Nephrology 🧻

Question 1

4 weeks old boy with projectile non bilious vomiting abd exam: olive mass.
Which of the following expected :

A. HyperNa, HyperK, Met alkalosis
B. HypoNa, HypoK, Met alkalosis
C. HyperNa, HyperK, Met acidosis
D. HyperNa, HyperK, Met acidosis

Answer 1

B. HypoNa, HypoK, Met alkalosis

Question 2

4 weeks old boy with projectile non bilious vomiting abd exam: olive mass.
What would you expect in urine ?

A. High urine Na
B. High urine K
C. Alkaline urine
D. High urine Ca

Answer 2

B. High urine K

Dehydration » ADH & Aldosterone
Aldosterone » reabsorb Na, secrete K & H+
Urine Serum
Na 🔻 🔻
K 🔺 🔻
pH Acidic Alkalosis

Question 3

Child with RTA had head injury, admitted to ICU. After 12hrs he is anuric
- serum osm: 🔺
- urine osm: 🔻
- serum Na: 🔺
Most likely cause

A. Central Diabetes insipidus
B. Renal Diabetes insipidus
C. Fluid overload
D. SIADH

Answer 3

A. Central Diabetes insipidus

Fluid overload = 🔻serum osm
SIADH = 🔻Na, concentrated urine
Head injury » central > nephrogenic

💊 central DI = ADH
💊 nephrogenic DI = Thiazide

Question 4

5 yo with meningitis. Lab findings
HypoNa
Low serum osm
High urine osm
High urine Na
Most likely diagnosis:

A. DI
B. SIADH
C. Hypoaldosteronism
D. Renal failure

Answer 4

B. SIADH

💊 DI = thiazide سكر المية يحتاجو موية زيادة
💊 SIADH = frusemide أصحاب السيادة يحتاجو حجر فيروز و ملح زيادة

Question 5

At what age nocturnal enuresis should be alarming?
A. 5 years
B. 6 years
C. 7 years
D. 8 years

Answer 5

C. 7 years

5-6: behavioral
7: desmopressin or alarm therapy

Question 6

Child with long history of enuresis
What is the most important investigation ?
A. VCUG
B. Urinalysis
C. KFT
D. Urine culture

Answer 6

Urinalysis
Long time = primary enuresis

💡Who need Extensive investigation?
1. Secondary (were initially dry for 6m then develop enuresis)
2. Growth failure
3. Symptoms: UTI, weak urine stream, polyuria, daytime incontinence

Question 7

8 years old boy. Poor training to bathroom
Which muscle targeted in therapy?

A. Perianal
B. Pelvic floor
C. Rectus
D. Detrusor

Answer 7

Detrusor

Question 8

6 yo boy mother concerned about bed wetting. You will:
A. Do extensive investigayion
B. Start desmopressin
C. Reassure that its self limited condition
D. Refer him to psychiatrist

Answer 8

C. Reassure

Question 9

8 yo boy with nocturnal enuresis. I/A is normal. Your best initial action is:
A. Behavior and modification therapy
B. Desmopressin
C. Alarm
D. Renal US

Answer 9

A. Behavior and modification therapy

🔹Nocturnal enuresis tx :
1. Behavioral for 6 mo » failed ❌
2. Bed Alarm
3. Desmopressin

Question 10

A child has history of nocturnal enuresis at age 5 and started on behavioral tx
At age 7 started to have dysuria, foul smelling urine and urine showed WBC.
Most likely cause:

A. Glomerulonephritis
B. UTI
C. Interstitial nephritis
D. Stones

Answer 10

B. UTI

Question 11

K/c of Sjögren syndrom
Which type of RTA most likely?
A. Type 1
B. Type 2
C. Type 3
D. Type 4

Answer 11

Type1
1mmune 🧬

Question 12

Which type of RTA associated with hyperkalemia?
A. Type 1
B. Type 2
C. Type 3
D. Type 4

Answer 12

Type 4

Question 13

Child present with polyuria, growth failure, Blood gas shows metabolic alkalosis, hyponatremia & hypokalemia
Most likely affected channel:

A. ATPase
B. NCB
C. Na-K-2Cl
D. Aldosterone

Answer 13

C. Na-K-2Cl
= frusemide = Bratter syndrome “salt losing disease”

Question 14

Child present with dark urine, fever, hx of constipation.
Urine: 🔺 WBC 🔺 RBC 🔺 protein
Most likely cause:

A. UTI
B. Acute PSGN
C. HSP
D. Nephrotic syndrome

Answer 14

UTI

Fever + abd pain = UTI
Glomerulonephritis usually painless & afebrile

Question 15

4 yo child with fever 39.9, dark urine, irritability.
O/E: tender abd, no organomegaly.
WBC: 16.000
U/A: proteinuria 2+ erythrocyte 18
Tx:

A. Furosemide
B. Ceftriaxone
C. Salt restriction
D. Steroids

Answer 15

Ceftriaxone
UTI

Question 16

Which of the following is true regarding UTI in infants (2-24 mo):

A. Urine bag should be collected for urine culture
B. 3 days of ABx is enough
C. Renal US be performed after 1st febrile UTI
D. Voiding cystourethrogram should be sone to rule out VUR

Answer 16

C. Renal US be performed after 1st febrile UTI

In infants:
- Suprapubic catheter is the gold standard for culture
- ABx duration: 7-10 days
- Renal US should be done routinely in any child with 1st febrile UTI

Question 17

A child came with UTI you want to investigate for possible renal scarring
Best test:

A. MCUG
B. US
C. DMSA
D. DTPA

Answer 17

DMSA
for Scarring

• MCUG: VUR, post urethral valve
• DMSA: post UTI for scarring
• DTPA: identify area of blockage

Question 18

3 months old girl with recurrent UTI
What should you order?

A. Renal US
B. Renal US and VCUG
C. Voiding cytourethrogram
D. IV polygraph

Answer 18

B. Renal US and VCUG

VCUG to look for VUR
1. Recurrent UTI (<6 months)
2. Atypical UTI (3 years)
3. US: hydroneohrosis (3 years)

Question 19

Bilateral hydroneohrosis in baby
Best diagnostic test:
A. MCUG
B. DTPA
C. DMSA
D. CT

Answer 19

MCUG
look for VUR / post urethral valve

Unilateral »DTPA … Bilateral » MCUG
- transient - post urethral valve
- PUJ obstruction - neurogenic bladder
- VUR - VUR

Question 20

In 5 months old child which of the following is most risk factor for recurrent UTI?

A. Constipation
B. Vesicoureteral reflux
C. Obstruction
D. Voiding dysfunction

Answer 20

Vesicoureteral reflux

Question 21

Which of the following is most common cause for UTI in children with renal stones

A. E. Coli
B. Proteus
C. Pseudomonas
D. Klebsiella

Answer 21

Proteus
💎STONES💎

Question 22

What finding on urinalysis associated with low risk UTI
[…] urine osm […] urine pH

Answer 22

Low urine osm» hydrated 💦
Low urine pH» 🚫 urease production

Question 23

1 year old child with VUR grade 4
Best action:

A. Surgical intervention
B. Continue ABx treatment
C. Intermittent ABx prophylaxis
D. Cystoscopy

Answer 23

B. Continue ABx treatment

🔪Surgical indications:
1. 5 years old
2. Grade 5
3. HTN
4. RF or Renal scar
5. Failure of medical treatment

Question 24

A child with VUR decide to start ABx prophylaxis. How long should you continue the prophylaxis ?

A. 6 months
B. 12 months
C. 18 months
D. 24 months

Answer 24

12 months

Question 25

6 yo came with high fever and loin pain, O/E he is looking toxic. You ABx choice:
A. Oral augementin
B. Oral cefuroxime
C. IV ceftriaxond
D. IV gentamycin

Answer 25

B. Oral cefuroxime

Oral antibiotics first line tx of upper/lower UTI
#1: Oral cephalosporin (2nd/3rd gen)

Question 26

How ling should you give ABx for uncomplicated cystitis?
A. 3-5 days
B. 5-7 days
C. 7-10 days
D. 10-14 days

Answer 26

3-5 days

Cystitis: 3-5 d TMP-SMX
Pyelonephritis: 7-10 d cephalosporin

Question 27

9 yo history of blood in urine / foul smelling , no pain, palpable left loin mass
A. Hydronephrosis
B. Polycystic kidney disease
C. Leukemia
D. Renal stones

Answer 27

B. Polycystic kidney disease

Question 28

5 yo male present with picture of nephrotic syndrome. When to say he is steroid reaistant?
A. No response after 2 weeks
B. No response after 4 weeks
C. No response after 8 weeks
D. No response after 12 weeks

Answer 28

4 weeks

Most common cause of steroid resistant nephrotic is : FSGS
Tx: cyclosporine, diuretics, ACE-i

Question 29

4 years old boy known nephrotic syndrome. He presented with fever and abd pain
Most likely cause:
A. Pancreatitis
B. Peritonitis
C. Renal vein theombosis
D. Appendicitis

Answer 29

B. Peritonitis

Question 30

6 yo child came for accidental finding of RBC in urine during routine U/A mother said she was having exercise yesterday. She looks healthy otherwise. Best action:

A. Ask for serum Cr
B. Do serum albumin
C. Repeat urine analysis in few days
D. Send her for biopsy

Answer 30

C. Repeat urine analysis in few days

Most common cause of isolated microscopic hematyria:
- Transient (fever / excercise)
- Benign familial hematuria
- Hypercalciuria
💡role out Alport syndrome

Question 31

Steroid sensitive age (common Q❤️)
A. 6-24 months
B. 6-12 months
C. 96-105 months
D. 24-96 months

Answer 31

24-96 months

Typical age of nephrotic syndrome 2-8 yr
Renal biopsy if steroid resistant

Question 32

6 yo girl found to have high Cr, HTN, urine showed many RBC. Few weeks ago she had skin infection.
Most likely etiology:

A. Acute post infectious GN
B. HSP
C. UTI
D. SLE

Answer 32

A. Acute post infectious GN

Question 33

Patient with PSGN you decide to start her on furosemide. The rational for furosemide:
A. For hypertension
B. For edema
C. For hematuria
D. For proteinuria

Answer 33

A. For Hypertension

Question 34

6 yo with PSGN. Most likely lab results:
A. Normal C3 and C4
B. Low C3 and C4
C. Low C3 and normal C4
D. Normal C3 and low C4

Answer 34

C. Low C3 and normal C4

🟢C3 🟢C4: IgA nephropathy, HSP
🔻C3 🟢C4: PSGN
🔻C3 🔻 C4: SLE, MPGN, IE

Question 35

A child develop gross hematuria 2 days after URT infection. Most likely cause:
A. PSGN
B. IgA nephropathy
C. SLE
D. Nephrotic syndrome

Answer 35

B. IgA nephropathy

PSGN: 2-6 wk. Pharyngitis or skin. 🔻C3
IgA: 2-3 days. URTI or GI. 🟢C3

Question 36

6 yo girl and found to have HTN, high Cr, hematuria and currently has skin lesion.
Most likely cause:
A. PSGN
B. HSP
C. Nephrotic syndrome
D. IgA nephropathy

Answer 36

B. HSP

Question 37

5 years child presented with HTN, edema, proteinuria, hematuria.
Most important related question:

A. Recurrent UTU
B. Impetigo 1 week ago
C. Contact with TB
D. Constipation

Answer 37

B. Impetigo 1 week ago

PSGN can follow
🔹URTI 1-2 weeks
🔹Impetigo 4-6 weeks
..Could be A ( if URTI not UTI )..

Question 38

A patient has history of fever and found to have murmur. He had dental extraction few weeks ago. Urine show RBC and protein. He is also Hypertensive. Most likely cause:

A. UTI
B. Glomerulonephritis
C. Nephrotic syndrome
D. Interstitial nephritis

Answer 38

B. Glomerulonephritis

IE can cause GN from immune complex deposition

Question 39

Boy with GN (hematuria), after week he developed hemoptysis what is the dx?
A. HSP
B. Goodpasture syndrome
C. Rapid deterioration
D. IgA nephropathy

Answer 39

B. Goodpasture syndrome

Hemoptysis + Hematuria
Tx: plasma exchange

Question 40

Hypertension in children defined as
A more than […]th percentile for age and gender

Answer 40

95

BP> 90th : elevated BP
BP> 95th : HTN
BP 90th + 12 : Stage 1
BP 95th + 12 : Stage 2

Question 41

5 yo came to ER and found to have high urea and Cr
Which of the following suggestive of pre-renal rather than renal ?

A. Urine osm of 200
B. Urine Na of 10 mmol/L
C. Presence of casts
D. Presence of abdominal mass

Answer 41

B. Urine Na of 10 mmol/L

Prerenal:
BUN:Cr >20
FENa <1%
Urine Na <20
Uosm >500

Question 42

A case of HUS. What is the diagnostic culture test?
A. Blood
B. Urine
C. MRI
D. Stool

Answer 42

D. Stool

Hemolytic Uremic Syndrome:
Hemolysis + Thrombocytopenia + RF
Bloody diarrhea after rating uncooked meat

Question 43

A male child with abdominal mass that noticed by mother while she was bathing him, on exam healthy boy with Right flank mass. What is the initial investigation?
A. US
B. MRI
C. CT
D. X ray

Answer 43

US

Initial = US
Best diagnostic: CT / MRI

Question 44

A child with recurrent UTI and stones. Renal US showed multiple cysts through renal parenchyma:
A. Polycystic kidney disease
B. Medullary sponge kidney
C. Wilms tumor
D. Hydronephrosis

Answer 44

A. Polycystic kidney disease

Medullary sponge kidney: cysts @ medulla
PKD: cysts through all renal parenchyma (cortex & medulla)

Question 45

12 months old child found to have abdominal mass that does not cross midline. HTN, and proptosis
Most likely cause:
A. Wilms tumor
B. Neuroblastoma
C. Lymphoma
D. Leukemia

Answer 45

B. Neuroblastoma
Sympathetic chain = proptosis

Neuroblastoma … Nephroblastoma (wilms)
Adrenal medulla Kidney
Cross midline Do NOT cross midline
Fixed, immobile Displaced
Normotensive HTN + hematuria
Opsoclonus-myoclonus
“Dancing eyes - dancing feet”

Question 46

3 years old child found to have abdominal mass and absent iris and undescending testicle
A. Down syndrome
B. CHARGE
C. WAGR
D. Neuroblastoma

Answer 46

WAGR

Wilms tumor
Aniridia
Genitourinary malformations
Retardation (mental)

Question 47

Radiosensitive testicular tumor
A. Seminomas
B. Yolk sac
C. Embryonal carcinoma
D. Non germinal

Answer 47

A. Seminomas