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Question 1
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: Low C4 level
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 2
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: Post-streptococcal glomerulonephritis
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 3
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: eGFR
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 4
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 5
Correct
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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: 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 6
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: Cirrhosis
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 7
Correct
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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: 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 8
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 9
Incorrect
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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: Raised serum haptoglobins
Correct 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 10
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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