Nephrology

1.    Dehydration.

***) A 9 month old infant presented with the following lab results, scrum (Na 160meq/l), (K 4meq/l), BUN 28mg%, Blood sugar 180mg%, the calculated serum osmolality is:

A.    375

B.     184

C.     300

D.    248

E.     348

Answer: E* 348

???) One year old child with gastroenteritis and moderate dehydration is vomiting, ORS is given to him, the next most appropriate step is to:

Stop all feeds for 12 hours and try again

Dilute the ORS and give it

Give small frequent ORS amounts using spoon

Give i.v. fluids containing 10% G/W

Put nasogastric tube and give antibiotics i.m.

Answer: 3* Give small frequent ORS amounts using spoon

???) The simplest proper oral replacement solution is done by giving the infant with gastroenteritis is one of the following:

Half strength milk

Plain water

Salt and glucose added to the water

Glucose added to the water

Salt added to the water

Answer: 3* Salt and glucose added to the water

???) Regarding hyper-natremic dehydration all are true except:

Serum sodium is more than 155 mmol/L

Leads to intracellular dehydration

Doughy like skin

The correction should be done very quickly within 4-6 hours

Concentrated ORS could be the cause

Answer: D* The correction should be done very quickly within 4-6 hours (It should be done slowly to avoid brain edema)

???) All of the following are usually signs of severe dehydration, except:

Very sunken eyes

Decreased skin turgor

Oliguria

Rapid pulse

The child drinks fluids eagerly

Answer: 5* The child drinks fluids eagerly

???) One of the following measures is appropriate to the management of a 10 months old infant with mild gastroenteritis:

Advise the mother to give him only rice water for 24 hours and to do stools culture

Advise the mother to give ORS (Aquasal) and to continue normal diet

Prescribe antiemetic suppositories

Prescribe antiperistaltic drugs to suppress gut motility

Avoid any food and milk for 24 hours and to give only amoxicillin syrup

Answer: 2* Advise the mother to give ORS (Aquasal) and to continue normal diet

***) All of the following are features of moderate dehydration, except:

Dry mucous membranes

Oliguria

Sunken eyes

Decreased skin turgor

Depressed anterior fontanel

Answer: 2* Oliguria

2.    Fluid and Electrolyte Therapy.

***) The average fluid requirement in a one year old child is:

A.    30-40 ml/kg/24hrs

B.     40-60 ml/kg/24hrs

C.     70-80 ml/kg/24hrs

D.    80-100 ml/kg/24hrs

E.     100-120ml/kg/24hrs

Answer: E* 100-120ml/kg/24hrs

3.    Hemolytic Uremic Syndrome (HUS).

***) The most common cause of acute renal failure in childhood is:

A.    Acute glomerulonephritis

B.     Hemolytic-uremic syndrome

C.     Renal vein thrombosis

D.    Minimal change nephrotic syndrome

E.     Pyelonephritis

Answer: B* Hemolytic-uremic syndrome

4.    Nephritic Syndrome.

***) A child with early stage renal failure is at high risk of developing all except:

Edema

Polyuria

Hypertension

Seizures

Congestive heart failure

Answer: E* Congestive heart failure

5.    Nephrotic Syndrome.

***) About post streptococcal glomerulonephritis in children all are true, except:

Follows upper respiratory tract infections

Follows streptococcal skin infections

Most patients go into chronic phase

Causes low C3

Causes red blood cell casts in urine

Answer: 3* Most patients go into chronic phase

***) All of the following in children with nephrotic syndrome are true, except:

A.    Steroid resistance is associated with a poor prognosis

B.     Patients should receive high protein, low fat diet

C.     Minimal lesion nephrosis is the most common type seen in children

D.    Low salt diet is important during relapse

E.     Patients are susceptible to gram positive organisms during relapse

Answer: E* Patients are susceptible to gram positive organisms during relapse

***) Concerning minimal lesion nephrotic syndrome all of the following are true, except:

A.    It is the commonest cause of nephrotic syndrome in children

B.     Always progresses to renal failure

C.     Gross albuminuria is a recognized feature

D.    Relapse is common

E.     In children most cases respond to steroids

Answer: B* Always progresses to renal failure

***) Nephrotic range proteinuria in children is defined as:

A.    More than 150 mg protein in a 24 hour urine collection

B.     More than 10 mg protein in urine per kg of body weight per day

C.     More than 50 mg protein in urine per kg of body weight per day

D.    More than 2.5 g protein in a 24 hour urine collection

E.     Protein more than 50 mg per kg of body weight per hour in urine

Answer: E* Protein more than 50 mg per kg of body weight per hour in urine

???) Regarding nephrotic syndrome in children is correct:

Lupoid (minimal changes) type is the commonest

Most patients recover completely

Kidney biopsy is always indicated

Hyperkalemia is common

Most of them end in the end stage renal

Answer: 1* Lupoid (minimal changes) type is the commonest