Nephrology Practice Questions

Q: Which of the following statements are correct regarding management of hyperkalemia in a child? I. Intravenous calcium (gluconate or chloride) is given to enhance cellular uptake of potassium II. Beta adrenergic agonists (salbutamol or terbutaline) are used to stabilize myocardial cell membrane III. Regular insulin and glucose given intravenously enhance cellular uptake of potassium IV. Sodium polystyrene sulfonate enhances total body potassium elimination Select the answer using the code given below :

III and IV. ***III and IV*** - Intravenous **regular insulin and glucose** work by promoting the intracellular shift of potassium, thereby lowering serum potassium levels. Insulin stimulates the Na+-K+ ATPase pump, moving potassium into cells, and glucose is given to prevent **hypoglycemia**. - **Sodium polystyrene sulfonate (SPS)** is a cation exchange resin that binds potassium in the gastrointestinal tract and promotes its excretion in the stool, thus enhancing **total body potassium elimination**. *I and II* - Intravenous calcium (gluconate or chloride) is given to **stabilize the myocardial cell membrane**, reducing the risk of arrhythmias, not to enhance cellular uptake of potassium. - Beta-adrenergic agonists like **salbutamol** or **terbutaline** promote the intracellular shift of potassium, similar to insulin, but they **do not stabilize the myocardial cell** membrane. *II and III* - Beta-adrenergic agonists **(salbutamol or terbutaline)** promote the cellular uptake of potassium, but they do not stabilize the myocardial cell membrane; that is the role of calcium. - While regular insulin and glucose given intravenously do enhance cellular uptake of potassium, the statement regarding beta-adrenergic agonists is incorrect in its function to stabilize the myocardial cell membrane. *I and IV* - Intravenous calcium (gluconate or chloride) is administered to **protect the heart** from the effects of hyperkalemia by stabilizing the myocardial cell membrane, not to enhance cellular uptake of potassium. - Although sodium polystyrene sulfonate (SPS) correctly enhances total body potassium elimination, the initial statement regarding calcium's mechanism of action is incorrect.

Q: A 5-year-old boy is brought to the office by his mother with complaints of facial puffiness and “frothy” urine for 4 days. The puffiness first started in his eyes and then spread to the face. His mother does not provide any history of similar symptoms in the past. Past medical history is non-significant. His birth history is uneventful and all his vaccinations are up to date. The vital signs include: blood pressure 100/62 mm Hg, pulse 110/min, temperature 36.7°C (98.0°F), and respiratory rate 16/min. On examination, there is pitting edema of the upper and lower extremities bilaterally. Urinalysis results are as follows: pH 6.2 Color light yellow RBC none WBC 3–4/HPF Protein 4+ Cast Fat globules Glucose absent Crystal none Ketone absent Nitrite absent 24-hour urine protein excretion 4.1 g A renal biopsy is sent which shows normal glomeruli on light microscopy. Which of the following is the most likely diagnosis?

Lipoid nephrosis. ***Lipoid nephrosis*** - The classic presentation in a young child with **facial puffiness**, **edema**, **frothy urine**, **heavy proteinuria** (>3.5 g/24h), and **fat globules** in the urine (suggesting **lipoid nephrosis** or minimal change disease). - Normal glomeruli on **light microscopy** is a hallmark finding of **minimal change disease** (lipoid nephrosis), as the pathology is primarily at the podocyte level, which is only visible on electron microscopy showing **effacement of foot processes**. *Incorrect Option: Post-infectious glomerulonephritis* - Often follows a **streptococcal infection** and presents with **hematuria**, **hypertension**, and **mild proteinuria**, which are not seen here. - Light microscopy would typically show **hypercellular glomeruli** with immune deposits, contrasting with the normal findings in this case. *Incorrect Option: Focal segmental glomerulosclerosis* - While it can cause nephrotic syndrome, this condition typically presents with **hypertension** and **microscopic hematuria**, which are absent in this patient. - Light microscopy would reveal **segmental scarring** and **sclerosis** of some glomeruli, which is not consistent with the "normal glomeruli" described. *Incorrect Option: Membranoproliferative glomerulonephritis* - This condition is characterized by **thickened glomerular basement membranes** and **mesangial cell proliferation**, leading to a "tram track" appearance on microscopy. - It often presents with mixed nephritic-nephrotic features, including **hematuria** and **hypertension**, which are not observed in this child.

Q: Treatment of choice used in nocturnal enuresis is:

Bed alarms. ***Bed alarms*** - **Bed alarms** are the **first-line, non-pharmacological treatment (TOC)** for nocturnal enuresis, working through classical conditioning to train the child to wake up when urination begins. - They have a high success rate and durable response once treatment is completed. *Trazodone* - **Trazodone** is an antidepressant primarily used for **insomnia** and depression; it is not indicated for the treatment of nocturnal enuresis. - It works by modulating serotonin reuptake and blocking alpha-1 adrenergic receptors, with a different mechanism of action than treatments for enuresis. *Fluoxetine* - **Fluoxetine** is a Selective Serotonin Reuptake Inhibitor (SSRI) primarily used to treat **depression, anxiety disorders**, and OCD. - It is not a recommended treatment for nocturnal enuresis and does not address the underlying physiological mechanisms. *Imipramine* - **Imipramine** is a tricyclic antidepressant that has been used for nocturnal enuresis, but it is **not the treatment of choice** due to potential side effects and the availability of safer, more effective options. - It works by anticholinergic and alpha-adrenergic effects to increase bladder capacity and arousal, but its use is often limited by its adverse effect profile.

Q: A child presents with abdominal pain, arthralgia, hematuria, and hypertension. What is the diagnosis?

Hemolytic uremic syndrome. ***Hemolytic uremic syndrome*** - The combination of **abdominal pain**, **hematuria**, and **hypertension** in a child, particularly after a diarrheal illness, is highly suggestive of **hemolytic uremic syndrome (HUS)** [1], [2]. - HUS is characterized by **microangiopathic hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury**, which can manifest as hematuria and hypertension [1], [2]. *Dengue* - While **abdominal pain** and **arthralgia** can be symptoms of dengue, it typically also presents with **fever**, **rash**, and **bleeding manifestations** like petechiae or mucosal bleeding. - Dengue does not typically cause **hematuria** with **hypertension** as a primary feature of renal involvement. *Rheumatic fever* - **Rheumatic fever** is characterized by **arthralgia** (migratory arthritis), but it is primarily a sequela of **Streptococcal pharyngitis** and presents with **carditis**, **chorea**, **erythema marginatum**, and **subcutaneous nodules**. - It does not typically cause the combination of **abdominal pain**, **hematuria**, and **hypertension** seen here. *Henoch-Schönlein Purpura* - **Henoch-Schönlein Purpura (HSP)** involves **abdominal pain**, **arthralgia**, and **hematuria**, and can sometimes cause hypertension. - However, the hallmark of HSP is a **palpable purpuric rash** on the lower extremities and buttocks, which is not mentioned in the patient's presentation.

Q: The most common underlying anomaly in a child with recurrent urinary tract infections is:

Vesicoureteric reflux. ***Vesicoureteric reflux*** - **Vesicoureteric reflux (VUR)** is the most common anatomic anomaly contributing to recurrent UTIs in children, allowing urine to flow backward from the bladder to the kidneys. - This retrograde flow can carry bacteria from the bladder to the upper urinary tract, leading to **pyelonephritis** and kidney damage. *Posterior urethral valves* - **Posterior urethral valves (PUV)** are a cause of severe urinary obstruction almost exclusively in newborn males, leading to bladder and kidney damage, but are less common than VUR for recurrent UTIs in childhood generally. - While PUV can cause recurrent UTIs due to stasis and obstruction, its incidence is lower than VUR, and it typically presents with more severe obstructive symptoms early in life. *Neurogenic bladder* - **Neurogenic bladder** results from nerve damage (e.g., spina bifida) affecting bladder control, leading to incomplete emptying, stasis, and recurrent UTIs. - While a significant cause of UTIs in affected children, it is a specific neurological condition and not the *most common underlying anomaly* overall for recurrent UTIs. *Renal calculi* - **Renal calculi (kidney stones)** can cause urinary obstruction and provide a nidus for bacterial growth, leading to recurrent UTIs. - However, kidney stones are less common in children than adults and are not the primary underlying anatomical anomaly; they are often secondary to other metabolic or structural issues.

Q: A breast fed child presents with hypernatremia (Serum sodium > 170m Eq/L). His urine sodium is 70 mEq/L. Which of the following is the most likely cause –

Excessive intake of sodium. ***Excessive intake of sodium*** - A critically elevated **serum sodium (>170 mEq/L)** coupled with a high **urine sodium (70 mEq/L)** in a breastfed infant indicates that the kidneys are actively trying to excrete excess sodium. This pattern is consistent with an exogenous sodium overload. - This scenario suggests the ingestion of a **hypertonic solution** or food, likely by mistake, leading to significant sodium toxicity requiring rapid renal excretion. *Acute tubular necrosis* - In ATN, there's impaired renal concentration and reabsorption, but acute kidney injury often leads to **normonatremia or hyponatremia**, not severe hypernatremia. - While urine sodium can be high in ATN due to tubular damage, the primary cause of such extreme hypernatremia would typically be external sodium load. *Severe dehydration* - Severe dehydration usually causes **pre-renal acute kidney injury**, characterized by **high serum sodium** due to water loss, but the kidneys would **conserve sodium**, resulting in a very **low urine sodium** (<20 mEq/L). - The high urine sodium of 70 mEq/L in this case **argues against dehydration** as the primary cause of hypernatremia. *Diabetes insipidus* - Diabetes insipidus (DI) causes **hypernatremia due to free water loss** from the kidneys, resulting in a **dilute urine** with a **low urine osmolality** and typically **low urine sodium**. - The elevated urine sodium of 70 mEq/L is inconsistent with the renal handling of sodium seen in diabetes insipidus.

Q: The following are causes of hematuria in childhood except

Alpha thalassemia. ***Alpha thalassemia*** - **Alpha thalassemia** primarily affects **hemoglobin production**, leading to anemia. It does not directly cause hematuria. - While severe anemia can sometimes lead to organ dysfunction, hematuria is not a characteristic or direct symptom of alpha thalassemia itself. *Alport syndrome* - **Alport syndrome** is a genetic disorder affecting the **glomerular basement membrane**, leading to microscopic or macroscopic hematuria, proteinuria, and progressive renal failure. - It classically presents with **hematuria in childhood**, often accompanied by hearing loss and ocular abnormalities. *Factor V Leiden mutation* - The **Factor V Leiden mutation** increases the risk for **thrombophilia** and **venous thromboembolism**. - While it can lead to clots in renal veins, causing hematuria, its primary manifestation is not direct hematuria but rather a predisposition to thrombosis that can secondarily cause it. *E. coli O157* - **_E. coli_ O157 infection** can cause **hemolytic uremic syndrome (HUS)**, particularly in children. - HUS is characterized by a **microangiopathic hemolytic anemia**, thrombocytopenia, and acute kidney injury, which often manifests with hematuria due to glomerular damage.

Q: In Henoch–Schönlein purpura, renal involvement is generally not seen if there is no involvement by:

4 month after onset. ***4 month after onset*** - Renal involvement in **Henoch-Schönlein Purpura (HSP)** typically manifests within the first 4 to 6 weeks of disease onset. - If **renal complications** have not appeared by 4 months, it is highly unlikely they will develop later. *3 month after onset* - While most renal involvement occurs earlier, waiting until 3 months may miss some cases, as the window extends slightly beyond this. - The critical period for **HSP nephritis** is usually considered to be within the first 6-8 weeks. *1 month after onset* - This period is too short to completely rule out renal involvement, as some cases may still emerge between 1 and 4 months. - Many patients, especially children, can develop **renal complications** even after the first month. *2 month after onset* - Similar to the 1-month mark, 2 months is still within the active window where **HSP nephritis** can develop. - The risk significantly decreases after this point, but it's not completely negligible until later.

Q: A 2-year-old child with severe dehydration has sudden-onset gross hematuria with a unilateral flank mass. The most likely diagnosis is

Renal vein thrombosis. ***Renal vein thrombosis*** - Severe dehydration in infants can lead to a **hypercoagulable state**, predisposing to **renal vein thrombosis**. - This condition presents with sudden-onset **gross hematuria** and a unilateral **flank mass** due to swelling of the affected kidney. *Hemolytic syndrome* - This term is broad; if referring to **Hemolytic Uremic Syndrome (HUS)**, it typically involves a prodrome of **diarrhea** and presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. - While it causes kidney injury and hematuria, it generally presents with systemic symptoms and a different clinical progression than described. *Wilms tumor* - This is a common pediatric renal malignancy presenting as an **abdominal mass**, but hematuria is often microscopic and less sudden in onset. - While it is a differential for a flank mass in a child, the acute presentation with severe dehydration and gross hematuria points away from a primary tumor. *Hydronephrosis* - This is the **swelling of the kidney** due to urine backup, often caused by an obstruction in the urinary tract. - While it can present with a flank mass and sometimes hematuria (especially if there's an associated infection or stone), severe dehydration leading to acute gross hematuria is not its typical presentation.

Question 1

Which of the following statements are correct regarding management of hyperkalemia in a child?
I. Intravenous calcium (gluconate or chloride) is given to enhance cellular uptake of potassium
II. Beta adrenergic agonists (salbutamol or terbutaline) are used to stabilize myocardial cell membrane
III. Regular insulin and glucose given intravenously enhance cellular uptake of potassium
IV. Sodium polystyrene sulfonate enhances total body potassium elimination

Select the answer using the code given below :

Accepted Answer

III and IV

Answer

I and II

Answer

II and III

Answer

I and IV

Question 2

Which of the following statements are correct regarding hypernatremia in children?
I. Diabetes insipidus due to a deficiency of antidiuretic hormone (ADH) may cause hypernatremia
II. Addison disease may be associated with hypernatremia
III. Use of boiled skimmed milk can lead to hypernatremia
IV. Use of lactulose can lead to hypernatremia

Select the answer using the code given below :

Accepted Answer

I, III and IV

Answer

II, III and IV

Answer

I, II and IV

Answer

I, II and III

Question 3

A 5-year-old boy is brought to the office by his mother with complaints of facial puffiness and “frothy” urine for 4 days. The puffiness first started in his eyes and then spread to the face. His mother does not provide any history of similar symptoms in the past. Past medical history is non-significant. His birth history is uneventful and all his vaccinations are up to date. The vital signs include: blood pressure 100/62 mm Hg, pulse 110/min, temperature 36.7°C (98.0°F), and respiratory rate 16/min. On examination, there is pitting edema of the upper and lower extremities bilaterally.
Urinalysis results are as follows:
pH 6.2
Color light yellow
RBC none
WBC 3–4/HPF
Protein 4+
Cast Fat globules
Glucose absent
Crystal none
Ketone absent
Nitrite absent
24-hour urine protein excretion 4.1 g
A renal biopsy is sent which shows normal glomeruli on light microscopy. Which of the following is the most likely diagnosis?

Accepted Answer

Lipoid nephrosis

Answer

Post-infectious glomerulonephritis

Answer

Focal segmental glomerulosclerosis

Answer

Membranoproliferative glomerulonephritis

Question 4

Treatment of choice used in nocturnal enuresis is:

Accepted Answer

Bed alarms

Answer

Trazodone

Answer

Fluoxetine

Answer

Imipramine

Question 5

A child presents with abdominal pain, arthralgia, hematuria, and hypertension. What is the diagnosis?

Accepted Answer

Hemolytic uremic syndrome

Answer

Dengue

Answer

Rheumatic fever

Answer

Henoch-Schönlein Purpura

Question 6

The most common underlying anomaly in a child with recurrent urinary tract infections is:

Accepted Answer

Vesicoureteric reflux

Answer

Posterior urethral valves

Answer

Neurogenic bladder

Answer

Renal calculi

Question 7

A breast fed child presents with hypernatremia (Serum sodium > 170m Eq/L). His urine sodium is 70 mEq/L. Which of the following is the most likely cause –

Accepted Answer

Excessive intake of sodium

Answer

Acute tubular necrosis

Answer

Severe dehydration

Answer

Diabetes insipidus

Question 8

The following are causes of hematuria in childhood except

Accepted Answer

Alpha thalassemia

Answer

Alport syndrome

Answer

Factor V Leiden mutation

Answer

E. coli O157

Question 9

In Henoch–Schönlein purpura, renal involvement is generally not seen if there is no involvement by:

Accepted Answer

4 month after onset

Answer

3 month after onset

Answer

1 month after onset

Answer

2 month after onset

Question 10

A 2-year-old child with severe dehydration has sudden-onset gross hematuria with a unilateral flank mass. The most likely diagnosis is

Accepted Answer

Renal vein thrombosis

Answer

Hemolytic syndrome

Answer

Wilms tumor

Answer

Hydronephrosis

Nephrology — MCQs

Nephrology — MCQs

On this page

Practice by Chapter

Want unlimited practice?