Pedia2 Reviewer (Neuro/Nephro/IMCI)

Question 1

A 15-year-old male presents with a 6-month history of right-sided headache, dull in character (grade 3/10), usually preceded by flashes of light. He prefers to stay in a dim and quiet room during headache episodes. What is the most likely diagnosis?
a. Migraine with typical aura
b. Migraine without aura
c. Migraine with brainstem aura
d. Vestibular migraine with vertigo

Answer 1

A. Migraine with typical aura

Rationale: Migraines with aura are characterized by neurological symptoms such as visual disturbances (flashes of light) that precede the headache. This distinguishes it from migraines without aura, which lack these prodromal symptoms.

Question 2

Which of the following is a recommended treatment for increased intracranial pressure (ICP)?
a. Hyperventilation for 20 minutes
b. Start hypertonic saline solution
c. Hydration with colloid solution
d. Elevate head to 60 degrees

Answer 2

B. Start hypertonic saline solution

Rationale: Hypertonic saline helps reduce cerebral edema by drawing fluid out of brain tissues, thereby lowering ICP. Hyperventilation is not recommended as a first-line treatment due to the risk of cerebral ischemia. Head elevation is recommended at 30 degrees, not 60 degrees.

Question 3

The edema in nephrotic syndrome is best explained by:
a. Acute tubular necrosis
b. Salt and water retention
c. Elevated angiotensin
d. Massive protein loss in the urine

Answer 3

D. Massive protein loss in the urine

Rationale: The hallmark of nephrotic syndrome is massive proteinuria, leading to hypoalbuminemia. This decreases oncotic pressure, resulting in fluid leakage into the interstitial spaces, causing edema.

Question 4

An 8-year-old male diagnosed with post-streptococcal glomerulonephritis (PSGN) three months ago presents for follow-up. He is asymptomatic. Urinalysis reveals straw-colored urine, normal pH and specific gravity, RBC 20-30/hpf, and protein +1. What is the best course of action?
a. Reassure parents that this is expected and schedule another follow-up in a month
b. Undergo a renal biopsy
c. Prepare him for the possibility of rapidly progressive glomerulonephritis
d. Resume an antibiotic course of Penicillin, but this time for 21 days

Answer 4

A. Reassure parents that this is expected and schedule another follow-up in a month

Rationale: Microscopic hematuria can persist for 6 months to 1 year after PSGN resolution. Since the patient is asymptomatic and has mild proteinuria, reassurance and monitoring are appropriate.

Question 5

A 5-year-old presents with weakness and diarrhea. Physical exam reveals severe stunting, moderate wasting, and moderate dehydration. Labs show alkaline urine, hypokalemia, and metabolic acidosis, which persist despite hydration and potassium correction. The urine anion gap is +3. What is the most likely type of renal tubular acidosis (RTA)?
a. Type III
b. Type I
c. Type II
d. Type IV

Answer 5

B. Type I

Rationale: Type I (distal) RTA is characterized by hypokalemia, metabolic acidosis, and alkaline urine due to impaired hydrogen ion excretion in the distal tubule. A positive urine anion gap supports this diagnosis.

Question 6

An 18-month-old female is brought to the ER due to seizures. A few minutes before the event, she wanted to play with her doll, but her older sister refused to give it to her. She started crying, became cyanotic for 2 minutes, and had jerky extremity movements. What is the most likely diagnosis?
a. Shuddering attack
b. Breath-holding spells
c. Pseudoseizures
d. Paroxysmal kinesigenic choreoathetosis

Answer 6

B. Breath-holding spells

Rationale: Breath-holding spells are non-epileptic events triggered by emotional distress, leading to cyanosis and loss of consciousness. They can mimic seizures but resolve spontaneously without postictal confusion.

Question 7

Which among the following potentiating factors for recurrent urinary tract infections (UTI) is not seen on renal ultrasound?
a. Vesicoureteral reflux
b. Urolithiasis
c. Encopresis
d. Incomplete bladder voiding

Answer 7

C. Encopresis

Rationale: Encopresis (chronic constipation leading to fecal incontinence) is a risk factor for UTIs due to urinary stasis from bowel distention. However, it is not visualized on renal ultrasound, unlike vesicoureteral reflux (seen on VCUG), urolithiasis (seen as echogenic calculi), and incomplete bladder voiding (seen as post-void residual urine).

Question 8

The edema in nephrotic syndrome is best managed by:
a. Strict sodium restriction
b. Aggressive use of diuretics
c. Albumin transfusion
d. Fluid restriction

Answer 8

A. Strict sodium restriction

Rationale: Sodium restriction (≤2 g/day) is the first-line management of edema in nephrotic syndrome. Aggressive diuresis can cause intravascular depletion, worsening renal function. Albumin infusion is reserved for severe, refractory edema.

Question 9

Hydrocephalus in suppurative meningitis is due to:
a. Fibrosis of the cerebral aqueduct
b. Vasospasm of blood vessels
c. The release of interleukin and tumor necrosis factors
d. Hypotonicity of the brain

Answer 9

A. Fibrosis of the cerebral aqueduct

Rationale: Post-meningitic hydrocephalus is due to scarring and fibrosis of CSF pathways (e.g., cerebral aqueduct, arachnoid granulations), leading to obstructive or communicating hydrocephalus.

Question 10

The initial management of idiopathic nephrotic syndrome is:
a. Penicillin
b. Diuretics
c. High protein diet
d. Prednisone

Answer 10

D. Prednisone

Rationale: Idiopathic nephrotic syndrome (minimal change disease in children) is steroid-responsive. Prednisone (2 mg/kg/day for 6 weeks, then tapered) is the first-line treatment. Antibiotics and diuretics are not first-line.

Question 11

Which diagnostic workup differentiates distal RTA (dRTA) and proximal RTA (pRTA)?
a. Urine anion gap
b. Arterial blood gas
c. Serum creatinine
d. Normal anion gap

Answer 11

A. Urine anion gap

Rationale: Urine anion gap (UAG) helps differentiate renal causes of acidosis (positive UAG in dRTA) from gastrointestinal causes (negative UAG in pRTA).

Question 12

Which of the following is TRUE about distal renal tubular acidosis (dRTA)?
a. The primary defect is H+ secretion and HCO₃⁻ reabsorption in the distal segment of the nephron.
b. Urine pH during the acute phase is acidic.
c. The primary defect is the Na-HCO₃ reabsorption in the distal basolateral membrane.
d. Nephrocalcinosis and renal calculi are rarely seen in dRTA.

Answer 12

A. The primary defect is H+ secretion and HCO₃⁻ reabsorption in the distal segment of the nephron.

Rationale: dRTA is due to defective H+ secretion in the distal tubule, leading to metabolic acidosis, alkaline urine (pH >5.5), and nephrocalcinosis (due to hypercalciuria).

Question 13

Which of the following distinguishes post-streptococcal glomerulonephritis (PSGN) from other primary glomerulonephritides?
a. A favorable response to antibiotics
b. A latent period
c. More severe manifestations
d. A progressive course

Answer 13

B. A latent period

Rationale: PSGN follows a latent period of 1-2 weeks after pharyngitis or 3-6 weeks after impetigo. Unlike primary GN, antibiotics do not alter the course.

Question 14

The drug of choice for infantile spasms is:
a. Phenobarbital
b. Lacosamide
c. Valproic acid
d. Vigabatrin

Answer 14

D. Vigabatrin

Rationale: Vigabatrin is the first-line treatment for infantile spasms, especially in tuberous sclerosis complex. ACTH is also used but is expensive and has side effects.

Question 15

A 6-year-old was struck by a metal object hitting the occiput. In the ER, he is arousable to name calling but easily falls back to sleep. What is his state of consciousness?
a. Obtunded
b. Awake
c. Comatose
d. Drowsy

Answer 15

D. Drowsy

Rationale: Drowsiness is a mild impairment of consciousness where the patient can be awakened but easily falls back asleep. Obtundation involves moderate impairment with decreased alertness.

Question 16

Post-streptococcal glomerulonephritis (PSGN) is secondary to:
a. Antigen-antibody reaction forming immune complexes
b. Toxin production
c. Complement system cascade of reactions causing chemotaxis and cell lysis
d. Direct invasion of streptococcal organisms in the kidney

Answer 16

A. Antigen-antibody reaction forming immune complexes

Rationale: PSGN occurs due to immune complex deposition in the glomeruli after a group A Streptococcus (GAS) infection. Toxins and direct bacterial invasion do not cause PSGN. The immune response triggers complement activation, leading to glomerular inflammation.

Question 17

A 5-year-old child weighing 18 kg was hypotensive with severe dehydration. Urine output was 100 cc over the past 16 hours. After fluid resuscitation, his creatinine level was 9 mg/dL. According to KDIGO staging of acute kidney injury (AKI), the patient is in:
a. Stage III
b. Stage II
c. Stage I
d. Stage IV

Answer 17

A. Stage III

Rationale: KDIGO Stage III AKI is defined by a creatinine level ≥4 mg/dL or a threefold increase from baseline. Additionally, urine output <0.3 mL/kg/hour for ≥24 hours or anuria for ≥12 hours also meets Stage III criteria.

Question 18

Nephrotic range proteinuria is defined as a 24-hour urine albumin result of more than:
a. 40 mg/m²/hour
b. 80 mg/m²/hour
c. 20 mg/m²/hour
d. 60 mg/m²/hour

Answer 18

B. 80 mg/m²/hour

Rationale: Nephrotic range proteinuria is defined as ≥50 mg/kg/day or ≥3.5 g/24 hours in adults, which correlates to ≥80 mg/m²/hour in children.

Question 19

Congenital aqueductal stenosis is due to:
a. Third ventricle outlet obstruction
b. Fourth ventricle outlet obstruction
c. Third or fourth ventricle outlet obstruction
d. Lateral ventricle outlet obstruction

Answer 19

A. Third ventricle outlet obstruction

Rationale: Aqueductal stenosis is caused by obstruction at the cerebral aqueduct (Sylvius), which connects the third and fourth ventricles. This leads to non-communicating hydrocephalus.

Question 20

The involuntary eye closure to intense light illumination is called:
a. Dazzle reflex
b. Blink reflex
c. Corneal reflex
d. Startle reflex

Answer 20

A. Dazzle reflex

Rationale: The dazzle reflex is a subcortical protective response to bright light, mediated by the midbrain. Unlike the blink reflex (elicited by touch or air puffs on the cornea), the dazzle reflex is light-induced.

Question 21

Which of the following does NOT increase the risk of recurrent UTI?
a. Vesicoureteral reflux
b. Neurogenic bladder
c. Constipation
d. Unidirectional urine flow

Answer 21

D. Unidirectional urine flow

Rationale: Unidirectional urine flow (normal voiding mechanism) protects against UTI. VUR, neurogenic bladder, and constipation contribute to urinary stasis, increasing infection risk.

Question 22

An 11-year-old was admitted for oliguria, hematuria, and anasarca for 5 days. He was given an IV medication that increased his urine output within 20 minutes. Where is the site of action of this drug?
a. Angiotensin-converting enzyme
b. Thick ascending limb of the loop of Henle
c. Calcium channel blocker
d. Angiotensin receptor

Answer 22

B. Thick ascending limb of the loop of Henle

Rationale: Loop diuretics (e.g., Furosemide) act on the thick ascending limb of the loop of Henle, blocking the Na-K-2Cl symporter, leading to rapid diuresis.

Question 23

A 4-year-old male patient with renal tubular acidosis (RTA) and hyperkalemic metabolic acidosis is categorized as:
a. Type III RTA
b. Type II RTA
c. Type I RTA
d. Type IV RTA

Answer 23

D. Type IV RTA

Rationale: Type IV RTA is characterized by hyperkalemia and metabolic acidosis, due to aldosterone deficiency or resistance. In contrast, Type I and II RTA present with hypokalemia.

Question 24

Which of the following is a risk factor for renal venous thrombosis (RVT) in neonates?
a. Dehydration
b. Cyanotic heart disease
c. Nephrotic syndrome
d. Use of radiologic contrast media

Answer 24

A. Dehydration

Rationale: Neonatal RVT is most commonly due to dehydration, perinatal asphyxia, or maternal diabetes. Nephrotic syndrome is a cause of RVT in older children, while contrast media and cyanotic heart disease are not primary neonatal risk factors.

Question 25

For subependymal giant cell astrocytoma (SEGA), the recommended medical management is: a. Rapamycin b. Everolimus c. Temsirolimus d. Deforolimus

Answer 25

B. Everolimus Rationale: Everolimus (mTOR inhibitor) is the first-line treatment for SEGA in tuberous sclerosis complex (TSC), as it reduces tumor size and delays the need for surgery.

Question 26

A 15-year-old female presents with high-grade fever and dysuria. Urinalysis shows pyuria, (+) nitrites, (+) leukocytes. What is the next best step? a. Start PO cefuroxime b. Start IV ceftriaxone c. Wait for urine culture and sensitivity result d. Start nitrofurantoin

Answer 26

B. Start IV ceftriaxone Rationale: Febrile UTI in adolescents suggests acute pyelonephritis, requiring empiric IV antibiotics (e.g., ceftriaxone). Nitrofurantoin is for uncomplicated cystitis.

Question 27

A 5-year-old child with vomiting and diarrhea for 2 days was hypotensive with severe dehydration. He received two boluses of 20 cc/kg IV fluids. After 1 hour, his vital signs improved, and urine output returned. Under pRIFLE classification, this child is in: a. Failure b. Loss c. Injury d. Risk

Answer 27

D. Risk Rationale: The pRIFLE criteria for AKI define "Risk" as a 25% reduction in estimated glomerular filtration rate (eGFR) or urine output <0.5 mL/kg/hr for 8 hours. Since the patient responded to fluids, they are at risk but not yet in "injury" or "failure" stage.

Question 28

Which reflex persists throughout life? a. Landau reflex b. Tonic neck reflex c. Parachute reflex d. Hoffmann’s reflex

Answer 28

C. Parachute reflex Rationale: The parachute reflex (extending arms when "falling") appears at 6–9 months and persists for life. Other primitive reflexes (e.g., tonic neck, Landau) disappear in infancy.

Question 29

A 2-month-old infant being treated for bacterial meningitis suddenly develops focal seizures, fever, and a bulging fontanel. What is the most likely diagnosis? a. Subdural effusion b. Subdural empyema c. Subdural hematoma d. Subdural hygroma

Answer 29

B. Subdural empyema Rationale: Subdural empyema is a severe complication of bacterial meningitis, presenting with seizures, fever, and signs of increased intracranial pressure. It requires urgent surgical drainage and antibiotics.

Question 30

A 17-year-old male has hypertension and palpitations. Ultrasound reveals a suprarenal mass, but the kidneys and urinary tract are normal. What is the best antihypertensive therapy? a. ACE inhibitor b. Alpha-1 blocker c. Calcium-channel blocker d. Loop diuretic

Answer 30

B. Alpha-1 blocker Rationale: A suprarenal mass with hypertension suggests pheochromocytoma. First-line treatment is alpha-blockade (e.g., phenoxybenzamine, doxazosin) before considering surgery.

Question 31

The first ECG change in patients with hyperkalemia is: a. Widening QRS complex b. Flattening P wave c. Tall peaked T waves d. Prolonged PR interval

Answer 31

C. Tall peaked T waves Rationale: The earliest ECG change in hyperkalemia is tall, peaked T waves due to faster repolarization. Widened QRS and P wave flattening occur later as potassium levels continue to rise.

Question 32

A 17-year-old male had a head-on collision with a truck. At the ER, he has: No eye opening to pain Abnormal extension to pain Mumbled, incomprehensible words What is his Glasgow Coma Scale (GCS) score? a. GCS 7 b. GCS 5 c. GCS 3 d. GCS 9

Answer 32

B. GCS 5 Rationale: Eye response: No response (1) Motor response: Abnormal extension (2) Verbal response: Incomprehensible sounds (2) Total = 5 (Severe head injury)

Question 33

Which epilepsy syndrome has the worst prognosis? a. Rasmussen syndrome b. Ohtahara syndrome c. Lennox-Gastaut syndrome d. West syndrome

Answer 33

B. Ohtahara syndrome Rationale: Ohtahara syndrome (early infantile epileptic encephalopathy) has severe neurodevelopmental impairment and drug-resistant seizures, leading to a very poor prognosis.

Question 34

A 5-year-old child with severe dehydration was given IVF boluses. After 1 hour, vital signs improved, and urine output returned. What is the most probable cause of acute kidney injury (AKI)? a. Pre-renal b. Pre-renal and Intrinsic c. Intrinsic d. Post-renal

Answer 34

A. Pre-renal Rationale: Pre-renal AKI occurs due to hypovolemia (dehydration), leading to decreased renal perfusion. Reversal with fluids confirms pre-renal cause. Intrinsic AKI would not respond so quickly.

Question 35

The most common mimic of seizures in a 5-year-old child is: a. Pseudoseizures b. Tics c. Benign vertigo d. Jitteriness

Answer 35

B. Tics Rationale: Tics (motor or vocal) are involuntary, repetitive, and commonly misdiagnosed as seizures. Pseudoseizures (psychogenic non-epileptic seizures) are more common in older children/adolescents.

Question 36

A 5-year-old child with 2-year history of intermittent hematuria presents with: Seizures Anasarca BP 140/90 No urine output for 24 hours Serum creatinine 10 mg/dL Bilateral contracted kidneys on ultrasound Metabolic acidosis and hyperkalemia What is the most likely diagnosis? a. Intrinsic acute kidney injury category failure b. Chronic renal insufficiency c. Intrinsic acute kidney injury category injury d. Chronic kidney failure

Answer 36

D. Chronic kidney failure Rationale: Bilateral contracted kidneys with long-standing hematuria and renal dysfunction indicate chronic kidney failure (CKD stage 5). AKI would not show contracted kidneys on ultrasound.

Question 37

The definitive diagnosis of IgA nephropathy is aided by: a. Genetic studies b. Renal histology c. Clinical presentation of recurrent gross hematuria d. Elevated serum IgA assay

Answer 37

B. Renal histology Rationale: IgA nephropathy (Berger’s disease) is diagnosed by kidney biopsy, which shows IgA deposits in the mesangium. Serum IgA may be elevated, but it is not diagnostic.

Question 38

A 3-year-old male with 2 weeks of fever presents with: Seizures Aphasia and right-sided weakness CSF analysis: WBC: 350/mm³ Neutrophils: 20% Protein: 300 mg/dL Glucose: 18 mg/dL What is the most likely diagnosis? a. Tuberculous meningitis b. Fungal meningitis c. Viral encephalitis d. Bacterial meningitis

Answer 38

A. Tuberculous meningitis Rationale: Low CSF glucose, high protein, and moderate WBC with lymphocyte predominance suggest tuberculous meningitis. Viral encephalitis has higher glucose and lower protein.

Question 39

A 1-hour-old male has a low sacral mass but is otherwise healthy. What neurologic deficit is expected? a. Bowel and bladder incontinence b. Kyphotic gibbus c. Orthopedic deformities d. Mental retardation

Answer 39

A. Bowel and bladder incontinence Rationale: A low sacral mass (e.g., myelomeningocele, spina bifida) often affects bowel and bladder control due to sacral nerve involvement.

Question 40

A 6-year-old male with 10 days of diarrhea develops: Lower extremity heaviness Inability to walk Weakness progressing to difficulty getting up Which part of the peripheral nervous system is affected? a. Peripheral nerves b. Spinal cord c. Muscles d. Anterior horn cells

Answer 40

A. Peripheral nerves Rationale: Guillain-Barré Syndrome (GBS) is a post-infectious autoimmune disorder affecting peripheral nerves, leading to ascending paralysis and weakness. Anterior horn cell diseases (e.g., polio) have different clinical courses.

Question 41

A 3-year-old with periorbital edema and hypertension secondary to post-streptococcal glomerulonephritis (PSGN) has a chest X-ray showing pulmonary congestion. What is the antihypertensive drug of choice? a. Calcium channel blocker b. Beta-blocker c. Loop diuretic d. ACE inhibitor

Answer 41

C. Loop diuretic Rationale: Hypertension in PSGN is volume-dependent (due to fluid overload), so the first-line treatment is a loop diuretic (e.g., furosemide) to reduce volume overload and pulmonary congestion. ACE inhibitors and beta-blockers are not first-line in volume-overload hypertension.

Question 42

Brainstem reflexes used to confirm brain death include: a. Ankle clonus b. Corneal reflex c. Babinski sign d. Gag reflex

Answer 42

B. Corneal reflex Rationale: Brainstem reflexes (e.g., corneal reflex, pupillary reflex, oculocephalic reflex, and gag reflex) must be absent to confirm brain death. Ankle clonus and Babinski sign are spinal reflexes, not brainstem reflexes.

Question 43

A 14-year-old male with recurrent ear infections presents with: Stiff neck Yellow, foul-smelling ear discharge bilaterally Horizontal nystagmus What is the most likely diagnosis? a. Bacterial meningitis b. Glioblastoma multiforme c. Brain abscess (cerebellum) d. Ependymoma

Answer 43

C. Brain abscess (cerebellum) Rationale: Chronic otitis media with neurological symptoms (e.g., nystagmus, stiff neck) suggests a cerebellar abscess. Brain abscess is a known complication of recurrent ear infections.

Question 44

A 5-year-old male with severe stunting, metabolic acidosis, hypokalemia, and renal calculi likely has: a. Distal renal tubular acidosis (dRTA) b. Aldosterone deficiency c. Pseudohypokalemia d. Proximal renal tubular acidosis (pRTA)

Answer 44

A. Distal renal tubular acidosis (dRTA) Rationale: dRTA is associated with renal calculi, alkaline urine, and hypokalemia due to defective H+ secretion in the distal tubules. pRTA does not cause nephrocalcinosis.

Question 45

The most common cause of eosinophilic meningitis is: a. Gnathostoma spinigerum b. Angiostrongylus cantonensis c. Trichinella sp. d. Taenia solium

Answer 45

B. Angiostrongylus cantonensis Rationale: Angiostrongylus cantonensis (rat lungworm) is the most common cause of eosinophilic meningitis, especially in Southeast Asia. It is transmitted through raw or undercooked snails/slugs.

Question 46

A 1-year-old with fever (40°C) and poor intake was diagnosed with UTI and started on ceftriaxone. After 48 hours, there was no improvement. When should a renal ultrasound (KUB) be done? a. Within 6 weeks of infection b. Not warranted c. During the acute infection d. 4-6 months after acute infection

Answer 46

C. During the acute infection Rationale: Persistent febrile UTI despite 48 hours of antibiotics warrants an immediate ultrasound to rule out anatomical abnormalities (e.g., hydronephrosis, abscess). Delaying imaging is inappropriate.

Question 47

A 12-year-old girl presents with: Growth retardation Polyuria Hypertension Predominantly WBCs on urinalysis What is the most likely diagnosis? a. Renovascular lesion b. Reflux nephritis c. Lupus nephritis d. Essential hypertension

Answer 47

B. Reflux nephritis Rationale: Reflux nephropathy (chronic pyelonephritis due to vesicoureteral reflux) causes growth failure, hypertension, polyuria, and WBCs in the urine. Renovascular lesions cause hypertension but not pyuria.

Question 48

The most common cause of seizures in a 24-hour-old neonate is: a. Hypoxic-ischemic encephalopathy b. Meningitis c. Maple syrup urine disorder d. Intracranial hemorrhage

Answer 48

A. Hypoxic-ischemic encephalopathy Rationale: HIE is the leading cause of neonatal seizures in the first 24 hours due to perinatal asphyxia. Meningitis and metabolic disorders typically present later.

Question 49

Which is NOT a diagnostic criterion for neurofibromatosis type I (NF1)? a. Kayser-Fleischer ring b. Learning disability c. Optic glioma d. Sphenoid dysplasia

Answer 49

A. Kayser-Fleischer ring Rationale: Kayser-Fleischer rings (copper deposits in the cornea) are seen in Wilson’s disease, not NF1. NF1 is diagnosed based on café-au-lait spots, optic glioma, sphenoid dysplasia, neurofibromas, and learning disabilities.

Question 50

An 8-year-old presents with oliguria, tea-colored urine, and anasarca for 3 days. History of impetigo 4 weeks ago What antihypertensive is ideal? a. Beta-2 antagonist b. Loop diuretic c. Alpha-1 blocker d. Calcium channel blocker

Answer 50

B. Loop diuretic Rationale: Post-streptococcal glomerulonephritis (PSGN) causes volume overload hypertension, best managed with diuretics. Calcium channel blockers may be used if hypertension persists after diuresis.

Question 51

Which drug enhances potassium entry into cells? a. Insulin b. Calcium gluconate c. Kayexalate d. Sorbitol

Answer 51

A. Insulin Rationale: Insulin shifts potassium into cells by increasing sodium-potassium ATPase activity. Calcium gluconate stabilizes cardiac membranes, while Kayexalate removes potassium via the GI tract.

Question 52

Massive protein loss in nephrotic syndrome is due to injury to: a. Epithelial cells b. Podocytes c. Juxtaglomerular cells d. Endothelial cells

Answer 52

B. Podocytes Rationale: Podocyte injury leads to disruption of the glomerular filtration barrier, causing proteinuria. Endothelial and juxtaglomerular cells are not directly involved in protein loss.

Question 53

Which patients do NOT require routine BP monitoring upon consultation? a. 1-year-old with recurrent acute pyelonephritis b. 4-year-old brought to the clinic for vaccination c. 5-month-old with a history of bronchopulmonary dysplasia d. 2-year-old with cough and colds

Answer 53

B. 4-year-old brought to the clinic for vaccination Rationale: BP screening is recommended for children ≥3 years old, or younger if at risk (e.g., prematurity, UTI, kidney disease). Routine vaccination visits do not require BP checks.

Question 54

A 5-year-old girl with 3-week history of sore throat develops tea-colored urine. If post-streptococcal glomerulonephritis (PSGN) is suspected, which laboratory finding strengthens the diagnosis? a. Low serum C3 b. Presence of hematuria c. Hyponatremia d. Elevated BUN and creatinine

Answer 54

A. Low serum C3 Rationale: PSGN is associated with low C3 due to complement activation. Hematuria and elevated BUN/creatinine occur in many renal conditions, but low C3 is more specific.

Question 55

Which clinical condition can lead to dilutional hyponatremia? a. Aldosterone deficiency b. Diabetes insipidus c. Acute diarrhea d. Nephrotic syndrome

Answer 55

D. Nephrotic syndrome Rationale: Nephrotic syndrome causes hypoalbuminemia, leading to water retention and dilutional hyponatremia. Diabetes insipidus and diarrhea cause dehydration, not fluid overload.

Question 56

Which child with a headache requires neuroimaging? a. 5-year-old with cerebral palsy b. 17-year-old with intermittent headaches for 5 years c. 9-year-old with early morning headaches worsened by coughing d. 6-year-old with a normal neurologic exam

Answer 56

C. 9-year-old with early morning headaches worsened by coughing Rationale: Headaches worse in the morning and with Valsalva (e.g., coughing) suggest increased intracranial pressure, warranting neuroimaging. Chronic intermittent headaches are less concerning.

Question 57

A 9-year-old female presents with 6 weeks of on-and-off headaches, occasional vomiting, drooling, facial asymmetry, and unsteadiness. MRI: Diffuse expanded mass near the cervicomedullary junction Which statement is true regarding this impression? a. Greater than 75% survival rate b. 90-100% survival in resected patients c. More than 90% mortality is expected in diffuse tumors d. Less than 20% survival rate

Answer 57

C. More than 90% mortality is expected in diffuse tumors Rationale: Diffuse intrinsic pontine gliomas (DIPG) have a very poor prognosis, with a >90% mortality rate. These tumors are highly infiltrative and often unresectable.

Question 58

A hypertensive female has: No BP gradient between upper and lower extremities Predominantly RBCs on urinalysis What is the most likely diagnosis? a. Ureteropelvic junction obstruction b. Reflux nephritis c. Lupus nephritis d. Recurrent UTI

Answer 58

C. Lupus nephritis Rationale: Lupus nephritis causes hypertension, proteinuria, and hematuria due to immune complex deposition in the kidneys. BP gradient is absent (seen in coarctation of the aorta).

Question 59

CT scan is superior to MRI in which condition? a. Tuberous sclerosis b. Medulloblastoma c. Craniocerebral trauma d. Epilepsy

Answer 59

C. Craniocerebral trauma Rationale: CT is the preferred imaging for acute head trauma due to its speed and ability to detect fractures and hemorrhages. MRI is better for tumors and epilepsy evaluation.

Question 60

A 5-year-old presents with: Intermittent hematuria for 2 years Seizures Anasarca, BP 140/90 Bilateral contracted kidneys on KUB ultrasound Creatinine: 10 mg/dL Metabolic acidosis and hyperkalemia What is the indication for renal replacement therapy (RRT)? a. Severe metabolic acidosis unresponsive to treatment b. Pulmonary edema refractory to diuretics c. Persistent hyperkalemia d. All of the choices are correct

Answer 60

D. All of the choices are correct Rationale: Dialysis is indicated for refractory acidosis, fluid overload, and life-threatening hyperkalemia in end-stage renal disease.

Question 61

A 4-month-old boy with his first episode of acute pyelonephritis became afebrile after 48 hours of ceftriaxone. When should a DMSA scan be performed? a. No need for DMSA scan b. Within 4-6 months of infection c. During the acute infection d. Within 6 weeks of infection

Answer 61

B. Within 4-6 months of infection Rationale: DMSA scanning is done 4-6 months after infection to detect renal scarring and long-term damage. It is not necessary in first uncomplicated UTIs.

Question 62

A 5-year-old presents with: Intermittent hematuria for 2 years Seizures, anasarca, BP 140/90 Bilateral contracted kidneys on ultrasound Creatinine: 10 mg/dL, metabolic acidosis, hyperkalemia Which is the correct initial management? a. Fluid bolus at 10-40 cc/kg as fast drip b. Furosemide 1-2 mg/kg/dose every 8 hours c. Dopamine at 10 mcg/kg/min d. Furosemide 1-2 mL/kg/day every 8 hours

Answer 62

B. Furosemide 1-2 mg/kg/dose every 8 hours Rationale: Furosemide is used to manage fluid overload and hypertension in chronic kidney disease. Fluid boluses and dopamine are contraindicated in volume-overloaded CKD.

Question 63

A patient has: Significant omphalitis Non-healing ulcers with polymicrobial infections requiring prolonged antibiotics Severe gingivitis What is the most likely diagnosis? a. B cell deficiency b. Complement deficiency c. Phagocyte deficiency d. T cell deficiency

Answer 63

C. Phagocyte deficiency Rationale: Chronic granulomatous disease (CGD) or leukocyte adhesion deficiency (LAD) causes impaired neutrophil function, leading to poor wound healing, recurrent infections, and gingivitis.

Question 64

Nephrotic-range proteinuria is defined as a protein/creatinine ratio of more than: a. 4 b. 3 c. 2 d. 1

Answer 64

D. 1 Rationale: Nephrotic-range proteinuria is defined as a urine protein-to-creatinine ratio >2 in adults and >1 in children. Higher ratios indicate massive protein loss.

Question 65

Sports are not encouraged in patients with: a. Sleep-related seizures b. Seizures with impaired consciousness c. Acute symptomatic seizure d. First unprovoked seizure

Answer 65

B. Seizures with impaired consciousness Rationale: Seizures with loss of consciousness (e.g., complex partial, generalized tonic-clonic) pose a higher risk of injury during sports. Sleep-related seizures, first unprovoked seizures, and acute symptomatic seizures do not automatically contraindicate sports participation.