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Question 1
Correct
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A 2 year old boy is brought by his mother to the emergency department with colicky pain. The boy has experienced such episodes of pain in the past, which radiates from his loin to the groin. After clinical examination and investigations, a 7mm stone has been found in his ureter. What is the single most appropriate next step?
Your Answer: Conservative treatment
Explanation:Renal stones < 5mm generally pass spontaneously with adequate fluid intake. Stones 5mm-10mm with pain not resolving, require medical expulsive therapy with Nifedipine or Tamsulosin. For stones larger than 10mm, ESWL or Ureteroscopy is indicated. For stones as big as 2cm, percutaneous nephrolithotomy should be applied.
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This question is part of the following fields:
- Renal
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Question 2
Correct
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A 11-year-old boy is admitted to the hospital with diarrhoea and lethargy. There is a known local outbreak of E coli 0157:H7, and his initial bloods show evidence of acute renal failure. Given the likely diagnosis, which one of the following investigation results would be expected?
Your Answer: Fragmented red blood cells
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli. The laboratory results will usually include fragmented RBCs, decreased serum haptoglobin, reduced platelet count, nonspecific WBC changes, and normal coagulation tests (PTT included).
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This question is part of the following fields:
- Renal
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Question 3
Incorrect
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A 15-year-old girl is referred to the paediatric unit with reduced urine output and lethargy. She has been passing bloody diarrhoea for the past four days. On admission she appears dehydrated. Bloods show the following:Na+: 142 mmol/lK+: 4.8 mmol/lBicarbonate: 22 mmol/lUrea: 10.1 mmol/lCreatinine: 176 µmol/lHb: 10.4 g/dlMCV: 90 flPlt: 91 * 109/lWBC: 14.4 * 109/lGiven the likely diagnosis, which one of the following organisms is the most likely cause?
Your Answer: Salmonella
Correct Answer: E. coli
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli.
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This question is part of the following fields:
- Renal
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Question 4
Incorrect
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A 15-year-old boy presents with hypertension and acute renal failure after an episode of diarrhoea. What is the most likely diagnosis?
Your Answer: Legionellosis
Correct Answer: Haemolytic-uraemic syndrome
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli causing diarrhoea in these cases as well.
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This question is part of the following fields:
- Renal
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Question 5
Incorrect
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An 8 year old boy is admitted to the ward with renal colic. Family history is significant for similar renal calculi in his mother. Which of the following is the most likely explanation for this recurrent colic in both mother and child?
Your Answer:
Correct Answer: Idiopathic hypercalciuria
Explanation:Idiopathic hypercalciuria (IH) is the commonest metabolic abnormality in patients with calcium kidney stones. It is characterized by normocalcemia, absence of diseases that cause increased urine calcium, and calcium excretion that is above 250 mg/day in women and 300 mg/day in men. Subjects with IH have a generalized increase in calcium turnover, which includes increased gut calcium absorption, decreased renal calcium reabsorption, and a tendency to lose calcium from bone. Despite the increase in intestinal calcium absorption, negative calcium balance is commonly seen in balance studies, especially on a low calcium diet. The mediator of decreased renal calcium reabsorption is not clear; it is not associated with either an increase in filtered load of calcium or altered PTH levels. There is an increased incidence of hypercalciuria in first-degree relatives of those with IH, but IH appears to be a complex polygenic trait with a large contribution from diet to expression of increased calcium excretion. Increased tissue vitamin D response may be responsible for the manifestations of IH in at least some patients.
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This question is part of the following fields:
- Renal
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Question 6
Incorrect
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A 4 year old girl is brought to the emergency due to fever and urinary urgency. The temperature is recorded to be 39C. Which of the following is the best investigation in this case?
Your Answer:
Correct Answer: Clean catch of urine
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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This question is part of the following fields:
- Renal
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Question 7
Incorrect
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A 12 year old boy has a high HbA1c and is being checked by the diabetic specialist nurse. He has been skipping meals lately and his school teachers have noticed that he's been unhappy. Who do you suggest his parents take him to?
Your Answer:
Correct Answer: Clinical psychologist
Explanation:The boy is most probably a type 1 diabetic patient. Such a condition can affect the behaviour and psychological state of a young child reflected in their behaviour. The parents should seek the help of a clinical psychologist.
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This question is part of the following fields:
- Renal
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Question 8
Incorrect
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A 7-year-old child presented to the paediatric clinic with a swollen face, hands and feet. She gained 2 kilograms over the last month despite poor feeding. What is the investigation of choice in this case?
Your Answer:
Correct Answer: Urinary albumin
Explanation:This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.
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This question is part of the following fields:
- Renal
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Question 9
Incorrect
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A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2-3 white blood cells/mm3.What is the most probable diagnosis?
Your Answer:
Correct Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
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This question is part of the following fields:
- Renal
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Question 10
Incorrect
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A 10 year old boy presents with generalized swelling. This includes puffiness in the face and swollen ankles - these symptoms have been present for 4 days. The swelling began just a few days after he suffered from a mild cold with a runny nose. His only past medical history is that of eczema. His urine analysis showed the following: haematuria; proteinuria (10g/24h); creat60umol/l; and albumin of 15g/l. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer:
Correct Answer: IgA nephropathy
Explanation:A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).
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This question is part of the following fields:
- Renal
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Question 11
Incorrect
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A 7-year-old girl is given cephalexin to treat an infection and develops hives, with localised facial oedema. Which of the following conditions will cause localised oedema?
Your Answer:
Correct Answer: Angio-oedema
Explanation:Angio-oedema, is the rapid swelling of the skin, mucosa and submucosal tissues. The underlying mechanism typically involves histamine or bradykinin. The version related to histamine is to due an allergic reaction to agents such as insect bites, food, or medications. The version related to bradykinin may occur due to an inherited C1 esterase inhibitor deficiency, medications e.g. angiotensin converting enzyme inhibitors, or a lymphoproliferative disorder.
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This question is part of the following fields:
- Renal
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Question 12
Incorrect
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A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for two weeks. Urine analysis reveals proteinuria. Which of the following is the most appropriate treatment for this child?
Your Answer:
Correct Answer: Prednisolone
Explanation:The presentation is suggestive of nephrotic syndrome. A trial of corticosteroids is the first step in treatment of idiopathic nephrotic syndrome. Diuretics are useful in managing symptomatic oedema. Cyclosporin and cyclophosphamide are indicated in frequently relapsing and steroid dependant disease.
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This question is part of the following fields:
- Renal
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Question 13
Incorrect
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A 13-year-old male presented in the OPD with bilateral ankle oedema. On examination, his BP was normal. Urinalysis showed a high degree of proteinuria was present. Which of the following is the most probable diagnosis in this patient?
Your Answer:
Correct Answer: Minimal change GN
Explanation:Minimal change disease is a type of glomerulonephritis that mostly affects younger children. Proteinuria is present which leads to body oedema. But in these patients blood pressure is normal.
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This question is part of the following fields:
- Renal
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Question 14
Incorrect
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A 7-year-old boy with facial oedema was brought to the hospital by his parents. Renal function is normal and urinalysis revealed the presence of a profound proteinuria. Which of the following is the most probable cause of these findings?
Your Answer:
Correct Answer: Minimal-change disease
Explanation:Minimal-change disease (MCD) refers to a histopathologic glomerular lesion, typically found in children, that is almost always associated with nephrotic syndrome. The most noticeable symptom of MCD is oedema, which can develop very rapidly. Due to the renal loss of proteins muscle wasting and growth failure may be seen in children. Renal function is usually not affected and a proteinuria of more than 40 mg/h/m2 is the only abnormal finding in urinalysis.
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This question is part of the following fields:
- Renal
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Question 15
Incorrect
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A 2-month-old infant was brought to the paediatrics ward by her mother with a complaint of excessive crying during urination. The urine culture of the infant revealed E.coli. Which of the following investigations should be done next?
Your Answer:
Correct Answer: US
Explanation:Urine culture confirms a diagnosis of a UTI. A kidney ultrasound will be the next best investigation because it will help us to visualise the bladder, kidneys, and ureters to rule out any congenital obstruction in the urinary tract that might be the actual cause of infection in this 2-month old girl.
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This question is part of the following fields:
- Renal
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Question 16
Incorrect
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer:
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal
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Question 17
Incorrect
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A 3 year old boy is brought to the emergency by his parents with worsening ataxia. They also mention that the boy's urine has a distinct sweet odour. Further investigations reveal the presence of leucine, isoleucine and valine in the urine. What is the diagnosis?
Your Answer:
Correct Answer: Maple Syrup Urine Disease
Explanation:Maple syrup urine disease (MSUD) is an autosomal recessive metabolic disorder affecting branched-chain amino acids. It is one type of organic academia. The condition gets its name from the distinctive sweet odour of affected infants’ urine, particularly prior to diagnosis, and during times of acute illness. MSUD, also known as branched-chain ketoaciduria, is an aminoacidopathy due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine.
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This question is part of the following fields:
- Renal
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Question 18
Incorrect
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A 15-year-old boy presented to a urologist with a complaint of blood in the urine and pain in his abdomen. On examination, abdominal swelling is present and blood pressure is elevated. Which of the following is the most appropriate investigation in this case?
Your Answer:
Correct Answer: Ultrasound
Explanation:Haematuria and abdominal swelling may indicate either polycystic kidney disease or a tumour. Because of the patient’s age, the likelihood of a tumorous growth is small, thus an ultrasound is the best choice for this case.
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This question is part of the following fields:
- Renal
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Question 19
Incorrect
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A 11-year-old boy has a history of tonsillitis followed by haematuria and hypertension about 10 days later.What would be the characteristic blood test finding in this condition?
Your Answer:
Correct Answer: Depressed CH 50 level
Explanation:Because the medical history included tonsillitis followed by haematuria and hypertension, there is a strong suspicion of a case of post-streptococcal glomerulonephritis (PSGN). Patients with PSGN usually have serological findings showing depressed serum haemolytic component CH50 and serum concentrations of C3. Sometimes depressed C4 levels are also apparent, but not always, therefore, the answer to this question is: depressed CH50 level.
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This question is part of the following fields:
- Renal
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Question 20
Incorrect
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A 16-year-old girl developed haemoptysis with acute kidney injury requiring dialysis. She suffered from recurrent epistaxis for the past 2 weeks. Renal biopsy showed crescentic glomerulonephritis. Which antibody would you expect to be positive?
Your Answer:
Correct Answer: Antiproteinase 3
Explanation:This patient has pulmonary renal syndrome which is most commonly due to an ANCA positive vasculitis. The history of recurrent epistaxis makes Wegener’s granulomatosis the most probable diagnosis. Wegener’s granulomatosis, microscopic polyangiitis, and idiopathic pauci-immune necrotizing crescentic glomerulonephritis (NCGN) are strongly associated with antineutrophil cytoplasmic autoantibodies (ANCAs) directed against either proteinase 3 (anti-PR3) or myeloperoxidase (anti-MPO).
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This question is part of the following fields:
- Renal
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SESSION STATS - PERFORMANCE PER SPECIALTY
