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  • Question 1 - A 6 year old girl with a history of polyuria and polydipsia undergoes...

    Incorrect

    • A 6 year old girl with a history of polyuria and polydipsia undergoes a water deprivation test. Previous urine dipstick results were negative for blood, glucose, or protein. The test is started and once the girl loses 3% of her body weight, her serum osmolarity is more than 300 whereas her urine osmolarity is less than 300. Doctors administer desmopressin but osmolarity levels do not change. What is the most likely diagnosis?

      Your Answer: Diabetes Mellitus

      Correct Answer: Nephrogenic Diabetes Insipidus

      Explanation:

      Nephrogenic Diabetes Insipidus is an acquired or hereditary condition that affects the water balance. It presents with polyuria and polydipsia, leading commonly to dehydration.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 2 - Following a urinary tract infection, which imaging modality is the best in the...

    Incorrect

    • Following a urinary tract infection, which imaging modality is the best in the assessment of renal scars?

      Your Answer:

      Correct Answer: Dimercaptosuccinic acid (DMSA) scan

      Explanation:

      Renal scaring resulting from urinary tract infections can best be determined using Dimercaptosuccinic acid (DMSA) scintigraphy. The scan utilises technetium-99 mixed with the DMSA which is injected into the bloodstream. The radiological dye is taken up by the kidney where it binds to the proximal convoluted tubules. It therefore detects the size, shape and position of the kidney and any scars but is not as useful in assessing dynamic renal excretion. Ultrasound scans are better suited to assess hydronephrosis and dilated ureters. MAG3 scans and MCUG are able to determine the function of kidneys and detect obstructions such as posterior urethral valves and reflux.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 3 - A 17-year-old teenage girl presents with a systolic blood pressure of 170 mmHg...

    Incorrect

    • A 17-year-old teenage girl presents with a systolic blood pressure of 170 mmHg in all four limbs. Femoral pulses are palpable. Physical examination revealed several large cafe-au-lait patches and axillary freckling.
      The girl's father died of intracerebral haemorrhage associated with hypertension at the age of 50.
      Which one of the following is the most likely cause of hypertension in this patient?

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      The patient shows features of neurofibromatosis. The most likely cause for hypertension in this patient would be renal artery stenosis.

      Note:
      Neurofibromatosis is an inherited autosomal dominant disorder which could have affected this girl’s father, and she appears to have the classic skin lesions.
      A renal bruit might be heard in these patients.
      Polycystic kidney disease can occur in association with tuberous sclerosis, which also has skin lesions associated (different from those described in this patient).
      Most causes of hypertension in childhood have underlying renal causes, and a renal ultrasound with doppler is the first-line investigation of choice. Even if this is normal, further imaging would be indicated here, for example, isotope renal scans and angiography.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 4 - Which of the following conditions do NOT result in polyuria? ...

    Incorrect

    • Which of the following conditions do NOT result in polyuria?

      Your Answer:

      Correct Answer: Hyperkalaemia

      Explanation:

      Polyuria is defined as a total increase in the urine output or > 2L/m2 of daily urine produced in children. Polyuria can be a symptom of a vast number of medical conditions. The commonest and most important disease having polyuria as the main symptom is diabetes mellitus. Nephrogenic and central diabetes insipidus also results in polyuria along with polydipsia. Other conditions that lead to an increase in the urine output are renal failure, acute tubular necrosis, and exposure to high altitude. Hyperkalaemia does not result in polyuria; rather hypokalaemia can be an associated finding with polyuria in the case of diuretic abuse.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 5 - A 16-year-old male presents to the emergency with severe testicular pain and is...

    Incorrect

    • A 16-year-old male presents to the emergency with severe testicular pain and is diagnosed with suspected testicular torsion. He is scheduled for surgical exploration. The surgeon makes an incision on the skin and then the dartos muscle. Which of the following tissue layers will be incised next?

      Your Answer:

      Correct Answer: External spermatic fascia

      Explanation:

      Coverings of the spermatic cord:
      Spermatic cord is covered by three concentric layers of fasciae, derived from the layers the of anterior abdominal wall. Developmentally, each covering is acquired as the processus vaginalis descends into the scrotum through the layers of the abdominal wall. The layers are:

      External spermatic fascia: It is derived from the external oblique muscle. It attaches to the margins of superficial inguinal ring.
      Cremasteric fascia: It is derived from the internal oblique muscle. It covers the cremaster muscle.
      Internal spermatic fascia: It is derived from the fascia transversalis (fascia covering the transversus abdominis muscle). It is attached to the margins of the deep inguinal ring.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 6 - A patient undergoes investigation for chronic upper urinary tract obstruction with intravenous urography...

    Incorrect

    • A patient undergoes investigation for chronic upper urinary tract obstruction with intravenous urography (IVU).
      The patient should be informed about which severe complication of IVU?

      Your Answer:

      Correct Answer: Contrast hypersensitivity

      Explanation:

      Allergy: A history of a prior allergic-like reaction to contrast media is associated with an up to a 5-fold increase in the likelihood of experiencing a subsequent reaction. Also, any patient with a predilection to allergic reactions may predispose them to a reaction after the administration of contrast media. Given the increased risk of severe life-threatening anaphylaxis related to the administration of contrast media in the setting of the history of atopy, the risk versus benefits should be discussed before following through with the procedure. A premedication regimen may be used to reduce the risk of anaphylaxis.

      Asthma: A history of asthma may be indicative of a higher likelihood of developing a contrast reaction.

      Cardiac status: Attention must be turned to patients with significant cardiac disease (congestive heart failure, aortic stenosis, severe cardiomyopathy, and/or pulmonary hypertension), as higher volumes and osmolality of contrast material may result in an increased risk for a contrast reaction.

      Renal insufficiency: Contrast nephrotoxicity is defined as the rapid deterioration of renal function after the administration of contrast media when no other aetiology can be determined from the clinical records. The major predisposing risk factors include pre-existing renal insufficiency (defined as serum creatinine level >1.5 mg/dL) and diabetes. Other risk factors include dehydration, cardiovascular disease, the use of diuretics, advanced age (>70 years old), hypertension, and hyperuricemia. Obtaining multiple contrast-enhanced studies within 24 hours is also thought to increase the risk for contrast-induced nephrotoxicity.

      Miscellaneous: Relative contraindications to the use of high osmolality iodinated contrast media (HOCM) in patients with pheochromocytoma, sickle cell disease, and multiple myeloma have been reported. Although the administration of low osmolality or iso-osmotic contrast media may be beneficial in patients with pheochromocytoma and sickle cell disease, little evidence suggests that these agents mitigate the risks associated with multiple myeloma.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 7 - Which factor is most likely to trigger renin stimulation? ...

    Incorrect

    • Which factor is most likely to trigger renin stimulation?

      Your Answer:

      Correct Answer: Hypovolaemia

      Explanation:

      The most common physiological factors that influence renin secretion include renal perfusion pressure, renal sympathetic nerve activity, and tubular sodium chloride load.
      The perfusion pressure in the renal artery is the most profound parameter to influence renin secretion; when the renal perfusion pressure falls (i.e. hypovolaemia), renin secretion rises, and vice versa.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 8 - When measuring blood pressure in infants and children, which one of the following...

    Incorrect

    • When measuring blood pressure in infants and children, which one of the following statements is accurate?

      Your Answer:

      Correct Answer: Doppler methods of auscultation are especially helpful in infants

      Explanation:

      Using a Doppler device, you can estimate systolic BP even when the pulse is inaudible. Handheld and portable, the device uses ultrasound waves to detect the velocity of arterial blood flow. Helpful for patients with traumatic injuries or shock, the Doppler technique is also useful for children and patients whose BP is hard to hear because of oedema, obesity, vasoconstriction, or low cardiac output.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 9 - A 6 year old child presents with clinical features of nephrotic syndrome and...

    Incorrect

    • A 6 year old child presents with clinical features of nephrotic syndrome and a history of hypertension. He has normal serum cholesterol levels, however, his urine microscopy reveals oval fat bodies. Which of the following most likely represents the cause of the nephrotic syndrome?

      Your Answer:

      Correct Answer: Minimal change glomerulonephritis

      Explanation:

      Minimal change glomerulonephritis presents with mild or benign urinalysis findings. However, proteinuria together with the presence of oval fat bodies are typical.
      Minimal change glomerulonephritis (nephropathy) accounts for most cases of childhood nephrotic syndrome and 20-25% of adult nephrotic syndrome.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 10 - A 19-year-old female arrives at the clinic complaining of a facial rash and...

    Incorrect

    • A 19-year-old female arrives at the clinic complaining of a facial rash and stiffness in her joints. On examination, she has +1 oedema, slightly swollen metacarpophalangeal joints and ulceration of her buccal mucosa. Her BP is 145/95. Serum creatinine is 92 x 10^12/l. Urinalysis is significant for blood and protein, both +3. High titres of anti-dsDNA are detected in her serum. Which of the following histological changes would be observed in the renal tissue?

      Your Answer:

      Correct Answer: Diffuse proliferative glomerulonephritis with deposits of IgG, IgM and C3

      Explanation:

      Diffuse proliferative glomerulonephritis is a term used to describe a distinct histologic form of glomerulonephritis common to various types of systemic inflammatory diseases, including autoimmune disorders (e.g., systemic lupus erythematosus [SLE]), vasculitis syndromes (e.g., granulomatosis with polyangiitis), and infectious processes. In DPGN, more than 50% of the glomeruli (diffuse) show an increase in mesangial, epithelial, endothelial (proliferative), and inflammatory cells (i.e., glomerulonephritis).

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 11 - Haemolytic uremic syndrome is associated with which of the given laboratory findings? ...

    Incorrect

    • Haemolytic uremic syndrome is associated with which of the given laboratory findings?

      Your Answer:

      Correct Answer: Low platelet count

      Explanation:

      Haemolytic uremic syndrome belongs to a heterogeneous group of disorders characterized by a triad of thrombocytopenia, microangiopathic haemolytic anaemia, and acute kidney injury. It is one of the most common causes of renal injury in children. The clinical findings are due to thrombotic microangiopathy, which leads to arterioles and capillary wall thickening along with endothelial swelling and detachment. The significant laboratory findings include increased white cell count, raised serum urea and creatinine, increased serum LDH, decreased platelet count, haematuria, and proteinuria.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 12 - A 5 month old baby presents with failure to thrive, and the following...

    Incorrect

    • A 5 month old baby presents with failure to thrive, and the following blood results:
      Na=135 mmol/l
      K=2.3 mmol/l
      Urea=2.0 mmol/l
      Creatinine 30 µmol/l
      P=0.8 mmol/l
      Bicarbonate=17 mmol/l
      Ca=2.5 mmol/l
      Additionally, urinalysis reveals 1+ glucose and 1+ protein.
      Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Fanconi tubular syndrome

      Explanation:

      Fanconi tubular syndrome is characterised by malabsorption of various electrolytes and substances commonly absorbed by the proximal tubule. Hypokalaemia, hypophosphatemia, and hyperchloremic metabolic acidosis is usually present. Also, urinalysis reveals an increased fractional excretion of glucose.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 13 - A 6 year old child is admitted with generalised oedema, albuminuria, hypoalbuminemia, and...

    Incorrect

    • A 6 year old child is admitted with generalised oedema, albuminuria, hypoalbuminemia, and hyperlipidaemia. The renal biopsy is normal. What would you expect to see on electron microscopy?

      Your Answer:

      Correct Answer: Fusion of foot processes of the glomerular epithelial cells

      Explanation:

      The child has nephrotic syndrome which is most commonly caused by minimal change nephropathy in this age group. The condition presents with fusion of foot processes of the glomerular epithelial cells under the microscope.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 14 - A 12-year-old girl presents with constant dripping of urine despite being able to...

    Incorrect

    • A 12-year-old girl presents with constant dripping of urine despite being able to void a full volume bladder.

      An ultrasound scan shows bilaterally enlarged kidneys.

      What is the most probable diagnosis for this patient?

      Your Answer:

      Correct Answer: Duplex kidney with ectopic ureter

      Explanation:

      The most probable diagnosis for this patient would be a duplex kidney with an ectopic ureter inserting below the bladder neck.

      Rationale:
      The Weigert-Myer law states that the upper moiety ureter inserts inferior and medial to the lower moiety ureter.

      Other options:
      – Horseshoe kidney would display as a single pelvic kidney on an ultrasound scan.
      – Ureterocele would be a cystic lesion within the bladder or may prolapse at birth.
      – Continence should not be affected by polycystic kidney disease.
      – The overactive bladder would cause frequency and urgency, neither of which is mentioned in the history.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 15 - Which of the following patient populations is most likely to present with primary...

    Incorrect

    • Which of the following patient populations is most likely to present with primary vesicoureteric reflux?

      Your Answer:

      Correct Answer: New-born girls

      Explanation:

      Vesicoureteric reflex (VUR) is described as the retrograde flow of urine from the bladder into the ureter due to an incompetent uterovesical junction. In primary VUR the lower urinary tract functions normally, while secondary VUR is associated with a poorly functioning lower urinary tract. The incidence of VUR is highest in new-born girls. They can present with hydronephrosis, or urinary tract infections.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 16 - A 6 year old child diagnosed with minimal change nephrotic syndrome, presents with...

    Incorrect

    • A 6 year old child diagnosed with minimal change nephrotic syndrome, presents with lower limb oedema. Which of the following is most likely lost upon urination?

      Your Answer:

      Correct Answer: Anti-thrombin III

      Explanation:

      Minimal change nephrotic syndrome leads to the loss of anti-thrombin III which protects the body from forming venous emboli. It may be triggered by virus, immunisations, medication, non-Hodgkin lymphoma, or leukaemia
      Characterised by oedema, proteinuria, hypoalbuminemia, and hypercholesterolemia.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 17 - A 6 year old boy with a history of pharyngitis 10 days ago,...

    Incorrect

    • A 6 year old boy with a history of pharyngitis 10 days ago, presents with periorbital oedema. You perform a urine dipstick test which shows 1+ for protein and 3+ for blood. Family history is clear. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Glomerulonephritis

      Explanation:

      The child has a history of pharyngitis followed 10 days later by signs of glomerulonephritis. In this particular case, it is most probably a post-streptococcus glomerulonephritis which accounts for 80% of paediatric cases of glomerulonephritis.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 18 - A 4 year old boy diagnosed for the first time with nephrotic syndrome...

    Incorrect

    • A 4 year old boy diagnosed for the first time with nephrotic syndrome presents with oedema, low serum albumin and proteinuria. In which of the following circumstances is albumin infusion indicated?

      Your Answer:

      Correct Answer: Capillary refill time of 5 seconds

      Explanation:

      In nephrotic syndrome, one of the main pathological processes is the excretion of protein by the kidneys. The resultant signs including; low serum albumin, oedema and hypovolemia all occur as a result of fluid escaping into the extracellular space due to a low oncotic pressure. While an albumin infusion may help to increase oncotic pressure, its indications specifically include hypovolemia, which is assessed by a capillary refill time more than 5 seconds, an elevated haematocrit, or severe symptomatic oedema, such as scrotal oedema. Hypertension not an indication for an infusion, and most patients needing an albumin infusion have oliguria.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 19 - Renal tubular acidosis affects the reabsorption of bicarbonate in the proximal tubule or...

    Incorrect

    • Renal tubular acidosis affects the reabsorption of bicarbonate in the proximal tubule or excretion of hydrogen ions from the distal tubule. Which of the following is a key difference in clinical presentation of these two types of renal tubular acidosis?

      Your Answer:

      Correct Answer: Renal stone formation

      Explanation:

      Distal renal tubular acidosis (dRTA) is characterised by a decreased hydrogen ion excretion from the alpha intercalated cells of the collecting duct of the distal nephron. The resultant acidosis causes calcium and phosphates to be released from bones to buffer the acidosis causing hypercalciuria. This precipitates calcium compounds in the kidney, predisposing it to renal stone formation. On the other hand, proximal renal tubular acidosis is characterised by an impairment in bicarbonate resorption. Both types lead to metabolic acidosis and electrolyte imbalances including potassium depletion. Children often present with failure to thrive. One way to differentiate between the two conditions is with an acid challenge test. In proximal RTA (type 2) administering an ammonium chloride load will decrease the urinary pH whereas in distal disease (type 1), the urine pH will not decrease below 5.3.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 20 - To which structure does the mesonephric duct give rise? ...

    Incorrect

    • To which structure does the mesonephric duct give rise?

      Your Answer:

      Correct Answer: Seminal vesicles

      Explanation:

      The mesonephric duct is one of the paired embryogenic tubules that drain the primitive kidney (mesonephros) to the cloaca. It also gives off a lateral branch forming the ureteric bud. In both the male and the female the Wolffian duct develops into the trigone of the urinary bladder.
      When the ducts are exposed to testosterone during embryogenesis, male sexual differentiation occurs: the mesonephric duct develops into the rete testis, the ejaculatory ducts, the epididymis, the ductus deferens and the seminal vesicles.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 21 - What is the most common presenting feature of Wilms tumour?
    ...

    Incorrect

    • What is the most common presenting feature of Wilms tumour?

      Your Answer:

      Correct Answer: Abdominal mass

      Explanation:

      The most common manifestation of Wilms tumour is an asymptomatic abdominal mass; an abdominal mass occurs in 80% of children at presentation. Abdominal pain or haematuria occurs in 25%. Urinary tract infection and varicocele are less common findings than these. Hypertension, gross haematuria, and fever are observed in 5-30% of patients. A few patients with haemorrhage into their tumour may present with hypotension, anaemia, and fever. Rarely, patients with advanced disease may present with respiratory symptoms related to lung metastases.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 22 - A young female presents with vaginal discharge and itching. She is diagnosed with...

    Incorrect

    • A young female presents with vaginal discharge and itching. She is diagnosed with prepubertal atrophic vaginitis. What is the pathophysiology behind prepubertal atrophic vaginitis?

      Your Answer:

      Correct Answer: Lack of vaginal oestrogen causing infection-prone alkaline environment

      Explanation:

      Prepubertal atrophic vaginitis is due to a lack of vaginal oestrogen. The pathophysiology behind prepubertal atrophic vaginitis:
      1.The proximity of the vagina to the anus
      2.Lack of oestrogen – leads to thinning of the vaginal mucosa
      3.Lack of pubic hair to protect the area
      4.Lack of labial fat pads

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 23 - Which of the given laboratory findings is NOT suggestive of Fanconi syndrome? ...

    Incorrect

    • Which of the given laboratory findings is NOT suggestive of Fanconi syndrome?

      Your Answer:

      Correct Answer: Haematuria

      Explanation:

      Fanconi syndrome is a rare disorder characterized by defective proximal renal tubular reabsorption, which leads to excessive excretion of potassium, phosphate, uric acid, bicarbonates, glucose, and certain amino acids in the urine. Loss of potassium in the urine leads to hypokalaemia, while the loss of phosphate may lead to hypophosphatemic rickets. The overall impact is the failure to thrive and growth retardation.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 24 - A 19-year-old girl presents with polydipsia (>3L daily), polyuria, nocturia, and new-onset nocturnal...

    Incorrect

    • A 19-year-old girl presents with polydipsia (>3L daily), polyuria, nocturia, and new-onset nocturnal enuresis.
      A urine dipstick reveals no glucose or ketones, but her pregnancy test is positive.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Gestational diabetes insipidus

      Explanation:

      The presenting features with the positive pregnancy test are highly suggestive of gestational diabetes mellitus.

      Diabetes Insipidus:
      It is much less common than gestational diabetes mellitus. It is characterised by the inability to concentrate urine, with marked thirst.

      Presenting symptoms include polydipsia (>3L daily), polyuria, nocturia, nocturnal enuresis.
      Physical examination may reveal features of dehydration and an enlarged bladder.
      Investigations include biochemical analysis for electrolytes, urine and plasma osmolality, fluid deprivation test, and cranial MRI.

      The main differential diagnosis is for diabetes insipidus is psychogenic polydipsia.

      There are three broad categories of diabetes insipidus (DI):
      – Central (cranial) DI:
      It is the most common form of diabetes insipidus.
      It occurs due to decreased secretion of ADH. It usually occurs due to hypothalamic disease and may show response to low-dose desmopressin.
      – Peripheral (nephrogenic) DI:
      It is characterised by the resistance of the kidney to ADH.
      It usually does not respond to low-dose desmopressin.
      – Gestational DI:
      It is rare and is mostly seen in teenage pregnancy.
      It usually presents in the third trimester and often resolves 4-6 weeks post-partum.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 25 - A 6 year old child presents with secondary nocturnal enuresis. He is otherwise...

    Incorrect

    • A 6 year old child presents with secondary nocturnal enuresis. He is otherwise healthy and with a clear family history. He drinks sufficient amounts of fluids but is a fussy eater. Clinical examination reveals a mass in the left iliac fossa. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Constipation

      Explanation:

      Constipation is often associated with nocturnal enuresis in children. The palpable mass is the impacted stool. The decreased appetite is common in those with constipation.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 26 - Which of the following features is true of Alport syndrome?
    ...

    Incorrect

    • Which of the following features is true of Alport syndrome?

      Your Answer:

      Correct Answer: It is caused by defects in collagen

      Explanation:

      Alport syndrome is a genetic condition characterized by kidney disease, hearing loss, and eye abnormalities.
      Alport syndrome can have different inheritance patterns. About 80 percent of cases are caused by mutations in type IV collagen genes (COL4A5) and are inherited in an X-linked autosomal recessive pattern.
      Alport syndrome has autosomal dominant inheritance in about 5 percent of cases.
      People with Alport syndrome experience progressive loss of kidney function. Almost all affected individuals have blood in their urine (haematuria), which indicates abnormal functioning of the kidneys. Many people with Alport syndrome also develop high levels of protein in their urine (proteinuria). The kidneys become less able to function as this condition progresses, resulting in end-stage renal disease (ESRD).
      People with Alport syndrome frequently develop sensorineural hearing loss, which is caused by abnormalities of the inner ear, during late childhood or early adolescence. Affected individuals may also have misshapen lenses in the eyes (anterior lenticonus) and abnormal coloration of the light-sensitive tissue at the back of the eye (retina). These eye abnormalities seldom lead to vision loss.
      Significant hearing loss, eye abnormalities, and progressive kidney disease are more common in males with Alport syndrome than in affected females.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 27 - A 15-year-old boy presents with a concern that he is the shortest in...

    Incorrect

    • A 15-year-old boy presents with a concern that he is the shortest in his class, and his voice has not 'broken' yet.
      A thorough examination reveals that his sexual development is within the normal range, and he is reassured that puberty occurs at different times for everyone.
      Which of the following cells in the testes secrete testosterone?

      Your Answer:

      Correct Answer: Leydig cells

      Explanation:

      The cells in the testes that secrete testosterone are the Leydig cells.

      Other cells in testes include:
      – Spermatogonia: These are undifferentiated male germ cells which undergo spermatogenesis in the seminiferous tubules of the testes.
      – Sertoli cells: They are a part of the seminiferous tubule of the testes, cells are activated by FSH and nourish developing sperm cells.
      – Myoid: They are squamous contractile cells which generate peristaltic waves, they surround the basement membrane of testes.
      – Fibroblasts: Cells which synthesise collagen and the extracellular matrix.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 28 - A young boy presents with signs of kidney disease. He has a long-standing...

    Incorrect

    • A young boy presents with signs of kidney disease. He has a long-standing history of proteinuria and hypocomplementemia which were not responsive to steroid treatment. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Membranoproliferative glomerulonephritis

      Explanation:

      Membranoproliferative glomerulonephritis primarily affects children and young adults, with patients presenting with nephrotic or nephritic syndrome or with asymptomatic renal disease. There are 3 types defined by pathologic features. All three types are associated with hypocomplementemia, but they manifest somewhat different mechanisms of complement activation. This type of glomerulonephritis often progresses slowly to end-stage renal disease, and it tends to recur after renal transplantation, especially type II.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 29 - A 10-year-old boy was brought to the clinic by his parents. They are...

    Incorrect

    • A 10-year-old boy was brought to the clinic by his parents. They are worried because they are unable to see his testes. They state they were present at birth.
      On examination, both testes are clearly in the groin. On manipulation, they can be brought into the scrotum.

      Which of the following is the most probable diagnosis and most appropriate course of action for this child?

      Your Answer:

      Correct Answer: Bilateral retractile testis, discharge with reassurance

      Explanation:

      The most probable diagnosis for this patient is bilateral retractile testes. This a normal phenomenon in some pre-pubertal boys.

      Rationale:
      Testicular descent can continue until about 3-months of age. The pre-pubertal testis is small enough that with activation of the cremasteric reflex, they can enter the inguinal canal.
      This in itself is a normal finding providing the testis can be brought into the scrotum without tension and does not require surgical correction. With time the testis will lie within the scrotum.

      Orchidopexy for true undescended testis can be performed from 6-months of age. It is also warranted if the testes remain undescended or intra-abdominally leading to infertility.

      Other options:
      – An ascending testis is one, typically, following hernia or orchidopexy surgery that was in the testis but with time is within the inguinal canal and cannot be brought into the scrotum. Orchidopexy is required for this.
      – No surgery is required as when the testis enlarges with puberty it will remain within the scrotum.
      – The testes can be brought into the scrotum. Therefore they are not undescended.
      – The testes are retractile not ascending; ascending testis cannot be brought into the scrotum and would require orchidopexy.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 30 - Proteinuria is NOT a recognized feature of which of the following conditions? ...

    Incorrect

    • Proteinuria is NOT a recognized feature of which of the following conditions?

      Your Answer:

      Correct Answer: Landau-Kleffner syndrome

      Explanation:

      Proteinuria refers to an increased amount of protein excretion in urine, which should be greater than 100mg/m2 per day on a single spot urine collection. The limit is even more relaxed for infants and neonates. Proteinuria is a prominent manifestation of cystinosis, acute tubular necrosis, Fanconi syndrome, and celiac disease. Landau-Kleffner syndrome is a rare childhood convulsive disorder, associated with acquired aphasia and auditory verbal agnosia.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 31 - Which among the following is the part of the nephron where ADH (antidiuretic...

    Incorrect

    • Which among the following is the part of the nephron where ADH (antidiuretic hormone) primarily acts?

      Your Answer:

      Correct Answer: Collecting ducts

      Explanation:

      ADH primarily acts on the collecting ducts.

      Other options:
      – The juxtaglomerular apparatus is the site of renin production.
      – The proximal tubule conducts isosmotic reabsorption of about 60% of sodium chloride and volume. Most of the glucose, amino acids, potassium and phosphate are absorbed here.
      – The loop of Henle is the site of 25% of sodium reabsorption. Active Chloride transport provides the basis for the counter current multiplier aiding urinary concentration.
      – The distal convoluted tubule is impermeable to water and acts via active sodium chloride absorption to dilute urine.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 32 - A 6 year old boy presents with severe gastroenteritis and dehydration. He is...

    Incorrect

    • A 6 year old boy presents with severe gastroenteritis and dehydration. He is receiving IV fluids and a routine blood test is done to evaluate kidney function and look for signs of acute kidney injury. All of the following are being used to evaluate for kidney injury, except:

      Your Answer:

      Correct Answer: Potassium >6mmol/l

      Explanation:

      Hyperkalaemia is not to evaluate or detect AKI but rather the result of it. If one of the rest of the options is present, then AKI would be suspected.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 33 - What is the investigation of choice to look for renal scarring in a...

    Incorrect

    • What is the investigation of choice to look for renal scarring in a child with vesicoureteric reflux?

      Your Answer:

      Correct Answer: DMSA

      Explanation:

      Vesicoureteral reflux is a common disorder in children but can result in kidney scarring following acute pyelonephritis. The gold standard diagnostic test to detect renal scars in children is 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 34 - An 8 year old male child presents with frequent and recurrent headaches and...

    Incorrect

    • An 8 year old male child presents with frequent and recurrent headaches and a history of dark-coloured urine. He has a blood pressure of 150/100 mmHg and normal serum urea and creatinine levels. Urine microscopy reveals erythrocytes and erythrocyte casts. His 24-hour urine protein is about 2 g.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Acute nephritic syndrome

      Explanation:

      The child most likely has nephritic syndrome which is characterised by a reduced renal function, proteinuria of non-nephrotic range, haematuria, erythrocyte casts, and oedema.

      Polyarteritis nodosa usually occurs in middle-aged men but can also be seen in young children. It is accompanied by severe systemic manifestations such as fever, malaise, weight loss and myalgia.

      Renal cell carcinoma usually presents around 55 years with the classic triad of haematuria, loin pain and a unilateral mass in the flank.

      Polycystic kidney disease usually presents in adult life with acute loin pain and palpation of masses in the flanks.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 35 - Which of the given medical conditions is associated with renal cysts and follows...

    Incorrect

    • Which of the given medical conditions is associated with renal cysts and follows an autosomal dominant pattern of inheritance?

      Your Answer:

      Correct Answer: Von Hippel-Lindau syndrome

      Explanation:

      Von Hippel-Lindau syndrome is a genetic disorder inherited in autosomal dominant fashion. It is caused by the mutations of the VHL gene located on chromosome 3. The syndrome is characterized by the creation of multiple benign and malignant tumours involving various bodily systems along with the formation of numerous visceral cysts, including the renal and epididymal cysts.
      Down’s syndrome is associated with renal cysts, but it does not follow the autosomal dominant mode of inheritance, rather it is caused by non-disjunction of chromosome 21 during meiosis.
      Exomphalos is a defect of the medial abdominal wall leading to abnormal protrusion of abdominal viscera through it. It is not associated with renal cysts.
      Turner’s syndrome may be associated with renal cysts formation, but it is not transmitted in an autosomal dominant fashion.
      Polycystic kidney disease of childhood follows an autosomal recessive pattern of transmission.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 36 - Which of the following statements is correct for distal renal tubular acidosis? ...

    Incorrect

    • Which of the following statements is correct for distal renal tubular acidosis?

      Your Answer:

      Correct Answer: Children can present with nephrocalcinosis

      Explanation:

      Distal renal tubular acidosis (dRTA) is characterised by a decreased hydrogen ion excretion from the alpha intercalated cells of the collecting duct of the distal nephron. The resultant acidosis causes Ca and phosphates to be released from bones to buffer the acidosis causing hypercalciuria, thus precipitating calcium compounds in the kidney. Other consequences of the dRTA in children include rickets, hypokalaemia, and polyuria. While dRTA can occur as a result of various pathologies including autoimmune disease, proximal renal tubular acidosis often presents as part of Fanconi’s syndrome. One way to differentiate between the two conditions is with an acid challenge test. In proximal RTA offering the child an acid load will decrease the urinary ph whereas in distal disease the pH will be unaffected due to impairment in hydrogen ion secretion.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 37 - A 5 month old boy is admitted with recurrent, brief grand mal seizures....

    Incorrect

    • A 5 month old boy is admitted with recurrent, brief grand mal seizures. Cranial CT reveals various circular lesions and renal ultrasound shows discrete cysts. Family history reveals that his father has had a renal transplant and has profound acne-like spots on his nose and cheeks. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Tuberous sclerosis

      Explanation:

      Tuberous sclerosis presents with the growth of numerous noncancerous (benign) tumours in many parts of the body. They may appear in the brain, kidneys, skin or various other organs.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 38 - A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of...

    Incorrect

    • A 5 week old boy with pyloric stenosis is vomiting forcefully. Which of the following findings would you expect to be in his blood results?

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Progressive vomiting due to pyloric stenosis leads to hypochloraemic, hypokalaemic, metabolic alkalosis.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 39 - A 15-year-old boy diagnosed with pulmonary tuberculosis was initiated on treatment. A month...

    Incorrect

    • A 15-year-old boy diagnosed with pulmonary tuberculosis was initiated on treatment. A month later, he presents with anorexia, malaise, reduced urine output and fever.
      Laboratory investigations reveal:
      Hb - 12.6 g/dL
      WBC Count - 13,000/µL
      Urea - 30 mmol/L
      Creatinine - 400 µmol/L; and
      Urinalysis shows numerous pus cells.

      What is the probable cause of the presenting symptoms of the patient?

      Your Answer:

      Correct Answer: Acute interstitial nephritis

      Explanation:

      Among the given options, the most likely cause for the patient’s presenting symptoms is acute interstitial nephritis secondary to anti-tubercular therapy (ATT)
      Drug-induced acute interstitial nephritis can occur following treatment with beta-lactams, sulphonamides, rifampicin, ethambutol, and erythromycin. They can cause an acute allergic reaction with the infiltration of immune cells.
      Acute interstitial nephritis is said to be the most common renal complication in patients undergoing anti-TB treatment. Rifampicin is the most implicated drug, although ethambutol can also be a cause. The pathogenesis involves an immune-complex mediated acute allergic response, which leads to their deposition on renal vessels, the glomerular endothelium, and the interstitial area.

      Other options:
      Isoniazid does not affect the kidneys.
      Pulmonary-renal syndrome is a feature of Goodpasture’s syndrome. It is characterized by renal failure and lung haemorrhage. Severe cardiac or renal failure ensues and is complicated by pulmonary oedema, systemic lupus erythematosus, Henoch-Schonlein purpura, and cryoglobulinemia.

    • This question is part of the following fields:

      • Nephro-urology
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  • Question 40 - A 15-year-old boy presents to the physician complaining of malaise and inability to...

    Incorrect

    • A 15-year-old boy presents to the physician complaining of malaise and inability to participate in physical activities due to exhaustion. His vitals, including the blood pressure are within the normal range and the labs are as follows:
      sodium 145 mmol/l
      potassium 2.8 mmol/l
      bicarbonate 30 mmol/l
      chloride 83 mmol/l (95-107)
      magnesium 0.5 mmol/l (0.75-1.05)
      glucose 5.0 mmol/l
      renin 5.1 mmol/ml per h (3-4.3)
      aldosterone 975 mmol/l (330-830)
      urea 5.2 mmol/l.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Gitelman's syndrome

      Explanation:

      Gitelman syndrome is a kidney disorder that causes an imbalance of charged atoms (ions) in the body, including ions of potassium, magnesium, and calcium.

      The signs and symptoms of Gitelman syndrome usually appear in late childhood or adolescence. Common features of this condition include painful muscle spasms (tetany), muscle weakness or cramping, dizziness, and salt craving. Also common is a tingling or prickly sensation in the skin (paraesthesia), most often affecting the face. Some individuals with Gitelman syndrome experience excessive tiredness (fatigue), low blood pressure, and a painful joint condition called chondrocalcinosis. Studies suggest that Gitelman syndrome may also increase the risk of a potentially dangerous abnormal heart rhythm called ventricular arrhythmia.

    • This question is part of the following fields:

      • Nephro-urology
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