Rationale: Pneumonia in children is treated with empiric antibiotics, typically amoxicillin or cotrimoxazole, for at least 5 days.
- In assessing and classifying a child with diarrhea, which of the following is NOT included?
A. Are there signs of dehydration?
B. Ask if there is blood in the stools
C. Ask for the duration of diarrhea
D. Ask for the presence of vomiting
D. Ask for the presence of vomiting
❌ Incorrect
Correct Answer: Vomiting is considered in dehydration assessment. However, it is not the main criterion for classifying diarrhea itself. The correct answer should be none of the above, as all listed factors are part of the diarrhea assessment
- A 5-year-old boy was brought in due to a 3-day history of fever, cough, and colds. How should you assess the patient?
A. Look for rashes and conjunctivitis
B. Treat the child with oral antimalarial
C. Do a thick and thin smear
D. Do a CBC
A. Look for rashes and conjunctivitis
Rationale: Fever with cough and coryza suggests viral illnesses like measles, which presents with rash and conjunctivitis.
- Regarding severe malnutrition, which of the following statements is NOT correct?
A. Give iron supplementation as initial management
B. Give Vitamin A as initial management
C. Presence of edema in both feet
D. Presence of severe wasting
A. Give iron supplementation as initial management
Rationale: Iron should be given after acute complications resolve, as it may worsen infections in malnourished children.
- Which of the following is NOT a clinical sign of a possible bacterial infection?
A. Fever
B. Lethargy
C. Red umbilicus
D. Fast breathing
D. Fast breathing
Rationale: While fast breathing suggests pneumonia, it is not a direct sign of bacterial sepsis. Fever, lethargy, and red umbilicus are more specific.
- Which of the following is a sign of a local bacterial infection?
A. Less than normal movement
B. Nasal flaring
C. Bulging fontanelle
D. Umbilicus draining pus
D. Umbilicus draining pus
Rationale: Local bacterial infections include omphalitis (umbilical infection), while bulging fontanelle suggests meningitis.
- You are teaching mothers about Vitamin A supplementation. Which of the following is NOT true?
A. The first dose is at 6 months or above
B. Infants 6 months old should receive 100,000 IU Vitamin A
C. Subsequent doses are given every 6 months until 59 weeks of age
D. 200,000 IU Vitamin A is given to children 12 months to 59 months every 6 months
C. Subsequent doses are given every 6 months until 59 weeks of age
Rationale: Vitamin A supplementation continues until 59 months (5 years old), not 59 weeks.
- A 5-month-old boy presents with febrile convulsions, maculopapular rash, cough, conjunctivitis, and corneal clouding. What is the appropriate action in the health center?
A. Give 200,000 IU of Vitamin A
B. Ask to follow up in 2 days
C. Apply gentian violet to the eyes
D. Refer urgently to the hospital
D. Refer urgently to the hospital
Rationale: Corneal clouding suggests severe Vitamin A deficiency, requiring urgent hospitalization to prevent blindness.
- An infant has a feeding problem if he is:
A. Well attached to the breast when feeding
B. Suckling effectively
C. Does not receive any other foods or drinks
D. Low weight for age
D. Low weight for age
Rationale: Low weight for age indicates poor nutrition, often due to ineffective feeding, malabsorption, or underlying illness.
- A previously healthy 5-year-old child has a 5-minute generalized tonic-clonic seizure associated with fever (39°C). Past history reveals a febrile seizure at 8 months old. PE shows ear discharge with a perforated tympanic membrane but no nuchal rigidity or altered mental status. Family history is positive for maternal febrile seizures. Which statement is TRUE about the patient’s condition?
A. The initial drug of choice is a benzodiazepine.
B. An EEG must be done prior to discharge.
C. The risk of recurrence increases to 20%.
D. CSF analysis should be done.
C. The risk of recurrence increases to 20%.
Rationale: Febrile seizures are common in young children, and a history of a previous febrile seizure increases the recurrence risk to about 30-50%, not just 20%. However, this is the best choice as it acknowledges an increased recurrence risk. EEG is not necessary for simple febrile seizures, CSF analysis is only needed if signs of meningitis are present, and benzodiazepines are used only if seizures persist beyond 5 minutes.
- A 3-month-old female presents with a generalized seizure lasting 25 minutes, refractory to rectal diazepam and IV lorazepam. Temperature is 37.5°C, with no trauma. What is the best next intervention?
A. Get glucose level and correct hypoglycemia.
B. Support the airway.
C. Start IV phenobarbital.
D. Start hypertonic saline for suspected hyponatremia.
B. Support the airway.
Rationale: The immediate priority in a status epilepticus case refractory to first-line benzodiazepines is airway support and preventing hypoxia, which is the primary cause of mortality. Glucose should be checked but is not the next immediate step. Phenobarbital can be considered after airway management if seizures persist.
- A 12-month-old child with epileptic spasms upon arousal is admitted. History reveals only limited motor milestones (can turn from supine to prone). EEG shows a high-voltage, slow, and chaotic background with multifocal spikes. What is the diagnosis?
A. West syndrome
B. Dravet syndrome
C. Ohtahara syndrome
D. Doose syndrome
A. West syndrome
Rationale: West syndrome presents with epileptic spasms, developmental delay, and a characteristic EEG pattern known as hypsarrhythmia (high-voltage, chaotic background with multifocal spikes). Dravet syndrome typically presents with febrile seizures early in infancy, Ohtahara syndrome manifests in neonates with burst-suppression EEG, and Doose syndrome is characterized by myoclonic-astatic seizures.
- A child with Lennox-Gastaut syndrome presents to the ER due to drop attacks. After stabilization, you plan to start an anticonvulsant. Which drug should be your least priority due to potential toxicity?
A. Topiramate
B. Felbamate
C. Lamotrigine
D. Rufinamide
B. Felbamate
Rationale: Felbamate is associated with severe adverse effects, including aplastic anemia and hepatotoxicity, making it a last-resort option for Lennox-Gastaut syndrome. Topiramate, Lamotrigine, and Rufinamide are safer and commonly used for seizure control in this syndrome.
- A 10-year-old with controlled seizures presents with gingival hyperplasia. Which anticonvulsant is most likely responsible?
A. Valproic acid
B. Carbamazepine
C. Levetiracetam
D. Phenytoin
D. Phenytoin
Rationale: Phenytoin is well known for causing gingival hyperplasia as a side effect. Valproic acid is associated with weight gain and hepatotoxicity, carbamazepine with agranulocytosis, and levetiracetam with mood changes.
- A 6-year-old with tetralogy of Fallot (TOF) has a first episode of febrile seizures. Postictally, there is preferential movement of one side. What is the best initial step in management?
A. Start continuous IV anticonvulsive drugs.
B. Request a cranial CT scan with contrast.
C. Start hypertonic saline therapy at 5 mg/kg.
D. Request serum glucose levels and arterial blood gas.
B. Request a cranial CT scan with contrast.
Rationale: In a child with Tetralogy of Fallot and postictal hemiparesis, concern for a vascular event such as a stroke (TOF patients are at higher risk of embolic events) warrants neuroimaging. Continuous anticonvulsants are not indicated without recurrent seizures, hypertonic saline is not relevant, and serum glucose/ABG are secondary considerations.
- A 15-year-old presents with decreased sensorium, fever, headache, and vomiting for 2 days. PE shows nuchal rigidity. CSF analysis: opening pressure 150 mmH₂O, WBC 800/mm³ (lymphocytic predominance), protein 320 mg/dL, glucose 35 mg/dL. What is the most likely diagnosis?
A. Acute bacterial meningitis
B. Tuberculous meningitis
C. Viral meningoencephalitis
D. Fungal meningitis
B. Tuberculous meningitis
Rationale: The presence of lymphocytic pleocytosis, high protein, and low glucose in CSF is characteristic of tuberculous meningitis. Bacterial meningitis typically shows neutrophilic predominance, while viral meningitis has a normal glucose level. Fungal meningitis is more common in immunocompromised patients.
- An 18-year-old male is brought in unconscious. His friends report alcohol consumption. PE shows no trauma, BP 80/50 mmHg, HR 50 bpm, RR 8 cpm, temperature 35.8°C, decreased DTRs, and pinpoint pupils. What is the most likely cause?
A. Methamphetamine
B. Methadone
C. LSD
D. Cocaine
B. Methadone
Rationale: Opioid overdose (e.g., methadone) presents with decreased consciousness, pinpoint pupils, bradycardia, hypothermia, and respiratory depression. Methamphetamine and cocaine cause sympathetic stimulation (tachycardia, hypertension, mydriasis), while LSD leads to hallucinations without significant autonomic instability.
- A 17-year-old female is brought in due to agitation. History reveals a breakup with a boyfriend who is addicted to mobile games. PE shows dry flushed skin, BP 150/100 mmHg, HR 160 bpm, decreased bowel sounds, and dilated pupils. Her parents found an empty bottle of an unknown medication. What is the most likely cause?
A. Fluoxetine
B. Phenelzine
C. Diazepam
D. Desipramine
D. Desipramine
Rationale:
Desipramine, a tricyclic antidepressant (TCA), is the best answer given the clinical presentation of dilated pupils, decreased bowel sounds, hypertension, tachycardia, and agitation. TCAs cause anticholinergic toxicity, which includes urinary retention, constipation (decreased bowel sounds), hyperthermia, dry flushed skin, and mydriasis (dilated pupils).
Fluoxetine (SSRI) and Phenelzine (MAOI) can cause serotonin syndrome, but they are more associated with diarrhea and hyperreflexia, which are absent here.
Diazepam (benzodiazepine) would cause sedation, respiratory depression, and normal/decreased BP rather than agitation and hypertension.
Thus, the key clues in the question—dilated pupils, decreased bowel sounds, dry skin, and tachycardia—point toward anticholinergic toxicity, which is characteristic of tricyclic antidepressants like Desipramine.
- Electrolyte imbalances are common in children with symmetrical and nonstructural causes of coma. Aside from hyponatremia and hypernatremia, which electrolyte imbalance most likely presents with decreased sensorium?
A. Hypomagnesemia
B. Hyperphosphatemia
C. Hypermagnesemia
D. Hypophosphatemia
C. Hypermagnesemia
Rationale: Hypermagnesemia can cause depressed mental status, reduced deep tendon reflexes, hypotension, and respiratory depression. Hypophosphatemia and hyperphosphatemia do not typically cause coma, and hypomagnesemia presents with neuromuscular excitability rather than decreased sensorium.
- A 2-year-old child presents with fever, vomiting, and decreased level of consciousness. PE shows nuchal rigidity. After oxygen supplementation and IV line insertion, the child develops a seizure and is given IV diazepam. To prevent seizure recurrence in bacterial meningitis, which anticonvulsant should be administered?
A. Valproic acid
B. Phenytoin
C. Levetiracetam
D. Carbamazepine
B. Phenytoin
Rationale: Seizure prophylaxis in bacterial meningitis aims to prevent recurrence, especially in prolonged or complicated cases. Phenytoin is used for seizure prevention in acute settings due to its efficacy in controlling prolonged seizures, whereas valproic acid and carbamazepine are not preferred in acute settings. Levetiracetam is an alternative but is more commonly used for long-term control
- A 5-month-old child is diagnosed with pneumococcal meningitis. Which of the following statements about pneumococcal meningitis is incorrect?
A. The duration of antibiotic therapy is 10-14 days.
B. Streptococcus pneumoniae alters the nasopharyngeal microbiome by producing hydrogen peroxide to inhibit H. influenzae type B growth.
C. T-lymphocyte defects increase the risk of pneumococcal meningitis.
D. Pneumococcal meningitis is more common in patients with cochlear implants.
C. T-lymphocyte defects increase the risk of pneumococcal meningitis. (Incorrect statement)
Rationale: T-lymphocyte defects primarily predispose individuals to opportunistic infections like Listeria monocytogenes, not pneumococcal meningitis, which is more associated with B-cell and complement deficiencies. The other statements are correct regarding antibiotic duration, microbiome effects, and cochlear implant-associated risks
- Many inborn errors of metabolism can cause neonatal seizures. Which disorder presents with prominent hiccups, persistent generalized seizures, and lethargy leading to coma?
A. Propionic acidemia
B. Maple syrup urine disease
C. Nonketotic hyperglycinemia
D. Leigh disease
C. Nonketotic hyperglycinemia
Rationale: Nonketotic hyperglycinemia presents with neonatal seizures, prominent hiccups, lethargy, and coma due to an inborn error of metabolism. It is diagnosed via elevated CSF/plasma glycine ratio. Propionic acidemia and maple syrup urine disease present with metabolic acidosis, while Leigh disease is associated with lactic acidosis
- A 15-year-old female presents with seizures, fever, headache, and confusion for 5 days. History is unremarkable. PE reveals vesicular lesions around the mouth and pubic area. What is TRUE about this patient’s condition?
A. HSV-2 causes a severe but recurrent form of meningoencephalitis.
B. Up to 50% of untreated HSV meningoencephalitis cases are fatal.
C. HSV-1 causes sporadic encephalitis leading to coma.
D. HSV-1 has generalized brain involvement, unlike the localized involvement in HSV-2.
C. HSV-1 causes sporadic encephalitis leading to coma.
Rationale: HSV-1 is the most common cause of sporadic encephalitis, affecting the temporal lobes and leading to seizures and altered mental status.
- A 5-year-old boy presents with acute onset seizures. History reveals fever, headache, right ear pain, and preauricular swelling extending to the angle of the mandible for 7 days. What CSF analysis finding is TRUE for this patient’s condition? (Dx: Mumps meningoencephalitis)
A. Glucose may be <40 mg/dL
B. Protein is >500 mg/dL
C. WBC count >1000 cells/μL
D. High mononuclear count early in the disease
A. Glucose may be <40 mg/dL
Rationale: Mumps meningoencephalitis often presents with low glucose levels in the CSF.
- A 25-hour-old term infant (3.5 kg) presents with seizures. The jerking stops when touched. The infant was born via NSD with prolonged second-stage labor. Apgar: 6 (1 min), 9 (10 min). ABG: pH 7.25, PCO₂ 50 mmHg, Serum Na 134 mmol/L, Total Ca 1.8 mmol/L, Glucose 59 mg/dL. What is the most likely cause of seizures?
A. Hypoglycemia
B. Hypocalcemia
C. Myoclonic jerks
D. Hypoxic-ischemic encephalopathy
C. Myoclonic jerks
Rationale: Infantile myoclonic jerks often appear benign and self-resolve. They are distinguished from pathological seizures by cessation when touched.
- A newborn is diagnosed with myelomeningocele. Which of the following statements is NOT true?
A. Periconceptional folic acid use reduces the risk of neural tube defects by ≥50%.
B. Valproic acid increases neural tube defect risk by 1-2% when taken in pregnancy.
C. Hydrocephalus occurs in ≥80% of patients with myelomeningocele.
D. Lower spinal deformities increase hydrocephalus risk.
D. Lower spinal deformities increase hydrocephalus risk. (Incorrect statement)
Rationale: Hydrocephalus is common (>80%) in myelomeningocele, but lower spinal defects do not directly increase the risk. Instead, it is associated with Chiari II malformation, leading to obstructive hydrocephalu
- A pregnant woman asks about meningocele vs. myelomeningocele on a prenatal ultrasound. What is the main distinguishing feature?
A. Presence of a subcutaneous mass
B. Exposure of neural placode through a midline skin defect
C. Presence of a dilated central canal
D. Position of the neural placode relative to the skin surface
D. Position of the neural placode relative to the skin surface
Rationale: In meningocele, the placode is deep inside the sac. In myelomeningocele, the neural placode is exposed.
- A newborn presents with a fluctuant midline mass on the thoracolumbar region without skin opening. What best describes this mass?
A. Herniation of a CSF-filled sac lined by dura and arachnoid mater
B. Abnormal skin-bowel connection
C. Neural placode exposure through a skin defect
D. Dilated central canal herniation
A. Herniation of a CSF-filled sac lined by dura and arachnoid mater
Rationale: A fluctuant midline mass without skin opening suggests meningocele, which consists of a CSF-filled sac covered by meninges. If neural tissue were exposed, it would be myelomeningocele
- You deliver an infant with thoracolumbar myelomeningocele. The father asks about possible complications before surgical repair. Which is least likely?
A. Neurogenic bladder
B. Neurogenic bowel
C. Lower extremity paralysis
D. Sudden infant death
D. Sudden infant death (Least likely complication)
Rationale: Sudden infant death syndrome (SIDS) is not a recognized complication of myelomeningocele. Instead, neurogenic bladder, bowel dysfunction, and lower limb paralysis are common due to spinal cord involvemen
- One pathology of hydrocephalus is the obliteration of the subarachnoid cisterns. Which of the following conditions can cause this type of hydrocephalus?
A. Achondroplasia
B. Chiari malformation
C. Dandy-Walker malformation
D. Klippel-Feil syndrome
A. Achondroplasia
Rationale: Achondroplasia can cause communicating or non-communicating hydrocephalus by obliterating the subarachnoid cisterns due to skull base abnormalities.
- An infant presents with delayed gross motor skills, motor stiffness, and spastic paraplegia. Imaging reveals Dandy-Walker malformation. Which of the following statements is NOT correct about Dandy-Walker malformation?
A. Cystic dilatation of the fourth ventricle
B. Displacement of the cerebellar tonsils through the foramen magnum
C. Hypoplasia of the cerebellar vermis
D. An enlarged posterior fossa
B. Displacement of the cerebellar tonsils through the foramen magnum (Incorrect statement)
Rationale: Dandy-Walker malformation is characterized by cystic dilation of the fourth ventricle, hypoplasia of the cerebellar vermis, and an enlarged posterior fossa. Unlike Chiari malformation, it does not cause cerebellar tonsillar herniation
.
- A 12-year-old child falls from a 3-story building and arrives at the ER unconscious, with BP 80/50 mmHg, HR 100 bpm, shallow respiration, and unequal pupils. You suspect increased intracranial pressure due to intracranial hemorrhage. Which intervention is least prioritized?
A. Hyperventilation with bag-mask ventilation
B. Normal saline fluid boluses
C. Elevation of the head to at least 30 degrees
D. Start mannitol therapy
D. Start mannitol therapy
Rationale: Hypotension is present, so mannitol is not prioritized until fluid resuscitation stabilizes blood pressure.
- A 7-year-old child with a brain mass presents to the ER with BP 150/100 mmHg, HR 60 bpm, and irregular breathing. IV mannitol therapy is started. Besides osmotic diuresis, what other mechanism does mannitol use to decrease intracranial pressure?
A. Mannitol increases serum tonicity
B. Mannitol may cause cerebrovasodilation
C. Mannitol decreases blood viscosity
D. Mannitol increases serum sodium level
C. Mannitol decreases blood viscosity
Rationale: Mannitol reduces blood viscosity, improving cerebral perfusion and decreasing intracranial pressure.
- An 18-year-old boy presents to the ER unconscious with severe headache (10/10), BP 160/90 mmHg, HR 70 bpm, and unilateral pupillary dilation. CT scan shows subarachnoid hemorrhage with cerebral edema. What is the primary mechanism behind vasogenic cerebral edema?
A. Intracellular accumulation of excess fluid
B. Increased permeability of neuronal membranes
C. Increased permeability of capillaries
D. Greater swelling in gray matter than in white matter
C. Increased permeability of capillaries
Rationale: Vasogenic edema results from breakdown of the blood-brain barrier, leading to extracellular fluid accumulation.
- A child loses consciousness while playing. CT scan reveals intracerebral hemorrhage in the right basal ganglia. PE shows a fixed, dilated right pupil, while the left pupil reacts normally to light. What is the likely diagnosis?
A. Right uncal herniation
B. Left uncal herniation
C. Cerebellar tonsil herniation
D. Right cingulate gyrus herniation
A. Right uncal herniation
Rationale: Uncal herniation causes ipsilateral pupillary dilation due to oculomotor nerve compression.
- A comatose child with suspected intracerebral hemorrhage presents with hyperventilation. Noxious stimuli cause both arms and legs to extend (decerebrate posture). Pupils are midposition and fixed. What structure is most likely compressed?
A. Corpus callosum
B. Medulla
C. Cerebellar tonsils
D. Midbrain
D. Midbrain
Rationale: Midbrain compression causes decerebrate posturing, fixed pupils, and central hyperventilation.
- A 5-month-old presents with weak extremities for 1 month, frog-leg posture, pooling of oral secretions, and recurrent pneumonia since 3 months old. The child’s older sibling had similar symptoms and died at 2 months old. What is the most likely type of spinal muscular atrophy (SMA)?
A. Type 1A
B. Type 1B
C. Type 1C
D. Type 2
C. Type 1C
- A 12-month-old presents with progressive limb weakness and tongue fasciculations. The mother noted prominent lower extremity weakness over the past month. What lab finding is consistent with this disorder?
A. ECG shows localized somatic muscle fibrillations
B. Motor nerve conduction shows mild slowing early in the disease
C. Serum creatine kinase is elevated 4x the upper normal limit
D. Electromyography shows fibrillation potential without muscle denervation
C. Serum creatine kinase is elevated 4x the upper normal limit
Rationale: Elevated CK levels are characteristic of neuromuscular disorders like SMA.
- A 7-year-old presents with flaccid paralysis of the right leg following a fever and malaise that lasted 2-3 days. The fever resolved, but paralysis appeared 2 days later. PE shows decreased DTRs on the right leg. No vaccinations since birth. CSF analysis would show all of the following EXCEPT:
A. Pleocytosis with 20-300 cells/μL in CNS involvement
B. Predominantly PMNs
C. Near normal CSF cell values
D. CSF protein 50-100 mg/dL
B. Predominantly PMNs
- A 12-year-old boy diagnosed with Guillain-Barré syndrome (GBS) is admitted to the ward for disease progression monitoring. Which of the following tests best assesses his respiratory function?
A. Arterial blood gas
B. Chest radiograph
C. Peak expiratory flow rate
D. Vital capacity
D. Vital capacity
Rationale: Vital capacity is the best indicator of respiratory decline in GBS and helps determine the need for intubation.
- You request CSF analysis for a 17-year-old girl with ascending symmetric weakness. Which CSF finding is consistent with GBS?
A. Elevated protein with WBC elevation
B. Elevated WBC without protein elevation
C. Elevated protein without WBC elevation
D. Normal CSF protein and WBC count
C. Elevated protein without WBC elevation
Rationale: Albuminocytologic dissociation (↑ protein, normal WBC) is the hallmark CSF finding in GBS.
- Patients with Guillain-Barré syndrome (GBS) present with flaccid weakness and sensory loss. Which finding best differentiates botulism from GBS?
A. Intermittent weakness
B. Fixed dilated pupils
C. Paralysis with intact sensation
D. Weakness worsened by exertion
B. Fixed dilated pupils
Rationale: Botulism presents with pupillary involvement (fixed, dilated pupils), while GBS spares the pupils.
- A morbidly obese adolescent with suspected GBS is admitted to the ICU. Which cost-effective early intervention shortens the disease course and reduces permanent paralysis?
A. Immune globulin
B. Corticosteroids
C. Plasma exchange
D. Immobilization and stabilization
C. Plasma exchange
Rationale: Plasma exchange (plasmapheresis) and IVIg are first-line therapies for GBS, but plasmapheresis is more cost-effective.
- A 12-year-old girl presents with asymmetric ptosis and extraocular muscle weakness after taking antibiotics for cough and colds. She later develops respiratory distress and requires intubation. Which antibiotic most likely caused this condition?
A. Ciprofloxacin
B. Amoxicillin
C. Clindamycin
D. Trimethoprim-sulfamethoxazole
A. Ciprofloxacin
Rationale:
The child presents with asymmetric ptosis, extraocular muscle weakness, and respiratory distress—suggestive of myasthenic crisis. Certain antibiotics can worsen neuromuscular weakness and trigger myasthenic crises, particularly in patients with underlying neuromuscular disorders like Myasthenia Gravis (MG)
.
Fluoroquinolones (e.g., Ciprofloxacin) are known to exacerbate myasthenia gravis and cause profound neuromuscular blockade, leading to respiratory failure in susceptible individuals
.
Aminoglycosides, beta-blockers, procainamide, and chloroquine also worsen MG, but these were not listed in the choices
.
The other antibiotics (Amoxicillin, Clindamycin, Trimethoprim-sulfamethoxazole) are not known to precipitate neuromuscular weakness or myasthenic crisis to the same extent as fluoroquinolones.
- Myasthenia gravis (MG) must be differentiated from other neuromuscular disorders. What is the most specific test for MG?
A. Muscle biopsy
B. Electromyography
C. Anti-AChR antibodies
D. Serum creatine kinase
B. Electromyography
- A child with GBS is treated with IVIg. Which function is expected to improve last?
A. Sensation
B. Bulbar muscles
C. Anal sphincters
D. Tendon reflexes
D. Tendon reflexes
Rationale: Tendon reflexes take the longest to recover in GBS, often persisting for weeks to months after other improvements.
- All the following myopathies are characterized by proximal muscle wasting, EXCEPT:
A. Becker dystrophy
B. Myotonic dystrophy
C. Duchenne dystrophy
D. Central core myopathy
B. Myotonic dystrophy
Rationale: Myotonic dystrophy primarily affects distal muscles, while Becker, Duchenne, and central core myopathy affect proximal muscles.
- In spinal muscular atrophy (SMA) type 1, all the following are spared, EXCEPT:
A. Heart
B. Diaphragm
C. Anal sphincter
D. Extraocular muscles
B. Diaphragm
Rationale: SMA type 1 causes progressive diaphragmatic weakness, leading to respiratory failure.
- Which of the following vaccines does NOT induce Guillain-Barré syndrome (GBS)?
A. Oral polio vaccine (OPV)
B. Rotavirus vaccine
C. Influenza vaccine
D. Conjugated meningococcal vaccine
B. Rotavirus vaccine
Rationale: GBS is associated with OPV, influenza, and meningococcal vaccines, but not with rotavirus vaccine.
- The aura associated with migraine is a neurological warning sign. Which of the following is the least common type of typical aura in migraine?
A. Dysphasic aura
B. Visual aura
C. Vertigo
D. Distortion
A. Dysphasic aura
Rationale: Visual aura is the most common, while dysphasic aura (speech/language dysfunction) is the least common type.
- A 10-year-old child presents with headache. Which of the following is NOT an indication for neuroimaging?
A. Abnormal neurological examination
B. Headache worst upon awakening
C. Frontal headache
D. Migrainous headache in a child with no family history
C. Frontal headache
Rationale: Frontal headaches are common and usually benign. Neuroimaging is indicated for abnormal neurological findings or red flag symptoms.
- Which condition most likely causes slowly progressive ataxia, greater in the lower extremities, with positive Romberg test, absent DTRs, and extensor plantar response?
A. Ataxia-telangiectasia
B. Friedreich ataxia
C. Roussy-Levy disease
D. Ramsay Hunt syndrome
B. Friedreich ataxia
Rationale: Friedreich ataxia presents with progressive ataxia, absent DTRs, and extensor plantar response due to spinocerebellar degeneration.
- A child with spastic diplegia cerebral palsy undergoes cranial MRI. Which of the following findings is most commonly seen?
A. Periventricular leukomalacia
B. White matter injury
C. Multicystic cortical encephalomalacia
D. Enlarged thalamocortical pathways
A. Periventricular leukomalacia
Rationale: Periventricular leukomalacia is the most common finding in spastic diplegia cerebral palsy, resulting from white matter ischemia.
- An adolescent presents to the ER with unsteady gait. Which medication is least likely to cause ataxia?
A. Alcohol
B. Imipramine
C. Phenobarbital
D. Dextromethorphan
B. Imipramine
Rationale: Alcohol, phenobarbital, and dextromethorphan can cause ataxia, whereas imipramine (a tricyclic antidepressant) does not typically cause ataxia.
- Miller-Fisher syndrome presents with acute ophthalmoplegia, ataxia, and areflexia. Which cranial nerve is most commonly affected?
A. CN V (Trigeminal)
B. CN VI (Abducens)
C. CN VII (Facial)
D. CN VIII (Vestibulocochlear)
B. CN VI (Abducens)
Rationale: Miller-Fisher syndrome is a GBS variant that frequently involves CN VI, leading to ophthalmoplegia and diplopia.
- A 7-year-old boy presents with recurrent eye blinking and sudden, repetitive limb movements for the past 9 months. What is the most likely diagnosis?
A. Tourette’s disorder
B. Persistent motor tic disorder
C. Provisional tic disorder
D. Sydenham chorea
C. Provisional tic disorder
- A 5-year-old boy has a family history of Huntington chorea. His mother requests predictive genetic testing. What is the most appropriate response?
A. Whatever the result, it will not affect the disease process.
B. This is an age-dependent disorder and may not manifest.
C. Leave the decision to the child when they are older.
D. We should weigh the benefits vs. risks of testing.
C. Leave the decision to the child when they are older.
- A child with Sydenham chorea is started on penicillin for rheumatic heart disease prevention. Which drug can be added for symptom control?
A. Prednisone
B. Phenobarbital
C. Haloperidol
D. Chlorpromazine
A. Prednisone
Rationale:
Steroids, particularly prednisone, have been shown to reduce the duration and severity of Sydenham chorea.
A randomized, double-blinded study found that high-dose prednisone (2 mg/kg/day, max 60 mg) for 4 weeks significantly reduced the time to remission (54.3 days vs. 119.9 days in controls)
.
Immunomodulatory therapy like IVIG and plasma exchange has been used in severe cases, but steroids remain a first-line option for symptom relief
- A 13-year-old boy presents with delirium, mumbling speech, tachycardia, dry flushed skin, dilated pupils, myoclonus, urinary retention, and decreased bowel sounds. He later develops seizures and arrhythmias. What is the most likely cause?
A. Amitriptyline
B. Amphetamine
C. Barbiturates
D. Edrophonium
A. Amitriptyline
Rationale: Tricyclic antidepressant (TCA) toxicity (e.g., amitriptyline) presents with anticholinergic symptoms, seizures, and cardiac arrhythmias (QRS widening).
- The recurrence risk of neural tube defects (NTDs) in subsequent pregnancies is:
A. 1% to 2%
B. 3% to 4%
C. 5% to 6%
D. 7% to 8%
B. 3% to 4%
Rationale:
The recurrence risk of neural tube defects (NTDs) after having one affected child is 3–4%.
If two prior children are affected, the risk increases to 10%
.
The cause of NTDs is multifactorial, involving genetic predisposition, folate deficiency, hyperthermia, certain drugs (e.g., valproic acid), and maternal conditions like diabetes and obesity.
Periconceptional folic acid supplementation significantly reduces the risk of NTDs, which is why it is recommended for all women of childbearing age.
- A 3-year-old boy presents with fever, anorexia, headache, and positive meningeal signs. CSF analysis shows ↑ lymphocytes and ↓ glucose. He has a history of prolonged steroid use for nephrotic syndrome. What is the most likely diagnosis?
A. Partially treated bacterial meningitis
B. Fungal meningitis
C. Viral meningitis
D. Parasitic meningitis
B. Fungal meningitis
Rationale: Fungal meningitis (e.g., Cryptococcus) is common in immunocompromised patients (e.g., those on prolonged steroids). CSF shows ↑ lymphocytes, ↓ glucose, and ↑ protein.
- An 8-year-old girl undergoes EEG, revealing generalized 3-Hz spike-and-wave activity. What is the most likely diagnosis?
A. Benign childhood epilepsy
B. Generalized absence seizure
C. West syndrome
D. Simple partial seizure
B. Generalized absence seizure
Rationale: Absence seizures (petit mal seizures) present with brief staring spells and a classic EEG pattern of 3-Hz spike-and-wave discharges.
- The duration of anticonvulsant therapy varies by seizure type. Most children can stop medication after 2 seizure-free years, but which condition usually requires lifelong treatment?
A. Simple partial seizure
B. Complex partial seizure
C. Juvenile myoclonic epilepsy
D. Infantile spasm
C. Juvenile myoclonic epilepsy
Rationale: Juvenile myoclonic epilepsy (JME) requires lifelong anticonvulsant therapy as it has a high recurrence rate even after prolonged seizure-free periods.
- A 6-month-old infant presents with severe hypotonia and generalized weakness. His CK is mildly elevated, EMG shows fasciculations and fibrillations, and muscle biopsy shows grouped atrophy. What is the most likely finding on exam?
A. Absent deep tendon reflexes
B. Absent sensation
C. Bilateral ptosis
D. Persistent Moro reflex
A. Absent deep tendon reflexes
Rationale: Spinal muscular atrophy (SMA) presents with severe hypotonia, absent DTRs, tongue fasciculations, and grouped atrophy on muscle biopsy. Sensation remains intact.
- A 5-year-old boy presents to the ER with severe scrotal pain. What is the most likely cause?
A. Retractile testes
B. Testicular torsion
C. Epididymitis
D. Incarcerated hernia
B. Testicular torsion
Rationale: Testicular torsion presents with acute, severe scrotal pain, absent cremasteric reflex, and high-riding testis. It is a surgical emergency requiring immediate detorsion.
- Children with kidney transplants require immunosuppressive therapy. Which of the following is NOT a side effect?
A. Nephrotoxicity
B. Cardiovascular complications
C. Sudden death
D. Infections
C. Sudden death
Rationale: Nephrotoxicity, cardiovascular disease, and infections are well-known complications of immunosuppressive therapy in kidney transplant patients. Sudden death is not a direct complication.
- A 3-week-old neonate presents with an abdominal mass. What is the most common renal cause?
A. Ureteropelvic junction obstruction
B. Posterior urethral valves
C. Multicystic renal dysplasia
D. Polycystic kidney disease
A. Ureteropelvic junction obstruction
Rationale: Ureteropelvic junction (UPJ) obstruction is the most common cause of a neonatal abdominal mass and the most frequent obstructive uropathy in children. It is typically diagnosed via antenatal ultrasound revealing fetal hydronephrosis. In neonates, it presents as a palpable renal mass or hydronephrosis without ureteral dilation.
- A 9-year-old boy presents to the ER with severe headache and BP of 160/90 mmHg in the left arm. What is the most likely cause?
A. Endocrine disorders
B. Renal disorders
C. Neurologic disorders
D. Vascular diseases
E. Metabolic syndromes
B. Renal disorders
Rationale: Renal disorders (e.g., renal artery stenosis, glomerulonephritis, or chronic kidney disease) are the most common cause of secondary hypertension in children.
- Dietary management in chronic kidney disease (CKD) includes all of the following EXCEPT:
A. Increased caloric intake
B. Protein restriction
C. Iron supplementation
D. Low potassium diet
E. Low phosphorus diet
B. Protein restriction
Rationale: Protein restriction is not typically recommended in children with chronic kidney disease (CKD) due to concerns about impaired growth and development. Instead, children with CKD should receive 100% (or more for those on dialysis) of the dietary reference intake (DRI) for protein. Other dietary modifications, such as iron supplementation, low potassium, and low phosphorus diets, are necessary to manage CKD-related complications.
- A 6-month-old girl presents with bilateral abdominal masses and hypertension. Her older sister died as a neonate after the mother was diagnosed with oligohydramnios. What is the most likely diagnosis?
A. Wilm’s tumor
B. Polycystic kidney disease
C. Neuroblastoma
D. Vesicoureteral reflux stage 4
B. Polycystic kidney disease
Rationale: Autosomal recessive polycystic kidney disease (ARPKD) presents with large, cystic kidneys, neonatal respiratory distress, and oligohydramnios (Potter sequence).
- The most common intrinsic cause of acute kidney injury (AKI) in childhood is:
A. Acute interstitial nephritis
B. Rhabdomyolysis
C. Glomerulonephritis
D. Acute tubular necrosis
D. Acute tubular necrosis
Rationale: Acute tubular necrosis (ATN) is the most common intrinsic cause of AKI in children due to ischemia (shock, sepsis) or nephrotoxic injury (aminoglycosides, contrast).
- The classic electrolyte disturbance seen in renal tubular acidosis (RTA) is:
A. Hypocalcemia
B. Hypokalemia
C. Hyperchloremic metabolic acidosis
D. Hyperkalemia
C. Hyperchloremic metabolic acidosis
Rationale: Renal tubular acidosis (RTA) presents with normal anion gap (hyperchloremic) metabolic acidosis due to impaired renal acid excretion.
- A 4-day-old newborn presents with gross hematuria, lethargy, dry mucous membranes, hypertension, and a right-sided flank mass. The mother had gestational diabetes. What is the most likely diagnosis?
A. Hypercalciuria
B. Renal vein thrombosis
C. Hemorrhagic cystitis
D. Sickle cell disease
B. Renal vein thrombosis
Rationale: Renal vein thrombosis (RVT) is associated with infants of diabetic mothers and presents with gross hematuria, flank mass, and thrombocytopenia.
- Acute kidney injury (AKI) refers to an abrupt decrease in GFR and tubular function. What are possible etiologies?
A. Prerenal
B. Postrenal
C. Renal parenchymal
D. Vascular
E. All of the above
E. All of the above
Rationale: AKI can be classified as:
Prerenal (e.g., hypovolemia, heart failure)
Renal parenchymal (e.g., ATN, glomerulonephritis)
Postrenal (e.g., obstruction)
Vascular (e.g., renal vein thrombosis, vasculitis)
- Hemolytic uremic syndrome (HUS) is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal injury. What is the best indicator of renal injury in HUS?
A. Anemia
B. Leukocytosis
C. Hematuria
D. Increased LDH
C. Hematuria
Rationale: Renal injury in HUS manifests as hematuria, proteinuria, and increased creatinine. LDH is elevated due to hemolysis, but not specific for kidney injury.
- A 12-year-old girl with systemic lupus erythematosus (SLE) develops nephrotic syndrome (NS). What is the most common type of secondary NS in lupus?
A. Membranoproliferative glomerulonephritis
B. Membranous nephropathy
C. Focal segmental glomerulosclerosis
D. Minimal change nephrotic syndrome
B. Membranous nephropathy
Rationale: Membranous nephropathy is the most common cause of nephrotic syndrome in lupus patients and is classified under class V lupus nephritis.
- Microscopic hematuria is defined as >3-5 RBCs per high-power field in centrifuged urine. All of the following can cause hematuria EXCEPT:
A. Acute kidney injury
B. Urinary tract malformation
C. Trauma
D. Renal vein thrombosis
E. Hemoglobinuria
E. Hemoglobinuria
Rationale: Hemoglobinuria is free hemoglobin in urine (from intravascular hemolysis), not true hematuria (which comes from RBCs in urine).
- A 6-year-old boy with nephrotic syndrome develops severe abdominal pain while on corticosteroids. Peritoneal fluid analysis: RBC 500,000/mm³, WBC 5,000/mm³. What is the most likely diagnosis?
A. Acute appendicitis
B. Staphylococcal peritonitis
C. Pneumococcal peritonitis
D. Mesenteric lymphadenitis
C. Pneumococcal peritonitis
Rationale: Nephrotic syndrome increases the risk of spontaneous bacterial peritonitis (SBP), most commonly due to Streptococcus pneumoniae.
- Which of the following is NOT associated with chronic kidney disease (CKD)?
A. Polyhydramnios
B. Intrauterine growth restriction
C. Premature delivery
D. Down syndrome
E. Spontaneous abortion
D. Down’s syndrome
Rationale: Chronic kidney disease (CKD) is associated with adverse maternal and fetal outcomes, including intrauterine growth restriction, premature delivery, spontaneous abortion, and oligohydramnios rather than polyhydramnios. While certain genetic syndromes may predispose to kidney abnormalities, Down syndrome its
- Alport syndrome is a hereditary nephritis caused by defective type IV collagen. Which of the following is NOT a feature of Alport syndrome?
A. Deafness
B. Visual impairment
C. Proteinuria
D. Microscopic hematuria
E. Renal failure
B. Visual impairment
Rationale: Alport syndrome is associated with sensorineural hearing loss, renal failure, and ocular abnormalities (anterior lenticonus), but not true visual impairment.
- Which antibody is found in post-streptococcal glomerulonephritis (PSGN)?
A. Anti-streptolysin B
B. Anti-DNAse B
C. Anti-hyaluronic acid
D. Anti-staphylokinase
E. Anti-adenine dinucleotidase
B. Anti-DNAse B
Rationale: Anti-DNAse B antibodies indicate recent streptococcal infection and are present in post-streptococcal glomerulonephritis (PSGN).
- Which of the following renal conditions is NOT associated with impaired growth in children?
A. Congenital nephrotic syndrome
B. Vesicoureteral reflux
C. Autosomal recessive polycystic kidney disease (ARPKD)
D. Steroid therapy
B. Vesicoureteral reflux
Rationale: Vesicoureteral reflux (VUR) does not usually impair growth unless complicated by recurrent pyelonephritis and chronic kidney disease. The others directly affect growth.
- A 5-year-old child has poor growth due to CKD. Which of the following is NOT part of management?
A. Increased caloric intake
B. Increased protein intake
C. Recombinant growth hormone (GH)
D. Vitamin D analogues
B. Increased protein intake
Rationale: Protein restriction is recommended in CKD to prevent uremic symptoms. Growth hormone therapy and vitamin D analogs help counteract CKD-related growth delay.
- Complement C3 is a β-protein that is decreased in which condition?
A. Acute post-streptococcal glomerulonephritis (APSGN)
B. IgA nephropathy
C. Nephrotic syndrome
D. Rapidly progressive glomerulonephritis (RPGN)
A. Acute post-streptococcal glomerulonephritis (APSGN)
Rationale: APSGN is associated with low complement (C3) due to immune complex deposition. IgA nephropathy and nephrotic syndrome usually have normal C3.
- Common manifestations of UTI in older children include:
A. Fever, vomiting, diarrhea
B. Abdominal/flank pain, dysuria, malodorous urine
C. Asymptomatic
D. Oliguria, hypertension, edema
B. Abdominal/flank pain, dysuria, malodorous urine
Rationale: Older children with UTI present with dysuria, urgency, frequency, abdominal or flank pain, and foul-smelling urine. Younger children may have nonspecific symptoms like fever and vomiting.
- Definitive diagnostic test for acute pyelonephritis in children:
A. Intravenous pyelogram
B. Ultrasound
C. Vesico-cystourethrogram (VCUG)
D. Renal scan
B. Ultrasound
- A 16-year-old boy notices a painless mass in the left scrotum. Most likely diagnosis:
A. Torsion of the testes
B. Epididymitis
C. Varicocele
D. Hydrocele
C. Varicocele
Rationale: Varicocele is the most common cause of a painless scrotal mass in adolescent males, often affecting the left side due to venous drainage differences. Torsion is painful and an emergency.
- A newborn with oligohydramnios and a single umbilical artery is associated with:
A. Polycystic kidney disease
B. Hydronephrosis
C. Renal agenesis
D. Renal hypoplasia
C. Renal agenesis
Rationale: Renal agenesis, especially bilateral (Potter sequence), leads to oligohydramnios, pulmonary hypoplasia, and facial anomalies. A single umbilical artery is a common finding.
- Recommended age for corrective surgery in unilateral undescended testes:
A. Between 12 – 18 months
B. After puberty
C. Newborn period
D. Before puberty
A. Between 12 – 18 months
Rationale: Orchiopexy should be done before 18 months to prevent testicular atrophy and malignancy risk. Spontaneous descent is unlikely after 6 months.
- A child with APSGN has persistent low C3 and high BUN/Creatinine after 4 months. Next step?
A. VCUG
B. Renal biopsy
C. Renal scanning
D. Plain KUB
B. Renal biopsy
Rationale: Persistent low C3 (>8 weeks) and worsening kidney function suggest an alternative diagnosis, such as membranoproliferative GN or lupus nephritis, requiring biopsy.
- A 2-year-old with generalized edema, proteinuria (+4), hyperlipidemia, and normal BP. Most likely diagnosis?
A. PSGN
B. IgA Nephropathy
C. Henoch-Schönlein Purpura nephritis
D. Minimal change nephrotic syndrome
D. Minimal change nephrotic syndrome
Rationale: Minimal change disease is the most common cause of nephrotic syndrome in children. Characterized by proteinuria, hypoalbuminemia, and hyperlipidemia.
- Which statement about APSGN in children is correct?
A. Most common in children >15 years
B. Presents as acute renal failure
C. Occurs 3-4 days after streptococcal infection
D. Can result from streptococcal pharyngitis or impetigo
D. Can result from streptococcal pharyngitis or impetigo
Rationale: APSGN can follow either pharyngitis (1-2 weeks) or impetigo (2-4 weeks). It is most common in 5-12 years old, not >15 years.
- Most common presenting sign of Wilms tumor (nephroblastoma)?
A. Hematuria
B. Abdominal pain
C. Weight loss
D. Abdominal mass
D. Abdominal mass
Rationale: Wilms tumor presents as an asymptomatic abdominal mass, often found incidentally. Other symptoms may include hematuria and hypertension.
- First sign in a 5-year-old with dark brown urine and healing impetigo?
A. Headache
B. Oliguria
C. Periorbital edema
D. Dyspnea
C. Periorbital edema
Rationale: APSGN presents with cola-colored urine, periorbital edema, hypertension, and oliguria following a streptococcal infection. Edema is often the first sign.
- The most common cause of gross hematuria in pediatrics:
A. Acute Pyelonephritis
B. Acute Post-Streptococcal Glomerulonephritis (APSGN)
C. Benign Familial Hematuria
D. IgA Nephropathy
D. IgA Nephropathy
Rationale: IgA nephropathy (Berger disease) is the most common cause of gross hematuria in children, often following an upper respiratory infection (“synpharyngitic hematuria”).
- Least commonly observed clinical feature in APSGN:
A. Hematuria
B. Edema
C. Hypertension
D. Renal failure
D. Renal failure
Rationale: Hematuria, edema, and hypertension are common in APSGN, while renal failure is uncommon and occurs in severe cases. Most cases resolve without progressing to renal failure.
- A 1-year-old with recurrent UTI and enlarged kidneys on ultrasound. Best diagnostic test:
A. Renal CT Scan
B. Voiding Cystourethrogram (VCUG)
C. Plain Film KUB
D. MRI
B. Voiding Cystourethrogram (VCUG)
Rationale: VCUG is the gold standard for diagnosing vesicoureteral reflux (VUR), a common cause of recurrent UTI and hydronephrosis in children. CT scan is reserved for complications like renal abscess.
- A 3-year-old boy with abdominal mass, hydronephrosis, and recurrent UTI with E. coli. Most likely cause:
A. Adrenal Hemorrhage
B. Wilms Tumor
C. Ureteropelvic Junction Obstruction
D. Vesicoureteral Junction Obstruction
C. Ureteropelvic Junction Obstruction
Rationale: Ureteropelvic junction (UPJ) obstruction is the most common congenital cause of hydronephrosis in children and often presents with recurrent UTI and abdominal mass.
- A 3-year-old boy had diarrhea, followed by oliguria, edema, and petechial rashes. Labs show anemia, thrombocytopenia, proteinuria, and RBCs in urine. Most likely diagnosis:
A. Hemolytic Uremic Syndrome (HUS)
B. Post-Streptococcal Glomerulonephritis (APSGN)
C. Nephrotic Syndrome
D. Systemic Lupus Erythematosus
A. Hemolytic Uremic Syndrome (HUS)
Rationale: HUS is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (triad). It follows Shiga toxin-producing E. coli (STEC) diarrhea.
- Common findings in children with chronic renal failure:
A. Mental Retardation
B. Growth Retardation
C. Hypotension
D. Hypokalemia
B. Growth Retardation
Rationale: Growth failure is a major complication of chronic kidney disease (CKD) due to metabolic disturbances, acidosis, and poor nutrition. Hypertension, not hypotension, is common.
- Correct statement about management of nephrotic syndrome:
A. Renal biopsy before immunosuppressive therapy
B. Steroid responsive in minimal change disease
C. Steroid-resistant if no response after 1 week of prednisone
D. Complete remission if proteinuria >40 mg/m²/hr
B. Steroid responsive in minimal change disease
Rationale: Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children and is highly responsive to corticosteroids. Biopsy is only done if non-responsive.
- Most frequent cause of graft loss in pediatric renal transplant patients:
A. Trauma to the graft
B. Technical difficulties
C. Rejection reactions
D. Infection
C. Rejection reactions
Rationale: Graft rejection is the most common cause of kidney transplant failure. Acute and chronic rejection lead to progressive graft dysfunction.
- True statement about Vesicoureteral Reflux (VUR):
A. It is non-hereditary
B. It predisposes to pyelonephritis
C. It always requires surgery
D. Only boys are affected
B. It predisposes to pyelonephritis
Rationale: VUR increases the risk of recurrent pyelonephritis and renal scarring. It can be hereditary, often resolves spontaneously, and affects both boys and girls.
- Last finding to resolve in a child with APSGN:
A. Elevated BUN
B. Hypertension
C. Edema
D. Microscopic Hematuria
D. Microscopic Hematuria
Rationale: Microscopic hematuria can persist for 6-12 months in APSGN. Hypertension and edema resolve earlier. BUN and creatinine normalize with renal recovery.
- True statement about undescended testes:
A. It is histologically normal at birth
B. It is usually located in the inguinal canal
C. Testicular descent occurs early in gestation
D. It descends spontaneously 6 months after birth
A. It is histologically normal at birth
- Complete reduction of a hydrocele when compressed suggests:
A. Epididymitis
B. Spermatocele
C. Testicular tumor
D. Inguinal hernia
D. Inguinal hernia
Rationale: A reducible scrotal swelling is suggestive of an inguinal hernia. Hydrocele may fluctuate in size but is not completely reducible like a hernia.
- Hyperlipidemia in Nephrotic Syndrome is due to:
A. Overproduction of lipoproteins
B. Lower levels of lipoprotein lipase
C. Both (A) and (B) are correct
D. Neither (A) nor (B) are correct
C. Both (A) and (B) are correct
Rationale: Nephrotic syndrome leads to increased lipoprotein synthesis in response to low oncotic pressure and decreased clearance of lipids due to reduced lipoprotein lipase activity.
- Clinically apparent edema usually occurs when serum albumin drops below:
A. 5.0 gm/dL
B. 4.0 gm/dL
C. 3.0 gm/dL
D. 2.0 gm/dL
D. 2.0 gm/dL
Rationale: Generalized edema in nephrotic syndrome typically occurs when albumin falls below 2 g/dL due to decreased oncotic pressure.
- Indication for renal biopsy in a nephrotic syndrome patient:
A. Continued proteinuria after 1 week of prednisone
B. History of systemic lupus erythematosus
C. Cholesterol >400 mg/dL
D. Relapse 1 year after initial therapy
B. History of systemic lupus erythematosus
Rationale: Renal biopsy is indicated in nephrotic syndrome if there is suspicion of an underlying secondary cause, such as lupus nephritis. Biopsy is also considered if there is steroid resistance or atypical features.
- Most common cause of mortality in primary idiopathic nephrotic syndrome:
A. Bacterial infection
B. Congestive heart failure
C. Seizures
D. Acute renal failure
A. Bacterial infection
Rationale: Nephrotic syndrome predisposes children to serious infections such as peritonitis, pneumonia, and sepsis due to urinary loss of immunoglobulins and complement factors.
- Recurrent UTI in children (<10 years) is most commonly associated with:
A. Renal stones
B. Chronic glomerulonephritis
C. Vesicoureteral reflux (VUR)
D. Renal tumors
C. Vesicoureteral reflux (VUR)
Rationale: VUR occurs in 25-30% of children with recurrent UTI and can lead to renal scarring (reflux nephropathy) and CKD.
- Best treatment for generalized edema in nephrotic syndrome:
A. Antibiotics
B. Diuretics
C. 5% Albumin
D. Prednisone
D. Prednisone
Rationale: Prednisone is first-line therapy for nephrotic syndrome (minimal change disease). Diuretics may be used for symptomatic relief but do not treat the underlying condition.
- Most appropriate initial pharmacologic therapy for a 12-year-old with severe reflux nephropathy and hypertension:
A. Diuretic
B. ACE inhibitor
C. Beta-blocker
D. Calcium channel blocker
B. ACE inhibitor
Rationale: ACE inhibitors reduce proteinuria, control hypertension, and slow progression of chronic kidney disease (CKD) in reflux nephropathy.
- Most common cause of chronic renal failure (CKD) requiring transplantation in children:
A. Reflux nephropathy
B. Familial nephritis
C. Polycystic kidney disease
D. Obstructive uropathy
D. Obstructive uropathy
Rationale: Obstructive uropathy (e.g., posterior urethral valves, congenital anomalies) is the most common cause of CKD in children, leading to ESRD and requiring transplantation.
- A 2-year-old presents with 2 days of diarrhea and vomiting, no wet diapers in 12 hours. Labs show mild dehydration (Hct 44%, Na 135 mEq/L, K 3.0 mEq/L, BUN 16, Creatinine 0.8 mg/dL). The most likely diagnosis is:
A. Posterior urethral valves
B. Hemolytic uremic syndrome
C. Rotavirus infection
D. Glomerulonephritis
C. Rotavirus infection
Rationale: Rotavirus is the most common cause of viral gastroenteritis in young children, leading to severe dehydration and electrolyte imbalances. No evidence of renal obstruction (PUV), hemolysis (HUS), or glomerular disease.
- A 7-year-old boy with CKD due to posterior urethral valves has progressively worsening renal function. Best way to optimize growth before kidney transplant:
A. Assuring caloric intake of 120 kcal/kg/day
B. Providing high-protein diet
C. Growth hormone (GH) injections
D. Maintaining hemoglobin >13 g/dL
C. Growth hormone (GH) injections
Rationale: GH therapy can improve height and growth velocity in children with CKD, especially before renal transplantation. Excessive protein intake can worsen uremia.
- Indication for renal biopsy in nephrotic syndrome:
A. Age 2-6 years at initial presentation
B. Relapse 1 year after initial diagnosis
C. Lack of response after 1 week of prednisone
D. Low serum complement level at initial presentation
D. Low serum complement level at initial presentation
Rationale: Renal biopsy is indicated in nephrotic syndrome when atypical features are present, such as low serum complement levels, which may suggest underlying conditions like membranoproliferative glomerulonephritis (MPGN) or lupus nephritis. Other indications include steroid resistance (typically after 4 weeks, not just 1 week), age <1 year or >12 years, persistent hematuria, and hypertension. Most children aged 2-6 years with typical minimal change disease (MCD) do not require a biopsy as they usually respond well to steroids.
54.A 5 year old girl presents with periumbilical abdominal pain of increasing severity over the past 2 days. She has been receiving treatment for nephrotic syndrome with prednisone for the last 3 weeks. On physical examination febrile 38.5 C HR 124, RR 34 BP 80/50 mm Hg. with poor peripheral perfusion, puffy face and 3 + pedal edema. There is generalized abdominal tenderness with guarding and rebound tenderness. Abdominal UTZ shows ascites. Which of the following is the next most appropriate diagnostic step? *
A. Exploratory laparotomy
B. Abdominal paracentesis
C. CT of the abdomen
D. Doppler ultrasound of renal vessels
- B. Abdominal paracentesis
Rationale: This child with nephrotic syndrome on prednisone presents with fever, hypotension, peritoneal signs (abdominal tenderness, guarding, and rebound tenderness), and ascites, which strongly suggest spontaneous bacterial peritonitis (SBP)—a life-threatening infection in nephrotic syndrome due to loss of immunoglobulins and complement factors in urine. The next step is an abdominal paracentesis to confirm SBP by analyzing ascitic fluid for WBC count, differential, protein, glucose, and bacterial culture. Exploratory laparotomy is not indicated unless there is evidence of bowel perforation. CT of the abdomen is not the first-line diagnostic test and may delay necessary treatment. Doppler ultrasound of renal vessels is used for vascular causes like renal vein thrombosis, which is not the primary concern here.
- IgA nephropathy: Which of the following does NOT indicate an increased risk of renal failure?
A. Proteinuria
B. Hypertension
C. Reduced GFR
D. Interstitial fibrosis on biopsy
E. Macroscopic hematuria
E. Macroscopic hematuria
Rationale: Gross hematuria is common in IgA nephropathy but does not predict poor prognosis. Persistent proteinuria, HTN, decreased GFR, and fibrosis indicate higher risk of CKD.
- 7-year-old boy with crampy abdominal pain and rash on the buttocks and legs. Labs show proteinuria and microhematuria. Likely diagnosis:
A. Systemic lupus erythematosus
B. Henoch-Schönlein purpura (HSP)
C. Post-streptococcal glomerulonephritis
D. Polyarteritis nodosa
B. Henoch-Schönlein purpura (HSP)
Rationale: HSP is an IgA-mediated vasculitis that presents with purpuric rash, abdominal pain, arthritis, and nephritis. Renal involvement mimics IgA nephropathy.
- Ultrasound of KUB in UTI is used to rule out:
A. Renal thrombosis
B. Enlarged kidney
C. Vesicoureteral reflux (VUR)
D. Cystitis
B. Enlarged kidney
Rationale: Ultrasound of the kidneys, ureters, and bladder (KUB) is commonly used in urinary tract infections (UTIs) to evaluate kidney size, detect hydronephrosis, congenital anomalies, and possible renal scarring. Enlarged kidneys may indicate underlying conditions like pyelonephritis, obstruction, or congenital anomalies. While vesicoureteral reflux (VUR) requires a voiding cystourethrogram (VCUG) for diagnosis, and cystitis is usually diagnosed clinically, renal ultrasound helps rule out kidney enlargement as a complication of UTI.
- Glomerulonephritis associated with low serum C3:
A. Henoch-Schönlein purpura
B. Post-streptococcal glomerulonephritis (APSGN)
C. IgA nephropathy
D. Hemolytic uremic syndrome
B. Post-streptococcal glomerulonephritis (APSGN)
Rationale: APSGN is characterized by low C3 levels due to activation of the alternative complement pathway. C3 normalizes in 6-8 weeks.
- Urinary tract infection (UTI) in girls:
A. Colonic bacteria are usually Klebsiella
B. Equal ratio with boys
C. Often occurs at the onset of toilet training
D. Always arises by hematogenous spread
C. Often occurs at the onset of toilet training
Rationale: Girls have a higher risk of UTI due to shorter urethras, and the risk increases at toilet training due to incomplete voiding. Most UTIs are ascending, not hematogenous.
- Renal disorders associated with hypertension (EXCEPT):
A. Post-streptococcal glomerulonephritis (PSGN)
B. IgA nephropathy
C. Membranoproliferative glomerulonephritis (MPGN)
D. Idiopathic rapidly progressive glomerulonephritis (RPGN)
B. IgA nephropathy
Rationale: While many glomerular diseases are associated with hypertension, IgA nephropathy usually presents with hematuria and proteinuria but only mild to moderate hypertension. It is rarely severe enough to cause a hypertensive emergency, unlike post-streptococcal glomerulonephritis (PSGN), membranoproliferative glomerulonephritis, and idiopathic rapidly progressive glomerulonephritis, which often involve significant hypertension due to glomerular inflammation and reduced renal function.
