peds nephrology

Question 1

Which of the factors shown below is at the origin of proteinuria in pediatric minimal change nephrotic syndrome?
A) immune-complex deposition in the glomeruli
B) functional damage of the podocyte-basement immune-complex functional unit
C) hypercholesterinaemia
D) none of the above

Answer 1

B) functional damage of the podocyte-basement immune-complex functional unit

Question 2

Characteristic for minimal change nephrotic syndrome are the following (with one exception). Which one is the exception?
A) hypoproteinaemia
B) hypercholesterinaemia
C) low serum calcium level
D) predisposition to hypocalcemic spasms

Answer 2

D) predisposition to hypocalcemic spasms

Question 3

Characteristics for minimal change nephrotic syndrome are the following with one exception. Which one is the exception?
A) its onset is usually between 1–6 years
B) podocyte foot process effacement is seen on electron microscopy
C) it frequently leads to renal insufficiency
D) hypertension is not part of the clinical signs
E) patients have hyperlipidemia

Answer 3

C) it frequently leads to renal insufficiency

Question 4

What is the definition of steroid resistance in idiopathic nephrotic syndrome in childhood?
A) if hematuria is present from the beginning of observation
B) if the patient needs high doses of steroid to stay in remission
C) in case of extreme cushingoid appearance
D) if after 4 weeks of high dose prednisolone treatment (60 mg/m2) the patient is still proteinuric
E) if hypertension develops during therapy

Answer 4

D) if after 4 weeks of high dose prednisolone treatment (60 mg/m2) the patient is still proteinuric

Question 5

The following are signs of acute post-streptococcal glomerulonephritis, with one exception. Which one is the exception?
A) Hematuria
B) Proteinuria
C) Bacteriuria
D) Hypertension
E) Elevated ASO titer

Answer 5

C) Bacteriuria

Question 6

Acute poststreptococcal glomerulonephritis is characterized by the following with one exception. Which is the exception?
A) early antibiotic treatment of the primary infection may prevent the development of the disease
B) it may be the consequence of scarlet fever
C) the prognosis in childhood is usually good
D) hypertensive encephalopathy may be the first presenting sign
E) Streptococci are always present in the urine

Answer 6

E) Streptococci are always present in the urine

Question 7

All but one of the following may be complications of acute glomerulonephritis. Which one is the exception?
A) heart failure
B) urosepsis
C) hyperkalaemia
D) uraemia
E) encephalopathy

Answer 7

B) urosepsis

Question 8

The following pediatric diseases may cause hematuria with one exception. Which one is the exception?
A) Wilms-tumor
B) minimal change nephrotic syndrome
C) polycystic kidney disease
D) subacute bacterial endocarditis
E) renal artery thrombosis
F) renal vein thrombosis

Answer 8

B) minimal change nephrotic syndrome

Question 9

Bacteriuria is termed significant if the mid-stream urine culture shows one of the results below. Which one?
A) some uniform colonies of bacteria
B) 100 000/ml mixed bacterial colonies
C) 100 000/ml uniform colonies of a single bacterium strain
D) 1000/ml E. Coli + Proteus
E) 1 000 000/ml mixed bacterial colonies

Answer 9

C) 100 000/ml uniform colonies of a single bacterium strain

Question 10

One of the statements below does not apply to pediatric lower urinary tract infections. Which one?
A) leucocyturia and bacteriuria are present
B) high fluid intake is part of the therapy
C) preemptive treatment with penicillin as the first choice is indicated until the results of urine culture allow targeted treatment
D) targeted treatment should be continued at least for 5-7 days
E) after ending treatment penicillin urine control is indicated

Answer 10

C) preemptive treatment with penicillin as the first choice is indicated until the results of urine culture allow targeted treatment

Question 11

All but one of the following are used to treat acute renal failure. Which one is the exception?
A) fluid rescue in the case of hypovolemia
B) furosemide should be used as diuretic
C) an osmotic diuretic (20% Mannisol) may be tried
D) if oligo-anuria persists further fluid intake should be restricted
E) an oral fluid load is used to break through oliguria

Answer 11

E) an oral fluid load is used to break through oliguria

Question 12

All but one among the causes below may cause chronic renal insufficiency. Which is the exception?
A) chronic pyelonephritis
B) about half of the cases of acute post-streptococcal glomerulonephritis
C) nephrocalcinosis
D) membranoproliferative glomerulonephritis
E) focal segmental glomerulosclerosis

Answer 12

B) about half of the cases of acute post-streptococcal glomerulonephritis

Question 13

Intravenous urography is indicated in childhood, in one of the following cases:
A) in acute upper urinary tract infection
B) in every case following acute urinary tract infection
C) in nephrotic or nephritic syndrome, if macroscopic hematuria is also present
D) in the case of obstructive uropathy associated with pyelon and ureter duplex, if surgical intervention is planned

Answer 13

D) in the case of obstructive uropathy associated with pyelon and ureter duplex, if surgical intervention is planned

Question 14

Steroids are effective in the treatment of most cases of pediatric idiopathic nephrotic syndrome since there is an inflammation mediated by immuncomplexes in the glomeruli.
A) both are true and there is a cause-effect relation between them
B) both are true but there is no cause-effect relation between them
C) the first is true, the second is false
D) the first is false, the second is true
E) both are false

Answer 14

C) the first is true, the second is false

Question 15

The most probable diagnosis is:
A 6-year-old boy complains for abdominal pain, nausea, his left knee and right ankle are painful and swollen. He is transferred to the hospital because of epigastrial pain and bloody stools. At admission his feet is swollen and painful. Erythematous, maculo-papular eruptions are seen at the lower extremities, the ankles and the buttocks. The differential shows moderate leucocytosis and anemia. In the urine microscopic hematuria is present. Blood pressure is normal for his age. Antistreptolysin titer is high (1200 U).
A) rheumatoid arthritis
B) colitis ulcerosa
C) Schönlein–Henoch-purpura
D) SLE
E) febris rheumatica
F) haemolytic uraemic syndrome
G) acute glomerulonephritis

Answer 15

C) Schönlein–Henoch-purpura

Question 16

The platelet count is important for the differential diagnosis in the following cases:
A 6-year-old boy complains for abdominal pain, nausea, his left knee and right ankle are painful and swollen. He is transferred to the hospital because of epigastrial pain and bloody stools. At admission his feet is swollen and painful. Erythematous, maculo-papular eruptions are seen at the lower extremities, the ankles and the buttocks. The differential shows moderate leucocytosis and anemia. In the urine microscopic hematuria is present. Blood pressure is normal for his age. Antistreptolysin titer is high (1200 U).
1) febris rheumatica
2) rheumatoid arthritis
3) acute glomerulonephritis
4) Schönlein–Henoch purpura
5) hemolytic uraemic syndrome

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) answers 4 and 5 are correct
E) all of the answers are correct

Answer 16

D) answers 4 and 5 are correct

Question 17

The disease does not always recover without sequelae because Streotococcus infection may play a role in the etiology
A 6-year-old boy complains for abdominal pain, nausea, his left knee and right ankle are painful and swollen. He is transferred to the hospital because of epigastrial pain and bloody stools. At admission his feet is swollen and painful. Erythematous, maculo-papular eruptions are seen at the lower extremities, the ankles and the buttocks. The differential shows moderate leucocytosis and anemia. In the urine microscopic hematuria is present. Blood pressure is normal for his age. Antistreptolysin titer is high (1200 U).
A) both are true and there is a cause-effect relation between them
B) both are true but there is no cause-effect relation between them
C) the first is true, the second is false
D) the first is false, the second is true
E) both are false

Answer 17

B) both are true but there is no cause-effect relation between them